Joan Rosen Bloch

Postpartum Physical Symptoms in New Mothers: Their Relationship to Functional Limitations and Emotional Well-being

BACKGROUND Postpartum physical health problems are common and have been understudied. The purpose of this investigation was to explore the associations among reported physical symptoms, functional limitations, and emotional well-being of postpartum women. METHODS The study included data from interviews conducted at 9 to 12 months postpartum from 1,323 women who had received prenatal care at nine community health centers located in Philadelphia, Pennsylvania, United States, between February 2000 and November 2002. Emotional well-being was assessed with the Center for Epidemiological Studies Depression Scale and perceived emotional health. Functional limitations measures were related to child care, daily activities (housework and shopping), and employment. A summary measure of postpartum morbidity burden was constructed from a checklist of potential health problems typically associated with the postpartum period, such as backaches, abdominal pain, and dyspareunia. RESULTS More than two-thirds (69%) of the women reported experiencing at least one physical health problem since childbirth. Forty-five percent reported at least one problem of moderate or major (as opposed to minor) severity and 20 percent reported at least one problem of major severity. The presence, severity, and cumulative morbidity burden associated with postpartum health problems were consistently correlated with reports of one or more functional limitations and measures of emotional well-being including depressive symptomatology. CONCLUSIONS Although physical problems typically associated with the postpartum period are often regarded as transient or comparatively minor, they are strongly related both to womens functional impairment and to poor emotional health. Careful assessment of the physical, functional, and emotional health status of women in the year after childbirth may improve the quality of postpartum care.

Recruitment and retention of women in a large randomized control trial to reduce repeat preterm births: the Philadelphia Collaborative Preterm Prevention Project

BackgroundRecruitment and retention of patients for randomized control trial (RCT) studies can provide formidable challenges, particularly with minority and underserved populations. Data are reported for the Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large RCT targeting risk factors for repeat preterm births among women who previously delivered premature (< 35 weeks gestation) infants.MethodsDesign of the PCPPP incorporated strategies to maximize recruitment and retention. These included an advanced database system tracking follow-up status and assessment completion rates; cultural sensitivity training for staff; communication to the community and eligible women of the benefits of participation; financial incentives; assistance with transportation and supervised childcare services; and reminder calls for convenient, flexibly scheduled appointments. Analyses reported here: 1) compare recruitment projections to actual enrollment 2) explore recruitment bias; 3) validate the randomization process 4) document the extent to which contact was maintained and complete assessments achieved 5) determine if follow-up was conditioned upon socio-economic status, race/ethnicity, or other factors.ResultsOf eligible women approached, 1,126 (77.7%) agreed to participate fully. Of the 324 not agreeing, 118 (36.4%) completed a short survey. Consenting women were disproportionately from minority and low SES backgrounds: 71.5% consenting were African American, versus 38.8% not consenting. Consenting women were also more likely to report homelessness during their lifetime (14.6% vs. 0.87%) and to be unmarried at the time of delivery (81.6% versus 47.9%). First one-month postpartum assessment was completed for 83.5% (n = 472) of the intervention group (n = 565) and 76% (426) of the control group. Higher assessment completion rates were observed for the intervention group throughout the follow-up. Second, third, fourth and fifth postpartum assessments were 67.6% vs. 57.5%, 60.0% vs. 48.9%, 54.2% vs. 46.3% and 47.3% vs. 40.8%, for the intervention and control group women, respectively. There were no differences in follow-up rates according to race/ethnicity, SES or other factors. Greater retention of the intervention group may reflect the highly-valued nature of the medical and behavior services constituting the intervention arms of the Project.ConclusionFindings challenge beliefs that low income and minority women are averse to enrolling and continuing in clinical trials or community studies.

Human Papillomavirus and Cervical Cancer Knowledge, Health Beliefs, and Preventative Practices in Older Women

OBJECTIVE To explore knowledge of Human Papillomavirus (HPV) and cervical cancer, health beliefs, and preventative practices in women 40 to 70 years. DESIGN Cross-sectional descriptive. SETTING Three urban ambulatory Obstetrics and Gynecology offices connected with a teaching hospitals Department of Obstetrics and Gynecology in the Mid-Atlantic section of the United States. PARTICIPANTS A convenience sample of 149 women age 40 to 70. METHODS To assess HPV and cervical cancer knowledge, health beliefs, and preventative practices a self-administered survey, the Awareness of HPV and Cervical Cancer Questionnaire was distributed to women as they waited for their well-woman gynecologic exam. RESULTS The mean knowledge score was 7.39 (SD=3.42) out of 15. One third of the questions about the relationship of HPV and risks for cervical cancer were answered incorrectly by more than 75% of these women. Although most appreciate the seriousness of cervical cancer, they believed themselves not particularly susceptible. CONCLUSION There is a need for HPV and cervical cancer awareness and education for women older than age 40. Womens health care professionals are well positioned to act as a catalyst to improve HPV and cervical cancer knowledge, health beliefs, and preventative practice to ensure optimum health promotion for all women.

Application of the Kessner and Kotelchuck Prenatal Care Adequacy Indices in a Preterm Birth Population

OBJECTIVES Healthy People 2010 goals to eliminate racial and ethnic health disparities that persist in the utilization of prenatal care (PNC) highlight the importance of measuring PNC as a variable in maternal and infant health outcomes research. These disparities are significantly correlated to adverse infant outcomes in preterm birth (PTB), a leading cause of infant mortality and life-long morbidity. Currently the most extensively used PNC adequacy indices (Kessner and Kotelchuck) were developed to measure outcomes in populations consisting mostly of full-term births. It is unclear whether these PNC adequacy indices are reliable when pregnancy is truncated due to PTB (<37 weeks). This paper compares and demonstrates how they can be applied in a specific PTB cohort. DESIGN AND SAMPLE This secondary analysis of a nested case-control study compares Kessner and Kotelchuck adequacy scores of 367 mothers of PTB infants. RESULTS There were significant differences in the rating of PNC inadequacy ( p<.001) depending on the PNC adequacy index used. CONCLUSION Critical evaluation is warranted before using these PNC adequacy indices in future public health nursing and PTB research.

Subjective Social Status and Maternal Health in a Low Income Urban Population

Appropriate measurement of socioeconomic status (SES) in health research can be problematic. Conventional SES measures based on ‘objective’ indicators such as income, education, or occupation may have questionable validity in certain populations. The objective of this investigation was to determine if a relatively new measurement of SES, subjective social status (SSS), was more consistently and strongly associated with multiple health outcomes for low income mothers. Data available from a large scale community-based study examining maternal and infant health for a low income urban population were used to examine relationships between SSS and a wide range of postpartum physical and emotional health outcomes. Crosstabulations and multivariate analyses focused on the breadth and depth of these relationships; in addition, the relative strength of the relationships between SSS and the health outcomes was compared to that of conventional measures of SES, including both income and education. SSS was significantly related to all physical and emotional health outcomes examined. The overall pattern of findings indicated that these relationships were independent of, as well as more consistent and stronger than, those between conventional measures of SES and postpartum health outcomes. SSS represents an important dimension of the relationship between SES and postpartum physical and emotional health. In low income populations the failure to account for this dimension likely underestimates the influence of SES on postpartum health. This has important implications for the interpretation of findings in empirical studies which seek to control for the effects of SES on maternal health outcomes.

Using a Pedagogical Approach to Integrate Evidence-Based Teaching in an Undergraduate Women's Health Course

BACKGROUND Evidence-based practice (EBP) is promoted as a foundation for nursing practice. However, the 2005 U.S. survey of nurses revealed that they do not have requisite skills for EBP. PURPOSE AND GOALS: To evaluate a pedagogical approach aimed at (1) fostering undergraduate nursing students EBP competencies, and (2) identifying gaps in the literature to direct future womens health research. METHODS A secondary analysis of data abstracted from required EBP clinical journals for an undergraduate womens health course in which students (n = 198) were asked to find evidence to answer their clinical questions. Content analysis was used to identify main themes of the topics of inquiry. RESULTS Students identified 1,808 clinical questions and 30.3% (n = 547) of these could not be answered or supported by evidence in the literature. CONCLUSIONS This assignment was an important teaching and assessment tool for EBP. Questions reflected critical thinking and quest for in-depth knowledge to support nursing practice. Some students lacked skills in searching databases and a significant number of knowledge gaps were identified that can direct womens health research.

Incident Smoking During Pregnancy and the Postpartum Period in a Low-Income Urban Population

Objectives. We determined the prevalence of first lifetime use of cigarettes during pregnancy or in the early postpartum period (incident smoking) and identified sociodemographic and health-related characteristics of incident smokers. Methods. We used statistics based on data from a longitudinal study of a large cohort of pregnant, low-income, urban women (n= 1,676) to describe the timing of first-time use and to compare incident smokers with those who had never smoked and those who had already smoked prior to pregnancy. Results. About one in 10 (10.2%) women who had not previously smoked initiated cigarette smoking during pregnancy or in the early postpartum period. Compared with those who had never smoked, incident smokers were more likely to report high levels of stress and to have elevated levels of depressive symptomatology, which may be rooted in relatively poor social and economic conditions. Conclusion. A significant number of women may be initiating smoking during pregnancy or in the early postpartum period. These women have characteristics that are consistent with the risk factors associated with smoking. Further research is warranted to determine prevalence in other populations, identify the risk factors for incident smoking, and assess the potential for primary prevention efforts designed to help women who had previously avoided cigarette use to remain smoke-free throughout pregnancy and in the postpartum period.

Drug Shortages and the Burden of Access to Care: A Critical Issue Affecting Patients With Cancer

Pharmaceutical drug shortages are multifaceted and complex problems that affect all aspects of health care, including patients, caregivers, healthcare providers, third-party payers, the pharmaceutical industry, and regulators. Drug shortages have increased significantly since 2000, which cause increases in healthcare costs and compromised patient care. New government regulations have led the U.S. Food and Drug Administration to focus efforts on updating policies and improving regulation of the pharmaceutical industry to limit and avoid drug shortages. This article discusses the current issues surrounding the pharmaceutical drug shortage and the implications for patients and healthcare providers. A review of the literature presents the multidimensional impact of the pharmaceutical drug shortage, and the analysis shows patients who are most burdened by drug shortages and have experienced substandard care, increased cost of care, and compromised quality of health care.

The human papillomavirus in women over 40: Implications for practice and recommendations for screening

Purpose: Cervical cancer is the second leading cause of cancer deaths among women worldwide. Human papillomavirus (HPV) has been shown to be the precursor of cervical cancer in over 99% of these cases. Although preventative measures have greatly reduced the burden of HPV‐induced cervical cancer, these measures cannot be utilized by women who are unaware of the existence of HPV and its relationship to their health. Women over the age of 40 are being newly diagnosed with HPV, profoundly impacting their lives and their sense of well‐being. This article highlights the necessity for clinicians to assess knowledge, health beliefs, and preventative measures regarding HPV and cervical cancer in women over the age of 40. Data sources: Review of scientific literature of knowledge, health beliefs, and preventative measures in women regarding HPV and cervical cancer and clinical practice guidelines. Conclusions: Although women aged 40 and above are not specifically considered high risk for HPV infection, many women are testing positive in this age group and are facing the impact of an HPV diagnosis that implicates a sexually transmitted disease and is known to be a precursor to cervical cancer. Implications for practice: Suggested questions to use for all patients are presented as it is crucial for healthcare providers to understand the healthcare needs of this age group in order to appropriately direct resources and to save the lives of women from this preventable disease.

Postpartum Health in Mothers of Term and Preterm Infants

ABSTRACT Mothers have inadequate information about what to expect in the postpartum period in terms of their own health. Understanding common patterns of postpartum health may be particularly important for mothers of preterm low birthweight infants, so that they can plan how to optimize their own health as they care for their vulnerable infants. The purpose of this study was to compare the health of mothers of preterm and term infants prospectively for the first four months following delivery. This longitudinal descriptive study measured health status of 33 mothers of preterm infants and 32 mothers of term infants using health diaries and the Health Review Questionnaire every month for the first four months following delivery. No difference was observed between the two groups of mothers in how ill mothers reported feeling over time. The most common symptoms mothers experienced were headaches and cold symptoms. On average mothers reported between one and four days every month that they were not able to conduct their usual activities. Mothers reported feeling ill more frequently than they sought health care. The average mother at four months postpartum was still reporting she felt ill between 3 and 7 days during the month. This study has implications for families, health care providers, and policy makers.