Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.     

Demography and housing demand—what can we learn from residential construction data?

There are obvious reasons why residential construction should depend on the population’s age structure. We estimate this relation on Swedish time series data and Organization for Economic Cooperation and Development panel data. Large groups of young adults are associated with higher rates of residential construction, but there is also a significant negative effect from those above 75. Age effects on residential investment are robust and forecast well out-of-sample in contrast to the corresponding house price results. This may explain why the debate around house prices and demography has been rather inconclusive. Rapidly aging populations in the industrialized world makes the future look bleak for the construction industry.

The health returns to schooling—what can we learn from twins?

This paper estimates the health returns to schooling, using a twin design. For this purpose, I use data on monozygotic twins from the Midlife in the United States survey. The results suggest that completing high school improves health, as measured through self-reported health, chronic conditions, and exercise behavior, but that additional schooling does not lead to additional health gains. Controlling for certain early life factors that may vary within twin pairs does not alter the main conclusions of this paper.     

Indigenous fertility in the Northern Territory of Australia: what do we know? (and what can we know?)

In the Northern Territory of Australia, Indigenous people make up 30% of the population. Demographic features of the Indigenous population are thus important for understanding Northern Territory population dynamics, but our understanding of what is happening within the Indigenous population is limited by poor data and limited research attention. This paper exploits birth registration and census data to explore Northern Territory Indigenous fertility trends over a 20-year period. It investigates whether fertility decline identified for the 1960 and 1970s is a contemporary feature of Indigenous fertility in the Northern Territory. Results show that our understanding of Northern Territory Indigenous fertility is heavily constrained by data and that trend analysis is essential for avoiding erroneous conclusions because of annual fluctuations. The outstanding feature of Indigenous fertility in the Northern Territory is women becoming mothers at extremely early ages, particularly in rural and remote parts of the Territory. Age patterns appear to have changed little since the middle of last century despite modest declines in age-specific fertility at the youngest ages. While these declines may continue, any trends will be slow to emerge. Continued close scrutiny of data sources and monitoring of trends is needed to ensure that Northern Territory population dynamics are properly understood, and care must be taken in interpreting results to make certain policy interventions aimed at population outcomes are appropriate and achievable.     

Fetal movements: What are we telling women?

Problem

Information that women receive about the importance of monitoring fetal movements and what to do if there are changes is inconsistent and may not be evidence based.

Ethnic Intermarriage and Social Cohesion. What Can We Learn from Yugoslavia?

Social cohesion theory is tested using data on ethnic intermarriage in former Yugoslavia. Before the disintegration of Yugoslavia, the proportion of marriages outside the own ethnic group was generally low, but in this respect large differences among the groups existed. The proportion of mixed marriages with a Serbian partner was much higher among the Montenegrins and Hungarians than among the Muslims, Slovenes, or Albanians. The findings are largely in line with the predictions of social cohesion theory that intermarriage reduces the probability of violent conflict among social groups. Besides proportions of mixed marriages, loglinear parameters are presented. These parameters show that percentages not always give a good indication of the social distances among groups. The boundaries of the largest ethnic groups, the Serbians and Croatians, were less closed than their rather low intermarriage rates suggested. The social distance between the Hungarians and the Serbians, on the other hand, was larger than expected on the basis of their intermarriage rates. The findings stress the importance of including information on ethnically mixed marriages into models of ethnological monitoring and early warning systems for ethnic conflicts.     

How well can we track cohabitation using the SIPP? A consideration of direct and inferred measures

Cohabitation is an alternative to marriage and to living independently for an increasing number of Americans. Still, research that explores links between living arrangements and economic behavior is limited by a lack of data that explicitly identify cohabiting couples. To aid researchers in using the Survey of Income and Program Participation's (SIPP) rich data to explore cohabitation issues, we consider direct and inferred measures of cohabitation. We find, first, that the use of inferred definitions (relative to direct measures) in the SIPP is likely to yield higher cohabitation rates in the United States by incorrectly coding roommates as cohabitors. Second, the SIPP (whether by direct or inferred measures) counts a significantly larger number of cohabiting couples than the widely used Current Population Survey (CPS). Third, spells of cohabitation occur less frequently and last longer when a direct measure of cohabitation is used than when either of the two inferred measures of cohabitation is used; ours is the first article to reveal this result.     

Vaginal births after caesarean: What does Google think about it?

AimVaginal birth after caesarean (VBAC) is a relatively safe alternative to repeat caesarean birth in the proper context. This important decision to undergo an elective caesarean versus VBAC is ultimately a decision of the mother. The purpose of our study was to assess the quality of online information in relation to VBAC collected using the most common search engine: Google.MethodsThe 10 most common hit sites for the keywords “VBAC” and “Vaginal birth after caesarean” were evaluated using the search engine Google. The quality of websites was rated based on the Silberg scale for accountability, the modified Abbott's criteria for presentation and the SMOG index for readability. The content of each website was compared to the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines for VBAC.Findings13 out of 20 identified websites met the adequate criteria for accountability, with 85% of the websites indicating authorship. 11 websites were deemed aesthetically agreeable. The target audience, assessed by the readability score, was notably above the non-medical population with an average SMOG index score of 14.75. Only half of the websites contained recommendations, as detailed by the SOGC guidelines.ConclusionAlmost all sites target a higher academic level, making it beyond the comprehension of the general population. Woman friendly web-assessment tools should be provided to enable pregnant women to take an active role in their decision making.     

‘How can we go on caring when nobody here cares about us?’ Australian public maternity units as contested care sites

BackgroundProvision of personalised, continuous care focused on ‘well women’ is now central to midwifery identity and work ideals, but it remains difficult in hospital contexts shaped by increased demand and by neoliberal policies. Previous accounts of occupational and work-family conflicts in midwifery and nursing have pointed to the ‘moral distress’ associated with managing conflicting expectations in health workplaces.QuestionThis paper examines these issues in the Australian context and considers further the ethical implications of midwives not feeling ‘cared for’ themselves in health care organisations.MethodsQualitative research in several Victorian maternity units included use of interviews and observational methods to explore staff experiences of organisational and professional change. Data were coded and analysed using NVivo.FindingsMidwives reported frequent contestation as they sought to practice their ideal of themselves as caregivers in what they reported as often ‘uncaring’ workplaces. To interpret this data, we argue for seeing midwifery caring as embodied social practice taking place within ‘organisation carescapes’.ConclusionTheoretical analysis of the moral and ethical dimensions of the contemporary organisational structure of maternity care suggests that a practice-based and dialogical ethic should form the core principle of care both for women in childbirth and for their carers.     

What Did Stiglitz,Sen and Fitoussi Get Right and What Did They Get Wrong?

The aim of this critical assessment of the Stiglitz, Sen and Fitoussi Report was to provoke discussion and improvements in future developments of quality of life research undertaken by official statistical agencies. I would like to thank Jochen Jesinghaus and Andrea Saltelli for their helpful comments on earlier drafts of the paper.     

Is social engagement linked to body image and depression among aging women?

Maintaining an active and engaged social life is a critical component of aging well, and women are generally more socially active than men. However, as women age their self-perceptions of their bodies may reduce social behaviors and consequently, increase depressive symptoms. Because little is known about how body image is associated with social engagement and depressive symptoms among aging women, four aspects of body image: satisfaction with cosmetic features, body function, physical appearance, and weight were assessed among women aged 65 and older (n = 123). Regression analyses indicated that cosmetic appearance, body function, and physical appearance were associated with depressive symptoms, whereas satisfaction with weight was unrelated. Further, both greater satisfaction with cosmetic features and body function were associated with higher levels of social engagement, and social engagement mediated the association between these aspects of body satisfaction and depressive symptoms. The findings indicate that specific age-relevant aspects of body satisfaction are linked to social behavior and depression among aging women, and reduced body satisfaction may lead to lower social engagement, and consequently aging women’s health and well-being may be diminished.     

How much Confidence can we have in EU-SILC? Complex Sample Designs and the Standard Error of the Europe 2020 Poverty Indicators

If estimates are based on samples, they should be accompanied by appropriate standard errors and confidence intervals. This is true for scientific research in general, and is even more important if estimates are used to inform and evaluate policy measures such as those aimed at attaining the Europe 2020 poverty reduction target. In this article I pay explicit attention to the calculation of standard errors and confidence intervals, with an application to the European Union Statistics on Income and Living Conditions (EU-SILC). The estimation of accurate standard errors requires among others good documentation and proper sample design variables in the dataset. However, this information is not always available. Therefore, I complement the existing documentation on the sample design of EU-SILC and test the effect on estimated standard errors of various simplifying assumptions with regard to the sample design. It is shown that accounting for clustering within households is of paramount importance. Although this results in many cases in a good approximation of the standard error, taking as much as possible account of the entire sample design generally leads to more accurate estimates, even if sample design variables are partially lacking. The effect is illustrated for the official Europe 2020 indicators of poverty and social exclusion and for all European countries included in the EU-SILC 2008 dataset. The findings are not only relevant for EU-SILC users, but also for users of other surveys on income and living conditions which lack accurate sample design variables.     

Negative population growth: how to go about it? (Letter to the editor)

It proves an interesting exercise to try to determine the effects of a national policy of government control developed on the basis of the need to conserve scarce resources, lessen environmental pollution, and to reduce the U.S. population to 1/2 of the 1970 figures within 100 years without increasing the risks of death. Let it additionally be assumed that in order to minimize the required reduction of fertility that there be no net migration. At the end of the reduction process, the stationary state in stable equilibrium might hopefully be achieved. If these are the goals, the process would include 1) reduction of the annual stream of births immediately to the number that would ultimately be required to sustain a population 1/2 as large as the present number and 2) smooth decline of the totals but with constituent age groups shifting drastically as the sharply reduced stream of births spreads upward through the span of life, with those 65 years and older making up 12% of the population. To obtain a fixed annual stream of births from sharply changing numbers of women of childbearing age would require rapid and drastic changes in the rates of childbearing. The same reduced population could be obtained from a system involving less drastic changes in the age composition, but these means would not be positive ones for older individuals. Both fertility and age distribution could move more smoothly if the mortality risks increased or with considerable emigration of the aged. Other means of reducing the population to 1/2 the present size within 100 years would create even more turbulence in the age distribution and rates of childbearing than those just discussed.