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Rondung E, Ternström E, Hildingsson I, Haines HM, Sundin Ö, Ekdahl J, Karlström A, Larsson B, Segeblad B, Baylis R, Rubertsson C. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10420. [PMID: 30097422 PMCID: PMC6109226 DOI: 10.2196/10420] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. OBJECTIVE This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. METHODS This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. RESULTS We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). CONCLUSIONS Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).
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Affiliation(s)
- Elisabet Rondung
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helen M Haines
- Department of Rural Health, The University of Melbourne, Victoria, Australia
| | - Örjan Sundin
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | | | | | - Birgitta Segeblad
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Rebecca Baylis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Faculty of Medicine, Lund university, Lund, Sweden
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Opie CA, Haines HM, Ervin KE, Glenister K, Pierce D. Why Australia needs to define obesity as a chronic condition. BMC Public Health 2017; 17:500. [PMID: 28535781 PMCID: PMC5442589 DOI: 10.1186/s12889-017-4434-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/15/2017] [Indexed: 11/22/2022] Open
Abstract
Background In Australia people with a diagnosed chronic condition can be managed on unique funded care plans that allow the recruitment of a multidisciplinary team to assist in setting treatment goals and adequate follow up. In contrast to the World Health Organisation, the North American and European Medical Associations, the Australian Medical Association does not recognise obesity as a chronic condition, therefore excluding a diagnosis of obesity from qualifying for a structured and funded treatment plan. Body The Australian guidelines for management of Obesity in adults in Primary Care are structured around a five step process -the ‘5As’: Ask & Assess, Advise, Assist and Arrange’. This article aims to identify the key challenges and successes associated with the ‘5As’ approach, to better understand the reasons for the gap between the high Australian prevalence of overweight and obesity and an actual diagnosis and treatment plan for managing obesity. It argues that until the Australian health system follows the international lead and defines obesity as a chronic condition, the capacity for Australian doctors to diagnose and initiate structured treatment plans will remain limited and ineffective. Conclusion Australian General Practitioners are limited in their ability manage obesity, as the current treatment guidelines only recognise obesity as a risk factor rather than a chronic condition.
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Affiliation(s)
- C A Opie
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia.
| | - H M Haines
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - K E Ervin
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - K Glenister
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
| | - D Pierce
- Department of Rural Health Graham Street Shepparton Victoria, The University of Melbourne, Victoria, 3630, Australia
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Haines HM, Baker J, Marshall D. Continuity of midwifery care for rural women through caseload group practice: Delivering for almost 20 years. Aust J Rural Health 2017; 23:339-45. [PMID: 26683716 DOI: 10.1111/ajr.12232] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the clinical outcomes and sustainability factors of a long-standing midwifery led caseload model of rural maternity care. DESIGN Retrospective clinical audit from 1998 to 2011 and autoethnographic narrative of the midwifery program told by the longest serving midwives under three key themes relating to sustainable practice. SETTING Regional Health Service with annual birth rate of 500. Maternity care is provided by either public antenatal clinic/GP shared care or midwife-led care. PARTICIPANTS Women attending a rural caseload midwifery group practice between the period 1998-2011 and midwives working in the same group practice during that period. MAIN OUTCOME MEASURES Antenatal attendance, maternal mortality, infant morbidity and mortality, mode of birth, known midwife at birth, initiation of breastfeeding. RESULTS There were 1674 births between 1998 and 2011. Clinical outcomes for women and infants closely reflected national maternity indicator data. The group practice midwives attribute sustainability of the program to the enjoyment of flexibility in their working environment, to establishing trust amongst themselves, the women they care for, and with the obstetricians, GPs and health service executives. The rigorous application of midwifery principles including robust clinical governance have been hallmarks of success. CONCLUSION This caseload midwifery group practice is a safe, satisfying and sustainable model of maternity care in a rural setting. Clinical outcomes are similar to standard care. Success can be attributed to strong leadership across all levels of policy, health service management and, most importantly, the rural midwives providing the service.
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Affiliation(s)
- Helen M Haines
- Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.,Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Janet Baker
- Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Diana Marshall
- Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
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Haines HM, Bannon-Murphy H, Amos T, Krones R. Prevalence and management of diabetes in residential aged care facilities in north-east Victoria, Australia. Aust Fam Physician 2016; 45:908-911. [PMID: 27903042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Managing diabetes in residential aged care facilities (RACFs) presents challenges to general practitioners (GPs) as the incidence of the disease increases. OBJECTIVE The objective of this article is to describe the prevalence and management of diabetes in RACFs in north-east Victoria. METHODS The method used for this study was a cross-sectional audit of medical files. RESULTS Ten RACFs were invited and agreed to participate, giving a sample of 593 residents. Diabetes prevalence was 18.2% (n = 108). Half of the residents with diabetes had received a glycated haemoglobin (HbA1c) test in the previous six months. Of these residents, half had an HbA1c result of 8%. The frequency of hypoglycaemic events was found to be 10%. Hyperglycaemic episodes (HbA1C >10%) occurred in 69% of residents with diabetes; 21% had hyperglycaemic episodes when defined by levels greater than those set by the resident's GP. Diabetes-related unscheduled hospitalisations was found to be 6.5%, while diabetes-related general practice visits was 23%. DISCUSSION The prevalence of diabetes in the RACFs was higher than previously reported in rural Victoria. Practice variance from evidence-based guidelines may be contributing to unplanned hospitalisations and increased acute general practice visits.
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Pallant JF, Haines HM, Green P, Toohill J, Gamble J, Creedy DK, Fenwick J. Assessment of the dimensionality of the Wijma delivery expectancy/experience questionnaire using factor analysis and Rasch analysis. BMC Pregnancy Childbirth 2016; 16:361. [PMID: 27871320 PMCID: PMC5117613 DOI: 10.1186/s12884-016-1157-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/14/2016] [Indexed: 12/04/2022] Open
Abstract
Background Fear of childbirth has negative consequences for a woman's physical and emotional wellbeing. The most commonly used measurement tool for childbirth fear is the Wijma Delivery Expectancy Questionnaire (WDEQ-A). Although originally conceptualized as unidimensional, subsequent investigations have suggested it is multidimensional. This study aimed to undertake a detailed psychometric assessment of the WDEQ-A; exploring the dimensionality and identifying possible subscales that may have clinical and research utility. Methods WDEQ-A was administered to a sample of 1410 Australian women in mid-pregnancy. The dimensionality of WDEQ-A was explored using exploratory (EFA) and confirmatory factor analysis (CFA), and Rasch analysis. Results EFA identified a four factor solution. CFA failed to support the unidimensional structure of the original WDEQ-A, but confirmed the four factor solution identified by EFA. Rasch analysis was used to refine the four subscales (Negative emotions: five items; Lack of positive emotions: five items; Social isolation: four items; Moment of birth: three items). Each WDEQ-A Revised subscale showed good fit to the Rasch model and adequate internal consistency reliability. The correlation between Negative emotions and Lack of positive emotions was strong, however Moment of birth and Social isolation showed much lower intercorrelations, suggesting they should not be added to create a total score. Conclusion This study supports the findings of other investigations that suggest the WDEQ-A is multidimensional and should not be used in its original form. The WDEQ-A Revised may provide researchers with a more refined, psychometrically sound tool to explore the differential impact of aspects of childbirth fear. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1157-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J F Pallant
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia
| | - H M Haines
- Department of Rural Health, The University of Melbourne, Graham St, Shepparton, Australia.
| | - P Green
- Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - J Toohill
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Gamble
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - D K Creedy
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia
| | - J Fenwick
- Menzies Health Institute, Griffith University, Meadowbrook Queensland, Australia.,Gold Coast University Hospital Southport, Queensland, 4215, Australia
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Haines HM, Pallant JF, Fenwick J, Gamble J, Creedy DK, Toohill J, Hildingsson I. Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort. Sex Reprod Healthc 2015; 6:204-10. [PMID: 26614602 DOI: 10.1016/j.srhc.2015.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/01/2015] [Accepted: 05/11/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice. AIM To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women. METHOD Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics. RESULTS 1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean. CONCLUSION This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.
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Affiliation(s)
- H M Haines
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia; Northeast Health, Green St, Wangaratta, Victoria, Australia.
| | - J F Pallant
- Rural Health Academic Centre, The University of Melbourne, 49 Graham St, Shepparton, Victoria, Australia
| | - J Fenwick
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia; Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland 4215, Australia
| | - J Gamble
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - D K Creedy
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - J Toohill
- Griffith Health Institute and School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - I Hildingsson
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Rubertsson C, Pallant JF, Sydsjö G, Haines HM, Hildingsson I. Maternal depressive symptoms have a negative impact on prenatal attachment – findings from a Swedish community sample. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.992009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pallant JF, Haines HM, Hildingsson I, Cross M, Rubertsson C. Psychometric evaluation and refinement of the Prenatal Attachment Inventory. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2013.871627] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Intravenous thrombolysis improves functional outcomes in acute ischaemic stroke. However, many rural stroke patients are denied thrombolysis because of a rural neurologist shortage. 'Telestroke' facilitates thrombolysis by providing remote access to neurologists via videoconferencing systems. AIMS To develop a safe and feasible Telestroke system in a rural Victorian hospital that facilitates delivery of intravenous thrombolysis to acute ischaemic stroke patients. METHODS A pilot videoconferencing Telestroke system was set up between Royal Melbourne Hospital and Northeast Health Wangaratta. Acute stroke patients presenting within 4.5 h of symptom onset without intracranial haemorrhage were eligible for Telestroke. However, eligible patients were excluded from Telestroke if they had haemorrhagic risk factors. Data were collected from intervention (October 2009-September 2010) and control group (October 2008-September 2009) by medical file audit. Primary outcome measure was percentage of patients thrombolysed. Secondary outcome measures included incidence of symptomatic intracerebral haemorrhage and door-to-computed tomography time. RESULTS One hundred and forty-five acute stroke patients presented in control year and 130 patients in intervention year. Fifty-four patients in intervention and 36 patients in control group were eligible for thrombolysis. In intervention group, 24 patients had Telestroke activated and 8 patients underwent thrombolysis. There was no thrombolysis in the control group. There were neither symptomatic intracerebral haemorrhages nor deaths attributable to thrombolysis. Median door-to-computed tomography time did not significantly differ between eligible patients in control and intervention groups. CONCLUSION Telestroke has the potential to bridge the gap of rural-metropolitan inequality in acute stroke care. Our Telestroke system successfully introduced safe thrombolysis and early specialist review of acute stroke patients in rural Victoria.
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Affiliation(s)
- K J Nagao
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Haines HM, Hildingsson I, Pallant JF, Rubertsson C. The role of women's attitudinal profiles in satisfaction with the quality of their antenatal and intrapartum care. J Obstet Gynecol Neonatal Nurs 2013; 42:428-41. [PMID: 23773005 DOI: 10.1111/1552-6909.12221] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. DESIGN Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth. SETTING Two hospitals in Sweden and Australia. PARTICIPANTS Five hundred and five (505) pregnant women from one hospital in Västernorrland, Sweden (n = 386) and one in northeast Victoria, Australia (n = 123). RESULTS Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. CONCLUSIONS Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.
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Affiliation(s)
- Helen M Haines
- Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Akademiskasjukhuset, Uppsala, Sweden.
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Haines HM, Rubertsson C, Pallant JF, Hildingsson I. The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy Childbirth 2012; 12:55. [PMID: 22727217 PMCID: PMC3449179 DOI: 10.1186/1471-2393-12-55] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 06/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored. METHODS Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes. RESULTS Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 -20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02- 2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0). CONCLUSIONS In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.
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Affiliation(s)
- Helen M Haines
- Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85, Uppsala, Sweden.
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Krones R, Radford P, Cunningham C, Krones D, Haines HM. Thrombolysis for acute ST elevation myocardial infarction: a pilot study comparing results from GP led small rural health emergency departments with results from a physician led sub-regional emergency department. Rural Remote Health 2012; 12:2013. [PMID: 22681194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Urgent angiogram is best treatment for patients presenting with ST elevation myocardial infarction (STEMI) in the first 90 min after contacting medical help. For Australian residents of inner and outer regional areas and remote or very remote areas, quick access to angiograms is not available. Numerous approaches have been developed to maximize reperfusion but delays due to systematic and patient factors persist. Diminishing confidence of some GPs in small rural health services to administer thrombolytics was one barrier to timely reperfusion identified in northeast Victoria, Australia. The aim of this study was to compare the frequency and outcomes of STEMI patients treated with thrombolysis by GPs in small rural emergency departments (EDs) with the outcomes from thrombolysis for STEMI in the physician-led, sub-regional ED in northeast Victoria. METHODS Data were gathered by a medical file audit. Outcome measures were the frequency of STEMI, symptom to presentation times, mode of transport to hospital, ambulance call to presentation at ED times, door to needle (DTN) times, subsequent percutanous intervention (PCI) or coronary artery bypass grafts (CABG), physician follow up and death. RESULTS In total 68 cases were audited. Univariate analysis showed no significant differences between the GP-led or physician-led EDs in time from onset of symptoms to presentation, DTN times, thrombolysis related complications or subsequent access to PCI or CABG. Follow-up care was similar in both groups. Transport to hospital differed between the groups with only half of all cases arriving at the ED by ambulance, almost all of which went to the sub-regional hospital. CONCLUSIONS Thrombolysis for STEMI in the small GP-led EDs had similar results to thrombolysis administered by the physician-led ED. There is substantial time benefit to be gained by encouraging GP-led EDs to provide thrombolysis treatment, thereby improving patient prognosis and survival.
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Affiliation(s)
- Robert Krones
- Rural Health Academic Centre, The University of Melbourne, Wangaratta, Victoria, Australia.
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Wells CL, van de Westerlo EM, Jechorek RP, Haines HM, Erlandsen SL. Cytochalasin-induced actin disruption of polarized enterocytes can augment internalization of bacteria. Infect Immun 1998; 66:2410-9. [PMID: 9596696 PMCID: PMC108218 DOI: 10.1128/iai.66.6.2410-2419.1998] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Cytochalasin-induced actin disruption has often been associated with decreased bacterial internalization by cultured epithelial cells, although polarized enterocytes have not been systematically studied. In assays using confluent polarized HT-29 enterocytes, cytochalasin D appeared to increase internalization of wild-type Salmonella typhimurium, Proteus mirabilis, and Escherichia coli. HeLa and HEp-2 epithelial cells, as well as HT-29 and Caco-2 enterocytes, were used to clarify this unexpected observation. Resulting data showed that cytochalasin D was associated with increased internalization of S. typhimurium and P. mirabilis by both HT-29 and Caco-2 enterocytes and with increased internalization of E. coli by HT-29 enterocytes; with either HeLa or HEp-2 cells, cytochalasin was associated with no change or a decrease in internalization of these same bacterial strains. Cytochalasin caused decreased internalization of Listeria monocytogenes by HT-29, Caco-2, HeLa, and HEp-2 cells, indicating that cytochalasin did not consistently augment bacterial internalization by polarized enterocytes. Fluorescein-labeled phalloidin confirmed marked disruption of filamentous actin in cytochalasin-treated HT-29, Caco-2, HeLa, and HEp-2 cells. Cytochalasin had no noticeable effect on epithelial viability but caused distorted apical microvilli, cell rounding, and separation of adjacent enterocytes in confluent cultures (with a corresponding decrease in transepithelial electrical resistance). Scanning electron microscopy showed that cytochalasin-induced enhanced bacterial internalization was associated with preferential bacterial adherence on the exposed enterocyte lateral surface. Colchicine, used to disrupt microtubules, had no noticeable effect on bacterial internalization by HT-29 or Caco-2 enterocytes. These data indicated that for HT-29 and Caco-2 enterocytes, cytochalasin-induced disruption of filamentous actin might augment internalization of some bacterial species by a mechanism that appeared to involve exposure of the enterocyte lateral surface.
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Affiliation(s)
- C L Wells
- Department of Laboratory Medicine, University of Minnesota, Minneapolis, Minnesota 55455-0385, USA.
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