An analysis of online pregnancy message boards: Mother-to-mother advice on medication use

Problem and backgroundPsychotropic medication use is increasingly common among pregnant women. Many women solicit information from other mothers about the safety of these medications for use during pregnancy, yet little is known about the specific advice they receive.AimThe purpose of the current study was to examine the type of feedback women receive on a popular internet message board about psychotropic medication use during pregnancy.MethodsA modified Consensual Qualitative Research approach was used to analyze 1728 comments posted by Babycenter.com users about the safety of the use of six common psychotropic medications during pregnancy. Researchers analyzed the comments for overall themes and core ideas.FindingsResults found that comments were comprised of six themes: (1) Personal Anecdotes, (2) Suggesting Alternative Solutions, (3) Directives, (4) Judgement, (5) Social Support, (6) Skepticism & Mistrust, and (7) Risks vs. Benefits. While many comments conveyed emotional support, or encouraged women to seek professional advice, others contained inaccurate and/or contradictory information, or harsh criticism.ConclusionGiven that the decision about the use of medication during pregnancy has implications for the health of the mother and fetus, it is important for care providers to be aware of what feedback women may receive from this source. Providers should address questions and concerns that women have about safety of these medications and recognize how the social context of the internet impacts the emotional health of pregnant women faced with these decisions.     

Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

IssueFear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions.AimTo conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them.MethodsA meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis.FindingsOne overarching theme “Ownership of Childbirth” and three analytical themes “Facing the fear”, “Feeling empowered”, “Managing the fear with a sense of security” were generated through the synthesis. There were no studies outside of Scandinavia located.DiscussionThis meta-synthesis provides a new way to describe the process of moving from fear to “Ownership of childbirth”. The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff.ConclusionThese findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.     

Effect of health literacy interventions on pregnancy outcomes: A systematic review

BackgroundLow health literacy has been associated with worse health outcomes, but little is known about the effectiveness of health literacy interventions developed for pregnant women.AimTo assess the effectiveness of health literacy interventions on pregnancy outcomes through a systematic review of randomised controlled trials.MethodsRandomised controlled trials that assessed health literacy interventions designed to improve pregnancy outcomes were included. The study protocol was registered with PROSPERO (CRD42018094958).FindingsOf the 1512 records initially identified, 13 studies were included. Three reported on decision-aid interventions, six on face-to-face interventions and four on written interventions (including computer-based interventions or information leaflets). The primary outcomes of interest for this systematic review were knowledge (10/13 studies) and health literacy (2/13 studies) with one study not reporting either primary outcome. A significant improvement in knowledge was found across the 10 studies, however the two studies which measured health literacy only assessed health literacy at a single time-point. Secondary outcomes including health behaviours, fetal outcomes and health-service utilisation were reported in 11 studies, with inconsistent results.DiscussionFew health literacy interventions have been developed specifically for pregnant women. Although health literacy interventions have the potential to improve knowledge and pregnancy outcomes, current evidence is limited by inconsistent outcomes and measurement, and limited use of health literacy theory to inform intervention design and content. Few studies directly measured health literacy.ConclusionMore research is needed to properly assess the effect of health literacy interventions on pregnancy outcomes. This research should include consideration of health literacy theory in the development of the interventions.     

Smoking cessation care during pregnancy: A qualitative exploration of midwives’ challenging role

ProblemThe majority of South Australian pregnant women who smoke do not quit during pregnancy. Additionally, the prevalence of smoking is higher among pregnant women living in socially disadvantaged areas.BackgroundUnderstanding challenges in midwives’ provision of smoking cessation care can elucidate opportunities to facilitate women’s smoking cessation.AimWe aimed to understand midwives’ perspectives on current practices, perceived barriers and facilitators to delivery of smoking cessation care, and potential improvements to models of smoking cessation care.MethodsAn exploratory qualitative research methodology and thematic analysis was used to understand the perspectives of midwives in five focus groups.FindingsFour themes were generated from the data on how midwives perceived their ability to provide smoking cessation care: Tensions between providing smoking cessation care and maternal care; Organisational barriers in the delivery of smoking cessation care; Scepticism and doubt in the provision of smoking cessation care; and Opportunities to enable midwives’ ability to provide smoking cessation care.DiscussionA combination of interpersonal, organisational and individual barriers impeded on midwives’ capacities to approach, follow-up and prioritise smoking cessation care. Working with women living with disadvantage and high rates of smoking, the midwife’s role was challenging as it balanced delivering smoking cessation care without jeopardising antenatal care.ConclusionProviding midwives with resources and skills may alleviate the sense of futility that surrounds smoking cessation care. Provision of routine training and education could also improve understandings of the current practice guidelines.     

Midwifery continuity of care for women with complex pregnancies in Australia: An integrative review

BackgroundAll women require access to quality maternity care. Continuity of midwifery care can enhance women’s experiences of childbearing and is associated with positive outcomes for women and infants. Much research on these models has been conducted with women with uncomplicated pregnancies; less is known about outcomes for women with complexities.AimTo explore the outcomes and experiences for women with complex pregnancies receiving midwifery continuity of care in Australia.MethodsThis integrative review used Whittemore and Knafl’s approach. Authors searched five electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and MAG Online) and assessed the quality of relevant studies using the Critical Appraisal Skills Programme (CASP) appraisal tools.FindingsFourteen studies including women with different levels of obstetric risk were identified. However, only three reported outcomes separately for women categorised as either moderate or high risk. Perinatal outcomes reported included mode of birth, intervention rates, blood loss, perineal trauma, preterm birth, admission to special care and breastfeeding rates. Findings were synthesised into three themes: ‘Contributing to safe processes and outcomes’, ‘Building relational trust’, and ‘Collaborating and communicating’. This review demonstrated that women with complexities in midwifery continuity of care models had positive experiences and outcomes, consistent with findings about low risk women.DiscussionThe nascency of the research on midwifery continuity of care for women with complex pregnancies in Australia is limited, reflecting the relative dearth of these models in practice.ConclusionDespite favourable findings, further research on outcomes for women of all risk is needed to support the expansion of midwifery continuity of care.     

Test for Trend With a Multinomial Outcome

ABSTRACT

There is no established procedure for testing for trend with nominal outcomes that would provide both a global hypothesis test and outcome-specific inference. We derive a simple formula for such a test using a weighted sum of Cochran–Armitage test statistics evaluating the trend in each outcome separately. The test is shown to be equivalent to the score test for multinomial logistic regression, however, the new formulation enables the derivation of a sample size formula and multiplicity-adjusted inference for individual outcomes. The proposed methods are implemented in the R package multiCA.     

转型期中国公众的分配公平感：结果公平与机会公平

本文考察了中国公众的结果公平感和机会公平感,检验并比较了社会结构解释和相对剥夺解释在中国的适用性。研究发现,大多数公众认可结果公平和机会公平,且机会公平感高于结果公平感,但二者仅微弱相关。结果公平感由收入水平决定,机会公平感主要受教育水平影响。外资和私营单位雇员比国有和集体单位雇员更具机会公平感,城市中下层就业者对结果和机会分配均持批评态度。“个体相对剥夺”而不是“群体相对剥夺”对分配公平感有决定性影响,结果公平感只受横向剥夺影响,而机会公平感则主要受纵向剥夺影响。     

On the significance of social control: Treatment‐entry pressures,self‐choice and alcohol and drug dependence criteria one year after treatment

Storbjörk J. On the significance of social control: treatment‐entry pressures, self‐choice and alcohol and drug dependence criteria one year after treatment This article explores how self‐choice and treatment‐entry pressures are associated with one‐year treatment outcome (dependence symptoms, 0–6, 12 months) among alcohol and drug misusers, respectively. Informal pressures (from family and friends), formal pressures (related to work, healthcare, social services, social allowances, child custody) and legal pressures (related to the police, criminal justice system, compulsory treatment) were analysed. A sample (N= 1,210) representative of the addiction treatment system of Stockholm County was interviewed when starting a new treatment episode and after one year. Regression analyses indicated that self‐choice and pressures are associated with outcome among alcohol misusers but not among drug misusers when controlling for background factors and severity. Self‐choice (without pressures) correlated with a good outcome (a lower number of dependence criteria). Pressures were generally associated with poorer outcome. Alcohol misusers who had experienced threats regarding child custody did better in comparison with those not experiencing such pressure. The difference in results by drug type and implications were discussed.     

Psychiatric Symptoms and Perceived Need for Psychiatric Care After Divorce

Abstract

The study investigated level of psychiatric symptoms and perceived need for psychiatric care among recently divorced males and females. Furthermore, various demographic factors and characteristics of the marriage and divorce related to psychiatric symptoms and perceived need for psychiatric care, were identified. Six hundred fifty eight recently divorced males and females living in five different counties in Norway participated. Their level of psychiatric symptoms was compared with the general Norwegian population. Divorced individuals had substantially higher level of psychiatric symptoms as compared to the general population. No consistent gender differences were observed. For both males and females, level of conflict with the ex-spouse and being leaver or being left, were the variables being most strongly related to psychiatric symptoms and need of psychiatric care. However, the variables accounted for only a modest proportion of the variance in the mental health outcome.