Barbara A. Anderson

Stress as a mediating factor in the association between the DRD2 TaqI polymorphism and alcoholism.

Results of earlier studies have shown that rating of prior stress exposure in preadolescent boys influenced the association between DRD2 genotypes and alcoholism risk factors, suggesting that variability in stress exposure, either in patient or control samples, could readily account for at least part of the confusion in DRD2 study outcomes. In order to test the hypothesis that the DRD2 A1 allele is only associated with alcoholism in subjects with elevated stress exposure, we examined the gene-stress interactional model in a sample of males of Mayan descent in the Olancho district of Honduras. Ascertainment was based on an epidemiologic, observational cross-sectional design, and the study was approved by the Institutional Review Board. A total of 309 adult males (age range 18-87 years) were interviewed by a physician or a public health nurse, blood samples were obtained for genetic studies, and participants were administered the short version of the Michigan Alcoholism Screening Test (S-MAST) and the Hispanic Stress Inventory (HSI). Three explanatory models were evaluated. The first model tested the effect of the demographic variables alone as predictors of MAST scores, the second tested the effects of stress and DRD2 genotypes separately, and the third tested the effect of the interaction between stress and the DRD2 genotypes. Neither model 1 nor model 2 yielded significant results; neither MAST scores nor HSI scores were found to be associated with DRD2 genotypes. However, Model 3 was confirmed reflecting a significant (P<.05) interaction between DRD2 genotype and stress score as a predictor of MAST score. Additionally, this difference was found to be largely accounted by the HSI occupational/economic stress score, which had a highly significant (P=.003) interaction with DRD2 genotype as a predictor of MAST score. This stress score was the only one of four that showed levels of stress as high as HSI scores in a US population. The MAST scores of A2A2 genotype participants were found to be nearly identical in low stress and high stress participants, whereas the MAST scores of A1A2 participants increased modestly with stress (P=.01) and that of A1A1 participants increased markedly with stress (P=.001). These findings support the hypothesis that DRD2 genotype-phenotype associations depend on the magnitude of stress exposure, and they lend support to the view that variability in DRD2 study outcomes may in part be explained by this gene-environment interaction.

IDENTIFYING INTIMATE PARTNER VIOLENCE AT ENTRY TO PRENATAL CARE: CLUSTERING ROUTINE CLINICAL INFORMATION

Intimate partner violence (IPV) is the greatest trauma-related risk to American women. Pregnant women are no exception, and escalation of IPV frequently occurs during pregnancy. Many studies have linked IPV during pregnancy to adverse maternal and fetal outcomes. This study examined IPV at the beginning of prenatal care to identify correlates of routine entry-to-care information with responses on a validated IPV screening tool, the Abuse Assessment Screen. The purpose of the study was to identify specific data from routine, standard intake information, which could alert clinicians to the potential of violence even in the presence of a negative IPV score or no formally administered screening tool. The point prevalence of abuse, as measured by the Abuse Assessment Screen at entry to care, was slightly in excess of the national mean, reinforcing the need for continual assessment throughout pregnancy. Abused women in this study were more likely to be young, single, and without family or partner support. These women relied on friends for support, admitted to depression, and desired their pregnancies. The findings are consistent with previous studies. Further research needs to be conducted to determine if this cluster of findings at entry to care, with or without a positive score on an IPV screening tool, are consistent markers for an increased risk of IPV.

Evaluation of three influenza neuraminidase inhibition assays for use in a public health laboratory setting during the 2011-2012 influenza season.

Objectives. We evaluated the implementation of three commericially available neuraminidase inhibition assays in a public health laboratory (PHL) setting. We also described the drug susceptibility patterns of human influenza A and B circulating in Maryland during the 2011–2012 influenza season. Methods. From January to May 2012, 169 influenza virus isolates were tested for phenotypic susceptibility to oseltamivir, zanamivir, and peramivir using NA-Fluor™, NA-Star®, and NA-XTD™ concurrently. A 50% neuraminidase inhibitory concentration (IC50) value was calculated to determine drug susceptibility. We used the standard deviation based on the median absolute deviation of the median analysis to determine the potential for reduced drug susceptibility. We evaluated each assay for the use of resources in high- and low-volume testing scenarios. Results. One of the 25 2009 influenza A (H1N1) pandemic isolates tested was resistant to oseltamivir and peramivir, and sensitive to zanamivir, on all three platforms. Eighty-two influenza A (H3N2) and 62 B isolates were sensitive to all three drugs in all three assays. For a low-volume scenario, NA-Star and NA-XTD took 120 minutes to complete, while NA-Fluor required 300 minutes to complete. The lowest relative cost favored NA-Star. In a high-volume scenario, NA-Fluor had the highest throughput. Reagent use was most efficient when maximizing throughput. Cost efficiency from low- to high-volume testing improved the most for NA-Star. Conclusions. Our evaluation showed that both chemiluminescent and fluorescent neuraminidase inhibition assays can be successfully implemented in a PHL setting to screen circulating influenza strains for neuraminidase inhibitor resistance. For improved PHL influenza surveillance, it may be essential to develop guidelines for phenotypic drug-resistance testing that take into consideration a PHLs workload and available resources.

Grief and Women: Stillbirth in the Social Context of India.

INTRODUCTION Few in Western society would argue the potentially devastating impact of stillbirth related grief; but in many developing countries where stillbirth remains the highest in the world, perinatal grief is barely recognized as an issue. The purpose of this study was to explore how poor, rural central Indian women perceive and cope with stillbirths. METHODS Seventeen key informant interviews and two focus groups (N = 33) with local health care providers, family members, and women who experienced stillbirth were conducted over a 1-month period in 2011 and then systematically coded for emerging themes using grounded theory methods to explore how women experienced stillbirth. RESULTS Although usually never talked about and not recognized as an issue, perinatal grief emerged as a significant shared experience by all. The perceptions of stillbirth-related grief emerged in three major themes and bear evidence of gender and power issues and indicate that local social norms negatively factor heavily into their perinatal grief experiences. DISCUSSION The findings in this richly textured study add to the limited literature regarding rural, central Indian womens experiences with stillbirth and factors influencing their resulting perinatal grief. In light of the void of recognition of this phenomenon in Indian society, a better understanding of the context in which poor Indian women experience perinatal grief will be a first step toward developing much needed culturally rooted interventions to positively impact the womens abilities to better cope with stillbirth in the context of their realities.

Experiential Public Health Study Abroad Education: Strategies for Integrating Theory and Practice:

Several reputable commissions on higher education have recommended that U.S. schools of public health develop competency-based education grounded in greater realism through enhanced field experience. The purpose of this article is to present a case study that illustrates an experiential public health education delivery model that meets these expectations. A 3-week field-based course is taught in developing countries each year to expose students to public health strategies in resource poor environments. A primary educational aim is to facilitate comprehension of the multiple influences (financial, political, technical, and cultural) that impact health care delivery and national development. Course participants are exposed to and interact with governmental and nongovernmental organizations in host countries. Students actively participate in course management. Measurable benefits accrue to the students, faculty, and the School of Public Health through this field-based academic program.

“Being With Woman”: Is There a Cost for Midwives and Students Attending Traumatic Births?

Witnessing and/or providing care during a traumatic birth increases vulnerability to secondary traumatic stress, with potential effects on mental health of and attrition among the midwifery workforce. With the global shortage of the midwifery workforce, retention and peak functioning are critical to the well-being of childbearing women and their infants. PubMed, Scopus, CINAHL, and PsycINFO databases were searched to identify studies that examined secondary traumatic stress in both midwives and midwifery students. Fifteen studies were located from eight different countries. Four of these studies examined secondary traumatic stress in midwifery students and 11 in practicing midwives. This article discusses the limited research on secondary traumatic stress among midwives and students who have attended or witnessed traumatic births. The vulnerability and potential workforce attrition of midwives and students experiencing secondary traumatic stress are highlighted. The development of a comprehensive body of literature is needed on prevalence, impact, clinical implications, and healing strategies addressing this workforce issue.

Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants

Guatemalan maternal and infant mortality rates remain high, particularly among indigenous populations. In remote areas, traditional birth attendants (TBAs), without formal midwifery education, are frequently the only maternal care providers. We conducted a mixed methods study to evaluate knowledge, skills, and attitudes of 26 TBAs in western Guatemala. The purposes of this study were to evaluate the efficacy of a community-based midwifery training program and to determine how the knowledge, skills, and attitudes of TBAs influence the care provided to indigenous mothers and infants. Themes from 5 key informant interviews included survival of mother and baby, facilitating referrals, and community pressure not to refer. We offered a 2-week simulation-based training designed for low resource settings. Participants completed pre- and posttests and demonstrated midwifery skills. Knowledge scores and objectively measured skills improved significantly. Attitude outcomes included increased endorsement regarding importance of pre- and postnatal visits, recognizing risk/complications, and partnering with medical providers. Potential effects discussed include safe TBA practice, training value, and intent to disseminate learnings in their communities.

Prevention of Neonatal Hypothermia: A Skin-to-Skin Practices Education Project in Rural Uganda

PURPOSE: In low resource areas, neonatal hypothermia is an important source of neonatal morbidity. Separating newborns from their mothers at birth puts neonates at risk for hypothermia. The Teso Safe Motherhood Project (TSMP) in Soroti, Uganda provides birth center care for women in conflict areas of Northern Uganda. After conducting a needs assessment at TSMP, a continuing education project was developed to facilitate change in clinical practice to enhance prevention and recognition of neonatal hypothermia, including implementation of skin-to-skin practices at birth. STUDY DESIGN: This education project employed multiple learning strategies including pretest and posttest questionnaires, group discussion of cultural beliefs and practices, didactic education, participation in creative informational art, and demonstration, supervision, and return demonstration of skills. MAJOR FINDINGS: At the completion of the program, 100% of participants demonstrated a statistically significant increase in both knowledge and skills in the prevention and management of neonatal hypothermia (p = .011). MAIN CONCLUSION: The participants reported that this continuing education project enhanced their skills in neonatal hypothermia prevention and management. The cost-effective strategies employed in this project can be replicated in low resource settings, contributing to decreased mortality and morbidity from newborn hypothermia.