The experience of pregnancy in teenage girls.

Pregnancy in unmarried teenaged girls in America today is a growing concern to health care workers, educators, government officials and parents. Pregnancy during adolescence is not an issue because births to teenagers are increasing but because teenage pregnancy is no longer a societal option. This paper describes adolescent pregnancy from within the context of the subculture of adolescence and from the perspective of 16 pregnant, teenaged girls. The findings revealed a description of the life experiences of pregnant teenagers and introduced health-care issues that were not previously disclosed in other research studies of pregnant teens. The anthropological concepts of liminality, the double-bind, social labeling, and schizmogenesis served to guide the research. The concepts also helped to explain many behaviors and observations that were made of the informants throughout the research. An ethnographic approach using participant observation and ethnographic interviews was used to collect data from 16 pregnant, unmarried, teenaged girls in a large Southwestern, urban area. The informants ranged in age from 14 through 19 years and represented various backgrounds. Nine informants resided in a home for unwed, pregnant teenagers with the remainder residing in diverse locations. Data analyses occurred concurrently with data collection as part of an ongoing process. Data were ordered and transcribed within a framework designed to enhance thematic analysis. Transcribed interview and observational data were transferred onto the Ethnograph, a data-management software program. Data were coded using substantive and conceptual codes. Codes were linked according to patterns of association and frequency of occurrence which in turn led to the revealing of recurrent thematic patterns. In all, eight themes were revealed: (1) pregnancy is bad; (2) loneliness; (3) waiting it out; (4) dependency; (5) looking bad; (6) giving up baby; (7) losing what was; and (8) losing control. Thematic content also disclosed many inconsistencies and double-binds between the larger Western macroculture and adolescent subculture. Ethnographic themes and expressions of these themes provided new information for constructing health-related interventions with pregnant teens

Health Care in Appalachia: A Population-Based Approach

The health status of people who live in the rural, coal-producing counties of southwest Virginia remains problematic despite an apparent high primary care provider-to-population threshold. This descriptive exploratory study surveyed 922 households representing 2,188 people, with regard to the availability, need, and access to health care services. Findings indicated a population who had a greater morbidity for chronic illnesses such as heart disease and hypertension than the rest of the state, a large number of people without health and prescription coverage, and an overall perception of fair-to-poor health status. Findings also indicated a substantial proportion of the population who were in need of dental and visual care and general preventive services and those who were dealing with depression at home without outside intervention. One disturbing finding was the large number of people who shared prescriptive medications with family and friends. The Community As Partner Model might be used by community health nurses in this region to help structure interventions. Overall findings suggest a need for interventions aimed at screening for depression, managing prescriptive medications, and identification of low-cost and free preventive, dental, and visual care services

Postpartum Care for Women with Gestational Diabetes.

PURPOSE: To assess postpartum gestational diabetes mellitus (GDM) practice patterns of providers in a large, tertiary care hospital. A retrospective review of medical records for women with GDM receiving postpartum care in 2012 was conducted to estimate the percentage who received a postpartum visit, glucose testing, and preventive follow-up care. STUDY DESIGN AND METHODS: A sample of 97 charts was reviewed. Pearson\u27s chi-squared tests and Fisher\u27s exact test were used, as appropriate, to examine differences in documented care by race/ethnicity, insurance type, and type of medical provider. RESULTS: Within the system of study, 53 of 97 women (55%) with GDM had a documented postpartum visit, with disparities by race/ethnicity and insurance type, and 18 (19%) had a documented oral glucose tolerance test after 6 weeks postpartum. Most providers routinely documented interacting with patients around infant feeding, family planning, and emotional status, but fewer documented providing specific care to help patients manage future diabetes risk, with advance practice nurses significantly more likely than physicians to document some aspects of preventive care. CLINICAL IMPLICATIONS: Postpartum GDM care could be improved by educating providers on the current postpartum GDM standard of care and use of the 5 A\u27s framework for health promotion; prompting providers to order appropriate screenings and document the 5 A\u27s; coordinating follow-up glucose screening and behavioral management with the postpartum visit and subsequent family planning visits; notifying primary care providers and pediatricians of the GDM diagnosis to ensure continuity of care; and referring to allied healthcare providers for intensive behavior change support