Journal of midwifery & women's health最新文献_第8页

Research and Professional Literature to Inform Practice, January/February 2024 为实践提供信息的研究和专业文献，2024 年 1 月/2 月

IF 2.7 4区医学 Q1 Nursing

Journal of midwifery & women's health

Pub Date : 2024-01-15 DOI: 10.1111/jmwh.13607

Nancy A. Niemczyk CNM, CHSE, PhD, Elizabeth Humphreys SN, Lauren Narbey CNM, CRNP, MSc, MSN

引用次数: 0

Systematic Reviews to Inform Practice, January/February 2024 为实践提供依据的系统综述》，2024 年 1 月/2 月刊。

IF 2.7 4区医学 Q1 Nursing

Journal of midwifery & women's health

Pub Date : 2024-01-12 DOI: 10.1111/jmwh.13605

Abby Howe-Heyman CNM, PhD

引用次数: 0

Factors Associated with Provider Counseling Against Breastfeeding in the Setting of Marijuana Use: A Population-Based Survey 在吸食大麻的情况下，提供母乳喂养咨询的相关因素：基于人口的调查。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-01-11 DOI: 10.1111/jmwh.13583

Joy A. Fatunbi MD, Brent C. Monseur MD, ScM, Vincenzo Berghella MD, Jerrine R. Morris MD, MPH

Introduction

The purpose of this study was to explore patient demographic factors associated with counseling against breastfeeding and concurrent marijuana use.

Methods

A cross-sectional study derived using data from the Centers for Disease Control and Prevention administered Pregnancy Risk Assessment Monitoring System (PRAMS) in collaboration with state and local health departments. This study sample included survey participants whose responses indicate they received counseling discouraging breastfeeding with concurrent marijuana use. Bivariate and multivariate regression analyses assessed the relationship between factors associated with counseling against breastfeeding and concurrent marijuana use.

Results

Of the 10,911 participants in this sample, 9,695 participants who answered the question about receiving counseling discouraging breastfeeding while using marijuana were included in the analysis (89% response rate for the total sample). Twenty nine percent of participants were advised by a provider not to breastfeed while using marijuana. Participants who received this counseling were more likely to be people of color, age less than or equal to 29, with a high school education or less, unmarried, report governmental or no insurance prepregnancy, and report marijuana use postpartum. In the multivariate analysis, age less than or equal to 20 (P = .001), being unmarried (P = .023), and marijuana use postpartum (P = .034) remained associated with counseling against breastfeeding.

Discussion

Our results suggest that individuals are being counseled differently. Unmarried and young people (age <20 years) were more likely to report receiving counseling against breastfeeding with concurrent marijuana use. Given the growing national acceptability of marijuana use, the known benefits of breastfeeding, and the unclear risks of marijuana in human milk, there is a need to standardize counseling to avoid a missed opportunity to educate breastfeeding populations who use marijuana and to reduce the risk of counseling based on providers’ personal attitudes and biases not aligned with evidence-based guidelines.

引言本研究旨在探讨与母乳喂养咨询和同时吸食大麻相关的患者人口统计学因素：这是一项横断面研究，使用的数据来自美国疾病控制与预防中心（Centers for Disease Control and Prevention）与州和地方卫生部门合作管理的妊娠风险评估监测系统（PRAMS）。该研究样本包括调查参与者，他们的回答表明他们接受过劝阻母乳喂养同时吸食大麻的咨询。二元和多元回归分析评估了与劝阻母乳喂养和同时吸食大麻相关的因素之间的关系：在 10,911 名样本参与者中，有 9,695 名参与者回答了在吸食大麻的同时接受劝阻母乳喂养咨询的问题，这些参与者被纳入分析范围（总样本的回答率为 89%）。有 29% 的参与者在吸食大麻期间接受过医疗服务提供者不要母乳喂养的建议。接受这种建议的参与者更有可能是有色人种、年龄小于或等于 29 岁、高中或以下学历、未婚、孕前报告有政府保险或无保险、产后报告吸食大麻。在多变量分析中，年龄小于或等于 20 岁（P = .001）、未婚（P = .023）和产后吸食大麻（P = .034）仍与母乳喂养咨询有关：讨论：我们的研究结果表明，个人受到的咨询有所不同。未婚和年轻人（年龄

{"title":"Factors Associated with Provider Counseling Against Breastfeeding in the Setting of Marijuana Use: A Population-Based Survey","authors":"Joy A. Fatunbi MD, Brent C. Monseur MD, ScM, Vincenzo Berghella MD, Jerrine R. Morris MD, MPH","doi":"10.1111/jmwh.13583","DOIUrl":"10.1111/jmwh.13583","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The purpose of this study was to explore patient demographic factors associated with counseling against breastfeeding and concurrent marijuana use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study derived using data from the Centers for Disease Control and Prevention administered Pregnancy Risk Assessment Monitoring System (PRAMS) in collaboration with state and local health departments. This study sample included survey participants whose responses indicate they received counseling discouraging breastfeeding with concurrent marijuana use. Bivariate and multivariate regression analyses assessed the relationship between factors associated with counseling against breastfeeding and concurrent marijuana use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 10,911 participants in this sample, 9,695 participants who answered the question about receiving counseling discouraging breastfeeding while using marijuana were included in the analysis (89% response rate for the total sample). Twenty nine percent of participants were advised by a provider not to breastfeed while using marijuana. Participants who received this counseling were more likely to be people of color, age less than or equal to 29, with a high school education or less, unmarried, report governmental or no insurance prepregnancy, and report marijuana use postpartum. In the multivariate analysis, age less than or equal to 20 (<i>P</i> = .001), being unmarried (<i>P</i> = .023), and marijuana use postpartum (<i>P</i> = .034) remained associated with counseling against breastfeeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our results suggest that individuals are being counseled differently. Unmarried and young people (age <20 years) were more likely to report receiving counseling against breastfeeding with concurrent marijuana use. Given the growing national acceptability of marijuana use, the known benefits of breastfeeding, and the unclear risks of marijuana in human milk, there is a need to standardize counseling to avoid a missed opportunity to educate breastfeeding populations who use marijuana and to reduce the risk of counseling based on providers’ personal attitudes and biases not aligned with evidence-based guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia 在助产士陪伴下分娩：费城助产士护理的种族和保险状况与连续性的关系。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-01-06 DOI: 10.1111/jmwh.13604

Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH

Introduction

From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.

Methods

This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.

Results

After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).

Discussion

These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.

介绍：从 2013 年到 2019 年，费城与妊娠相关的死亡案例中，黑人妇女占 73%。目前，关于助产护理从开始产前护理到分娩的连续性与种族/族裔和收入等特征的关系的研究还很缺乏。本研究旨在调查种族/民族和保险状况是否与开始接受助产士产前护理的孕妇继续接受助产护理分娩的可能性有关：这是一项回顾性队列研究，研究对象是2009年6月2日至2020年6月30日期间在一家大型三级甲等医院分娩并接受了注册助产士（CNM）首次产前检查的不同孕妇群体（n = 5121）。我们使用多变量对数二叉回归模型计算了转到医生护理（与留在 CNM 护理）的风险比，并对年龄、种族/民族、孕前体重指数、保险类型和合并症进行了调整：调整妊娠相关风险因素后，非西班牙裔黑人患者（调整后相对风险 [aRR]，1.14；95% CI，1.04-1.24）和公共保险患者（aRR，1.11；95% CI，1.01-1.22）与非西班牙裔白人和私人保险患者相比，转由医生护理的风险更高。二次分析显示，非西班牙裔黑人患者转院并进行手术分娩的风险更高（aRR，1.35；95% CI，1.18-1.55），而公共保险患者因手术分娩以外的原因转院的风险更高（aRR，1.35；95% CI，1.18-1.54）：讨论：这些研究结果表明，即使在对合并症进行调整后，黑人和公共保险患者也比白人和私人保险患者更有可能转由医生护理。因此，还需要进一步研究，以确定造成助产护理连续性方面种族和经济差异的因素。

{"title":"Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia","authors":"Amanda Millatt MPH, Kimberly K. Trout CNM, PhD, Rachel Ledyard MPH, Susan E. Brunk CNM, MSN, Dominique G. Ruggieri PhD, Lesley Bates CNM, MSN, Anne M. Mullin BS, Heather H. Burris MD, MPH","doi":"10.1111/jmwh.13604","DOIUrl":"10.1111/jmwh.13604","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Effect of Virtual Reality On Pain and Anxiety Management During Pelvic Examination: A Randomized Controlled Trial 虚拟现实对盆腔检查时疼痛和焦虑管理的影响：随机对照试验

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2024-01-04 DOI: 10.1111/jmwh.13587

Gülay Kurt CM, Msc, Neslihan Keser Ozcan PhD, CN

Introduction

It is important for health care professionals to address women's pain and anxiety during pelvic examinations. This study aimed to evaluate the impact of virtual reality (VR) on pain and anxiety management during pelvic examinations.

Methods

The study was a randomized controlled clinical trial reported in according to the Consolidated Standards of Reporting Trials 2010 Guidelines. The research was conducted with 128 women (64 intervention, 64 control) who received care at a tertiary hospital outpatient clinic between November 2021 and February 2022. The intervention group received VR application via virtual glasses during pelvic examination, while the control group received routine care. Anxiety was measured using the State-Trait Anxiety Inventory before and after the pelvic examination, and the Visual Analog Scale was used to assess pain after the pelvic examination. The study was registered at ClinicalTrials.gov (NCT05545488).

Results

The mean anxiety scores of the women in the intervention and control groups were similar pretest (59.00 and 57.77). The mean anxiety score decreased after the pelvic examination to 36.53 in the intervention group and 47.55 in the control group. Results indicated a significant main effect for group assignment (F_9.56; η² = .071; P = .002), a significant main effect for time (F_384.14; η² = .753; P < .001), and a significant interaction between group and time (F_53.95; η² = .300; P < .001). Pain scores after the pelvic examination were lower in the intervention group (4.25) than in the control group (6.41; P < .001).

Conclusion

VR was effective in the management of pain and anxiety during pelvic examination. Future studies should compare the effectiveness of VR with other methods in reducing pain and anxiety during a pelvic examination.

介绍：对于医护人员来说，解决妇女在盆腔检查过程中的疼痛和焦虑问题非常重要。本研究旨在评估虚拟现实（VR）对盆腔检查期间疼痛和焦虑管理的影响：该研究是一项随机对照临床试验，根据《2010 年试验报告综合标准指南》进行报告。研究对象为 2021 年 11 月至 2022 年 2 月期间在一家三甲医院门诊接受治疗的 128 名妇女（64 名干预组，64 名对照组）。干预组在盆腔检查时通过虚拟眼镜接受 VR 应用，而对照组则接受常规护理。盆腔检查前后使用国家-特质焦虑量表测量焦虑程度，盆腔检查后使用视觉模拟量表评估疼痛程度。该研究已在ClinicalTrials.gov（NCT05545488）上注册：结果：干预组和对照组妇女在检查前的平均焦虑评分相似（分别为 59.00 分和 57.77 分）。盆腔检查后，干预组的平均焦虑评分降至 36.53 分，对照组降至 47.55 分。结果显示，组别分配具有显著的主效应（F9.56；η2 = .071；P = .002），时间具有显著的主效应（F384.14；η2 = .753；P < .001），组别与时间之间具有显著的交互作用（F53.95；η2 = .300；P < .001）。干预组盆腔检查后的疼痛评分（4.25）低于对照组（6.41；P <.001）：VR能有效缓解盆腔检查时的疼痛和焦虑。今后的研究应比较 VR 与其他方法在减轻盆腔检查时的疼痛和焦虑方面的效果。

{"title":"The Effect of Virtual Reality On Pain and Anxiety Management During Pelvic Examination: A Randomized Controlled Trial","authors":"Gülay Kurt CM, Msc, Neslihan Keser Ozcan PhD, CN","doi":"10.1111/jmwh.13587","DOIUrl":"10.1111/jmwh.13587","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>It is important for health care professionals to address women's pain and anxiety during pelvic examinations. This study aimed to evaluate the impact of virtual reality (VR) on pain and anxiety management during pelvic examinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was a randomized controlled clinical trial reported in according to the Consolidated Standards of Reporting Trials 2010 Guidelines. The research was conducted with 128 women (64 intervention, 64 control) who received care at a tertiary hospital outpatient clinic between November 2021 and February 2022. The intervention group received VR application via virtual glasses during pelvic examination, while the control group received routine care. Anxiety was measured using the State-Trait Anxiety Inventory before and after the pelvic examination, and the Visual Analog Scale was used to assess pain after the pelvic examination. The study was registered at ClinicalTrials.gov (NCT05545488).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean anxiety scores of the women in the intervention and control groups were similar pretest (59.00 and 57.77). The mean anxiety score decreased after the pelvic examination to 36.53 in the intervention group and 47.55 in the control group. Results indicated a significant main effect for group assignment (<i>F</i><sub>9.56</sub>; η<sup>2</sup> = .071; <i>P</i> = .002), a significant main effect for time (<i>F</i><sub>384.14</sub>; η<sup>2</sup> = .753; <i>P</i> < .001), and a significant interaction between group and time (<i>F</i><sub>53.95</sub>; η<sup>2</sup> = .300; <i>P</i> < .001). Pain scores after the pelvic examination were lower in the intervention group (4.25) than in the control group (6.41; <i>P</i> < .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>VR was effective in the management of pain and anxiety during pelvic examination. Future studies should compare the effectiveness of VR with other methods in reducing pain and anxiety during a pelvic examination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Effect of Nonstress Device Noise Level on Stress Parameters in Primigravid Women: A Randomized Controlled Trial 非压力设备噪音水平对初产妇压力参数的影响：随机对照试验

IF 2.7 4区医学 Q1 Nursing

Journal of midwifery & women's health

Pub Date : 2024-01-04 DOI: 10.1111/jmwh.13581

Turan Ayşenur PhD, Gençtürk Nuran PhD, Kaya Cihan MD, Bulut Huri PhD

Introduction

This study evaluated the effect of the noise level of the nonstress test (NST) device on stress parameters in primigravid women.

Methods

A total of 44 pregnant women participated in a randomized clinical trial between February and October, 2021. The participants were divided randomly into 4 equal groups using an automated web-based randomization system and ensuring allocation concealment: the control group (NST device volume turned off), intervention group I (1-35 dB(A)), intervention group II (36-60 dB(A)), and intervention group III (61 dB(A) and above). A data collection form was used to record personal information and stress parameters. Stress parameters (blood pressure, heart rate, oxygen saturation [SpO₂], blood glucose, salivary cortisol, and salivary adrenocorticotropic hormone [ACTH]) levels were measured pretest (0-2 minutes before NST starts), midtest (at 10 minutes of the NST), and posttest (within 0-2 minutes after NST was finished). The study was registered at ClinicalTrials.gov (identifier: NCT05488704).

Results

NST sound levels above 35 dB(A) increased the average cortisol and ACTH levels in the posttest. NST sound levels were positively correlated with posttest cortisol (r = .448) and posttest glucose (r = .302). There was interaction effect on heart rate, glucose, and cortisol level by time, indicating that the intervention groups experienced a significant acceleration in heart rate, glucose, and cortisol level after a noise intervention compared with the control group.

Discussion

Midwives should continue applying NST below 36 dB(A), considering the factors that may induce stress during the NST process.

简介：本研究评估了无压力测试（NST）装置的噪音水平对初产妇压力参数的影响：本研究评估了无应激测试（NST）装置的噪音水平对初产妇应激参数的影响：共有 44 名孕妇参加了 2021 年 2 月至 10 月期间的随机临床试验。参与者被随机分为 4 组，每组人数相等，采用基于网络的自动随机系统并确保分配隐藏：对照组（关闭 NST 装置音量）、干预 I 组（1-35 dB(A)）、干预 II 组（36-60 dB(A)）和干预 III 组（61 dB(A) 及以上）。数据收集表用于记录个人信息和压力参数。应激参数（血压、心率、血氧饱和度[SpO2]、血糖、唾液皮质醇和唾液促肾上腺皮质激素[ACTH]）水平分别在测试前（NST 开始前 0-2 分钟）、测试中（NST 开始 10 分钟时）和测试后（NST 结束后 0-2 分钟内）进行测量。该研究已在 ClinicalTrials.gov 上注册（标识符：NCT05488704）：结果：NST声级高于35 dB(A)会增加后测中皮质醇和促肾上腺皮质激素的平均水平。NST 声级与测试后皮质醇（r = .448）和测试后葡萄糖（r = .302）呈正相关。心率、血糖和皮质醇水平与时间存在交互效应，表明与对照组相比，干预组在噪音干预后心率、血糖和皮质醇水平明显加快：讨论：考虑到在 NST 过程中可能诱发应激的因素，助产士应继续将 NST 的噪音控制在 36 分贝（A）以下。

{"title":"The Effect of Nonstress Device Noise Level on Stress Parameters in Primigravid Women: A Randomized Controlled Trial","authors":"Turan Ayşenur PhD, Gençtürk Nuran PhD, Kaya Cihan MD, Bulut Huri PhD","doi":"10.1111/jmwh.13581","DOIUrl":"10.1111/jmwh.13581","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study evaluated the effect of the noise level of the nonstress test (NST) device on stress parameters in primigravid women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 44 pregnant women participated in a randomized clinical trial between February and October, 2021. The participants were divided randomly into 4 equal groups using an automated web-based randomization system and ensuring allocation concealment: the control group (NST device volume turned off), intervention group I (1-35 dB(A)), intervention group II (36-60 dB(A)), and intervention group III (61 dB(A) and above). A data collection form was used to record personal information and stress parameters. Stress parameters (blood pressure, heart rate, oxygen saturation [SpO<sub>2</sub>], blood glucose, salivary cortisol, and salivary adrenocorticotropic hormone [ACTH]) levels were measured pretest (0-2 minutes before NST starts), midtest (at 10 minutes of the NST), and posttest (within 0-2 minutes after NST was finished). The study was registered at ClinicalTrials.gov (identifier: NCT05488704).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>NST sound levels above 35 dB(A) increased the average cortisol and ACTH levels in the posttest. NST sound levels were positively correlated with posttest cortisol (<i>r</i> = .448) and posttest glucose (<i>r</i> = .302). There was interaction effect on heart rate, glucose, and cortisol level by time, indicating that the intervention groups experienced a significant acceleration in heart rate, glucose, and cortisol level after a noise intervention compared with the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Midwives should continue applying NST below 36 dB(A), considering the factors that may induce stress during the NST process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California 加利福尼亚州围产期临床医生类型和产前经验的连续性。

IF 2.7 4区医学 Q1 Nursing

Journal of midwifery & women's health

Pub Date : 2024-01-02 DOI: 10.1111/jmwh.13603

Brittany L. Ranchoff MPH, Mary T. Paterno CNM, PhD, Laura B. Attanasio PhD

Introduction

Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type.

Methods

For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences.

Results

Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences.

Discussion

Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.

简介持续接受临床医生的护理与提高满意度和改善治疗效果有关。临床医生类型（即妇产科医生或助产士）的连续性可能也会影响护理体验；然而，临床医生类型不连续的情况有多普遍以及其对分娩体验的影响尚不清楚。我们的目的是确定产前护理与分娩时使用不同临床医生类型的相关特征，并根据临床医生类型的连续性比较产前体验：这项横断面研究的数据来自 2017 年 "倾听加州母亲 "调查。分析样本仅限于接受助产士或妇产科医生产前护理的阴道分娩者（N = 1384）。双变量和多变量分析根据临床医生类型的连续性检查了个人特征。然后，我们研究了临床医生类型的连续性与产前护理经验的关联：结果：总体而言，74.4% 的人在产前护理和分娩时使用了相同类型的临床医生。在接受助产士产前护理的人中，45.1% 的人有不同的分娩临床医生类型，而在接受妇产科医生产前护理的人中，23.5% 的人有不同的分娩临床医生类型。临床医生类型的连续性与围产期护理临床医生的选择呈正相关。临床医生类型的连续性与产前护理经验之间没有统计学意义：讨论：研究结果表明，接受助产士产前护理的产妇经常会有不同类型的临床医生参与分娩，即使是阴道分娩的产妇也是如此。进一步的研究应探讨护理连续性的多个方面对围产期护理质量的影响。

{"title":"Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California","authors":"Brittany L. Ranchoff MPH, Mary T. Paterno CNM, PhD, Laura B. Attanasio PhD","doi":"10.1111/jmwh.13603","DOIUrl":"10.1111/jmwh.13603","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For this cross-sectional study, data were from the 2017 <i>Listening to Mothers in California</i> survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139076473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Social Support, Parenting Self-Efficacy, and Postpartum Depression Among Chinese Parents: The Actor-Partner Interdependence Mediation Model 中国父母的社会支持、育儿自我效能感与产后抑郁：行动者-伙伴相互依赖中介模型

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2023-12-26 DOI: 10.1111/jmwh.13588

Jie Zheng MSc, RN, Rongrong Han MSc, BSc, RN, Lingling Gao PhD, MSc, RN

Introduction

Postpartum depression affects both mothers and fathers. This study aimed to examine the relationships between social support, parenting self-efficacy, and postpartum depression in Chinese mothers and fathers and assess the mediating effect of parenting self-efficacy using a dyadic perspective.

Methods

A cross-sectional study was implemented from December 2020 to July 2021 in Guangzhou, China, with 309 pairs of parents. The Edinburgh Postnatal Depression Scale, Social Support Rating Scale, Parenting Sense of Competence Scale-Efficacy subscale, and sociodemographic data sheet were completed by both parents. Dyadic analysis was conducted using the actor-partner interdependence mediation model. An actor effect is the relationship between variables within an individual, whereas a partner effect is the relationship between variables in the individual and the dyadic partner.

Results

In total, 20.7% of mothers and 11.7% of fathers had elevated postpartum depressive symptoms at 6 weeks postpartum. The model revealed 6 actor effects: social support was positively associated with parenting self-efficacy for mothers (β, 0.39; 95% CI, 0.28-0.49) and fathers (β, 0.39; 95% CI, 0.30-0.48) and negatively associated with postpartum depression for mothers (β, −0.22; 95% CI, −0.32 to −0.12) and fathers (β, −0.37; 95% CI, −0.48 to −0.26). Parenting self-efficacy was negatively associated with postpartum depression in mothers (β, −0.41; 95% CI, −0.53 to −0.29) and fathers (β, −0.24; 95% CI, −0.37 to −0.12). Maternal social support had a partner effect on paternal parenting self-efficacy (β, 0.14; 95% CI, 0.04-0.24). Parenting self-efficacy mediated between social support and postpartum depression for both parents (mothers: β, −0.16; 95% CI, −0.23 to −0.10; fathers: β, −0.10; 95% CI, −0.16 to −0.05).

Discussion

Postpartum depression was a dyadic phenomenon. Increasing mother-centered social support has the potential to improve the parenting self-efficacy of both parents and reduce the likelihood of postpartum depression.

简介产后抑郁症对母亲和父亲都有影响。本研究旨在探讨中国母亲和父亲的社会支持、养育自我效能感与产后抑郁之间的关系，并从父子关系的角度评估养育自我效能感的中介效应：2020年12月至2021年7月，在中国广州进行了一项横断面研究，共有309对父母参加。父母双方均填写爱丁堡产后抑郁量表、社会支持评定量表、育儿能力感量表--效能感分量表和社会人口学数据表。采用行为者-伴侣相互依赖中介模型进行了二元分析。行为者效应是指个体内部变量之间的关系，而伙伴效应则是指个体与双亲伙伴之间变量的关系：共有 20.7% 的母亲和 11.7% 的父亲在产后 6 周出现产后抑郁症状加重。该模型显示了 6 种行为者效应：社会支持与母亲（β，0.39；95% CI，0.28-0.49）和父亲（β，0.39；95% CI，0.30-0.48）的养育自我效能呈正相关，与母亲（β，-0.22；95% CI，-0.32--0.12）和父亲（β，-0.37；95% CI，-0.48--0.26）的产后抑郁呈负相关。育儿自我效能与母亲（β，-0.41；95% CI，-0.53 至 -0.29）和父亲（β，-0.24；95% CI，-0.37 至 -0.12）的产后抑郁呈负相关。母亲的社会支持对父亲的养育自我效能感有伙伴效应（β，0.14；95% CI，0.04-0.24）。父母双方的育儿自我效能在社会支持和产后抑郁之间存在中介作用（母亲：β，-0.16；95% CI，-0.23 至 -0.10；父亲：β，-0.10；95% CI，-0.16 至 -0.05）：讨论：产后抑郁是一种双亲现象。讨论：产后抑郁是一种双亲现象，增加以母亲为中心的社会支持有可能提高双亲的育儿自我效能，降低产后抑郁的可能性。

{"title":"Social Support, Parenting Self-Efficacy, and Postpartum Depression Among Chinese Parents: The Actor-Partner Interdependence Mediation Model","authors":"Jie Zheng MSc, RN, Rongrong Han MSc, BSc, RN, Lingling Gao PhD, MSc, RN","doi":"10.1111/jmwh.13588","DOIUrl":"10.1111/jmwh.13588","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Postpartum depression affects both mothers and fathers. This study aimed to examine the relationships between social support, parenting self-efficacy, and postpartum depression in Chinese mothers and fathers and assess the mediating effect of parenting self-efficacy using a dyadic perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was implemented from December 2020 to July 2021 in Guangzhou, China, with 309 pairs of parents. The Edinburgh Postnatal Depression Scale, Social Support Rating Scale, Parenting Sense of Competence Scale-Efficacy subscale, and sociodemographic data sheet were completed by both parents. Dyadic analysis was conducted using the actor-partner interdependence mediation model. An actor effect is the relationship between variables within an individual, whereas a partner effect is the relationship between variables in the individual and the dyadic partner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 20.7% of mothers and 11.7% of fathers had elevated postpartum depressive symptoms at 6 weeks postpartum. The model revealed 6 actor effects: social support was positively associated with parenting self-efficacy for mothers (<i>β</i>, 0.39; 95% CI, 0.28-0.49) and fathers (<i>β</i>, 0.39; 95% CI, 0.30-0.48) and negatively associated with postpartum depression for mothers (<i>β</i>, −0.22; 95% CI, −0.32 to −0.12) and fathers (<i>β</i>, −0.37; 95% CI, −0.48 to −0.26). Parenting self-efficacy was negatively associated with postpartum depression in mothers (<i>β</i>, −0.41; 95% CI, −0.53 to −0.29) and fathers (<i>β</i>, −0.24; 95% CI, −0.37 to −0.12). Maternal social support had a partner effect on paternal parenting self-efficacy (<i>β</i>, 0.14; 95% CI, 0.04-0.24). Parenting self-efficacy mediated between social support and postpartum depression for both parents (mothers: <i>β</i>, −0.16; 95% CI, −0.23 to −0.10; fathers: <i>β</i>, −0.10; 95% CI, −0.16 to −0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Postpartum depression was a dyadic phenomenon. Increasing mother-centered social support has the potential to improve the parenting self-efficacy of both parents and reduce the likelihood of postpartum depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139041152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Certified Nurse-Midwives as Teachers: Expanding Interprofessional Collaboration Learning Opportunities for Medical Students on the Obstetrics and Gynecology Clerkship 注册助产士作为教师：为妇产科实习医学生拓展跨专业合作学习机会。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2023-12-26 DOI: 10.1111/jmwh.13602

Angela C. Liang MD, Anita Malone MD, Emily K. Kobernik PhD, MPH, Elizabeth Holman DrPh, MEd, MSc, Maya M. Hammoud MD, MBA, Christina Majszak CNM, Samantha Kempner MD, Helen K. Morgan MD

Introduction

Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse-midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife-supervised collaborative team.

Methods

Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5-point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes.

Results

Of 374 students, 370 (98.9%) completed the end-of-clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty-seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, P = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model.

Discussion

This work demonstrates the feasibility and benefits of this midwife-led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting.

介绍：跨专业经验为医学生提供了接触协作医疗团队的重要机会，但医学生在临床实习期间往往缺乏这种经验。为了弥补这一不足，我们在妇产科实习中设立了由注册助产士专门负责的分娩分诊轮转。我们试图评估在这个助产士监督的合作团队中轮转的医学生的临床学习经验：在 2018 年至 2020 年期间，我们在每次规定的实习结束后，以电子方式向所有医学生发送了一份评估报告。我们的主要结果是教学质量得分，即对教学质量声明的 5 点李克特量表的同意程度。次要结果是评估所有学生在轮转结束时参加的美国国家医学考试委员会（NBME）妇产科科目考试的分数。对参加分娩分诊轮转的学生和未参加分娩分诊轮转的学生的评价和评估进行了比较。对轮转分娩分诊的学生的评价意见进行整理，以确定共同的主题：在 374 名学生中，370 人（98.9%）完成了实习结束课程评估，312 人（83.4%）完成了教学评估。67名学生（17.9%）在分娩分诊中轮转，其中52名学生（77.6%）同时完成了课程和分诊轮转评价。与所有其他轮转相比，在教学质量平均得分（3.9 ± 1.2 vs 3.8 ± 1.2，P = 0.54）或 NBME 妇产科科目考试分数方面，在产科和分娩分诊轮转的学生之间没有差异（79.9% ± 7.2% vs 80.2% ± 7.8%，P = 0.436）。教学评估中的评论强调了学生对助产士护理理念模式的接触：这项工作证明了助产士主导的真实跨专业合作体验对医学生的可行性和益处。该模式可作为如何在临床环境中实施和评估跨专业合作体验的范例。

{"title":"Certified Nurse-Midwives as Teachers: Expanding Interprofessional Collaboration Learning Opportunities for Medical Students on the Obstetrics and Gynecology Clerkship","authors":"Angela C. Liang MD, Anita Malone MD, Emily K. Kobernik PhD, MPH, Elizabeth Holman DrPh, MEd, MSc, Maya M. Hammoud MD, MBA, Christina Majszak CNM, Samantha Kempner MD, Helen K. Morgan MD","doi":"10.1111/jmwh.13602","DOIUrl":"10.1111/jmwh.13602","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Interprofessional experiences provide critical exposure to collaborative health care teams, yet medical students often lack this experience during clinical clerkships. We created a labor and delivery triage rotation exclusively staffed by certified nurse-midwives in the obstetrics and gynecology clerkship to address this gap. We sought to evaluate the clinical learning experiences of medical students rotating on this midwife-supervised collaborative team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2018 and 2020, we electronically sent all medical students an evaluation after each required clerkship. Our primary outcome was the quality of teaching score, as defined by level of agreement on a 5-point Likert scale with a statement regarding teaching quality. A secondary outcome evaluated scores from the National Board of Medical Examiners (NBME) Obstetrics and Gynecology subject examination taken by all students at the end of the rotation. Evaluations and assessments were compared between students rotating on labor and delivery triage and those who did not. Evaluation comments from students rotating on labor and delivery triage were collated to identify common themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 374 students, 370 (98.9%) completed the end-of-clerkship course evaluation and 312 (83.4%) completed teaching evaluations. Sixty-seven students (17.9%) rotated in labor and delivery triage; of these, 52 (77.6%) completed both the course and triage rotation evaluations. There were no differences in the mean quality of teaching scores (3.9 ± 1.2 versus 3.8 ± 1.2, p = 0.54) or in NBME Obstetrics and Gynecology subject examination scores between students rotating in labor and delivery triage compared to all other rotations (79.9% ± 7.2% vs 80.2% ± 7.8%, <i>P</i> = 0.436). Comments from teaching evaluations highlighted student exposure to the midwifery philosophy of care model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This work demonstrates the feasibility and benefits of this midwife-led authentic interprofessional collaborative experience for medical students. This model can serve as an example of how to implement and evaluate interprofessional collaboration experiences in the clinical setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jmwh.13602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service 在 COVID-19 中突然转向远程保健：大型助产服务机构产前护理中远程医疗使用差异的回顾性队列研究。

IF 2.1 4区医学 Q2 NURSING

Journal of midwifery & women's health

Pub Date : 2023-12-18 DOI: 10.1111/jmwh.13601

Denise C. Smith CNM, PhD, E. Brie Thumm CNM, PhD, MBA, Jessica Anderson CNM, WHNP, DNP, Katherine Kissler CNM, PhD, Sean M. Reed CNS, PhD, Sophia M. Centi MPH, Alyse W. Staley MS, Teri L. Hernandez PhD, RN, Amy J. Barton PhD, RN

Introduction

The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service.

Methods

We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors.

Results

When comparing pre–COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (P < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression.

Discussion

No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.

导言：2019 年冠状病毒病（COVID-19）大流行造成了医疗保健服务的中断，包括在 2020 年 3 月中旬突然过渡到远程医疗的使用。本研究旨在探讨在 COVID-19 大流行期间，大型学术性助产护士服务机构中接受护理者产前护理就诊模式的变化以及远程医疗使用（提供者与患者之间的信息传递、电话就诊和视频就诊）的预测因素：我们对 2019 年至 2021 年期间在 2 个助产护士诊所接受产前护理的人员（n = 3172）进行了一项回顾性队列研究。使用结果包括接诊次数和类型：亲自接诊和远程医疗（主要结果）。比较了 COVID-19 之前和期间的就诊次数和类型。对远程医疗就诊次数这一结果进行了负二项回归拟合，并将种族/民族、年龄、语言、准孕期、高血压、糖尿病和抑郁症作为预测因素：将 COVID-19 前（2020 年 3 月前）与 COVID-19 期间（2020 年 3 月后）相比，总体就诊次数从每人平均 15.9 次增至 19.5 次（P < .001）。增加的原因是远程医疗就诊次数的增加；大流行前和大流行期间的亲自产前就诊次数没有显著差异。患者与医疗服务提供者直接发送信息是最常见的远程医疗方式。远程医疗就诊的预测因素包括英语为主要语言以及糖尿病或抑郁症诊断：讨论：面对面产前保健就诊的频率没有差异，这表明远程保健就诊使患者与助产士有了更多的接触，并没有取代面对面就诊。在大流行期间，讲西班牙语的患者最不可能使用远程医疗提供的产前护理；有一小部分患者没有或很少使用远程医疗，但这一比例相当大，还有很大一部分患者大量使用远程医疗。在未来的产前护理中整合远程医疗应考虑公平性、患者和医疗服务提供者的满意度、可及性、冗余和医疗服务提供者的工作量等问题。

{"title":"Sudden Shift to Telehealth in COVID-19: A Retrospective Cohort Study of Disparities in Use of Telehealth for Prenatal Care in a Large Midwifery Service","authors":"Denise C. Smith CNM, PhD, E. Brie Thumm CNM, PhD, MBA, Jessica Anderson CNM, WHNP, DNP, Katherine Kissler CNM, PhD, Sean M. Reed CNS, PhD, Sophia M. Centi MPH, Alyse W. Staley MS, Teri L. Hernandez PhD, RN, Amy J. Barton PhD, RN","doi":"10.1111/jmwh.13601","DOIUrl":"10.1111/jmwh.13601","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The coronavirus disease 2019 (COVID-19) pandemic created disruption in health care delivery, including a sudden transition to telehealth use in mid-March 2020. The purpose of this study was to examine changes in the mode of prenatal care visits and predictors of telehealth use (provider-patient messaging, telephone visits, and video visits) during the COVID-19 pandemic among those receiving care in a large, academic nurse-midwifery service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study of those enrolled for prenatal care in 2 nurse-midwifery clinics between 2019 and 2021 (n = 3172). Use outcomes included number and type of encounter: in-person and telehealth (primary outcome). Comparisons were made in frequency and types of encounters before and during COVID-19. A negative binomial regression was fit on the outcome of telehealth encounter count, with race/ethnicity, age, language, parity, hypertension, diabetes, and depression as predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When comparing pre–COVID-19 (before March 2020) with during COVID-19 (after March 2020), overall encounters increased from 15.9 to 19.5 mean number of encounters per person (<i>P</i> < .001). The increase was driven by telehealth encounters; there were no significant differences for in-person prenatal visit counts before and during the pandemic period. Direct patient-provider messaging was the most common type of telehealth encounter. Predictors of telehealth encounters included English as primary language and diagnoses of diabetes or depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>No differences in the frequency of in-person prenatal care visits suggests that telehealth encounters led to more contact with midwives and did not replace in-person encounters. Spanish-speaking patients were least likely to use telehealth-delivered prenatal care during the pandemic; a small, but significant, proportion of patients had no or few telehealth encounters, and a significant proportion had high use of telehealth. Integration of telehealth in future delivery of prenatal care should consider questions of equity, patient and provider satisfaction, access, redundancies, and provider workload.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16468,"journal":{"name":"Journal of midwifery & women's health","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0