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1.
J Occup Rehabil ; 2024 Jul 02.
Article in English | MEDLINE | ID: mdl-38954248

ABSTRACT

PURPOSE: This study assessed the effectiveness of Individual Placement and Support (IPS), Participatory Workplace Intervention (PWI), and IPS + PWI on work participation and health of people with work disabilities. METHODS: A randomised controlled 2 × 2 factorial trial with 120 clients and an 18-month follow-up was performed. Differences between IPS and no-IPS and between PWI and no-PWI were assessed using log-rank tests and Cox proportional hazards models. RESULTS: In the IPS group, restricted mean survival time (RMST) for sustainable paid employment was 352 days, compared to 394 in the no-IPS group (HR = 1.47, 95% CI = 0.81-2.63). In the PWI group the RMST was 378 days, compared to 367 in the no-PWI group (HR = 0.89, 95% CI = 0.48-1.64). For the secondary outcome 'starting any paid employment, a trial placement, or education' RMST was significantly lower for the IPS group (222 days) than for the no-IPS group (335 days; HR = 1.85, 95% CI = 1.01-3.42). Mental health was significantly lower (worse) in the PWI group (difference -4.07, 95% CI = -7.93 to -0.22) than in the no-PWI group. For all other secondary outcomes, no statistically significant differences were found. CONCLUSION: No statistically significant differences were observed in the duration until starting sustainable employment between IPS and no-IPS, and between PWI and no-PWI. The duration until starting any paid employment, a trial placement, or education was shorter in the IPS group than in the no-IPS group, but further research should explore whether this also increases sustainable employment in the longer term.

2.
Ghana Med J ; 58(1): 44-52, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38957282

ABSTRACT

Objective: To compare cervical ripening time with the use of vaginal Misoprostol plus Hyoscine-N-Butylbromide, with vaginal Misoprostol alone. Design: A double-blind randomized controlled trial with Pan-African Clinical Trials Registry (PACTR) approval number PACTR202112821475292. Setting: Federal Medical Centre, Asaba, Nigeria. Participants: A total of 126 eligible antenatal patients for cervical ripening were enrolled. Interventions: Participants in Group A had 25µg of vaginal misoprostol with 1ml of intramuscular placebo, and those in Group B had 25µg of vaginal misoprostol with 20mg of Intramuscular Hyoscine (1 ml). Oxytocin infusion was used when indicated, and the labour was supervised as per departmental protocol. Main outcome measure: Cervical ripening time. Results: The mean cervical ripening time was statistically significantly shorter in the hyoscine group (8.48±4.36 hours) than in the placebo group (11.40±7.33 hours); p-value 0.02, 95% CI 0.80-5.05. There was no statistically significant difference in the mean induction-delivery interval in Group A (7.38±5.28 hours) compared to Group B (7.75±5.04 hours), with a value of 0.54. The mode of delivery was comparable. However, women in Group B (53, 84.1%) achieved more vaginal deliveries than women in Group A (50, 79.4%); p-value 0.49. Thirteen women in Group A (20.6%) had a caesarean section, while ten women (15.9%) in Group B had a caesarean section (p-value 0.49, RR 0.94, CI 0.80-1.11). Adverse maternal and neonatal outcomes were not statistically significant between the two groups. Conclusion: Intramuscular hyoscine was effective in reducing cervical ripening time when used as an adjunct to vaginal Misoprostol, with no significant adverse maternal or neonatal outcome. Funding: None declared.


Subject(s)
Cervical Ripening , Misoprostol , Oxytocics , Humans , Female , Pregnancy , Misoprostol/administration & dosage , Double-Blind Method , Cervical Ripening/drug effects , Adult , Administration, Intravaginal , Oxytocics/administration & dosage , Young Adult , Butylscopolammonium Bromide/administration & dosage , Nigeria , Labor, Induced/methods , Time Factors , Drug Therapy, Combination
3.
Afr Health Sci ; 24(1): 145-150, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38962350

ABSTRACT

Background: Antenatal corticosteroids (ACS) are given to pregnant women at risk of preterm delivery to hasten the maturation of the lungs, lowering the risk of newborn respiratory distress syndrome (RDS) and perinatal mortality. Objective: The aim of this study was to determine whether exposure to ACS was associated with lower rates of perinatal mortality and RDS in preterm infants delivered by women with preterm labour. Methods: This is a secondary analysis of data from four hospitals in Mwanza, Tanzania. All singletons and twins born to women who were in preterm labour between July 2019 and February 2020 and delivered in-hospital between 24 and 34 weeks of gestation were included. Data were recorded from participants' medical records and analysed using STATA Version 14. Results: Over an eight-month period, 588 preterm infants were delivered to 527 women. One hundred and ninety (36.1%) women were given ACS. Infants who were exposed to ACS in utero had a lower rate of perinatal mortality (6.8% vs 19.1%) and RDS (12.3% vs 25.9%) compared to those not exposed to ACS. In adjusted multivariable models, ACS exposure was related to a lower risk of perinatal mortality, aRR 0.23 (95% CI 0.13 - 0.39), and RDS, aRR 0.45 (95% CI 0.30 - 0.68). Conclusion: ACS significantly reduced the risk of perinatal mortality and RDS among preterm infants exposed to ACS in utero and delivered by women in preterm labour. The use of ACS should be encouraged in low-resource settings where preterm birth is prevalent to improve perinatal outcomes.


Subject(s)
Adrenal Cortex Hormones , Obstetric Labor, Premature , Perinatal Mortality , Prenatal Care , Respiratory Distress Syndrome, Newborn , Humans , Female , Pregnancy , Tanzania/epidemiology , Obstetric Labor, Premature/prevention & control , Infant, Newborn , Respiratory Distress Syndrome, Newborn/prevention & control , Respiratory Distress Syndrome, Newborn/epidemiology , Adult , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Prenatal Care/methods , Infant, Premature , Gestational Age , Premature Birth/prevention & control , Premature Birth/epidemiology , Young Adult
5.
Midwifery ; 136: 104077, 2024 Jun 26.
Article in English | MEDLINE | ID: mdl-38972198

ABSTRACT

AIMS: Maternal positions during childbirth play an important role in safe vaginal births and might also influence women's childbirth experiences greatly. Lateral positions, as a potential position to reduce negative maternal and neonatal outcomes, have become popular in recent years, especially in China where the adoption of conventional lithotomy positions is still common. However, the childbirth experience of those who gave birth in lateral positions has been rarely studied. This study aimed to describe and compare women's childbirth experiences of adopting the newly introduced lateral positions and the conventional lithotomy positions during the second stage of labour. STUDY DESIGN: A cross-sectional study was conducted in two tertiary hospitals in China involving a total of 658 primiparous and parous women who adopted lateral and lithotomy positions during the second stage of labour from July to November 2020. Sociodemographic characteristics, maternal and neonatal outcomes as well as childbirth experience assessed by the Childbirth Experience Questionnaire (CEQ) were collected. This study followed the STROBE guidelines. RESULTS: Women who once adopted lateral positions during the second stage of labour had better positive childbirth experiences compared with those in the lithotomy positions group, as demonstrated by their overall higher CEQ scores. Women in the lateral position group also reported better participation and perceived safety, and a greater sense of control during childbirth. Lateral positions remained an influential factor in CEQ scores after controlling for potential confounders. In this study, adverse maternal and neonatal outcomes were rare. Women in lateral positions had comparatively better perineal outcomes. CONCLUSION: This study described and compared women's childbirth experiences of adopting conventional lithotomy positions and lateral positions during the second stage of labour using a valid instrument. Women who adopted lateral positions during the second stage of labour reported better childbirth experiences than those giving birth in the conventional lithotomy positions. Thus, assisting women in giving birth in lateral positions might be a promising way to improve women's childbirth experience.

6.
Cureus ; 16(5): e61358, 2024 May.
Article in English | MEDLINE | ID: mdl-38947718

ABSTRACT

Fetal head position significantly influences birth outcomes, with higher rates of complications observed when the fetal head is in the Occiput Posterior (OP) position compared to Occiput Transverse (OT) or Occiput Anterior (OA) positions. There is no consensus in the current literature on the precise rotational point at which the fetal occiput shifts from posterior to transverse, reducing clarity in both scientific and clinical communication. Different studies employ varying definitions of these positions, which affects management decisions. This study aims to determine if a definable threshold exists between the directly posterior and directly transverse positions that correlates with different birth outcomes, thereby proposing a consistent and clinically useful definition for OP versus OT. We analyzed ultrasound data from 570 patients at full dilatation from five previous studies, correlating the angle of the fetal occiput (noted on a clock-face) with birth outcomes. Adverse outcomes were defined as cesarean delivery, instrumental vaginal delivery, significant postpartum hemorrhage (500 ml or more), obstetric anal sphincter injury, five-minute Apgar scores <7, arterial cord pH <7, base excess less than -12, or neonatal intensive care unit admission. The analysis was conducted using SAS version 9.4. The study found a continuous relationship between the fetal occipital angle and adverse birth outcomes without a distinct threshold separating OP from OT positions. No clear inflection point was demonstrated in pregnancy outcomes between OT and OP. The relationship between the angle of occiput position and pregnancy outcomes was continuous: the closer the fetal head was to directly OP, the higher the likelihood of adverse outcomes. Given the lack of a clear cut-off and to improve consistency in future research, we recommend dividing the occiput position into four quadrants of 90 degrees each. This classification could standardize reporting and potentially improve clinical decision-making regarding fetal position during labor.

7.
Article in English | MEDLINE | ID: mdl-38943364

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, mitigation measures were associated with a reduction in preterm birth rates; while not clearly proven, this observation has sparked significant interest. AIM: To understand the cause of this reduction by exploring the characteristics of preterm birth cohorts. MATERIAL AND METHODS: We performed a retrospective cohort study where we compared women who delivered preterm in three Melbourne maternity hospitals and conceived between November 2019 and February 2020 (mitigation measures-exposed cohort) to women who delivered preterm and conceived between November 2018 and February 2019 (non-exposed cohort). We compared maternal characteristics, pregnancy complications, antenatal interventions, intrapartum care, and indications for delivery. RESULTS: In the exposed cohort, 252/3129 women delivered preterm (8.1%), vs 298/3154 (9.4%) in the non-exposed cohort (odds ratio (OR) 0.84, 95% CI 0.70-1.00, P = 0.051). The baseline characteristic of two cohorts were comparable. Rates of spontaneous preterm labour (sPTL) without preterm pre-labour rupture of membranes (PPROM) were lower in the exposed cohort (13.1% vs 24.2%, OR 0.47, P = 0.001) while PPROM occurred more often (48.0% vs 35.6%, OR 1.67, P = 0.003). With a non-statistically significant prolongation of pregnancy in the cohort exposed to mitigation measures for both sPTL without PPROM (35.4 vs 34.9 weeks, P = 0.703) and PPROM (35.6 vs 34.9 weeks, P = 0.184). The rate of spontaneous labour after PPROM was higher in the exposed cohort compared to the non-exposed cohort (40.1% vs 24.1%, OR 2.09, P < 0.001). CONCLUSION: The reduction in preterm delivery during mitigation measures may have been driven by a reduction in spontaneous labour without PPROM, which seemed to result in more PPROM later in pregnancy.

8.
Int J Occup Saf Ergon ; : 1-12, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38835292

ABSTRACT

Slope failure during or immediately after slope-cutting can cause fatal accidents. This study analyses the characteristics of labour accidents caused by slope failure during slope-cutting in Japan and presents a countermeasure to prevent accidents caused by slope failure, such as the implementation of a slope guideline by MHLW. A case history conducted during slope-cutting and nailing was presented as an example of the application of the slope guideline to ensure safety. Furthermore, monitoring methods were implemented to gain a quantitative understanding of slope deformation. Geological conditions other than those assumed prior to excavation and small collapses attributed to groundwater are indications of landslide risk. The guideline's quick checklist reflects the slope condition or deformation, allowing the client, designer and contractor to discuss and agree on a quick solution to a problem. The case study confirmed the effectiveness of the slope guideline as a tool for sharing information during construction.

9.
Sociol Health Illn ; 2024 Jun 30.
Article in English | MEDLINE | ID: mdl-38946022

ABSTRACT

This article identifies the health of the worker as a third source of labour power indeterminacy to be added to the indeterminacy of labour effort and the indeterminacy of labour mobility. The paper clearly differentiates worker health from effort as a distinct source of labour power indeterminacy-something that cannot be guaranteed and that varies for an individual over time. It considers the relationship between worker health as a new source of indeterminacy and the two extant sources of labour power indeterminacy, focussing on the way in which health moderates the relationship between effort and output. The paper also considers the way in which worker health investment moderates the indeterminacy of labour effort and labour mobility, independently of its impact on the health of the worker. The paper documents the potential value of worker health investment to the organisation and also considers the boundary conditions for investment in worker health.

10.
Plant Biol (Stuttg) ; 2024 Jun 11.
Article in English | MEDLINE | ID: mdl-38861656

ABSTRACT

Heteranthery, the presence of different types of anthers on the same flower, is a floral adaptation that aims to balance the need for pollinators to collect pollen as a food resource while ensuring sufficient pollen for pollination. We investigate the role of heteranthery in the pollination of Senna arnottiana flowers and how it is affected by the behaviour of visiting bee species, with a particular focus on the impact of the invasive bumblebee Bombus terrestris. In three populations of S. arnottiana we measured the size of three sets of anthers and style, stigma-anther separation, pollen quantity and fruit set, and contrasted it with the body size, behaviour, and pollination effectiveness of all floral visitors. Different bee species visited S. arnottiana flowers, and their foraging behaviour varied. Large-bodied native bees, including Centris cineraria, Caupolicana sp. and Cadeguala occidentalis, preferentially visited short anthers, whereas B. terrestris, an exotic bumblebee, foraged from both short and long anthers without distinction. In addition, B. terrestris contacted the stigma at a lower rate than large-bodied native bees. Instead of concentrating its pollen-gathering efforts on the feeding anthers, as predicted by the "division of labor" hypothesis, B. terrestris indiscriminately visited both types of anthers similarly. This behaviour of B. terrestris may disrupt the adaptive significance of heteranthery by mixing the roles of pollination and feeding anthers of S. arnottiana. Therefore, our results highlight the potential disruption of this relationship by exotic pollinators and the need to consider it in conservation efforts.

11.
BMC Pregnancy Childbirth ; 24(1): 421, 2024 Jun 12.
Article in English | MEDLINE | ID: mdl-38867160

ABSTRACT

BACKGROUND: Peripartum asphyxia is one of the main causes of neonatal morbidity and mortality. In moderate and severe cases of asphyxia, a condition called hypoxic-ischemic encephalopathy (HIE) and associated permanent neurological morbidities may follow. Due to the multifactorial etiology of asphyxia, it may be difficult prevent, but in term neonates, therapeutic cooling can be used to prevent or reduce permanent brain damage. The aim of this study was to assess the significance of different antenatal and delivery related risk factors for moderate and severe HIE and the need for therapeutic hypothermia. METHODS: We conducted a retrospective matched case-control study in Helsinki University area hospitals during 2013-2017. Newborn singletons with moderate or severe HIE and the need for therapeutic hypothermia were included. They were identified from the hospital database using ICD-codes P91.00, P91.01 and P91.02. For every newborn with the need for therapeutic hypothermia the consecutive term singleton newborn matched by gender, fetal presentation, delivery hospital, and the mode of delivery was selected as a control. Odds ratios (OR) between obstetric and delivery risk factors and the development of HIE were calculated. RESULTS: Eighty-eight cases with matched controls met the inclusion criteria during the study period. Maternal and infant characteristics among cases and controls were similar, but smoking was more common among cases (aOR 1.46, CI 1.14-1.64, p = 0.003). The incidence of preeclampsia, diabetes and intrauterine growth restriction in groups was equal. Induction of labour (aOR 3.08, CI 1.18-8.05, p = 0.02) and obstetric emergencies (aOR 3.51, CI 1.28-9.60, p = 0.015) were more common in the case group. No difference was detected in the duration of the second stage of labour or the delivery analgesia. CONCLUSIONS: Smoking, induction of labour and any obstetric emergency, especially shoulder dystocia, increase the risk for HIE and need for therapeutic hypothermia. The decisions upon induction of labour need to be carefully weighed, since maternal smoking and obstetric emergencies can hardly be controlled by the clinician.


Subject(s)
Hypothermia, Induced , Hypoxia-Ischemia, Brain , Humans , Hypoxia-Ischemia, Brain/therapy , Hypoxia-Ischemia, Brain/epidemiology , Female , Infant, Newborn , Case-Control Studies , Risk Factors , Pregnancy , Retrospective Studies , Male , Adult , Asphyxia Neonatorum/therapy , Asphyxia Neonatorum/complications , Finland/epidemiology , Delivery, Obstetric
12.
Sex Reprod Healthc ; 41: 100985, 2024 May 25.
Article in English | MEDLINE | ID: mdl-38823161

ABSTRACT

INTRODUCTION: Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage. OBJECTIVE: To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women. METHODS: A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. RESULTS: The analysis resulted in four themes: "An unknown phase" that entailed remaining in a phase that the women lacked an awareness of. "Trust and mistrust in the body's ability" represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme "Loss of control" included experiences of frustration, fatigue, and having to deny bodily instincts. "Support through presence and involvement" signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence. CONCLUSIONS: The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

13.
BJOG ; 2024 Jun 03.
Article in English | MEDLINE | ID: mdl-38828568

ABSTRACT

OBJECTIVES: To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource-limited setting. DESIGN: Prospective study. SETTING: Obstetrics and Gynaecology department in a tertiary hospital in Ghana. POPULATION: Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD. METHODS: Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements. MAIN OUTCOME MEASURES: Lower uterine segment findings at laparotomy, successful vaginal birth. RESULTS: A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI -0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80-1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03-1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5-99.8%) and specificity of 81.8% (95% CI 75.8-86.8%). CONCLUSION: Accurate TVUS measurement of the LUS is technically feasible in a resource-limited setting. This approach could help in making safer decisions on mode of birth in limited-resource settings.

14.
BMC Pregnancy Childbirth ; 24(1): 403, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38824569

ABSTRACT

BACKGROUND: The practice of intrapartum use of oxytocin for induction and augmentation of labour is increasing worldwide with documented wide variations in clinical use, especially dose administrations. There is also evidence of intrapartum use by unauthorized cadre of staff. AIM: This study assessed the patterns - frequency of intrapartum use of oxytocin, the doses and routes of administration for induction and augmentation of labour, and identified the predictors of oxytocin use for induction and augmentation of labour by healthcare providers in Nigeria. METHODS: This was a cross-sectional study conducted among healthcare providers - doctors, nurses/midwives and community health workers (CHWs) in public and private healthcare facilities across the country's six geopolitical zones. A multistage sampling technique was used to select 6,299 eligible healthcare providers who use oxytocin for pregnant women during labour and delivery. A self-administered questionnaire was used to collect relevant data and analysed using STATA 17 statistical software. Summary and inferential statistics were done and further analyses using multivariable regression models were performed to ascertain independent predictor variables of correct patterns of intrapartum oxytocin usage. The p-value was set at < 0.05. RESULTS: Of the 6299 respondents who participated in the study, 1179 (18.7%), 3362 (53.4%), and 1758 (27.9%) were doctors, nurses/midwives and CHWs, respectively. Among the respondents, 4200 (66.7%) use oxytocin for augmentation of labour while 3314 (52.6%) use it for induction of labour. Of the 1758 CHWs, 37.8% and 49% use oxytocin for induction and augmentation of labour, respectively. About 10% of the respondents who use oxytocin for the induction or augmentation of labour incorrectly use the intramuscular route of administration and about 8% incorrectly use intravenous push. Being a doctor, and a healthcare provider from government health facilities were independent positive predictors of the administration of correct dose oxytocin for induction and augmentation of labour. The CHWs were most likely to use the wrong route and dose administration of oxytocin for the induction and augmentation of labour. CONCLUSION: Our study unveiled a concerning clinical practice of intrapartum oxytocin use by healthcare providers in Nigeria - prevalence of intrapartum use of oxytocin, inappropriate routes of administration for induction and augmentation of labour, varied and inappropriately high start dose of administration including unauthorized and high intrapartum use of oxytocin among CHWs.


Subject(s)
Health Personnel , Labor, Induced , Oxytocics , Oxytocin , Humans , Oxytocin/administration & dosage , Nigeria , Female , Pregnancy , Cross-Sectional Studies , Labor, Induced/methods , Labor, Induced/statistics & numerical data , Oxytocics/administration & dosage , Adult , Health Personnel/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Surveys and Questionnaires , Labor, Obstetric , Male , Young Adult
15.
AoB Plants ; 16(3): plae028, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38854500

ABSTRACT

Land-use change and tourism development have seriously threatened the ecosystems of coastal protection forests and beaches. Light and nutrients are spatially heterogeneously distributed between the two ecosystems. Clonal plants, such as Calystegia soldanella, which play a crucial role in maintaining the ecological stability of coastal habitats, are likely to encounter diverse environments. In this study, we investigated clonal integration and the division of labour in C. soldanella under heterogeneous (high nutrient and low light [HNLL]; low nutrient and high light [LNHL]) and homogeneous habitats. We cultivated pairs of connected and severed ramets of C. soldanella in these environments. Our results showed the total biomass (TB) of connected ramets was higher than that of severed ramets in heterogeneous environments, suggesting clonal integration enhances growth in heterogeneous habitats. The root shoot ratio was significantly lower in HNLL than in LNHL conditions for connected ramets, demonstrating a division of labour in growth under heterogeneous conditions. However, parameters of clonal propagation of C. soldanella did not significantly differ between connected and severed ramets in heterogeneous environments, indicating no division of labour in clonal propagation. In homogeneous environments, the growth of C. soldanella did not benefit from clonal integration. Connected ramets in heterogeneous habitats exhibited higher TB than in homogeneous habitats. The TB of one ramet in HNLL was consistently higher than that in LNHL, irrespective of ramet's states, which suggests that high soil nutrients may enhance the growth. We conclude that C. soldanella has the capability of clonal integration to achieve high biomass in heterogeneous but not in homogeneous conditions, and the establishment of coastal protection forests (high nutrient and low light) may foster the growth of C. soldanella.

16.
BJOG ; 2024 Jun 10.
Article in English | MEDLINE | ID: mdl-38857898

ABSTRACT

OBJECTIVE: Warm water immersion during labour provides women with analgesia and comfort. This cohort study aimed to establish among women using intrapartum water immersion analgesia, without antenatal or intrapartum risk factors, whether waterbirth is as safe for them and their babies as leaving the water before birth. DESIGN: Cohort study with non-inferiority design. SETTING: Twenty-six UK NHS maternity services. SAMPLE: A total of 73 229 women without antenatal or intrapartum risk factors, using intrapartum water immersion, between 1 January 2015 and 30 June 2022. The analysis excluded 12 827 (17.5%) women who received obstetric or anaesthetic interventions before birth. METHODS: Non-inferiority analysis of retrospective and prospective data captured in NHS maternity and neonatal information systems. MAIN OUTCOME MEASURES: Maternal primary outcome: obstetric anal sphincter injury (OASI) by parity; neonatal composite primary outcome: fetal or neonatal death, neonatal unit admission with respiratory support or administration of antibiotics within 48 hours of birth. RESULTS: Rates of the primary outcomes were no higher among waterbirths compared with births out of water: rates of OASI among nulliparous women (waterbirth: 730/15 176 [4.8%] versus births out of water: 641/12 210 [5.3%]; adjusted odds ratio [aOR] 0.97, one-sided 95% CI, -∞ to 1.08); rates of OASI among parous women (waterbirth: 269/24 451 [1.1%] versus births out of water 144/8565 [1.7%]; aOR 0.64, one-sided 95% CI -∞ to 0.78) and rates of the composite adverse outcome among babies (waterbirth 263/9868 [2.7%] versus births out of water 224/5078 [4.4%]; aOR 0.65, one-sided 95% CI -∞ to 0.79). CONCLUSION: Among women using water immersion during labour, remaining in the pool and giving birth in water was not associated with an increase in the incidence of adverse primary maternal or neonatal outcomes.

17.
Proc Biol Sci ; 291(2024): 20240876, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38864319

ABSTRACT

The joint actions of animals in partnerships or social groups evolve under both natural selection from the wider environment and social selection imposed by other members of the pair or group. We used experimental evolution to investigate how jointly expressed actions evolve upon exposure to a new environmental challenge. Our work focused on the evolution of carrion nest preparation by pairs of burying beetles Nicrophorus vespilloides, a joint activity undertaken by the pair but typically led by the male. In previous work, we found that carrion nest preparation evolved to be faster in experimental populations without post-hatching care (No Care: NC lines) than with post-hatching care (Full Care: FC lines). Here, we investigate how this joint activity evolved. After 15 generations of experimental evolution, we created heterotypic pairs (NC females with FC males and NC males with FC females) and compared their carrion nest making with homotypic NC and FC pairs. We found that pairs with NC males prepared the nest more rapidly than pairs with FC males, regardless of the female's line of origin. We discuss how social coadaptations within pairs or groups could act as a post-mating barrier to gene flow.


Subject(s)
Coleoptera , Nesting Behavior , Animals , Male , Female , Coleoptera/physiology , Selection, Genetic , Social Behavior , Biological Evolution , Maternal Behavior , Paternal Behavior
18.
Sociol Health Illn ; 2024 Jun 08.
Article in English | MEDLINE | ID: mdl-38850204

ABSTRACT

The COVID-19 pandemic had a disproportionate impact on ethnically minoritised and other marginalised communities, yet little is known about the impacts of long COVID-19 (LC) on this group. Living with LC takes its toll both physically, emotionally and financially and even more so when a diagnosis is hard to come by. By using qualitative interviews centring the view of undiagnosed and marginalised communities already classed as 'underserved' in the medical literature, we show the range of barriers and impacts faced by these groups in the UK, and the strategies of resilience they use. Whether trapped on a 'diagnostic odyssey' at the level of primary care, struggling to maintain employment and businesses, or managing family commitments, we argue many minoritised communities are caught in a liminal space of misrecognition, invalidation and ambiguity. We show how these impacts are generated by tensions and challenges in the process and categorisation of diagnosis, and how this effects the daily lives of many individuals already on the receiving end of health inequity. We also offer some examples and suggestions for best practices.

19.
Heliyon ; 10(11): e31401, 2024 Jun 15.
Article in English | MEDLINE | ID: mdl-38832284

ABSTRACT

The COVID-19 pandemic led to a labour shortage crisis at maritime ports. Therefore, stakeholders of this industry must have robust tools to maintain good performance indicators of productivity and competitiveness. One of the most critical issues is the labour force related to allocation, performance evaluation, and foreseeing/adapting to new requirements. Many authors have studied the characteristics, elements, trends, and factors crucial in its management. However, there needs to be a comprehensive understanding of this concern. Therefore, this paper aims to develop a systematic literature review on labour force management in the maritime ports to (1) understand the elements and factors that strongly relate to human management and (2) identify future research directions to address the impact of labour shortages. Research questions and keywords were used to search academic databases for peer-reviewed papers, articles, or books. The search, selection and quality assessment processes were performed using the PRISMA methodology. This resulted in 32 documents for review and categorised based on their contributions to the research questions and content. The main findings include factors in labour force management, challenges in optimisation, technology and automation use, methods for evaluating performance, and the impact of the regulatory framework. In addition, potential future research streams were proposed to guide further studies into the needs of this industry.

20.
Work ; 2024 Jun 21.
Article in English | MEDLINE | ID: mdl-38905069

ABSTRACT

BACKGROUND: Education is crucial for empowering women in the labour market. However, the choice of occupation may not always necessarily be determined by their level of education. OBJECTIVE: The present study seeks to answer two important questions: (1) Does education help in determining occupational choices of women working in the informal sector? (2) How do factors like number of dependents in the family, woman staying with family, migration status of a woman and the use of networks in the job-search process, affect the occupational choices of women working in the informal sector? METHOD: The study utilised the data collected from 476 women, working in the urban informal sector of three northern States of India. We have estimated multinomial Probit model to analyse the data. RESULTS: This paper argues that education level cannot be the sole premise for a woman to have a better occupational choice within the informal sector. Other factors play a relatively significant role in determining the choice of occupation by a woman. CONCLUSION: Working women in the urban informal sector have less autonomy in the choice of their occupation and the education levels alone cannot help in providing access to more hygienic, career enriching and well-paying options to them.

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