This document outlines the steps for conducting a risk and opportunity analysis according to ISO 9001:2015. It involves systematically investigating and analyzing potential risks and their probabilities and consequences to prioritize actions. Key business processes are analyzed, along with external and internal issues and requirements of interested parties. A risk analysis tool is chosen and a ranking method is defined using severity and probability tables to determine risk levels and appropriate actions. Interested parties and their needs are also defined. The analysis is then carried out on identified key processes.
This chapter focuses on describing logistic regression classification. Logistic regression can be used to assign data points to a finite number of categories or predict the probability that a data point belongs to a particular category. Some key points to consider when selecting a classifier are choosing an appropriate classifier type, optimization method, loss function, feature extraction from data, and evaluation metrics. Constraints in selecting a classifier include execution time and model complexity.
In this module we will discuss :-
Setting shipping charges
Payout calculation
Maximum limits of shipping charges
Update shipping charges on seller panel
Market Research Report : Container logistics (cfs & icd) market in india 2015...Netscribes, Inc.
For the complete report, get in touch with us at: info@netscribes.com
Abstract :
Netscribes’ latest market research report titled Container Logistics (CFS & ICD) Market in India 2015 highlights the overall scenario of the container logistics market in India. Growth of Indian container traffic has led to the demand for transit facilities such as CFS and ICD, which offer services for containerization of break bulk cargo and also handles custom activities. CFS and ICD facilities are an integral component of the logistics sector infrastructure. India, being at the brim of experiencing heightened trade with emerging countries makes this market attractive segment that constitutes a growing asset in the EXIM supply chain. The market is set to expand predominantly owing to the growth in containerized cargo, improvement in custom clearance activities, higher margins in comparison to other logistics activities, and construction of dedicated freight corridor. Government initiatives in the form of allowance of 100% FDI in logistics sector, development of the port sector via Maritime Agenda-Vision 2020, investments in shipbuilding along with policies to invite private sector to build logistics parks and Free Trade Warehouse Zones (FTWZ) have provided the much needed impetus to the container logistics market in terms of space, planned assets and low cost superior services.
Poor infrastructure facility and high costs associated with setting up of CFS and ICD facilities are the basic challenges faced by the industry. However, continuous investments in major ports towards capacity creation and improving container handling efficiency have well added to the advantage of the market. Further analyzing the environmental perspective, container ships are the cleanest modes of transport for bulk cargo. Thus promotion of coastal shipping is a much desired trend. Focus on investment strategy and improving efficiency of container ports are the key strategies to expect a sustainable growth trajectory in the overall container logistics sector.
Table of Contents :
Slide 1: Executive Summary
Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2011-12 – 2014-15), Inflation Rate: Monthly (Jul 2013 – Dec 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly (Apr 2014 – Sep 2014)
Slide 4: Lending Rate: Annual (2011-12 – 2014-15), Trade Balance: Annual (2010-11 – 2013-14), FDI: Annual (2009-10 – 2012-13)
Introduction
Slide 8-12: Logistics Market Overview – India, Logistics Performance Indicator (2010 – 2014), Logistic Market Size & Growth (2013 – 2018e), Logistics Sector Segmentation based on Service Areas, Container Traffic Scenario in India, Containerization Levels – India vs. Global (2012-13), Container Logistics Segments, EXIM Services – Value Chain and Container Logistics Market – Supply Chain
This document outlines the steps for conducting a risk and opportunity analysis according to ISO 9001:2015. It involves systematically investigating and analyzing potential risks and their probabilities and consequences to prioritize actions. Key business processes are analyzed, along with external and internal issues and requirements of interested parties. A risk analysis tool is chosen and a ranking method is defined using severity and probability tables to determine risk levels and appropriate actions. Interested parties and their needs are also defined. The analysis is then carried out on identified key processes.
This chapter focuses on describing logistic regression classification. Logistic regression can be used to assign data points to a finite number of categories or predict the probability that a data point belongs to a particular category. Some key points to consider when selecting a classifier are choosing an appropriate classifier type, optimization method, loss function, feature extraction from data, and evaluation metrics. Constraints in selecting a classifier include execution time and model complexity.
In this module we will discuss :-
Setting shipping charges
Payout calculation
Maximum limits of shipping charges
Update shipping charges on seller panel
Market Research Report : Container logistics (cfs & icd) market in india 2015...Netscribes, Inc.
For the complete report, get in touch with us at: info@netscribes.com
Abstract :
Netscribes’ latest market research report titled Container Logistics (CFS & ICD) Market in India 2015 highlights the overall scenario of the container logistics market in India. Growth of Indian container traffic has led to the demand for transit facilities such as CFS and ICD, which offer services for containerization of break bulk cargo and also handles custom activities. CFS and ICD facilities are an integral component of the logistics sector infrastructure. India, being at the brim of experiencing heightened trade with emerging countries makes this market attractive segment that constitutes a growing asset in the EXIM supply chain. The market is set to expand predominantly owing to the growth in containerized cargo, improvement in custom clearance activities, higher margins in comparison to other logistics activities, and construction of dedicated freight corridor. Government initiatives in the form of allowance of 100% FDI in logistics sector, development of the port sector via Maritime Agenda-Vision 2020, investments in shipbuilding along with policies to invite private sector to build logistics parks and Free Trade Warehouse Zones (FTWZ) have provided the much needed impetus to the container logistics market in terms of space, planned assets and low cost superior services.
Poor infrastructure facility and high costs associated with setting up of CFS and ICD facilities are the basic challenges faced by the industry. However, continuous investments in major ports towards capacity creation and improving container handling efficiency have well added to the advantage of the market. Further analyzing the environmental perspective, container ships are the cleanest modes of transport for bulk cargo. Thus promotion of coastal shipping is a much desired trend. Focus on investment strategy and improving efficiency of container ports are the key strategies to expect a sustainable growth trajectory in the overall container logistics sector.
Table of Contents :
Slide 1: Executive Summary
Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2011-12 – 2014-15), Inflation Rate: Monthly (Jul 2013 – Dec 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly (Apr 2014 – Sep 2014)
Slide 4: Lending Rate: Annual (2011-12 – 2014-15), Trade Balance: Annual (2010-11 – 2013-14), FDI: Annual (2009-10 – 2012-13)
Introduction
Slide 8-12: Logistics Market Overview – India, Logistics Performance Indicator (2010 – 2014), Logistic Market Size & Growth (2013 – 2018e), Logistics Sector Segmentation based on Service Areas, Container Traffic Scenario in India, Containerization Levels – India vs. Global (2012-13), Container Logistics Segments, EXIM Services – Value Chain and Container Logistics Market – Supply Chain
Market Research Report : Freight forwarding market in india 2015 - SampleNetscribes, Inc.
For the complete report, get in touch with us at: info@netscribes.com
Abstract :
Netscribes’ latest market research report titled Freight Forwarding Market in India 2015 states that India is expected to witness considerable growth in freight market provided freight companies diversify their business to other logistic segments. The Indian freight market is rapidly being aided by improved warehousing infrastructure and growth in containerized cargo, which necessitates a robust freight network. Amongst the segments, air and sea freight together contribute maximum to the market in terms of value, however volume-wise they carry the minimum freight. Further inland water transportation has tremendous scope in the domestic market. An overall comparative analysis of the domestic transport sector highlights the modal composition in freight movement, with road being the dominant mode of transport and indicates the advantages of coastal shipping and inland water transport. Global comparison of the same highlights that the Indian transportation sector has tremendous scope to improvise, invest and improve on in order to exploit the potentials of the freight market.
The current market is largely mulled by rising freight costs due to volatile fuel prices, lack of skilled manpower and infrastructural bottlenecks. However, a surge of government initiatives in the form of National Highways Development Project (NHDP), Special Accelerated Road Development Program in North East (SARDP-NE) and Left Wing Extremism (LWE) in the road sector, development of Dedicated Freight Corridor of Indian Railways, port sector initiatives and shift to GST regime are providing the necessary impetus to the freight industry. Emergence of EDI platform, UPLIFT - universal platform for logistics & integrated freight transport and 4S eTrans built on J2EE platform is some recent technology trends in the freight industry. Focus on emerging trade lines and diversifying business portfolio to multiple logistics segments are the key strategies to expect a sustainable growth trajectory in the sector.
Table of Contents :
Slide 1: Executive Summary
Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2011-12 – 2014-15), Inflation Rate: Monthly (Jul 2013 – Dec 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly (Apr 2014 – Sep 2014)
Slide 4: Lending Rate: Annual (2011-12 – 2014-15), Trade Balance: Annual (2010-11 – 2013-14), FDI: Annual (2009-10 – 2012-13)
Introduction
Slide 8-14: Evolution of the Freight Forwarder, Freight Forwarding – Supply Chain Integration, Freight Forwarding – Definition and Types, Freight Forwarding – Value Chain, Freight Forwarding – Service Areas, Freight Forwarders – Streams of Income,
Market Overview
Slide 16-24: Asia – Pacific Market Overview, Logistics Market Overview – India, Logistics Performance Indicator (2010 – 2014), Logistic Market Size & Growth (2013 – 2018e)
Market Research Report : Shipping and port market in india 2014 - SampleNetscribes, Inc.
For the complete report, get in touch with us at: info@netscribes.com
Abstract:
Netscribes’ latest market research report titled Shipping and Port Market in India 2014 states that the Indian shipping sector is expected to witness a major growth due to the rapid increase in economic activities and increased EXIM trade. The Indian shipping sector comprises of the coastal shipping, ship building and ship repair industries, whereas the port sector consists of the major and non-major ports. Shipping and port industry is one of the major industries in India and has always been a major area of focus for the Indian government. It plays a crucial role in the development of the Indian economy. Coastal shipping is an important part of the shipping industry with immense potential to grow. The industry is still in its nascent stage wherein the government is taking steps to promote it.
Significant increase in economic activities and favorable initiatives taken by the government and investment from both the public and private sector is helping in the growth of the Indian ports industry. The major drivers propelling the growth of the market are increase in imports of coal, oil, iron-ore and food grains. But at the same time the industry is plagued with some challenges including, increased competition in terms of ship building from China and Korea and oversupply of tonnage. Overall the industry is showing a favorable growth rate and is expected to grow in the coming decade.
Coverage
• Overview of the shipping and port sector in Indiaand forecasted shipbuilding market sizeover 2013 to 2018e
• Active government initiatives encouraging the shipping and port sector in the country
• Qualitative analysis of the major drivers and challenges affecting the market
• Analysis of the competitive landscape and detailed profiles of majorplayers
Table of Contents:
Slide 1: Executive Summary
Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2011-12– 2014-15), Inflation Rate: Monthly (Jul 2013 – Dec 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly(Apr 2014 – Sep 2014)
Slide 4: Lending Rate: Annual (2011-12 – 2014-15), Trade Balance: Annual(2010-11– 2013-14), FDI: Annual (2009-10 – 2012-13)
Introduction
Slide 5: Shipping and Port Industry – Segments
Slide 6: Shipping Vessels (2012 and 2013)
Market Overview
Slide 7: Shipping – Overview, Growth of Indian Tonnage (2011 – 2013), Indian Overseas Seaborne Trade (1999-00 and 2012-13)
Slide 8: Coastal Shipping – Overview, Number of Coastal Vessels (2010 – 2013), Capacity of Coastal Vessels (2010 – 2013)
Slide 9: Shipbuilding – Overview, Market Size of Shipbuilding (2013 – 2018e), Shipbuilding No and Capacity (2011-12 and 2012-13)
Slide 10: Ship Repair – Overview, Market Share and Size (India and Rest of the World), Number of Ships Repaired (2009 – 2012)
Slide 11-12: Trends observed in the market
Sli
The Indian shipping industry plays an important role in India's economy as 90% of its international trade is conducted by sea. India has over 1000 ships engaged in coastal and overseas trade. The top shipping companies control 70% of total tonnage, while many smaller companies have just 1-2 ships. India has a long coastline and over 200 ports, with Mumbai being the largest handling 50% of exports. Major reforms are underway to modernize India's shipping industry and ports to better support the country's trade and economic growth.
The customer journey could essentially be divided into 7 elements. We’ll touch upon the issue of ‘Privacy’ and how one balance social and commercial value. Practical examples of
customer analytics at its best will be discussed as well as the importance of the eco-system.
Building an enduring, multi-billion dollar consumer technology company is hard. As an investor, knowing which startups have the potential to be massive and long-lasting is also hard. From both perspectives, identifying companies with this potential is a combination of “art” and “science” — the art is understanding how products work, and the science is knowing how to measure it. At the earliest stages of a company, it comes down to understanding how a product is built to maximize and leverage user engagement.
In this presentation, Sarah Tavel shares her "Hierarchy of Engagement" framework she uses to evaluate non-transactional consumer companies she is looking to invest in.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
Safety of Mebendazole Use During Lactationmothersafe
This case series study evaluated the safety of mebendazole use in 45 lactating women and their infants. Mebendazole was administered using single or repeated doses and was well tolerated by both the mothers and infants, with no adverse effects observed in infants. Mild GI irritability occurred in two treated mothers. This study provides the first evidence that mebendazole is safe for use in breastfeeding.
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
(마더리스크라운드) Thyroid disease in pregnancy 임신 중 갑상선mothersafe
This study examined pregnancy outcomes for women exposed to antithyroid medications or levothyroxine for thyroid disorders. The study found that infants of mothers treated for hyperthyroidism with antithyroid medications were more likely to be born preterm or with low birth weight. However, treatment of hypothyroidism with levothyroxine did not negatively impact birth outcomes and showed no increased risk of infant mortality. Additionally, the study found no evidence that levothyroxine exposure increased the risk of major congenital anomalies.
Diclectin in NVP, 44th 유럽기형학회보고 / 한정열 교수mothersafe
This document summarizes a presentation on making a difference as concerned scientists in an environmentally contaminated world. It discusses how scientists have identified problems like chemical pollution and investigated effects on human health. It provides examples like Rachel Carson's Silent Spring which brought attention to pesticide impacts and led to regulations. Endocrine disrupting chemicals can alter fetal development with impacts like reduced intelligence only appearing later. The document then summarizes several talks on topics like the impacts of maternal health conditions like diabetes and epilepsy during pregnancy, using the human placenta to test chemical safety, prenatal metal exposure and DNA methylation in the placenta, free fetal hemoglobin as a potential cause and target for preeclampsia, and revising guidelines
Maternal smoking during pregnancy was associated with an increased risk of major malformations in newborns. A study of over 2000 pregnancies found the risk of major malformations was 3.3 times higher for babies exposed to maternal smoking compared to non-exposed babies. Paternal smoking was also high among the smoking mothers, occurring in over 60% of smoking mothers compared to 38% of non-smoking mothers. Exposure to alcohol and lower education levels were also associated with increased risk of maternal smoking during pregnancy.
Market Research Report : Freight forwarding market in india 2015 - SampleNetscribes, Inc.
For the complete report, get in touch with us at: info@netscribes.com
Abstract :
Netscribes’ latest market research report titled Freight Forwarding Market in India 2015 states that India is expected to witness considerable growth in freight market provided freight companies diversify their business to other logistic segments. The Indian freight market is rapidly being aided by improved warehousing infrastructure and growth in containerized cargo, which necessitates a robust freight network. Amongst the segments, air and sea freight together contribute maximum to the market in terms of value, however volume-wise they carry the minimum freight. Further inland water transportation has tremendous scope in the domestic market. An overall comparative analysis of the domestic transport sector highlights the modal composition in freight movement, with road being the dominant mode of transport and indicates the advantages of coastal shipping and inland water transport. Global comparison of the same highlights that the Indian transportation sector has tremendous scope to improvise, invest and improve on in order to exploit the potentials of the freight market.
The current market is largely mulled by rising freight costs due to volatile fuel prices, lack of skilled manpower and infrastructural bottlenecks. However, a surge of government initiatives in the form of National Highways Development Project (NHDP), Special Accelerated Road Development Program in North East (SARDP-NE) and Left Wing Extremism (LWE) in the road sector, development of Dedicated Freight Corridor of Indian Railways, port sector initiatives and shift to GST regime are providing the necessary impetus to the freight industry. Emergence of EDI platform, UPLIFT - universal platform for logistics & integrated freight transport and 4S eTrans built on J2EE platform is some recent technology trends in the freight industry. Focus on emerging trade lines and diversifying business portfolio to multiple logistics segments are the key strategies to expect a sustainable growth trajectory in the sector.
Table of Contents :
Slide 1: Executive Summary
Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2011-12 – 2014-15), Inflation Rate: Monthly (Jul 2013 – Dec 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly (Apr 2014 – Sep 2014)
Slide 4: Lending Rate: Annual (2011-12 – 2014-15), Trade Balance: Annual (2010-11 – 2013-14), FDI: Annual (2009-10 – 2012-13)
Introduction
Slide 8-14: Evolution of the Freight Forwarder, Freight Forwarding – Supply Chain Integration, Freight Forwarding – Definition and Types, Freight Forwarding – Value Chain, Freight Forwarding – Service Areas, Freight Forwarders – Streams of Income,
Market Overview
Slide 16-24: Asia – Pacific Market Overview, Logistics Market Overview – India, Logistics Performance Indicator (2010 – 2014), Logistic Market Size & Growth (2013 – 2018e)
Market Research Report : Shipping and port market in india 2014 - SampleNetscribes, Inc.
For the complete report, get in touch with us at: info@netscribes.com
Abstract:
Netscribes’ latest market research report titled Shipping and Port Market in India 2014 states that the Indian shipping sector is expected to witness a major growth due to the rapid increase in economic activities and increased EXIM trade. The Indian shipping sector comprises of the coastal shipping, ship building and ship repair industries, whereas the port sector consists of the major and non-major ports. Shipping and port industry is one of the major industries in India and has always been a major area of focus for the Indian government. It plays a crucial role in the development of the Indian economy. Coastal shipping is an important part of the shipping industry with immense potential to grow. The industry is still in its nascent stage wherein the government is taking steps to promote it.
Significant increase in economic activities and favorable initiatives taken by the government and investment from both the public and private sector is helping in the growth of the Indian ports industry. The major drivers propelling the growth of the market are increase in imports of coal, oil, iron-ore and food grains. But at the same time the industry is plagued with some challenges including, increased competition in terms of ship building from China and Korea and oversupply of tonnage. Overall the industry is showing a favorable growth rate and is expected to grow in the coming decade.
Coverage
• Overview of the shipping and port sector in Indiaand forecasted shipbuilding market sizeover 2013 to 2018e
• Active government initiatives encouraging the shipping and port sector in the country
• Qualitative analysis of the major drivers and challenges affecting the market
• Analysis of the competitive landscape and detailed profiles of majorplayers
Table of Contents:
Slide 1: Executive Summary
Macroeconomic Indicators
Slide 2: GDP at Factor Cost: Quarterly (2011-12– 2014-15), Inflation Rate: Monthly (Jul 2013 – Dec 2013)
Slide 3: Gross Fiscal Deficit: Monthly (Feb 2013 – Jul 2013), Exchange Rate: Half Yearly(Apr 2014 – Sep 2014)
Slide 4: Lending Rate: Annual (2011-12 – 2014-15), Trade Balance: Annual(2010-11– 2013-14), FDI: Annual (2009-10 – 2012-13)
Introduction
Slide 5: Shipping and Port Industry – Segments
Slide 6: Shipping Vessels (2012 and 2013)
Market Overview
Slide 7: Shipping – Overview, Growth of Indian Tonnage (2011 – 2013), Indian Overseas Seaborne Trade (1999-00 and 2012-13)
Slide 8: Coastal Shipping – Overview, Number of Coastal Vessels (2010 – 2013), Capacity of Coastal Vessels (2010 – 2013)
Slide 9: Shipbuilding – Overview, Market Size of Shipbuilding (2013 – 2018e), Shipbuilding No and Capacity (2011-12 and 2012-13)
Slide 10: Ship Repair – Overview, Market Share and Size (India and Rest of the World), Number of Ships Repaired (2009 – 2012)
Slide 11-12: Trends observed in the market
Sli
The Indian shipping industry plays an important role in India's economy as 90% of its international trade is conducted by sea. India has over 1000 ships engaged in coastal and overseas trade. The top shipping companies control 70% of total tonnage, while many smaller companies have just 1-2 ships. India has a long coastline and over 200 ports, with Mumbai being the largest handling 50% of exports. Major reforms are underway to modernize India's shipping industry and ports to better support the country's trade and economic growth.
The customer journey could essentially be divided into 7 elements. We’ll touch upon the issue of ‘Privacy’ and how one balance social and commercial value. Practical examples of
customer analytics at its best will be discussed as well as the importance of the eco-system.
Building an enduring, multi-billion dollar consumer technology company is hard. As an investor, knowing which startups have the potential to be massive and long-lasting is also hard. From both perspectives, identifying companies with this potential is a combination of “art” and “science” — the art is understanding how products work, and the science is knowing how to measure it. At the earliest stages of a company, it comes down to understanding how a product is built to maximize and leverage user engagement.
In this presentation, Sarah Tavel shares her "Hierarchy of Engagement" framework she uses to evaluate non-transactional consumer companies she is looking to invest in.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
Safety of Mebendazole Use During Lactationmothersafe
This case series study evaluated the safety of mebendazole use in 45 lactating women and their infants. Mebendazole was administered using single or repeated doses and was well tolerated by both the mothers and infants, with no adverse effects observed in infants. Mild GI irritability occurred in two treated mothers. This study provides the first evidence that mebendazole is safe for use in breastfeeding.
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
(마더리스크라운드) Thyroid disease in pregnancy 임신 중 갑상선mothersafe
This study examined pregnancy outcomes for women exposed to antithyroid medications or levothyroxine for thyroid disorders. The study found that infants of mothers treated for hyperthyroidism with antithyroid medications were more likely to be born preterm or with low birth weight. However, treatment of hypothyroidism with levothyroxine did not negatively impact birth outcomes and showed no increased risk of infant mortality. Additionally, the study found no evidence that levothyroxine exposure increased the risk of major congenital anomalies.
Diclectin in NVP, 44th 유럽기형학회보고 / 한정열 교수mothersafe
This document summarizes a presentation on making a difference as concerned scientists in an environmentally contaminated world. It discusses how scientists have identified problems like chemical pollution and investigated effects on human health. It provides examples like Rachel Carson's Silent Spring which brought attention to pesticide impacts and led to regulations. Endocrine disrupting chemicals can alter fetal development with impacts like reduced intelligence only appearing later. The document then summarizes several talks on topics like the impacts of maternal health conditions like diabetes and epilepsy during pregnancy, using the human placenta to test chemical safety, prenatal metal exposure and DNA methylation in the placenta, free fetal hemoglobin as a potential cause and target for preeclampsia, and revising guidelines
Maternal smoking during pregnancy was associated with an increased risk of major malformations in newborns. A study of over 2000 pregnancies found the risk of major malformations was 3.3 times higher for babies exposed to maternal smoking compared to non-exposed babies. Paternal smoking was also high among the smoking mothers, occurring in over 60% of smoking mothers compared to 38% of non-smoking mothers. Exposure to alcohol and lower education levels were also associated with increased risk of maternal smoking during pregnancy.
This document summarizes guidelines and studies on screening and management of subclinical hypothyroidism during pregnancy. Key points include:
- Guidelines from thyroid societies recommend trimester-specific reference ranges for TSH and treatment of SCH with levothyroxine.
- Studies show mixed results on associations between SCH and adverse pregnancy/child outcomes, and limited benefits of levothyroxine treatment.
- Targeted high-risk screening misses a significant percentage of women with thyroid dysfunction compared to universal screening.
- While evidence is still limited, most experts recommend universal screening to detect and treat overt hypothyroidism given potential benefits.
This document provides information about external cephalic version (ECV):
1. ECV is a procedure performed near term to manually turn a breech baby into a head-down position. The success rate of ECV is reported between 35-86%.
2. ECV has been performed since ancient times but was improved in the 1970s by performing it under tocolysis after screening with ultrasound and fetal monitoring. Recent studies show ECV effectively reduces non-cephalic births and C-sections for malpresentation.
3. Guidelines from obstetric organizations recommend offering ECV to women with a breech fetus near term due to evidence it can reduce C-sections. Factors like adequate amni
1. Proper management of diabetes before and during pregnancy is important to reduce risks of complications. Tight glucose control through medical nutrition therapy, exercise, and insulin treatment can decrease risks of fetal anomalies and growth issues.
2. Gestational diabetes is diagnosed through an oral glucose tolerance test and treated with lifestyle changes and possibly insulin to control blood glucose. Women with a history of GDM require follow up after pregnancy to screen for diabetes.
3. Preconception counseling and care is crucial for women with pre-existing diabetes to optimize health before pregnancy in order to lower risks during pregnancy through strict glucose monitoring and management.
This document discusses alcohol intake during pregnancy and fetal alcohol spectrum disorders (FASD). It provides statistics on alcohol use during pregnancy from various studies. It notes that a safe level of alcohol during pregnancy has not been determined, as the effects of alcohol on the fetus are variable depending on factors like the mother's metabolism and drinking patterns. Low to moderate prenatal alcohol exposure has not shown effects in some studies, but other research has found children with FAS even with reported low alcohol intake. The document describes clinical features of FASD including facial abnormalities, growth issues, central nervous system anomalies, and functional impairments. It discusses diagnostic criteria from various organizations and guidelines for diagnosing FASD.
3. 질풍노도의 시기
호르몬의 변화
신체상의 변화
역할 혼란
대인관계 중요성 상승
여성호르몬의 급격한 변화
임신중 / 산후의 몸의 변화
나에서 엄마로, 직업상태변동
부부 갈등, 대인관계 제한
4. 임산부 우울증의 현황
산후우울증의 유병율: 10-20%
산후 12개월 내 정신과 질환: 25.3% (미국)
임산부의 25-35%가 우울증상을 호소
7-13%가 주요 우울장애의 진단기준에 충족
산후우울증 → 주산기 우울증 (DSM 5, 2013)
Major depressive disorder, postpartum onset (출산 4주 이내 발생
한 우울증)
→ peripartum onset (임신기간 및 출산 4주 이내 발생한 우울증)
5. 주산기 우울증의 Risk Factors
- 기존 연구 결과
인구학적요인: 낮은 연령, 낮은 교육 수준, 낮은 경제수준, 파
트너의 부재(싱글맘), 보험종류, 직업
산과력: 많은 자녀 수, 유산/사산 횟수, 계획하지 않은 임신,
원치 않은 임신
과거력: 우울증의 과거력, 흡연
정신사회적요인: 부족한 사회적 지지, 생활 스트레스, 불안,
가정폭력,
국내 연구결과 (산후우울증을 대상으로 )
낮은 사회경제적상태
경산부
배우자의 지지 부족, 임신기의 스트레스
20. Risk Management
Greater challenges exist for Peripartum depression
조정할 수 있는 것과 할 수 없는 것의 가지치기
분야 선정된 위험요인 후보 (Probable risk factors)
역학 나이, 체중/BMI, 결혼상태, 직업상태, 가계소득, 학력
흡연음주력, 가족력, 과거력 가족력, 과거력
산과력 GPLDA, 계획임신여부, 입덧, 절박유산
정신사회적 요인 신체활동, 생활스트레스
21. Risk Management
체중관리 : 산전체중관리, 임신중 적정체중증가
신체활동: ‘가벼운 활동’이 권장
10분 이상 걷기
사무, 관리, 기술직 종사자, 가사일이 적은 주부 : 직업활동은 긍정적 효과
스트레스
가정문제: 배우자와의 관계 (가장 중요), 자녀와의 관계(보육), 시댁과의 관계,
친정과의 관계
신체관련 스트레스: 목욕, 거동과 같은 문제
주의를 기울일 집단
경산부, 계획하지 않은 임신
입덧이 심하거나 절박유산이 있었던 경우
저소득층, 현재 직업이 없는 경우, 현재 배우자가 없는 경우
22. Risk Management
배우자 참여의 중요성
신체활동, 직업활동, 대인관계충족의 동시 향상
함께 면담을 온 것 만으로도 효과
Promoting Motivation
It Timing!
환자 심리와 비슷한 임산부의 심리
퇴행, 자신감이 적어지고, 불안, 서운함
Stress- Obstetrical Complication간의 관련성
Mother-child relationship에 엄마의 자존감이 중요
Editor's Notes
산후의 체중잔류와 비만 문제에 대해서 우울이 어떻게 영향을 주고, 또 받는지에 대해서 리뷰하고자 합니다. 그리고 이어서 연구데이터를 토대로 산모에서의 비만과 임신중/산후우울증간의 관련성을 소개하고자 합니다.
2014년 산모 평균 출산 연령 서울 32.47세, 전국 31.84세
한국기준이 서양기준보다 커트라인이 낮아 1분기 %가 높은 경향이 있음.
국내 기존연구(임신기간 총합 약26.5%, 2009년 최세경 등) / 서양연구 (12%내외)
아마도 p value가 0.001이하인 변수를 파란색으로 표시하신 듯 합니다만, 위험도 분석에서는 adjusted OR이 더 중요시 되어 그 기준으로 다시 표시를 하였습니다^^
현재 기혼 상태가 아니면 임신중 우울증 발생의 위험도가 2.3배
현재 직업이 없을 경우 우울증 발생 위험도는 1.3배
가계소득이 300만원 미만인 집단이 500만원 이상인 집단에 비해 위험도가 1.9배 상승하는 것으로 나타났다.
=> odds ratio가 가장 큰 요인은 결혼여부로, 혼전임신상태 또는 결혼상태의 깨어짐이 산모의 우울을 유발하는 데 가장 크게 기여하는 역학적 요인으로 보인다.
각종 과거력 요인에서는,
본인이 우울증을 앓았던 적이 있을 경우 임신중 우울증 발생 위험도가 3.2배 상승하였으며,
당뇨가 있을 경우 2.8배, 우울증 가족력이 있을 경우 2.5배 임신중우울증의 위험도가 상승하였다.
산과력 중에서는, 인공유산의 과거력이 있을 경우 현재 임신중 우울이 발생할 위험도가 2.1배 상승하였으며,
임신1분기에 입덧이 있는 산모가 없는 산모에 비해 1.5배 위험도가 높은 것으로 나타났다.
다음은 스트레스 측정 척도의 문항을 통해 정신사회적 위험요소를 영역별로 분석한 결과이다.
실생활 문제에서 유의미한 위험 요인은 자녀보육, 주거, 재정 문제로 이 중 재정문제가 있을 경우 우울증위험도가 1.9배로 가장 높게 상승되었다.
가정문제 중에서는 배우자와의 문제가 있을 경우 우울증 위험도가 3.6배, 시댁과의 문제가 있을 경우 위험도가 1.8배로 유의미하게 상승하였다.
정서문제 항목은 우울증과 연관된 단어들로, 산모가 이러한 단어로 문제를 호소할 경우 모두 우울증의 위험도가 올라감을 알 수 있으며 가장 위험도가 높은 단어는 “우울함” 이었다.
** 배우자와의 문제는 “우울함”이라는 정서 단어를 제외하면 3.6배로 가장 위험도가 높게 나타난 요인이다.
신체문제 중 유의미하게 임신중 우울의 발생 위험을 높이는 요인은 거동, 소화불량, 기억력, 피부건조/가려움, 수면, 손발쑤심이었다.
이 중 기억력과 수면 문제는 우울증의 증상이므로 예상가능한 부분이나, 나머지 거동, 소화불량, 피부건조, 손발쑤심의 신체문제는 정서문제로도 발전할 수 있는 불편들이므로 더욱 관심을 요한다 하겠다.
