What do women know about the risks of delayed childbearing?

BACKGROUND: Women aged 35 and older account for an increasing proportion of births and are at increased risk of pregnancy complications and poor infant outcomes. The objectives of the study were: 1) to determine what women know about delayed childbearing, including pregnancy complications and outcomes associated with low birthweight (LBW, < 2500 grams), preterm delivery (< 37 weeks) and multiple birth, and 2) to assess the characteristics of women with limited knowledge of risks. METHODS: A computer-assisted telephone interview survey was conducted with 1,044 randomly selected women who delivered their first live-born infant, between July 2002 and September 2003, in two urban centres, Calgary and Edmonton, in Alberta, Canada. RESULTS: The proportion of women aware of specific childbearing risks associated with advanced maternal age were as follows: conception difficulties (85.3%), multiple birth (24.0%), caesarean section (18.8%), preterm delivery (21.8%), and LBW (11.2%). Knowledge of specific developmental and health-related risks of suboptimal infant outcomes ranged between 18.0% and 46.5%. Logistic regression revealed that limited knowledge of maternal age-related pregnancy risks were associated with unplanned pregnancy (OR, 1.48; 95% CI, 1.03-2.14), smoking (OR, 1.83; 95% CI, 1.29-2.60) and non-use of fertility treatment (OR, 2.15; 95% CI, 1.44-3.19). Characteristics associated with limited knowledge of the risks associated with suboptimal birth outcomes were: age 35-39 years (OR, 2.98; 95% CI, 1.35-6.58), less than post-graduate education (< or = high school OR, 2.14; 95% CI, 1.20-3.82), and not currently enrolled as a student (OR, 1.75; 95% CI, 1.02-3.00). CONCLUSIONS: Many women are generally unaware of the potential consequences of delayed childbearing. There are missed opportunities in preconception counselling and education, which should be addressed to allow for more informed decision-making about family planning.     

What do we conclude from re-admissions about quality of inpatient care?

Quality assurance in hospital care increasingly focuses on evaluation of outcome. Problems arise with displaying results of medical care beyond discharge. In this context hospital readmissions are often used as outcome variable. But it is unclear whether readmissions are meaningful indices of quality of hospital care and if so, where to get valid data on readmissions. We used claims data of the regional health insurance fund in Saxony-Anhalt (AOK Saxony-Anhalt) from 2002 and 2003 (850,000 insured; nearly 300,000 cases per year). All hospital admissions of a insured person are identified by an anonymous id-number independent of the admitting hospital. By this way we can analyze readmissions individually. Readmission are frequent events in hospital care. Nearly one third of all patients were admitted at least a second time in 2003. 18 % of all hospital cases are readmissions within 30 days after discharge. Readmissions concentrated on chronically ill, oncological, or multimorbid patients. Many of the readmissions take place in the context of planned therapies or post-operative treatment. 'Revolving-door patients' with multiple readmissions point to problems in cooperation of ambulatory and hospital care. By defining tracer diagnoses and specific causes of readmissions unplanned readmissions may be identified as a quality indicator of suboptimal care. Readmissions don't express suboptimal care per se. But taking into account methodological aspects a tracer approach with defining specific unplanned readmissions may provide meaningful outcome indicators. These can be derived from claims data fast, routinely, and with low costs. Further validation of the approach is needed.     

What role do Death Doulas play in end‐of‐life care? A systematic review

Current health and social care systems do not always meet the needs of the dying in our communities. As a result, patients and families are choosing to place their trust in those who can advocate for them or fill the gaps in care. Birth Doulas have been working with women during pregnancy and after birth for many years, and we are now seeing a new role, that of a Death Doula emerging in the end‐of‐life care space. How Death Doulas work within health and social care systems is not understood and we conducted a systematic review to explore the published literature to explore the role and potential implications for models of care delivery. Following the PRISMA recommendations, we searched the literature in January 2018 via bibliographic databases and the grey literature without search date parameters to capture all published literature. We looked for articles that describe the role/work of a death doula or a death midwife in the context of end‐of‐life care, or death and dying. Our search retrieved 162 unique records of which five papers were included. We analysed the papers in relation to relationship to health service, funding source, number and demand for services, training, licensing and ongoing support, and tasks undertaken. Death Doulas are working with people at the end of life in varied roles that are still little understood, and can be described as similar to that of “an eldest daughter” or to a role that has similarities to specialist palliative care nurses. Death doulas may represent a new direction for personalised care directly controlled by the dying person, an adjunct to existing services, or an unregulated form of care provision without governing oversight.     

What do young school‐age children know about occupational therapy? An evaluation study

Occupational therapy is a poorly understood profession. In response to this fact, the American Occupational Therapy Association has launched a national campaign to increase awareness of occupational therapy among adults. Little is known, however, about children's perceptions of occupational therapy. The current evaluation study reports on the assessment of children's perceptions of occupational therapy prior to, and following, an interactive demonstration on occupational therapy as part of a larger neuroscience exposition. One hundred and three elementary school‐aged children (55 boys and 48 girls) from local schools attended a one‐day neuroscience exposition held at the Boys & Girls Clubs of Omaha. At three of 18 booths at the exposition, occupational therapy faculty and students explained what occupational therapists do, and demonstrated the link between brain function and occupational performance. Children completed pre and post questionnaires. Results revealed that on pre‐test, the vast majority of participants could not answer the question or had no idea of what occupational therapists do. On post‐test, 75% reported that they had knowledge of what occupational therapists do. These preliminary findings suggest that a campaign of public awareness about occupational therapy for children would be highly effective and beneficial, and that a neuroscience exposition including occupational therapy is one effective intervention to promote such awareness. Copyright © 2001 Whurr Publishers Ltd.