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Observed Versus Predicted Vaginal Birth After Cesarean for Patients of a Community Health Center 社区医疗中心患者剖腹产后阴道分娩的观察结果与预测结果对比
IF 2.7 4区 医学 Q2 NURSING Pub Date : 2024-09-17 DOI: 10.1111/jmwh.13687
Ann Ledbetter, Tracy Wandtke Herrmann, Karen Lupa, Menachem Graupe
IntroductionThe Maternal‐Fetal Medicine Units Network calculator for vaginal birth after cesarean (VBAC) probability was updated to exclude a race and ethnicity variable, but its impact on marginalized groups is unknown. We assessed the tool with attention to birth history and body mass index (BMI) in a predominately Hispanic cohort and examined the possible effect of discouraging labor after cesarean (LAC) with a low score.MethodsWe conducted a retrospective cohort study of LACs by patients who entered spontaneous or induced labor with a live, nonanomalous fetus in cephalic presentation between 2012 and 2022. Observed VBAC rates were compared with the mean predicted VBAC probability derived from the calculator. Areas under the curve (AUCs) were calculated for the entire cohort and for individuals with LAC with and without prior vaginal birth. A z‐test was used to determine the significance between VBAC rates in 4 BMI categories. The impact of discouraging LAC with VBAC probability below 70% was examined.ResultsA total of 400 people experienced 507 LACs, with 417 (82.2%) resulting in VBAC compared with a mean predicted probability of 71.2%. The AUC for all LACs was 0.76 (95% CI, 0.71‐0.81), whereas the AUC for LACs with prior vaginal birth was 0.70 (95% CI, 0.56‐0.85) and without was 0.60 (95% CI, 0.52‐0.67). Observed VBAC rates exceeded predicted rates for individuals with overweight and obese BMIs: <25 (79.6% vs 75.6%; P = .520), 25 to 30 (83.2% vs 71.9%; P = .007), 30 to 40 (82.7% vs 70.0%; P = .004), and ≥40 (82.8% vs 58.3%; P = .040). Discouraging LAC below 70% probability might have prevented 71 unsuccessful LACs, 160 initial VBACs, and 57 subsequent VBACs, decreasing the VBAC rate to 39.4% (200/507).DiscussionIn a predominately Hispanic cohort, the updated calculator underestimated VBAC potential for people with no vaginal birth history and/or an elevated BMI. Discouraging LAC based on low VBAC probability may prevent both initial and subsequent VBACs.
导言:母胎医学单位网络的剖宫产后阴道分娩(VBAC)概率计算器已更新,排除了种族和民族变量,但其对边缘群体的影响尚不清楚。我们对这一工具进行了评估,并关注了以西班牙裔为主的队列中的出生史和体重指数(BMI),同时研究了低分对剖宫产后分娩(LAC)的可能影响。方法我们对 2012 年至 2022 年期间头位胎儿为活产、非畸形的自然分娩或引产患者的 LAC 进行了回顾性队列研究。将观察到的VBAC率与计算器得出的平均预测VBAC概率进行了比较。计算了整个队列的曲线下面积(AUC),以及有阴道分娩史和无阴道分娩史的 LAC 患者的曲线下面积(AUC)。使用 z 检验来确定 4 个 BMI 类别的 VBAC 率之间的显著性。结果 共有 400 人经历了 507 次 LAC,其中 417 人(82.2%)进行了 VBAC,而平均预测概率为 71.2%。所有 LAC 的 AUC 为 0.76(95% CI,0.71-0.81),而有阴道分娩史的 LAC 的 AUC 为 0.70(95% CI,0.56-0.85),无阴道分娩史的 AUC 为 0.60(95% CI,0.52-0.67)。在体重指数超重和肥胖的人群中,观察到的 VBAC 率超过了预测率:<25(79.6% vs 75.6%;P = .520)、25 至 30(83.2% vs 71.9%;P = .007)、30 至 40(82.7% vs 70.0%;P = .004)和≥40(82.8% vs 58.3%;P = .040)。在以西班牙裔为主的队列中,更新的计算器低估了无阴道分娩史和/或体重指数升高者的 VBAC 可能性。基于 VBAC 可能性低而不鼓励 LAC 可能会阻止初次和后续的 VBAC。
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引用次数: 0
Intimate Partner Violence 亲密伴侣暴力。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-09-16 DOI: 10.1111/jmwh.13691

Intimate partner violence (IPV), also called domestic violence, is when someone is in a relationship and is physically, sexually, or emotionally harmed by their partner. IPV can happen to anyone who is in a relationship. It doesn't matter how much money you have, your occupation, or where you live. Anyone can be in a relationship and not feel safe. Women experience higher rates of abuse. About one of every 3 women will be abused at some point in their life. Men, as well as gay or transgender people can also experience abuse. If you are unsure if you are in an abusive relationship, there are people that you can talk to confidentially about your situation. If you determine that you want help, there are resources that can support you and help you develop a plan to protect yourself and your family.

Abuse can be different in every case. Usually, one person wants power and control over someone else. Abuse can be physical, emotional, verbal, sexual, or financial. The actions or words are meant to scare someone or control them.

Almost everyone who is being abused does not think abuse is happening when it starts. Many people who abuse their partners were nice at the beginning of the relationship. No one wants to think that the person they love would hurt them. Your partner may try to make you feel that the abuse is your fault. It is important to remember that you are never to blame for someone abusing you.

This handout may be reproduced for noncommercial use by health care professionals to share with patients, but modifications to the handout are not permitted. The information and recommendations in this handout are not a substitute for health care. Consult your health care provider for information specific to you and your health.

亲密伴侣暴力(IPV),又称家庭暴力,是指某人在恋爱关系中受到其伴侣的身体、性或情感伤害。IPV 可能发生在任何有伴侣关系的人身上。你有多少钱、你的职业或你住在哪里并不重要。任何人都可能在一段关系中没有安全感。女性遭受虐待的比例更高。大约每 3 位女性中就有 1 位会在一生中的某个阶段受到虐待。男性、同性恋或变性人也可能遭受虐待。如果您不确定自己是否处于受虐待的关系中,您可以向一些人私下倾诉自己的情况。如果您确定自己需要帮助,有些资源可以为您提供支持,帮助您制定保护自己和家人的计划。通常情况下,一个人希望对另一个人拥有权力和控制。虐待可以是身体虐待、情感虐待、语言虐待、性虐待或经济虐待。几乎每个被虐待的人在虐待开始时都不认为虐待正在发生。许多虐待伴侣的人在关系开始时都是好人。没有人愿意去想自己所爱的人会伤害自己。您的伴侣可能会试图让您觉得虐待是您的错。重要的是要记住,你永远不会因为别人虐待你而受到责备。本讲义可由医护人员复制用于非商业目的,与患者分享,但不允许对讲义进行修改。本手册中的信息和建议不能替代医疗保健。请咨询您的医疗保健提供者,以了解与您和您的健康状况相关的具体信息。
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引用次数: 0
The Impact of Obesity on Childbirth Expectations 肥胖对分娩期望的影响
IF 2.7 4区 医学 Q2 NURSING Pub Date : 2024-09-10 DOI: 10.1111/jmwh.13685
Tamara A. Messer, Fabienne Blank, Jean Anthony Grand‐Guillaume‐Perrenoud, Evelyne M. Aubry
IntroductionPositive childbirth expectations are crucial for fostering a positive labor experience and enhancing the health and well‐being of both the woman and her newborn. However, the impact of obesity on childbirth expectations remains underexplored. We aim to assess childbirth expectations in women living with obesity to enhance perinatal care tailored to their specific needs.MethodsUsing an adapted version of the Childbirth Expectation Questionnaire (CEQ) in a nationwide online survey, we assessed expectations on childbirth of pregnant women living in Switzerland. We performed one‐way analysis of variance and independent t tests to analyze associations between childbirth expectations and women's characteristics such as body mass index (BMI). Binomial logistic regressions estimated the likelihood of positive birth expectations occurring based on individual and contextual factors.ResultsIn total, 961 pregnant women responded to the CEQ through social media. Increased BMI was associated with lower mean scores in overall birth expectations (P = .008), whereas women accompanied by midwives during pregnancy showed significantly increased mean scores (P < .001). Regression analysis revealed that women living with obesity were less likely to have positive expectations for their upcoming childbirth when compared with others (adjusted odds ratio [aOR], 0.63; 95% CI, 0.42‐0.95; P = .027). Conversely, midwifery care and plans for nonclinical births were associated with increased positive childbirth expectations (aOR, 3.65; 95% CI, 2.11‐6.32; P < .001 and aOR, 4.77; 95% CI, 3.37‐6.74; P < .001, respectively).DiscussionWomen living with obesity exhibited significantly lower childbirth expectations compared with other women, impacting birth outcomes and satisfaction. Midwife involvement correlated with more positive expectations, emphasizing their role in improving women's realistic expectations and fostering well‐being. Enhanced accessibility to models of care with midwifery continuity may be a crucial factor in promoting positive expectations among women living with obesity.
导言:积极的分娩预期对于促进积极的分娩体验以及提高产妇和新生儿的健康和福祉至关重要。然而,肥胖对分娩期望的影响仍未得到充分研究。我们的目的是评估肥胖妇女的分娩期望,以便根据她们的具体需求加强围产期保健。方法在一项全国性的在线调查中,我们使用改编版分娩期望问卷(CEQ)评估了瑞士孕妇的分娩期望。我们采用单因素方差分析和独立 t 检验来分析分娩期望与女性特征(如体重指数)之间的关系。结果共有 961 名孕妇通过社交媒体回复了 CEQ。体重指数(BMI)的增加与总体生育期望平均分的降低有关(P = .008),而孕期有助产士陪伴的妇女的平均分显著增加(P < .001)。回归分析表明,与其他人相比,患有肥胖症的妇女不太可能对即将到来的分娩抱有积极的期望(调整赔率比 [aOR],0.63;95% CI,0.42-0.95;P = .027)。相反,助产护理和非临床分娩计划与积极分娩预期的增加有关(aOR,3.65;95% CI,2.11-6.32;P <;.001 和 aOR,4.77;95% CI,3.37-6.74;P <;.001)。助产士的参与与更积极的预期相关,强调了助产士在改善妇女的现实预期和促进幸福感方面的作用。提高助产士连续性护理模式的可及性可能是促进肥胖妇女对分娩抱有积极期望的关键因素。
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引用次数: 0
Preventing Vertical Transmission of Chagas Disease: An Emerging Public Health Issue in Perinatal Care 预防南美锥虫病的垂直传播:围产期护理中新出现的公共卫生问题。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-08-26 DOI: 10.1111/jmwh.13682
Sarah M. Hinton MSM, CPM, LM

Chagas [shah-guhs] disease, caused by the Trypanosoma cruzi parasite, presents a growing concern for health care providers overseeing perinatal care in the United States due to existing and expanding vector-borne transmission and population migration. This life-threatening disease can be transmitted vertically during pregnancy, although adequate testing and treatment can effectively reduce morbidity and mortality caused by Chagas disease. This article presents an overview of the disease burden in the United States and its implications for perinatal care providers including recommended testing and treatment practices and the information needed for patient education and shared decision-making regarding the management of care for individuals at risk of Chagas disease. Being informed about Chagas disease and its implications is needed for all individuals providing perinatal care and is especially critical for those overseeing the care of refugee and immigrant populations.

恰加斯[shah-guhs]病是由克鲁斯锥虫寄生虫引起的,由于病媒传播和人口迁移的存在和扩大,美国负责围产期保健的医疗服务提供者越来越关注这种疾病。尽管适当的检测和治疗可以有效降低南美锥虫病的发病率和死亡率,但这种危及生命的疾病在怀孕期间可以垂直传播。本文概述了美国的疾病负担及其对围产期保健提供者的影响,包括推荐的检测和治疗方法,以及患者教育和共同决策所需的信息,这些信息涉及对恰加斯病高危人群的护理管理。所有提供围产期保健服务的人员都需要了解恰加斯病及其影响,这对负责难民和移民群体保健的人员尤为重要。
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引用次数: 0
Antepartum Preparation and Consent for Intrapartum Events: An Ethical Gap 产前准备和产中事件的同意:伦理空白。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-08-12 DOI: 10.1111/jmwh.13683
Michele Megregian CNM, PhD, Cathy L. Emeis CNM, PhD, Ellen Tilden CNM, PhD
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引用次数: 0
Innovations in Preconception Care: Optimizing Health for All Individuals 孕前保健创新:优化所有人的健康。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-08-06 DOI: 10.1111/jmwh.13681
Cynthia Nypaver CNM, PhD, WHNP-BC, Amanda Yeager CNM, MSN

Optimizing the overall health of individuals prior to pregnancy can improve both pregnancy and lifelong health outcomes. Despite extremely high financial expenditure on birth in the United States, maternal and infant mortality rates continue to rise. Moreover, significant racial and ethnic disparities persist in perinatal health outcomes. Preconception care, or health care provided before or between pregnancies, has the capacity to meet these challenges. Preconception care can be integrated into every health care visit, including visits with primary care, reproductive health, and mental health care clinicians. Increasing awareness among clinicians of the benefits of preconception care and equipping them with innovative strategies to implement this care into practice, the number of people receiving optimal care could be increased. Recent innovations in preconception care include group care, health applications (apps), reminders in electronic health records, social marketing campaigns, social media movements, community-based partnerships, health care policy and access, and improving public and clinician education on preconception health topics. Ultimately, improving preconception health is best done in partnership between the consumer and clinician. Midwives, whose care is person-centered and partnership-focused, are well positioned to champion the innovation and implementation of equitable preconception care. The purpose of this State of the Science review, therefore, is to synthesize the literature on recent evidence-based innovations that may be used to improve preconception health and counseling.

在怀孕前优化个人的整体健康可以改善妊娠和终生健康状况。尽管美国在生育方面的财政支出极高,但孕产妇和婴儿死亡率却持续上升。此外,在围产期健康结果方面,种族和民族之间仍然存在巨大差异。孕前保健,即在怀孕前或怀孕期间提供的保健服务,有能力应对这些挑战。孕前保健可以融入到每一次医疗保健就诊中,包括初级保健、生殖健康和心理保健临床医生的就诊。提高临床医生对孕前保健益处的认识,并让他们掌握将这种保健付诸实践的创新策略,可以增加接受最佳保健的人数。最近在孕前保健方面的创新包括集体保健、健康应用程序(Apps)、电子健康记录中的提醒、社会营销活动、社交媒体运动、社区合作、医疗保健政策和获取途径,以及改善有关孕前保健主题的公众和临床医生教育。归根结底,改善孕前健康的最佳方式是消费者与临床医生合作。助产士的护理以人为本,注重伙伴关系,她们完全有能力倡导创新和实施公平的孕前护理。因此,这篇科学现状综述的目的是,对近期可用于改善孕前健康和咨询的循证创新进行文献综述。
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引用次数: 0
History of Midwifery at Tuskegee: Vanguards of Midwifery Education 塔斯基吉助产史:助产教育的先锋。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-08-06 DOI: 10.1111/jmwh.13667
Sharon L. Holley CNM, DNP, Stephanie Mitchell CNM, CPM, DNP, Elizabeth G. Muñoz CNM, DNP, Anne Z. Cockerham CNM, PhD, WHNP

Tuskegee, in Macon County, Alabama, has played an important role in Alabama's midwifery legacy and was home to 2 different midwifery education programs from the 1920s through the 1940s. In response to a 1918 state law requiring midwives to pass an examination to receive a practice permit in their county, stakeholders developed a four-week course for Black Alabamian midwives on the grounds of Tuskegee Institute at the John A. Andrew Memorial Hospital. In the 1940s, in the same location on the grounds of Tuskegee Institute, the Tuskegee School of Nurse-Midwifery educated Black nurse-midwives to improve Black maternal and neonatal outcomes in the South.

位于阿拉巴马州梅肯县的塔斯基吉在阿拉巴马州的助产传统中发挥了重要作用,从 20 世纪 20 年代到 40 年代,这里曾举办过两次不同的助产教育课程。1918 年,州法律要求助产士必须通过考试才能在本县获得执业许可,为此,相关人员在约翰-A-安德鲁纪念医院塔斯基吉学院为阿拉巴马州黑人助产士开设了为期四周的课程。20 世纪 40 年代,在塔斯基吉研究所的同一地点,塔斯基吉助产士学校为黑人助产士提供教育,以改善南方黑人产妇和新生儿的状况。
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引用次数: 0
Canadian Midwives’ Experiences with Nutrition in Their Training and Practice: A Cross-Sectional Study 加拿大助产士在培训和实践中的营养体验:一项横断面研究。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-08-05 DOI: 10.1111/jmwh.13665
Jordyn Butler MScFN, RD, Yvana Sawaya MSc, Jamie A. Seabrook PhD, Janet Madill PhD, RD, FDC, Jasna Twynstra PhD

Introduction

Midwives are primary prenatal care providers well-positioned to offer nutrition advice to pregnant individuals; however, no Canadian study has assessed midwives’ experience with nutrition education. The objective of this study was to investigate Canadian midwives’ experiences with nutrition in their practice, their level of nutrition education, and their recommendations on select nutrition topics.

Methods

This cross-sectional study used an anonymous online survey consisting of 4 sections: demographics, opinions on the importance of nutrition, nutrition recommendations for pregnancy, and nutrition topics that midwives would like more information on. Responses were recorded using Likert-type scales, multiple choice, or open-ended questions. Eligible participants, registered Canadian midwives, were recruited through advertisements in e-newsletters via national and provincial midwifery associations, social media posts, and emails to midwifery clinics. An independent samples t test compared differences in means for continuous outcomes, the χ2 test compared categorical variables, and the Mann-Whitney U test compared ordinal variables. A P < .05 was considered statistically significant.

Results

In total, 161 midwives completed the online survey. Most midwives (92.5%) indicated that nutrition for pregnancy was important, and 83.2% believed their role in providing nutrition information to pregnant women was important. Almost two-thirds (63.8%) of midwives received nutrition education. Comfort levels were highest (median = 4) when providing nutrition advice on healthy eating, weight gain, Listeria, anemia, heartburn, safe food handling, nutrition for breastfeeding, and weight gain for women with obesity. Almost all the midwives (99.4%) had provided nutrition information to pregnant women, and 85.2% of their recommendations aligned with Canadian guidelines and literature.

Discussion

Canadian midwives valued the importance of nutrition during pregnancy and their role in providing nutrition information to pregnant women. The level of comfort in advising on nutrition ranged from uncomfortable to very comfortable depending on the topic, and most (85.2%) of their advice aligned with Canadian guidelines and relevant literature.

导言:助产士是产前护理的主要提供者,有能力为孕妇提供营养建议;然而,加拿大还没有研究对助产士的营养教育经验进行评估。本研究旨在调查加拿大助产士在实践中的营养经验、她们的营养教育水平以及她们对某些营养主题的建议:这项横断面研究采用匿名在线调查的方式,包括 4 个部分:人口统计学、对营养重要性的看法、孕期营养建议以及助产士希望获得更多信息的营养主题。采用李克特量表、多项选择或开放式问题记录回答。符合条件的参与者是加拿大注册助产士,她们是通过国家和省级助产士协会的电子通讯广告、社交媒体帖子以及向助产士诊所发送的电子邮件招募的。独立样本 t 检验比较连续结果的均值差异,χ2 检验比较分类变量,Mann-Whitney U 检验比较顺序变量。A P 结果:共有 161 名助产士完成了在线调查。大多数助产士(92.5%)表示孕期营养很重要,83.2%的助产士认为她们在向孕妇提供营养信息方面的作用很重要。近三分之二(63.8%)的助产士接受过营养教育。在提供有关健康饮食、体重增加、李斯特菌、贫血、胃灼热、安全处理食物、母乳喂养营养和肥胖妇女体重增加的营养建议时,舒适度最高(中位数 = 4)。几乎所有助产士(99.4%)都向孕妇提供过营养信息,85.2%的建议与加拿大指南和文献一致:讨论:加拿大助产士重视孕期营养的重要性以及她们在向孕妇提供营养信息方面的作用。根据主题的不同,助产士在提供营养建议时的舒适程度从不觉舒适到非常舒适不等,她们的大多数建议(85.2%)与加拿大指南和相关文献一致。
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引用次数: 0
Clinical Applications of Fetal Cell-Free DNA: State of the Science 无胎儿细胞 DNA 的临床应用:科学现状。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-07-25 DOI: 10.1111/jmwh.13674
Julie Knutson CNM, DNP, Kathryn Anthony MD, Melissa L. Russo MD, Martha B. Kole-White MD

Advances in technology have correlated with expanding prenatal genetic testing options for pregnant people. Leading medical organizations recommend cell-free DNA as the most sensitive screening test for trisomies 13, 18, and 21, as well as for fetal sex chromosome aneuploidies. The commercially available testing options go beyond these recommended tests, and prenatal care professionals should be familiar with the tests that their patients may choose despite being beyond the scope of current medical recommendations. This article explains updates in cell-free DNA technology and clinical considerations for prenatal care professionals, recognizing that this is a rapidly changing field of science and health care.

随着技术的进步,孕妇产前基因检测的选择范围也在不断扩大。领先的医学组织推荐无细胞 DNA 是筛查 13、18 和 21 三体以及胎儿性染色体非整倍体最灵敏的检测方法。商业化的检测方案超出了这些推荐的检测范围,产前保健专业人员应熟悉病人可能选择的检测方法,尽管这些方法超出了目前医学推荐的范围。本文介绍了无细胞 DNA 技术的最新进展以及产前护理专业人员的临床注意事项,并指出这是一个日新月异的科学和医疗保健领域。
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引用次数: 0
Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review 孕期抑郁和焦虑症筛查与治疗模式的差异:综合评述。
IF 2.1 4区 医学 Q2 NURSING Pub Date : 2024-07-25 DOI: 10.1111/jmwh.13679
Rachel Eakley PhD, RN, PMHNP-BC, Audrey Lyndon PhD, RNC

Introduction

Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy.

Methods

Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria.

Results

Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access.

Discussion

Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.

导言:孕期抑郁和焦虑症状如不及时治疗,会对孕妇、分娩结果和儿童发育造成严重不良影响。然而,与非孕妇相比,孕妇接受筛查和治疗的可能性较低。在本系统综述中,我们旨在探讨影响孕期抑郁和焦虑筛查、识别和治疗模式的个人、提供者和系统因素:2012年1月至2023年1月期间,在美国境内进行的、以英语发表的研究均符合纳入条件。每项研究都包含对筛查、识别或治疗参与率进行比较的分析,并明确讨论了边缘化群体的差异或健康公平问题。有 15 篇文章符合全部纳入标准:结果显示,不同患者群体在筛查、识别和治疗孕期抑郁和焦虑方面存在差异。筛查率从波多黎各的 51.3% 到阿拉斯加的 90.7% 不等。在特定的临床人群中,筛查率低至 2.0%。根据筛查或诊断结果转诊治疗的患者不到一半。年龄、种族、民族、社会经济和健康因素、精神健康史和肥胖等患者特征与筛查、诊断或治疗参与率的差异有关。语言因素是导致筛查率和治疗率较低的最常见因素:讨论:结果表明,许多孕妇被忽视,缺乏适当的转诊或治疗资源。结果与之前的研究结果一致,即角色混乱、缺乏时间、提供者培训和兴趣导致筛查和治疗率较低。未来的研究必须关注系统层面的因素,以系统、公平的方式解决筛查和治疗孕期抑郁和焦虑症的障碍。
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引用次数: 0
期刊
Journal of midwifery & women's health
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