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Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers.
To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377.
Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality.
At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10–0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14–0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks.
Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.
Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia.
We examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk.
In a population-based, repeated cross-sectional study (2011–2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15–44 years (n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion.
Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5–17.5 v. 12.8–13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16–1.54). They also had higher abortion ratios (592–736 v. 321–341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96–2.59). Younger age (<25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39–2.44), multiparity (aRR 2.17, 95% CI 1.66–2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34–3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47–2.34) were associated with increased abortion risk.
These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Maternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.
To establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.
We searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.
We reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6–22.8) in the first trimester, 19.1% (95% CI 15.9–22.4) in the second trimester and 24.6% (95% CI 21.2–28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0–21.4) and 4.1% (95% CI 1.9–6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1–24 weeks was 15.0% (95% CI 13.7–16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1–13.8), and 5.7% (95% CI 2.3–9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.
Results suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.
Patients may present to Emergency Departments (ED) in shock for various reasons. Emergency medicine physicians may require the use of vasopressors or inotropes to manage these patients. The Critical Care Practice Committee of the Canadian Association of Emergency Physicians (C4) conducted an intensive literature search and guideline development process to help create an evidence based approach for use of these agents in the stabilization of shock.
Up to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission.
To describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission.
Systematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission.
The review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias.
Many effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.
To achieve higher renewable energy (RE) shares than the low levels typically found in present energy supply systems will require additional integration efforts starting now and continuing over the longer term. These include improved understanding of the RE resource characteristics and availability, investments in enabling infrastructure and research, development and demonstrations (RD&D), modifications to institutional and governance frameworks, innovative thinking, attention to social aspects, markets and planning, and capacity building in anticipation of RE growth.
In many countries, sufficient RE resources are available for system integration to meet a major share of energy demands, either by direct input to end-use sectors or indirectly through present and future energy supply systems and energy carriers, whether for large or small communities in Organisation for Economic Co-operation and Development (OECD) or non-OECD countries. At the same time, the characteristics of many RE resources that distinguish them from fossil fuels and nuclear systems include their natural unpredictability and variability over time scales ranging from seconds to years. These can constrain the ease of integration and result in additional system costs, particularly when reaching higher RE shares of electricity, heat or gaseous and liquid fuels.
Existing energy infrastructure, markets and other institutional arrangements may need adapting, but there are few, if any, technical limits to the planned system integration of RE technologies across the very broad range of present energy supply systems worldwide, though other barriers (e.g., economic barriers) may exist. Improved overall system efficiency and higher RE shares can be achieved by the increased integration of a portfolio of RE resources and technologies.
The first part of this chapter describes the edge effects of patterned ferromagnetic films. The edge pole of the ferromagnetic film plays a significant role in the film properties, in particular, the magnetic energy state. Since the magnetic memory cells are made of tiny pieces of patterned film or film stack, the effects due to the end poles become a dominant factor governing the stability and switching behavior of the memory cell. The second part of this chapter deals with the switching properties of a small patterned film under an external magnetic field. A coherent switching model is introduced to describe the switching properties of the film. This is the basis of the write operation of the field-MRAM cells.
Edge poles and demagnetizing field
When a ferromagnetic thin film is patterned and etched into shapes, the magnetic poles at the edge of the film are exposed. Like the end of a bar magnet, magnetic flux emits from the poles at the edge of the thin film. Inside the film, the flux points in a direction opposite to the magnetization. The magnetic field associated with the end poles is called the demagnetizing field, HD. The magnitude of HD is position-dependent.
Consider a semi-infinite film of thickness t and saturation magnetization MS. The film extends from y = 0 in the +y-direction toward infinity and extends in both the +x- and –x-direction toward infinity (see Fig. 3.1).
A short time after the discovery of magnetic tunneling devices, tunneling magnetoresistance (TMR) replaced giant magnetoresistance (GMR) read sensor in the hard disk drive. This marked the first successful commercialization of magnetic tunnel junction technology. The first mass production of the magnetic recording head based on a MgO tunnel barrier took place in 2006. In the same year, 4 Mb MRAM chips were commercialized, and it was the first field-MRAM product working in the toggle-write mode. The viability of MTJ technology at the product level is proven. Subsequently, electronic system designers started to consider seriously how to take advantage of this technology. Many new applications of MTJ technology begin to emerge. One of the new circuit elements is the non-volatile magnetic flip-flop device, which is used for the reduction of VLSI chip power as well as for run-time system re-configuration. Such new applications can only be realized with the unique properties of magnetic tunnel junction devices.
Other new applications are being explored in the field of healthcare. GMR and TMR chips are used for detecting biological molecules labeled with magnetic particles, and this could be a powerful platform for next-generation diagnostics. The sensitivity achievable with simple portable instrumentation can be orders of magnitude better than the current methods. Since this application is still in its infancy, it will not be discussed further here. Interested readers are referred to the references above.