Addressing Intimate Partner Violence: Development of a Trauma Informed Workforce

Abstract available through the Annals of Behavioral Medicine

Georgia’s Rural Hospital Closures: The Common-Good Approach to Ethical Decision-Making

Background: Critical access hospitals provide several essential services to local communities. Along with the functions associated with providing necessary medical care, they also offer employment opportunities and other economic benefits to the communities they serve. Since 2010, the number of rural hospitals closures has steadily increased. The common-good approach to ethical decision-making provides a framework that aids in evaluation of the effects that hospital closures have on rural residents and communities. Methods: This analysis includes results of a systematic overview of peer-reviewed literature to address the following research questions: 1) How have state policies and the adoption of Medicaid expansion influenced the viability or rural hospitals? 2) What are the ethical implications of Medicaid expansion and state policy reform/adoption pertaining to viability of rural hospitals? and 3) What are the ethical implications of critical access hospitals closures on rural communities in Georgia? Information related to these questions is presented, along with tactics to addressing these in an ethical manner. Results: This descriptive analysis shows that the largest number of state-specific closures have occurred in states with a federal exchange and which chose not to expand Medicaid. Characteristics of the state of Georgia and the counties with recent closures show that these counties typically have smaller populations with a high minority presence, lower education and income levels, and higher numbers of medically uninsured. Conclusions: The common-good approach to ethical decision-making is suitable for evaluating the ethical implications of policy-level decisions impacting the closure of critical access hospitals serving the rural communities of Georgia

Self-creation of a Future Leader

Our generation is viewed as lazy, technology obsessed and spoiled. Participants will help examine the culture shift from previous leaders to emerging leaders. Prior to leading others, you have to understand what makes you capable of being that distinctive leader

Effect of Maternal Effortful Control on Breastfeeding Continuation

Breastfeeding has health benefits for mother and child, allowing a mother to protect her newborn from numerous infections while promoting healthy nutrition and growth. Breastfed babies have decreased risk of later negative health problems including respiratory infection, asthma, obesity, and Type II diabetes. The minimum acceptable time a mother should breastfeed is six weeks, but major healthcare organizations, such as the American Academy of Pediatrics, recommend exclusive breastfeeding for the first six months of life. Nationally, 43.1% of babies were exclusively breastfed the first six weeks in 2009, and rates in rural Appalachia are known to be significantly lower than national averages. Researchers have found factors such as age, socioeconomic, marital, and smoking statuses to be predictive of breastfeeding continuation, but maternal innate characteristics have not been explored extensively. To clarify why a mother chooses to breastfeed or not, it is important to additionally look at intrinsic characteristics such as temperament. Temperament is an individual’s biologically based ability to think, behave, and react. Effortful control, a specific component of temperament, is the voluntary regulation of emotions and behaviors. The current study examined the impact of effortful control on participants’ likelihood of breastfeeding at six weeks postpartum. Informationwas collected from pregnant women recruited from Northeast Tennessee as part of the Tennessee Intervention for Pregnant Smokers Program. As part of the larger study, women completed detailed research interviews multiple times during pregnancy, and at six weeks post-partum. The responses of interest came from 230 women who had complete demographic questionnaire, Adult Temperament Questionnaire (ATQ), delivery and birth chart information, and six-week interview breastfeeding status. Logistic regression was used to assess the impact of maternal effortful control (subscale of the ATQ) on the mother’s decision to exclusively breastfeed the child up to six weeks postpartum. The model contained five variables that were significantly correlated with the breastfeeding continuation: maternal age, birth weight (normal/low), prematurity (yes/no), delivery type (vaginal/C-section), and maternal effortful control scores. The full model containing all predictors was statistically significant, X2 (5, N=230) =24.610, p \u3c .001. Effortful control had an Exp(B) of .420, CI (.264, .668) p\u3c.001. Those women who are still breastfeeding at six weeks have significantly higher self-reported effortful control than those who are not still breastfeeding at six weeks, controlling for several other known correlates of breastfeeding continuation. Effortful control was found to predict decreased breastfeeding at six weeks. Because effortful control is an aspect of temperament, and is therefore relatively fixed, its measurement may be useful for identifying women who are less likely to breastfeed so they can be targeted by health educators and clinicians for more intensive intervention. Any increase in breastfeeding holds the potential for positive health outcomes for both mother and child

Inattention and Risk Factors for Unplanned Pregnancy

Aspects of ADHD, such as inattention, may be predictive of unplanned pregnancy. An unplanned pregnancy can have negative effects on both maternal and child health. Women surprised by pregnancy may not be physically, emotionally, or financially capable of caring for a child and may postpone or neglect prenatal care.In 2006, approximately 49% of pregnancies were unplanned in the United States. Furthermore, in Tennessee, the percentage was even higher with 56% of pregnancies being unintended. Maternal Attention Deficit Hyperactive Disorder (ADHD) has been linked to decreased female contraceptive use and to increased risky sexual behavior. Failure to use contraception significantly increases the risk of unplanned pregnancy. This study examined inattention (a characteristic known to be elevated in individuals diagnosed with ADHD) and risk factors (i.e., marital status, education, depression) associated with unplanned pregnancy in Appalachian women. Information was collected from pregnant women recruited from Southern Appalachia as part of the Tennessee Intervention for Pregnant Smokers Program. As part of the larger study, women completed detailed research interviews upon entry into prenatal care. A total of 457 pregnant women had responses on the measures of interest in the current investigation. Logistic regression was performed to assess the ability of Inattention (determined by the Current Symptoms Scale) to predict the probability of a woman experiencing an unplanned pregnancy. The full logistic regression model containing all predictors was statistically significant Χ2 (7, N=457) = 92.35, p \u3c.001 indicating that the predictors as a set reliably distinguished between those women who did, and did not, have an unplanned pregnancy. Inattention had an Adjusted Odds Ratio of 1.76, CI (1.09, 2.86) p =.02 indicating that controlling for the other variables in the model, those women who scored high on the Inattention measure were significantly more likely to experience an unplanned pregnancy. This model correctly classified 76.8% of participants. Additionally, consistent with previous research findings, women who were unmarried and had lower levels of education were also significantly more likely to have an unintended pregnancy. Furthermore, women who reported higher levels of depressive symptoms were significantly more likely toexperience an unplanned pregnancy. Ages and at-risk alcohol use (TACE) were also examined in this study but did not significantly contribute to the model. These results confirm that known risk factors were also found in this population. This study found that inattention predicted unplanned pregnancy. Because inattention is one aspect of ADHD, this could suggest that women diagnosed with ADHD would be more likely than others to experience an unplanned pregnancy. Identifying risk factors can assist health practitioners to target women who are at risk for unplanned pregnancy for purposeful discussion on contraceptive options