The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

ProblemAlthough perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.AimTo compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).MethodsWomen attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an ‘at-risk’ flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the ‘at-risk’ flag for PIPA than for Usual-Care. Each model’s performance was evaluated using the midwife’s agreement with the ‘at-risk’ flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.FindingsBoth models performed well at identifying ‘at-risk’ women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying ‘at-risk’ women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.DiscussionOverall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as ‘at-risk’ and ‘not at-risk’ of perinatal psychosocial morbidity.     

The effects of maternal depression,anxiety, and perceived stress during pregnancy on preterm birth: A systematic review

BackgroundExperiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices.AimThe aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress.MethodsFour electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013.FindingsOf 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth.ConclusionComplex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants.     

Ethnic Related Variations from the Cass Model of Homosexual Identity Formation: The Experiences of Two-Spirit,Lesbian and Gay Native Americans

Synthesis of current research with the self-stories of Native American two-spirit, lesbian and gay people suggests differences in social locations that may produce sexual orientation identity development processes absent from the current literature. We employed a modified form of grounded theory analysis to explore the identity experiences of six self-identified two-spirit, lesbian or gay Native Americans recounted during in-depth interviews. The resulting five themes are presented with quotes from participants for clarification and support, along with a discussion of their fit with the Cass Model of Homosexual Identity Development and interpersonal congruency theory. Results suggest two developmental pathways, one following the course of Cass' model and a second path notable for its absence of many of the key experiences specified by Cass.     

Discrimination,Subjective Wellbeing,and the Role of Gender: A Mediation Model of LGB Minority Stress

ABSTRACT

The present study examined the link between discrimination and the three components of subjective wellbeing (positive and negative affect and life satisfaction) among a cisgender sample of lesbian, gay, and bisexual (LGB) adults. Specifically, we investigated internalized homonegativity and expectations of rejection as potential mediators of the links between discrimination and subjective wellbeing among a sample of 215 participants. Results from our structural equation model demonstrated a strong, positive direct link between discrimination and negative affect. Discrimination also had small, negative indirect effects on life satisfaction through our two mediators. Interestingly, neither discrimination nor our two mediators were related with positive affect, demonstrating the need for future research to uncover potential buffers of this link. Finally, our model evidenced configural, metric, and scalar invariance, suggesting that our model applies well for both women and men. Practical implications and future directions for research are discussed.     

邻里社会资本、城市医疗卫生服务体系与自评健康——基于中国劳动力动态调查的实证研究

从仅依靠卫生健康系统转向社会整体联动,实现将健康融入所有政策,是健康中国战略实施的重点.本研究基于中国劳动力动态调查数据和多层次随机截距模型,探讨邻里社会资本、城市医疗卫生服务体系对城市居民健康状况的影响效应,以及健康促进的多层次作用机理.研究发现,个人层次和社区层次的邻里社会资本都有利于提高城市居民的健康水平.邻里社...     

Developing an Index of Deprivation Which Integrates Objective and Subjective Dimensions: Extending the Work of Townsend,Mack and Lansley,and Halleröd

This article presents a new approach to index development, extending the methods used by Townsend, Mack and Lansley and Halleröd to measure deprivation in the developed world. The index combines three ‘objective’ dimensions of deprivation (i.e. monetary, consumption and work-related), and weighs them according to subjective perceptions regarding which items are more critical to deprivation. A particular application of factor analysis to determining deprivation measures and their corresponding weights leads to a more sophisticated and theoretically robust index than those used previously. The index draws on data from interviews with both partners of 17 households randomly sampled from a Turkish squatter settlement. The article contends that the methodological and substantive advantages of this approach are relevant to both developing and developed contexts.     

Poor Queer Studies: Class,Race, and the Field

ABSTRACT

This study asks, What are the material conditions under which queer studies is done in the academy? It finds a longstanding association of queer studies with the well-resourced, selective colleges and flagship campuses that are the drivers of class and race stratification in higher education in the U.S. That is, the field of queer studies, as a recognizable academic formation, has been structured by the material and intellectual resources of precisely those institutions that most steadfastly refuse to adequately serve poor and minority students, including poor and minority queer students. In response, “poor queer studies” calls for a critical reorientation of queer studies toward working-poor schools, students, theories, and pedagogies. Taking the College of Staten Island, CUNY as a case study, it argues for structural crossing over or “queer-class ferrying” between high-status institutions that have so brilliantly dominated queer studies’ history and low-status worksites of poor queer studies.     

灾后重建过程中受灾群众的社区融入与适应——以“一村两地”居住模式下的羌村为个案

在灾后重建过程中,受灾群众的社区融入与适应问题是一个急需解决的问题。我们抽取了因地震而成为灾民社区的北川张坪村和黄坪坝村进行走访和调查．分析了他们的生存现状、社区融入与适应方面存在的问题及其影响．并就此提出了相应的对策与措施。     

Quality of Work Life: Theoretical and Methodological Problems, and Presentation of a New Model and Measuring Instrument

Purpose: Ever since the concept of Quality of Work Life (QWL) was first used over 30 years ago, a range of definitions and theoretical constructs have succeeded each other with the aim of mitigating the many problems facing the concept. A historical overview of the concept of QWL is presented here. Given the lack of consensus concerning the solutions that have been developed to date, a new definition of QWL is suggested, inspired by the research on a related concept, general Quality of Life (QOL) which, as the literature shows, has faced the same conceptualization and definition problems as QWL. Based on the suggested definition of QOL, a definition of QWL is provided and the measuring instrument that results therefrom (the Quality of Working Life Systemic Inventory – QWLSI) is presented. Finally, the solutions that this model and measuring instrument provide for the above-mentioned problems are discussed.     

社会性别化的风险、经历与反应——对美国妇女与艾滋病的探讨

艾滋病目前已成为美国一个严重的社会问题和大众健康问题。妇女从 2 0世纪 80年代在边缘徘徊 ,到 90年代已陷入了该危机的“震中”。本文将从女权主义的视野来审视这场社会性别化的传染病 ,即把社会性别当作主要变量来考察它同种族、族裔、阶级、性取向以及文化等诸因素的交叉互动 ,并从纷繁复杂的艾滋病现象和文献中梳理出妇女与艾滋病关系上的社会性别差异。文章最后将提出若干可资借鉴并值得我们警觉的建议     

Smoking during pregnancy,stigma and secrets: Visual methods exploration in the UK

BackgroundMoral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this moral gaze.AimTo gain an in-depth understanding of the health issues affecting 10 low income pregnant women from deprived areas of south Wales, UK.MethodsParticipants completed visual activities (timelines, collaging or thought bubbles and dyad sandboxing) prior to each interview. Participants’ visual representations were used in place of a topic guide, to direct the interview. Guided by feminist principles, 28 interviews were completed with 10 women. Data were analysed thematically.FindingsSmoking was discussed at length during interviews, and this paper focuses on this issue alone. Five of the participants had smoked during pregnancy. Negative reactions were directed towards pregnant women who smoked in public, resulting in maternal smoking being undertaken in private. Participants also reported awkward relationships with midwives and other health professionals, including receipt of public health advice in a judgemental tone.DiscussionSmoking during pregnancy is a particularly demonised and stigmatised activity. This stigma is not always related to the level of risk to the foetus, and instead can be seen as a moral judgement about women. We urgently need to move from individualised neo-liberal discourses about the failure of individual smokers, to a more socio-ecological view which avoids victim blaming.ConclusionStigma from friends, family, strangers and health professionals may lead to hidden smoking. This is a barrier to women obtaining evidence based stop smoking support.     

Queer Phenomenology,Sexual Orientation,and Health Care Spaces: Learning From the Narratives of Queer Women and Nurses in Primary Health Care

ABSTRACT

Queer phenomenology as an interpretive framework can advance health research by illuminating why primary health care providers (HCPs) must move beyond definitions of sexuality as a set of reified identity formations indexed to normative gender, gender of partner, and sexual and reproductive practices. Our interviews with queer women participants and primary care nurses offer an implicit critique of heteronormative health care space, temporality, and power relations, as they form the lived experiences of our participants. We conclude by pointing to the limits of our methodology in exposing the larger relations of power that dictate experiences of heteronormative health care.     

子女孩次性别结构与女性再生育——基于孩次性别递进生育率的分析

现有子女的孩次性别结构是影响女性再生育的重要因素。使用中国2000年人口普查数据和时期孩次性别递进生育指标对女性生育水平进行了测算。结果显示,女性普遍生育但终身只生育一个孩子的比例很大,基于孩次性别结构的生育行为体现了男孩偏好;城市和镇在生育第一孩时就存在性别选择;第一个孩子是女孩的女性生育二孩的可能性较大,且二孩是男孩的比例显著大于是女孩的比例;第一个孩子是男孩的城市和镇的女性大部分不再生育,而农村女性有很大比例会生育二孩,但几乎不存在性别选择。采用某地区2019年的数据进行补充验证,同样发现:只有一个女孩的女性相比较只有一个男孩的女性生育者生第二孩的可能性要高很多,以上研究发现对当前二孩生育行为具有一定的启示意义。     

人口预测的方法比较——以生态足迹法、灰色模型法及回归分析法为例

人口预测是城乡规划的重要内容之一,本文以陕西省汉中市人口预测为例,运用生态足迹法、灰色模型法及回归分析法,对2015年汉中市总人口进行预测,并针对预测结果进行比较分析,得出：基于生态足迹分析的预测所得汉中人口规模偏大,其原因在于生态足迹分析的本质——环境容量;灰色模型预测所得结果较为保守,其原因在于原始数据序列经累加生成后发展趋势稳定;回归分析预测结果居于二者之间,其原因在于综合多种不同的回归模型,人口变化发展趋势较为灵活。     

农村“妇小贷”政策满意度模型构建的实证研究--基于PCA和Delphi赋权法

正式试点实施已逾六年的妇女小额担保贷款（以下简称“妇小贷”）政策以其显著的经济和社会效益倍受广大妇女特别是农村妇女的高度称赞,然而学界围绕农村“妇小贷”的研究并不深入和全面。本研究以626户借贷农妇的调研数据为依托,基于主成份分析（PCA）和德尔菲法（Delphi）主客观结合确定指标权重的方法,构建起了“妇小贷”农妇满意度模型;以期为该政策及其它基于性别视角下的公共政策深入研究工作提供参考。     

甘肃省农村最低生活保障标准测算与分析--基于扩展线性支出模型

本文分析了甘肃省农村低保制度的实施现状,基于扩展线性支出模型,以马斯洛需要层次理论为指导,测算甘肃省近五年的低保标准。发现农村低保制度实施存在覆盖范围广、水平低的不合理现象,仅能满足食品需求的低保标准仍处于较低水平,且无法满足贫困群体的多元需求等问题。提出低保制度实施要逐步采用积极的价值取向;促进低保标准与多元化需求的有机统一;拓展农村低保资金筹措渠道;充分重视基层工作建设等对策。     

人口变动对长期经济发展的作用——基于台湾地区的经验数据

通过运用台湾地区1952～1999年的经验数据和向量误差修正计量模型检验了人口、技术进步与经济发展三者间的关系,研究发现总人口、技术进步和经济发展之间存在长期的稳定关系,经济发展是总人口和技术进步的函数;同时总人口对经济发展具有直接的负效果和间接的正效果,但是总体来看人口对于经济发展的作用是积极的。因此从长期经济发展的角度看,我国庞大的人口基数将是实现经济持续增长的有利条件。     

海外智力回流的复合动力模型与行动类型——基于中国留学生归国动因的历史检视

影响智力行动者作出回流决策的动力来源和动力方向是多样性的,包括来自东道国的粘力和斥力、母国的拉力和推力,以及第三国的吸力;而且作用机制也是多元化的,既有经济驱动力(包括工资水平、就业机会、经济前景、购买力等),也涉及制度、网络、文化、生命周期等驱动力。作为理性行动者,智力迁移者们的回流决定主要是因为他们明确感受到来自母国的拉力(PS-PR),或者来自母国的拉力明显强于来自东道国的粘力(PS>PL)。同时文章认为,智力行动的最终回流决策事实上并不都是经济理性行动,还涉及制度强制驱动型、政策诱导型、移民网络驱动型、文化价值驱动型等社会理性行动。最后,基于中国留学生回流历史,分析不同发展阶段智力回流的主要动机和行动类型。研究发现,在长达170余年的中国海归史中,海归们的回流动机表现出多元化特征,并且在不同发展阶段呈现出不同的行动类型,具有明显的政治性、社会性和复合性,其中在限制性流动阶段,海归回流是以制度强制驱动型为主;在自由性流动阶段,海归回流动力来源表现更为多元,包括经济驱动型、政策诱导型甚至爱国情感驱动型等。