Weight Variability, Weight Gain Goals, and Biopsychosocial Factors Among Pregnant Women

This study investigated the pattern of weight variability over 8 weeks and its associations with achieving weight gain goals and five biopsychosocial factors among pregnant women. We conducted a secondary analysis of 117 weeks of data from 16 pregnant women with a body mass index (BMI) ≥25. Weight variability was calculated from the difference of ending and beginning and maximum and minimum weights in a week and percent of each difference from baseline weight. Loess smoother, repeated measures model, and compound symmetric covariance matrix were used for analysis. The variability measure of maximum-minimum weight (overall mean: 2.1 ± 0.4 lbs.) was greater than the ending-beginning weight measure (overall mean: 0.7 ± 0.6 lbs.). Weight variability was negatively associated with achieving weight gain goals but not with biopsychosocial factors. Assessing weight variability is important during pregnancy so that preventive measures or lifestyle counseling can be instituted immediately to prevent excessive weight gain.

Laser Acupuncture Analgesia on Postpartum Low Back Pain: A Prospective Randomized Controlled Study

BACKGROUND

Unresolved postpartum LBP may affect women...s physical and psychological health.

AIM

To investigate the analgesic effects of laser acupuncture therapy (LAT) for postpartum LBP.

METHOD

Postpartum women with LBP were recruited and randomly assigned to the intervention group or the control group from November 2017 to July 2018. The participants in the intervention group received LAT and standard care. The participants in the control group received only standard care. The primary outcome was the Visual Analogue Scale for LBP. Secondary outcomes were limitation of daily activities and physical activity; perceived stress scale; and salivary cortisol values.

RESULTS

In all, 106 participants were recruited and assigned to the intervention group or the control group. As compared with the control group, the participants in the LAT group had significantly lower intensity of LBP (mean ± SD: 1.21 ± 0.99 vs 3.25 ± 1.14; p < .001), limitations of daily activities (mean ± SD: 3.17 ± 2.09 vs 10.40 ± 4.72; p < .001) and physical activity (mean ± SD: 3.04 ± 2.17 vs 9.79 ± 4.71; p < .001), perceived stress (mean ± SD: 26.13 ± 3.97 vs 28.85 ± 4.26; p = .001), and salivary cortisol levels (mean ± SD: 0.194 ± 0.131 vs 0.280 ± 0.234; p = .02) post-intervention.

CONCLUSIONS

For postpartum LBP, LAT combined with standard care had greater analgesic efficacy, lower perceived stress, lower limitations of daily activities and physical activity, and lower salivary cortisol levels than standard care alone.

Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women

OBJECTIVE

To describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women.

DESIGN

Secondary data analysis.

SETTING

Data from the national Nurse-Family Partnership program.

PARTICIPANTS

Women who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554).

METHODS

We used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression.

RESULTS

The prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively).

CONCLUSION

Prevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.

Engagement design in studies on pregnancy and infant health using social media: Systematic review

Social media utilization is prevalent among reproductive-age women. The literature on how researchers engage women in studies using social media platforms is scarce. This systematic review analyzed participant engagement design in studies using social media and focused on pregnancy and infant health.

METHODS

A literature search of EBSCO and PubMed databases was conducted. Included studies had to be completed with quantitative data, focus on pregnancy, postpartum or infant health, and use social media in the research process. A matrix of three engagement designs (passive, interactive, independent) and three research processes (recruitment, data analysis, intervention) was used for analysis.

FINDINGS

Thirty-one articles that reported 30 studies met the inclusion criteria. Of these, four were randomized controlled trials (RCT), four were non-RCT interventions, and 22 were observational/descriptive studies. The main purpose of using social media was for recruitment (n = 16), data analysis (n = 6), intervention (n = 8), or both recruitment and intervention (n = 1). Passive engagement was a fundamental design approach in all studies to access a data source that was either the participant or the data provided by the participants in social media. Interactive engagement, mostly for recruitment and intervention, was to engage participants in completing study enrollment or in interacting with the study team or fellow participants. Independent engagement involved off-line activities and appeared sporadically in intervention studies.

CONCLUSIONS

Passive and interactive engagement designs are more frequently used than independent engagement design. Researchers should select suitable designs when studying pregnancy and infant health using social media.

Health Care Encounters of Pregnant and Postpartum Women with Substance Use Disorders

The purpose of this review is to describe how pregnant and postpartum women with substance use disorders (SUDs) experience health care encounters in prenatal care, labor and delivery, postpartum, and nursery/neonatal intensive care unit (NICU) settings. Findings from 23 qualitative studies on the topic were synthesized using a metasummary approach. The majority of the studies revealed that pregnant and postpartum women with SUDs tend to experience their health care encounters as conflictual, although some studies revealed that some women experience their health care encounters as supportive. The results of metasummary included a taxonomy of health care encounters. Five types of adverse encounters were identified: judgmental, disparaging, scrutinizing, disempowering, and deficient-care. Three types of beneficial encounters were identified: recovery-based, accepting, and effective-care. The findings suggest the importance of stigma awareness, therapeutic patient-provider communication, patient activation, and integrated care.

Two-minute versus 6-minute walk distances during 6-minute walk test in neuromuscular disease: Is the 2-minute walk test an effective alternative to a 6-minute walk test?

Functional tests such as Motor Function Measure-32 (MFM-32), supine to stand, ascend/descend stairs permit the assessment of task-specific motor function in neuromuscular disease (NMD). The 6-min walk test (6MWT), though functional, is primarily used to assess endurance and disease progression in children with neuromuscular disorders. Barriers to 6MWT administration, in this population, can include reduced attention span due to age and inability to tolerate test length due to weakness. We propose task-specific functional deficits are related to endurance. Additionally, the 2-min walk test (2MWT) could effectively replace the 6MWT in this population. Seventy-seven participants, ages 5-18, with a variety of neuromuscular disorders performed the 6MWT, timed functional tests (TFT), and the MFM-32. Correlation and paired t-test analyses were used to compare the distance walked in the first 2 min (2MWD) to the distance walked in the entire 6 min (6MWD) and to the functional outcome measures above. The 2MWD strongly correlated with 6MWD and the other outcome measures. Paired t-test analysis also showed that the 2MWD did not differ from the distance walked in the last 2 min of the 6MWT. Although equivalence testing could not reject the claim that this difference exceeded the upper practical limit of 9.5 m, it only showed a modest overestimation of the 4-6MWD compared with the 2MWD. Together, our results support the ability of the 2MWD to predict the 6MWD, specifically in the pediatric neuromuscular disease population.

Intervention strategies for preventing excessive gestational weight gain: systematic review and meta-analysis

BACKGROUND

Interventions relevant to energy intake to prevent excessive gestational weight gain in pregnant overweight and obese women are important but scarce. This review synthesized healthy eating and physical activity strategies and their effects on excessive gestational weight gain prevention.

METHODS

Twenty-three randomized controlled trials that included healthy eating and/or physical activity as an intervention in healthy pregnant overweight or obese adult women and gestational weight gain as a primary or secondary outcome were reviewed.

FINDINGS

Heathy eating and/or physical activity (21 studies, n = 6,920 subjects) demonstrated 1.81 kg (95% CI: -3.47, -0.16) of gestational weight gain reduction favouring intervention. Healthy eating (-5.77 kg, 95% CI: -9.34, -2.21, p = 0.02) had a larger effect size than combined healthy eating/physical activity (-0.82 kg, 95% CI: -1.28, -0.36, p = 0.0005) in limiting gestational weight gain. Physical activity did not show a significant pooled effect. Healthy eating with prescribed daily calorie and macronutrient goals significantly limited gestational weight gain by 4.28 kg and 4.23 kg, respectively.

CONCLUSION

Healthy eating and/or physical activity are effective in gestational weight gain control. Healthy eating with calorie and macronutrient goals are especially effective in limiting excessive gestational weight gain among pregnant overweight and obese women.

Care Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss

OBJECTIVE

To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss.

DESIGN

A qualitative, descriptive design with secondary data analysis.

SETTING

The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States.

PARTICIPANTS

Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review.

METHODS

We used thematic analysis to analyze interview data.

RESULTS

Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death.

CONCLUSION

Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.

Reasons women do not seek health care for dysmenorrhea

AIMS AND OBJECTIVES

To identify and describe reasons women do not seek health care for dysmenorrhea symptoms.

BACKGROUND

Although dysmenorrhea is highly prevalent among women, can cause significant disruptions in their daily lives, and may increase their risk for future chronic pain conditions, few women seek health care for dysmenorrhea. A better understanding of why women do not seek health care is necessary to develop strategies that facilitate care seeking and optimal symptom management.

DESIGN

A qualitative descriptive design was used to guide the study and summarise text responses to an open-ended survey question.

METHODS

Participants in an online survey study who had not sought health care for dysmenorrhea (N = 509) were asked to write about their reasons for not seeking care. Data were collected in January and February 2015. Participants' text responses were analysed using qualitative content analysis.

RESULTS

Nine categories of reasons were identified as follows: assuming symptoms are normal, preferring to self-manage symptoms, having limited resources, thinking providers would not offer help, being unaware of treatment options, considering symptoms to be tolerable, being wary of available treatments, feeling embarrassed or afraid to seek care and not seeking health care generally.

CONCLUSIONS

Findings can guide the development of strategies to promote care seeking and inform policy and clinical practice to improve dysmenorrhea management.

RELEVANCE TO CLINICAL PRACTICE

Findings underscore the need to provide routine screening for dysmenorrhea, avoid dismissing dysmenorrhea symptoms, initiate discussions and provide education about dysmenorrhea, provide treatments options based on evidence and women's preferences and raise public awareness of dysmenorrhea and its impact.

Association of Self-Efficacy and Self-Regulation with Nutrition and Exercise Behaviors in a Community Sample of Adults

This study examined the association of self-efficacy and self-regulation with nutrition and exercise behaviors. The study used a cross-sectional design and included 108 participants (54 men, 54 women). Nutrition behaviors (fruit/vegetable consumption, dinner cooking, and restaurant eating) and exercise were measured using total days in last week a behavior was reported. Instruments measuring self-efficacy and self-regulation demonstrated excellent Cronbach's alphas (.93-.95). Path analysis indicated only fruit/vegetable consumption and exercise were associated with self-efficacy and self-regulation. Self-regulation showed direct association with fruit/vegetable consumption and exercise, but self-efficacy had direct association only with exercise. Self-efficacy and self-regulation should be strategically used to promote health behaviors.

Feasibility and Potential Benefits of a Self-Monitoring Enhanced Lifestyle Intervention to Prevent Excessive Gestational Weight Gain in Women Who Are Overweight or Obese

OBJECTIVE

To evaluate the feasibility and potential benefits of a self-monitoring enhanced lifestyle intervention to prevent excessive gestational weight gain in women who are overweight and obese.

DESIGN

A one-group, prospective design involving 8 weeks of healthy eating and physical activity and self-monitoring of weight, nutrition, and walking.

SETTING

Recruitment and enrollment in prenatal clinics and self-monitoring at home.

PARTICIPANTS

Women (N = 22) at 14 to 24 gestational weeks, with body mass indexes of 25 to 40 kg/m², without medical and psychiatric diseases that affected cognition or walking.

METHODS

Participants self-monitored weight and nutrition intake for the first 4 weeks and weight, nutrition intake, and walking in the second 4 weeks. Feasibility data were collected weekly (attrition, self-monitoring adherence, program safety, participant feedback) or at the end of Week 8 (satisfaction ratings). Potential benefits included weight, nutrition, and physical activity, measured at baseline (T1), the end of Week 4 (T2), or the end of Week 8 (T3).

RESULTS

Attrition rates were 27.3% by T2 and 40.9% by T3. Adherence to log return was 100%. No adverse effects were noted, but food craving was persistent, and stress levels were high. Program satisfaction was high. Trends for improved activity and reduced trans fat consumption were seen.

CONCLUSION

Our findings indicate that the intervention is worthy of further development and testing with a randomized controlled trial.

The Feto-Maternal Health Cost of Intimate Partner Violence Among Delivery-Related Discharges in the United States, 2002-2009

Our purpose was to estimate the national prevalence of intimate partner violence (IPV) among delivery-related discharges and to investigate its association with adverse feto-maternal birth outcomes and delivery-related cost. A retrospective cross-sectional analysis of delivery-related hospital discharges from 2002 to 2009 was conducted using the Nationwide Inpatient Sample (NIS). We used ICD-9-CM codes to identify IPV, covariates, and outcomes. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between IPV and each outcome. Joinpoint regression was used for trend analysis. During the study period, 3,649 delivery-related discharges were diagnosed with IPV (11.2 per 100,000; 95% CI = [10.0, 12.4]). IPV diagnosis during delivery is associated with stillbirth (AOR = 4.12, 95% CI = [2.75, 6.17]), preterm birth (AOR = 1.97, 95% CI = [1.59, 2.44]), fetal death (AOR = 3.34, 95% CI = [1.99, 5.61]), infant with poor intrauterine growth (AOR = 1.55, 95% CI = [1.01, 2.40]), and increased inpatient hospital care cost (US$5,438.2 vs. US$4,080.1) per each discharge, incurring an additional cost of US$4,955,707 during the study period. IPV occurring during pregnancy has a significant health burden to both the mother and infant. Education about IPV; screening at periodic intervals, including during obstetric visits; and ongoing clinical care could help to reduce or eliminate adverse effects of pregnancy-related IPV. Preventing the lifelong consequences associated with IPV can have a positive effect on the overall health of all women and delivery-related health care cost.

Depressive symptoms and obesity/weight gain factors among Black and Hispanic pregnant women

This study examined the relationships between depressive symptoms and obesity/weight gain factors in 56 Black and Hispanic pregnant women and the differences in these variables between the 2 ethnic groups. Of the women, 32% were likely depressed, 66% were overweight/obese, and 45% gained excessive gestational weight. Depressive symptoms were positively correlated with prepregnancy body mass index (BMI; r = .268, p = .046), inversely related to gestational weight gain (r = -.329, p = .013), and not associated with excessive gestational weight gain. Black women were more likely to have excessive gestational weight gain than Hispanic women. Prepregnancy BMI and gestational weight gain data can be useful in identifying pregnant women with depression.

Weight control behaviors among emerging adults with type 1 diabetes

PURPOSE

The purpose of this study was to examine the association of weight control behaviors (WCBs) with living and educational situations among emerging adults with type 1 diabetes during the first year after high school graduation.

METHODS

Among 184 emerging adults with type 1 diabetes, data were collected every 3 months for 12 months on WCBs, body mass index (BMI), living and educational situations; at baseline and 12 months, on impulse control; and at baseline, on sex, depressive symptoms, and glycemic control. Generalized linear models incorporated repeated measures (0, 3, 6, 9, and 12 months).

RESULTS

No significant associations existed between WCBs and living or educational situations, when controlling for covariates. More depressive symptoms and higher BMIs were associated with a greater likelihood of involvement in unhealthy WCBs, whereas more depressive symptoms-not higher BMI-were associated with higher odds for involvement in very unhealthy WCBs. Although healthy WCBs were also associated with more depressive symptoms and higher BMIs, they were also associated with greater impulse control.

CONCLUSIONS

Health care professionals should assess emerging adults with type 1 diabetes for WCBs along with BMI, depressive symptoms, and impulse control.

The Impact of Cultural Competence Education on Short-Term Medical Mission Groups

Background: There are large numbers of short-term medical mission (STMM) groups traveling yearly from the United States to underdeveloped countries. Medical professionals educated in the Western biomedical model of treatment have an ethnocentric view of how to treat illness. Purpose: The purpose of this pilot study was to demonstrate that a 2-hour culturally sensitive educational program administered to medical professionals travelling to Haiti on a STMM could raise their cultural competency as measured by a specific tool. Method: The participants were invited to a short educational program designed to help them understand their own biases and make better treatment decisions for their patients based on the five constructs of Dr. Campinha-Bacote’s cultural competence model. Findings: Following an evidence-based educational program, the members of the STMM groups demonstrated improved levels of cultural competency. Implications: This program could provide an appropriate way to raise the cultural competency of medical mission health care providers.

Comparisons in perceived importance of and needs for maternal gestational weight information between african american and caucasian pregnant women

This study compared the perceived importance of and needs for maternal gestational weight information between African American and Caucasian pregnant women. A secondary analysis of data from 113 pregnant women (82 African Americans and 31 Caucasians) attending an inner-city prenatal clinic was conducted for this study. Perceived importance of and needs for information were measured in five areas: (1) nutrition, (2) prenatal vitamins, (3) rest/activity balance, (4) exercise, and (5) appropriate weight gain. African American women demonstrated significantly higher perceived importance of and needs for information on rest/activity balance and appropriate weight gain than Caucasian women. Exercise information was rated lower in importance but was most needed by both African American and Caucasian women. Education programs about maternal gestational weight need to be cognizant of ethnic women's needs.

Factors associated with health information-seeking in low-income pregnant women

The purpose of this study was to examine the relationships of health literacy, self-efficacy, and fetal health locus of control to health information-seeking in low-income pregnant women and the contribution from each factor alone or in combination to the variance in health information-seeking. This was a cross-sectional study of 143 English-speaking pregnant women who were recruited from a prenatal clinic and were 18 years of age or older in 2007-2008. Health literacy, self-efficacy, fetal health locus of control, and health information-seeking were measured using the Short Form of the Test of Functional Health Literacy in Adults, the Health Information Competence Scale, the Fetal Health Locus of Control Scale, and the Pregnancy Health Information-Seeking Scale. Health literacy was not significantly correlated with health information-seeking. Self-efficacy (r = .33) and internal fetal health locus of control (r = .27) demonstrated significant correlations with health information-seeking, and together they accounted for 15% of the variance in health information-seeking. After controlling for covariates, self-efficacy (p = .0006) and internal fetal health locus of control (p = .03) remained significantly associated with health information-seeking. In conclusion, pregnant women's characteristics, such as self-efficacy and internal fetal health locus of control belief, are associated with their health information-seeking during pregnancy.

Understanding the impact of health literacy on women's health

Low health literacy negatively affects a woman's health knowledge, preventive behavior, ability to navigate the health care system, and ability to care for her children. Interventions to increase a woman's heath literacy include written education materials with proper reading level and design, clear communication, and education to increase health knowledge, self-efficacy, and self-advocacy skills. Health literacy should also be incorporated in nursing education programs.

Health literacy and its association with the use of information sources and with barriers to information seeking in clinic-based pregnant women

We investigated health literacy and its association with the use of information sources and with barriers to information seeking in clinic-based pregnant women. The Short Test of Functional Health Literacy in Adults (STOFHLA) was used to measure health literacy in 143 English-speaking low-income pregnant women. About 15% of the participants demonstrated low health literacy. Participants with low health literacy were less likely to use the Internet and more likely to have self-efficacy barriers than participants with high health literacy. Interventions to promote information-seeking skills and Internet access are indicated for women with low health literacy.

Information-seeking and its predictors in low-income pregnant women

This study examined information-seeking and its predictors (information needs and barriers) in low-income pregnant women. Eighty-four pregnant women from a prenatal clinic were interviewed using three scales that measured the frequency of information-seeking from eight different sources, information needs for 20 pregnancy health topics, and 15 barriers to seeking information, respectively. Most women were black, unmarried, between 20 and 29 years of age, high school educated or less, multigravidas, and in their third trimester of pregnancy. Information needs and barriers were significant predictors of information-seeking. Together, they explained 26% of the variance in the seeking outcome. High information needs and low barriers predicted more frequent information-seeking. First pregnancy and asthma during pregnancy were significant covariates for information-seeking. Information needs and barriers are related to information-seeking among low-income pregnant women. To facilitate pregnant women's information-seeking, health care providers may assess a woman's need for information and barriers that the woman experiences when seeking information, and factors such as first pregnancy and asthma.

Correlates of clinically significant fatigue in women with newly diagnosed breast cancer

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Background: Cancer related fatigue (CRF) is common in cancer survivors. CRF has been reported to be one of the most distressing symptoms associated with cancer and its treatment. Activity and biological profiles of those who suffer from CRF, have been poorly characterized. This IRB approved prospective, natural history study reports fatigue and associated findings in women newly diagnosed with breast cancer (BrCa), receiving standard treatment. Methods: All women were evaluated pre-operatively and at >9 months after diagnosis. Variables measured: Age, height, marital status, presence of children, menopausal status, tumor size, node status, estrogen receptor (ER+), hemoglobin, white blood cell count, fasting blood glucose, and BMI. Patient reported outcomes included visual analog scale (VAS) of fatigue (F), SF-36 version2, Physical Activity Questionnaire (PAQ, Harvard Alumni Health Study) and Sleep Questionnaire. Some variables were dichotomized to maximize the statistical power for the relatively small sample size. Bivariate correlations, and logistic regression analyses were performed using two fatigue conditions: presence of any F, or presence of clinically significant fatigue (CSF) defined as >=4 on the VAS. Results: 61 women, mean age of 51y, 39% had BMI >=25, 85% had >= 1 child, 52% were post-menopause, 92% ER+. Increased F at follow-up was statistically significant when compared to baseline (p=<0.0001, using paired t-test). Significant correlations (p<0.1) are reported between CSF and the following: node+, BMI>=25; inverse correlations with amount of vigorous activity (PAQ), physical function and vitality on SF-36. Physical function (SF-36) had significant inverse correlations with: age, menopause, and BMI. Low vitality was associated with: large tumor size, high WBC, longer time sleeping. Node+, BMI>=25, low physical function and vitality levels retained statistically significant relationships to CSF in the regression analyses. Conclusions: Node+ BrCa, BMI>=25, low level of physical activity and vitality (SF-36) are correlated with CSF. Except node status, each is treatable and may reduce CSF

No significant financial relationships to disclose.

Severity of Drug Use, Initiation of Prenatal Care, and Maternal‐Fetal Attachment in Pregnant Marijuana and Cocaine/Heroin Users

OBJECTIVE

To compare the severity of drug use, initiation of prenatal care, and maternal-fetal attachment between pregnant marijuana and cocaine/heroin users.

DESIGN

A cross-sectional design.

SETTING

A prenatal clinic of a medical center in the northeast of the United States.

PARTICIPANTS

19 marijuana, 17 cocaine, and 4 heroin users. Cocaine and heroin users were combined in one group.

MAIN OUTCOME MEASURES

The Severity of Drug Use Questionnaire containing 11 questions of withdrawal, dependence, and medical, legal, and interpersonal issues was used to assess the severity of drug use. Initiation of prenatal care was obtained from the chart and was calculated by weeks of gestation when care began. Cranley's Maternal-Fetal Attachment Scale measured maternal-fetal attachment.

RESULTS

Pregnant cocaine/heroin users were 6 years older, had experienced more pregnancies, had higher drug severity scores, and initiated prenatal care later than marijuana users. No significant difference in maternal-fetal attachment was found.

CONCLUSION

Interventions to help especially cocaine/heroin users initiate early prenatal care and reduce severity of drug use are indicated.

From contagious to chronic: a life course experience with leprosy in Taiwanese women

This study used the narrative analysis method to explore stories told by Taiwanese women who had suffered from leprosy. Twenty-one women from a leprosarium, a long-term care centre, and the community participated in either focus group discussions or individual interviews. The age range for the participants was 54-88, with an average of 68 years old. Physical impairments and disabilities of the participants included skin scars, claw fingers, drop feet, amputated legs, and facial disfigurement. Their stories were analysed in two phases: structural and holistic content analyses. Structural analysis identified four life stages: before being diagnosed, after being diagnosed, living with leprosy, and the future. Holistic content analysis uncovered common themes in each life stage. Findings indicated that stigma was experienced throughout the life course of these women. At this stage of life, these women were facing not only physical impairments and disabilities from the leprosy, but also the usual chronic health problems of the elderly. This study suggests that prevention and treatment of leprosy-related physical impairments and chronic diseases are important.

Evaluation of a Clinical Teaching Method Involving Stories

A clinical teaching method involving stories was evaluated in this study. A total of 25 ASN and BSN students participated in Phase I evaluation and another 16 ASN students were included in Phase II. Each student created a story about an obstetric or a pediatric topic. The story was then read by the story writer to peers and faculty. The faculty member facilitated dialogues and reflections on the meanings of the story. In Phase I, students offered written responses about the effectiveness of the story teaching. In Phase II, a 5-item questionnaire measured pre- and post-test scores of perceived improvement in five knowledge areas. Results showed that students perceived the story teaching positively because it brought learning to a personal level and facilitated in-depth discussion and critical thinking. Perceived knowledge improvement was evident after the story teaching in nursing interventions, the physiological and psychosocial alterations, legal/ethical/cultural issues, and community resources. In conclusion, this teaching method was acceptable to students and may have contributed to positive learning outcomes.

Self-Care and Well-Being Model for Elderly Women: A Comparison of Rural and Urban Areas

The purposes of this study were to examine the relationships among age, social class, perceived health, self-care, and well-being in urban and rural elderly women and to validate and compare two models using these two groups. A causal model of self-care and well-being was proposed for this study based on Orem's self-care model and empirical data. Data were collected using a survey-interview method. Of the 351 elderly women recruited, 159 were in the urban group and 192 in the rural group. Two models of self-care and well-being were tested using path analysis with the LISREL 8 program. The resultant models yielded a Chi-squared of 1.98 with two degrees of freedom (p = 0.37) in the urban group and a Chi-squared of 4.20 with three degrees of freedom (p = 0.24) in the rural group, indicating good fit between the data and the two models. These two models provide guidelines for community nurses to design appropriate self-care programs for elderly women.

International exchange program: findings from Taiwanese graduate nursing students

This study explored Taiwanese graduate nursing students' transcultural experiences in the United States during an international exchange program. A qualitative method with content analysis was used to analyze journal entries on perceptions of American culture, American nursing, and reflections on personal and professional growth written by nine graduate nursing students from Taiwan. The mean age of the participants was 32 (range, 29-45). Taiwanese nursing students perceived American culture as full of hospitality and patriotism, valuing human rights and social welfare, and favoring direct and expressive affection. American nursing was viewed as a combination of independence, confidence, autonomy, and knowledge, with caring being the core element, fostered by an environment conducive to patient care. In personal and professional growth, three themes surfaced: reinforcement of holistic care, nursing without borders, and lifelong learning and changing. American culture and nursing were perceived by Taiwanese students as a paradigm of Western culture valuing individual rights, autonomy, and independence. A caring and supportive patient care environment was a positive perception of American nursing; it was the desired practice standard that was lacking in these students' homeland. Overall, the exchange program was thought by these students to foster their personal and professional growth.

Maternal-fetal attachment in pregnant women who use illicit drugs

OBJECTIVE

To explore cognitive, affective, and altruistic dimensions of maternal-fetal attachment in pregnant women who use illicit drugs.

DESIGN

Content analysis with deductive and inductive coding methods was used to uncover common themes in each dimension of attachment.

SETTING

A prenatal clinic of a tertiary medical center in the northeastern United States.

PARTICIPANTS

Forty pregnant women. Inclusion criteria were the following: used illicit drugs after the last menstrual period, had felt fetal movement, and could read and speak English. Women in methadone treatment programs were excluded.

RESULTS

Knowing the baby's characteristics and health through fetal movement, acknowledging the fetus as an individual with physical and emotional functions, and knowing the baby by relating the fetus to self and family members are the three major themes in cognitive attachment. Themes in affective attachment include mixing strong affection with guilt and viewing fetal movement as visual and tactile enjoyment but also discomfort. Common themes with conflicting feelings were salient in altruistic attachment, including feeling uncomfortable versus feeling worthwhile, viewing being pregnant as an incentive for lifestyle changes, battling with substance use and concern for fetal health, and alternating between uncertainty and hope in preparing for the baby's arrival.

CONCLUSION

Maternal-fetal attachment is not a phenomenon that is present or absent, but a struggle manifested by guilt, concern, and uncertainty. Without proper treatment and counseling, many women struggle between illicit drug use and development of maternal-fetal attachment.

Lipid remodeling in mouse liver and plasma resulting from delta6 fatty acid desaturase inhibition

Electrospray/tandem mass spectrometry was used to quantify lipid remodeling in mouse liver and plasma during inhibition of polyunsaturated fatty acid synthesis by the delta6 fatty acid desaturase inhibitor, SC-26196. SC-26196 caused increases in linoleic acid and corresponding decreases in arachidonic acid and docosahexaenoic acid in select molecular species of phosphatidylcholine, phosphatidylethanolamine, and cholesterol esters but not in phosphatidylserine, phosphatidylinositol, or triglycerides. For linoleic acid-, arachidonic acid-, and docosahexaenoic acid-containing phospholipid species, this difference was, in part, determined by the fatty acid at the sn-1 position, namely, palmitic or stearic acid. An understanding of phospholipid remodeling mediated by delta6 desaturase inhibition should aid in clarifying the contribution of arachidonic acid derived via de novo synthesis or obtained directly in the diet during inflammatory responses.

What do we know about maternal-fetal attachment?

A review of the literature suggests that there are three critical attributes related to the concept of maternal-fetal attachment, including cognitive, affective, and altruistic attachment. Cognitive attachment is the desire to know the baby. Affective attachment is the pleasure associated with thoughts of or interaction with the fetus. Altruistic attachment refers to a desire to protect the unborn child. Existing measurements on maternal-fetal attachment are developed based on low-risk and white pregnant women and previous research has not yet resulted in a consistent theoretical model. Future research should focus on development of culturally sensitive instruments and combining qualitative and quantitative measures to broaden theoretical understanding of the concept. Nursing assessment of maternal-fetal attachment is an on-going process. The nurse's role is to reassure those who have developed attachment to their fetuses and to motivate those who are unaware of or unconcerned about their attachment to their fetuses. Collecting data from different attributes of attachment helps nurses identify each woman's attachment patterns and areas of concern.

Concept analysis of well-being

Traditionally, mortality and morbidity were considered two important indicators of health outcome. Until recently, the measurement of health outcome focused on individuals' subjective perceptions of well-being. Well-being has been popularly used in many scientific disciplines. The definitions of well-being, however, were diverse and inconsistent in previous literature. The ambiguous concept used in research study will impede the development of knowledge and theory. Concept analysis, therefore, is necessary to synthesize the existing views of well-being and distinguish it from other concepts to explicate the meaning of well-being.