The prevalence of autism spectrum disorder (ASD) is estimated to be one in every 150 births. While both genetic and postpartum environmental exposure have been linked to ASD, prenatal maternal weight has not been investigated. The objective of the study is to assess whether overweight or obesity at pregnancy is an important risk factor for the diagnosis of ASD in offspring. A case-control study was designed to answer this question using the public health ecosocial theory. The study population consisted of 70 mothers, who were recruited via the Internet using the viral expansion loop. Multiple logistic regression analysis was used to test the hypotheses. No significant difference in risk of ASD by level of body mass index (BMI) was found after adjusting for covariates. The odds ratio for obese women in comparison to normal or underweight women was 1.19, 95% CI [0.53, 2.66] after adjusting for covariates. Gaining the appropriate amount of weight during gestation, as determined by the Institute of Medicine, was not associated with ASD either, with the odds ratio at 0.67, 95% CI [0.31, 1.48]. The results indicate that BMI category at pregnancy and gestational weight gain were not risk factors for autism in children. The implications for positive social change include a better understanding of maternal prenatal BMI as a risk factor for autism spectrum disorder. Appropriate health information provided to mothers prenatally could result in improved birth outcomes.

The separation between behavioral services and traditional medicine is increasingly being seen as counterproductive on personal and societal levels. Despite this, there has been little research examining how integrated models blending mental and physical health services could be implemented. The literature revealed that behavioral interventions have been incorporated into traditional medical treatments, but this often has been piecemeal in nature and has yielded equivocal results. This study examined the assertion that effective integration between behavioral and medical services will increase the standard of care for the patient. Integration in this study was accomplished by colocating a psychologist on the primary care unit, implementing formal behavioral screening, and ongoing consultations between primary care and psychological/psychiatric providers. Data obtained from 15 medical providers pre and post implementation examined if there would be an increase in the number of behavioral discussions between patients and providers, and the number of behavioral referrals generated. Also, data was examined to determine if there would be a drop in the number of emergency room and psychiatric admissions related to these provider's patients. A repeated measures ANOVA showed a significant increase in mental health discussions and referrals by providers for their patients post intervention. With integrated services, positive social change for patients could be realized in decreased stigma associated with mental health issues, less personal distress, and the ability to better manage daily demands. There will be positive societal results with increased productivity in the workplace and relief from the burdens of increased healthcare utilization associated with comorbid behavioral and medical issues.

According to the CDC, each year approximately 0.06 % of the world's population dies in infancy. The March of Dimes indicated that the leading causes of infant mortality include birth defects, preterm birth, low birth weight, sudden infant death syndrome, maternal complications of pregnancy, and respiratory distress syndrome, most of which are considered preventable with access to adequate prenatal care by mothers. The goal of this study was to examine the association between maternal health literacy levels and preterm birth. This research was based on the theoretical framework of the Interaction Model of Client Health Behavior. The hypothesis for this study was that reproductive-age women with low levels of maternal health literacy would be more likely to experience a preterm birth. In this case control study, cases were defined as women delivering before 37 weeks gestation. The REALM health literacy assessment tool was used in a sample of 169 women meeting the criteria; 56 fit the case criteria and 113 fit the control criteria. The data were analyzed in SPSS using logistic regression, with preterm birth as the dependent variable, and health literacy levels as the independent variable. When comparing mothers who delivered preterm to mothers that delivered term, there was no significance difference (p = 0.112) with respect to maternal health literacy. There was no association between low maternal health literacy levels, as assessed by the REALM instrument, and preterm birth for English-speaking women between the ages of 18 and 35 within the metropolitan Atlanta area. This study reinforces the need to reengage health practitioners to achieve a modest understanding of the principals of health literacy and the health literacy levels of their patients to assist in maternal health improvements. A focus on the development and implementation of educational competencies for clinicians on maternal health literacy would attribute to a positive social change.

Thesis (M.H.A.)--University of Michigan, 1968.

Thesis (M.H.A.)--University of Michigan, 1968.

Despite increased access to prenatal care, birth outcomes continue to be a major source of disparity among women in the United States. The focus on lifestyle choices and negative behaviors prior to a pregnancy to reduce adverse birth outcomes has become a well-documented strategy. The purpose of this study was to determine if preparing for a pregnancy in advance improves birth outcomes for African American women of childbearing age between the ages of 12 and 45 years in the State of Rhode Island (RI). The theoretical foundation for this study was based on Prochaska's model of change, which is also known as the readiness to change model. This study was conducted using secondary data from the Rhode Island Department of Health PRAMS data set. The research questions determined if African American women received preconception care education at the same rate as White women, if African American women had a higher rate of infant mortality than other races, and if African American women had a higher rate of unintended pregnancies than White women in the state of Rhode Island. Independent t tests and chi square tests were used to answer the research questions. The results indicated a difference between the infant mortality rates for African American women compared to other races as well as a difference between African American women compared to White women with regard to unintentional pregnancies in Rhode Island. However, there was no difference in African American women compared to White women receiving preconception education in the state of Rhode Island. The implications for positive social change include micro- and macro-level changes in support of how planning for a pregnancy in advance can reduce poor birth outcomes.

This study investigated the effect of postpartum home teaching on primiparous women's knowledge of infant care. Twenty-one low-risk primigravidae women were randomly placed in a control or experimental group. Subjects in the experimental group viewed a videotaped program on infant care a second time, at home on the third day postpartum. Tests were administered prior to hospital discharge, on the third day postpartum, and at 28-32 days postpartum. A short interview was conducted to obtain opinions regarding videotaped educational materials. The subjects (n = 21) retained most of the information presented after the first viewing and expressed satisfaction with the educational format. The results were not statistically significant, though mean test scores increased over the three test intervals.

A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management, Johannesburg, 2011 / Mecklenburg Hospital provides a comprehensive package of promotive, preventive, curative and rehabilitative reproductive health services for women which are not available in primary health care clinics and community health centres. These services require special equipment (such as cardiotochograph machine) and personnel (such as medical doctors) that are not available in these health facilities. The availability of medical equipment is one of the crucial components of effective maternal health services. Specific life saving medical equipment must be available for routine and emergency management of maternal and neonatal complications. This study is undertaken since no formal study has been done to systematically study the availability and related cost of medical equipment in a district Hospital maternity ward.

The influence of hormonal variations during the menstrual cycle on pain fluctuations is an area that has not previously been considered as playing an integral part in the pain process. This exploratory study examined fluctuations of pain and the menstrual cycle in eight premenstrual women with RA. Pain was measured on seven visual analog scales covering the dimensions of intensity, affect, inflammation, stiffness, and difficulty of function. Participants completed the instruments for a period of two cycles. Hypotheses stated that there was no relationship between each dimension of pain measured and the menstrual cycle in women with rheumatoid arthritis. / A repeated measures analysis of variance was used for each hypothesis. A relatively large number of repeated measures increased the sensitivity of the test. However, because of the violation of the sphericity of the covariance matrix assumption, p values adjusted by the Greenhouse-Geiser Epsilon were derived. None of these values reached significance. Therefore, the null hypotheses were not rejected. Unadjusted p values were significant for the variables intensity, affect, inflammation, stiffness, and difficulty of function across one or both cycles. Average measures across all variables were analyzed for trends in order to discern if there did appear to be any relationship between pain fluctuations and the menstrual cycle. Trends were found to exist for the intensity and affect variables across both cycles, and the inflammation, stiffness, and difficulty of function variables for one cycle. Pain ratings were highest for these variables at the extremes of the cycle, with day one of the cycle being the first day of menses. This pattern negatively correlates with expected patterns of oestradiol levels during the cycle, with the highest levels of oestradiol occurring midcycle. This finding is consistent with other studies using RA populations, suggesting pain increase in the face of decreased oestradiol levels. / Source: Dissertation Abstracts International, Volume: 55-12, Section: B, page: 5597. / Major Professor: E. Jane Burkhead. / Thesis (Ph.D.)--The Florida State University, 1994.

BACKGROUND: Early-term infants (37-38 weeks) are at increased risk of short- and long-term morbidities compared with full term infants (39-40 weeks). In 2009, the American College of Obstetricians and Gynecologists (ACOG) issued guidelines to discourage early elective deliveries prior to 39 weeks of gestation, and Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA, adopted a policy to implement these guidelines. The impact of this policy on Neonatal Intensive Care Unit (NICU) utilization at BIDMC is unknown. Objectives: The objectives of this study were to (1) examine the gestational age distribution of infants at BIDMC from 2004 to 2015 and confirm a reduction in proportion of early-term births (37-38 weeks) after policy implementation in 2009, (2) compare the incidence of NICU admissions among infants ≥37 weeks of gestation before and after policy implementation, and (3) compare the length of NICU stays among infants ≥37 weeks of gestation before and after policy implementation. METHODS: We conducted a medical record review of infants ≥37 weeks of gestation born from January 1, 2004, through November 10, 2015. We used chi-square tests to compare the incidence of early-term deliveries and NICU admissions in two time periods: 2004-2008 (pre-period) and 2010-2015 (post-period). We excluded infants born in 2009 from the analysis. We used logistic regression to calculate the odds ratio of both short (>4 to <24 hours) and long (≥24 hours) NICU admissions in the two time periods. NICU stays ≤4 hours were excluded as they most often occur among asymptomatic infants for evaluation of sepsis in the setting of maternal fever during labor. We also excluded infants transferred to other hospitals. We considered potential confounding variables such as multiple births, maternal age, race and ethnicity, parity, insurance, and marital status. We compared median lengths of stay using a Wilcoxon test. RESULTS: A total of 50,373 infants were born ≥37 weeks of gestation during the study period, 46,254 of whom were included in the analysis excluding 4,119 infants born in 2009, the washout period. The incidence of early-term delivery was lower in the post-period (27.1%) versus the pre-period (34.2%) (P <0.0001). We detected a slight but statistically insignificant decrease in the incidence of overall NICU admissions from 9.1% in the pre-period to 8.9% in the post-period (P = 0.3). The incidence of short NICU admissions also decreased from 5.3% in the pre-period to 4.6% in the post-period (P < 0.0001). Interestingly, there was an increase in the incidence of long NICU stays from 3.8% in the pre-period to 4.3% in the post-period (P = 0.006). Term infants born after 2009 had lower odds of short NICU stays in adjusted models (adj. OR 0.84; 95% CI 0.77, 0.91). Among NICU admissions >4 hours, the median length of stay (LOS) increased from 21 hours (pre-period) to 39 hours (post-period) (P <0.0001). CONCLUSION: A local policy aligned with ACOG national guidelines to reduce early elective deliveries was associated with a reduction in early-term births. We observed a concurrent reduction of short but not long NICU stays. Our findings suggest that a reduction in early elective deliveries before 39 weeks of gestation may lead to more opportunities for infants to stay with their families in the first 24 hours but may not affect the incidence of significant morbidities requiring longer NICU stays. / 2017-06-16T00:00:00Z