Nancy H. Liu

Women's preference for caesarean section: a systematic review and meta-analysis of observational studies

Please cite this paper as: Mazzoni A, Althabe F, Liu N, Bonotti A, Gibbons L, Sánchez A, Belizán J. Women’s preference for caesarean section: a systematic review and meta‐analysis of observational studies. BJOG 2011;118:391–399.

Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas

Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio‐environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual‐focused, health system‐focused, and community level and policy‐focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.

Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study

BackgroundOver the last three decades, cesarean section (CS) rates have been rising around the world despite no associated improvement in maternal and perinatal mortality and morbidity. The role of women’s preferences for mode of delivery in contributing to the high CS rate remains controversial; however these preferences are difficult to assess, as they are influenced by culture, knowledge of risk and benefits, and personal and social factors. In this qualitative study, our objective was to understand women’s preferences and motivational factors for mode of delivery. This information will inform the development and design of an assessment aimed at understanding the role of the women’s preferences for mode of delivery.MethodsWe conducted 4 focus group discussions (FGDs) and 12 in-depth interviews with pregnant women in Buenos Aires, Argentina in 4 large non-public and public hospitals. Our sample included 29 nulliparous pregnant women aged 18–35 years old, with single pregnancies over 32 weeks of gestational age, without pregnancies resulting from assisted fertility, without known pre-existing medical illness or diseases diagnosed during pregnancy, without an indication of elective cesarean section, and who are not health professionals. FGDs and interviews followed a pre-designed guide based on the health belief model and social cognitive theory of health decisions and behaviors.ResultsMost of the women preferred vaginal delivery (VD) due to cultural, personal, and social factors. VD was viewed as normal, healthy, and a natural rite of passage from womanhood to motherhood. Pain associated with vaginal delivery was viewed positively. In contrast, women viewed CS as a medical decision and often deferred decisions to medical staff in the presence of medical indication.ConclusionsThese findings converge with quantitative and qualitative studies showing that women prefer towards VD for various cultural, personal and social reasons. Actual CS rates appear to diverge from women’s preferences and reasons are discussed.

Using Google AdWords for International Multilingual Recruitment to Health Research Websites

Background Google AdWords, the placement of sponsored links in Google search results, is a potent method of recruitment to Internet-based health studies and interventions. However, the performance of Google AdWords varies considerably depending on the language and the location of the target audience. Objective Our goal was to describe differences in AdWords performance when recruiting participants to the same study conducted in four languages and to determine whether AdWords campaigns can be optimized in order to increase recruitment while decreasing costs. Methods Google AdWords were used to recruit participants to the Mood Screener, a multilingual online depression screening tool available in English, Russian, Spanish, and Chinese. Two distinct recruitment periods are described: (1) “Unmanaged”, a 6-month period in which ads were allowed to run using only the AdWords tool itself, with no human intervention, and (2) “Managed”, a separate 7-week period during which we systematically sought to optimize our recruitment campaigns. Results During 6 months of unmanaged recruitment, our ads were shown over 1.3 million times, resulting in over 60,000 site visits. The average click-through rate (ratio of ads clicked to ads displayed) varied from 1.86% for Chinese ads to 8.48% for Russian ads, as did the average cost-per-click (from US

Memory as a moderator in the relationship between child sexual abuse and maladaptive functioning in people with severe mental illness.

0.20 for Chinese ads to US

Longitudinal relationships between neurocognition, theory of mind, and community functioning in outpatients with serious mental illness

0.50 for English ads). Although Chinese speakers’ click-through rate was lowest, their rate of consenting to participate was the highest, at 3.62%, with English speakers exhibiting the lowest consent rate (0.97%). The conversion cost (cost to recruit a consenting participant) varied from US

Heterogeneity and the Longitudinal Recovery of Functioning During Inpatient Psychiatric Rehabilitation for Treatment-Refractory Severe Mental Illness

10.80 for Russian speakers to US

Assessing Suicide Attempts and Depression Among Chinese Speakers Over the Internet

51.88 for English speakers. During the 7 weeks of “managed” recruitment, we attempted to improve AdWords’ performance in regards to the consent rate and cost by systematically deleting underperforming ads and adjusting keywords. We were able to increase the number of people who consent after coming to the site by 91.8% while also decreasing per-consent cost by 23.3%. Conclusions Our results illustrate the need to linguistically and culturally adapt Google AdWords campaigns and to manage them carefully to ensure the most cost-effective results.

Emotional context processing in severe mental illness: Scale development and preliminary construct validity

Despite substantial research literature supporting the impact of child sexual abuse (CSA) on neuropsychological development and functional outcomes, severity of CSA has been neglected in the outcome analyses in people with severe mental illness. Furthermore, there is a paucity of studies examining variables that may moderate the relationship between CSA severity and functional outcomes. The purpose of the present study was to examine the influence of CSA severity on maladaptive functioning (e.g., irritability and psychoticism) in people with severe mental illness, and to explore the moderating effect of memory on the relationship between CSA and maladaptive functioning. Among 33 inpatients with severe mental illness, severity of CSA was positively associated with maladaptive functioning as measured by the Nurses’ Observation Scale for Inpatient Evaluation-30. Persons with higher memory capacity, even among those exposed to severe CSA, were less likely to display irritability and psychoticism in an in-patient psychiatric rehabilitation program. Implications for treatment and assessment in severe mental illness are discussed.

Depression and Stigma Among HIV-Positive Injection Drug Users in China: An Exploratory Study

Abstract The purpose of this study was to examine relationships between neurocognition, theory of mind, and community functioning in a sample of 43 outpatients with serious mental illness (SMI). Relationships between baseline values and changes over time were analyzed using multilevel modeling. The results showed that a) neurocognition and theory of mind were each associated with community functioning at baseline, b) community functioning improved during approximately 12 months of treatment, c) greater improvement in neurocognition over time predicted higher rates of improvement in community functioning, d) theory of mind did not predict change in community functioning after controlling for neurocognition, and e) the effect of change in neurocognition on community functioning did not depend on the effect of baseline neurocognition. This study provides empirical support that individuals with SMI may experience improvement in community functioning, especially when they also experience improvement in neurocognition. Limitations and recommendations for future research are discussed.