SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of encounters at which postnatal depression was managed. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.
Idjwi Island in Lake Kivu in eastern Zaire supports approximately 50,000 largely subsistence farmers, the Bani-Iju. Rapid population growth, a declining economy, and a deteriorating environment have already converged to produce significant malnutrition in this isolated community. The highly structured and traditional social order, particularly regarding reproductive mores, is examined here in its relevance to an intervention program for reducing the demographic pressure by increasing birth spacing. The mean birth interval of approximately three years appears to be shrinking, and is far too brief to prevent rapid population growth. The program, which included films about contraception, did not lead to a longer birth interval among the Bani-Iju, but did succeed in informing women about family planning. It is concluded that no intervention program for promotion of family planning is likely to be effective without substantial improvement in the economy.
The awareness of the inherent risks attached to medication use during pregnancy is increasing. There is, however, a paucity of available following childbirth. We have conducted a prospective study in women who gave birth in hospital with the objective of analysing the use of medication in this lying in period. The results show that, in addition to the vitamins and minerals routinely prescribed for every young mother and the antipyretics administered as required, the following medicaments were most often used: analgesics (by approx. 9%), anti-inflammatory agents (49%) and antibiotics (38%). The antibiotics were either used prophylactically or, in cases of proven infection, administered therapeutically. The use of antibiotics appears more intensive compared to western countries, presumably due to the greater risk of infection in this group in India. On the other hand, the use of sleep inducing medication and tranquillizers during the lying in period appears, in comparison to other studies, almost negligible. The majority of the women were unaware of the potential side-effects of medication during breastfeeding.
BACKGROUND: Concern about harm to newborns from early postpartum discharges led to laws establishing minimum hospital stays in the mid-1990s. We evaluated the effects of an early-discharge protocol (a hospital stay of one postpartum night plus a home visit) in a health maintenance organization (HMO) and a subsequent state law guaranteeing a 48-hour hospital stay. METHODS: Using interrupted-time-series analysis and data on 20,366 mother-infant pairs with normal vaginal deliveries, we measured changes in length of stay, newborn examinations on the third or fourth day of life, and office visits, emergency department visits, and hospital readmissions for newborns. We also examined expenditures for hospitalizations and home-based care. RESULTS: The early-discharge program increased the rate of stays of less than two nights from 29.0 percent to 65.6 percent (P<0.001). The rate declined to 13.7 percent after the state mandate (P<0.001). The rate of newborn examinations on the third or fourth day of life increased from 24.5 percent to 64.4 percent with the program (P<0.001), then dropped to 53.0 percent after the mandate (P<0.001)--changes that primarily reflected changes in the rate of home visits. The rate of nonurgent visits to a health center increased from 33.4 percent to 44.7 percent (P<0.001) after the reduced-stay program was implemented. There were no significant changes in the rate of emergency department visits (quarterly mean, 1.1 percent) or rehospitalizations (quarterly mean, 1.5 percent). Results were similar for a vulnerable subgroup with lower incomes, younger maternal age, a lower level of education, or some combination of these characteristics. Average HMO expenditures on hospital and home-based services decreased by $90 per delivery with the early-discharge program and increased by $100 after the mandate. CONCLUSIONS: Neither policy appears to have affected the health outcomes of newborns. After the mandate, newborns were less likely to be examined as recommended on day 3 or 4. Because of changes in hospital prices, the two policies had minimal effects on HMO expenditures for hospital and home-based services.
Asian women consuming a traditional diet high in soy have a low incidence of breast cancer, yet when they emigrate to the USA the second but not the first generation lose this protection. Accordingly, we hypothesized that early exposure to genistein, a major component of soy, could have a permanent protective effect against breast cancer. Sprague-Dawley CD rats were exposed to genistein from conception to day 21 post-partum in the diet at concentrations of 0, 25 and 250 mg genistein/kg AIN-76A diet. At day 50 post-partum, all animals were treated with 80 mg dimethylbenz[a]anthracene/kg body wt to induce mammary cancers. Dietary genistein resulted in dose-dependent protection against development of mammary tumors (fewer tumors per rat). Analysis of mammary whole mounts showed that 21- and 50-day-old female rats had fewer terminal end buds, terminal ductal structures that were undifferentiated and were most susceptible to carcinogenesis. Bromodeoxyuridine incorporation studies revealed that dietary perinatal genistein resulted in a smaller proliferative compartment for terminal end buds. In rats fed the high genistein dose (250 mg/kg diet) total genistein concentrations in the serum and milk of dams 7 days postpartum were 418+/-198 and 137 pmol/ml, respectively. Total genistein concentrations in stomach milk, serum and mammary glands of 7-day-old offspring were 4439+/-1109 and 726 pmol/ml and 440+/-129 pmol/g, respectively. Total genistein concentrations in the serum and mammary glands of 21-day-old offspring were 1810+/-135 pmol/ml and 370+/-36 pmol/g, respectively. Dietary perinatal genistein did not cause significant toxicity in F0 and F1 females. We conclude that genistein in the diet at 'physiological levels' enhances cell differentiation, resulting in programming of mammary gland cells for reduced susceptibility to mammary cancer, with no observed toxicity to the reproductive tract of F1 females.
"Is there any reason why healthy women should not have access to simple pain medication when they require it?" This is the question pharmacists at the Salvation Army Grace Hospital in Ottawa were asked in addressing the needs of new mothers. And, while post-partum self-medication programs have existed for over a decade in Canada, the Grace has developed and implemented a comprehensive, patient-focused, multidisciplinary system with an innovative and user-friendly approach that benefits patients and staff.
This study examines the development of mothers' understanding of their infants' crying. Semistructured tape-recorded interviews were conducted with 17 mothers at 6 weeks, 10 weeks, and 16 weeks postpartum. The mothers (9 primiparous, 8 multiparous) were chosen for their good health status and for their immediate support system. Two major themes were identified from the interviews. In general, it was found that as the mothers became more experienced, the understanding of the cry situation became more complete and soothing was more effective. The relation between crying and soothing became more differentiated, more cohesive, and more complete. The effect of experience on understanding was particularly dramatic in the case of multiparous mothers. Both health promotional and illness prevention programming are proposed as nursing care measures for mothers of crying infants. The important assumptions underlying each approach are delineated.
Although the clinical impact of maternal cocaine abuse has been well documented in recent years, there have been no reports on the direct and indirect costs of such abuse. This study compares hospital charges of a cocaine-abusing population with those of a control group. Ninety-one mother-infant pairs testing positive for cocaine at delivery were compared with a screened drug-free control population matched for socioeconomic status, age, and parity. When compared with controls, cocaine-positive mothers were more likely to deliver prematurely (37 versus 2%) and to have low birth weight (2613 versus 3340 g) or growth-retarded infants (12 versus 0%) with Apgar scores less than 7 at 5 minutes (8 versus 1%), signs of cocaine exposure (63 versus 0%), neonatal intensive care use (30 versus 3%), and extensive hospitalization (11 versus 3 days). As expected, there was a substantial cost difference between the study and control groups. Hospital charges for the labor, delivery, and postpartum care of cocaine-positive mothers in the study group averaged $3608, whereas maternal control charges averaged $3147 (P less than .05). Neonatal charges from the cocaine-positive study group averaged $13,222, whereas control charges averaged only $1297 (P less than .03). Most of the statistically significant differences in perinatal cost between the cocaine-positive and control populations can be traced to the association between cocaine abuse and premature birth. This information should benefit institutions and organizations trying to assess cost-benefit aspects of programs for prevention and treatment of cocaine abuse during pregnancy.
PURPOSE: To test the feasibility and efficacy of a Parenting Enhancement Program (PEP) on adolescent mothers' perceptions of the neonate and to ascertain the extent to which PEP reinforces the effects of maternal age or self-esteem on their perceptions. METHODOLOGY: Ninety-two pregnant adolescents were placed into one of two groups; one group participated in a PEP and the other group did not. A Background Information Questionnaire, Self-Esteem Scale (SES), and Neonatal Perception Inventory (NPI) were used to collect data from all the subjects at five intervals beginning during pregnancy and ending at 3 months postpartum. RESULTS: A t-test revealed significant differences between the two groups at 1 month postpartum on the NPI. The PEP group had a significant gain on the NPI from the second day postpartum to 1 month postpartum. The PEP subjects showed a significant gain on the SES over time. A significant relationship was found between SES and NPI at 1 month postpartum. CONCLUSIONS: The findings lend support for the use of the PEP. Self-esteem served to reinforce the effects of the PEP, but age did not make a difference.
OBJECTIVE: To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes. STUDY DESIGN: The subjects were women who voluntarily enrolled in Project Link, an intensive outpatient substance abuse treatment program at Women and Infants Hospital, Providence, RI. A total of 87 women received substance abuse treatment in conjunction with their prenatal care; the comparison group of 87 women received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered. The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories. Univariate and multivariate analyses were performed. The key outcomes were gestational age at delivery, birth weight, preterm delivery, Apgar scores, and neonatal intensive care admission rate. Factors controlled in the multivariate models included demographics, socioeconomic status, parity, and prenatal care. RESULTS: Infants born to women who enrolled prenatally were 400 gm heavier (p < 0.001), and their gestational age was 2 weeks longer (p < 0.001) than infants of mothers enrolled postpartum. In addition, they were approximately one-third as likely to be born with a low birth weight (p < 0.01) and approximately one-half as likely to be admitted to the neonatal intensive care unit (p < 0.05). CONCLUSION: Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum.
Although the programs are of increasing popularity, little has been published on the effects of discharging maternity patients early from the hospital. In particular, there is almost no evidence to date to prove that these programs actually achieve two objectives for which they were designed; to reduce occupancy pressure on maternity beds and to lower hospital costs. Evaluation of the early stages of a relatively small and flexible maternity early discharge program in Alberta, Canada suggests that the program is effective in reducing length of stay in the hospital and hospital costs, but there is little evidence that it is actually used to reduce pressure on bed space in the maternity unit.
Because of the unique nature of the Canadian health-care system, postpartum home care in Canada has taken on a distinctive form. The provision of postpartum home care is the responsibility of the individual provinces, and different approaches have been developed in each location. The most commonly observed pattern of postpartum care involves publicly funded services provided by public health nurses. Health-care reform and shortened hospital stays have led to changing patterns of care. In turn, these changes have precipitated issues for the mother-infant dyad, the family, and the community.
CONTEXT: Although the proportion of US children who are appropriately immunized increased dramatically in the past decade, rates remain suboptimal among low-income, inner-city youth. Timely initiation of immunization is an important predictor of immunization status later in childhood; however, prospective studies identifying predictors of initiation are lacking. OBJECTIVES: The objectives of this study were to: 1) describe immunization patterns in a cohort of infants born to predominantly low-income, inner-city mothers; 2) identify determinants, as measured at birth, of immunization status at 3 and 7 months of age; and 3) identify determinants of continuation of immunization among those who initiate immunization by 3 months of age. DESIGN: Prospective, birth cohort study. METHODS: Maternal/infant dyads were systematically selected from 3 District of Columbia hospitals between August 1995 and September 1996. Three hundred sixty-nine mothers were interviewed shortly after delivery, at 3 to 7 months postpartum, and at 7 to 12 months postpartum. Medical records were reviewed at all reported sites of care for 324 (88%) infants. Vaccinations assessed included diphtheria, tetanus, and pertussis; polio; and Haemophilus influenzae type B. Multivariate logistic regression analyses were used to determine factors associated with immunization status of infants at 3 and 7 months of age. RESULTS: At 3 months of age, 75% of infants were up-to-date (UTD) versus only 41% at 7 months. In adjusted analyses, baseline factors associated with being UTD at 3 months included enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during pregnancy, intention to breastfeed, and presence of the infant's grandmother in the household. Infants were less likely to be UTD if their mothers perceived higher barriers to immunization. Baseline factors associated with being UTD at 7 months included lower birth order and maternal employment. Among the subset of infants who were UTD at 3 months, only 53% remained UTD at 7 months. Factors measured at the first follow-up interview that were associated with continuation of immunization at 7 months included maternal employment and lower perceived barriers. CONCLUSIONS: Immunization rates during the first 7 months of life were low in this inner-city population. Factors associated with immunization status that are potentially amenable to change included perceived barriers to immunization and enrollment in WIC during pregnancy.
PROBLEM/CONDITION: Certain modifiable maternal behaviors and experiences before, during, and after pregnancy are associated with adverse health outcomes for the mother and her infant (e.g., physical abuse, insufficient folic acid consumption, smoking during pregnancy, and improper infant sleep position). Information about these behaviors and experiences is needed to monitor trends in maternal and infant health, enhance understanding of the relation between maternal behaviors and infant health outcomes, plan and evaluate maternal and infant health programs, direct policy decisions, and monitor progress toward achieving the national Healthy People 2010 [HP 2010] objectives (US Department of Health and Human Services. Healthy people 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington, DC: US Department of Health and Human Services; 2000). REPORTING PERIOD COVERED: 2000-2003. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers; nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of perinatal health behaviors and experiences among women delivering live infants. This report summarizes data for 2000-2003 from 19 states (Alabama, Alaska, Arkansas, Colorado, Florida, Hawaii, Illinois, Louisiana, Maine, Nebraska, New Mexico, New York, North Carolina, Ohio, Oklahoma, South Carolina, Utah, Washington, and West Virginia) that measured progress toward achieving HP 2010 objectives for eight perinatal indicators: 1) pregnancy intention, 2) multivitamin use, 3) physical abuse, 4) cigarette smoking during pregnancy, 5) cigarette smoking cessation, 6) drinking alcohol during pregnancy, 7) breastfeeding initiation, and 8) infant sleep position. RESULTS: In 2003, prevalence of intended pregnancy among women having a live birth ranged from 48.1% in Louisiana to 66.5% in Maine; during 2000-2003, no state experienced a statistically significant (p< or =0.05) increase in prevalence of intended pregnancy, and one state experienced a significant decrease. In 2003, prevalence of multivitamin use at least four times per week during the month before pregnancy ranged from 23.0% in Arkansas to 45.2% in Maine; during 2000-2003, multivitamin use increased significantly in three states (Illinois, North Carolina, and Utah). In 2003, prevalence of physical abuse by a husband or partner during the 12 months before pregnancy ranged from 2.2% in Maine to 7.6% in New Mexico; during 2000-2003, significant decreases were recorded in three states (Alaska, Hawaii, and Nebraska). In 2003, prevalence of abstinence from cigarette smoking during the last 3 months of pregnancy ranged from 72.5% in West Virginia to 96.1% in Utah; during 2000-2003, a significant increase was recorded in Utah. In 2003, prevalence of smoking cessation during pregnancy ranged from 30.2% in West Virginia to 65.8% in Utah; during 2000-2003, a significant increase was recorded in Utah. In 2003, prevalence of abstinence from alcohol during the last 3 months of pregnancy ranged from 91.3% in Colorado to 98.0% in Utah; during 2000-2003, abstinence increased significantly in Louisiana and Utah but decreased significantly in Florida and Nebraska. In 2003, prevalence of mothers who breastfed their babies in the early postpartum period ranged from 51.2% in Louisiana to 90.3% in Alaska; during 2000-2003, significant increases were recorded in six states (Arkansas, Illinois, Louisiana, Nebraska, North Carolina, and South Carolina). In 2003, prevalence of healthy full-term infants who were placed to sleep on their backs ranged from 50.0% in Arkansas to 78.7% in Washington; during 2000-2003, significant increases were recorded in eight states (Alaska, Colorado, Illinois, Louisiana, Maine, Nebraska, North Carolina, and West Virginia). In 2003, all 19 states achieved or exceeded the HP 2010 objective for smoking cessation during pregnancy, and 16 states achieved the HP 2010 objective for abstinence from alcohol during the last 3 months of pregnancy. In addition, nearly half of the states achieved the objectives for breastfeeding in the early postpartum period and infant back sleep position. However, no state achieved the HP 2010 objectives for intended pregnancy, multivitamin use before pregnancy, absence of physical abuse before pregnancy, or abstinence from smoking during pregnancy. INTERPRETATION: PRAMS data indicate variability among states regarding progress toward achieving HP 2010 objectives in the area of maternal and child health. More progress has been made in achieving objectives focused on the period during and after pregnancy (e.g., smoking cessation and proper infant sleep position); less progress has been made in achieving objectives related to behaviors and experiences in the preconception period (e.g., pregnancy intention and multivitamin use). PUBLIC HEALTH ACTION: State maternal and child health programs can use these state- and population-based data to monitor progress toward achieving HP 2010 objectives, identify indicators to target for intervention, and plan and evaluate programs that promote positive maternal and infant health behaviors, experiences, and outcomes. These data also can be used to guide policy decisions that could affect the health of mothers and infants.
Since activated macrophages and cytokines are found in human milk (HM), a flow cytometry study was conducted to determine whether T cells in HM display phenotypic markers of recent or previous activation. HM was collected during the first 3 d of lactation. The Paint-a-Gate program was used to optimize gating on the lymphocyte population. A mean +/- 1 SD of 4 +/- 3% of total HM leukocytes were lymphocytes and 96 +/- 3% were macrophages and granulocytes (N = 33 subjects). HM lymphocyte populations were further analyzed in five subjects. T cells (CD3+) represented 83 +/- 11% and B cells (CD19+) were 6 +/- 4% of HM lymphocytes. The mean CD4/CD8 ratio of T cells in HM was 0.88 (range 0.40-1.25). This ratio was significantly decreased compared to the peripheral blood (PB) of control adults (P less than 0.02) and postpartum women (P less than 0.02), due mostly to a significant increase in CD8+ CD3+ cells in HM compared to the PB of control adults (P less than 0.002) and postpartum women (P less than 0.05). T cells bearing markers of recent activation were significantly increased in HM compared to the PB of control adults: 85 +/- 7% of CD3+ cells in HM were HLA-DR+ (controls, 10 +/- 4%; P less than 0.001), and 15 +/- 6% of CD3+ cells in HM were IL-2R+ (controls, 6 +/- 2%; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
The effectiveness of a family-centered maternity program in promoting a positive feeling toward the infant and in preparing the mothers for their new role was evaluated. Seventy-three married primiparous women completed measures of anxiety and depression as well as a series of questionnaires relating to their attitudes toward pregnancy, the baby, and the hospital experience. Statistical analyses revealed that the women in the family-centered maternity program, when compared with those in the traditional program, had a more positive attitude toward their babies while in the hospital. In addition, they reported having received more experience in caring for their babies and more help from the hospital personnel in preparing for the mothering role.
OBJECTIVES: This study is an evaluation of relapse prevention interventions for smokers who quit during pregnancy. METHODS: Pregnant smokers at 2 managed care organizations were randomized to receive a self-help booklet only, prepartum relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months postpartum. RESULTS: The pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevalent abstinence was significantly greater for the pre/post intervention group than for the other groups at 8 weeks (booklet group, 30%; prepartum group, 35%; pre/post group, 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6 months (booklet group, 26%, prepartum group, 24%; pre/post group, 33%; P = .04) postpartum. A nonsignificant reduction in relapse among the pre/post group contributed to differences in prevalent abstinence. There was no difference between the groups in prevalent abstinence at 12 months postpartum. CONCLUSIONS: Relapse prevention interventions may need to be increased in duration and potency to prevent post-partum relapse.
One hundred eleven postpartum patients who received varying amounts of prenatal care (no care, inadequate care, intermediate care, and adequate care) were assessed for demographic, medical and sociocultural factors by interview and review of the medical chart. Six sociocultural factors identified by stepwise multiple regression contributed to 49% of the variance for amount of prenatal care: amount of insurance, attitudes toward health professionals, delays in suspecting pregnancy, delay in telling others about the pregnancy, perception of the importance of prenatal care, and initial attitudes about being pregnant. Results are discussed in terms of developing outreach programs altered to the patient's needs and life-styles.