Background: Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. Methods: A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. Results:The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95, 50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6-10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. Conclusions:This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

Abstract:Background: Involving patient in decision making for their care can enhance satisfaction and promote health outcomes in particular in the nursing fields. As The World Health Organization Principles of Perinatal Care has recommended that care should involve women in decision making. This principle strongly endorses for improving effective perinatal care. Decision making regard to treatment options is a concept that has increased widespread appeals to healthcare providers and users in recent year. Evidently, patient involvement in decision making has not always been implemented in clinical practice in particular during intrapartum period. Objective: The aim of this study was to investigate the involvement of women in decision making on episiotomy procedure during labor. Methods: A descriptive quantitative approach was conducted using selfadministered survey questionnaires in two government hospitals, Bangkok, Thailand. Participating hospitals were identified by convenience and remained anonymous. The Participant, eligible women included those who have reached 37 to 42 weeks of gestation, experienced vaginal birth, have a live baby, and admitted in the postpartum units. An appropriate sample size was assigned based on a 95 percent confidence level. A sample size was drawn from two hospitals based on a binomial probability distribution. There were 400 postpartum women participated in this study. Anonymous patient's data were analyzed using frequencies and percentages. Results: The results revealed that 80% of all women experienced episiotomy. The finding demonstrated that decision making on having this procedure made by health care providers and relatives 73.8%, 3.2%, respectively. 23% of them had a chance to make a decision on having episiotomy. There were 23.8% of women received information about risks and benefits of episiotomy procedure and 76.2% did not get information. Conclusion: The findings of this study demonstrated that women have less opportunity to make a decision on having episiotomy during labor and received less information about this procedure. Therefore, health care providers should be clearly discussed about risks and benefits of episiotomy before performing the procedure. The factors influencing patient involvement in decision making should be investigated to promote good experiences of women during delivery and increase satisfaction toward their care.

Background: Family communication can become a support system for adolescents. Ineffective communication in the family causes emotional problems and poor psychological well-being in adolescents. Purpose: This study aimed to analyze the determinant factor of effective family communication in adolescents. Methods: This was a cross-sectional multi-centre design with 357 participants aged 15-16 from fve high schools in Indonesia. We used the convenience sampling method to select participants. Communication in the family questionnaire, Rosenberg Self Esteem Instrument, Depression Anxiety Stress Scale (DASS-21), and the Scale for Suicide Ideation (SSI) questionnaires were used to measure communication within the family, selfesteem, stress, anxiety, depression, and suicide ideation, respectively. Data were analyzed using Chi-square and binary logistics regression. Results: Most of the adolescents were male (52.1%), had harmonious families (96.6%), had economic status above the minimum wage (65.5%), had high self-esteem (88.5%), and had high social support (67.8%). However, in terms of mental health problems, as many as 47.3%, 74.2%, 72%, and 30.5% of adolescents experienced stress, anxiety, depression, and suicidal ideation, respectively. The multivariate analysis concluded that gender (AOR: 0.499; 95% CI: 0.294-0.847) and socioeconomic status (AOR: 0.2.162; 95% CI: 1.296–3.608) were signifcantly correlated with family communication. Conclusion: Males adolescents are more likely to have ineffective family communication than female adolescents. Also, adolescents with a family socioeconomic status below the minimum wage have a greater risk of ineffective family communication. Therefore, it is essential to improve family communication through assertive communication training in adolescents and families in the educational and community setting.