Search Results (19)

Background: Over recent years, several pain management techniques have been proposed to control labour pain, including pharmacological and non-pharmacological interventions. Transcutaneous electrical nerve stimulation (TENS) is considered a safe, non-invasive, easily applicable, and inexpensive pain relief method. This study aimed to investigate the impact of TENS on consecutive labour stages and on maternal and neonatal outcomes. Methods: This retrospective, single-centre cohort study covered a two-year period (1 January 2022–31 December 2023). A total of 1451 women met the inclusion criteria. TENS was applied in 203 of them. In 54.67% of cases, TENS was combined with water immersion and, in 42.85%, with water immersion and Entonox (N₂O and O₂ mixture). Two groups of patients that either made use of TENS, or not, to reduce labour pain, were compared to assess the effect of TENS on the course of labour and the condition of the newborn. Results: The women in the TENS group experienced a significantly longer first stage of labour. There was no statistically significant difference between the groups in terms of oxytocin usage, perineal tearing, episiotomy, and umbilical cord blood pH. The simultaneous application of TENS and water immersion contributed to prolonging the first stage of labour relative to their independent effects. Conclusions: The application of TENS may prolong the first stage of labour, without increasing the rate of perineal tearing and episiotomy and without any adverse effects on the condition of the newborn. Full article

Between the eighth and ninth centuries, the world entered a second period of strong winter monsoons, which precipitated a series of recurrent natural disasters, including reduced summer rainfall and prolonged droughts. The various types of droughts that occurred in southeastern China are documented in historical records, which also include the official-led ritual prayers to the local deities that were conducted during these challenging periods. As evidenced in these historical records, officials implemented a series of measures to provide solace to the populace, including the restoration of shrines and temples and the offering of sacrifices and prayers to the local deities, such as the Wutang God 吳塘神 and the Chutan God 儲潭神. These actions were intended to leverage the influence of the local deities to mobilise labour and financial resources for the implementation of public works, including the reclamation of barren land and the construction of dikes and ponds. These initiatives ultimately proved instrumental in enabling the populace to withstand the adverse effects of disasters. This approach represents a distinctive strategy for coping with drought in ancient China. It may provide insights into how governments and non-governmental organisations can utilise the influence of religious beliefs to unite people in addressing the climate crisis in the present era. Full article

Mangrove Swamp Rice is a unique labour-, time-, and knowledge-intensive farming system across West Africa requiring a complex water management through dikes, canals, and pipes. Cooperation is crucial in the socio-spatial and temporal organisation of water management, helping mitigate risks like saltwater intrusion, prolonged submersion, and drying of paddies, particularly intensified by climate change. We adopted a mixed-methods approach integrating grounded theory with case study design and multi-level analysis and employed several tools, such as social network analysis, a land tenure register, a digital elevation model, and a machine learning model. This research strategy allowed us to gain an in-depth understanding of the complex socio-ecological system in water management. Our study examined the benefits of cooperation for water infrastructure management, highlighting its critical role in routine monitoring and repair, specialised technical advice, and annual belt dike maintenance. Within the large array of factors influencing cooperation, key drivers, such as spatial proximity and farmers’ technical knowledge, labour ethics, and fame, emerged and are discussed. Our findings provide important insights into the social organisation of “traditional” societies and offer valuable guidance for development practitioners, emphasising the importance of involving reputed farmers for sustainable socio-technical adaptation. Full article

Against the background of considerable regional disparities, we test the “discouraged worker” hypothesis, which postulates that poor regional socioeconomic conditions foster students’ aspirations for more education, ultimately leading to an extension of their educational careers. Our two dependent variables are (i) whether students aspire to prolong their general school careers or enter vocational training and (ii) whether they in fact prolong their school careers. To that end, we link regional-level data to individual-level data from the German National Educational Panel Study (NEPS). To describe regional conditions adequately, we illustrate geographical patterns in socioeconomic conditions relevant for school-to-work transitions (e.g., labour market conditions and availability of vocational training opportunities). We compare two operationalisations of regional areas: (i) administrative districts and (ii) public transport areas. Our results show that students are more likely to aspire to prolong their general school careers in socioeconomically deprived regions. Moreover, the effects are stronger when school-based vocational training opportunities are scarce. The effects on actual transitions vary according to the school track attended and the availability of educational alternatives in the general school system. Finally, the operationalisation of regions varies regarding effect sizes and corresponding levels of statistical significance. Full article

Background: Pelvic dimensions are crucial variables in the labour process. We used magnetic resonance imaging (MRI) pelvimetry to predict the probability of vaginal delivery and distinguish the cephalopelvic disproportion risk in women with prolonged active labour. Methods: This prospective cohort study enrolled term nulliparous women willing to undergo MRI pelvimetry and a trial of labour. A nomogram, with vaginal birth as the outcome, was developed and evaluated by calibration curve and decision curve analyses. The pairwise association between maternal and fetal parameters and a prolonged first stage of labour was quantified. Results: Head circumference (HC), abdominal circumference (AC), intertuberous distance (ITD), interspinous diameter (ISD), and body mass index (BMI) were introduced to develop a nomogram with good diagnostic performance (area under the curve = 0.799, sensitivity = 83%, and specificity = 73%). The cephalopelvic index of diameter (CID) in 54 women with a prolonged first stage of labour was much smaller in those who delivered via cesarean section compared with those who delivered vaginally (18.09 ± 1.14 vs. 21.29 ± 1.06; p = 0.046). Conclusions: An MRI pelvimetry-based nomogram may predict the probability of vaginal delivery. Practitioners should reassess the pelvimetry parameters to decide whether the trial of labour should be continued if it is prolonged. Full article

Background: Lumbar epidural analgesia (EA) is the most commonly used method for reducing labour pain, but its impact on the duration of the second stage of labour and on neonatal and maternal outcomes remains a matter of debate. Our aim was to examine whether EA affected the course and the outcomes of labour among patients divided according to the Robson-10 group classification system. Methods: Patients of Robson’s classes 1, 2a, 3, and 4a were divided into either the EA group or the non-epidural analgesia (NEA) group. A propensity score-matching analysis was performed to balance the intergroup differences. The primary goal was to analyse the duration of the second stage of labour. The secondary goals were to evaluate neonatal and maternal outcomes. Results: In total, 21,808 cases were analysed. The second stage of labour for all groups was prolonged using EA (p < 0.05) without statistically significant differences in neonatal outcomes. EA resulted in a lower rate of episiotomies in nulliparous patients, with a higher rate of operative vaginal deliveries (OVD) (p < 0.05) and Caesarean sections (CS) (p < 0.05) in some classes. Conclusions: EA prolonged the duration of labour without affecting neonatal outcomes and reduced the rate of episiotomies, but also increased the rate of OVDs. Full article

Homebirth is legal and has been regulated by law in Hungary since 2012. Despite the obvious advantages of homebirth, it has not yet been broadly accepted, due to various opinions related to safety and risks associated with giving birth outside of a hospital. Our study aimed at exploring both real maternal and feto-neonatal characteristics associated with Hungarian homebirths. A total of 2997 cases were considered in support of our retrospective cohort study. In the examined period, there was a significant, continual rise in the number of homebirths by a rate of 0.22% on average per year. Aggregated maternal complications (primary uterine inertia, prolonged second stage labour, and third stage haemorrhage) were prevalent among homebirth cases (1.29% vs. 0.72%, p < 0.05) and were associated with an average of 11.77% rate of transfer to a health care institution. On the other hand, the rate of operative (vaginal or caesarean) delivery was 26.31% among institutionalized births. A slightly better Apgar score and relatively high rate (20%) of caesarean deliveries were correlated with institutionalized births (p < 0.05). However, the overall intervention rate was lower among homebirths (0.11% vs. 42.57%) than institutional birth cases (p < 0.001). Overall, homebirth is a reliable option for childbirth for healthy and low-risk mothers with uncomplicated pregnancies, which is reflected in the increasing number of deliveries at home in Hungary. Furthermore, utilizing the experiences of countries where homebirth is a long-established method may further improve the outcome of homebirths in Hungary. Full article

Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment. Full article

Objectives: To solve the labour shortage, we clarify the definition and dimensions of sustainable employability, and make it possible to develop sustainable employability scales in the future and lay the foundation for subsequent quantitative research. Finally, people’s sustainable employability can be improved. Highly sustainable employability employees can continue to work in the labour market and their working lives can be prolonged. Labour market supply will increase and labour shortage will be partly solved. Methods: We discuss the concept of sustainable employability based on some previous studies. Our conclusion is that the existing definitions and measurement dimensions are problematic. The swAge-model, a tool that helps us understand how to make working life more sustainable and healthier for all ages, can be the basis of sustainable employability. Results: We develop a discussion paper concerning the definition and measurement dimensions of sustainable employability using the swAge-model with an added factor of intrinsic work value and the dynamic chain. Conclusions: Our definition of sustainable employability takes environmental factors into consideration and makes it clear that it is not a solely personal characteristic, but the result of an interaction between individuals and the environment, thus distinguishing employability from work ability. We use the swAge-model as a basis to make the composition of our definition more logical and informed. Our measurement dimensions are clearly described to facilitate the future development of a scale, and our concept may ultimately help to extend the working lives of older and retired workers and thus solve the future labour shortage problem. Full article

The research object is the installation process of modular green roofs with planters placed on the concrete roof’s surface. These roofs effectively reduce rainfall disposal, prolong the lifespan of the roof coating, and enhance urban aesthetic and recreational spaces. Green roofs reduce houses’ gas emissions and increase green spaces in densely built areas. The spatial–technological model was developed for the proposed modular green roof based on network planning, scheduling theory, and graph theory. The sequence and composition of technological processes and operations were established for the installation process. The functional model of installing a modular green roof has been developed. The model makes it possible to optimise the principles of saving labour contribution (working hours) and time. Full article

Rice production in Nigeria is vulnerable to climate risks and rice farmers over time have experienced the risks and their respective impacts on rice farming. Rice farmers have also responded to perceived climate risks with strategies believed to be climate-smart. Farmers’ perception of climate risks is an important first step of determining any action to be taken to counteract the negative effects of climate change on agriculture. Studies on the link between perceived climate risks and farmers’ response strategies are increasing. However, there are limited studies on the determinants of rice farmers’ perception of climate events. The paper therefore examined climate change perception and uptake of climate-smart agriculture in rice production in Ebonyi State, Nigeria using cross-sectional data from 347 rice farmers in an important rice-producing area in Nigeria. Principal component analysis, multivariate probit regression model and descriptive statistics were adopted for data analysis. Perceived climate events include increased rainfall intensity, prolonged dry seasons, frequent floods, rising temperature, severe windstorms, unpredictable rainfall pattern and distribution, late onset rain, and early cessation of rain. Farmers’ socioeconomic, farm and institutional characteristics influenced their perception of climate change. Additionally, rice farmers used a variety of climate-smart practices and technologies to respond to the perceived climate events. Such climate-smart practices include planting improved rice varieties, insurance, planting different crops, livelihood diversification, soil and water conservation techniques, adjusting planting and harvesting dates, irrigation, reliance on climate information and forecasts, planting on the nursery, appropriate application of fertilizer and efficient and effective use of pesticides. These climate-smart agricultural measures were further delineated into five broad packages using principal component analysis. These packages include crop and land management practices, climate-based services and irrigation, livelihood diversification and soil fertility management, efficient and effective use of pesticide and planting on the nursery. High fertilizer costs, lack of access to inputs, insufficient land, insufficient capital, pests and diseases, floods, scorching sun, high labour cost, insufficient climate information, and poor extension services were the barriers to uptake of climate-smart agriculture in rice production. Rice farmers should be supported to implement climate-smart agriculture in rice production in order to achieve the objectives of increased rice productivity and income, food security, climate resilience and mitigation. Full article

This prospective cross-sectional case-control study investigated the postpartal gene expression of microRNAs associated with diabetes/cardiovascular/cerebrovascular diseases in the peripheral white blood cells of women with anamnesis of preterm prelabor rupture of membranes (n = 58), spontaneous preterm birth (n = 55), and term delivery (n = 89) by a quantitative reverse transcription polymerase chain reaction. After pregnancies complicated by preterm prelabor rupture of membranes or spontaneous preterm birth, mothers showed diverse expression profiles for 25 out of 29 tested microRNAs (miR-1-3p, miR-16-5p, miR-17-5p, miR-20a-5p, miR-20b-5p, miR-21-5p, miR-23a-3p, miR-24-3p, miR-26a-5p, miR-29a-3p, miR-100-5p, miR-103a-3p, miR-125b-5p, miR-126-3p, miR-130b-3p, miR-133a-3p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-195-5p, miR-199a-5p, miR-221-3p, miR-499a-5p, and miR-574-3p). The earliest gestational ages at delivery and the lowest birth weights of newborns were associated with the highest postpartal levels of the previously mentioned microRNAs in maternal peripheral white blood cells. Administration of tocolytic drugs in order to prolong pregnancy, used in order to administer and complete a full course of antenatal corticosteroids, was associated with alterations in postpartal microRNA expression profiles to a lesser extent than in women with imminent delivery, where there was insufficient time for administration of tocolytics and antenatal corticosteroids. Overall, mothers who did not receive tocolytic therapy (miR-24-3p and miR-146a-5p) and mothers who did not receive corticosteroid therapy (miR-1-3p, miR-100-5p, and miR-143-3p) had increased or showed a trend toward increased postpartal microRNA expression when compared with mothers given tocolytic and corticosteroid therapy. In addition, mothers with serum C-reactive protein levels above 20 mg/L, who experienced preterm labour, showed a trend toward increased postpartal expression profiles of miR-143-3p and miR-199a-5p when compared with mothers with normal serum C-reactive protein levels. On the other hand, the occurrence of maternal leukocytosis, the presence of intra-amniotic inflammation (higher levels of interleukin 6 in the amniotic fluid), and the administration of antibiotics at the time of preterm delivery had no impact on postpartal microRNA expression profiles in mothers with a history of preterm delivery. Likewise, the condition of the newborns at the moment of birth, determined by Apgar scores at 5 and 10 min and the pH of cord arterial blood, had no influence on the postpartal expression profiles of mothers with a history of preterm delivery. These findings may contribute to explaining the increased cardiovascular risk in mothers with anamnesis of preterm delivery, and the greater increase of maternal cardiovascular risk with the decrease of gestational age at delivery. Women with preterm delivery in their anamnesis represent a high-risk group with special needs on a long-term basis, with a need to apply preventive and therapeutic interventions as early as possible. Full article

We evaluated the impact of the new coronavirus disease (COVID-19) on healthcare access in Japan in terms of the number of outpatients and hospitalized patients as well as the length of hospital stays, during the first wave of the pandemic, up to June 2020. This observational study evaluated the monthly average number of outpatients per day at hospitals, the average number of hospitalized patients per day, and the average length of hospital stays per patient, from December 2010 to June 2020, using the hospital reports data, which are open aggregated data on the utilization of hospitals from the Ministry of Health, Labour and Welfare. These numbers were compared with those from the same period of previous years, using a quasi-Poisson regression model. We found a nationwide decrease in the number of outpatients in general hospitals and hospitalized patients, particularly in long-term care beds in Japan, as well as the excess length of hospital stays among psychiatric care patients during the first wave of the COVID-19. This limited access to healthcare demonstrated the importance of the long-term health monitoring of vulnerable populations and the need for urgent management support to healthcare facilities in preparation for possible prolonged pandemics in the future. Full article

Background: Burnout syndrome is an increasingly prevalent problem, characterised by emotional exhaustion (EE), depersonalization (D), and low personal accomplishment (PA), feelings that appear with prolonged exposure to stress-inducing situations. The syndrome alters physical well-being and endangers the quality of services provided. Among nurses working in the paediatric area, the association between burnout and the corresponding risk profile has received little research attention, despite the highly stressful nature of this work. Materials and Methods: The study population was composed of 95 nurses working in four hospitals in the province of Granada. Data were collected using the Maslach Burnout Inventory, the NEO Personality Inventory, and the Educational-Clinical Questionnaire: Anxiety and Depression. Results: According to the results obtained, 22.0% of the nurses working in the paediatric area present high levels of EE, 18.5% present high levels of D, and 39.6% had feelings of low PA. These burnout levels do not depend on sociodemographic or labour variables, but the three domains of the syndrome are related to the psychological factors analysed. Conclusions: Among the nurses who participated in this study, 38.6% presented high levels of burnout, especially regarding feelings of low personal accomplishment. Personality factors play an important role in the development of this syndrome. This study shows the impact of burnout in paediatric nurses as well as the risk factors, providing information for the development of strategies to prevent it. Full article

In East Africa, soil nutrient depletion and low yields jeopardise the food security of smallholder farming families and exacerbate poverty. The main reasons for the depletion of soil nutrients are overuse due to population growth, limited land, and increasing uncertainty in agricultural production caused by climate change. This study aims to analyse and optimise nutrient flows and stocks in the homegardens of smallholder banana-coffee-based farming systems in the Kagera region in NW Tanzania. The plant nutrients nitrogen (N), phosphorus (P), and potassium (K) in plant-based biomass and organic farm waste are under investigation. We used data from a farm household survey (150 households) and from focus group discussions with 22 trainers who had been training about 750 farm households in sustainable land management (SLM) at a local farmer field school. In total, we identified six farm household types and calculated a nutrient balance (NB) for the homegardens of each household type. The NB was calculated for the following five management scenarios: S0: business as usual; S1: the use of 80% of the available human urine; S2: the incorporation of 0.5 t yr⁻¹ of the herbaceous legume species Crotalaria grahamiana into the soil; S3: the production of 5 m³ yr⁻¹ CaSa-compost (human excreta and biochar) and its application on 600 m² land; and S4: a combination of S1, S2, and S3. The results show that the NB varies considerably depending on whether farmers have implemented the SLM training, apply nutrient-preserving manure collection and storage methods, and purchase fodder (imported nutrients), or whether they do not collect manure or do not purchase fodder. Trained farm households are more likely to have a positive NB than untrained households because they have already improved the nutrient management of their farms through the successful implementation of SLM practices. Untrained households would improve the NB in their homegardens under all management scenarios. However, the NB depends on labour-intensive manure collection and compost production, labour shortages, prolonged dry seasons, and socio-economic imbalances. As long as these constraints remain, nutrient deficiencies will not be overcome with mineral fertilisers alone, because soils have to be further enriched with organic matter first. In this paper, we also emphasise the importance of the system boundary, because only a complete NB can give an estimate of actual nutrient removal and the resulting nutrient demand (including removals by fodder and trees). Further improvements in the SLM training may be achieved by (i) measuring the current nutrient status of soils, (ii) analysing the need for the coexistence of free-range livestock on the grassland and zero-grazing in trained households, and (iii) conducting an in-depth analysis of the socio-economic differences between successful and unsuccessful households. In conclusion, if smallholder farmers were to integrate further improved SLM training and optimised nutrient management (S1 to S4), we assume that the NB would turn positive. Last but not least, the SLM training by the farmer field school may serve as a best-practice example for training and policy recommendations made by government institutions. Full article