Showing papers in "Journal of Obstetric, Gynecologic, & Neonatal Nursing in 2011"

The Surgeon General's Call to Action to Support Breastfeeding

Abstract: Nancy K. Lowe Editor I n January 2011, U.S. Surgeon General Regina M. Benjamin released the landmark document The Surgeon General’s Call to Action to Support Breastfeeding. Prepared by three agencies of the U.S. Department of Health and Human Services (USDHHS; Centers for Disease Control and Prevention [CDC], the O⁄ce on Women’s Health [OWH], and the O⁄ce of the Surgeon General), this document summarizes the background literature around the importance of breastfeeding, rates of breastfeeding, barriers to breastfeeding in the United States, and breastfeeding from the public health perspective. It details the call to action with 20 speci¢c actions in the categories of mothers and their families, communities, health care, employment, research and surveillance, and public health infrastructure (Table 1). The full document is freely available as a download at http://surgeongeneral.gov/ topics / breastfeeding /calltoactiontosupportbreast feeding.pdf

A Pilot Randomized Controlled Trial of a Breastfeeding Self‐Efficacy Intervention With Primiparous Mothers

Abstract: Objectives To pilot test a newly developed breastfeeding self‐efficacy intervention Design Pilot randomized controlled trial (RCT). Setting An acute care hospital located in Northwestern Ontario that is the sole provider of maternity care for the city and referral center for the region Participants One‐hundred‐and‐fifty primiparous women intending to breastfeed their healthy, term, singleton infant Intervention A standardized, individualized nursing intervention protocol was designed and administered to increase mothers' breastfeeding self‐efficacy. Participants were randomly allocated to the intervention group or control group using sealed, opaque envelopes. Participants in the intervention group received three individualized, self‐efficacy enhancing sessions with the researcher: two in‐hospital and one by telephone. Participants in the control group received standard in‐hospital and community care Main Outcome Measures Feasibility, compliance, and the acceptability of the breastfeeding self‐efficacy intervention. Other outcomes assessed were breastfeeding self‐efficacy, duration, and exclusivity Results Findings suggest that the intervention was feasible; there was a high degree of protocol compliance, and the majority of mothers reported that the intervention was beneficial. Mothers in the intervention group had higher rates of breastfeeding self‐efficacy, duration, and exclusivity at 4 and 8 weeks postpartum. However, the differences between groups were not statistically significant Conclusion The pilot RCT provided valuable information in examining the feasibility of the trial design and intervention

Emotional Responses of Mothers of Late-Preterm and Term Infants

Abstract: Objective To compare the emotional responses of mothers of late‐preterm infants (34 0/7 to 36 6/7 weeks gestation) with those of mothers of full‐term infants. Design A mixed method comparative study. Setting A southeastern tertiary academic medical center postpartum unit. Participants Sixty mothers: 29 mothers of late‐preterm infants and 31 mothers of full‐term infants. Methods Measures of maternal emotional distress (four standardized measures of anxiety, postpartum depression, posttraumatic stress symptoms, and worry about infant health) and open‐ended semistructured maternal interviews were conducted in the hospital following birth and by phone at one month postpartum. Results Mothers of late‐preterm infants experienced significantly greater emotional distress immediately following delivery, and their distress levels continued to be higher at one month postpartum on each of the standardized measures. Mothers of late‐preterm infants also discussed the altered trajectories in their birth and postpartum experiences and feeling unprepared for these unexpected events as a source of ongoing emotional distress. Conclusion Mothers of late‐preterm infants have greater emotional distress than mothers of term infants for at least one month after delivery. Our findings suggest that it may not be a single event that leads to different distress levels in mothers of late‐preterm and full‐term infants but rather the interaction of multiple alterations in the labor and delivery process and the poorer‐than‐expected infant health outcomes. In the future, researchers need to examine how and when mothers' emotional responses change over time and how their responses relate to parenting and infant health and development.

Positive Effect of Kangaroo Mother Care on Long‐Term Breastfeeding in Very Preterm Infants

Abstract: Objective: To investigate the use of Kangaroo Mother Care (KMC) and its association with breastfeeding at 1 to 6 months of corrected age in mothers of very preterm (VPT) and preterm (PT) infants. Design: Prospective longitudinal study. Setting: Neonatal Intensive Care Units in four counties in Sweden. Participants: The study included 103 VPT (<32 gestational weeks) and 197 PT (32-36 gestational weeks) singleton infants and their mothers. Methods: Data on KMC, measured in duration of skin-to-skin contact/day during all days admitted to a neonatal unit, were collected using self-reports from the parents. Data on breastfeeding were obtained by telephone interviews. Results: VPT dyads that breastfed at 1, 2, 5, and 6 months had spent more time in KMC per day than those not breastfeeding at these times. A trend toward significance was noted at 3 and 4 months. In the PT dyads no statistically significant differences were found in the amount of KMC per day between those dyads that breastfed and those that did not. Conclusions: This study shows the importance of KMC during hospital stay for breastfeeding duration in VPT dyads. Hence, KMC has empowering effects on the process of breastfeeding, especially in those dyads with the smallest and most vulnerable infants.

Postpartum Depression and Help Seeking Behaviors in Immigrant Hispanic Women

Abstract: Objectives To describe perceptions of immigrant Hispanic women experiencing symptoms of postpartum depression (PPD) and to identify barriers to seeking mental health services. Design Qualitative descriptive. Setting Community health clinic. Participants Twenty immigrant Hispanic women scoring positive for symptoms of PPD receiving health care at a community health clinic who declined mental health services participated in audiotaped interviews held in their homes. Methods Following Institutional Review Board approval and informed consent, interviews were conducted with study participants. Transcribed data were analyzed as appropriate for qualitative inquiry. Results Some of the women did not recognize and/or denied their symptoms attributing their sadness to financial concerns, family relationships, and/or work stressors. Study participants articulately described their symptoms and identified personal barriers including beliefs about emotional health, the perceived stigma of mental illness, hesitancy to seek treatment for symptoms of PPD, and cultural beliefs about motherhood and the role of women. Social barriers included inadequate social support, immigration status, and limited English proficiency. Health care delivery barriers included financial and time constraints and lack of child care and transportation. Conclusion Limited social networks and barriers to health care should be addressed to foster positive outcomes. Mental health services should be embedded with primary health care or obstetric care clinics to facilitate access. Personal and professional support can make a significant contribution to the reduction of symptoms of PPD.

Health‐Related Quality of Life Among Adolescents with Polycystic Ovary Syndrome

Abstract: Objective To explore health‐related quality of life (HRQoL) among adolescents with polycystic ovary syndrome (PCOS). Design Qualitative study. Setting Two out‐patient gynecology clinics in Yorkshire, England. Participants Fifteen young women diagnosed with PCOS were recruited. Methods Semistructured interviews were carried out, transcribed verbatim, and subjected to thematic analysis using NVivo software version 2.0. Results A few areas were identified where PCOS had a positive impact upon HRQoL (e.g., improved relationships). However, overall the condition had a negative impact upon HRQoL. Weight problems (in particular the difficulties associated with managing/maintaining weight) and body perceptions appeared to be the most significant contributors to a reduced HRQoL. Menstrual dysfunction, fertility issues, and hirsutism also had adverse affects on emotional well‐being, self‐perception (including poor body image, self‐consciousness, & low self‐esteem), social functioning, and sexual behavior. A number of participants described receiving insufficient information from health care professionals (HCPs) and negative experiences in relation to the diagnosis and management of their condition. Conclusion Overall, PCOS has a negative impact on the HR QoL of adolescent girls with the condition. Emotional and social functioning appeared to be most affected rather than areas of physical functioning. Future research is needed to identify ways to improve communication between adolescents with PCOS and their HCPs, particularly around the diagnosis and potential for infertility. Finally, HCPs need to be more aware of the emotional impact of PCOS upon adolescents' HRQoL and of the potential for poor sexual health through risk‐taking behaviors that may occur due to the potential loss of fertility.

A longitudinal survey of childbirth-related fear and associated factors.

Abstract: Objective To investigate the prevalence of childbirth‐related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth‐related fear. Design A longitudinal regional survey. Setting Three hospitals in a northern part of Sweden. Participants Six hundred ninety‐seven (697) women who completed four questionnaires. Methods Data were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times. Results There was a statistically significant increase in childbirth fear from 12.4% in mid‐pregnancy to 15.1% one year after childbirth (p Conclusion Women with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.

A Community‐Based Screening Initiative to Identify Mothers at Risk for Postpartum Depression

Abstract: Objectives To conduct a community‐based, postpartum depression (PPD) screening initiative, and recommend PPD screening practices. Design Descriptive correlational. Settings Two academic medical centers, a university research office, and participants' homes. Participants Five thousand one hundred and sixty‐nine postpartum women age 14 to 49 years. Methods The Agency for Healthcare Research and Quality (AHRQ) framework was implemented by identifying a cohort of mothers and conducting PPD screening followed by diagnostic evaluation of those with positive screens. Mothers in the postpartum period were recruited from two academic medical centers and screened for PPD at 4 to 6 weeks postpartum by telephone or mail using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with EPDS scores ≥10 were invited to participate in the Structured Clinical Interview for DSM IV (SCID) to confirm PPD. Results Six hundred and seventy‐four (13%) women had EPDS scores ≥10; 185 women with elevated EPDS scores agreed to have a SCID diagnostic interview, and 144 were diagnosed with minor or major depression. A significantly higher percentage of women who self‐administered and mailed in the EPDS than women who were screened via telephone had scores ≥10. Elevated PPD scores were not associated with age or parity. Race/ethnicity identification other than White and having less than high school education were associated with higher PPD scores. Conclusions The AHRQ framework was effective in guiding a large‐scale PPD screening initiative by identifying mothers at risk for PPD. Results support previous findings regarding prevalence, selected risk factors, and continued use of the EPDS with SCID confirmation.

The Paradox of Breastfeeding‐Associated Morbidity Among Late Preterm Infants

Abstract: Objective To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population Data Sources Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles Study Selection Nine databased research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks Data Extraction: Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants Data Synthesis Among late preterm mother/infant dyads,breastfeeding initiation appears to be approximately 59% to 70% (U.S.),whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence‐based breastfeeding guidelines are lacking Conclusions Late preterm infants are at greater risk for breastfeedingassociated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts.Contributing factors have yet to be investigated systematically

Sex trafficking and the exploitation of adolescents

Abstract: Human trafficking affects a surprisingly large number of adolescents around the globe. Women and girls make up the majority of sex trafficking victims. Nurses must be aware of sex trafficking as a form of sexual violence in the adolescent population. Nurses can play a role in identifying, intervening, and advocating for victims of human trafficking as they currently do for patients that are the victims of other types of violent crimes.

A review of prenatal home-visiting effectiveness for improving birth outcomes.

Abstract: Objective To determine the effectiveness of prenatal home visiting for improving prenatal care utilization and preventing preterm birth and low birth weight. Data Sources Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Social Work Abstract databases were searched for articles that examined prenatal home‐visiting and prenatal care utilization or neonatal outcomes, with additional ascendancy and descendancy searches. Listservs were also used to identify unpublished evaluations. Study Selection Quantitative studies meeting the following criteria were included in the analyses: published between 1985 and 2009, published in English, reported providing prenatal home visiting, and reported on prenatal care utilization or a neonatal outcome. Data Extraction Study characteristics and findings related to prenatal care utilization, gestational age, and birth weight were abstracted independently by at least two authors. Study quality was assessed across five domains. Data Synthesis The search yielded 28 studies comparing outcomes for women who did and did not receive prenatal home visiting, with 14 (59%) using an RCT design. Five (17%) studies reporting on prenatal care utilization found a statistically significant improvement in use of prenatal care for women with home visiting. Of 24 studies reporting an effect on birth outcomes, five (21%) found a significant positive effect on gestational age, and seven of 17 (41%) found a significant positive effect on birth weight. Conclusions More evidence suggests that prenatal home visiting may improve the use of prenatal care, whereas less evidence exists that it improves neonatal birth weight or gestational age. These findings have implications for implementing Title II of the Affordable Care Act.

An Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals

Abstract: Objective To evaluate the distribution of births among United States (U.S.) hospitals in 2008 as part of the background for the Association of Women's Health, Obstetric and Neonatal Nurses' Guidelines for Professional Registered Nurse Staffing for Perinatal Units. Design Descriptive analysis of birth volumes in U.S. hospitals using American Hospital Association Annual Survey: 2008. Methods U.S. hospitals providing obstetric (OB) services were identified based on information in any of three fields: OB services, OB beds, or number of births. Data were verified via telephone and/or website for the top 100 hospitals based on volume, hospitals with "Healthcare System" as part of their names, hospitals reporting births but no OB service, and hospitals reporting Results Approximately 3,265 U.S. hospitals offered OB services in 2008. The top 500 hospitals based on volume (15.3%) accounted for almost one half (47.4%) of births, the top 1,000 for 69.2%, and the remaining 2,265 for 30.8%. Fourteen percent of hospitals with Conclusions U.S. births are unevenly distributed among hospitals; 15% have a disproportionate share of nearly one half of all births. Most hospitals (69.4%) are operating medium‐ to small‐volume OB units. Most hospitals (72.3%) with

Perspectives of Hospital‐Based Nurses on Breastfeeding Initiation Best Practices

Abstract: Objective To assess the variation in breastfeeding knowledge and practices of registered nurses in hospital women and family‐care units and the informal and formal hospital policies related to the initiation and support of breastfeeding. Design This qualitative study employed a focus group approach to solicit perceptions of hospital‐based nurses regarding breastfeeding best practices. Setting Eight state hospitals stratified by socioeconomic status (SES) and size served as settings to recruit participants for this study. Participants Forty female registered nurses from labor and delivery ( n =9), postpartum ( n= 13), labor and delivery/recovery/postpartum care (LDRP) ( n= 12) and neonatal intensive care unit (NICU) ( n= 6) constituted eight focus groups. Results The majority of nurses reported being knowledgeable of evidence‐based best practices related to breastfeeding initiation. However, in non‐Baby Friendly/Baby Friendly Intent (non‐BF/BFI) settings, nurses' knowledge often was not in accordance with current best practices in breastfeeding initiation, and reported hospital policies were not based upon evidence‐based practices. Barriers to best practices in breastfeeding initiation included hospital lactation policies (formal and informal), nurses' limited education in breastfeeding initiation best practices, high rates of surgical delivery, and lack of continuity of care with the transition of responsibility from one nurse to another from labor and delivery to transition care to postpartum care. Conclusions A significant disparity between nurses' intention to support breastfeeding and their knowledge suggests a need for education based on the World Health Organization Baby Friendly standards for nurses at non‐BF/BFI hospitals. A significant barrier to supporting breastfeeding is lack of hospital policy and inappropriate or outdated policy.

Using a trauma-informed framework to care for incarcerated women.

Abstract: Available health and social services in women's correctional facilities often do not consider the interrelationship of gender, trauma, and mental illness. As a result, preexisting health issues are often exacerbated, leaving women to reenter their communities with more complex health needs. We propose that a trauma-informed framework can be used to guide clinical interactions with female inmates. A case study is presented as an example of proposed best clinical practice. Future trauma-related practice implications are provided.

Postpartum obsessive-compulsive disorder.

Abstract: Objective To synthesize the extant literature on the prevalence, phenomenology, etiology and treatment of postpartum obsessive‐compulsive disorder (OCD). A discussion of differential diagnosis between postpartum OCD and other postpartum psychiatric conditions (e.g., depression, psychosis) and nonpostpartum‐onset OCD is provided. Data Sources, Study Selection and Data extraction All studies addressing postpartum OCD between the years 1950 and 2011 were reviewed. Data from all pertinent studies was explored as it related to postpartum OCD. Data Synthesis Studies were organized based on their empirical technique (e.g., retrospective, prospective), population studied (e.g., clinical OCD, nonclinical populations, males), and etiological or treatment theory (e.g., cognitive‐behavioral). Conclusion The prevalence, phenomenology, etiology, and treatment of postpartum OCD are reviewed. The limited data on treatment approaches and outcomes for postpartum OCD are highlighted with a discussion of the role of nurses in the prevention and identification of postpartum OCD.

The impact of Prenatal Care Coordination on birth outcomes.

Abstract: Objective To measure the impact of a Medicaid benefit called Prenatal Care Coordination (PNCC) on healthy birth outcomes. Design A cross sectional design was used to compare the birth outcomes of infants born to women who received Medicaid and PNCC services to the birth outcomes of infants born to women who received Medicaid but did not receive PNCC services. Setting Services were provided in community based settings in Wisconsin. Participants Of the 45,406 Medicaid births in 2001 to 2002, 10,715 (23.6%) mothers received PNCC services and were considered the treatment group. Methods Secondary analyses of birth certificate and Medicaid billing data were conducted using binary logistic regression analyses to evaluate the impact of PNCC and the hours of PNCC service on birth outcomes. Results Controlling for nine covariates, women who received PNCC services were found to have significantly better birth outcomes, including fewer low‐birth‐weight infants (odds ratio [OR]=0.84; 95% CI [.777, .912]), fewer very‐low‐birth‐weight infants (OR=0.70; 95% CI [.587, .855]), fewer preterm infants (OR=0.83; 95% CI [.776, .890]), and fewer infants transferred to the neonatal intensive care units (OR=.83; 95% CI [.759, .906]).Women who received 6 or more hours of service were less likely to deliver infants with poor birth outcomes. Conclusions The use of PNCC is an effective strategy for preventing adverse birth outcomes.Strategies to further enhance PNCC's positive benefits include increased outreach and engagement with at risk pregnant women.

On “A Call for Clarity in Infant Breast and Bottle‐Feeding Definitions for Research”

Abstract: Unclear and inconsistent infant-feeding definitions have plagued much of breastfeeding research. To determine accurate health outcomes associated with infant feeding, it is imperative that different types of feedings be explicitly described. Definitions must be based on content, not mode of milk delivery. Five new definitions for infant feeding are provided. These definitions are operationally useful for breastfeeding researchers, allowing for the inclusion of almost every infant into an appropriate sample group.

Young Women's Experiences Living with Polycystic Ovary Syndrome

Abstract: Objective To explore the psychosocial effects of living with polycystic ovary syndrome (PCOS) through the experiences of young women diagnosed with this endocrine disorder. Design A qualitative, phenomenological methodology was used. Data were obtained through personal, semistructured interviews. Setting College campuses in New England. Participants A purposive sample of 12 young women with PCOS age 18 to 23 years. Results The following themes emerged from analysis of participants' responses: concerns for older self, feeling physically inferior, coping with symptoms, patient–provider relationship, seeking useable information and support, and coming to terms with a chronic condition. Conclusions Participants in this study faced numerous physical, social, and emotional challenges on a daily basis. As these young women gathered information relevant to their needs, sought and received social support, and maintained their daily routines to improve their health and appearance, they came to terms with this chronic condition. Based on participants' relayed experiences, it became evident that a need exists for health care practitioners to include psychosocial support in a comprehensive holistic plan for the treatment of PCOS in adolescents and young women in their early twenties.

Staff perceptions and experiences of implementing the Baby Friendly Initiative in neonatal intensive care units in Australia.

Abstract: Objective To explore the perceptions, understandings, and experiences of maternity service staff toward the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Baby Friendly Hospital Initiative (BFHI) and its implementation in the Neonatal Intensive Care Unit (NICU). Design An exploratory study using naturalistic methods of inquiry. Setting Participants were recruited from a total of four Australian metropolitan maternity hospitals of which two included a NICU. Focus groups and individual interviews were undertaken in the participants' choice of location, usually hospital. Participants Forty‐seven participants included nursing and midwifery staff and one pediatrician. Methods Data from focus groups and interviews were transcribed and thematic analysis used to identify themes related to implementation and perceptions of staff regarding BFHI. Results Major themes identified focused on the differences in NICUs relative to maternity units, separate worlds of mother and infant, the hard work involved in implementing the BFHI, and the positive attitude that BFHI can be achieved. There were misconceptions by participants on the nature of the BFHI as it applied to NICUs. Factors hindering and supporting BFHI implementation were also identified. Conclusion Motivated staff, educational support, and clear guidelines are essential to support implementation of the BFHI in NICUs.

Predictors of breastfeeding exclusivity in a WIC sample.

Abstract: Objective To examine predictors of breastfeeding exclusivity in low‐income women who received services from a Chicago area clinic of the Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC). Design A secondary data analysis of existing clinical and administrative data. Setting An urban community health center serving low‐income families. Participants Two hundred and thirty‐five (235) low‐income women who initiated breastfeeding and received WIC services. Methods Logistic regression models were fit to existing prenatal and postpartum data to determine predictors of breastfeeding exclusivity during the immediate postpartum period. Results Only 23% of the sample breastfed exclusively. Women who received first‐trimester prenatal care were more likely to exclusively breastfeed than women who entered prenatal care in later trimesters (OR=2.02, p ≤0.05). Women who declared intentions prenatally to exclusively breastfeed were more likely to exclusively breastfeed than women who did not intend to breastfeed (OR=3.85, p ≤0.001). Overweight/obese women were less likely to exclusively breastfeed than normal/underweight women (OR=0.50, p ≤0.05). Conclusion Findings from this study can be used to develop tailored interventions to promote breastfeeding exclusivity among low‐income WIC recipients.

An evidence-based guideline for unintended pregnancy prevention.

Abstract: Despite the frequency of and significant costs related to unintended pregnancy, it has received less attention in research and prevention guidelines development than other important health threats. This lack of attention has resulted in a system-wide failure to provide care to reproductive aged women who are at risk of unintended pregnancy. An evidence-based blueprint for a coordinated system of primary, secondary, and tertiary prevention is proposed for health professionals who provide care for patients at risk for unintended pregnancy.

Early Hospital Discharge in Maternal and Newborn Care

Abstract: This article highlights the historic precedence of early discharge practices and the debate regarding length of stay for new mothers and newborns in the United States. Although the documented effects of early discharge on maternal and newborn health are inconsistent, research findings universally support follow-up care for mothers and infants within 1 week of hospital discharge. Research is needed to identify the components and timing of follow-up care to optimize maternal and newborn outcomes.

Abuse-Related Post-Traumatic Stress, Coping, and Tobacco Use in Pregnancy

Abstract: pregnancy cessation PTSD abuse coping ABSTRACT Objective: To examine the relationship between trauma history, posttraumatic stress disorder (PTSD), coping, and smoking in a diverse sample of pregnant women, some of whom are active smokers. Design: Secondary analysis from a prospective study on PTSD and pregnancy outcomes. Setting: Maternity clinics at three health systems in the midwestern United States. Participants: Women age 18 or older (1,547) interviewed at gestational age fewer than 28 weeks. Methods: Participants were classified at nonsmokers, quitters (stopped smoking during pregnancy), and pregnancy smokers. Demographic, trauma, and pregnancy factors, substance use, and use of tobacco to cope were compared across groups. Logistic regression assessed the influence of these factors on being a smoker versus a nonsmoker and a quitter versus a pregnancy smoker. Results: Smokers differed from nonsmokers on all demographic risk factors (being African American, being preg- nant as a teen, having lower income and less education, and living in high-crime areas), had higher rates of current and lifetime PTSD, and were more likely to report abuse as their worst trauma. Pregnancy smokers had lower levels of education, were more likely to classify their worst trauma as ''extremely troubling,'' and were more likely to exhibit PTSD hyperarousal symptoms. In regression models, smoking ''to cope with emotions and problems'' doubled the odds of continuing to smoke while pregnant even after accounting for several relevant risk factors.

An Integrated Review of Developmental Outcomes and Late‐Preterm Birth

Abstract: Objective: To evaluate existing evidence on long-term developmental outcomes of late-preterm infants (LPI; infants vational studies, two reviewers who were blind to each other's ratings assessed study quality. Ratings ranged from 12.5 to 14 with moderate to very good interrater agreement. Kappa (k) values were 0.83 (reporting), 0.63 (external validity), 0.73 (internal validity), and 0.83 (design) for the four subscales and 0.56 for the whole scale, with no major systematic disagreements between reviewers.

The Reproductive Life Plan as a Strategy to Decrease Poor Birth Outcomes

Abstract: The purpose of this article is to discuss the importance of implementing a life course perspective model that includes a reproductive life plan to improve health outcomes, especially in populations at risk for adverse outcomes. A reproductive life plan is a comprehensive strategy that can be incorporated into nursing practice at all levels to improve birth outcomes. Health care providers, especially nurses, should incorporate reproductive life planning into their daily encounters with patients.

Predicting the Insertion Length for Gastric Tube Placement in Neonates

Abstract: Objective To compare error rates of three existing methods of predicting the gastric tube insertion length in a group of neonates Design Randomized controlled trial. Setting Five neonatal care units in a large midwestern city. Participants One hundred and seventy‐three hospitalized neonates. Methods Neonates were randomly assigned to one of three groups: ARHB, NEX, or NEMU. For primary analysis, only tubes placed too high with the tube tip in the esophagus or at the gastroesophageal junction were considered to be misplaced. For secondary analysis, a stricter definition was used, and low placements (pylorus or duodenum) were also considered to be misplaced. All radiographs were blinded and read by a pediatric radiologist. Results For the primary analysis, the differences in percentages of correctly placed tubes among the three methods was statistically significant (χ 2 =34.45; p 2 =18.59, p 2 =21.34, p p =.0615). A new ARHB equation was developed specific for neonates Conclusions Direct distance nose‐ear‐xiphoid should no longer be used as an nasogastric/orogastric (NG/OG) tube insertion‐length predictor in neonates. Either NEMU for NG/OG tubes or the new ARHB equation for NG tubes should be used.

Social Cognitive and Clinical Factors Associated with HPV Vaccine Initiation Among Urban, Economically Disadvantaged Women

Abstract: Objective To learn more about human papilloma virus (HPV) knowledge and vaccination among teens and young women age 13 to 26 years from an economically disadvantaged, urban community. Our aim was to identify common beliefs about HPV vaccine initiation and describe the relationship between attitudes, norms, perceived control, and intention to receive HPV vaccine, drawing from the theory of planned behavior (TPB). Design Mixed method, descriptive design. Guided by the TPB, HPV vaccine beliefs were assessed through focus groups. Intention to receive the vaccine, demographic and clinical factors, and theoretical predictor variables (attitudes, norms, and control) were assessed through questionnaires. Setting After recruitment, focus groups were held at a convenient date and time for our participants in a small university conference room. Participants Participants were economically disadvantaged young women, age 13 to 26 (N = 34). Methods Specific behavioral, normative, and control beliefs were elicited in focus groups and analyzed using content analysis. Simple and multivariate general linear modeling with adjustment for prognostic demographic and clinical factors was completed to assess the influence of the theoretical predictor variables on the outcome of HPV vaccine initiation. Results Influential beliefs toward vaccination were identified. Analysis indicated attitudes, norms, and perceived control toward HPV vaccine initiation were highly significant predictors of intent, as was tobacco use; all p's Conclusion Barriers to HPV vaccine initiation were identified, and strong preliminary evidence supports use of the TPB to guide programs to promote urban, economically disadvantaged young women's intent to begin the HPV vaccine.

Attitudes toward physical activity of white midlife women.

Abstract: Objective To explore attitudes toward physical activity of White midlife women in the United States using a feminist perspective.

Enablers and barriers to seeking help for a postpartum mood disorder.

Abstract: Objective To explore the barriers and enablers identified by women experiencing a postpartum mood disorder (PPMD) that preclude and facilitate their help-seeking behaviors for this often devastating illness. Design A qualitative study using a grounded theory approach. Setting Well-Baby Clinics offered through the Public Health Department, Early Years Centres, Mothercraft, and a Parent Resource Centre in a large Canadian city. Participants Ten women who had either been formally diagnosed as having a PPMD or who self‐identified as experiencing a constellation of symptoms indicative of a PPMD. Methods Interviews that were transcribed verbatim and analyzed using a grounded theory approach as described by Strauss and Corbin. Results The core category of "having postpartum" captured the essence of women's experiences in seeking help for a PPMD. Women identified four main stressors that contributed to their development of a PPMD, two barrier categories, and an enabler category that influenced their help‐seeking behaviors. Through navigation of formal and informal help, women were able to begin to reclaim the mothering instincts they had lost to mental illness. Conclusions Pregnancy, birth, and becoming a mother collectively represent a critical period of physical and emotional upheaval in a woman's life. The need for a holistic care approach that supports the emotional and physical health of the dyad is imperative.

Pilot evaluation of an internet-based natural family planning education and service program.

Abstract: Objective To evaluate the efficacy, knowledge of fertility, and acceptability of a web‐based natural family planning (NFP) education and service program. Design A 6‐month repeated measure longitudinal evaluation pilot study. Setting A university based online website. Participants The website was piloted with 468 volunteer women seeking NFP services. Of these participants, 222 used the automatic online fertility charting system to avoid pregnancy. The 222 charting participants had a mean age of 29.9 years ( SD =5.6), 2.2 children ( SD =1.9), 37% were postpartum, and 47% had regular menstrual cycle lengths. Intervention Nurse‐managed web‐based NFP education and service program. Outcomes Pregnancies were confirmed by an online self‐assessed pregnancy evaluation form. A 10‐item fertility quiz and 10‐item acceptability survey was administered online. Results Among the 222 users avoiding pregnancy, at 6 months of use, there were two correct‐use unintended pregnancies that provided a pregnancy rate of 2% and seven total unintended pregnancies providing a typical use pregnancy rate of 7%. Mean knowledge of fertility increased significantly from time of registration (8.96, SD =1.10) to 1 month of use (9.46, SD =.10), t =4.60, p SD =8.98) to 6 months of use (48.4; SD =8.77). Conclusion The nurse‐managed online NFP system seems to provide adequate knowledge of fertility and help participants meet pregnancy intentions. Acceptability of such a system of NFP is still in question.