Neste trabalho foi proposto o estudo prospectivo de gestações após a 40a semana, objetivando: a) verificar os índices de morbidade e mortalidade perinatais; b) identificar os testes de avaliação da vitalidade fetal mais adequados para a vigilância destas gestações; c) comparar os resultados dos testes de avaliação da vitalidade fetal com os resultados perinatais na 1a e 2a semana, após a 40a semana de gestação, para testar o protocolo do Serviço. Para a realização do estudo, selecionaram-se 52, gestantes divididas em 2 grupos: GI (1a semana) com 32 gestantes e GIl (2a semana) com 20 gestantes. Acompanhou-se a vitalidade fetal com a Cardiotocografia de Repouso e Intraparto, Teste da Estimulação Sônica, Avaliação do Volume do Líquido Amniótico através da Técnica dos Quatro Quadrantes, Perfil Biofisico Fetal e Dopplerfluxometria Uterina e Umbilical, realizados 2 vezes na semana. Os resultados neonatais e os índices de morbidade foram: Índices de Apgar no 10 e 50 minutos (alterados < 7), pH da artéria umbilical (alterado < 7,20), peso dos recém-nascidos, tempo de internação dos recém-nascidos, oligoidrâmnia, líquido amniótico meconial, alterações na cardiotocografia com presença de desacelerações e índices de cesárea. O estudo permitiu como resultados e conclusões: a) a incidência de oligoidrâmnio foi de 44,23%, líquido meconial de 28,85%, cardiotocografia alterada, 50,00% e partos cesáreos, 57,70%, não havendo óbito fetal ou neonatal. Não houve alterações significativas nos índices de Apgar, pH da artéria umbilical e tempo de internação dos recém-nascidos. b) A cardiotocografia e, principalmente, a avaliação do volume do líquido amniótico, pelo índice de líquido amniótico, foram os métodos mais adequados na detecção de alterações verificadas neste grupo de gestantes. Do parâmetro ultra-sonográfico do Perfil Biofisico Fetal, apenas o Volume do Líquido Amniótico demonstrou ser importante. A Dopplerfluxometria (uterina e umbilical) não revelou nenhuma utilidade na vigilância destas gestações. c) A distribuição dos casos com oligoidramnia, líquido meconial, cardiotocografia alterada, índices de cesárea e pH da artéria umbilical < 7,20, semelhante na 41a semana (GI) e 42a semana (GIl), valida o protocolo do Serviço. d) Adicionalmente, este estudo permite ainda as seguintes observações: 1) importância da oligoidrâmnia e líquido meconial na determinação dos elevados índices de cesáreas; 2) incidência elevada (50,00) de nulíparas nesta casuística. / This study proposed pros.pectively the evaluation of the gestations after 40 weeks with these objectives: a) Analysis of the perinatal outcome. b) Identification of the proper test for fetal well-being assessment for this gestation. c) Comparation of these tests results with perinatal outcome at the first and second weeks after 40 weeks, therefore, testing the protocol of this Service. It recruited 52 patients divided in two groups: GI (1st week) with 32 patients and Gil (2nd week) with 20 patients. The fetal surveillance was assessed by antepartum and intrapartum cardiotocography, acoustic stimulation test, amniotic fluid volume assessment by the ultrasonographic four quadrant technique (amniotic fluid index), fetal biophysical profile and umbilical and uterine doppler velocimetry, ali tests were performed twice weekly. The neonatal outcome results and morbidity parameters were: Apgar index in 1st and s\" minutes (alterated < 7), umbilical artery pH (alterated < 7,20), the new born weight, oligohydramnios, meconium stained, deceleration (DIP 11 or umbilical deceleration) and cesarean section rates. The study permitted these results and conclusions: a) The oligohydramnios, meconium stained, cardiotocography alterations and cesarean section incidences were 44,23%, 28,85%, 50,00% and 57,70%, respectively. There was no fetal death. b) The cardiotocography and amniotic fluid assessment by the amniotic fluid index, were the best tests to detect the alterations verified. The amniotic fluid volume was the most important parameter in the fetal biophysical profile. Doppler (uterine and umbilical) revealed no utility. c) The equal distribution of the oligohydramnios, meconium stained, altereted cardiotocography, cesarean section and umbilical artery pH < 7,20 cases in the group studied reassure the Service protocol. d) In addition this study also permitted observation of: 1) The importance of the meconium stained in the cesarean section rate. 2) The nuliparus elevated incidence (50,00%) in this group.

La anemia en niños menores de tres años es un problema de salud pública en el Perú y el mundo. Se estima que la causa principal de la anemia, aunque no la única, es la deficiencia de hierro. Existen muchos estudios y revisiones sobre cómo esta carencia en los infantes impacta negativamente en el desarrollo psicomotor y, a pesar de corregirse la anemia, los niños con este antecedente presentan, a largo plazo, un menor desempeño en las áreas cognitiva, social y emocional. Estos hallazgos se describen en estudios observacionales, de seguimiento, así como en experimentales con grupo control. La anemia puede disminuir el desempeño escolar, y la productividad en la vida adulta, afectando la calidad de vida, y en general la economía de las personas afectadas. Se describen algunos posibles mecanismos de cómo la deficiencia de hierro, con o sin anemia, podría afectar el desarrollo en la infancia; por ello, causa preocupación la alta prevalencia de anemia que se observa en este grupo de edad. La prevención de la anemia en el primer año de vida debe ser la meta para evitar consecuencias en el desarrollo de la persona a largo plazo. / Anemia in children younger than 3 years is a public health problem in Peru and worldwide. It is believed that one of the primary causes of anemia is iron deficiency. Numerous studies and reviews have reported that iron deficiency limited psychomotor development in children and that, despite the correction of anemia, children with iron deficiency experienced poorer long-term performance in cognitive, social, and emotional functioning. These outcomes were reported in observational studies, follow-up studies, and experimental studies with a control group. Anemia can decrease school performance, productivity in adult life, quality of life, and the general income of affected individuals. Here we describe possible mechanisms underlying the effect of iron deficiency, with or without anemia, on childhood development. The high rate of anemia in this age group is a cause for concern. Moreover, anemia should be prevented in the first year of life to avoid long-term negative effects on individual development. / La investigación ha sido financiada por el Instituto Nacional de Salud de Perú. / Revisión por pares

The purpose of this study was to investigate the association between Chlamydia trachomatis reinfection rates of Puerto Rican adolescents and failure to follow the retesting protocol, failure of sexual partners to receive treatment, and failure to participate in the sexual orientation program about risk factors. Secondary data analysis, from a historical prospective study from the Health Department of Puerto Rico, was used in this study. Data analysis was restricted to adolescents 15 to 19-years-old who had a positive chlamydia result and reinfection pattern since January 2008 through December 2012. Multiple logistic regression analyses were run to predict Chlamydia trachomatis reinfection. Results showed a statistically significant association association between Chlamydia trachomatis reinfection and not having followed the retesting protocol (OR=1.243, 95% CI 1.089-2.930, p-value 0.038). A statistically significant association association was found between Chlamydia trachomatis reinfection and sexual partners having not received treatment (OR=1.713, 95% CI 0.761-2.024, p-value 0.029). A statistically significant association was found between Chlamydia trachomatis reinfection and having not participated in the Puerto Rico Department of Health's sexual orientation program (OR=1.243, 95% CI 0.762-2.026, p-value 0.034). The contribution to social change is identifying factors significantly associated with Chlamydia trachomatis reinfection. Study findings provide useful guidance for clinicians and public health professionals on how to reduce Chlamydia trachomatis reinfection rates among at risk Puerto Rican adolescents.

Although Grenada has an extensive health care infrastructure and cervical cancer screening rates are relatively high, Grenada also has a disproportionate rate of morbidity and mortality from cervical cancer. The aim of this study was to explore factors that contribute to these disproportionate rates in Grenada. Using a phenomenological qualitative approach, Andersen's behavioral model of health care utilization and a systems based model for assessing care were used as a guide to explore Grenadian women's follow-up experiences with Pap test and cervical cancer screening. Purposive sampling was used to recruit 8 women for semi-structured in-depth interviews. Data were collected on enabling, need, process and quality factors and coded using apriori and open strategies. Results showed that communication strategies used by private practitioners and good interpersonal relationships with nurses enabled follow-up whereas inadequate treatment services, delays in the receipt of test results, and lack of trust in the government clinics were hindrances. This research identified gaps in the follow-up system and is, therefore, significant for the Grenada Ministry of Health to inform planning and restructuring in order to increase system effectiveness. Implications of positive social change include broadening the knowledge base and skill sets of nurses, highlighting strengths of the public system, and identifying target areas for resource allocation. These changes can result in increased workforce efficiency, improved accessibility and quality, a more user-friendly follow-up process and, thus, reduced morbidity and mortality from cervical cancer.

As compared to pediatric and older adult cancer patients, young adults are the only oncology group that has not demonstrated an increase in survival rates. Low treatment adherence rates have been one explanation for this discrepancy, although this hypothesis has not been explored specifically. Guided by the biopsychosocial model of health and wellness, this study compared the treatment adherence rates of 46 young adult cancer patients (ages 18-39 years) to 46 older adult cancer patients (ages 40 years and older). Adherence was measured by a dichotomized variable, as yes/no, adhering to radiation treatment and follow-up appointments recommended by the physician, 95% of the time. Additionally, gender and race were explored in relationship to adherence to radiation treatment and follow-up appointments. Demographic data were first extracted from the Cancer Registry of a Midwestern Hospital. Then radiation appointments and follow-up appointments were examined for each patient, in paper and/or computerized charts, to determine adherence rates. McNemar's test was used to compare young adults and older adult oncology patients' adherence rates, and Chi-square analysis was used to explore gender and race in relationship to adherence. Results indicated a lower adherence rate to follow-up appointments for younger adults as compared to older adults, with older adults adhering 3 -½ times more than younger adults. Gender was also related to follow-up appointment adherence, with males adhering better than females. This study contributes to positive social change by increasing the knowledge base of healthcare providers on adherence rates of young adult patients and reducing the dollars spent on treatment for re occurrences.

Healthcare costs have risen from 13.8% in 2000 to 17.9% in 2009 (Gordon, Leiman, Deland, & Pardes, 2014). Poor transitional care has been identified as a cause of the high healthcare costs (Naylor et al., 2013; Obama, 2013). In 2009, the Department of Veterans Health Administration (VHA) implemented a national reform of outpatient care to create Patient-Aligned Care Teams (PACTs) with a goal to improve transitional care and reintegration into outpatient care through registered nurse case managers conducting discharge telephone follow-up calls. However, discharge telephone follow-up calls have not been explored within the VHA. This study explored the relationships among discharge telephone follow-up calls, selected Veteran characteristics including the length of index hospital stay, and 30-day all cause hospital readmissions between fiscal years 2011 and 2013. Hospital readmissions were explored in parallel time periods to the timing of the discharge telephone follow-up calls. Study data were collected retrospectively from VHA inpatient and outpatient records. Descriptive statistics, measures of central tendency, bivariate statistics, and logistic regression were used to analyze the data. The study found 124,069 Veterans were discharged from the VHA from 2011 to 2013. Of those discharges, 15,954 (12.86%) were readmitted to the hospital within 30 days and 35.06% of the readmissions occurred within the first seven days after discharge. Discharge telephone follow-up calls increased from 312 in 2011 to 26,549 in 2013. Increasing Veteran age, number of comorbidities, length of index hospital stay, and being identified as frequently hospitalized in the previous year were significantly related to hospital readmissions at each of the hospital readmission time frames (within two days, between three and seven days, and between eight and thirty days after hospital discharge). This study identified a relationship between discharge telephone follow-up calls and the parallel hospital readmission time period. However, only discharge telephone follow-up calls within two days were found to decrease the likelihood of hospital readmissions and only hospital readmissions within two days after discharge (OR=0.595). The relationships between discharge telephone follow-up calls and hospital readmissions potentially explains previously mixed results and suggests two potential explanations. One, discharge telephone follow-up calls have a limited relationship to hospital readmissions and a short duration of protective effects preventing hospital readmissions. The second explanation is self-selection bias confounds the relationship between discharge telephone follow-up calls and hospital readmissions. Both explanations suggest future research and clinical practice should focus on exploring bundled transitional care interventions as a method to reduce hospital readmissions.

The 1969 through 1976 graduating classes of the business education program at Utah State University were surveyed in this study. The questionnaire was designed to ascertain the work experience of the graduates, the educational status of the graduates, and the value the graduates place on the courses contained in the business education program according to the occupations of the graduates. Graduates are employed in a large variety of occupations, and the majority of the graduates hold teaching certificates. The majority of the graduates have not completed advanced degrees, and are undecided as to whether or not they will continue their education. In all but five courses, the graduates; occupations were found to be unrelated to their response concerning the value of a course when the chi square test was applied. The courses in which a significant difference at the .05 level of significance was found were: (1) methods of teaching typewriting, (2) methods of teaching shorthand, (3) economics I, (4) office practice, and (5) office management. The majority of the graduates indicated their preparation was "excellent" or "good". The members of the department of Business Education were listed as the greatest strength of the program by the graduates.

Dresher reported that today there is an increased and growing interest among the lay population as well as among educators in the appreciation of the drop-out problem of the public schools of the United States. Some educators believe that one of the most important issues facing education today is the problem of determining ways by which the high school pupil might be encouraged to finish his secondary trainings.

The purpose of the present study was to examine the effect of varying the amount of participant engagement on alcohol expectancy and drinking outcomes during a social/sexual expectancy challenge based on Darkes and Goldman's (1993, 1998) protocol. This study was also intended to provide a test of the efficacy of administering an alcohol/placebo expectancy challenge outside of a live drinking scenario through video presented as part of a computerized intervention. One hundred fifty-eight male participants across three sites were randomized into a no-intervention control group that received non alcohol-related information in a minimally interactive computerized format, a low-level engagement experimental group that received minimally interactive computerized expectancy-related information, and a high-level engagement experimental group that received the same expectancy-related information presented in a more interactive computerized format that included games and audiovisual elements such as video clips, graphics, live narrations, and music. It was hypothesized that high-level engagement participants would report being more engaged in their computerized program and demonstrate greater decreases in social/sexual alcohol expectancies and drinking levels relative to control and low-level engagement participants. Results indicated that while high-level engagement participants reported being more engaged in their interventions, none of the groups exhibited changes in the alcohol expectancies measured. In addition, all three groups experienced significant but comparable decreases in drinking levels. Exploratory follow-up analyses were also conducted to provide suggestions for future directions.

Grief is a life changing and universal experience, expressed through individual sets of responses and behaviours. Society and health workers’ interpretation and beliefs regarding grief and bereavement have changed throughout the decades. This is a continually evolving process. As we move into a new century, so too does grief move into a new era where a new postmodern paradigm is arising. We are thus deviating away from stage theories that are time limited, linear and predictable. Emphasis in this new wave of thought is placed upon grief as an oscillating and highly unique experience, one that encourages a continuation of a bond and lifetime relationship with the deceased. This current qualitative study explores the new phenomenon in relation to both the grief process and bereavement support programs, by extensively reviewing the literature and analysing data from a number of interviews with the bereaved. Furthermore the supports offered by society, with particular focus on a Melbourne Community Bereavement Follow Up Program, are reviewed. By observing and discussing expressions of grief it was found, although unique and varying, some patterns or common behaviors emerged. Supports and comforts that assisted the bereaved are explored. Issues, including inappropriate comments and problems with bureaucratic departments, are also developed and discussed. There is an emphasis placed upon the need of health care staff and the community in general to increase their understanding of the grief process and bereavement support, so as to enhance care and practice when working with people who have suffered loss.