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Harrison S, Quigley MA, Fellmeth G, Stein A, Ayers S, Alderdice F. The impact of the Covid-19 pandemic on postnatal anxiety and posttraumatic stress: Analysis of two population-based national maternity surveys in England. J Affect Disord 2024; 356:122-136. [PMID: 38574867 DOI: 10.1016/j.jad.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS. METHODS Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS. FINDINGS Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk. INTERPRETATION Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic.
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Affiliation(s)
- S Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - M A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G Fellmeth
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Stein
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - F Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Gerits ML, Bielen S, Lanssens D, Luyten J, Gyselaers W. Experience Counts: Unveiling Patients' Willingness to Pay for Remote Monitoring and Patient Self-Measurement. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02371-4. [PMID: 38795963 DOI: 10.1016/j.jval.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES This study aimed to (1) estimate patients' willingness to pay (WTP) for remote monitoring (RM) and patient self-measurement (PSM) for pregnant women at risk of gestational hypertensive disorders, (2) assess the impact of experience with these technologies on WTP, and (3) determine their impact on health-related quality of life (HRQoL). METHODS Data collection was part of a multicentric randomized controlled trial, Pregnancy Remote Monitoring II, with 2 interventions: RM and PSM. A contingent valuation survey, combining a payment card and open-ended question, was completed twice by 199 participants. Two-part models analyze the impact of experience on WTP, regression models estimated using ordinary least squares the impact of RM and PSM on HRQoL. RESULTS The mean WTP amount was approximately €120 for RM and €80 for PSM. Compared with having no experience, WTP RM was €63 higher after a long-term exposure to RM (P = .01) and WTP PSM was €26 lower after a short-term exposure to RM (P = .07). No significant impact of RM or PSM on HRQoL was found. CONCLUSIONS This study contributes to the discussion on the impact of experience on WTP. Those who had a long-term experience with RM, were willing to pay more for RM than those without experience. This confirms our hypothesis that involving patients without experience with the valued treatment, possibly underestimates WTP. A long-term experience has, however, no impact on the WTP for technologies for which the potential benefits are apparent without experiencing them, such as PSM.
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Affiliation(s)
- Marie-Lien Gerits
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium.
| | - Samantha Bielen
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium
| | - Dorien Lanssens
- Department of Physiology, Hasselt University, Hasselt, Limburg, Belgium; Mobile health unit, Hasselt University, Hasselt, Limburg, Belgium
| | - Janis Luyten
- Faculty of Business Economics, Hasselt University, Hasselt, Limburg, Belgium
| | - Wilfried Gyselaers
- Department of Physiology, Hasselt University, Hasselt, Limburg, Belgium; Department of Obstetrics, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
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Rhead R, Harber-Aschan L, Onwumere J, Polling C, Dorrington S, Ehsan A, Stevelink SAM, Khunti K, Mir G, Morriss R, Wessely S, Woodhead C, Hatch S. Ethnic inequalities among NHS staff in England: workplace experiences during the COVID-19 pandemic. Occup Environ Med 2024; 81:113-121. [PMID: 38378264 PMCID: PMC10958323 DOI: 10.1136/oemed-2023-108976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/23/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study. METHODS An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). RESULTS Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health. CONCLUSIONS Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.
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Affiliation(s)
- Rebecca Rhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Demography Unit, Stockholm University, Stockholm, Sweden
| | - Juliana Onwumere
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Catherine Polling
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Annahita Ehsan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sharon A M Stevelink
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, UK
- Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR ARC East Midlands, University of Nottingham, Nottingham, UK
| | - Simon Wessely
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Charlotte Woodhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Stephani Hatch
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
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Lai MM, August D, Sharfuddin Z, Palmer-Field K, Johnston L, Main E, Smith P, Kilgour CM, Kearney L. Outcomes and perspectives of woman-newborn dyads following discharge from a quaternary maternity service in Australia: A cross-sectional survey. Women Birth 2024; 37:248-256. [PMID: 37949741 DOI: 10.1016/j.wombi.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The average postnatal stay for most Australian mothers is two days. Postnatal length of stay is dependent on various factors, such as maternal preferences, mode of birth or complications following birth. However, little is known about the relationship between these elements. AIM To prospectively explore maternal and neonatal postnatal outcomes within the context of length of stay, model of care and personal expectations and experiences within the first 3-5 weeks following birth. METHODS A cross-sectional study within an urban quaternary Australian hospital was conducted between January 2021 to April 2021. A mixed methods convergent approach was taken. FINDINGS Of the 1066 questionnaires distributed, 216(20.2%) responses were usable for analysis. Most mothers (82%) were satisfied with their postnatal stay length (range 6-78 h). Models of care (such as GP shared care, midwifery group practice) were not associated with mothers' satisfaction with their postnatal stay length. Mothers following cesarean section felt less supported, had lower breastfeeding rates and more difficulty accessing postnatal services. Neonatal readmissions (n = 11, 5%) in the first week of life were most often for jaundice, poor feeding or both (n = 7, 64%). Three key themes were generated from the qualitative data and categorised into themes labeled 'Environmental and healthcare delivery constraints', 'Ready or not for discharge' and 'Home now, but support missing'. CONCLUSION Participants identified that improvements in postnatal care require more than extending in-hospital length of stay. Rather a more individualised woman-centred focus, in-home supported options, with flexibility in timing needed, especially for those following a complicated birth.
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Affiliation(s)
- Melissa M Lai
- Grantley Stable Neonatal Unit, Womens and Newborn Services, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Medicine, University of Queensland Centre for Clinical Research, Herston, Brisbane, Queensland, Australia.
| | - Deanne August
- Grantley Stable Neonatal Unit, Womens and Newborn Services, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Zoya Sharfuddin
- Grantley Stable Neonatal Unit, Womens and Newborn Services, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Kristina Palmer-Field
- Lactation Services, Womens and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Louise Johnston
- Postnatal Maternity Ward, Womens and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Elizabeth Main
- Postnatal Maternity Ward, Womens and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Patricia Smith
- Nursing and Midwifery Strategic Service Improvement, Metro North Health, Herston, Brisbane, Queensland, Australia
| | - Catherine M Kilgour
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Brisbane, Queensland, Australia
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Quigley MA, Harrison S, Levene I, McLeish J, Buchanan P, Alderdice F. Breastfeeding rates in England during the Covid-19 pandemic and the previous decade: Analysis of national surveys and routine data. PLoS One 2023; 18:e0291907. [PMID: 37819882 PMCID: PMC10566678 DOI: 10.1371/journal.pone.0291907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Few studies have compared breastfeeding rates before and during the pandemic using comparable data across time. We used data from two national maternity surveys (NMS) to compare breastfeeding rates in England before and during the pandemic. METHODS Analysis was conducted using the NMS from 2018 (pre-pandemic; n = 4,509) and 2020 (during the pandemic; n = 4,611). The prevalence of breastfeeding initiation, and 'any' breastfeeding and exclusive breastfeeding (EBF) at 6 weeks and 6 months were compared between these surveys. Data were interpreted in the context of underlying trends in these prevalences from previous NMS (from 2010 and 2014), and annual routine data for England (from 2009-10 to 2020-21). Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the effect of birth during the pandemic (2020 versus 2018) on breastfeeding, with adjustment for sociodemographic and birth-related factors. RESULTS Breastfeeding initiation and any breastfeeding at 6 weeks remained relatively constant in the NMS and the routine data. Birth during the pandemic was associated with a 3 percentage point decrease in EBF at 6 weeks in the NMS (aRR 0.92, 95%CI: 0.87, 0.98 for pandemic versus pre-pandemic), but a smaller decrease in the routine data. Birth during the pandemic was associated with a 3 percentage point increase in any breastfeeding at 6 months in the NMS (aRR 1.05, 95%CI: 1.00, 1.10). Breastfeeding varied across different groups of women in the NMS (i.e. marked inequalities), but the small changes observed between the pandemic and pre-pandemic NMS were broadly similar across the sociodemographic and birth-related factors examined (i.e. no change in inequalities). CONCLUSION Breastfeeding initiation and any breastfeeding at 6 weeks in England were unaffected by the pandemic, and the persistent inequalities in breastfeeding did not widen. Services should aim to reduce these inequalities in breastfeeding which have been documented since the 1970s.
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Affiliation(s)
- Maria A. Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sian Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ilana Levene
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jenny McLeish
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Phyll Buchanan
- Breastfeeding Supporter, The Breastfeeding Network, Paisley, United Kingdom
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Landripet I, Božičević I, Baćak V, Štulhofer A. Changes in sexually transmitted infections-related sexual risk-taking among young Croatian adults: a 2005-2021 three-wave population-based study. Croat Med J 2023; 64:186-197. [PMID: 37391916 PMCID: PMC10332298 DOI: 10.3325/cmj.2023.64.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/14/2023] [Indexed: 10/29/2023] Open
Abstract
AIM To assess the prevalence and dynamics of risky sexual behaviors among Croatian emerging adults in the 2005-2021 period. METHODS Three surveys were conducted on large-scale national samples of young adults aged 18-24 in 2005 (N=1092) and 18-25 in 2010 and 2021 (N=1005 and N=1210, respectively). The 2005 and 2010 studies were conducted with face-to-face interviews on stratified probabilistic samples. The 2021 study was conducted by computer-assisted web-interviewing on a quota-based random sample from the largest national online panel. RESULTS Compared with 2005 and 2010, the age at coital debut increased for both genders in 2021 (by a median of one year, to 18 years, and by a mean of half a year, to 17.5 years, in men and to 17.9 in women). In the 2005-2021 period, condom use increased by about 15% both at first intercourse (to 80%) and in consistent use (to 40% in women and 50% in men). When we controlled for basic socio-demographics, Cox and logistic regressions indicated that, for both genders, in 2005 and 2010 compared with 2021, the risks/odds were significantly higher for reporting an earlier sexual debut (adjusted hazard ratio 1.25-1.37), multiple sexual partners (adjusted odds ratio [AOR] 1.62-3.31), and concurrent relationships (AOR 3.36-4.64), while the odds were lower for condom use at first sexual intercourse (AOR 0.24-0.46) and consistently (AOR 0.51-0.64). CONCLUSION Risky sexual behaviors decreased in the 2021 survey compared with the previous two waves, in both genders. Nonetheless, sexual risk-taking is still frequent among young Croatian adults. The introduction of sexuality education and other national-level public health interventions to reduce sexual risk-taking thus remains a public health imperative.
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Affiliation(s)
- Ivan Landripet
- Ivan Landripet, Department of Sociology, Faculty of Humanities and Social Sciences, Ivana Lučića 3, 10000 Zagreb, Croatia,
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Harrison S, Quigley MA, Fellmeth G, Stein A, Alderdice F. The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014-2020). THE LANCET REGIONAL HEALTH. EUROPE 2023:100654. [PMID: 37363795 PMCID: PMC10183799 DOI: 10.1016/j.lanepe.2023.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Background Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using comparable data across time. We used data from three national maternity surveys in England to compare prevalence and risk factors for postnatal depression before and during the pandemic. Methods Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and 2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression. Findings Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95% CI: 4.0-7.4); RR = 1.55 (95% CI: 1.36-1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9-9.9); RR = 1.49 (95% CI: 1.34-1.66)). Having a long-term mental health problem (aRR range = 1.48-2.02), antenatal anxiety (aRR range = 1.73-2.12) and antenatal depression (aRR range = 1.44-2.24) were associated with increased risk of postnatal depression, whereas satisfaction with birth (aRR range = 0.89-0.92) and social support (aRR range = 0.73-0.78) were associated with decreased risk before and during the pandemic. Interpretation This analysis indicates that Covid-19 had an important negative impact on postnatal women's mental health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for postnatal depression were consistent before and during the pandemic. Timely identification, intervention and follow-up are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened during times of heightened risk such as the pandemic. Funding NIHR Policy Research Programme.
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Affiliation(s)
- Siân Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Gracia Fellmeth
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
| | - Alan Stein
- Department of Psychiatry, Medical Sciences Division, University of Oxford, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Health Research Institute, KwaZulu-Natal, South Africa
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, UK
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Harrison S, Pilkington V, Li Y, Quigley MA, Alderdice F. Disparities in who is asked about their perinatal mental health: an analysis of cross-sectional data from consecutive national maternity surveys. BMC Pregnancy Childbirth 2023; 23:263. [PMID: 37101310 PMCID: PMC10132923 DOI: 10.1186/s12884-023-05518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/14/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The perinatal period is a vulnerable time, with one in five women experiencing mental health problems. Antenatal and postnatal appointments are key contact points for identifying women in need of support. Since 2014, the UK National Institute for Health and Care Excellence (NICE) has recommended that all women be asked about their mental health at their antenatal booking appointment and early in the postnatal period. The aim of this study was to assess the proportions of women who reported being asked about their mental health during the perinatal period across consecutive national maternity surveys (NMS) in England and to evaluate sociodemographic disparities in who was asked. METHODS Secondary analysis was performed on cross-sectional data from the NMS in 2014-2020. In each survey, women reported whether they had been asked about their mental health antenatally (during their booking appointment) and postnatally (up to six months after giving birth). The proportions of women in each survey who reported being asked about their mental health were calculated and compared according to key sociodemographic characteristics and across survey years. Logistic regression was conducted to identify disparities in who was asked. RESULTS The proportion of women who reported being asked about their mental health antenatally increased from 80.3% (95%CI:79.0-81.5) in 2014 to 83.4% (95%CI:82.1-84.7) in 2020, yet the proportion of women who reported being asked postnatally fell from 88.2% (95%CI:87.1-89.3) in 2014 to 73.7% (95%CI:72.2-75.2) in 2020. Ethnic minority women (aOR range:0.20 ~ 0.67) were less likely to report being asked about their mental health antenatally and postnatally across all surveys compared to White women. Women living in less socioeconomically advantaged areas (aOR range:0.65 ~ 0.75) and women living without or separately from a partner (aOR range:0.61 ~ 0.73) were also less likely to report being asked about their mental health, although there was less consistency in these disparities across the antenatal and postnatal periods and across surveys. CONCLUSIONS Despite NICE recommendations, many women are still not asked about their mental health during the perinatal period, particularly after giving birth. Women from ethnic minority backgrounds are less likely to be asked and these disparities have persisted over time.
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Affiliation(s)
- Sian Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Victoria Pilkington
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford University Clinical Academic Graduate School, Oxford, UK
| | - Yangmei Li
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Harrison S, Alderdice F, Quigley MA. Impact of sampling and data collection methods on maternity survey response: a randomised controlled trial of paper and push-to-web surveys and a concurrent social media survey. BMC Med Res Methodol 2023; 23:10. [PMID: 36635637 PMCID: PMC9835028 DOI: 10.1186/s12874-023-01833-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Novel survey methods are needed to tackle declining response rates. The 2020 National Maternity Survey included a randomised controlled trial (RCT) and social media survey to compare different combinations of sampling and data collection methods with respect to: response rate, respondent representativeness, prevalence estimates of maternity indicators and cost. METHODS A two-armed parallel RCT and concurrent social media survey were conducted. Women in the RCT were sampled from ONS birth registrations and randomised to either a paper or push-to-web survey. Women in the social media survey self-selected through online adverts. The primary outcome was response rate in the paper and push-to-web surveys. In all surveys, respondent representativeness was assessed by comparing distributions of sociodemographic characteristics in respondents with those of the target population. External validity of prevalence estimates of maternity indicators was assessed by comparing weighted survey estimates with estimates from national routine data. Cost was also compared across surveys. RESULTS The response rate was higher in the paper survey (n = 2,446) compared to the push-to-web survey (n = 2,165)(30.6% versus 27.1%, difference = 3.5%, 95%CI = 2.1-4.9, p < 0.0001). Compared to the target population, respondents in all surveys were less likely to be aged < 25 years, of Black or Minority ethnicity, born outside the UK, living in disadvantaged areas, living without a partner and primiparous. Women in the social media survey (n = 1,316) were less representative of the target population compared to women in the paper and push-to-web surveys. For some maternity indicators, weighted survey estimates were close to estimates from routine data, for other indicators there were discrepancies; no survey demonstrated consistently higher external validity than the other two surveys. Compared to the paper survey, the cost saving per respondent was £5.45 for the push-to-web survey and £22.42 for the social media survey. CONCLUSIONS Push-to-web surveys may cost less than paper surveys but do not necessarily result in higher response rates. Social media surveys cost significantly less than paper and push-to-web surveys, but sample size may be limited by eligibility criteria and recruitment window and respondents may be less representative of the target population. However, reduced representativeness does not necessarily introduce more bias in weighted survey estimates.
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Affiliation(s)
- Siân Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus Headington, Oxford, OX3 7LF UK
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus Headington, Oxford, OX3 7LF UK
| | - Maria A. Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus Headington, Oxford, OX3 7LF UK
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Psychological Processes Associated With Resilience in UK-Based Unpaid Caregivers During the COVID-19 Pandemic. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e10313. [PMID: 36762350 PMCID: PMC9881121 DOI: 10.32872/cpe.10313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Unpaid caregivers have faced and dealt with additional challenges during the COVID-19 pandemic. Understanding the psychological processes associated with their resilience is warranted. The objective of this study was to examine the associations between resilience with mental distress, emotion regulation strategies (i.e., reappraisal and suppression) and interpretation bias in adult caregivers. Method Participants were living in the UK, aged 18+, and consisted of 182 unpaid caregivers of an adult aged 18+ living with a long-term health condition, and 120 non-caregivers. Data were collected in an online study during the first national UK COVID-19 lockdown (May and September 2020). Hierarchical multiple regression analyses explored whether emotion regulation strategies and interpretation bias explained unique variance in levels of resilience in caregivers whilst controlling for anxiety and depression. Results Compared to non-caregivers, caregivers reported higher levels of anxiety, depression, negative interpretation bias and lower levels of resilience. Emotion regulation strategies did not differ between groups. Within caregivers, greater resilience was associated with lower mood disturbance, a positive interpretation bias, and greater use of cognitive reappraisal and lower use of suppression strategies to regulate emotions. Emotion regulation and interpretation bias together predicted an additional 15% of variance in current levels of resilience. Conclusion Our findings indicate that psychological mechanisms such as emotion regulation strategies, particularly reappraisal, and interpretation bias are associated with resilience in caregivers. Although preliminary, our findings speak to exciting clinical possibilities that could form the target of interventions to improve resilience and lower mental distress in unpaid caregivers.
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Patient-Perceived Satisfaction and Knowledge Uptake in a Combined Cardio-Obstetrics Clinic. J Cardiovasc Dev Dis 2022; 9:jcdd9120433. [PMID: 36547430 PMCID: PMC9781400 DOI: 10.3390/jcdd9120433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
Heart disease is the leading cause of pregnancy-related mortality in the United States and has led to the development of combined cardio-obstetrics (COB) clinics as a model for prenatal care. In other areas of medicine, these types of collaborative care models have shown improvement in morbidity, mortality, and patient satisfaction. There is some data to suggest that a combined COB clinic improves maternal outcomes but there is no data to suggest patients prefer this type of care model. This study aims to evaluate patient satisfaction in a combined COB clinic and whether this type of model enhances perceived communication and knowledge uptake. A quality questionnaire was developed to assess patient perceptions regarding communication, satisfaction, and perceived knowledge. Patients who attended the clinic (n = 960) from 2014-2020 were contacted by email, with a response received from 119 (12.5%). Participants completed a questionnaire assessing satisfaction and perceived knowledge uptake with answers based on a Likert scale (7 representing very satisfied and 1 representing very unsatisfied). Safe and effective contraceptive use was evaluated by multiple choice options. Knowledge was also assessed by comparing contraceptive use before and after the clinic. Participants reported high levels of satisfaction with the clinic (6.2 ± 1.5), provider-to-patient communication (6.1 ± 1.6), and with the multidisciplinary appointment approach (6.3 ± 1.5). As well, participants reported an increase in knowledge about heart disease a result of collaborative counseling. In summary, a multidisciplinary approach to cardio-obstetrics not only improves outcomes but is a patient satisfier.
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Johansson A, Omar R, Carlsson GE, Sannevik J, Mastrovito B, Johansson A. Satisfaction with dental appearance in two cohorts of 75-year-olds examined in 2007 and 2017: A repeated cross-sectional study. J Oral Rehabil 2022; 49:1060-1068. [PMID: 35962634 PMCID: PMC9826060 DOI: 10.1111/joor.13361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/29/2022] [Accepted: 07/12/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Satisfaction with dental appearance plays an important role in the self-esteem and psychological well-being of the elderly, the significance of which the attending dentist may not always be fully cognisant of. OBJECTIVES To assess the level of satisfaction with dental appearance, its associated factors and temporal changes in two cohorts of 75-year-old Swedes born 10 years apart. METHODS In 2007, a questionnaire was mailed to all those living in Örebro and Östergötland counties, Sweden, who were born in 1932 (n = 5195), and in 2017 to all born in 1942 (n = 7204). The evaluation was carried out with a global question 'Are you satisfied with the appearance of your teeth?', and four attitude-related statements about dental appearance. RESULTS About 80% in both cohorts were 'very satisfied' or 'to large extent satisfied' with their dental appearance. The 1932 cohort was significantly more concerned about their dental appearance than the 1942 cohort, and women were generally also significantly more concerned than men. In the regression analysis, 'very satisfied' with dental appearance was predicted by good chewing efficiency, having complete dentures, no impact from Oral Impacts on Daily Performance, disagreement that 'minor esthetic imperfections of the teeth have no importance, only they should function well', better perceived general health than same-aged peers and belonging to the 1932 cohort. CONCLUSION Satisfaction with dental appearance among 75-year-olds was generally high, with attitudes varying by gender and temporally. Women and the earlier-born generation (1932) were more concerned about dental appearance than men and the later-born generation (1942), respectively.
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Affiliation(s)
- Anders Johansson
- Department of Clinical Dentistry – Prosthodontics, Faculty of MedicineUniversity of BergenBergenNorway
| | - Ridwaan Omar
- Department of Restorative Sciences – Prosthodontics, Faculty of DentistryKuwait UniversitySafatKuwait
| | - Gunnar E. Carlsson
- Department of Prosthetic DentistryThe Sahlgrenska Academy at Göteborg UniversityGöteborgSweden
| | | | - Berit Mastrovito
- Dental Commissioning UnitÖstergötland County CouncilLinköpingSweden
| | - Ann‐Katrin Johansson
- Department of Clinical Dentistry – Cariology, Faculty of MedicineUniversity of BergenBergenNorway
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Johansson A, Omar R, Sannevik J, Mastrovito B, Carlsson GE, Johansson A. Temporal changes and gender differences related to orofacial symptoms in two cohorts of 75-year-old Swedish subjects examined in 2007 and 2017: A repeated cross-sectional study. Clin Exp Dent Res 2022; 8:1540-1546. [PMID: 36193569 PMCID: PMC9760149 DOI: 10.1002/cre2.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To compare two cohorts of 75-year-old persons, born 10 years apart, in regard to reported symptoms related to temporomandibular disorders (TMD) and orofacial complaints with special reference to gender differences. MATERIAL AND METHODS In 2007, a questionnaire comprising questions on social factors, general and oral health, and a series of attitude-related questions was mailed to all individuals born in 1932 living in two Swedish counties (N = 5195), and in 2017 to all born in 1942 (N = 7204). The response rate for the cohort examined in 2007 was 71.9% (n = 3735) and 70.7% (n = 5091) for the cohort examined in 2017. Bivariate statistical analyses were applied. RESULTS Reported bruxism and pain from the temporomandibular joint were significantly higher in the 1942 cohort compared to the 1932 cohort, while reports of oral lesions and daytime dry mouth were lower. Women reported problems significantly more frequently in most of the domains investigated in both 2007 and 2017, that is, TMD, burning mouth, sensitive teeth, oral lesions, taste changes, daytime/night-time dry mouth, except bad breath. CONCLUSIONS TMD-related symptoms increased while complaints from oral lesions and daytime mouth dryness decreased between 2007 and 2017. Temporal changes were otherwise few, but the findings underline the gender inequalities that exist, to the disadvantage of women. This must be considered when planning for clinical care/dental education to appropriately address the needs of older people.
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Affiliation(s)
- Anders Johansson
- Department of Clinical Dentistry—Prosthodontics, Faculty of MedicineUniversity of BergenBergenNorway
| | - Ridwaan Omar
- Department of Restorative Sciences—Prosthodontics, Faculty of DentistryKuwait UniversitySafatKuwait
| | | | - Berit Mastrovito
- Dental Commissioning UnitÖstergötland County CouncilLinköpingSweden
| | - Gunnar E. Carlsson
- Department of Prosthetic DentistryThe Sahlgrenska Academy at Göteborg UniversityGöteborgSweden
| | - Ann‐Katrin Johansson
- Department of Clinical Dentistry—Cariology, Faculty of MedicineUniversity of BergenBergenNorway
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McCarthy K, Maru S, Nowlin S, Ram P, Glazer KB, Janevic T. The validity of self-reported SARS-CoV-2 results among postpartum respondents. Paediatr Perinat Epidemiol 2022; 36:518-524. [PMID: 35257392 PMCID: PMC9115458 DOI: 10.1111/ppe.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rapid and reliable health data on SARS-CoV-2 infection among pregnant individuals are needed to understand the influence of the virus on maternal health and child development, yet the validity of self-reported COVID-19 testing and diagnosis remains unknown. OBJECTIVES We assessed the validity of self-reported COVID-19 polymerase chain reaction (PCR) testing and diagnosis during delivery among postpartum respondents as well as how diagnostic accuracy varied by respondent characteristics. METHODS We validated receipt of a COVID-19 PCR test and test results by comparing self-reported results obtained through an electronic survey to electronic medical record data (gold standard) among a cross-sectional sample of postpartum respondents who delivered at four New York City hospitals between March 2020 and January 2021. To assess validity, we calculated each indicator's sensitivity, specificity and the area under the receiver-operating curve (AUC). We examined respondent characteristics (age, race/ethnicity, education level, health insurance, nativity, pre-pregnancy obesity and birth characteristics) as predictors of reporting accuracy using modified Poisson regression. RESULTS A total of 276 respondents had matched electronic record and survey data. The majority, 83.7% of respondents received a SARS-CoV-2 PCR test during their delivery stay. Of these, 12.1% had detected SARS-CoV-2. Among those tested, sensitivity (90.5%) and specificity (96.5%) were high for SARS-CoV-2 detection. The adjusted risk ratio (aRR) of accurate result reporting was somewhat lower among Hispanic women relative to white non-Hispanic women (aRR 0.90, 95% CI 0.90, 1.00) and among those who had public or no insurance vs. private (aRR 0.91, 95% CI 0.82, 1.01), controlling for recall time. CONCLUSION(S) High recall accuracy result reporting for COVID-19 PCR tests administered during labour and delivery suggest the potential for population-based surveys as a rapid mechanism to obtain accurate data on COVID-19 diagnostic history. Additional psychometric research is warranted to ensure accurate recall across respondent subgroups.
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Affiliation(s)
- Katharine McCarthy
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityUSA,Blavatnik Family Women’s Health Research InstituteIcahn School of Medicine at Mount SinaiNew York CityUSA
| | - Sheela Maru
- Department of Obstetrics, Gynecology, and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew York CityUSA,Department of Health System Design and Global HealthArnhold Institute for Global HealthIcahn School of Medicine at Mount SinaiNew York CityUSA,New York City Health + Hospitals/ElmhurstNew York CityUSA
| | - Sarah Nowlin
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityUSA,Department of NursingCenter for Nursing Research & InnovationIcahn School of Medicine at Mount SinaiNew York CityUSA
| | - Payal Ram
- Department of Health System Design and Global HealthArnhold Institute for Global HealthIcahn School of Medicine at Mount SinaiNew York CityUSA,Global Health InstituteElmhurst Hospital CenterNew York CityUSA
| | - Kimberly B. Glazer
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityUSA,Blavatnik Family Women’s Health Research InstituteIcahn School of Medicine at Mount SinaiNew York CityUSA,Department of Obstetrics, Gynecology, and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew York CityUSA
| | - Teresa Janevic
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityUSA,Blavatnik Family Women’s Health Research InstituteIcahn School of Medicine at Mount SinaiNew York CityUSA,Department of Obstetrics, Gynecology, and Reproductive ScienceIcahn School of Medicine at Mount SinaiNew York CityUSA
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A Comparison of Three Measures to Identify Postnatal Anxiety: Analysis of the 2020 National Maternity Survey in England. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116578. [PMID: 35682163 PMCID: PMC9180011 DOI: 10.3390/ijerph19116578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Perinatal anxiety affects an estimated 15% of women globally and is associated with poor maternal and infant outcomes. Identifying women with anxiety is essential to prevent these adverse associations, but there are a number of challenges around measurement. We used data from England’s 2020 National Maternity Survey to compare the prevalence of anxiety symptoms at six months postpartum using three different measures: the two-item Generalised Anxiety Disorders Scale (GAD-2), the anxiety subscales of the Edinburgh Postnatal Depression Scale (EPDS-3A) and a direct question. The concordance between each pair of measures was calculated using two-by-two tables. Survey weights were applied to increase the representativeness of the sample and reduce the risk of non-response bias. The prevalence of postnatal anxiety among a total of 4611 women was 15.0% on the GAD-2, 28.8% on the EPDS-3A and 17.1% on the direct question. Concordance between measures ranged between 78.6% (95% CI 77.4–79.8; Kappa 0.40) and 85.2% (95% CI 84.1–86.2; Kappa 0.44). Antenatal anxiety was the strongest predictor of postnatal anxiety across all three measures. Women of Black, Asian or other minority ethnicity were less likely to report self-identified anxiety compared with women of White ethnicity (adjusted odds ratio 0.44; 95% CI 0.30–0.64). Despite some overlap, different anxiety measures identify different groups of women. Certain population characteristics such as women’s ethnicity may determine which type of measure is most likely to identify women experiencing anxiety.
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Halpern LM, Zhang DA, Velarde A. Survey Response Rates to a Self-Initiated Longitudinal Survey Accessed by a Quick Response Code in Six Different Regions of the United States. Cureus 2022; 14:e25146. [PMID: 35747044 PMCID: PMC9206521 DOI: 10.7759/cureus.25146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background A quick response (QR) code allows rapid access to an online survey via a smartphone and may improve response rates for web-based surveys. We report the response rates for a QR code-based, self-initiated, longitudinal survey of opioid use and pain scores following hospital discharge in pediatric surgical patients. Methodology All parents of pediatric patients who underwent surgery at one of six pediatric medical facilities were asked to participate in the study from October 5, 2020, until July 15, 2021. Those who chose to participate accessed the initial enrollment survey using a QR code on a handout provided. The next day they received an emailed link to a daily survey until their child was not requiring opioids and had pain scores of less than 4 for the previous 48 hours. Results A total of 1,759 families were asked to participate in the study. The parents of 44 patients completed the initial enrollment survey by accessing the QR code (response rate of 2.5%). Of those who completed the initial survey, 67% were lost to follow-up during the survey series. Conclusions We found an extremely low response rate for a self-initiated survey accessed by QR code. Additionally, we found a drop in the response rate with each successive daily email-based survey. At the end of the survey series, the majority of the initial participants had dropped out. We recommend using alternative modalities (informed consent, telephone call, weekly surveys) for initiating and delivering surveys to improve response rates for similarly designed studies.
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Jensen HAR, Lau CJ, Davidsen M, Feveile HB, Christensen AI, Ekholm O. The impact of non-response weighting in health surveys for estimates on primary health care utilization. Eur J Public Health 2022; 32:450-455. [PMID: 35373254 PMCID: PMC9159316 DOI: 10.1093/eurpub/ckac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Low response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years. Methods Registry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents. Results Across all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%. Conclusions Applying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.
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Affiliation(s)
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Warne N, Rook S, Bevan Jones R, Brown R, Bates L, Hopkins-Jones L, Evans A, Hall J, Langley K, Thapar A, Walters J, Murphy S, Moore G, Rice F, Collishaw S. Collecting genetic samples and linked mental health data from adolescents in schools: protocol coproduction and a mixed-methods pilot of feasibility and acceptability. BMJ Open 2022; 12:e049283. [PMID: 35105567 PMCID: PMC8808403 DOI: 10.1136/bmjopen-2021-049283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To coproduce a school-based protocol and examine acceptability and feasibility of collecting saliva samples for genetic studies from secondary/high school students for the purpose of mental health research. DESIGN Protocol coproduction and mixed-methods feasibility pilot. SETTING Secondary schools in Wales, UK. PARTICIPANTS Students aged 11-13 years. PRIMARY AND SECONDARY OUTCOME MEASURES Coproduced research protocol including an interactive science workshop delivered in schools; school, parental and student recruitment rates; adherence to protocol and adverse events; ability to extract and genotype saliva samples; student enjoyment of the science workshop and qualitative analysis of teacher focus groups on acceptability and feasibility. RESULTS Five secondary schools participated in the coproduction phase, and three of these took part in the research study (eligible sample n=868 students). Four further schools were subsequently approached, but none participated. Parental opt-in consent was received from 98 parents (11.3% eligible sample), three parents (0.3%) actively refused and responses were not received for 767 (88.4%) parents. We obtained saliva samples plus consent for data linkage for 79 students. Only one sample was of insufficient quality to be genotyped. The science workshop received positive feedback from students. Feedback from teachers showed that undertaking research like this in schools is viewed as acceptable in principle, potentially feasible, but that there are important procedural barriers to be overcome. Key recommendations include establishing close working relationships between the research team and school classroom staff, together with improved methods for communicating with and engaging parents. CONCLUSIONS There are major challenges to undertaking large-scale genetic mental health research in secondary schools. Such research may be acceptable in principle, and in practice DNA collected from saliva in classrooms is of sufficient quality. However, key challenges that must be overcome include ensuring representative recruitment of schools and sufficient parental engagement where opt-in parental consent is required.
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Affiliation(s)
- Naomi Warne
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Sarah Rook
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Rhys Bevan Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Rachel Brown
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Lesley Bates
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Lucinda Hopkins-Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Alexandra Evans
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Jeremy Hall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Kate Langley
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Frances Rice
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Stephan Collishaw
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Goodwin L, Skrybant M, Kenyon S. Involving and engaging pregnant women in maternity-related research: reflections on an innovative approach. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:90. [PMID: 34915935 PMCID: PMC8679964 DOI: 10.1186/s40900-021-00332-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/07/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Meaningful public involvement in maternity research remains challenging, partly due to the transient nature of pregnancy. This paper reflects on the development, implementation and simple evaluation of an innovative and inclusive approach to engaging and involving pregnant and early postnatal women in research. METHODS Between January and February 2018, a Research Fellow in Maternity Care, a Professor of Evidence Based Maternity Care, and a Patient and Public Involvement Lead convened for a number of meetings to discuss how public involvement and engagement might be improved for pregnancy-related research. A stakeholder group was created, including a local community matron, a community engagement officer at a local children's centre, public contributors, and senior members of the Maternal and Child Health theme of the West Midlands Collaboration for Leadership in Applied Health Research and Care (CLAHRC WM). The team worked together to develop a format for Yoga for Bump sessions: a free 90-min session, offered weekly, which included research involvement/engagement, pregnancy yoga, and a 'question and answer' session with a midwife. RESULTS A total of 67 women from two local communities in Birmingham attended Yoga for Bump sessions, which ran between May and December of 2018. Evaluation of the sessions suggested benefits to both women and researchers: it created mutually beneficial relationships between contributors and researchers, provided opportunities for women to engage and get involved in research that was directly relevant to them, and provided a convenient and efficient way for researchers to involve and engage pregnant women from diverse backgrounds in their research. Unintended benefits included self-reported improvements in women's health and wellbeing. CONCLUSIONS Yoga for Bump demonstrates an innovative approach to engaging and involving pregnant and early postnatal women; combining a free exercise class with healthcare advice and opportunities to engage with and be involved in research, and demonstrating mutual benefits for those involved. This model has the potential to be replicated elsewhere to support inclusive public involvement in pregnancy-related research. Further work is needed to design and evaluate similar approaches to involvement/engagement and explore potential funding avenues to enhance sustainability.
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Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Glenside Campus, Bristol, BS16 1DD, UK.
| | - Magdalena Skrybant
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sara Kenyon
- Institute of Applied Health Research, Murray Learning Centre, University of Birmingham, Birmingham, B15 2TT, UK
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Stavem K, Johannessen A, Nielsen R, Gulsvik A. Respiratory symptoms and respiratory deaths: A multi-cohort study with 45 years observation time. PLoS One 2021; 16:e0260416. [PMID: 34807953 PMCID: PMC8608323 DOI: 10.1371/journal.pone.0260416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
This study determined the association between respiratory symptoms and death from respiratory causes over a period of 45 years. In four cohorts of random samples of Norwegian populations with 103,881 participants, 43,731 persons had died per 31 December 2016. In total, 5,949 (14%) had died from respiratory diseases; 2,442 (41%) from lung cancer, 1,717 (29%) chronic obstructive pulmonary disease (COPD), 1,348 (23%) pneumonia, 119 (2%) asthma, 147 (2%) interstitial lung disease and 176 (3%) other pulmonary diseases. Compared with persons without respiratory symptoms the multivariable adjusted hazard ratio (HR) for lung cancer deaths increased with score of breathlessness on effort and cough and phlegm, being 2.6 (95% CI 2.1–3.2) for breathlessness score 3 and 2.1 (95% CI 1.7–2.5) for cough and phlegm score 5. The HR of COPD death was 6.4 (95% CI 5.4–7.7) for breathlessness score 3 and 3.0 (2.4–3.6) for cough and phlegm score 5. Attacks of breathlessness and wheeze score 2 had a HR of 1.6 (1.4–1.9) for COPD death. The risk of pneumonia deaths increased also with higher breathlessness on effort score, but not with higher cough and phlegm score, except for score 2 with HR 1.5 (1.2–1.8). In this study with >2.4 million person-years at risk, a positive association was observed between scores of respiratory symptoms and deaths due to COPD and lung cancer. Respiratory symptoms are thus important risk factors, which should be followed thoroughly by health care practitioners for the benefit of public health.
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Affiliation(s)
- Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- * E-mail:
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Opondo C, Harrison S, Alderdice F, Carson C, Quigley MA. Electronic cigarette use (vaping) and patterns of tobacco cigarette smoking in pregnancy-evidence from a population-based maternity survey in England. PLoS One 2021; 16:e0252817. [PMID: 34086809 PMCID: PMC8177470 DOI: 10.1371/journal.pone.0252817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Exposure to tobacco products during pregnancy presents a potential harm to both mother and baby. This study sought to estimate the prevalence of vaping during pregnancy and to explore the factors and outcomes associated with vaping in pregnancy. SETTING England. PARTICIPANTS Women who gave birth between 15th and 28th October 2017. METHODS A cross-sectional population-based postal survey of maternal and infant health, the National Maternity Survey (NMS) 2018. The prevalence of vaping and patterns of cigarette smoking were estimated, and regression analysis was used to explore associations between maternal characteristics and vaping, and between vaping and birth outcomes. OUTCOME MEASURES Unweighted and weighted prevalence of vaping with 95% confidence intervals, and unadjusted and adjusted relative risks or difference in means for the association of participant characteristics and secondary outcomes with vaping. Secondary outcome measures were: preterm birth, gestational age at birth, birthweight, and initiation and duration of breastfeeding. RESULTS A total of 4,509 women responded to the survey. The prevalence of vaping in pregnancy was 2.8% (95%CI 2.4% to 3.4%). This varied according to the pattern of cigarette smoking in pregnancy: 0.3% in never-smokers; 3.3% in ex-smokers; 7.7% in pregnancy-inspired quitters; 9.5% in temporary quitters; and 17.7% in persistent smokers. Younger women, unmarried women, women with fewer years of formal education, women living with a smoker, and persistent smokers were more likely to vape, although after adjusting for pattern of cigarette smoking and maternal characteristics, persistent smoking was the only risk factor. We did not find any association between vaping and preterm birth, birthweight, or breastfeeding. CONCLUSIONS The prevalence of vaping during pregnancy in the NMS 2018 was low overall but much higher in smokers. Smoking was the factor most strongly associated with vaping. Co-occurrence of vaping with persistent smoking has the potential to increase the harms of tobacco exposure in pregnant women and their infants.
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Affiliation(s)
- Charles Opondo
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Siân Harrison
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Fiona Alderdice
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- Nuffield Department of Population Health, NIHR Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom
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22
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OASI2: a cluster randomised hybrid evaluation of strategies for sustainable implementation of the Obstetric Anal Sphincter Injury Care Bundle in maternity units in Great Britain. Implement Sci 2021; 16:55. [PMID: 34022926 PMCID: PMC8140475 DOI: 10.1186/s13012-021-01125-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Obstetric Anal Sphincter Injury (OASI) Care Bundle comprises four primary and secondary prevention practices that target the rising rates of severe perineal tearing during childbirth, which can have severe debilitating consequences for women. The OASI Care Bundle was implemented in 16 maternity units in Britain in the OASI1 project (2017-2018), which demonstrated the care bundle's effectiveness in reducing OASI rates. In OASI2, the care bundle will be scaled up to 20 additional National Health Service (NHS) maternity units in a hybrid effectiveness-implementation study that will examine the effectiveness of strategies used to introduce, implement and sustain the care bundle. METHODS OASI2 is a two-arm cluster-randomised control trial (C-RCT) of maternity units in England, Scotland and Wales, with an additional non-randomised study arm. C-RCT arm 1 (peer support, n = 10 units) will be supported by 'buddy' units to implement the OASI Care Bundle. C-RCT arm 2 (lean implementation, n = 10 units) will implement without external support. The additional study arm (sustainability, n = 10 units) will include some original OASI1 units to evaluate the care bundle's sustainability and OASI rates over time, from before OASI1 and through the end of OASI2. Units in all three study arms will receive an Implementation Toolkit with training resources and implementation support. The C-RCT arms will be compared in terms of OASI rate reduction (primary effectiveness outcome) and clinicians' adoption of the care bundle (primary implementation outcome). Clinical data will be collated from maternity information systems; implementation data will be collected through validated surveys with women and clinicians, supplemented by qualitative methods. Descriptive statistics and regression modelling will be used for analysis. Emergent themes from the qualitative data will be assessed using framework analysis. DISCUSSION OASI2 will study the impact of various implementation strategies used to introduce and sustain the OASI Care Bundle, and how these strategies affect the bundle's clinical effectiveness. The study will generate insights into how to effectively scale-up and sustain uptake and coverage of similar interventions in maternity units. A locally adaptable 'implementation blueprint' will be produced to inform development of future guidelines to prevent perineal trauma. TRIAL REGISTRATION ISRCTN26523605.
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Petty J, Whiting L, Fowler C, Green J, Mosenthal A. Exploring the knowledge of community-based nurses in supporting parents of preterm babies at home: A survey-based study. Nurs Open 2021; 9:1883-1894. [PMID: 34009710 PMCID: PMC8994940 DOI: 10.1002/nop2.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Aim This study aimed to investigate the confidence levels, knowledge base and learning needs of community‐based nurses relating to the care of preterm babies and parents, to explore what education is required and in what format. Design An online survey methodology was used. Methods A 32‐item questionnaire was distributed via social media platforms to community‐based nurses in Australia. Results Descriptive analysis was undertaken relating to knowledge base, confidence levels, previous training, learning and resource needs and barriers to education. It was deemed vital to expand confidence and knowledge in this area. Gaps in learning resources were identified and a need for more training in topics such as developmental outcomes, feeding, expected milestones, weight gain, growth trajectories and supporting parents. Online resources were the preferred format to teach key knowledge to community‐based health professionals, tailored to the specific features of preterm babies and support needs of parents.
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Affiliation(s)
- Julia Petty
- Children's Nursing, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Lisa Whiting
- Children's Nursing, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | | | - Janet Green
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Alison Mosenthal
- Children's Nursing, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Janevic T, Maru S, Nowlin S, McCarthy K, Bergink V, Stone J, Dias J, Wu S, Howell EA. Pandemic Birthing: Childbirth Satisfaction, Perceived Health Care Bias, and Postpartum Health During the COVID-19 Pandemic. Matern Child Health J 2021; 25:860-869. [PMID: 33909205 PMCID: PMC8079857 DOI: 10.1007/s10995-021-03158-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/06/2022]
Abstract
Objective To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health. Study Design We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020–May 11, 2020) to a pre-pandemic response period (January 1, 2020–March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery. Results Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD. Conclusion Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color.
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Affiliation(s)
- Teresa Janevic
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA.
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
- Blavatnik Family Women's Health Research Institute, New York, USA.
| | - Sheela Maru
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine At Mount Sinai, New York, USA
- New York City Health+Hospitals/Elmhurst, New York, USA
| | - Sarah Nowlin
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
- Department of Nursing, Center for Nursing Research & Innovation, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Katharine McCarthy
- Department of Population Health Science and Policy, Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
- Blavatnik Family Women's Health Research Institute, New York, USA
| | - Veerle Bergink
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA
- Blavatnik Family Women's Health Research Institute, New York, USA
- Department of Psychiatry, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Joanne Stone
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Jennifer Dias
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Stephanie Wu
- Department of Health System Design and Global Health and the Arnhold Institute for Global Health, Icahn School of Medicine At Mount Sinai, New York, USA
| | - Elizabeth A Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Prevalence and Determinants of Fatigue after COVID-19 in Non-Hospitalized Subjects: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042030. [PMID: 33669714 PMCID: PMC7921928 DOI: 10.3390/ijerph18042030] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 12/16/2022]
Abstract
This study assessed the prevalence and determinants of fatigue in a population-based cohort of non-hospitalized subjects 1.5-6 months after COVID-19. It was a mixed postal/web survey of all non-hospitalized patients ≥18 years with a positive PCR for SARS-CoV-2 until 1 June 2020 in a geographically defined area. In total, 938 subjects received a questionnaire including the Chalder fatigue scale (CFQ-11) and the energy/fatigue scale of the RAND-36 questionnaire. We estimated z scores for comparison with general population norms. Determinants were analyzed using multivariable logistic and linear regression analysis. In total, 458 subjects (49%) responded to the survey at median 117.5 days after COVID-19 onset, and 46% reported fatigue. The mean z scores of the CFQ-11 total was 0.70 (95% CI 0.58 to 0.82), CFQ-11 physical 0.66 (0.55 to 0.78), CFQ-11 mental 0.47 (0.35 to 0.59) and RAND-36 energy/fatigue -0.20 (-0.31 to -0.1); all CFQ-11 scores differed from those of the norm population (p < 0.001). Female sex, single/divorced/widowed, short time since symptom debut, high symptom load, and confusion during acute COVID-19 were associated with higher multivariable odds of fatigue. In conclusion, the burden of post-viral fatigue following COVID-19 was high, and higher than in a general norm population. Symptoms of fatigue were most prevalent among women, those having a high symptom load, or confusion during the acute phase.
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Harrison S, Alderdice F, Quigley MA. External validity of prevalence estimates from the national maternity surveys in England: The impact of response rate. PLoS One 2020; 15:e0242815. [PMID: 33253308 PMCID: PMC7703875 DOI: 10.1371/journal.pone.0242815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Prevalence estimates from surveys with low response rates are prone to non-response bias if respondents and non-respondents differ on the outcome of interest. This study assessed the external validity of prevalence estimates of selected maternity indicators from four national maternity surveys in England which had similar survey methodology but different response rates. Methods A secondary analysis was conducted using data from the national maternity surveys in 2006 (response rate = 63%), 2010 (response rate = 54%), 2014 (response rate = 47%) and 2018 (response rate = 29%). Unweighted and (for the 2014 and 2018 surveys) weighted survey prevalence estimates (with 95%CIs) of caesarean section, preterm birth, low birthweight and breastfeeding initiation were validated against population-based estimates from routine data. Results The external validity of the survey estimates varied across surveys and by indicator. For caesarean section, the 95%CIs for the unweighted survey estimates included the population-based estimates for all surveys. For preterm birth and low birthweight, the 95%CIs for the unweighted survey estimates did not include the population-based estimates for the 2006 and 2010 surveys (or the 2014 survey for preterm birth). For breastfeeding initiation, the 95%CIs for the unweighted survey estimates did not include the population-based estimates for any survey. For all indicators, the effect of weighting (on the 2014 and 2018 survey estimates) was mostly a shift towards the population-based estimates, yet the 95%CIs for the weighted survey estimates of breastfeeding initiation did not include the population-based estimates. Conclusion There were no clear differences in the external validity of prevalence estimates according to survey response rate suggesting that prevalence estimates may still be valid even when survey response rates are low. The survey estimates tended to become closer to the population-based estimates when weights were applied, yet the effect was insufficient for breastfeeding initiation estimates.
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Affiliation(s)
- Sian Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, United Kingdom
- * E-mail:
| | - Fiona Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, United Kingdom
| | - Maria A. Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, United Kingdom
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