Management

Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: a Cohort Analysis from China

Maternal Obesity, Caesarean Delivery and Caesarean Delivery on Maternal Request: a Cohort Analysis from China
Paediatric and Perinatal Epidemiology. 2015, 29, 232–240.

Y Zhou, J Blustein, H Li, R Ye, L Zhu, J Liu
07/22/2015

BackgroundTo quantify the association between maternal obesity and cesarean delivery, particularly cesarean delivery on maternal request [CDMR], a fast-growing component of cesarean delivery in many nations around the world.

MethodsWe follow 1 187 053 women registered in the Perinatal Healthcare Surveillance System during 1993-2010. Maternal body mass index (BMI, Kg/m2), before pregnancy or during early pregnancy, was classified as underweight (BMI <18.5), normal (BMI 18.5~<23; reference), overweight (BMI 23~<27.5), or obese (³27.5), consistent with WHO guidelines for Asian people. The association between maternal obesity and overall cesarean delivery and its subtypes was modeled using log binomial regression.

ResultsDuring the 18-year period, 450 436 (37.9%) cesarean deliveries and 103 723 (8.7%) CDMRs were identified. Maternal obesity was positively associated with overall cesarean and CDMR. Adjusted risk ratios for overall cesarean in the four ascending maternal BMI categories were 0.95, 1.00, 1.17, 1.40 [corresponding 95% confidence intervals (CIs): 0.94, 0.96; 1.00; 1.15, 1.18; 1.35, 1.44; P <0.001 for trend], and adjusted risk ratios for CDMR were 0.94, 1.00, 1.20, 1.47 [corresponding 95% CIs: 0.93, 0.96; 1.00; 1.19, 1.22; 1.43, 1.51; P<0.001 for trend]. Positive associations were consistently found in subgroups stratified by maternal age, education, rural or urban residence, level of delivering hospital, year of delivery, birthweight, and parity.

Conclusions—In a large prospective Chinese cohort, maternal obesity was associated with an increased risk of cesarean delivery and its subtypes, including CDMR. Given the rising global prevalence of obesity, and in view of the growth of CDMR, it seems likely that cesarean births will increase, absent changes in obstetrical practice

Supplying Health to the World

Supplying Health to the World
The Medicine Maker, 0315, Article #302.

Privett, N.
04/07/2015

New and improved drugs are released every year to tackle global health needs – and many pharma companies have initiatives to supply those drugs to the developing world. Unfortunately, efforts are wasted without proper supply chain management. Here, we prioritize the top ten challenges.

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes

Brian Elbel, Alyssa Moran, L Beth Dixon. Kamila Kiszko, Jonathan Cantor, Courtney Abrams and Tod Mijanovich
01/07/2015

Objective: To assess the impact of a new government-subsidized supermarket in a
high-need area on household food availability and dietary habits in children.
Design: A difference-in-difference study design was utilized.
Setting: Two neighbourhoods in the Bronx, New York City. Outcomes were
collected in Morrisania, the target community where the new supermarket was
opened, and Highbridge, the comparison community.
Subjects: Parents/caregivers of a child aged 3–10 years residing in Morrisania
or Highbridge. Participants were recruited via street intercept at baseline (presupermarket
opening) and at two follow-up periods (five weeks and one year
post-supermarket opening).
Results: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls
from a sample of predominantly low-income minorities. While there were small,
inconsistent changes over the time periods, there were no appreciable differences
in availability of healthful or unhealthful foods at home, or in children’s dietary
intake as a result of the supermarket.
Conclusions: The introduction of a government-subsidized supermarket into an
underserved neighbourhood in the Bronx did not result in significant changes in
household food availability or children’s dietary intake. Given the lack of healthful
food options in underserved neighbourhoods and need for programmes that
promote access, further research is needed to determine whether healthy food
retail expansion, alone or with other strategies, can improve food choices of
children and their families.

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field

The Top Ten Global Health Supply Chain Issues: Perspectives from the Field
Operations Research for Health Care. 3(4) 226-230.

Privett, N. and D. Gonsalves
12/01/2014

In the battle for global health, supply chains are often found wanting. Yet most of what is known about in-country pharmaceutical supply chains resides in the experiences of individual stakeholders, with limited amounts of this knowledge captured in technical reports and papers. This short communication taps into the collective experience and wisdom of global health supply chain professionals through interviews and surveys to identify and prioritize the top 10 global health pharmaceutical supply chain challenges: (1) lack of coordination, (2) inventory management, (3) absent demand information, (4) human resource dependency, (5) order management, (6) shortage avoidance, (7) expiration, (8) warehouse management, (9) temperature control, and (10) shipment visibility. As such, this work contributes to the foundational knowledge of global health pharmaceutical supply chains. These challenges must be addressed by researchers, policy makers, and practitioners alike if global pharmaceutical supply chains are to be developed and improved in emerging regions of the world.

A Cascade of Failures: Why Government Fails, and How to Stop It

A Cascade of Failures: Why Government Fails, and How to Stop It
Brookings Institute, Center for Effective Public Management, Washington D.C., July 2014.

Light, Paul C.
07/14/2014

In this research paper, Paul C. Light writes that the “first step in preventing future failures is to find a reasonable set of past failures that might yield lessons for repair.” To meet this goal, Light asks four key questions about past federal government failures: (1) where did government fail, (2) why did government fail, (3) who caused the failures, and (4) what can be done to fix the underlying problems?

Improving Visibility in Humanitarian Supply Chains

Improving Visibility in Humanitarian Supply Chains
The Humanitarian Space: Articles (The Humanitarian Practice Network).

Privett, N.
02/24/2014

Humanitarian supply chains must function in the most challenging environments and, consequently, supply chain visibility – information and data, for instance regarding products in transit and availability and stock levels at storage and distribution points – can often be poor. Increasing supply chain visibility has the potential to greatly improve humanitarian operations by providing data to inform more effective and accurate decisions, enabling evidence-based interventions and management, exposing issues for effective remedy and increasing accountability. This article identifies a core set of visibility needs for humanitarian supply chains, discusses technology and pilot projects aimed at providing increased visibility and compares and analyses current approaches.

A moral compass for management decision making: a healthcare CEO's reflections

A moral compass for management decision making: a healthcare CEO's reflections
Frontiers of Health Services Management. 2013; 30(1): 14-26.

John Donnellan
09/12/2013

Ethical behavior is good for business in any organization. In healthcare, it results in better patient care, a more committed and satisfied staff, more efficient care delivery, and increased market share. But it requires leaders who have a broad view of the role that ethics programs--and an effective, sustained ethical culture--play. Ethical organizations have integrated and shared ethical values and practices, an effective ethics infrastructure, ongoing ethics education for staff at every level, ethical and morally courageous leaders, and a culture that is consistent with the organization's values. The mission, vision, and values statements of these organizations have been successfully translated into a set of shared values--a moral compass that guides behavior and decision making.

Measuring Agency Attributes with Attitudes Across Time: A Method and Examples Using Large-Scale Federal Surveys

Measuring Agency Attributes with Attitudes Across Time: A Method and Examples Using Large-Scale Federal Surveys
Journal of Public Administration Research and Theory (2013). doi: 10.1093/jopart/mut040

Bertelli, A.M., D.P. Mason, J.M. Connolly, and D.A. Gastwrith
08/28/2013

Public management researchers are interested in many characteristics of organizations that cannot be directly captured, making aggregated attitudes from surveys an attractive proxy. Yet difficulties in measuring meaningful attributes over time and across organizations have frequently limited statistical designs to a single organization or time. We offer a method for creating such statistical measures across agencies and time using item response theory. Focusing our attention on US federal administrative agencies, we marshal a variety of questions from surveys commissioned by the Office of Personnel Management and Merit Systems Protection Board and employ statistical models to measure three important attributes—autonomy, job satisfaction, and intrinsic motivation—for 71 agencies between 1998–2010. Our study provides a wealth of data for quantitative public management research designs as well as an adaptable framework for measuring a wide range of concepts.

Policy Influence, Agency-Specific Expertise, and Exit in the Federal Service

Policy Influence, Agency-Specific Expertise, and Exit in the Federal Service
Journal of Public Administration Research and Theory, v. 23, n. 2 (2013). doi: 10.1093/jopart/mus044.

Anthony M. Bertelli and David E. Lewis
03/26/2013

Executive turnover influences agency performance, policy implementation, and ultimately the success of legislative delegations. We argue that turnover intention is a function of labor market opportunities—specifically, outside employment opportunities and the acquisition of nontransferable, agency-specific human capital—as well as perceptions about the way in which political decisions have affected federal executive influence over policymaking. Statistical evidence for these claims is provided using data from the 2007–2008 Survey on the Future of Government Service, the largest ever survey of US federal executives. Agency-specific human capital drives down turnover intention in our estimates. The availability of outside options has the opposite effect except in cases where the executive has invested a lot in agency-specific human capital. Turnover intention increases when an agency’s senior executives have little influence over policy. We draw out the implications of these findings for our understanding of federal labor markets, the construction of civil service systems, and the politicization of executive branch agencies.

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