Search results for: perinatal loss

Authors: Elisenda Camprecios, Alicia Macarrila, Montse Albiol, Neus Garriga Garriga

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The loss of a child during pregnancy, or shortly after birth, is not a common occurrence, but it is a prevalent fact in our society. When this loss happens, life and death walk together. The grief that parents experience following a perinatal loss is a devastating experience. Professionals are aware that the quality of care offered during this first period is crucial to support the families experiencing a perinatal loss and meet their needs. However, it is not always easy for the health care professionals to know what to say and what to do in these difficult circumstances. Given the complexity of the Health, painful process that a family must face when is affected by such loss, we believe that the creation of a protocol that pays special attention to the emotional needs of those couples can be a very valuable tool for the professionals. The short documentary named ‘When the illusion vanished’ was created as part of the material of this protocol, which focuses on the emotional needs of the families who have suffered a perinatal loss. This video is designed to see what impact has a perinatal death and to raise awareness among professionals working in this field. The methodology is based on interviews with couples who have experienced perinatal death and to professionals who accompany families suffering from perinatal loss. The use of sensitive and empathized words, being encouraged to express feelings, respect the time, appropriate training for the professionals are some of the issues reflected in this documentary. We believe that this video has contributed to help health care professionals to empathize and understand the need to be able to accompany these families with the appropriate care, respectful, empathetic attitude and professionalism so that they can start the path to a ‘healthy’ mourning.

Keywords: neonatal loss, midwifery, perinatal bereavement, perinatal loss

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Authors: Magdalena Hasplova, Katerina Ivanova

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Perinatal palliative care is a relatively young and developing field that includes the care of a fetus or newborn with a life-threatening or limiting defect and his family. However, the training of midwives in perinatal palliative care is insufficient and midwives do not feel prepared for this aspect of their work. This fact can affect the barriers to communication with the mother or family of the endangered child. The main aim was to analyze the awareness of midwifery students on the issue of perinatal palliative care in the Czech Republic. Based on the analysis, draw attention to possible communication barriers that may be caused by insufficient information. The research was carried out using a qualitative method, the method of data collection was a semi-structured interview. Eleven female students took part in the research, and the respondents were selected using the Snowballing method. Some methods of grounded theory (open coding and category creation) were used to analyze the data. Based on the results of the research, questions were set in a questionnaire focused on communication barriers between mothers (family) and health care professionals in the care of newborns with life-threatening or limiting disabilities. Based on the analysis of data, categories 1 were determined. Knowledge of perinatal palliative care 2. Education 3. Practical experience 4. Readiness and concerns in the provision of perinatal palliative care 6. Supervision. The questions in the questionnaire were then derived taking into account the data obtained, and the operationalization of health literacy in the field of perinatal palliative care was performed. The analysis of the interviews revealed that the education of midwives in the Czech Republic in the issue of perinatal palliative care is not uniform. The research confirmed the insufficient knowledge and skills of midwifery students preparing to provide perinatal palliative care. Respondents reported feelings of unpreparedness in the areas of communication with a woman after perinatal loss, psychological support for a woman and her family, the care of a stillborn or dying child, or self-coping with death. The questions in the questionnaire then develop these areas. We assumed that by analyzing and interpreting the data obtained from our research, we will help to better understand the concerns and motivations of students in providing holistic perinatal palliative care. We came to the conclusion that it would be appropriate to set up a unified and comprehensive education on this issue in the Czech Republic. Healthcare professionals are in a unique position that can positively or negatively affect the intensity of perinatal loss. Already properly set up education of health professionals leads to overcoming barriers in communication between health professionals and the family, experiencing perinatal loss.

Keywords: midwife, perinatal loss, perinatal palliative care, communication, barriers, mothers, family

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Authors: Kelsey Kimball

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Generalized anxiety disorder (GAD) is a common mental health illness affecting approximately 10% of the perinatal population. Research examining cognitive behavioral therapy in this population has only recently become more prevalent though exploring this subject is long overdue. This research examines the impact of cognitive behavioral therapy (CBT) on GAD during the perinatal period. The aim of this project was to identify the most effective way to manage GAD during the perinatal period to provide clinicians with evidence-based methods of caring for this population’s mental health. The research was conducted using several databases to identify ten primary research articles involving anxiety management. A critique and a systematic review of the literature was done. The results of the systematic literature review suggested that CBT had a significant positive impact on perinatal anxiety. Three main themes were derived from the literature: CBT for managing GAD in the general population, CBT for managing GAD in the perinatal population, and CBT’s effect on worry and problematic behaviors in both populations. Nurse practitioners are central in improving access to and treatment of perinatal anxiety disorders.

Keywords: anxiety, cognitive behavioral therapy, nurse practitioner, perinatal

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Authors: Mya Achike

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Background and Significance: Perinatal mental illness covers a wide range of conditions and has a huge influence on maternal-child health. Issues and challenges with perinatal mental health have been associated with poor pregnancy, birth, and postpartum outcomes. It is estimated that one out of five new and expectant mothers experience some degree of perinatal mental illness, which makes this a hugely significant health outcome. Certain factors increase the maternal risk for mental illness. Challenges related to poverty, migration, extreme stress, exposure to violence, emergency and conflict situations, natural disasters, and pandemics can exacerbate mental health disorders. It is widely expected that perinatal mental health is being negatively affected during the present COVID-19 pandemic. Methods: A review of studies that reported a measurement tool to assess perinatal mental health outcomes during the COVID-19 pandemic was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, CINAHL, and Google Scholar were used to search for peer-reviewed studies published after late 2019, in accordance with the emergence of the virus. The search resulted in the inclusion of ten studies. Approach to measure health outcome: The main approach to measure perinatal mental illness is the use of self-administered, validated questionnaires, usually in the clinical setting. Summary: Widespread use of these tools has afforded the clinical and research communities the ability to identify and support women who may be suffering from mental illness disorders during a pandemic. More research is needed to validate tools in other vulnerable, perinatal populations.

Keywords: mental health during covid, perinatal mental health, perinatal mental health measurement tools, perinatal mental health tools

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Authors: Victoria Bila, Iryna Ventskivska, Oleksandra Zahorodnia

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The goal of the study: To study the distribution of patients of the Kiyv Perinatal Center according to the Robson system and compare it with world data. Materials and methods: a comparison of the distribution of patients of Kiyv Perinatal center according to the Robson system for 2 periods - the first quarter of 2019 and 2020. For each group, 3 indicators were analyzed - the share of this group in the overall structure of patients of the Perinatal Center for the reporting period, the frequency of abdominal delivery in this group, as well as the contribution of this group to the total number of abdominal delivery. Obtained data were compared with those of the WHO in the guidelines for the implementation of the Robson system in 2017. Results and its discussion: The distribution of patients of the Perinatal Center into groups in the Robson classification is not much different from that recommended by the author. So, among all women, patients of group 1 dominate; this indicator does not change in dynamics. A slight increase in the share of group 2 (6.7% in 2019 and 9.3% - 2020) was due to an increase in the number of labor induction. At the same time, the number of patients of groups 1 and 2 in the Perinatal Center is greater than in the world population, which is determined by the hospitalization of primiparous women with reproductive losses in the past. The Perinatal Center is distinguished from the world population and the proportion of women of group 5 - it was 5.4%, in the world - 7.6%. The frequency of caesarean section in the Perinatal Center is within limits typical for most countries (20.5-20.8%). Moreover, the dominant groups in the structure of caesarean sections are group 5 (21-23.3%) and group 2 (21.9-22.9%), which are the reserve for reducing the number of abdominal delivery. In group 2, certain results have already been achieved in this matter - the frequency of cesarean section in 2019 here amounted to 67.8%, in the first quarter of 2020 - 51.6%. This happened due to a change in the leading method of induction of labor. Thus, the Robson system is a convenient and affordable tool for assessing the structure of caesarean sections. The analysis showed that, in general, the structure of caesarean sections in the Perinatal Center is close to world data, and the identified deviations have explanations related to the specialization of the Center.

Keywords: cesarian section, Robson system, Kyiv Perinatal Center, labor induction

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Authors: Tamara Jimah, Priscilla Kehoe, Pamela Pimentel, Amir Rahmani, Nikil Dutt, Yuqing Guo

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Ensuring equitable access to maternal health care is critical for public health. Particularly for underserved women, community health workers (CHWs) have been invaluable in providing support through health education and strategies for improved maternal self-care management. Our research aimed to assess the acceptance of technology by CHWs and perinatal women to promote healthy pregnancy and postpartum wellness. This pilot study was conducted at a local community organization in Orange County, California, where CHWs play an important role in supporting low-income women through home visitations. Questionnaires were administered to 14 CHWs and 114 pregnant and postpartum women, literate in English and/or Spanish. CHWs tested two wearable devices (Galaxy watch and Oura ring) and shared their user experience, including potential reception by the perinatal women they served. In addition, perinatal women provided information on access to a smart phone and the internet, as well as their interest in using wearable devices to self-monitor personal health with guidance from a CHW. Over 85% of CHWs agreed that it was useful to track pregnancy with the smart watch and ring. The majority of perinatal women owned a smartphone (97.4%), had access to the internet (80%) and unlimited data plans (78%), expressed interest in using the smart wearable devices to self-monitor health, and were open to receiving guidance from a CHW (87%). Community health workers and perinatal women embraced the use of wearable technology to monitor maternal health. These preliminary findings have formed the basis of an ongoing research study that integrates CHW guidance and technology (i.e., smart watch, smart ring, and a mobile phone app) to promote self-efficacy and self-management among underserved perinatal women.

Keywords: community health workers, health promotion and education, health equity, maternal and child health, technology

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Authors: Nermeen Saad Elbeltagy, Hoda Ghareeb, Hesham Adel Elsheshtawy, Nadim Hamed, Amany Ibrahim Mostafa, Sara Hazem Hassan

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Introduction: Depression is one of the most common mental health problems occurring in women during their child bearing years. Perinatal depression refers to major and minor depressive episodes that occur either during pregnancy or aer delivery. Although perinatal depression is common in developing countries, it is under-recognized in low and middle income countries making a substantial contribution to maternal and infant morbidity and mortality. About 12.5 - 42% of pregnant women and, 12 - 50% of post natal mothers in low and middle income countries such as Ethiopia had depression AIM OF THE WORK: To study prevalence, associated factors and impact of maternal perinatal depression in Alexandria. Patients and method: This study was conducted on 300 mothers at the postnatal ward in ElShatby Maternity Hospital from April 2022 unl October 2022. Females with past history of depression before pregnancy or females who receive medications inducing depression were excluded. The participants were asked to complete the questionnaire that includes the Edinburgh Postnatal Depression Scale (EPDS) as a screening test to obtain information concerning the current frame of mind at antepartum, partum and postpartum periods Results: The prevalence of perinatal depression was 22.3%. It was found that there is a significant negave moderate correlation between socioeconomic status and perinatal depression(r=-0.42). The present study revealed that about two thirds (60.7%) of postpartum women had low socioeconomic level. Also, less than one fourth (20%) of parents had high education and only one fourth (25.3%) of postpartum women were working. There was a statically significance difference between the number of previous abortions and perinatal depression (p=0.04). There was a significant moderate correlation between the amount of blood lost during delivery and an increased risk of developing postpartum depression. The prevalence of perinatal depression was high in cases of female neonates more than male ones. Conclusion: the prevalence of perinatal depression among the studied women was 22.3% of studied group. The significant factors identified in this study can be targeted to reduce the occurrence of perinatal depression among pregnant women in Alexandria through appropriate health interventions which includes perinatal depression screening, counseling, and the provision of support for pregnant women during antenatal care as well as lifestyle modification.

Keywords: mental health, depression in pregnancy, mental disorders, psychology in pregnancy

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Authors: Aishvarya Gupta, Keerthana Anand, Sasirekha Rengaraj, Latha Chathurvedula

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Introduction: Advances in assisted reproductive technology and increase in the proportion of infertile couples have both contributed to the steep increase in the incidence of twin pregnancies in past decades. Maternal and perinatal complications are higher in twins than in singleton pregnancies. Studies comparing the maternal and perinatal outcomes of ART twin pregnancies versus spontaneously conceived twin pregnancies report heterogeneous results making it unclear whether the complications are due to twin gestation per se or because of assisted reproductive techniques. The present study aims to compare both maternal and perinatal outcomes in twin pregnancies which are spontaneously conceived and after assisted conception methods, so that targeted steps can be undertaken in order to improve maternal and perinatal outcome of twins. Objectives: To study perinatal and maternal outcome in twin pregnancies conceived spontaneously as well as with assisted methods and compare the outcomes between the two groups. Setting: Women delivering at JIPMER (tertiary care institute), Pondicherry. Population: 380 women with twin pregnancies who delivered in JIPMER between June 2015 and March 2017 were included in the study. Methods: The study population was divided into two cohorts – one conceived by spontaneous conception and other by assisted reproductive methods. Association of various maternal and perinatal outcomes with the method of conception was assessed using chi square test or Student's t test as appropriate. Multiple logistic regression analysis was done to assess the independent association of assisted conception with maternal outcomes after adjusting for age, parity and BMI. Multiple logistic regression analysis was done to assess the independent association of assisted conception with perinatal outcomes after adjusting for age, parity, BMI, chorionicity, gestational age at delivery and presence of hypertension or gestational diabetes in the mother. A p value of < 0.05 was considered as significant. Result: There was increased proportion of women with GDM (21% v/s 4.29%) and premature rupture of membranes (35% v/s 22.85%) in the assisted conception group and more anemic women in the spontaneous group (71.27% v/s 55.1%). However assisted conception per se increased the incidence of GDM among twin gestations (OR 3.39, 95% CI 1.34 – 8.61) and did not influence any of the other maternal outcomes. Among the perinatal outcomes, assisted conception per se increased the risk of having very preterm (<32 weeks) neonates (OR 3.013, 95% CI 1.432 – 6.337). The mean birth weight did not significantly differ between the two groups (p = 0.429). Though there were higher proportion of babies admitted to NICU in the assisted conception group (48.48% v/s 36.43%), assisted conception per se did not increase the risk of admission to NICU (OR 1.23, 95% CI 0.76 – 1.98). There was no significant difference in perinatal mortality rates between the two groups (p = 0.829). Conclusion: Assisted conception per se increases the risk of developing GDM in women with twin gestation and increases the risk of delivering very preterm babies. Hence measures should be taken to ensure appropriate screening methods for GDM and suitable neonatal care in such pregnancies.

Keywords: assisted conception, maternal outcomes, perinatal outcomes, twin gestation

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Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

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In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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Authors: Oluwayemisi Femi-Pius, Kazeem Arogundade, Eberechukwu Eke, Jimmy Eko

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Introduction: Globally, community involvement in improving their own health has been widely adopted as a strategy in Sub-Saharan Africa principally to ensure equitable access to essential health care as well as improve the uptake of maternal and newborn health services especially in poor-resource settings. Method: The Saving Mother Giving Life (SMGL) Initiative implemented by Pathfinder International with funding support from USAID conducted a Health Facility Assessment (HFA) and found out that maternal mortality ratio in Cross River State was 812 per 100,000 live birth and perinatal mortality was 160 per 1000 live birth. To reduce maternal and perinatal mortality, Pathfinder International mobilized, selected and trained community members as community volunteers, traditional birth attendants, and emergency transport service volunteer drivers mainly to address the delay in decision making and reaching the health facility among pregnant women. Results: The results showed that maternal mortality ratio in Cross River State decrease by 25% from 812 per 100,000 live birth at baseline to 206 per 100,000 live birth at June 2018 and perinatal mortality reduced by 35% from 160 per 100,000 at baseline to 58 per 1000 live birth at June 2018. Data also show that ANC visit increased from 7,451 to 11,344; institutional delivery increased from 8,931 at baseline to 10,784 in June 2018. There was also a remarkable uptake of post-partum family planning from 0 at baseline to 233 in June 2018. Conclusion: There is clear evidence that community involvement yields positive maternal outcomes and is pivotal for sustaining most health interventions.

Keywords: maternal mortality, Nigeria, pathfinder international, perinatal mortality, saving mother giving life

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Authors: Wid Kattan, Rahaf Albarraq

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Background: Tokophobia is a pathological fear of pregnancy that can lead to the avoidance of childbirth. It is classified as primary or secondary. This report describes a patient with tokophobia, as well as her presentation, risk factors, comorbidities, and treatment. Case Presentation: A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in two clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires for assessment of different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth (FOC). Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practice. Full symptomatic recovery was achieved immediately after delivery. Conclusions: We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.

Keywords: tokophobia, fear of childbirth, mental health, anxiety, case report, depression, fear of delivery, psychiatry, cesarean section, perinatal depression

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Authors: Jamie E. Banker

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For many families, pregnancy and the postpartum time are filled with both anticipation and change. For some pregnant or postpartum women, this time is marked by the onset of a mood or anxiety disorder. Experiencing a mood or anxiety disorders during this time of life differs from depression or anxiety at other times of life. Not only because of the physical changes occurring in the mother’s body but also the mental and physical preparation necessary to redefine family roles, responsibilities, and develop new identities in the life transition. The presence of a mood or anxiety disorder can influence the way in which a mother defines herself and can complicate her understanding of her abilities and competencies as a mother. The complexity of experiencing a mood or anxiety disorder in the midst of these changes necessitates specific treatment interventions to match both the symptomatology and psychological adjustments. This study explores the use of narrative family therapy techniques when treating a mother who is experiencing postpartum depression. Externalization is a common technique used in narrative family therapy and can help client’s separate their identity from the problems they are experiencing. This is crucial to a new mom who is in the middle of defining her identity during her transition to parenthood. The goal of this study is to examine how the use of externalization techniques help postpartum women separate their mood and anxiety symptoms from their identity as a mother. An exploratory case study design was conducted in a single setting, private practice therapy office, and explored how a narrative family therapy approach can be used to treat perinatal mood and anxiety disorders. The therapy sessions were audio recorded and transcribed. Constructivism and narrative theory are used as theoretical frameworks and data from the therapy sessions, and a follow-up survey was triangulated and analyzed. During the course of the treatment, the participant reports using the new externalizing labels for her symptoms. Within one month of treatment, the participant reports that she could stop herself from thinking the harmful thoughts faster, and within three months, the harmful thoughts went away. The main themes in this study were building courage and less self-blame. This case highlights the role narrative family therapy can play in the treatment of perinatal mood and anxiety disorders and the importance of separating a women’s mood from her identity as a mother. This conceptual framework was beneficial to the postpartum mother when treating perinatal mood and anxiety disorder symptoms.

Keywords: externalizing techniques, narrative family therapy, perinatal mood and anxiety disorders, postpartum depression

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Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry

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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.

Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding

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Authors: Filiz Celik, Rachel Harrad, Rob Keasley, Paul Bennett

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The COVID-19 pandemic has posed a significant challenge to many, with some groups with particular vulnerability to adverse psychological impacts. These include those disadvantaged by mental ill health, either pre-existing or occurring during pregnancy or post-partum. Using a qualitative approach, the research aimed to identify the challenges posed by COVID-19 to women, their infants and families during the perinatal period and to suggest what further support can help alleviate the adverse mental health impact of COVID-19. 21 expectant and new mothers who were currently receiving support via a peri-natal mental health service participated in semi-structured interviews. In these interviews, participants explored the impact of changes in social circumstances and healthcare providers as a result of COVID-19 restrictions, with the resultant audio recordings transcribed and analyzed using Reflexive Thematic Analysis (RTA). Based on these accounts, it was concluded that women, their partners and potentially their infants experienced heightened peri-natal distress, and their experience at this time increased their risk for future mental health problems. Women described emerging as more vulnerable, owing to their role as primary caregivers during the perinatal period and also explained how social isolation and limited access to services meant protective buffers against mental health deterioration were reduced and the resources they needed in order to develop resilience were weakened. Although partners were invited to take part in the research, a sizeable volume of data could not be generated to fully assess the impact of the pandemic on a partner’s mental well-being. However, women expressed concerns about the paternal mental health of partners and husbands which invites us to be further vigilant to paternal mental health and associated experiences. Overall, these interviews serve to highlight and provide a voice to these women and their families who describe experiencing disadvantage at an already vulnerable time in their lives, as well as illustrating the need for services to prioritize the needs of this population when acute events strike, be those future pandemics or other disasters.

Keywords: patient experience, perinatal mental health, covid-19 pandemic, heightened anxiety, birth trauma, post-natal well-being

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Authors: Sumit Banerjee, Chandan Kumar Chanda

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The paper presents allocation of active power losses and energy losses to consumers connected to radial distribution networks in a deregulated environment for loads of composite types. A detailed comparison among four algorithms, namely quadratic loss allocation, proportional loss allocation, pro rata loss allocation and exact loss allocation methods are presented. Quadratic and proportional loss allocations are based on identifying the active and reactive components of current in each branch and the losses are allocated to each consumer, pro rata loss allocation method is based on the load demand of each consumer and exact loss allocation method is based on the actual contribution of active power loss by each consumer. The effectiveness of the proposed comparison among four algorithms for composite load is demonstrated through an example.

Keywords: composite type, deregulation, loss allocation, radial distribution networks

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Authors: Md. Rashidul Hasan, Atikur Rahman Baizid

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The Bayesian estimation approach is a non-classical estimation technique in statistical inference and is very useful in real world situation. The aim of this paper is to study the Bayes estimators of the parameter of exponential distribution under different loss functions and then compared among them as well as with the classical estimator named maximum likelihood estimator (MLE). In our real life, we always try to minimize the loss and we also want to gather some prior information (distribution) about the problem to solve it accurately. Here the gamma prior is used as the prior distribution of exponential distribution for finding the Bayes estimator. In our study, we also used different symmetric and asymmetric loss functions such as squared error loss function, quadratic loss function, modified linear exponential (MLINEX) loss function and non-linear exponential (NLINEX) loss function. Finally, mean square error (MSE) of the estimators are obtained and then presented graphically.

Keywords: Bayes estimator, maximum likelihood estimator (MLE), modified linear exponential (MLINEX) loss function, Squared Error (SE) loss function, non-linear exponential (NLINEX) loss function

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Authors: Liesbeth Van Kelst, Jozefiene Jansens

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Background: All care providers within mother and child care are confronted, at some point in their career, with the care for parents who (will) lose or have lost a baby. Obtaining the correct attitude and communicating well during these difficult moments are aspects that many healthcare provides continue to struggle with. Parents still encounter well-intentioned but inappropriate communication from healthcare providers. Aim: To study how communication, both verbal and non-verbal, around the death of a baby during pregnancy, birth, or in the first ten days postnatal was experienced by parents and healthcare providers. Methods: A qualitative study using grounded theory principles was conducted. Data were collected through 22 individual face-to-face in-depth interviews with parents who had lost a baby (n = 12) and intramural caregivers, such as midwives, nurses, gynecologists and neonatologists (n=10). In the first phase, data were analyzed within each group separately (parents and healthcare providers) and in the second phase, findings from both groups were compared and analyzed according to meta-synthesis principles. Results: The themes that emerged from the data demonstrated congruent experiences between the group of the parents and the health care providers. Both strengths and weaknesses in current care were named and suggestions for appropriate communication were formulated. Conclusion: Since most health care providers only occasionally care for parents with a deceased baby, a communication tool can optimize communication between healthcare professionals and parents who lose a baby. This is very important as the words which are said at this difficult period last a lifetime in the heads of parents.

Keywords: communication, death, perinatal loss, stillbirth

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Authors: K. Assis, K. P. Chong, A. S. Idris, C. M. Ho

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Oil palm or Elaeis guineensis is considered as the golden crop in Malaysia. But oil palm industry in this country is now facing with the most devastating disease called as Ganoderma Basal Stem Rot disease. The objective of this paper is to analyze the economic loss due to this disease. There were three commercial oil palm sites selected for collecting the required data for economic analysis. Yield parameter used to measure the loss was the total weight of fresh fruit bunch in six months. The predictors include disease severity, change in disease severity, number of infected neighbor palms, age of palm, planting generation, topography, and first order interaction variables. The estimation model of yield loss was identified by using backward elimination based regression method. Diagnostic checking was conducted on the residual of the best yield loss model. The value of mean absolute percentage error (MAPE) was used to measure the forecast performance of the model. The best yield loss model was then used to estimate the economic loss by using the current monthly price of fresh fruit bunch at mill gate.

Keywords: ganoderma, oil palm, regression model, yield loss, economic loss

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Authors: Wu Xiaoguang, Liu Jiaxin, Fang Miaomiao, Wei Saidong

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There are many prestressed concrete prefabricated girder Bridges with small and medium span and the damage is serious. This paper mainly study the effect of prestress loss of prefabricated bridge bearing performance, through the establishment of ANSYS finite element model, from the condition of different prestress loss research, get the stress and strain data, draw curve, finally get the following conclusion: loss of prestress can reduce the ultimate bearing capacity of Bridges, the side span across the deflection value than the influence of times side span, the influence of the deflection in the midspan cross value. Therefore, the prestress loss and the effective prestress should be strictly considered in the design and construction process.

Keywords: across the deflection, loss of prestress, prefabricated girder bridge, the main tensile stress

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Authors: Rickard Grassman, Carl Cederström

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In this paper, Lacanian theory will be used to illustrate the way discourses interact with the material by way of reifying antagonisms to shape our sense of identities in and around organizations. The ability to ‘sustain the loss’ is, in this view, the common structure here discerned in the very texture of a discourse, which reifies ‘lack’ as an ontological condition into something contingently absent (loss) that the subject hopes to overcome (desire). These fundamental human tendencies of identification are illustrated in the paper by examples drawn from history, cinema, and literature. Turning to a select sample of empirical accounts from a management consultancy firm, it is argued that this ‘sustaining the loss’ operates in discourse to enact identification in an organizational context.

Keywords: Lacan, identification, discourse, desire, loss

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Authors: Dchieche Amina, Aboulaich Rajae

Abstract:

Profit and loss sharing suggests an equitable sharing of risks and profits between the parts involved in a financial transaction. Salam is a contract in which advance payment is made for goods to be delivered at a future date. The purpose of this work is to price a new contract for profit and loss sharing based on Salam contract, using Khiyar Al Ghabn which is an agreement of choice in case of misrepresent facts.

Keywords: Islamic finance, shariah compliance, profit and loss sharing, derivatives, risks, hedging, salam contract

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Authors: Jonathan A. Mikhail, Arsenio Paez

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It is not uncommon for a viral infection to cause hearing loss. Many viral infections are associated with sudden-onset, often unilateral, idiopathic sensorineural hearing loss. We conducted an exploratory study with thirty patients with pre-existing hearing loss between 50 and 64 to evaluate if COVID-19 was associated with exacerbated hearing loss. We hypothesized that hearing loss would be exacerbated by COVID-19 infection in patients with pre-existing hearing loss. A statistically significant paired T-test between pure tone averages (PTAs) at the patient’s original diagnosis and a current, updated audiometric assessment indicated a regression in hearing (p-value < .001) sensitivity following the contraction of COVID-19. Speech reception thresholds (SRTs) and word recognition scores (WRSs) were also considered, as well as the participants' gender. SRTs between each ear exhibited a statistically significant change (p-value of .002 and p-value < .001). WRSs did not show statistically significant differences (p-value of .290 and p-value of .098). A non-statistically significant Two-Way ANOVA was performed to evaluate gender’s potential role in exacerbated hearing loss and proved to be statistically insignificant (p-value of .214). This study discusses practical implications for clinical and educational pursuits in understanding COVID-19's effect on the auditory system and the need to evaluate the deadly virus further.

Keywords: audiology, COVID-19, sensorineural hearing loss, otology, auditory research

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Authors: Filipa Cortez, Vanessa Pereira

Abstract:

Introduction: The main challenge of obesity treatment is long-term weight loss maintenance. The 3 phases method is a weight loss program that combines a low carb and moderately high-protein diet, food supplements and a weekly one-to-one consultation with a certified nutritionist. Sustained weight control is the ultimate goal of phase 3. Success criterion was the minimum loss of 10% of initial weight and its maintenance after 12 months. Objective: The aim of this study was to identify factors associated with successful weight loss maintenance after 12 months at the end of 3 phases method. Methods: The study included 199 subjects that achieved their weight loss goal (phase 3). Weight and body mass index (BMI) were obtained at the baseline and every week until the end of the program. Therapeutic adherence was measured weekly on a Likert scale from 1 to 5. Subjects were considered in compliance with nutritional recommendation and supplementation when their classification was ≥ 4. After 12 months of the method, the current weight and number of previous weight-loss attempts were collected by telephone interview. The statistical significance was assumed at p-values < 0.05. Statistical analyses were performed using SPSS TM software v.21. Results: 65.3% of subjects met the success criterion. The factors which displayed a significant weight loss maintenance prediction were: greater initial percentage weight loss (OR=1.44) during the weight loss intervention and a higher number of consultations in phase 3 (OR=1.10). Conclusion: These findings suggest that the percentage weight loss during the weight loss intervention and the number of consultations in phase 3 may facilitate maintenance of weight loss after the 3 phases method.

Keywords: obesity, weight maintenance, low-carbohydrate diet, dietary supplements

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Authors: Shahzad Yousaf, Imran Shafi

Abstract:

This paper presents a new method for calculation of pressure loss coefficients by use of the artificial neural network (ANN) in tee junctions. Geometry and flow parameters are feed into ANN as the inputs for purpose of training the network. Efficacy of the network is demonstrated by comparison of the experimental and ANN based calculated data of pressure loss coefficients for combining flows in a tee junction. Reynolds numbers ranging from 200 to 14000 and discharge ratios varying from minimum to maximum flow for calculation of pressure loss coefficients have been used. Pressure loss coefficients calculated using ANN are compared to the models from literature used in junction flows. The results achieved after the application of ANN agrees reasonably to the experimental values.

Keywords: artificial neural networks, combining flow, pressure loss coefficients, solar collector tee junctions

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Authors: Wilmer Osvaldo Martinez, Manuel Dario Hernandez, Juan Manuel Julio

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We propose to assess the performance of k forecast procedures by exploring the distributions of forecast errors and error losses. We argue that non systematic forecast errors minimize when their distributions are symmetric and unimodal, and that forecast accuracy should be assessed through stochastic loss order rather than expected loss order, which is the way it is customarily performed in previous work. Moreover, since forecast performance evaluation can be understood as a one way analysis of variance, we propose to explore loss distributions under two circumstances; when a strict (but unknown) joint stochastic order exists among the losses of all forecast alternatives, and when such order happens among subsets of alternative procedures. In spite of the fact that loss stochastic order is stronger than loss moment order, our proposals are at least as powerful as competing tests, and are robust to the correlation, autocorrelation and heteroskedasticity settings they consider. In addition, since our proposals do not require samples of the same size, their scope is also wider, and provided that they test the whole loss distribution instead of just loss moments, they can also be used to study forecast distributions as well. We illustrate the usefulness of our proposals by evaluating a set of real world forecasts.

Keywords: forecast evaluation, stochastic order, multiple comparison, non parametric test

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Authors: M. B. Ahmadi, A. A. Kaffash B., B. Mobaraki

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Slump loss, which refers to the gradual reduction of workability and the amount of slump in fresh concrete over time, is one of the significant challenges in the ready-mixed concrete industry. Therefore, having accurate knowledge of the factors affecting slump loss is a crucial solution in this field. In this paper, an attempt was made to investigate the effect of cement produced by different units on the slump of concrete in a laboratory setting. For this purpose, 12 cement samples were prepared from 6 different production units. Physical and chemical tests were performed on the cement samples. Subsequently, a laboratory concrete mix with a slump of 13 ± 1 cm was prepared with each cement sample, and the slump was measured at 0, 15, 30, 45, and 60 minutes. Although the environmental factors, mix design specifications, and execution conditions—factors that significantly influence the slump loss trend—were constant in all 12 laboratory concrete mixes, the slump loss trends differed among them. These trends were categorized based on the results, and the relationship between the slump loss percentage in 60 minutes, the water-cement ratio, and the LOI and K2O values of different cements were introduced.

Keywords: concrete, slump loss, portland cement, efficiency

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Authors: Kofi Kyei, Kenchi Matsui

Abstract:

Loss of vegetable products has been a major constraint in the post-harvest chain. Sources of post-harvest loss in the vegetable industry start from the time of harvesting to its handling and at the various market centers. Identifying vegetable farmers’ perceptions about post-harvest loss sources is one way of addressing this issue. In this paper, we assessed farmers’ perceptions about sources of post-harvest losses in the Ashanti Region of Ghana. We also identified the factors that influence their perceptions. To clearly understand farmers’ perceptions, we selected Sekyere-Kumawu District in the Ashanti Region. Sekyere-Kumawu District is one of the major producers of vegetables in the Region. Based on a questionnaire survey, 100 vegetable farmers growing tomato, pepper, okra, cabbage, and garden egg were purposely selected from five communities in Sekyere-Kumawu District. For farmers’ perceptions, the five points Likert scale was employed. On a scale from 1 (no loss) to 5 (extremely high loss), we processed the scores for each vegetable harvest. To clarify factors influencing farmers’ perceptions, the Pearson Correlation analysis was used. Our findings revealed that farmers perceive post-harvest loss by pest infestation as the most extreme loss. However, vegetable farmers did not perceive loss during transportation as a serious source of post-harvest loss. The Pearson Correlation analysis results further revealed that farmers’ age, gender, level of education, and years of experience had an influence on their perceptions. This paper then discusses some recommendations to minimize the post-harvest loss in the region.

Keywords: Ashanti Region, pest infestation, post-harvest loss, vegetable farmers

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Authors: Yoonsuh Jung, Steven N. MacEachern

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Check loss function is used to define quantile regression. In the prospect of cross validation, it is also employed as a validation function when underlying truth is unknown. However, our empirical study indicates that the validation with check loss often leads to choosing an over estimated fits. In this work, we suggest a modified or L2-adjusted check loss which rounds the sharp corner in the middle of check loss. It has a large effect of guarding against over fitted model in some extent. Through various simulation settings of linear and non-linear regressions, the improvement of check loss by L2 adjustment is empirically examined. This adjustment is devised to shrink to zero as sample size grows.

Keywords: cross-validation, model selection, quantile regression, tuning parameter selection

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Authors: Abdulrazaq O. Raji, Abba Mohammed, Ibrahim D. Mohammed

Abstract:

This study was conducted to investigate foetal loss among slaughtered livestock species at the Maiduguri abattoir from 2009 to 2013. Record of animals slaughtered monthly and fetuses recovered were collected from the management of the Maiduguri abattoir. Data was subjected to Analysis of Variance using the General Linear Model of SPSS 13.0 with Season, Species and their interaction as fixed factors. Average yearly slaughter at the Maiduguri abattoir was 63,225 animals with cattle, camel, goat and sheep accounting for 19737, 7374, 19281 and 17540 of the total. The corresponding number of those pregnant were 3117, 839, 2281 and 2432 out of a total of 8522 animals. Thus, cattle, camel, goat and sheep accounted for 30.87, 11.53, 30.16 and 27.44%, respectively of the animals slaughtered at the Abattoir and 35.96, 9.68, 26.31 and 28.05% of the foetal loss. The effect of season and species on foetal loss was significant (P < 0.05). The number of pregnant animals slaughtered and foetal loss were higher during wet than dry season. Similarly, foetal loss at the abattoir was higher in the month of May in respect of camel, goat and sheep, and August for cattle. Camel was the least slaughtered animal and had the least number of pregnant females. Foetal loss (%) was higher (P < 0.05) for cattle compared to other species. The interaction showed that camel was the least slaughtered species in both seasons and cattle in the wet season had the highest foetal loss.

Keywords: abattoir, foetal loss, season, species

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Authors: Rabiul Islam

Abstract:

The study was in order to assess soil erosion at plot scale Universal Soil Loss Equation (USLE) erosion model and Geographic Information System (GIS) technique have been used for the study 8 plots in Guthrie Corridor Expressway, Selangor, Malaysia. The USLE model estimates an average soil loss soil integrating several factors such as rainfall erosivity factor(R ), Soil erodibility factor (K), slope length and steepness factor (LS), vegetation cover factor as well as conservation practice factor (C &P) and Results shows that the four plots have very low rates of soil loss, i.e. NLDNM, NDNM, PLDM, and NDM having an average soil loss of 0.059, 0.106, 0.386 and 0.372 ton/ha/ year, respectively. The NBNM, PLDNM and NLDM plots had a relatively higher rate of soil loss, with an average of 0.678, 0.757 and 0.493ton/ha/year. Whereas, the NBM is one of the highest rate of soil loss from 0.842 ton/ha/year to maximum 16.466 ton/ha/year. The NBM plot was located at bare the land; hence the magnitude of C factor(C=0.15) was the highest one.

Keywords: USLE model, GIS, Guthrie Corridor Expressway (GCE), Malaysia

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