The results of this study suggest that Centering Pregnancy is not adequately aiding its patients in adopting healthy behaviors during pregnancy.

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

Contemporary worksite wellness programs may be limited in their ability to produce significant long-term behavior change, in part, because they fail to adequately address important psychosocial issues related to health behaviors. Research has been done recently, for example, that demonstrates moderate relationships between psychosocial constructs, such as self-esteem and locus of control, and health behaviors. Another psychosocial construct receiving greater attention lately is spiritual health.~-5 Some believe that this construct is really a broader measure of self-esteem, locus of control, connectedness, and possibly other psychosocial variables. 6 Hawks 6 states that spiritual health might be defined as a "high level of faith, hope, and commitment in relation to a well-defined worldview or belief system that provides a sense of meaning and purpose to existence in general, and that offers an ethical path to personal fulfillment which includes connectedness to self, others and a higher power or larger reality." Attitudes of faith, hope, and commitment imply an internal locus of control, and following an ethical path that involves fulfillment, purpose, and meaning may lead to enhanced self-esteem and a sense of connectedness with self and others. In at least one study, correlations between connectedness, meaning and purpose, sense of coherence (well-defined worldview), and spiritual well-being were strong enough to support the premise that spiritual health may be a broader concept that encompasses some of these psychosocial variables (M. Hull, unpublished data, 1990). Little research has been done to determine if a relationship exists between spiritual health (sometimes called

This paper reports on an exploratory study into social capital and its influence on the development of horizontal export-focused industry clusters for small-to-medium enterprises (SMEs). The paper contends that higher levels of social capital within firms can be externalized to other firms in industry clusters, and this makes the cluster more effective in international markets. The study assessed the levels of social capital evident within nine individual SMEs based in South East Queensland, Australia, across three different industry clusters. The study evaluated attitudes of the firm towards its other cluster members and found that higher levels of social capital within individual SMEs, was being externalized to their industry cluster, and this helped the firms to develop long-term relationships, develop common objectives and improve levels of trust among members. Higher levels of exposure in international markets, was evident in such firms in the cluster.

Tracheostomy is associated with increased aspiration rates, and swallowing disorders have not been well-studied in trauma patients with tracheostomy. Swallowing evaluations were conducted in 224 patients (102 trauma and 122 nontrauma patients). Half of the patients in each group had tracheostomies. Bedside swallow studies were conducted in 40 patients, videofluoroscopy swallow studies in 100 patients, and both studies in 84 patients. χ2, Fisher's exact test, Cramer's V, and descriptive statistics were used for data analysis. Aspiration occurred in 35 per cent (36 of 102) of trauma patients with or without tracheostomy and in 36 per cent (22 of 61) of nontrauma patients with tracheostomy. Aspiration with and without penetration was observed in 54 per cent of trauma patients (55% with tracheostomy) compared with 67 per cent of all nontrauma patients (61% with tracheostomy). Trauma patients with head injuries exhibited 41 per cent (26 of 63) aspiration and 68 per cent (43 of 63) dysphagia compared with 26 per cent (10 of 39) and 59 per cent (23 of 39) in trauma patients with other injuries. There was a lower incidence of dysphagia in trauma patients (65% versus 81% in nontrauma) and in patients with tracheostomy (71% versus 77% without tracheostomy). Tracheostomy was not associated with increased dysphagia or aspiration.