The Indigent Care Collaboration (ICC), a partnership of Austin, Texas, safety net providers, gathers encounter data and manages initiatives for the community's medically indigent patients. One such initiative is the establishment of a care management program designed to reduce avoidable hospitalizations. This study developed predictive models designed to take year-one encounter data and predict inpatient utilization in the following two years. The models were calibrated using 2003 through 2005 data for the 41,260 patients with encounters with ICC partner providers in all three years. Predictor variables included prior inpatient admissions, age, sex, and a summary measure of overall health status: the relative risk score produced by the Diagnostic Cost Groups prospective Medicaid risk-adjustment model. Using the 44,738 patients with encounter data in each of years 2004 through 2006 data, the performance of the predictive models was cross-validated and compared against the performance of the "common sense" method of choosing candidate patients based on prior year chronic disease diagnoses and high utilization, referred to herein as the Utilization Method (UM). The 620 patients with three or more 2005 through 2006 inpatient admissions were considered the actual high use patient subset. Each model's highest-risk 620 patients comprised its high-risk subset. Only 344 high-risk patients met the UM’s criteria. Prediction accuracy was described in terms of positive predictive value (PPV), i.e., the proportion of identified high-risk patients who were high-use patients. Three of the predictive models had a PPV of near 25% or greater, with the highest, the linear model using the DCG relative risk score, at 26.8%. The PPV of the UM was 17.1%, lower than that of all predictive models. When all high-risk subsets were limited to 344 patients (the number identified by the UM), the performance of the UM and the predictive models was similar. This study demonstrated that “common sense” targets for case management can be identified via simple filter as effectively as through empirically-based predictive models. However, once the supply of easily identifiable targets is exhausted, predictive models using a measure of health status identify high-risk patients who could not be easily identified by other means. / text

Advanced maternal age (AMA) is linked to several adverse pregnancy outcomes, hence these pregnancies are considered to be "high risk." Risk perception impacts pregnant women’s health care use, health behaviors, and adherence to medical recommendations. Yet, a gap remains in the understanding of perception of pregnancy risk and its contributing factors. This mixed methods research study was developed to address this gap, using a conceptual framework based on a literature review and the Psychometric Model of risk perception. The specific objectives of this study were to compare risk perception in nulliparous women of AMA with younger women, determine the factors influencing perception of pregnancy risk, and gain an understanding of women’s perspectives of risks associated with AMA. Between December 2009 and January 2011, a sample of 159 participants (105 women aged 20-29 years and 54 women aged 35 years or older) was recruited from a variety of settings in Winnipeg, Manitoba. Several questionnaires were completed by participants. Descriptive statistics, chi square, t tests, Pearson's r correlations, and stepwise multivariate linear regressions were used to analyze data. Fifteen women of AMA were chosen purposefully to participate in individual and semi-structured interviews. Interviews were audio-taped and transcribed verbatim, and content analysis was used to identify themes. Results revealed that pregnancy-related anxiety, maternal age, medical risk, perceived control (internal), and gestational age were significant predictors of perception of pregnancy risk accounting for 47-49% of the variance in risk perception. Maternal age interacted in a synergistic manner with pregnancy-related anxiety to increase perception of pregnancy risk levels. In the qualitative component, four main themes emerged from the data: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals. Women of AMA perceived higher pregnancy risk for both themselves and their fetuses than younger women. However, they were not a homogenous group in their pregnancy risk appraisal. This study contributed to the field by proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. Risk communication is an important element of developing care plans for women of AMA and should be integrated into prenatal care visits.

Advanced maternal age (AMA) is linked to several adverse pregnancy outcomes, hence these pregnancies are considered to be "high risk." Risk perception impacts pregnant women’s health care use, health behaviors, and adherence to medical recommendations. Yet, a gap remains in the understanding of perception of pregnancy risk and its contributing factors. This mixed methods research study was developed to address this gap, using a conceptual framework based on a literature review and the Psychometric Model of risk perception. The specific objectives of this study were to compare risk perception in nulliparous women of AMA with younger women, determine the factors influencing perception of pregnancy risk, and gain an understanding of women’s perspectives of risks associated with AMA. Between December 2009 and January 2011, a sample of 159 participants (105 women aged 20-29 years and 54 women aged 35 years or older) was recruited from a variety of settings in Winnipeg, Manitoba. Several questionnaires were completed by participants. Descriptive statistics, chi square, t tests, Pearson's r correlations, and stepwise multivariate linear regressions were used to analyze data. Fifteen women of AMA were chosen purposefully to participate in individual and semi-structured interviews. Interviews were audio-taped and transcribed verbatim, and content analysis was used to identify themes. Results revealed that pregnancy-related anxiety, maternal age, medical risk, perceived control (internal), and gestational age were significant predictors of perception of pregnancy risk accounting for 47-49% of the variance in risk perception. Maternal age interacted in a synergistic manner with pregnancy-related anxiety to increase perception of pregnancy risk levels. In the qualitative component, four main themes emerged from the data: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals. Women of AMA perceived higher pregnancy risk for both themselves and their fetuses than younger women. However, they were not a homogenous group in their pregnancy risk appraisal. This study contributed to the field by proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. Risk communication is an important element of developing care plans for women of AMA and should be integrated into prenatal care visits.

Objective: To examine the prevalence of adverse childhood experiences and associations with early alcohol use initiation and alcohol use patterns among high-risk urban youth in Kampala, Uganda. Methodology: Data from the Kampala Youth Survey (N=457) conducted in May through June 2011 in Kampala, Uganda was used for analysis. Indicators of adverse childhood experiences (ACEs) included: hunger, having parents, talking to parents, ever having lived on the street, parents hitting each other, parents hitting children and parental use of alcohol. These were dichotomized as either possessing the characteristic or not. Alcohol outcomes assessed were; age at alcohol initiation (age 13 was the cutoff point), frequent drinking and heavy drinking. Bivariate and multinomial logistic regression analyses were computed to determine statistical association between ACEs and alcohol use. Results: Findings in this study showed that parents hitting the youth, parental alcohol use, hunger, having ever lived on the street, and having been raped were significantly associated with the youth’s age of alcohol initiation by age 13, frequent drinking and heavy drinking in bivariate analyses. Results also showed gender differences for: parental alcohol use, parents hitting each other, being hungry, ever having lived on the street and having been raped. Girls reported higher values for most measures. Parental use of alcohol, having ever lived on the street and having been raped were particularly significant included in a multivariate model. Conclusion: This study demonstrates that adverse childhood experiences are strongly associated with early alcohol use initiation as well as frequent and heavy drinking.

Purpose: The overall objective of this prospective study was to quantify the prevalence of insulin resistance (IR), metabolic syndrome (MetS) and type 2 diabetes (T2D) in women at high risk for breast cancer, stratified by menopausal status. We also aimed to calculate the sample size required for a future case-control study comparing these prevalences to those of the general population. Methods: Participants consisted of 100 Caucasian women above the age of 35 with an estimated 5yr risk of breast cancer ≥1.7%. A comprehensive metabolic profile was obtained for each participant based on a questionnaire, fasting blood sample and biophysical measurements. Results: In comparison to published prevalence’s of IR, MetS and T2D in the general population, the prevalence of IR and MetS is higher in our study sample. High risk postmenopausal women have a higher prevalence of body mass index, waist circumference, MetS and hypertension than premenopausal women. We have shown a significant correlation between Gail score and high-density lipoprotein cholesterol. Conclusions: The sample size calculation, based on the prevalence’s obtained in the present study, support the significance and feasibility of a future case control study comparing the prevalence of IR and MetS in women at high risk and average risk for breast cancer. Further studies are needed to clarify the underlying mechanisms for the association between IR, MetS, T2D and breast cancer risk.

Background: Pregnancy associated cardiovascular pathologies have a significant impact on outcome for mother and child. Bioimpedance cardiography may provide additional outcome-relevant information early in pregnancy and may also be used as a predictive instrument for pregnancy-associated diseases. Methods: We performed a prospective longitudinal cohort trial in an outpatient setting and included 242 pregnant women. Cardiac output and concomitant hemodynamic data were recorded from 11th-13th week of gestation every 5th week as well as at two occasions post partum employing bioimpedance cardiography. Results: Cardiac output increased during pregnancy and peaked early in the third trimester. A higher heart rate and a decreased systemic vascular resistance were accountable for the observed changes. Women who had a pregnancy-associated disease during a previous pregnancy or developed hypertension or preeclampsia had a significantly increased cardiac output early in pregnancy. Furthermore, an effect of cardiac output on birthweight was found in healthy pregnancies and could be confirmed with multiple linear regression analysis. Conclusions: Cardiovascular adaptation during pregnancy is characterized by distinct pattern described herein. These may be altered in women at risk for preeclampsia or reduced birthweigth. The assessment of cardiac parameters by bioimpedance cardiography could be performed at low costs without additional risks.

Orientador: Márcia Guimarães da Silva / Resumo: O parto prematuro espontâneo, definido como nascimento antes das 37 semanas completas de gestação, apesar dos consideráveis avanços científicos, ainda representa um importante problema médico, humano e social. É representado por dois grandes grupos de patologias obstétricas definidas como Trabalho de Parto Prematuro (TPP) e Rotura Prematura de Membranas Pré-Termo (RPM-PT). O primeiro objetivo deste estudo foi avaliar os níveis de 8-oxo-2'-desoxiguanosina (8-OHdG) em membranas corioamnióticas de gestações complicadas pela prematuridade. Neste estudo transversal, foram estudadas 34 membranas corioamnióticas de gestações complicadas por TPP e 39 de gestações complicadas por RPM-PT, cujos partos ocorreram no período compreendido para a prematuridade. Como grupo controle foram incluídas no estudo 44 membranas corioamnióticas de partos a termo. As membranas corioamnióticas foram coletadas e a extração total de DNA foi realizada pelo Kit genomic-Prep Mini Spin e os níveis de 8-OHdG níveis foram analisados pela técnica de ELISA empregando-se o kit Highly Sensitive 8-OHdG. Em relação aos dados obtidos, os níveis de 8-OHdG nas membranas corioamnióticas do grupo termo foram significativamente maiores que nos grupos prematuros (p<0,001). Os níveis de 8-OHdG foram também mais elevados no grupo de termo do que nos grupos PTL ou RPM-PT (p<0,001), respectivamente. Nossos dados reforçam a tese que os danos oxidativos estão presentes nas membranas corioamnióticas de gestações a termo como cons... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Spontaneous preterm birth, defined as birth before 37 weeks completed gestation, despite the considerable scientific advances, still represents an important medical problem, human and social. It is represented by two large groups of obstetric pathologies defined as preterm labor (PTL) and premature rupture of preterm ovular membranes (pPROM). The first objective of this study was to evaluate the levels of 8-oxo-2'-deoxiguanosine (8-OHdG) in amniochorion membranes from pregnancies complicated by prematurity. In this crosssectional study, were enrolled 31 with PTL and 35 with pPRM who presented preterm delivery. As control group was included 37 pregnant women that delivery at term. Amniochorion membranes were collected and total DNA extraction was performed by ILLUSTRA tissue & cells genomic-Prep Mini Spin Kit and 8-OHdG levels were measured by an ELISA Highy Sensitive 8-OHdG Check kit. Regarding to data, 8-OHdG levels in amniochorion membranes of term group (2,90 ng/mL [min: 1,54 - max:4,06]) were significantly higher than premature group (0,61 ng/mL [min: 0,37 - max:0,91]) (p<0.001). 8- OHdG levels were also higher in term group than in PTL (0,71 ng/mL [min: 0,40 - max:1,47]) or pPROM groups (0,53 ng/mL [min: 0,37 - max:0,71]) (p<0.001), respectively. Our data reinforces that oxidative damage are present at term pregnancies as physiologic process of amnionchorion aging. The second objective of this study was to analyze the association among histologic chorioamnionitis, apoptosis occurence and 8-OHdG levels in amniochorion membranes from pregnancies complicated by pPROM and PTL. It was a prospective study and a total of 60 pregnant women were enrolled, being 31 pregnant women who presented pPROM and 29 with PTL. After delivery, the amniochorion membranes were subjected to a histopathological examination, to 8-OHdG levels analysis by an ELISA... (Complete abstract click electronic access below) / Doutor

This research aimed at identifying patterns of substance abuse among South African adolescents and exploring the relationship between psychological well-being and substance abuse. A thorough understanding of the numerous aetiologies suggested to account for substance abuse were set out at the beginning of the study, as these are crucial to the effective understanding of any high risk behaviour. Psychological well-being was examined as a psychological construct so as to allow for a proper understanding of the term. In this study, 1 918 learners from 13 schools in the Tshwane area participated. The sample consisted of learners from 12 to 19 years of age, 802 males and 1 005 females, from Indian, Coloured, White and Black cultural groups. The students completed a life skills questionnaire that comprised of a Psychological Well-Being Scale, the Life Satisfaction Questionnaire as well as various questions regarding high risk behaviours including substance use. A factor analysis was used to explore characteristics of the Psychological Well-Being Scale. It was found to be a reliable measure for this sample group. Self-report substance abuse patterns of the respondents were recorded. It was found that substance abuse (drinking, binge drinking, drug use) increases with age and that nearly twice as many male adolescents abuse substances. Culture was found to be a determining factor with regard to drinking and binge drinking, however, it was not found to influence drug use. In multifactorial analyses of variance it was found that both psychological well-being and life satisfaction had a significant relationship with drug abuse although no causality can be attributed from the results. Engel’s Biopsychosocial Model and Bronfenbrenner’s Ecological Model were used to explain the complexity of the relationship between psychological well-being and substance abuse. Both models highlighted that in order to understand the adolescent, it is crucial to examine his or her cultural and familial behaviours that support their high risk activities. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2007. / Psychology / unrestricted

Magister Artium (Psychology) - MA(Psych) / The presence of a supportive and attentive father has been shown to hold a myriad of positive health outcomes for a pregnancy, and benefits the wellbeing of the mother, child, and the father himself. Pregnancy is a key period for fathers to become invested in their children’s lives. However, obstetric research continues to be largely feminised, therefore neglects the experiences of men. Considering that existing research shows that the antenatal period is a turbulent time for men, the aim of this research was to explore fathers’ subjective lived experiences of their partner’s medically high-risk pregnancy.

Magister Artium (Psychology) - MA(Psych) / The stage of adolescence is a transitional stage in human development that can be confusing and stressful as it involves adjusting to adulthood which comes with independence and responsibilities. Adolescents solidify their journey towards self-identity as they gradually detach from being completely dependent on their parents. They form new bonds with peers and other people and are bound to be experimental as they embark on a life discovery journey. Studies reveal that adolescents are increasingly engaging in risk-taking behaviours such as risky sexual behaviour, substance use and violence, despite the implementation of numerous behavioural change interventions