Louise H. Flick

Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment.

OBJECTIVE: To estimate the prevalence of posttraumatic stress disorder and its treatment in economically disadvantaged pregnant women. METHODS: The sample included 744 pregnant Medicaid-eligible women from Women, Infants and Children Supplemental Nutrition Program sites in 5 counties in rural Missouri and the city of St. Louis. Race (black and white) was proportional to clients seen at each site. Women were assessed by using standardized measures of posttraumatic stress disorder, 18 other psychiatric disorders, environmental stressors, and pregnancy characteristics. Logistic regression identified risk factors associated with posttraumatic stress disorder. RESULTS: Posttraumatic stress disorder prevalence was 7.7% (n = 57/744). Comorbid disorders were common. Women with posttraumatic stress disorder were 5 times more likely to have a major depressive episode (odds ratio 5.17; 95% confidence interval 2.61, 10.26) and more than 3 times as likely to have generalized anxiety disorder (odds ratio 3.25; 95% confidence interval 1.22, 8.62). Besides these comorbid disorders, risk factors for posttraumatic stress disorder included a history of maternal separation for 6 months and multiple traumatic events. Although most women with posttraumatic stress disorder reported moderate impairment in their daily lives, only 7 of the 57 women with this disorder reported speaking with any health professional about it in the last 12 months. CONCLUSIONS: The prevalence of posttraumatic stress disorder in pregnancy and low treatment rates suggest that screening for this disorder should be considered in clinical practice. LEVEL OF EVIDENCE: II-2

Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths?

BackgroundYoung maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study.MethodsWe conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997–1999. Infant mortality rates for all singleton births to adolescent women (12–17 years, n = 10,131; 18–19 years, n = 18,954) were compared to those for older women (20–35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations.ResultsThe risk of infant (OR 1.95, CI 1.54–2.48), neonatal (1.69, 1.24–2.31) and post-neonatal mortality (2.47, 1.70–3.59) were significantly higher for younger adolescent (12–17 years) than older (20–34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14–2.64) but not neonatal mortality (1.43, 0.98–2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18–19 years) mothers.ConclusionSocioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.

Effect of exercise on birthweight.

Research evaluating the effect of physical activity on perinatal outcomes can be divided into two categories: work-related activities and exercise. According to previous qualitative reviews, the results from studies focusing on work-related activities have been inconsistent. Some studies have reported associations between specific activities (eg, prolonged standing and walking or heavy lifting) and an increased risk for preterm delivery and small-for-gestational age (SGA) infants. Others have argued that the associations may be due to other workrelated stressors or unknown confounders. Two meta-analyses have been conducted to evaluate the effect of maternal exercise on perinatal outcomes. In 1991, Lokey et al reported no difference in birthweight or gestational age at delivery for infants by maternal exercise status during pregnancy. They also reported no differences for the infants of women who exercised within or above the American College of Obstetricians and Gynecologists recommendation for exercise intensity ( 140 beats per minute) that were in effect when the meta-analysis was completed. In 2002, Kramer showed no weighted mean differences for birthweight or gestational age at delivery for infants born of mothers who did and did not participate in regular aerobic exercise while pregnant. The results for his meta-analysis were based on 10 clinical trials, whereas the Lokey et al meta-analysis included 18 studies regardless of design. Although both meta-analyses suggest that maternal exercise during pregnancy may not have any effect on specific fetal outcomes, a few questions remain as to whether differences in birthweight are dependent upon the physical conditioning of the mother previous to pregnancy, how long she continued to exercise during her pregnancy, and the type of controls used for comparison. Our meta-analysis addresses these questions using all published and unpublished studies as of December 31, 2002, that evaluated the effect of maternal exercise during pregnancy on birthweight.

Persistent Tobacco Use During Pregnancy and the Likelihood of Psychiatric Disorders

OBJECTIVES We examined the association between psychiatric disorders and tobacco use during pregnancy. METHODS Data were derived from a population-based cohort of 744 pregnant African American and White low-income women living in urban and rural areas. The Diagnostic Interview Schedule was used to assess women for 20 different psychiatric disorders. RESULTS In comparison with nonusers, persistent tobacco users (women who had used tobacco after confirmation of their pregnancy) and nonpersistent users (women who had used tobacco but not after pregnancy confirmation) were 2.5 and 2 times as likely to have a psychiatric disorder. Twenty-five percent of persistent users had at least 1 of the following diagnoses: generalized anxiety disorder, bipolar I disorder, oppositional disorder, drug abuse or dependence, and attention deficit-hyperactivity disorder. CONCLUSIONS In this cohort study, 5 diagnoses were more prevalent among persistent tobacco users than among nonusers, suggesting that several psychiatric disorders contribute to difficulty discontinuing tobacco use during pregnancy. Smoking cessation efforts focusing on pregnant women may need to address co-occurring psychiatric disorders if they are to be successful.

CVD risk among men participating in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010: differences by sexual minority status

Background Recent research indicates that sexual minority women are at increased risk for cardiovascular disease (CVD) compared with heterosexual women; however, few studies of CVD risk exist for sexual minority men (SMM). This study aimed to determine whether disparities in CVD risk exist for SMM and if CVD risk is consistent across subgroups of SMM. Methods This study utilised publicly available data from the National Health and Nutrition Examination Survey (NHANES), pooled from 2001 to 2010. CVD risk was calculated using the Framingham General CVD Risk Score and operationalised as the ratio of a participants vascular and chronological age. Differences in this ratio were examined between heterosexual and SMM as a whole, and within subgroups of SMM. Results SMM had vascular systems that were, on average, 4% (95% CI −7.5% to −0.4%) younger than their heterosexual counterparts; however, adjustment for education and history of hard drug use rendered this difference statistically insignificant. Analysis of SMM subgroups revealed increased CVD risk for bisexual men and decreased CVD risk for both gay and homosexually experienced heterosexual men when compared with heterosexual men. Differences in CVD risk persisted for only bisexual and homosexually experienced heterosexual men after adjustment for education and history of hard drug use. Conclusions Subgroups of SMM are at increased risk for CVD compared with heterosexual men, and this increased risk cannot be completely attributed to differences in demographic characteristics or negative health behaviours.

Psychiatric Disorders and Treatment in Low-Income Pregnant Women

AIMS This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. METHOD To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. RESULTS The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. CONCLUSIONS With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment.

Associations Between Psychiatric Disorders and Menstrual Cycle Characteristics

An understanding of the relationship between psychiatric disorders and menstrual characteristics is important to the assessment and care of women. Menstrual cycle regularity and length have significant associations with specific current and lifetime psychiatric disorders. The purpose of this study was to investigate whether psychiatric disorders are associated with menstrual cycle length or regularity. The sample included 628 pregnant Medicaid-eligible women from Women, Infants, and Childrens Supplemental Nutrition Program sites in five counties in rural Missouri and the city of St. Louis. Women were assessed for current (12-month) and lifetime psychiatric disorders with the Diagnostic Interview Schedule IV. Menstrual length and regularity were assessed by self-report. Analyses consisted of logistic regression while controlling for race. Independent of the effects of race, (a) women who reported irregular cycles were less than half as likely to have a current anxiety disorder as those that reported regular cycles, and (b) women with shorter cycles (<or=28 days) have one and a half times to two times greater risk of current affective disorder, lifetime affective disorder, lifetime anxiety disorder, lifetime substance use or dependence disorder, and lifetime drug abuse or dependence. A significant interaction effect for race and cycle length indicated that cycle length predicted likelihood of having any lifetime psychiatric disorder for Caucasians only and there was no association between cycle length and lifetime psychiatric diagnosis for African American women.

Building Community for Health: Lessons from a Seven-Year-Old Neighborhood/University Partnership

This article presents two case studies highlighting the role of community conflict in the process of community empowerment. A graduate program for community health nurses (CHNs) in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the communitys capacity to improve its own health and teaching CHNs community organizing as a means to improve health. Central to the partnership are a broad definition of health, trust developed through long-term involvement, a commitment to reciprocity, social justice, and Freires model of adult learning.

Ambient air pollution and the prevalence of obesity in chinese children: The seven northeastern cities study

The association between air pollution and the prevalence of overweight and obesity is evaluated.

The use of Focus Groups to Characterize Symptoms in Persons with Multiple Sclerosis

ABSTRACT Multiple sclerosis is a chronic neurological disease with a myriad of symptoms. Because most work has been quantitative, it is important to capture symptoms as described by patients who experience them, using a qualitative approach. The purpose of our study was to describe and identify symptoms, with emphasis on co-occurrence, using focus groups. Three focus groups were conducted (N = 16) with relapsing–remitting multiple sclerosis patients. Common symptoms, described as both singular and co-occurring, were problems with balance, cognition, vision, and heat intolerance. These findings augment past characterizations of symptoms experienced in persons with relapsing–remitting multiple sclerosis and provide evidence for future studies.