The Daily Assessment Form (OAF) retrospectively assessed symptoms of late luteal phase dysphoric disorder (LLPDD), both at the beginning and at the end of a 2-month time interval. Ninety-four women between the ages of 18 and 45 entered the study. Half of the subjects viewed a negative-case, stereotypic presentation of LLPDD prior to the pretest. sixty-eight subjects qualified on the pretest to complete the study. Half of the remaining no-case subjects and half of the remaining negative-case subjects completed 8 weeks' prospective ratings via the OAF. Forty-eight subjects remained to complete the posttest at the end of that time interval. Pretest Total and Pretest Criteria scores revealed significant main effects for case-presentation condition (E[l,63] = 7.08, R = .01) and (E[l,63] = 8.34, R = .01) and completion level (E[l,63] = 6.76, R = .01) and (E[l,63] = 3.76, R .06). Effect sizes equalled 0.48 and 0.45 for case presentation and 1.92 and 1.98 for completion.

Introduction: Long term care (LTC) residents require complete or extensive support, including 24-hour nursing and personal care. LTC residents contribute a greater number of emergency department (ED) visits when compared to community-dwelling older adults. Little is known about which resident-level characteristics at admission are predictive of LTC resident transfer to the ED. The objective of this thesis was to identify which admission characteristics are associated with ED transfers in Ontario, Canada. Methodology: I conducted a population-level retrospective cohort study using the Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS). The cohort included 56,433 LTC resident admission assessments from January 1, 2017, to December 31, 2018. Logistic regression and 10-fold cross-validation were used to identify adjusted associations between characteristics routinely collected during LTC admission assessment and ED transfers. Model performance was assessed using the area under the receiver operating characteristics curve (AUC). Outcomes of interest included any ED use, potentially preventable, and low acuity ED transfers. Results: A recent change in medical orders, previous ED visitation, female sex, the presence of an indwelling catheter, and the need for oxygen therapy were informative predictors for any, potentially preventable, and low acuity ED transfers. Deterioration in cognitive status and change in behavior was influential to any ED transfers only. Urinary tract infections, pneumonia, indictors of delirium, and change in mood are unique to potentially preventable ED transfers, and antibiotic resistance is unique to low acuity ED transfers. Similar discrimination was reached for any ED use (AUC = 0.630), potentially preventable transfers (AUC = 0.659), and low acuity transfers (AUC = 0.645). Conclusion: The factors associated with ED transfers may be modifiable, and closer attention to these factors may help reduce ED transfers. Although the discriminability of the models was poor, advanced knowledge of informative characteristics can support upstream decision-making for clinicians. Future studies are required to validate these findings, derive risk scales, and demonstrate the utility of this model in health service planning. / Thesis / Master of Science (MSc) / Long term care (LTC) provides residents with 24-hour nursing and personal care. When the care or clinical needs of the resident cannot be met in the LTC facility, they may be transferred to the Emergency Department (ED). However, the ED’s are poorly situated to manage the distinct needs of older adults, given the sole focus on medical acuity rather than geriatric complexity. Unwarranted ED transfers are burdensome for LTC residents and increase their risk for adverse health events, such as nosocomial infections, delirium, and injuries. Understanding characteristics associated with ED transfers can help identify which residents may be at a risk of an ED transfer. The objective of this thesis was to identify which LTC resident characteristics at admission are associated with ED transfers in Ontario, Canada. A recent change in medical orders, previous ED visitation, female sex, the presence of an indwelling catheter, and the need for oxygen therapy were informative predictors for ED transfers.

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第25182号 / 医博第5068号 / 新制||医||1071(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 今中 雄一, 教授 西浦 博, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Les études sur les couples traités par fécondation in vitro (FIV) ont jusqu’à présent porté essentiellement sur l’évaluation du succès en FIV. Très peu de données sont disponibles sur le devenir à long terme de couples traités par FIV. L’objectif de ce travail était d’estimer la fréquence de réalisation du projet parental à long terme, et d’étudier les facteurs associés aux interruptions précoces des traitements et aux naissances naturelles.L’enquête DAIFI-2009 a inclus 6 507 couples ayant débuté un programme de FIV en 2000-2002 dans l’un des 8 centres de FIV participant à l’étude. Les données médicales des couples et leur parcours dans le centre ont été obtenus à partir des dossiers médicaux des centres de FIV pour tous les couples. L’information sur le devenir des couples après le départ du centre a été obtenue par questionnaire postal auprès des couples en 2008-2009 (38% de participation 7 à 9 ans après l’initiation des FIV). L’étude des facteurs associés à la participation à l’enquête postale suggérait que la fréquence de réalisation du projet parental estimée sur les répondants seulement pourrait être biaisée. Les différentes méthodes mises en œuvre pour corriger la non réponse (pondération, imputation multiple) n’ont pas modifié l’estimation de la fréquence de réalisation du projet parental. Au total, 7 à 9 ans après l’initiation des FIV, 60% des couples ont réalisé leur projet parental de façon biologique, suite à un traitement ou suite à une conception naturelle. Lorsque les adoptions sont aussi prises en compte, 71% des couples ont réalisé leur projet parental. Après l’échec d’une première tentative de FIV, un couple sur 4 (26%) a interrompu les FIV dans le centre d’inclusion. Globalement, les couples avec de mauvais facteurs pronostiques ont un plus grand risque d’interrompre les FIV. Cependant, la proportion plus importante d’interruption parmi les couples avec une origine inexpliquée de l’infécondité pourrait s’expliquer par la survenue plus fréquente de naissance naturelle dans ce sous-groupe de couples. Parmi les couples n’ayant pas eu d’enfant suite aux traitements, 24% ont ensuite conçu naturellement en médiane 28 mois après l’initiation des FIV. Parmi les couples ayant eu un enfant suite aux traitements, 17% ont ensuite conçu naturellement en médiane 33 mois après la naissance de l’enfant conçu par AMP. Les facteurs associés aux naissances naturelles sont des indicateurs d’un meilleur pronostic de fertilité, particulièrement chez les couples sans enfant AMP.L’enquête DAIFI-2009 a permis d’apporter des informations sur le parcours à long terme des couples traités par FIV qui n’avait jusqu’à présent été que peu étudié, souvent sur de faibles effectifs et avec un suivi plus court. Ces résultats doivent apporter de l’espoir aux couples inféconds, puisque la majorité d’entre eux ont finalement réalisé leur projet parental, même si cela peut prendre de nombreuses années. / Until now, most studies of couples treated by in vitro fertilization (IVF) have been centered on IVF success. Very few data are available on the long-term outcome of these couples, including spontaneous conception and adoptions. This work aimed to estimate the long-term cumulative parenthood rate, and to study factors associated with early IVF discontinuation and with spontaneous live births.The DAIFI study is a retrospective cohort including 6,507 couples who began IVF in 2000-2002 in one of the eight participating French IVF centres. Medical data on all couples were obtained from centre databases. Information on long-term outcome after leaving the IVF center was collected by postal questionnaire sent to couples in 2008-2010 (7 to 9 years after IVF initiation, participation rate 38%). Study of factors associated with participation in the postal survey suggested that the cumulative parenthood rate estimated only in participants might be biased. The different methods used to correct for non-response bias (inverse probability weighting, multiple imputation) did not modify the estimation of the cumulative parenthood rate obtained with the complete case approach. Finally, 7 to 9 years after IVF initiation, the cumulative parenthood rate was estimated at 60%, including live births following IVF, other treatment or spontaneous conception. When adoptions were also considered, the cumulative parenthood rate reached 71%. After a first failed IVF cycle, just over one couple out of four (26%) discontinued IVF treatment. Globally, couples with poor prognostic factors had a higher risk of early discontinuation of IVF treatment. However, the higher proportion of early discontinuation observed among couples with unexplained infertility could be linked to a higher chance of spontaneous pregnancy in this subpopulation. Among couples who remained childless after treatment, 24% later had a spontaneous live birth (SLB), at a median of 28 months after the first IVF attempt. Among couples who had had a child during medical treatment, 17% later had an SLB, at a median of 33 months after the birth following medical treatment. Regarding factors associated with SLB, they can be viewed as indicators of a better fertility prognosis, especially among unsuccessfully treated couples.The DAIFI study has provided information on the long-term outcome of couples treated by IVF, which has until now been little studied, often on small samples and with a shorter duration of follow-up. These results should give hope to infertile couples as nearly three couples out of four finally became parents, even if it may take many years.

Europeiska Unionen står inför en komplex uppgift med att införa Digitala Produktpass (DPP) – en digital mekanism som strävar efter att förbättra hur information om produkters livslängd, tillförlitlighet och återanvändbarhet samlas och delas. Detta arbete utförs med syfte att utveckla och förbättra användbarheten i ett användargränssnitt som är tänkt att integreras i samband med onlineköp för att effektivisera och förenkla processen för skapandet av DPP. Genom att omfamna metoden Design Thinking, har arbetet utvecklat och utvärderat en prototyp. Detta genom att identifiera och analysera problem med användbarhet i en utvärdering beståendes av intervju, användartest i form av Retrospective Probing och en enkät. Resultaten från utvärderingen visade brister i användarnas förståelse för användargränssnittet och DPP. Detta har specifikt lett till förbättringar av designen för initieringsknappen i användargränssnittet. I initieringsknappens beskrivande text har det lagts till mer informtion om Digitala Produktpass, vilket syftar till att öka interaktionens tydlighet och användarnas nöjdhet. Slutsatserna av arbetet belyser både framgångar och identifierade begränsningar. Det framhäver inte bara de förbättringar som redan har genomförts med initieringsknappen, utan också de områden där ytterligare insatser krävs för att optimera användbarheten, som flera iterationer av Design Thinking. Arbetet ger även vägledning för kommande studier och implementeringar inom området genom att föreslå riktningar för framtida forskning för utvecklandet av användbarhet i användargränssnitt för DPP. Genom att skapa en smidig och intuitiv interaktion mellan användare och DPP kan det öka engagemanget och uppmuntra till ökad användning av DPP. Vilket slutligen hjälper Europeiska Unionen införa DPP. / The European Union faces a complex task in introducing the Digital Product Passport (DPP) – a digital mechanism that aims to improve the way information about product lifespan, reliability and reusability is collected and shared. This work is carried out with the aim of developing and improving the usability of a user interface that is intended to be integrated in connection with online purchases, in order to streamline and simplify the process of creating DPP. By embracing the Design Thinking method, the work has developed and evaluated a prototype. This was made by identifying and analysing usability issues in an evaluation consisting of interview, user tests in the form of Retrospective Probing Probing and surveys. The results from the evaluation, showed deficiencies in users’ understanding of the user interface and DPPs. This has specifically led to improvements in the design of the initiation button in the user interface. In the initiation button’s describing text, more information about Digital Product Passports has been added, which aims to increase the clarity of the interaction and the satisfaction of the users. The conclusions of the work highlights both successes and identified limitations. It not only highlights the improvements that have already been made with the initiation button, but also the areas where efforts are required to optimize usability, such as further iterations of Design Thinking. The work also provides guidance for future studies and implementations in the field, by suggesting directions for future research for the development of usability in user interfaces for DPP. By creating a smooth and intuitive interaction between users and DPP, it can increase engagement and encourage increased use of DPP. Which ultimately helps the European Union introduce the DPP.

Pregnancy and childbirth are critical life events and women and their families require physical as well as emotional support and care. The concepts continuity of care, choice and a sense of control are prominent in the literature on women’s satisfaction with as well as outcomes of care. Midwives have globally been identified as important role players in women-centred care for low risk pregnant women. To be able to offer their women safe, supportive care they need not only a certain degree of autonomy, but also the support of other health care professionals such as obstetricians to whom they can refer women with risk factors or complications. Maternity care has become “medicalised” and the overuse of interventions such as caesarean section is prevalent in many countries. South African women make use of either the public or private health sector for care during pregnancy and birth. The public sector is overburdened and women do not have a high level of continuity of care. The private sector is mainly obstetrician-led and intervention-driven, even for low risk women. The estimated caesarean section rate is higher than 70%. Private midwife-led care is available in South Africa, but is concentrated in the major cities. Private midwives practise at hospitals, birth centres, “active birth units” and women’s homes. No evidence could be found on the outcomes of private midwife-led care in South Africa. The objectives of this study were to explore and describe the outcomes of births attended by private midwives in Gauteng over a two year period and to compare these outcomes with the latest Cochrane review on midwife-led care. A retrospective cohort design was chosen to audit the birth registers of private midwives in Gauteng and conduct quantitative analyses. Gauteng midwives’ patients, when compared with the Cochrane review that juxtaposes midwife-led care with other models of care, had a significantly lower percentage of interventions such as induction of labour (9.6% versus 18.6%) but caesarean sections were performed significantly more frequently (19.3% for the women in Gauteng versus 12.5% for the women in the review). Women in Gauteng also made significantly less use of medications in labour. Maternal and neonatal outcomes were reassuring. Significantly more Gauteng women had intact perineums (53.4% versus 31.4%). A higher percentage of postpartum haemorrhage was found in the Gauteng sample (7.9% versus 6.2%). The difference is significant, although, only three women were admitted to high care units as a result of postpartum haemorrhage. Overall foetal loss (4.3% versus 6.7%) and neonatal ICU admissions (0.3% versus 2.9%) occurred significantly less frequently in the Gauteng sample. The study findings indicate that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of intervention rates and outcomes. / MCur, North-West University, Potchefstroom Campus, 2015