Komal Kochhar

The effect of pregnancy intention on important maternal behaviors and satisfaction with care in a socially and economically at-risk population

This study examined the association of pregnancy intention with maternal behaviors and the woman’s perceived satisfaction with her prenatal and delivery care. Face-to-face interviews with 478 primarily Medicaid eligible women in Indianapolis, Indiana during their postpartum hospital stay were conducted to assess their degree of satisfaction with prenatal care and pregnancy intention, stratified into wanting to be pregnant now, later or never. Behaviors and characteristics influencing utilization of prenatal care were obtained from linked birth certificate data. A greater proportion of younger women (15–29) wanted to be pregnant later, a greater proportion of African-Americans never wanted to be pregnant, a greater proportion of divorced and never married women wanted to be pregnant later or never, and as parity increased the percentage of women never wanting to be pregnant increased. Multivariate analyses found that women never wanting to be pregnant were twice as likely to underutilize prenatal care, twice as likely to smoke while pregnant, half as likely to utilize WIC services and half as likely to recommend their providers to pregnant friends or relatives compared to women with a planned pregnancy, controlling for confounding variables. Finally, women wanting to be pregnant later were half as likely to rate their overall hospital care and prenatal care provider as high. Providers assessing their patients’ pregnancy intention could better identify those women needing additional support services to adopt healthier behaviors and improve satisfaction with care. This study also demonstrated the value of more specific definitions of pregnancy intention.

Understanding the current anatomical competence landscape: Comparing perceptions of program directors, residents, and fourth-year medical students

A mixed methods survey of fourth‐year medical students, resident physicians, and residency program directors at the Indiana University School of Medicine gathered perceptions of anatomical competence—defined as the anatomical education necessary for effective clinical practice. The survey items explored numerous aspects of anatomical competence, including the most effective modes of instruction, perceptions of readiness for clinical practice, and specific suggestions for improving anatomical education during medical school and residency. The response rate was 46% for fourth‐year medical students, 47% for residents (as graduates from 137 medical schools), and 71% for program directors. A majority of students and residents reported that their course in Gross Anatomy prepared them well for clinical practice; that cadaveric dissection was important in the early development of their anatomical competence; and that placing a greater emphasis on clinical relevance in medical school would have improved their anatomical competence even further. However, in terms of anatomical preparedness upon entering residency, the program directors rated their residents less prepared than the residents rated themselves. All three groups agreed that there is need for additional opportunities for anatomical educational during medical school and residency. Suggestions for improving anatomical education included the following: providing more opportunities for cadaveric dissection during medical school and residency; more consistent teaching of anatomy for clinical practice; more workshops that review anatomy; and better integration of anatomy with the teaching of other subjects during medical school. Anat Sci Educ 9: 307–318.

Administrative Challenges to the Integration of Oral Health With Primary Care: A SWOT Analysis of Health Care Executives at Federally Qualified Health Centers.

Inadequate access to preventive oral health services contributes to oral health disparities and is a major public health concern in the United States. Federally Qualified Health Centers play a critical role in improving access to care for populations affected by oral health disparities but face a number of administrative challenges associated with implementation of oral health integration models. We conducted a SWOT (strengths, weaknesses, opportunities, and threats) analysis with health care executives to identify strengths, weaknesses, opportunities, and threats of successful oral health integration in Federally Qualified Health Centers. Four themes were identified: (1) culture of health care organizations; (2) operations and administration; (3) finance; and (4) workforce.

Assessing Knowledge and Perceptions Related to Preventive Methods and Treatment of Malaria in the Local Endemic Area of Trujillo, Honduras.

Malaria in Honduras is endemic and accounts for 40% of the total cases in Central America. Our goal was to assess knowledge of preventive methods and current treatment of malaria among the affected community of Trujillo, Honduras. A cross-sectional survey was administered to 71 individuals. Most respondents had a good understanding about common malaria symptoms but not about the complications associated with severe cases. More important, we found that less than 20% of the respondents recognized indoor residual sprays and insecticide-treated nets as effective preventive measures, which are the most efficient preventive methods. Our study highlights the perceptions the people of Trujillo have about malaria. From our observations, we put forward recommendations to implement a comprehensive campaign to educate the Trujillo population about malaria preventive methods and to recruit local and international efforts to distribute insecticide-treated nets.