Depression is the leading cause of diseaserelated disability among women. In particular, women of childbearing age are at high risk for major depression. Pregnancy and new motherhood may increase the risk of depressive episodes. Depression during the perinatal period can have devastating consequences, not only for the women experiencing it but also for the women’s children and family. Perinatal depression encompasses major and minor depressive episodes that occur either during pregnancy or within the first 12 months following delivery. When referring to depression in this population, researchers and clinicians frequently have not been clear about whether they are referring to major depression alone or to both major and minor depression. Major depression is a distinct clinical syndrome for which treatment is clearly indicated, whereas the definition and management of minor depression are less clear. In this report, we refer to major depression alone by identifying it discretely as major depression. Minor depression is an impairing, yet less severe, constellation of depressive symptoms for which controlled trials have not consistently indicated whether or not particular interventions are more effective than placebo. In this report, we refer to this grouping as major or minor depression or by the more general terms “depression” or “depressive illness.” Perinatal depression, whether one is referring to major depression alone or to either major or minor depression, often goes unrecognized because many of the discomforts of pregnancy and the puerperium are similar to symptoms of depression. Another mental disorder that can occur in the perinatal period is postpartum psychosis. Unlike postpartum depression, postpartum psychosis is a relatively rare event with a range of estimated incidence of 1.1 to 4.0 cases per 1,000 deliveries. The onset of postpartum psychosis is usually acute, within the first 2 weeks of delivery, and appears to be more common in women with a strong family history of bipolar or schizoaffective disorder. Postpartum psychosis is an important disorder in its own right, but it is not addressed specifically in this report. The precise level of the prevalence and incidence of perinatal depression is uncertain. Published estimates of the rate of major and minor depression in the postpartum period range widely—from 5 percent to more than 25 percent of new mothers, depending on the assessment method, the timing of the assessment, and population characteristics. In addition, although many screening instruments have been developed or modified to detect major and minor depression in pregnant and newly delivered women, the evidence on their screening accuracy relative to a reference standard has yet to be systematically reviewed and assessed. Evidence on the effectiveness of screening all pregnant women and providing a preventive intervention to those scoring at high risk has not been systematically investigated and evaluated either. To address these gaps, the Agency for Healthcare Research and Quality (AHRQ), in collaboration with the Safe Motherhood Group (SMG), commissioned this evidence report from the RTI International-University of North Carolina’s (RTI-UNC’s) Evidence-based Practice Center (EPC) for a systematic review of the evidence on three questions related to perinatal depression. These questions address the prevalence and incidence of perinatal depression, the accuracy of screening instruments for Evidence Report/Technology Assessment Number 119

Perinatal depression: prevalence, screening accuracy, and screening outcomes.

BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Association of American Medical Colleges

Thirty years after women became 50 percent of the college graduates in the United States, men still hold the vast majority of leadership positions in government and industry. This means that women’s voices are still not heard equally in the decisions that most affect our lives. In LEAN IN, Sheryl Sandberg examines why women’s progress in achieving leadership roles has stalled, explains the root causes, and offers compelling, commonsense solutions that can empower women to achieve their full potential.

每月一書：Lean In: Women, Work, and the Will to Lead

Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy

Applied researchers have employed chi-square tests for more than one hundred years. This paper addresses the question of how one should follow a statistically significant chi-square test result in order to determine the source of that result. Four approaches were evaluated: calculating residuals, comparing cells, ransacking, and partitioning. Data from two recent journal articles were used to illustrate these approaches. A call is made for greater consideration of foundational techniques such as the chi-square tests.

/pdf/your-chi-square-test-is-statistically-significant-now-what-zf3jn02ypi.pdf

Your Chi-Square Test Is Statistically Significant: Now What?.

http://www.columbia.edu/itc/hs/medical/residency/peds/new_compeds_site/pdfs_new/evins.pdf

Postpartum depression: a comparison of screening and routine clinical evaluation.

Infant mortality, low birth weight, and prematurity among Hispanic, white, and African American women in North Carolina.

PurposeTo examine the literature documenting successes in recruiting and retaining rural primary care physicians.MethodThe authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural p

/pdf/the-road-to-rural-primary-care-a-narrative-review-of-factors-18x8erv56m.pdf

Shelley L. Galvin

Papers

Postpartum depression: a comparison of screening and routine clinical evaluation.

Infant mortality, low birth weight, and prematurity among Hispanic, white, and African American women in North Carolina.

The Road to Rural Primary Care: A Narrative Review of Factors That Help Develop, Recruit, and Retain Rural Primary Care Physicians.

Trends in weight gain during pregnancy: a population study across 16 years in North Carolina.

The effect of the lunar cycle on frequency of births and birth complications.