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PubMed2003

Outpatient psychotherapy for mothers--first empirical results.

MOTHERHOOD is a vulnerable phase in the life of any woman, one that may be associated with an increased risk of mental illness. Despite the major clinical significance of this patient group, only a few psychotherapeutic treatment programs are tailored to the needs of mothers of infants. Even when treatment is urgently needed, many mothers of infants reject inpatient psychotherapy so as not to be separated from their children. The outcome may be chronification of disorders, in some cases with a negative impact on their children's development. A new psychotherapeutic outpatient treatment program adapted to the special needs of mothers and offering a substitute to inpatient treatment is presented. First empirical results show that the presented treatment concept led to significant improvements in the symptoms, whose stabilization continued up to the follow-up two years after the start of therapy.

Adult↗
PubMed2000

Influence of bovine antiserum (Bo-Bac 2X) injection on colostral immunoglobulin G absorption in neonatal dairy calves.

On the background of positive survival data from farms in Mississippi, treating calves with antiserum injection in addition to normal colostrum administration, the objective of the present study was to evaluate the influence of a single subcutaneously administered bovine antiserum injection (0.031 g of IgG/kg of body weight) and pooled colostrum administration on efficiency of Ig absorption and on 24-h plasma IgG concentration in neonatal bull calves. Twenty-nine male dairy calves (21 Holsteins and 8 Jerseys) were assigned randomly at parturition to receive one of four treatments: 1) colostrum (n = 9), 2) colostrum and bovine antiserum injection (n = 7), 3) milk replacer (n = 5), or 4) milk replacer and bovine antiserum injection (n = 8). At birth, calves either did or did not receive an injection of bovine antiserum and were fed pooled colostrum or milk replacer (Holsteins, 3.8 L; Jerseys, 1.9 L) via an esophageal feeder. Blood was collected immediately before administration of the colostrum or milk replacer, then again at 24 and 48 h postpartum. Immunoglobulin G concentrations of colostrum, milk replacer, antiserum, and plasma were monitored by single radial immunodiffusion. Colostrum administration and injection of bovine antiserum each increased plasma Ig concentration at 24 h posttreatment. In addition, antiserum injection increased the apparent efficiency of absorption of colostral Ig by 42% over that for calves fed colostrum alone. The increase in plasma IgG for antiserum-treated calves exceeded the total amount of IgG administered in the antiserum injection; hence, this increase appeared to be the result of an increase in total absorption of colostral IgG, or possibly antiserum injection somehow triggered active synthesis of IgG. Injection of antiserum might possibly serve as a beneficial adjunct to a colostrum management program by enhancing the acquisition of passive immunity from colostral sources.

Animals↗
PubMed1994

Use of perinatal and infant health services by Mexican-American Medicaid enrollees.

OBJECTIVES: Lack of health insurance and a regular source of medical care are barriers affecting use of health services by Mexican Americans. We studied perinatal and infant health service use by Mexican-American women and non-Hispanic white women and their infants enrolled in Arizona's Medicaid program and explored characteristics associated with use of health services. DESIGN: A descriptive comparative study that used data collected from office records, birth certificates, and household interviews. SETTING: Participants resided in the state's most populous county and were enrolled in the Arizona Health Care Cost Containment System, a health maintenance organization-oriented Medicaid demonstration project. SUBJECTS: Random sample of 308 Mexican-American mother-infant dyads and 312 non-Hispanic white mother-infant dyads. The women were enrolled before the sixth month of pregnancy and for 60 days post partum; their infants were continuously enrolled throughout their first year. OUTCOME MEASURES: Timing and number of prenatal visits and a modified Kessner Index, postpartum visits, number and purpose of office visits during the infants' first year, and immunizations received. RESULTS: Mexican Americans averaged fewer prenatal visits than non-Hispanic whites (8.6 vs 10.2 visits) and were less likely to have "adequate" care (41.1% vs 52.8%). Both groups of mothers are well below the 68% of women nationally who receive adequate prenatal care. Controlling for important socioeconomic status and cultural characteristics, ethnicity had a strong independent effect on the number of prenatal visits and adequacy of prenatal care. Mexican-American infants made fewer visits (8.2 vs 9.8) and completed fewer age-appropriate immunizations than non-Hispanic whites. CONCLUSIONS: Health insurance and a regular source of care are insufficient conditions for ensuring adequate use of maternal and child health services by Mexican-American Medicaid enrollees. Factors associated with their less frequent use of these preventive health services include higher numbers of children, transportation problems, and less assistance from their support system.

Acculturation↗
PubMed2001

It's just different in the country: postnatal depression and group therapy in a rural setting.

The treatment of postnatal depression (PND) via group therapy is an accepted practice in Sydney and other metropolitan areas throughout Australia. This article analyses the difficulties faced in the importation of this urban-developed treatment model into a rural setting. In 1995, this program was established in a major rural centre of New South Wales (NSW) and drew participants from the regional centre, surrounding rural properties, towns and villages. Participation in the program resulted in significant lowering or absences of depressive episodes following treatment. But beyond this significant aspect of a positive response to this treatment program is a fascinating aspect of differences between the rural and urban groups in this population. The differences occurred in group formation, group process and attitudes of the participants. We would suggest that group leaders in rural PND programs face more resistance to the idea of groups for therapeutic intervention, need to draw different lines between personal and professional boundaries from their urban counterparts and are confronted with participants who adhere more strongly to the prevailing mythology of motherhood. This mythology may increase the likelihood and intensity of postnatal depression and cause greater resistance to cognitive restructuring skills, which are essential for challenging thoughts that enhance depression.

Depression, Postpartum↗
PubMedDate not supplied

From research to application: the development of an antenatal psychosocial health assessment tool.

OBJECTIVE: To describe the development of an assessment tool for antenatal psychosocial risk factors associated with poor postpartum outcomes. METHODS: A survey of Ontario family physicians established a need for an antenatal psychosocial health assessment (ALPHA) form. A critical literature review identified important antenatal factors for inclusion on the form. Focus groups of obstetrical care providers indicated acceptance of the provider-completed ALPHA; their feedback led to the development of a self-report ALPHA. Satisfaction, yield and reliability of the self-report and provider-completed ALPHA forms were studied and found to be comparable. RESULTS: Physicians and patients reported good satisfaction and usefulness of the ALPHA form in identifying antenatal psychosocial risk factors. The provider ALPHA was further tested in clinical practice. ALPHA endorsement was obtained from physicians, nurses and midwives. CONCLUSION: A program planning process, which included multidisciplinary involvement, evaluation and endorsement by professional organizations, aided the development, refinement and application of the ALPHA forms as primary care tools. ALPHA topic headings are incorporated into the official 2000 Ontario Antenatal Record and the ALPHA adopted for use on Prince Edward Island.

Child Abuse↗
PubMed2000

Prenatal diagnosis for detecting congenital malformations: acceptance among Israeli Arab women.

BACKGROUND: A high rate of consanguineous marriages exists within the Israeli Arab community, with approximately half occurring between first cousins. This contributes towards a high incidence of congenital malformations and autosomal recessive diseases, many of which are detectable at prenatal diagnosis. OBJECTIVES: To assess the levels of both awareness and acceptance regarding prenatal diagnosis and termination of pregnancy among a group of Arab women in order to devise the optimal means of providing genetic counseling and general health services. METHODS: A total of 231 Arab women of childbearing age were interviewed 3 days postpartum to assess their knowledge of prenatal diagnosis and termination of pregnancy, their willingness to undergo prenatal diagnosis, and their opinions on termination of pregnancy in the event of a severely affected fetus. RESULTS: Half the women believed that prenatal testing is not an effective (or accurate) tool for diagnosing an affected fetus. A quarter had poor knowledge on prenatal diagnosis, and a quarter believed that prenatal diagnosis does provide the correct diagnosis. Ninety-five percent said they would agree to undergo prenatal diagnosis; and in the event of a severely affected fetus, 36% said they would agree to a termination of pregnancy, 57% said they would not, and 7% were undecided. CONCLUSIONS: There is a need for special intervention programs, with guidance by health professionals, geneticists and religious authorities, that will inform this population on the increased risk associated with consanguinity, stress the importance and effectiveness of prenatal testing to identify severe congenital malformations, and help them to accept prenatal diagnosis and termination of pregnancy if indicated.

Abortion, Eugenic↗
PubMedDate not supplied

Risk status and pregnancy outcome among medicaid recipients.

Although Medicaid has increased access to medical care for low-income pregnant women, the Medicaid population remains at high risk for poor pregnancy outcomes. In 1983 the Michigan Department of Public Health conducted 1 week of in-hospital, postpartum interviews addressing risk factors for poor pregnancy outcome among 1,945 women. These births represented over 90% of the births during the study period and constituted a sample of approximately 1.5% of the yearly births in Michigan. Of these women, 24.6% reported receiving Medicaid during pregnancy. The demographic characteristics of the Medicaid women placed them at greater risk for poor pregnancy outcomes than either insured or uninsured women. In terms of medical services, Medicaid recipients began prenatal care later and had fewer visits. In terms of behavioral risks, more Medicaid recipients reported tobacco and alcohol use than did the other mothers. Finally, the infants of Medicaid recipients were 200 g lighter than the other infants. We suggest that the Medicaid program--the major source of prenatal health care for these women--is not adequate to address their risks for poor pregnancy outcomes.

Adolescent↗
PubMed1999

Low prenatal weight gain among adult WIC participants delivering term singleton infants: variation by maternal and program participation characteristics.

OBJECTIVE: To determine the association of maternal and prenatal WIC program participation characteristics with low prenatal weight gain among adult women delivering liveborn, singleton infants at term. METHODS: WIC program data for 19,017 Black and White Alabama women delivering in 1994 were linked with birth certificate files to examine the association of anthropometric, demographic, reproductive, hematologic, behavioral and program participation characteristics with low prenatal weight gain. RESULTS: One third (31.0%) had low prenatal weight gain as defined by the Institute of Medicine. The incidence of low weight gain was increased among women who had < 12 years of education, were single, Black, anemic, had low or normal prepregnancy body mass index (BMI), increased parity, interpregnancy intervals < or = 24 months, used tobacco or alcohol, or entered prenatal care or WIC programs after the first trimester. After adjusting for selected maternal characteristics, the adjusted odds ratios (AOR) for low weight gain were increased with short interpregnancy intervals (AOR 1.21 to 2.20); tobacco use (AOR 1.16 to 1.40), anemia (AOR 1.20 to 1.25), and second trimester entry into prenatal care (AOR 1.14 to 1.20); the size of the AORs and 95% confidence intervals varied by BMI and racial subgroup. CONCLUSIONS: The results of this study suggest that WIC interventions targeting low prenatal weight gain be focused on risk factors present not only during pregnancy, but during the pre- and interconceptional periods as well. Interventions should target low BMI, tobacco use, and anemia, and include attention to nutrition screening and risk reduction among women in postpartum and family planning clinic settings.

Adult↗
PubMed1991

Mastitis prevalence in primigravid heifers at parturition.

Prevalence of intramammary infection was determined for 382 primigravid heifers within 3 d postpartum on 11 Vermont dairy farms. Data collected during a 5-yr period are summarized. Duplicate quarter milk samples were cultured on tryptose-blood agar plates containing .1% esculin. Intramammary infections were diagnosed in 45.5% of the heifers and 18.7% of quarters. Staphylococcus species were the most prevalent bacteria isolated: they appeared in 25.4% of the heifers and 12.1% of quarters. Only 2.6% of the heifers were diagnosed with Staphylococcus aureus; 22.8% had udder infection caused by other staphylococcal species. Environmental mastitis pathogens, coliforms, and streptococci other than Streptococcus agalactiae were isolated from 14.9% of the heifers and 4.8% of quarters. The prevalence of mastitis among these primigravid heifers at parturition indicates a need to improve methods of diagnosis and control programs.

Animals↗
PubMed2001

Monensin and growth hormone effects on glucose metabolism in the prepartum cow.

Twenty-seven multiparous Holstein dairy cows were used to evaluate the singular and combined effects of somatotropin and monensin treatments during the late dry period on postpartum metabolism and production. Treatments were 1) control, 2) injection of exogenous bovine somatotropin (bST); 3) total mixed rations top-dressed with 300 mg of monensin/d, and 4) monensin and somatotropin in combination, during the last 28 d before expected parturition. A 500-mg subcutaneous injection of sustained-release somatotropin was administered at d-28 and -14 relative to expected calving. Glucose kinetics was evaluated on d 15 before expected calving date using a tracer dose of 45 mg of U-13C-labeled glucose. Jugular blood was sampled 20 times during 8 h after tracer injection. Intake of DM was 1.9% of BW, and daily feed was supplied in six equal meals before the glucose kinetic assay. The CONSAM simulation program, which assumes a two-compartment model, was used to analyze the glucose 13C enrichment curves with time. Average glucose distribution space, glucose mass, and glucose residence time in compartment 1 were increased in monensin-treated cows and were decreased in bST-treated cows. On the day of the glucose kinetic assay, blood concentrations of glucose, NEFA, and urea were similar among treatments. The changes in glucose pool and distribution space suggest that monensin increases propionate supply and bST facilitates glucose flow into glucose consuming organs. It is concluded that dairy cows might benefit from a combined application of monensin and bST before parturition.

Animals↗
PubMed1988

Influence of protein intake and feeding strategy on reproductive performance of dairy cows.

A study was conducted to determine the impact of dietary CP concentration (13 vs. 20%) and feeding strategy (total mixed ration vs. separate feeding of the forage and concentrate) on reproductive performance of 57 early lactation dairy cows. Cows were assigned to one of four treatments in a 2 x 2 factorial arrangement. Rations composed of 40% forage (50% grass-legume silage:50% corn silage) and 60% concentrate (DM basis) were fed from d 5 to 100 postpartum. Cows fed a total mixed ration had lower ruminal ammonia and plasma urea N concentrations compared with cows fed separately. Feeding strategy groups showed no differences in reproductive performance. Cows fed a 20% CP ration had higher CP intake, higher ruminal ammonia, and higher urea N concentration in plasma and vaginal mucus. There were no differences between low and high CP groups in days to first observed estrus (24 vs. 27), days to first service (55 vs. 59), days open (72 vs 82) or services per conception (1.5 vs. 1.8). Days to first estimated ovulation were longer (22 vs. 17) in the high vs. low CP groups, and there was an interaction between protein intake and lactation number. Cows managed with an intensive program for detection of estrus and for reproductive health did not show differences in reproductive efficiency when fed 13 or 20% CP rations.

Animals↗
PubMed2001

Women's lived experiences of pregnancy: a tapestry of joy and suffering.

The phenomenological study of the lived experiences of pregnancy described in this article is part of a Finnish caring science research program. Eighty interviews with 40 women combined with nonparticipant observation were analyzed according to Colaizzi. Pregnant women wishing for a perfect child want to promote the health of their unborn baby, no longer take health for granted, and try to change their health behavior. Their altered mode of being involves body changes, variations in mood, and worries. The striving to achieve family communion is seen in the evolving significance of the baby; in dreams, hopes, and plans; and in changing relationships. In relation to Eriksson's ontological health model, the joy and suffering in pregnancy are based on being there for another. Taking seriously the women's experiences and the hidden questions that reveal suffering in both lay and professional caring might prevent the serious postpartum misery of motherhood.

Attitude to Health↗
PubMed1989

Parental adjustment to intrapartum and delivery room loss. The role of a hospital-based support program.

Perinatal loss prompts a unique bereavement for parents and their families that is unlike the mourning process experienced at the death of other loved ones. The Support Center For Perinatal and Childhood Death has developed a comprehensive program to provide support, counseling, and information to families who experience miscarriage, stillbirth, fetal anomalies, and therapeutic abortion for genetic or congenital abnormalities. The impact of perinatal loss is felt not only in the real loss of the wished-for child but also in the loss of self-esteem, the role of parent, and the loss of confidence in the ability to produce a healthy child. The emotional experience of miscarriage or stillbirth creates an atmosphere of despair and confusion for families anticipating a joyous event. The presence of a support counselor and medical caregivers at this time can help parents to navigate the crisis surrounding the loss in ways that promote a healthy grieving process and avert pathologic adaptations. Prenatal, intrapartum, and postpartum counseling opportunities are afforded to families as the situation and parental needs dictate. Services also are extended to other family members, with particular attention to surviving siblings who might be vulnerable to the consequences of unresolved or unacknowledged grief. Grief is experienced as a long-term process, which frequently emerges fully after discharge from the hospital and lasts well beyond the interest and stamina of supportive family members and friends. Support groups, which meet the specific needs of families who experience perinatal loss, contemplate subsequent pregnancy, or face the prenatal decision to terminate a genetically or congenitally compromised pregnancy, have been run successfully for a period of several years. Beyond the experience of intrapartum loss in the delivery room, the experience comes full circle for families who enter the delivery room again with a subsequent child. The expressed need for support in acknowledging the rekindled memories of prior loss at this poignant time are matched only by parents' needs to find reassuring ways of differentiating healthy newborns from the memory of those who died. It is often at the time of the subsequent birth that the memory of the lost child can take its proper place in the family. Stein expresses the essence of grief work and resolve: Mourning is not just feeling sad. It is the specific psychological process by which human beings become able to give up some of the feelings they have invested in a person who no longer exists, and extend their love to the living. Mourning is hard, emotional work.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗
PubMed2003

Pregnancy-related substance use in the United States during 1996-1998.

OBJECTIVE: To provide a baseline estimate of the national prevalence of pregnancy-related illicit drug use and abstinence rates. METHODS: We analyzed data collected between 1996 and 1998 from the National Household Survey on Drug Abuse, a nationally representative sample survey of 22,303 noninstitutionalized women aged 18-44 years, of whom 1,249 were pregnant. RESULTS: During 1996-1998, 6.4% of nonpregnant women of childbearing age and 2.8% of pregnant women reported that they used illicit drugs. Of the women who used drugs, the relative proportion of women who abstained from illicit drugs after recognition of pregnancy increased from 28% during the first trimester of pregnancy to 93% by the third trimester. However, because of postpregnancy relapse, the net pregnancy-related reduction in illicit drug use at postpartum was only 24%. Marijuana accounted for three-fourths of illicit drug use, and cocaine accounted for one-tenth of illicit drug use. Of those who used illicit drugs, over half of pregnant and two-thirds of nonpregnant women also used cigarettes and alcohol. Among the sociodemographic subgroups, pregnant and nonpregnant women who were young (18-30 years) or unmarried, and pregnant women with less than high school education had the highest rates of illicit drug use. CONCLUSION: The continued burden of illicit drug use during pregnancy calls for policy efforts to enable primary care providers to identify and refer women who use substances to treatment and support services. Prevention of uptake of illicit drug use should be an integral part of public health programs for young women.

Adolescent↗
PubMed2005

Psychosocial assessment by phone for high-scoring patients taking the Edinburgh Postnatal Depression Scale: communication pathways and strategies.

The well-documented risks associated with perinatal depression provide a strong argument for universal screening. However, uncertainty about what to do with findings is a significant barrier to implementing screenings where obstetric care is provided. Based on experience with a comprehensive screening program, we describe a protocol for those critical communication pathways that encourage a dynamic phone exchange between a mental health caller and the patient who has scored in the high range on the Edinburgh Postnatal Depression Scale. In addition, we present guidelines for developing an action plan for addressing intervention needs and closing the feedback loop to the original administrators of the scale.

Adult↗
PubMed2000

Creating a patient classification system: one birth center's experience in the triage process.

Adequate nurse staffing is crucial to the provision of quality maternity care in the rapidly changing health care market including the triage of obstetric patients. The mandate for cost-efficient services must be balanced by the triage of health team members who are essential to safe and effective operations in the inpatient perinatal setting. The transformation of traditional perinatal units to single-site maternity care centers requires the development of creative staffing designs that permit the expeditious allocation of human resources in a cost-effective manner. Creating an acuity-based patient classification system for a single-site unit is a challenging task. The authors describe the process of creating a patient classification system when a new unit, The Birth Center, was opened at San Francisco General Hospital Medical Center. The unit combined the staff and patient populations of a labor and delivery unit with an antepartum-postpartum-gynecology unit and included a triage room for evaluation of pregnant clients. The two units had different modalities for budget and staffing. An activity study was conducted to determine unit and staff activities. A patient classification system was created for the single-site maternity unit, which allowed for acuity-driven staffing.

Continuity of Patient Care↗
PubMed1997

Effectiveness of a teen pregnancy clinic in a managed care setting.

We retrospectively examined the effectiveness of a teen pregnancy clinic at a large multispecialty group between 1991 and 1994 using measurements of statistical differences in intervention and outcome variables. The 72 teens in the intervention group attended significantly more prenatal visits, more postpartum visits and gained more weight than the 33 controls. Other outcome variables such as fetal birth weight, Apgar scores, and neonatal intensive care unit admission showed trends toward improvement, but were not significantly different. We conclude that a teen pregnancy clinic in a managed care setting can be a cost-effective intervention in improving mental and neonatal outcome.

Adolescent↗