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Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database

October 23, 2014 Comments off

Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database
Source: PLoS Medicine

Background
Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women’s clinical diagnoses.

Methods and Findings
Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status.

The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age.

Conclusions
Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight the need for more comprehensive or linked data including parity and gestational age as well as examination of other factors—such as hospital policies, practices, and culture—in determining cesarean section use.

See also: Variation in Caesarean Section Rates in the US: Outliers, Damned Outliers, and Statistics

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What Would Happen If Health Care in the U.S. Improved?

October 23, 2014 Comments off

What Would Happen If Health Care in the U.S. Improved?
Source: Commonwealth Fund

The United States health care system is the most expensive in the world, but the Commonwealth Fund report Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally shows the U.S. underperforms relative to 11 other industrialized countries on most dimensions of performance. Use this interactive to see what would happen if the U.S. were to raise its health system performance to the levels achieved elsewhere in the world.

UK — State of the Nation 2014 Report

October 23, 2014 Comments off

State of the Nation 2014 Report
Source: Social Mobility and Child Poverty Commission, Cabinet Office, Department for Education and Department for Work and Pensions

This is the Commission’s second annual State of the Nation report to be presented to Parliament. The Commission was created by the UK Government in 2012 as an independent and statutory body to monitor and report on what is happening to child poverty and social mobility in our country.

The report assesses what the UK government, the Scottish government and the Welsh government are doing (the Commission’s remit does not cover the Northern Ireland government), what progress is being made, and what is likely to happen in future. The report also examines the role of employers and professions, councils and colleges, schools and universities, parents and charities. The report makes a number of recommendations for action.

This is the last State of the Nation report prior to the 2015 UK General Election. As such it presents a verdict on the past and provides a window into the future. The central conclusion is that the next government will have to adopt radical new approaches if poverty is to be beaten, mobility improved and if Britain is to avoid becoming a permanently divided society. We define that as the 2020 challenge.

Hong Kong: one country, two systems?

October 23, 2014 Comments off

Hong Kong: one country, two systems?
Source: European Parliamentary Research Service

The on-going heated debate about the introduction of universal suffrage for the election of Hong Kong’s Chief Executive has turned into widespread protests on the territory’s streets. Hopes that the public would be able to nominate candidates were dashed by China’s decision to allow only committee-based nomination of candidates in the 2017 election. The Occupy Central protests, widely known as the Umbrella Revolution, kicked off on 28 September. Agreement to talks, scheduled for 10 October, saw tensions lowered, but after those talks were cancelled by the authorities, organisers called for protesters to return to the streets. With numbers not reaching earlier heights, the authorities appear to have concluded that the protests’ momentum is going.

Posthumously Conceived Children: An International and Human Rights Perspective

October 22, 2014 Comments off

Posthumously Conceived Children: An International and Human Rights Perspective
Source: Journal of Law & Health

This essay considers posthumous conception from an international and child-centered approach. After a sketch in Part I of the phenomenon of posthumous conception and the complexities it evokes, Part II examines the types of issues arising in court cases concerning posthumous conception. Part III considers how courts in their rulings have addressed the welfare and best interests of posthumously conceived children and analyzes the scope and meaning of relevant decisions. Part IV looks into children’s rights or interests raised in those judicial decisions: parental acknowledgement, family structures, identity harm, and inheritance and social benefits. This part draws on the Convention on the Rights of the Child (CRC), a prime instrument to advance children’s rights on the international level, incorporating as much as possible the perspectives of children. I argue that the discourse must include concern for the rights and interests of posthumously conceived children and that a new special category of children who are “outcast” cannot stand the test of equality and non-discrimination, nor of the entrenched principles of child welfare and best interests. Moreover, I suggest that attending to children’s perspectives may illuminate the gaps in the current discourse and what needs to be addressed. Finally, Part V draws some conclusions and calls for a more relational approach to ensure that posthumously conceived children do not pay the price of their parents’ decisions and that their welfare and best interests are upheld.

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation

October 22, 2014 Comments off

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation
Source: Journal of Medical Internet Research

Background:
Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers.

Objective:
The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program?

Methods:
Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score.

Results:
The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms.

Conclusions:
There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool.

How Much (More) Should CEOs Make? A Universal Desire for More Equal Pay

October 22, 2014 Comments off

How Much (More) Should CEOs Make? A Universal Desire for More Equal Pay (PDF)
Source: Perspectives on Psychological Science (forthcoming)

Do people from different countries and different backgrounds have similar preferences for how much more the rich should earn than the poor? Using survey data from 40 countries (N = 55,238), we compare respondents’ estimates of the wages of people in different occupations – chief executive officers, cabinet ministers, and unskilled workers – to their ideals for what those wages should be. We show that ideal pay gaps between skilled and unskilled workers are significantly smaller than estimated pay gaps, and that there is consensus across countries, socioeconomic status, and political beliefs for ideal pay ratios. Moreover, data from 16 countries reveals that people dramatically underestimate actual pay inequality. In the United States – where underestimation was particularly pronounced – the actual pay ratio of CEOs to unskilled workers (354:1) far exceeded the estimated ratio (30:1) which in turn far exceeded the ideal ratio (7:1). In sum, respondents underestimate actual pay gaps, and their ideal pay gaps are even further from reality than those underestimates.

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