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PubMed1990

Prenatal education outcomes for pregnant adolescents and their infants using trained volunteers.

This study evaluated the effects of lessons taught by trained nonprofessional volunteers in community prenatal clinics. Project participants (n = 210) and comparison subjects (n = 189) were pregnant women, aged 18 years or younger. Participants were divided according to those who attended eight or more lessons (high treatment, n = 94) and those who attended fewer lessons (n = 116). A system of rewards for attendance was used. The number of prenatal visits was significantly different between the three groups (p less than 0.001), with the high-treatment participants having a significantly greater number of visits than the other groups. The groups differed on gestational age at delivery (p less than 0.006), favoring the infants of high-treatment participants; however, only 8% of gestational age variance was attributable to prenatal visits. A significantly greater proportion of high-treatment participants returned for postpartum care (p less than 0.011 vs. low-treatment participants, p less than 0.002 vs. comparison subjects). Postpartum return was not improved by a hospital visit by a volunteer. Regardless of treatment, most (99%) accepted a contraceptive method at their postpartum visit. The groups did not differ on their return for method check at 3 months. However, a significantly greater proportion of the high-treatment participants returned for an annual family planning evaluation (p less than 0.015 vs. low-treatment participants, p less than 0.005 vs. comparison subjects). Both the high- and low-treatment participants differed significantly from the comparison subjects on having taken their infants for at least one well-child visit during the first year (p less than 0.001 for both tests).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Improving breastfeeding support: a community health improvement project.

BACKGROUND: Because of the brevity of the postpartum hospital stay, mothers and their newborns are discharged home before breastfeeding is well established. In 1992, feedback from patients who had given birth at Fletcher Allen Health Care (Burlington, VT) suggested a need for more consistent, expert, and timely assistance with breastfeeding in the hospital and better continuity of care during the first few weeks at home. QUALITY IMPROVEMENT TEAM: In 1993 a team developed objectives, analyzed the problem and possible solutions, and made eight recommendations on how the hospital could do more to promote breastfeeding. Implementation by team members and hospital staff included policy development, staff education, acquisition of funding, a visiting professorship, development of a lactation consultant coordinator and team, and patient surveys to evaluate the program. A late 1994 survey of 63 postpartum patients on their day of discharge indicated a high level of satisfaction with breastfeeding support in the hospital. CURRENT STATUS: Activities are being undertaken for lactation consultation coverage, further policy development, implementation of nurse competency validation, improved patient and family education materials, and continued evaluation of the breastfeeding support program through patient surveys. CONCLUSION: In the face of barriers such as the project's large scope, a paucity of internal team members, and a large number and variety of recommendations, some of the recommendations and follow-up plans have yet to be implemented. Yet the project has yielded improvements in care and provides a model of how hospitals can expand their traditional boundaries of care and quality improvement into community health issues.

Breast Feeding↗
PubMedDate not supplied

One-stop shopping: description of a model program to provide primary care to substance-abusing women and their children.

Primary care services were developed to provide comprehensive women's health and pediatric care to substance-abusing women and their children in a substance abuse treatment program. A pediatric nurse practitioner and a certified nurse mid-wife functioned in collaborative roles with the objective of providing women and their children better access to health services. Data were collected on intake on general health maintenance, birth variables, and parenting education. Findings that were consistent with current research literature included better outcomes at birth for women who received prenatal care, up-to-date health maintenance visits, and improved immunization rates. An increase in relapse was noted for women during the postpartum period. Through a structured parenting education program women were found to have improved parenting skills. Women in drug treatment respond positively to a collaborative comprehensive model of practice. Many women who left the program continued to bring their children to the pediatric nurse practitioner for health care.

Adolescent↗
PubMed2005

Cervical cytological screening and management in pregnant and postpartum women.

OBJECTIVE: To examine and follow up cervical cytology of pregnant and postpartum women and study their cytopathologic characteristics, so as to determine screening and managing programs for abnormal cervical cytology. METHODS: Totally 5296 patients in pregnancy and postpartum, in which 3729 by computer-assisted cytology test and 1567 by liquid-based monolayers cytology test, were examined and diagnosed by the Bethesda System made in 2001. Those proven epithelial abnormalities patients were followed up until the lesions regressed to normal. The remaining patients, who exhibited persistent abnormalities or progression, were given further examinations. RESULTS: The positive rate of cervical cytological test was 8.72% (462/5296), including squamous carcinoma (SCA) 1 case (0.02%), high grade squamous intraepithelial lesion (HSIL) 34 cases (0.64%), low grade squamous intraepithelial lesion (LSIL) 145 cases (2.74%), atypical glandular cells (AGC) 5 cases (0.09%), atypical squamous cells cannot exclude HSIL (ASC-H) 14 cases (0.26%), atypical squamous cells of undetermined significance (ASC-US) 263 cases (4.97%). The 419 proven cytological abnormality cases were followed up successfully. The total transnegative rate in three months was 73.74% (309/419), in which 303 cases (72.32%) persisted normal status for more than six months after regression. And the transnegative rate of ASC-US, ASC-H, AGC, LSIL, and HSIL were 79.56%, 64.29%, 100%, 72.14% and 44.12%, respectively. Forty-six cases received biopsy directed by colposcopy. The distribution of coincidence of cytopathologic and histopathologic diagnosis was: SCA 1 case (100%), HSIL 10 cases (76.92%), LSIL 13 cases (65%), ASC-H 2 cases (50%), ASC-US 3 cases (37.50%), total 29 cases (63.04%). CONCLUSIONS: We should cast more attention to screening cervix lesions in pregnant and postpartum women. Their cytopathologic characteristics are liable to make the clinician give a false positive diagnosis. So we propose to follow up them closely and to lower the indication of biopsy.

Adult↗
PubMed1986

What is the relationship between postpartum withdrawal from school and repeat pregnancy among adolescent mothers?

An association between the failure of teenage mothers to return to school postpartum and rapid repeat pregnancy (recidivism) has been described. We report the postpartum education pursuits and contraceptive practices of 29 teenage mothers. Our data, together with the literature, suggest that with close postpartum follow-up, young mothers who are not motivated to return to school following delivery can effectively postpone pregnancy.

Adolescent↗
PubMed2004

A community health center smoking-cessation intervention for pregnant and postpartum women.

OBJECTIVES: To evaluate the effect of a provider counseling and office systems intervention in obstetric, pediatric, and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics on smoking and relapse rates in pregnant and postpartum women. METHODS: Five community health centers were randomized to special intervention (SI) or usual care (UC). Subjects (n =601) were current smokers or had quit with pregnancy. Prenatal and postpartum interviews assessed smoking status and related factors. Data were collected between May 1997 and November 2000. RESULTS: There was a statistically significant difference in 30-day abstinence rates between SI (26%) and UC (12%) conditions at the end of pregnancy among women who had not quit spontaneously with pregnancy (odds ratio [OR]=2.57, p =0.05). This effect remained at 1 month postpartum but was lost at 3- and 6-month postpartum follow-ups. CONCLUSIONS: Brief interventions delivered by healthcare providers during routine prenatal care increased smoking abstinence during pregnancy among women who did not quit spontaneously. Interventions extended into postpartum care did not affect relapse and smoking rates postdelivery.

Adult↗
PubMed2007

Prevalence and risk factors for postpartum anovulatory condition in dairy cows.

The objectives of this research were to determine the prevalence of the anovulatory condition within a temperate region of North America and identify cow-level and herd-level risk factors for this condition. A total of 1,341 cows from 18 herds were classified as cycling or anovular based on skim milk progesterone concentration determined at 46 and 60 +/- 7 d in milk. Calving history, periparturient disease incidence, body condition score, milk ketone concentration in the first 2 wk of lactation, and first 305-d mature-equivalent milk projections were recorded. Reproductive and culling information was retrieved monthly from the Dairy Herd Improvement Association. The cow-level prevalence of anovulation was 19.5%, with a herd-specific range from 5 to 45%. Accounting for the effect of clustering at the herd level, cows experiencing a difficult calving, cows with twin calvings, displaced abomasum, and cows with subclinical ketosis in the first week after calving were at greater risk for diagnosis of anovulation. Anovular cows within herds using ovulation synchronization programs were inseminated at the same time postpartum with a 6-percentage point reduction in the probability of pregnancy relative to cycling herdmates (29.7 vs. 35.9%, respectively), whereas anovular cows in herds breeding based on observed estrus were inseminated 8 d later and suffered a 10-percentage point reduction in the probability of pregnancy at first insemination (20.3 vs. 30.5). Time to pregnancy was delayed in anovular cows by 30 d (156 vs. 126 d). Using survival analysis, the impact of anovulation decreased with time. The daily probability of pregnancy (hazard ratio) was similar to cycling cows by 165 d in milk. The results underline the important associations of peripartum health with reproductive function and performance.

Animals↗
PubMed1993

A group psychotherapy approach to postpartum depression.

In this article, the current knowledge of postpartum depression is reviewed, leading to an understanding of this form of depression as an expression of psychosocial factors compounded by the biological changes of the puerperium. A rationale for treating women in the context of the postpartum period is described. A novel approach to treatment is presented. The treatment uses the medium of group psychotherapy to administer interventions. The interventions are introduced in three phases across six months in weekly group sessions. The systematic intervention program focuses on decreasing four symptoms common to postpartum depression: depressed feelings, anxiety, distress, and low self-esteem. Spouses are involved in the treatment plan from the onset, participating in assessment sessions and in a couples group.

Adult↗
PubMed1990

Incentives and their influence on appointment compliance in a teenage family-planning clinic.

The purpose of this study was to ascertain whether or not the family-planning compliance patterns of indigent adolescents could be influenced by various types of incentives. From February 1988 through January 1989, 534 postpartum inner city teenagers, aged 12-19, who delivered at a large city-county public hospital, participated. Teens were randomly assigned to two treatment groups that either offered a coupon for milk for the infant or a gift for the teenage mother if they returned for their postpartum visit 4-6 weeks after delivery. A third group, which used no incentive for appointment keeping, acted as a control. Although overall compliance was low, a significant relationship was found between type of program incentive and compliance outcome. The program using milk coupons as an incentive had the best compliance rate. This incentive appeared to be most effective with black adolescents. Such incentive programs, although not without controversy, offer a potential way to enhance postpartum contraceptive appointment-keeping compliance in a high-risk population.

Adolescent↗
PubMed1989

Fertility, menstrual characteristics, and contraceptive practices among white, black, and Southeast Asian refugee adolescents.

This study compares fertility and menstrual characteristics and contraceptive practices of white, black, and Southeast Asian refugee adolescents participating in the Minneapolis Health Department's Maternal and Infant Care Program between 1980 and 1982. Mean ages were similar among all racial groups; however, half the Hmong adolescents had a live birth as compared to less than 25% of the other racial groups. More than 75% of the Hmong and other Southeast Asian adolescents were married as compared to 11% of the whites and 8% of the blacks. Menarche was significantly later (2 years) for Hmong and other Southeast Asians, and the interval between menarche and first pregnancy was significantly shorter for the Hmong. While more than half of the whites and blacks previously used contraception, 14% of the Hmong and 29% of the other Southeast Asians had used contraception. Oral contraceptives were the most frequently used method for whites, blacks, and Southeast Asians; the Hmong were equally likely to choose oral contraceptives or barrier methods. The Hmong were less likely to choose contraception postpartum than were the other groups.

Adolescent↗
PubMed1997

An assessment of the use and impact of ancillary prenatal care services to Medicaid women in managed care.

OBJECTIVES: Managed care plans under Medicaid are becoming a usual source of care for low-income pregnant women. This study describes an ancillary prenatal care service intervention developed by one managed care organization (MCO) for Medicaid-enrolled women, assesses the extent to which the intervention services were used, and appraises the influence of the intervention on prenatal care participation. METHOD: There were 226 intervention and 258 control women with a single live birth delivered between 28 and 44 weeks gestation who (1) were enrolled in the MCO's Medicaid program, (2) were high-risk based on a prenatal risk assessment, and (3) started prenatal care prior to 26 weeks gestation. Less than adequate and intensive prenatal care utilization were chosen as intervention outcomes measures. RESULTS: Family planning, a 2-month postpartum baby visit, a maternal postpartum visit, and a WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) referral were among the most self-selected intervention services for this population; home health aide and breast-feeding support were the least requested services. Over 90% of those needing family planning or breast-feeding services received the services, while over 20% of the intervention group refused child care, food assistance and family violence referrals, and home health aide and smoking cessation services. The intervention group had a significantly lower risk of less than adequate utilization of prenatal care (OR = .32; 95% CI: 0.17-0.60) and was more likely to have an intensive number of prenatal care visits (OR = 1.61; 95% CI: 1.05-2.48). CONCLUSIONS: The ability of managed care organizations to provide ongoing prenatal care to Medicaid populations in a cost-effective manner depends partly on their development of packages of prenatal services that foster positive preventive health care utilization behaviors and good pregnancy outcomes. The results of this project suggest that the intervention was beneficial in the area of improving utilization of prenatal care.

Adolescent↗
PubMed2001

Physiology and endocrine changes underlying human lactogenesis II.

Lactogenesis stage II, the onset of copious milk secretion, takes place during the first 4 d postpartum in women and involves a carefully programmed set of changes in milk composition and volume. The evidence is summarized that progesterone withdrawal at parturition provides the trigger for lactogenesis in the presence of high plasma concentrations of prolactin and adequate plasma concentrations of cortisol. Although the process is generally robust, delayed lactogenesis does occur with stressful deliveries and in poorly controlled diabetes. Failure of early removal of colostrum from the breast is associated with high milk sodium and poor prognosis for successful lactation in many women. We speculate that this problem may result from accumulation of a substance in the mammary alveolus that inhibits lactogenesis, even in the face of appropriate hormonal changes after parturition.

Female↗
PubMed2005

Depression among Latina immigrant mothers separated from their children.

OBJECTIVE: Latinas who immigrate to the United States and leave their children in their homelands may experience psychological consequences of this separation. This study examined whether immigrant Latinas who were separated from their children differed in rates of probable major depression from those who lived with their children and from those who did not have any children. METHODS: Data were obtained between March 1997 and May 2002 from women in Women, Infants, and Children programs that target low-income pregnant and postpartum women and their children (up to five years of age), women in county-run Title X family planning clinics, women in pediatric clinics for low-income families, and women who were living in a subsidized-housing project or attending programs for county welfare recipients. Latinas in this study were all immigrants to the United States. The women were screened for major depressive disorders with the Primary Care Evaluation of Mental Disorders. RESULTS: A total of 5,122 Latina immigrants were screened. Overall, 11.7 percent of the sample screened positive for major depression. The rates of depression were 11.4 percent for women who lived with their children, 10.9 percent for those who did not have children, and 18.1 for those who were not living with their children. When the analyses controlled for demographic differences, the odds of depression for immigrant Latinas who were separated from their children were 1.52 times as great as the odds for those whose children were currently living with them (p=.02). Odds of depression were similar among women who lived with their children and those who did not have children. CONCLUSIONS: Separation from children during immigration may lead to increased risk of depression for immigrant Latinas. Health care clinicians who treat young immigrant women should pay close attention to signs of depression among women who have left children with relatives in their homelands.

Adult↗
PubMedDate not supplied

Item response theory in affective instrument development: an illustration.

The benefits of item response theory (IRT) analysis in obtaining empirical support for construct validity make it an essential step in the instrument development process. IRT analysis can result in finer construct interpretations that lead to more thorough descriptions of low- and high-scoring respondents. A critical function of IRT is its ability to determine the adequacy with which the attitude continuum underlying each dimension is assessed by the respective items in an instrument. Many nurse researchers, however, are not reaping the benefits of IRT in the development of affective instruments. The purpose of this article is to familiarize nurse researchers with this valuable approach through a description of the Facets computer program. Facets uses a one parameter (i.e., item difficulty) Rasch measurement model. Data from a survey of 525 new mothers that assessed the psychometric properties of the Postpartum Depression Screening Scale are used to illustrate the Facets program. It is hoped that IRT will gain increased prominence in affective instrument development as more nurse researchers become aware of computer programs such as Facets to assist in analysis.

Affect↗
PubMed2005

Assessment of quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, 2004.

PURPOSE: Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims to assess quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals to show weakness and gaps areas in the care procedure for future improvement intervention programs. It is a descriptive study to assess quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, in 2003. DESIGN/METHODOLOGY/APPROACH: Using quota sampling, 60 healthy women were recruited for the study. Data were collected using three forms including a questionnaire with demographic and obstetrics questions, a check-list for the postpartum care and education quality assessment. Control of vital signs, uterus assessment, perineum assessment, leaving bed, urinary system assessment, digestive system assessment, breast examination, extremities assessment, psychological assessment, as well as education about perineum self-care, breast-feeding, infant care, education before discharge and educational method. Validity and reliability of the questionnaire and checklist were assessed prior to use. Data were analyzed using SPSS. FINDINGS: Results showed compatibility of provided postpartum care with the standards as follows: method of patient's education (52.68 per cent); control of vital signs (43.21 per cent); education about breast-feeding (26.06 per cent); care in getting out of bed (25.83 per cent); psychological care (19.36 per cent); urinary system assessment (16.66 per cent); education about perineum care (13.12 per cent); uterus assessment (10.6 per cent); digestive system assessment (9.69 per cent); patient's education before discharge (7.99 per cent); education about infant's care (7.81 per cent); perineum assessment (6.72 per cent); breast examination (1.11 per cent); and assessment of extremities (0.81 per cent). The study demonstrated that weak postpartum care was provided in 82 per cent of cases but also that mothers were satisfied with provided care in all domains of care. Mothers were very satisfied with facilities and less satisfied with personnel interaction with their visitors in hospital. There was no significant correlation between quality of services and clients' satisfaction (Spearman test, p < 0.05). ORIGINALITY/VALUE: For the first time in Iran, this study has evaluated quality of care in postpartum wards of hospitals based on the defined standards. The study provided a defined standard for postpartum care, which is necessary for regular monitoring and evaluation and so evidence-based intervention programs to improve the system of care. It was also postulated that mothers' satisfaction with care is not always a good indicator of services quality.

Adult↗
PubMed2000

First ovulation and ketone body status in the early postpartum period of dairy cows.

The effect of ketone body status on occurrence of first ovulation during early lactation was assessed in 84 multiparous dairy cows under field conditions. Animals were equally distributed across 8 farms and were controlled by the same herd fertility monitoring program. Cows were visited twice antepartum and 6 times postpartum at weekly intervals between 5:30 and 8:30 AM. On these occasions, body condition scores and milk yields were measured, blood and milk samples were taken, cows were gynecologically examined, and parameters of reproduction were determined. The onset of first ovulation was specified by milk progesterone determination and rectal palpation. Cows starting postpartum ovarian cyclicity within or after 30 d were classified as early and late responders (ER and LR, respectively). Resumption of the estrous cycle within 30 d postpartum is considered optimal under practical conditions, and classification based on this threshold value resulted in groups of equal size and equal distribution of ER + LR cows within farms. Ketone bodies measured were beta-hydroxybutyrate in serum and acetoacetate and acetone in serum and milk. Blood serum and milk ketone body concentrations during the first 6 wk of lactation were higher in LR than in ER, whereas plasma glucose and nonesterified fatty acid and milk fat, protein and urea concentrations did not differ between groups. Maximal concentrations of ketone bodies from parturition to first ovulation were better predictors of the onset of the estrous cycle than mean or minimal concentrations over the same period. Milk acetone and serum beta-hydroxybutyrate concentrations provided the most reliable information with regard to resumption of ovarian activity of all ketone bodies.

3-Hydroxybutyric Acid↗