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PubMedDate not supplied

Epidemiology of congenital rubella and results of rubella vaccination in Australia.

Congenital rubella was not notifiable in Australia until recently, but the national incidence of childhood deafness has been accurately documented since 1949. On the basis of these data and a study of congenital rubella in Western Australia, it is estimated that the national incidence of congenital rubella has decreased from a mean of at least 120 cases annually (one in 2,000 live births) to approximately 20 or less since 1977. This decrease has occurred since the introduction of rubella vaccination programs in 1971. The aim of these programs was to reduce the incidence of congenital infection by vaccinating girls (aged 10-14 years) at school without assessing their immunity. Nonpregnant seronegative women were also offered vaccination in family planning clinics as were postpartum seronegative women in obstetric units. By 1983, 96% of 8,226 pregnant women were seropositive for rubella antibody, as compared with only 82% of a similar group of women in 1971. This improvement in the immune status of pregnant women appears to be the result of rubella vaccination. Rubella vaccination also appears to have been successful in preventing congenital infection.

Adolescent↗
PubMed2004

Childbearing practices in anadier Mennonite women.

Cross-cultural nursing practices call for attention to be paid to the unique beliefs and practices of the groups with which nurses come in contact. The Kanadier Mennonites are a conservative religious group who live in Alberta, Manitoba and Ontario. An exploratory, descriptive study was conducted with this group in southern Alberta to generate information about their health and illness beliefs. This article focuses on their knowledge, beliefs and practices in relation to childbearing. Interviews were conducted with 45 women, the majority of whom were married and had been born in Mexico. Among the sample there had been a range of one to 16 pregnancies. The participants noted that childbearing is not a topic openly discussed with others. Women learn about childbearing from their mothers and other women but also from physicians and books. During pregnancy there are particular activities to be avoided including the use of strong cleaning fluids and hand milking of cows. Foods such as milk need to be ingested to ensure a healthy pregnancy Prenatal care was not emphasized in Mexico nor has it become a customary practice in Canada but deliveries in hospital are the norm in both these countries. During the postpartum the women receive support from their immediate and extended family in order to recuperate. Nurses need to explore individual Kanadier Mennonite beliefs regarding childbearing and work with this group in developing acceptable health promotion programs to help ensure healthy pregnancy outcomes. The blending of nursing practice knowledge in a non-intrusive manner with a group of people with differing belief systems is a necessary and achievable goal.

Adult↗
PubMed1998

Economic aspects of the perinatal hospital stay.

This article concentrates on the economics of the perinatal hospital stay for normal vaginal and cesarean section deliveries. Published studies in the United States are reviewed under three headings: inpatient costs for traditional stays, outpatient costs for postpartum services, and costs for short stays with follow-up services. Despite the increasing attention on length of stay after delivery, there has been minimal research examining the true costs of an early discharge program and services compared with longer hospital stays. Formal analysis of alternative strategies and well-designed clinical studies are needed before an optimal policy for caring for mothers and infants can be identified.

Ambulatory Care↗
PubMed2007

Severity of ruminal acidosis in primiparous holstein cows during the periparturient period.

The objectives of this study were: 1) to determine the effect of providing additional prepartum concentrate on the occurrence and severity of ruminal acidosis (RA) and lactational performance during the periparturient period in primiparous cows; and 2) to characterize the occurrence and severity of RA during the periparturient period. We hypothesized that providing additional concentrate prepartum would reduce postpartum RA. Fourteen ruminally cannulated Holstein heifers were paired by expected calving date and body condition score. The heifers were assigned to 1 of 2 prepartum feeding regimens: 1) a control treatment consisting of a far-off diet (forage:concentrate, F:C = 80:20) fed from d -60 to d -25 and a close-up diet (F:C = 54:46) fed from d -24 until parturition; or 2) a high-concentrate (HC) feeding program consisting of 4 prepartum diets, HC-1 (F:C = 68:32) fed from d -60 to d -43, HC-2 (F:C = 60:40) fed from d -42 to d -25, HC-3 (F:C = 52:48) fed from d -24 to d -13, and HC-4 (F:C = 46:54) fed from d -12 until parturition. All cows received the same lactation diet postpartum. Ruminal pH was measured continuously from d -5 to d +5, and for 3 consecutive days starting on d +17 +/- 1.2, d +37 +/- 1.4, and d +58 +/- 1.5 relative to parturition using an indwelling ruminal pH system. Ruminal acidosis was considered to occur when ruminal pH was <5.8 (total RA). Ruminal acidosis was further partitioned into: 1) mild RA (5.8 > ruminal pH > 5.5), 2) moderate RA (5.5 > ruminal pH > 5.2), and 3) acute RA (ruminal pH < 5.2). Feeding additional concentrate prepartum did not reduce postpartum RA. In fact, cows fed the HC treatment had more daily episodes of acute RA than cows fed the control treatment. Day relative to parturition affected the occurrence and severity of RA; RA increased following parturition and was sustained thereafter. The DM intake during the last 5 d of gestation was lower for cows fed the HC treatment compared with cows fed the control treatment, but lactational performance was not affected. We conclude that, under the conditions imposed, feeding additional concentrate prepartum does not reduce postpartum RA. Furthermore, the incidence and severity of RA increases immediately postpartum, emphasizing the need to develop and implement feeding strategies that reduce this risk.

Acidosis↗
PubMed2006

To treat or not to treat postpartum pelvic girdle pain with stabilizing exercises?

Women with pelvic girdle pain (PGP) often consult physical therapists for help and are treated with different therapies without firm evidence for the effectiveness. Two randomized controlled trials have investigated the effect of stabilizing exercises for PGP. The most recent study demonstrated significant positive results in favour of exercises (Stuge et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy. A randomized controlled trial. Spine 2004a;29(10):351-9), the other did not (Mens et al. Diagonal trunk muscle exercises in peripartum pelvic pain: a randomized clinical trial. Phys. Ther. 2000;80(12):1164-73). Consequently, the two studies provide contradictory advice for treatment of PGP. The question is thus, whether stabilizing exercises should be recommended as treatment for PGP. Both the studies are of high methodological quality and are comparable with regard to subjects studied. However, there are several differences in the interventions and these are explored and discussed for better understanding of the conflicting results. Exercises that focused on only global muscles showed no effect. However, these exercises were not individualized and they were instructed by videotape. In the more recent study, exercises that initially focused on local muscles, and then gradually added global muscles showed a significant, positive effect. Exercises in that study were supervised, corrected, individualized concerning choice of exercises, order and dosage, and pain was avoided. This comparison indicates that effective treatment of postpartum PGP may be achieved when exercises for the entire spinal musculature are included, individually guided and adapted to each individual.

Adult↗
PubMed1981

Attitudes and perceptions of perinatal concepts during pregnancy in women from three cultures.

Interviewed Black-American, White-Anglo, and Cuban-Hispanic women (N = 126) during pregnancy and the puerperium in a longitudinal study of perinatal attitudes. Cultural differences emerged for the attitude toward Pregnancy, and differences across time emerged for the perception of activity of Unborn (Newborn) Baby. Such cultural and psychological factors need to be considered in the development of comprehensive prenatal care programs.

Attitude to Health↗
PubMed1998

From efficacy to effectiveness: selecting indicators for a community-based lactational amenorrhoea method promotion programme.

This paper reviews the results of clinical trials and community studies of lactational amenorrhoea and its role as a contraceptive method (LAM). Indicators which are used in efficacy trials and effectiveness interventions are compared and sets of indicators of effectiveness appropriate to community-based LAM programmes are recommended. A five-tiered ecological framework is used to facilitate selection of indicators which range from individual to policy level outcomes. The indicator framework is intended as a tool for health practitioners in family planning and maternal and child health service delivery settings who are interested in designing programmatic interventions for the promotion of LAM, particularly among less well-educated women of lower socioeconomic communities.

Amenorrhea↗
PubMedDate not supplied

Working group report on high blood pressure in pregnancy.

This report updates the 1990 National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy and focuses on classification, pathophysiology, and management of the hypertensive disorders of pregnancy. Using evidence-based medicine and consensus, this report updates contemporary approaches to hypertension control during pregnancy by expanding on recommendations made in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The recommendations to use K5 for determining diastolic pressure and to eliminate edema as a criterion for diagnosing pre-eclampsia are discussed. In addition, the use of blood pressure increases of 30 mm Hg systolic or 15 mm Hg diastolic as a diagnostic criterion has not been recommended, as available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Management considerations are made between chronic hypertension that is present before pregnancy and those occurring as part of the pregnancy-specific condition preeclampsia, as well as management considerations in women with comorbid conditions. A discussion of the pharmacologic treatment of hypertension in pregnancy includes recommendations for specific agents. The use of low-dose aspirin, calcium, or other dietary supplements in the prevention of pre-eclampsia is described, and expanded sections on counseling women for future pregnancies and recommendations for future research are included. Once again we thank Dr. Ray Gifford, Jr., and his committee for volunteering their time to produce this important report. We hope it helps the busy clinician prevent and manage a very important problem.

Antihypertensive Agents↗
PubMed1997

A smoking cessation program at a public antenatal clinic.

OBJECTIVES: A randomized trial evaluated the impact of smoking cessation interventions on point prevalence and consecutive quit rates at an Australian public prenatal clinic. METHODS: Self-reports and urine cotinine tests confirmed patients' smoking status at the midpoint and end of pregnancy and 6 weeks postpartum. RESULTS: At all points, validated abstinence rates were significantly higher in the experimental group than in the control group. The rate of failed biochemical validation was significantly higher in the control group than in the experimental group. CONCLUSIONS: Prenatal clinic staff can significantly increase quit rates by using cognitive-behavioral strategies. Brief advice appears to be ineffective.

Australia↗
PubMed2006

[Study on the maternal mortality ratio from 1995 to 2004 among residential and migrant women in Beijing].

OBJECTIVE: To analyze the maternal mortality ratio (MMR) of residential and migrant women in Beijing. METHODS: A retrospective study from 1995 to 2004 was performed to analyze data from the maternal death cases. RESULTS: The MMR of resident and migrant of Beijing from 1995 to 2004 were 17.9 and 51.3 per ten thousand respectively. The main reasons of maternal deaths among residents were embolism (21.2%), hypertensive disorder complicating pregnancy (18.3%), postpartum hemorrhage (14.4%) and ectopic pregnancy/heart disease (9.6%). The main reasons of migrant maternal deaths were postpartum hemorrhage (25.2%), embolism (19.7%), hypertensive disorder complicating pregnancy (17.3%) and liver disease (9.5%). The avoidable deaths were accounted for 18.9%. CONCLUSION: The MMR in Beijing local residents was close to that in developed countries. To further reduce MMR in Beijing would depend on the better administration of related issues among floating population. Poor quatily delivery must be banned together with strengthening the training programs on health workers. It is also important to improve the knowledge and skills of medical staff for rescuing the complications of pregnancy and ectopic pregnancy.

China↗
PubMed1995

[Prevention and treatment of hemorrhage in obstetrical hospitals].

Introduction of a program of prophylactic and organizational and therapeutic measures helped reduce the incidence of massive blood loss in 741 women at various modes of delivery, including cases with obstetrical bleedings. The incidence of hemorrhages in the placental and postpartum periods reduced from 1.6 to 0.3%.

Blood Transfusion↗
PubMed1994

Interpersonal conflict and physical violence during the childbearing year.

Reducing physical abuse directed at women by male partners is one of the nation's Year 2000 health objectives. An important target group for achieving this health objective is pregnant women. The present study examines the frequency, severity, perpetrators and psychosocial correlates of violence during the childbearing year. A panel of 275 women were interviewed 3 times during pregnancy and at 6 months postpartum. Moderate or severe violence was somewhat more common during the postpartum period than during the prenatal period--19% of women reported experiencing moderate or severe violence prenatally, compared to 25% in the postpartum period. For partner-perpetrated violence, being better educated was associated with increased risk of violence as was having had a sex partner who ever shot drugs; being older, having a confidant and having social support from friends were significant protective factors. For violence perpetrated by someone other than a male partner, having a confidant was a significant protective factor. Obstetric care providers who routinely come in contact with pregnant women, as well as emergency department staff, need to be systematically screening for violence against women. Efforts to enhance women's social support networks should be included in primary and secondary prevention programs.

Adolescent↗
PubMed1983

Effects of various forage feeding programs during dry period on body condition and subsequent lactation health, production, and reproduction.

During 3 yr, 289 Holstein cows prior to being dried off were assigned randomly to one of three diets: all long hay, 50% hay and 50% corn silage, and limit-fed corn silage plus 1.1 kg liquid protein supplement added per cow per day. Body weights, condition scores, and calving difficulties were recorded. Calf weights were recorded at birth. All cows were distributed across eight postpartum experiments. Body condition was similar for all cows at termination of dry period. Cows fed limited corn silage plus liquid supplement gave birth to heavier calves and had greater calving difficulty. Diet for dry period had little effect on health in the subsequent lactation. Cows fed long hay while dry consumed more dry matter, produced more milk with lower milk fat percent, and were not different for 4% fat-corrected milk compared to cows fed the other two diets in dry period. Days open were greater for cows fed long hay while dry. In general, as long as the ration is nutritionally balanced and fed in amounts to achieve or maintain adequate body condition, forage programs ranging from all hay to all corn silage can be fed successfully during the dry period.

Animals↗
PubMed2004

[The effects of the systemic follow up health care program on the health promotion and the risk reduction in premature infants and their mothers].

PURPOSE: This research was conducted to evaluate the effects of a systemic follow-up care program on health promotion and risk reduction in 64 high-risk infants (HRI) including premature infants and their mothers. METHOD: The intervention consisted of systemic NICU education, tele-counseling and 3 home visits in 6 months. The subjects were divided into either the intervention group or the control group receiving the conventional education without the tele-counseling and home visiting. Infant health promotion was measured using physical assessment, types of health problems, reflexes, OPD visiting history, DDST, immunization, feeding assessment, Infant death rate, etc. Maternal self-esteem, postpartum depression and family function were measured using the maternal self-report inventory (MRI), EPDS, and family apgar score (Fapgar), retrospectively. RESULT: All premature infants in the intervention group were in the normal range of growth and development, and the regular vaccination schedule. The health problems in the intervention group were addressed early so not to develop into adverse effects. The follow-up program for 6 months showed beneficial effects on MRI, EPDS, and Fapgar. CONCLUSION: A systemic follow-up health care program is beneficial on health promotion and risk reduction in 64 HRI including premature infants and their mothers.

Adult↗
PubMedDate not supplied

Breast-feeding initiation in low-income women: Role of attitudes, support, and perceived control.

Despite the documented health and emotional benefits of breast-feeding to women and children, breast-feeding rates are low among subgroups of women. In this study, we examine factors associated with breast-feeding initiation in low-income women, including Theory of Planned Behavior measures of attitude, support, and perceived control, as well as sociodemographic characteristics. A mail survey, with telephone follow-up, of 733 postpartum Medicaid beneficiaries in Mississippi was conducted in 2000. The breast-feeding initiation rate in this population was 38%. Women who were older, white, non-Hispanic, college-educated, married, not certified for the Supplemental Nutrition Program for Women, Infants, and Children, and not working full-time were more likely to breast-feed than formula-feed at hospital discharge. Attitudes regarding benefits and barriers to breast-feeding, as well as health care system and social support, were associated with breast-feeding initiation at the multivariate level. Adding the health care system support variables to the regression model, and specifically support from lactation specialists and hospital nurses, explained the association between breast-feeding initiation and women's perceived control over the time and social constraints barriers to breast-feeding. The findings support the need for health care system interventions, family interventions, and public health education campaigns to promote breast-feeding in low-income women.

Adult↗