Indicators of a balanced long-term service and support system: examining the impact on individuals aging with a lifelong disability

This article explores how rebalancing efforts can support the needs of individuals aging with a lifelong disability. The National Balancing Indicator project examined the overall long-term supports and services system (LTSS) progress in five indicators within the Sustainability, Coordination and Transparency, and Prevention principles toward a balanced LTSS system for those aging with a lifelong disability. In assessing state efforts to create a balanced participant-directed LTSS system with the National Balancing Indicators, the findings suggest states are better equipping the system to handle a burgeoning population of individuals aging with a lifelong disability, but more progress is still needed. Overall, states need to continue to create a seamless system that allows individuals with lifelong disabilities to transition smoothly through the life course.     

巴斯克人的土地

巴斯克地区一部分在西班牙,一部分在法国,它给学者们一种地理和民族学方面的神秘感。巴斯克领土北临比斯开湾,西起西班牙的毕尔巴鄂省,东至法国的安道尔山口,南与埃布罗河上游水域和比利牛斯山脉的丘陵地带接壤。其海岸线在西班牙和法国境内分别是100公里和30公里。巴斯克地区包括4个西班牙省:即比斯     

Comparing quantile residual life functions by confidence bands

In this article we present a nonparametric method for constructing confidence bands for the difference of two quantile residual life (qrl) functions. These bands provide evidence for two random variables ordering with respect to the qrl order. The comparison of qrl functions is of importance, specially in the treatment of cancer when there exists a possibility of benefiting from a new secondary therapy. A qrl function is the quantile of the remaining life of a surviving subject, as it varies with time. We show the applicability of this approach in Medicine and Ecology. A simulation study has been carried out to evaluate and illustrate the performance and the consistency of this new methodology.     

Developing a best practice model of refugee maternity care

BackgroundAbout one third of refugee and humanitarian entrants to Australia are women age 12–44 years. Pregnant women from refugee backgrounds may have been exposed to a range of medical and psychosocial issues that can impact maternal, fetal and neonatal health.Research questionWhat are the key elements that characterise a best practice model of maternity care for women from refugee backgrounds? This paper outlines the findings of a project which aimed at developing such a model at a major maternity hospital in Brisbane, Australia.Participants and methodsThis multifaceted project included a literature review, consultations with key stakeholders, a chart audit of hospital use by African-born women in 2006 that included their obstetric outcomes, a survey of 23 African-born women who gave birth at the hospital in 2007–08, and a survey of 168 hospital staff members.ResultsThe maternity chart audit identified complex medical and social histories among the women, including anaemia, female circumcision, hepatitis B, thrombocytopenia, and barriers to access antenatal care. The rates of caesarean sections and obstetric complications increased over time. Women and hospital staff surveys indicated the need for adequate interpreting services, education programs for women regarding antenatal and postnatal care, and professional development for health care staff to enhance cultural responsiveness.Discussion and conclusionsThe findings point towards the need for a model of refugee maternity care that comprises continuity of carer, quality interpreter services, educational strategies for both women and healthcare professionals, and the provision of psychosocial support to women from refugee backgrounds.     

Does the way maternity care is provided affect maternal and neonatal outcomes for young women? A review of the research literature

BackgroundYoung pregnant women who continue a pregnancy are primarily from a socioeconomically deprived background. The risk factors associated with low socio-economic status may independently affect perinatal and neonatal morbidity to a greater extent than the young age of the woman. Young pregnant women are frequently sceptical about health care providers who they can perceive to be judgemental. This may lead to late booking for pregnancy care, attending few appointments, or not attending the health service for any antenatal care.QuestionDoes the way maternity care is provided affect maternal and neonatal outcomes for young women?MethodA systematic search of the major health databases.ResultsNine research articles met the eligibility criteria: one randomised controlled trial, three prospective cohort studies, two comparative studies with concurrent controls, two comparative studies with historical controls, and one case series.DiscussionProviding young women with a non-standard model of maternity care has some beneficial and no known detrimental effects on childbirth outcomes. While there is a dearth of evidence on the effectiveness of a Midwifery Group Practice model of care for young women, there is strong evidence to suggest that a Group Antenatal Care model increases antenatal visit attendance and breastfeeding initiation, and decreases the risk of preterm birth. There is research to indicate that a Young Women's Clinic model may also increase antenatal visit attendance and decrease the incidence of preterm birth.ConclusionMore well-designed and resourced midwifery models of care for young women should be implemented and rigorously researched.     

Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature

ObjectiveTo undertake a systematic review of the literature to determine whether Asian ethnicity is an independent risk factor for severe perineal trauma in childbirth.MethodOvid Medline, CINAHL, and Cochrane databases published in English were used to identify appropriate research articles from 2000 to 2010, using relevant terms in a variety of combinations. All articles included in this systematic review were assessed using the Critical Appraisal Skills Programme (CASP) ‘making sense of evidence’ tools.FindingsAsian ethnicity does not appear to be a risk factor for severe perineal trauma for women living in Asia. In contrast, studies conducted in some Western countries have identified Asian ethnicity as a risk factor for severe perineal trauma. It is unknown why (in some situations) Asian women are more vulnerable to this birth complication. The lack of an international standard definition for the term Asian further undermines clarification of this issue. Nevertheless, there is an urgent need to explore why Asian women are reported to be significantly at risk for severe perineal trauma in some Western countries.ConclusionCurrent research on this topic is confusing and conflicting. Further research is urgently required to explore why Asian women are at risk for severe perineal trauma in some birth settings.     

法国青年社会学的范例和理论结构演变

1．机构状况1.1法国特点1）首先，与绝大多数欧洲国家不同，法国从来没有任何青年研究机构或青年问题研究中心。每次试图建立此类机构的努力均遭到来自科学团体的强烈反对。这里有着许多原因，最主要的是担心这种机构会被政治所左右：青年是一个极为敏感的研究领域，科学调查可能被用来为政治运作服务。如果建立起了隶属于某个机构或政治部门的特殊机构，那么青年研究学者就有丧失自主权的危险。除了以上对可能受人控制的担心外，法国没有青年研究机构还有着理论和认识论的选择。2）法国社会科学家都非常关心诸如艺术社会学、家庭社会学、教…     

The fourth shift: exploring the gendered nature of sleep disruption among couples with children

The study of sleep has been neglected within sociology, yet may provide insights into fundamental aspects of the nature of gender inequalities. This article examines how, for couples with children, sleep is influenced by the gendered nature of caring. A key concern is not only who gets up to care for children's physical needs at night, but whether this changes with women's increased role in the labour market. Of concern also is how changes in the nature of caring for older children, as opposed to young children, may impact on parents' sleep. This article analyses qualitative data from an ESRC funded multi-disciplinary project on couples' sleep based on in-depth audio-tape recorded interviews with 26 couples (aged 20-59) with younger and older children. Additionally, one week's audio sleep diaries were completed and follow up in-depth interviews were undertaken with each partner on an individual basis. Physical and emotional care for young children at night was largely provided by women, with a lack of explicit negotiation between partners about who provides this care, even when women return to employment. Thus, considerably more women than men continued their daytime and evening shifts, as well as undertaking an ongoing third shift of sentient activity for their family, into the night. This resulted in a fourth night-time shift where physical caring, and sentient activities continued. As a consequence, women were more likely to subjugate their own sleep needs to those of their family. Fathers did not, in general, undertake this fourth night-time shift. Those that did were more likely to be the fathers of young adult children who were staying out late at night, with the focus of their concerns being the safety of their children.