Reducing psychiatric illness in the perinatal period: A review and commentary

This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.

Violent Death Reporting in Maryland: Demographic Variability in Data Completeness

OBJECTIVES

To analyze the completeness of precipitating circumstance information recorded in the Maryland Violent Death Reporting System and identify limitations that could affect the system's utility.

METHODS

We reviewed all violent deaths among Maryland residents for the years 2003 through 2014 (n = 19 161). We assessed the presence of precipitating circumstance data (abstracted from medical examiner and police reports) by manner of death and demographic characteristics. We further evaluated homicide records with multivariable regression.

RESULTS

Demographic variation in circumstance reporting was most pronounced for homicide. Circumstances were known for 53.2% of homicide cases, and this percentage was lower among non-Latino Blacks (48.2%), males (50.7%), those aged 18 to 25 years (47.9%), those residing in jurisdictions with higher-than-average homicide rates (46.1%), and those who died outside in a public place (43.4%) or in a correctional facility (48.9%). With the exception of male gender, these factors were significantly associated with circumstance reporting when we controlled for demographic and situational variables.

CONCLUSIONS

Circumstance reporting was least likely among groups most at risk for homicide in Maryland. Collection of circumstance data for the most affected groups should be strengthened to help develop better prevention strategies.

Characteristics of Violent Deaths Among Homeless People in Maryland, 2003-2011

INTRODUCTION

People experiencing homelessness are susceptible to many adverse health events, including violence. The purpose of this study was to provide a descriptive analysis of homeless individuals who suffered a violent death in Maryland. Characterizing these deaths will provide a basis for additional analyses that can inform violence prevention activities.

METHODS

This study used data from the Maryland Violent Death Reporting System to examine violent deaths of homeless people occurring from 2003 through 2011. This surveillance system collects information on all violent deaths occurring in Maryland. Victim demographics, injury and death information, precipitating circumstances contributing to deaths, and toxicology information were examined. All analyses were conducted in 2014 and 2015.

RESULTS

Among all violent death victims from 2003 through 2011 (N=14,327), a total of 279 (2.0%) were identified as homeless victims. More than half (65.2%) of deaths were of undetermined intent, 21.2% were homicides, and 13.6% were suicides. The most common method of injury was poisoning (59.0%). Substance abuse and having a current mental health problem were among the most commonly reported circumstances relating to death.

CONCLUSIONS

This study found substance abuse and mental health problems to be major circumstances precipitating violent death among people experiencing homelessness. This study will serve as a starting point for more in-depth analyses on experiences of violent death among homeless people that can inform violence prevention policy and programming.

Assessing Evidence-Based Practice Knowledge, Attitudes, Access and Confidence Among Dental Hygiene Educators

PURPOSE

To assess U.S. dental hygiene educators' evidence-based practice (EBP) knowledge, attitude, access and confidence and determine whether a correlation exists between assessment scores and level of education, length teaching and teaching setting (didactic, clinical or both).

METHODS

A cross-sectional survey was conducted with a sample of dental hygiene faculty from all 334 U.S. dental hygiene schools. ANOVA and Pearson correlation coefficient statistical analysis were utilized to investigate relationships between demographic variables and application of evidence-based principles of patient care.

RESULTS

This study involved a non-probability sample (n=124), since the total faculty among all U.S. dental hygiene schools was not determined. Analysis demonstrated a positive correlation between EBP knowledge, access and confidence scores indicating that as knowledge scores increased, so did confidence and access scores (r=0.313, p<0.01 and r=0.189, p<0.05, respectively). Study findings also revealed that faculty who held advanced educational degrees scored significantly higher in EBP knowledge (F3,120=2.81, p<0.04) and confidence (F3,120=7.26, p<0.00).

CONCLUSION

This study suggests the level of EBP knowledge, attitude, access and confidence increases with additional education. Therefore, more EBP training may be necessary for faculty who do not possess advanced education. Results of the study indicate that further incorporation of EBP into dental hygiene curricula may occur as dental hygiene educators' knowledge of EBP increases, which in turn could enhance students' acquisition of EBP skills and their application of EBP principles toward patient care.

Assessing Evidence-Based Practice Knowledge, Attitudes, Access and Confidence Among Dental Hygiene Educators

PURPOSE

To assess U.S. dental hygiene educators' evidence-based practice (EBP) knowledge, attitude, access and confidence and determine whether a correlation exists between assessment scores and level of education, length teaching and teaching setting (didactic, clinical or both).

METHODS

A cross-sectional survey was conducted with a sample of dental hygiene faculty from all 334 U.S. dental hygiene schools. ANOVA and Pearson correlation coefficient statistical analysis were utilized to investigate relationships between demographic variables and application of evidence-based principles of patient care.

RESULTS

This study involved a non-probability sample (n=124), since the total faculty among all U.S. dental hygiene schools was not determined. Analysis demonstrated a positive correlation between EBP knowledge, access and confidence scores indicating that as knowledge scores increased, so did confidence and access scores (r=0.313, p<0.01 and r=0.189, p<0.05, respectively). Study findings also revealed that faculty who held advanced educational degrees scored significantly higher in EBP knowledge (F3,120=2.81, p<0.04) and confidence (F3,120=7.26, p<0.00).

CONCLUSION

This study suggests the level of EBP knowledge, attitude, access and confidence increases with additional education. Therefore, more EBP training may be necessary for faculty who do not possess advanced education. Results of the study indicate that further incorporation of EBP into dental hygiene curricula may occur as dental hygiene educators' knowledge of EBP increases, which in turn could enhance students' acquisition of EBP skills and their application of EBP principles toward patient care.

Effect of prenatal hypoxia in transgenic mouse models of preeclampsia and fetal growth restriction

Mice lacking endothelial nitric oxide synthase (eNOS(-)(/-)) or catechol-O-methyl transferase (COMT(-/-)) exhibit a preeclampsia-like phenotype and fetal growth restriction. We hypothesized that a hypoxic insult would result in a more severe phenotype. Pregnant eNOS(-/-), COMT(-/-) and control (C57BL/6J) mice were randomized to hypoxic (10.5% O(2)) or normal conditions (20.9% O(2)) from gestational day 10.5 to 18.5. Hypoxia increased the blood pressure in all genotypes and proteinuria in C57BL/6J and eNOS(-/-) mice. Fetal survival was significantly reduced following hypoxia, particularly in eNOS(-/-) mice. Birth weight was decreased in both C57BL/6J and COMT(-/-) mice. Placentas from COMT(-/-) mice demonstrated increased peroxynitrite. Despite similar hypoxia-induced effects on maternal blood pressure and proteinuria, eNOS(-/-) embryos have a decreased tolerance to hypoxia. Compared to C57BL/6J, COMT(-/-) mice exhibited less severe changes in proteinuria and fetal growth when exposed to prenatal hypoxia. This relative resistance to prenatal hypoxia was associated with a significant increase in placental levels of peroxynitrite.

Effect of gestational diabetes on maternal artery function

Endothelial dysfunction has been observed systemically in women with gestational diabetes (GDM). Important cardiovascular adaptations occur during pregnancy, including enhanced endothelium-dependent vasodilation in systemic and uterine arteries, which are necessary to ensure the health of both mother and fetus. The effects of GDM, however, on uterine artery function and the possible mechanisms that mediate endothelial dysfunction remain unknown. The aim of this study was to utilize a mouse model of GDM to investigate (a) effects on uteroplacental flow, (b) endothelial function of uterine and mesenteric arteries, and (c) possible mechanisms of any dysfunction observed. Pregnant mice heterozygous for a leptin receptor mutation (Lepr(db) (/+); He) spontaneously develop GDM and were compared to wild-type (WT) mice at day 18.5 of gestation. Uterine artery flow was assessed using ultrasound biomicroscopy. Uterine and mesenteric artery function was assessed using wire myography. Arterial superoxide production was measured using oxidative fluorescence microphotography. In vivo uteroplacental perfusion was impaired in mice with GDM, indicated by a significant increase in uterine artery resistance index. Maximal endothelium-dependent relaxation to methacholine was significantly impaired in mesenteric arteries from mice with GDM, while sensitivity was significantly reduced in uterine arteries. Both uterine and mesenteric arteries from mice with GDM exhibited a greater dependence on nitric oxide and increased superoxide production compared with those from mice with a healthy pregnancy. A significant source of superoxide in GDM mice was uncoupled nitric oxide synthase. These changes may contribute to the development of some of the fetal and maternal complication associated with GDM.

Satisfaction and patient outcomes of a telephone-based nurse triage service

PURPOSE

Describe patient satisfaction and patient-reported outcomes after voluntary use of a telephone-based nurse triage service.

METHODS

A random sample of symptomatic callers who contacted the triage service in 1999 was identified. A computer-assisted telephone survey was conducted, resulting in a response rate of 58.9 percent and a sample size of 35,374.

SUMMARY

Overall satisfaction with the service was 90.4 percent and did not vary greatly when stratified by demographic and health status characteristics. Of all callers who reported following the triage recommendation to use self-care instructions while monitoring the condition for change (n = 12,037), 11.5 percent scheduled an office visit and 1.5 percent used hospital emergency-room (ER) services for further care.

CONCLUSIONS

Overall satisfaction with telephone-based nurse triage services was high and did not vary substantially by caller characteristics.