Impact of having a high-risk pregnancy on future postpartum contraceptive method choice

BackgroundTo compare the knowledge and preference of preconceptional contraception to future postpartum contraceptive method choice in high-risk pregnancies.Research questionDoes a high-risk pregnancy condition affect future postpartum contraceptive method choice?MethodWomen hospitalised at the High Risk Pregnancy unit of a tertiary research and training hospital were asked to complete a self-reported questionnaire that included demographic characteristics, presence of unintended pregnancy, contraceptive method of choice before the current pregnancy, plans for contraceptive use following delivery and requests for any contraceptive counselling in the postpartum period.FindingsA total of 655 pregnant women were recruited. The mean age, gravidity and parity of the women were 27.48 ± 6.25 years, 2.81 ± 2.15 and 1.40 ± 1.77, respectively. High-risk pregnancy indications included 207 (31.6%) maternal, 396 (60.5%) foetal and 52 (7.9%) uterine factors. All postpartum contraceptive choices except for combined oral contraceptives (COCs) usage were significantly different from preconceptional contraceptive preferences (p < 0.001). High-risk pregnancy indications, future child bearing, ideal number of children, income and education levels were the most important factors influencing postpartum contraceptive choices. While the leading contraceptive method in the postpartum period was long-acting reversible contraceptive methods (non-hormonal copper intrauterine device Cu-IUD, the levonorgestrel-releasing intrauterine system (LNG-IUS) (40%), the least preferred method was COCs use (5.2%) and preference of COCs use showed no difference between the preconceptional and postpartum periods (p = 0.202). Overall 73.7% of the women wanted to receive contraceptive counselling before their discharge.ConclusionA high-risk pregnancy condition may change the opinion and preference of contraceptive use, and also seems to affect the awareness of family planning methods.     

A longitudinal study of perinatal depression among Chinese high-risk pregnant women

Background

Information is needed on the prevalence of depression in Chinese women with medically defined complications across the perinatal period, as well as key risk factors to develop appropriate perinatal mental health services and ensure the services target those most in need.

Healthy relationship education for dating violence prevention among high-risk youth

A federal grant was awarded to provide the Love U2 healthy relationship curriculum to low-income, high-risk youth. This research sought to examine the relative effectiveness of a brief intervention with this curriculum compared to the much more intensive relationship education programs that have been previously provided to high-risk youth. Data were collected from 233 participants through measures of training and relationship outcomes pre- and post-training. Participants experienced high levels of training satisfaction, significant increases in relationship knowledge and self-efficacy related to conflict resolution. They also experienced a significant improvement in attitudes toward couple violence in the desired direction. Implications of these findings for promoting healthy relationships and reducing dating violence among high-risk youth are discussed.     

Between badness and sickness: Reconsidering medicalization for high risk children and youth

Most of the sociological literature about “troubling” children and youth focuses on how the scientific authority of medical experts, with a discourse of sickness, has come to displace the moral authority of justice enforcement officials and their rhetoric of badness as arbiters of childhood pathology. Yet my experience working with high-risk children and youth during a post-MSW fellowship strongly suggests that discourses of badness have not supplanted discourses of sickness. Indeed, these discourses remain deeply intertwined with implications for the way we conceptualize troubling children and youth, for the treatment we prescribe, and for how children and youth understand themselves. Discussing two composite cases to illustrate how negotiations of badness and sickness unfold, I argue that shifts in attributions of badness and sickness follow predictable patterns generally occurring in response to: (1) changes in the context (whether the child is at home, school, or in a treatment setting); (2) changes in an actor's interests or role (parents may attribute troubling behaviors as badness at home but frame them as sickness with people outside the family); and/or (3) changes in external structures of time (e.g. the end of the school year or the end of a Medicaid authorization). In conclusion, I consider the implications of partial medicalization and these patterns of narrative negotiations for future research and practice.     

Implementation of an enhanced probation program: Evaluating process and preliminary outcomes

Supervision, Monitoring, Accountability, Responsibility, and Treatment (SMART) is Kentucky's enhanced probation pilot program modeled after Hawaii's Opportunity Probation with Enforcement (HOPE). SMART is proposed to decrease substance use, new violations, and incarceration-related costs for high-risk probationers by increasing and randomizing drug testing, intensifying supervision, and creating linkages with needed resources (i.e., mental health and substance use). SMART adopts a holistic approach to rehabilitation by addressing mental health and substance abuse needs as well as life skills for fostering deterrence of criminal behavior vs. punitive action only. A mixed methods evaluation was implemented to assess program implementation and effectiveness. Qualitative interviews with key stakeholders (i.e., administration, judges, attorneys, and law enforcement/corrections) suggested successful implementation and collaboration to facilitate the pilot program. Quantitative analyses of secondary Kentucky Offender Management System (KOMS) data (grant Year 1: 07/01/2012–06/30/2013) also suggested program effectiveness. Specifically, SMART probationers showed significantly fewer: violations of probation (1.2 vs. 2.3), positive drug screens (8.6% vs. 29.4%), and days incarcerated (32.5 vs. 118.1) than comparison probationers. Kentucky's SMART enhanced probation shows preliminary success in reducing violations, substance use, and incarceration. Implications for practice and policy will be discussed.     

Effective Adolescent Substance Abuse Treatment in Juvenile Justice Settings: Practice and Policy Recommendations

Juvenile justice—increasingly the service delivery point for adolescents with substance abuse and co-occurring problems lacking resources for other assistance—can be a model for improved and expanded, yet cost-effective, adolescent substance abuse treatment. An emergent standard of care challenges systemic inequities; a new service array facilitates dialogue among justice and treatment professionals, families, and the youth themselves. Such evidence-based practice—and the policy to implement it—have the power to transform disconnected laws, programs and professionals into an effective, efficient and successful community of responders, helping youth reclaim their lives while improving public health and public safety.

Maternity high-dependency care and the Australian midwife: A review of the literature

Background

Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable.

Adolescent Gambling and Coping within a Generalized High-risk Behavior Framework

Data were collected for 1998 middle/high-school students in Ontario to assess involvement in gambling, substance use, and generalized risky behavior. To predict these outcomes, measures for anxiety, family cohesion, and coping style were also administered. Three a-priori models were posited to account for the impact of risk factors, protective factors, and combined risk/protective factors on the development of risky behaviors. A high-risk cohort composed of subjects endorsing at least one risky behavior (gambling, substance use, or generalized risky behavior) within the clinical range was created to test an unobserved outcome variable created from all three measures of risky behavior, which was successfully predicted by two of the three a-priori models. Implications for the inclusion of gambling within a constellation of high-risk behaviors and recommendations for future prevention efforts are discussed. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.