Toothbrush Contamination: A Review of the Literature

Toothbrushes are commonly used in hospital settings and may harbor potentially harmful microorganisms. A peer-reviewed literature review was conducted to evaluate the cumulative state of knowledge related to toothbrush contamination and its possible role in disease transmission. A systematic review was conducted on adult human subjects through three distinct searches. The review resulted in seven experimental and three descriptive studies which identified multiple concepts related to toothbrush contamination to include contamination, methods for decontamination, storage, design, and environmental factors. The selected studies found that toothbrushes of healthy and oral diseased adults become contaminated with pathogenic bacteria from the dental plaque, design, environment, or a combination of factors. There are no studies that specifically examine toothbrush contamination and the role of environmental factors, toothbrush contamination, and vulnerable populations in the hospital setting (e.g., critically ill adults) and toothbrush use in nursing clinical practice

To B or not to B? Plan B and Post-Assault Comprehensive Care

Purpose: Despite the high prevalence of rape in the United States and the long-term effects on a woman’s health, too few women receive comprehensive post-assault care. The recent change in status of emergency contraception (EC), such as Plan B, to an over-the-counter (OTC) product may be changing care-seeking in the post-assault period, introducing the risk of missed opportunities for care. The purpose of this dissertation project is to: (a) examine an integrated conceptual framework for evaluating post-assault decision making; (b) evaluate the framework’s utility at predicting unmet needs in pregnant rape survivors; and (c) quantify OTC EC use in the post-assault period and elicit survivors’ desires for care. Methods: The first set of data were collected from: (a) women purchasing OTC EC at four university pharmacies in the Midwest (n=55) and (b) women and men in an undergraduate Midwestern university class (n=165). This descriptive, participatory action research study employed an anonymous self-administered survey and mixed methods analysis to explore theory testing and prevalence. The second set of data included a secondary analysis of a prospective study with pregnant women. Logistic regression was used to explore the utility of the conceptual framework in evaluating unmet needs among pregnant survivors with a history of rape (n=99). Results: Results indicate that an integrated conceptual framework provides a useful overview of factors related to post-assault decision-making. The framework was supported as a way to organize research and clinical practice related to rape survivors’ long-term health status when there have been unmet post-assault needs. Quantitative results indicate annual prevalence rates of OTC EC use in the post-assault period as 7.3% for the pharmacy sample and 5.4% for the classroom sample. Qualitative analyses indicate survivors desire post-assault care information to be distributed with OTC EC. Conclusions: Annual prevalence rates of OTC EC use by survivors of rape within the university setting closely resemble the annual incidence rate of rape of 5%. Participants describe OTC EC as an important but incomplete form of post-assault care. Future work should focus on intervention development to provide all OTC EC users with information about post-assault resources to prevent long-term sequelae.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/100067/1/mlmunro_1.pd

History, Policy and Nursing Practice Implications of the Plan B® Emergency Contraceptive

Numerous policy changes have expanded access to emergency contraception, such as Plan B®, in recent years. Plan B® is a progesterone‐based medication that prevents pregnancy from occurring up to 120 hours after unprotected intercourse by preventing ovulation and tubal transport. Increased access to Plan B® allows women to make independent decisions regarding reproductive health. Nurses play an important role in providing education as well as comprehensive, compassionate and holistic care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111254/1/life12186.pd

Lessons learned in Liberia: preliminary examination of the psychometric properties of trust and teamwork among maternal healthcare workers

Abstract Background Post-conflict Liberia has one of the fastest growing populations on the continent and one of the highest maternal mortality rates among the world. However, in the rural regions, less than half of all births are attended by a skilled birth attendant. There is a need to evaluate the relationship between trained traditional healthcare providers and skilled birth attendants to improve maternal health outcomes. This evaluation must also take into consideration the needs and desires of the patients. The purpose of this pilot study was to establish the validity and reliability of a survey tool to evaluate trust and teamwork in the working relationships between trained traditional midwives and certified midwives in a post-conflict country. Methods A previously established scale, the Trust and Teambuilding Scale, was used with non- and low-literate trained traditional midwives (n=48) in rural Liberia to evaluate trust and teamwork with certified midwives in their communities. Initial results indicated that the scale and response keys were culturally inadequate for this population. A revised version of the scale, the Trust and Teamwork Scale – Liberia, was created and administered to an additional group of non- and low-literate, trained traditional midwives (n=42). Exploratory factor analysis using Mplus for dichotomous variables was used to determine the psychometric properties of the revised scale and was then confirmed with the full sample (n=90). Additional analyses included contrast validity, convergent validity, and Kuder-Richardson reliability. Results Exploratory factor analysis revealed two factors in the revised Trust and Teamwork Scale – Liberia. These two factors, labeled trust and teamwork, included eleven of the original eighteen items used in the Trust and Teamwork Scale and demonstrated contrast and convergent validity and adequate reliability. Conclusions The revised scale is suitable for use with non- and low-literate, trained traditional midwives in rural Liberia. Continued cross-cultural validation of tools is essential to ensure scale adequacy across populations. Future work should continue to evaluate the use of the Trust and Teamwork Scale – Liberia across cultures and additional work is needed to confirm the factor structure.http://deepblue.lib.umich.edu/bitstream/2027.42/112398/1/12913_2012_Article_2549.pd

Psychometric Testing of the Decisional Conflict Scale: Genetic Testing Hereditary Breast and Ovarian Cancer

BACKGROUND: Hereditary breast and ovarian cancer (HBOC) syndrome is attributed mostly to mutations in the Breast Cancer 1 and Breast Cancer 2 genes (BRCA1/2). Mutation carriers of BRCA1/2 genes have significantly higher risk for developing breast cancer compared with the general population (55%-85% vs. 12%) and for developing ovarian cancer (20%-60% vs. 1.5%). The availability of genetic testing enables mutation carriers to make informed decisions about managing their cancer risk (e.g., risk-reducing surgery). However, uptake of testing for HBOC among high-risk individuals is low, indicating the need to better understand and measure the decisional conflict associated with this process. OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the modified Decisional Conflict Scale for use in decisions associated with genetic testing for HBOC. METHODS: This cross-sectional cohort study, recruited women who pursued genetic testing for HBOC in two genetic risk assessment clinics affiliated with a large comprehensive cancer center and one of their female relatives who did not pursue testing. The final sample consisted of 342 women who completed all 16 items of the Decisional Conflict Scale. The psychometric properties of the scale were assessed using tests of reliability and validity, including face, content, construct, contrast, convergent, divergent, and predictive validity. RESULTS: Factor analysis using principal axis factoring with oblimin rotation elicited a three-factor structure: (a) Lack of Knowledge About the Decision (α = .97), (b) Lack of Autonomy in Decision Making (α = .94), and (c) Lack of Confidence in Decision Making (α = .87). These factors explained 82% of the variance in decisional conflict about genetic testing. Cronbach's alpha coefficient was .96. DISCUSSION: The instrument is an important tool for researchers and healthcare providers working with women at risk for HBOC who are deciding whether genetic testing is the right choice for them

Career Cartography: From Stories to Science and Scholarship

PurposeTo present four case scenarios reflecting the process of research career development using career cartography.Organizing ConstructsCareer cartography is a novel approach that enables nurses, from all clinical and academic settings, to actively engage in a process that maximizes their clinical, teaching, research, and policy contributions that can improve patient outcomes and the health of the public.MethodsFour earlyâ career nurse researchers applied the career cartography framework to describe their iterative process of research career development. They report the development process of each of the components of career cartography, including destination statement, career map, and policy statement.ConclusionsDespite diverse research interests and career mapping approaches, common experiences emerged from the four nurse researchers. Common lessons learned throughout the career cartography process include: (a) have a supportive mentorship team, (b) start early and reflect regularly, (c) be brief and to the point, (d) keep it simple and avoid jargon, (e) be open to change, (f) make time, and (g) focus on the overall career destination.Clinical RelevanceThese four case scenarios support the need for nurse researchers to develop their individual career cartography. Regardless of their background, career cartography can help nurse researchers articulate their meaningful contributions to science, policy, and health of the public.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136693/1/jnu12289.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136693/2/jnu12289_am.pd

Increasing postpartum family planning uptake through group antenatal care: a longitudinal prospective cohort design

Abstract Background Despite significant improvements, postpartum family planning uptake remains low for women in sub-Saharan Africa. Transmitting family planning education in a comprehensible way during antenatal care (ANC) has the potential for long-term positive impact on contraceptive use. We followed women for one-year postpartum to examine the uptake and continuation of family planning following enrollment in group versus individual ANC. Methods A longitudinal, prospective cohort design was used. Two hundred forty women were assigned to group ANC (n = 120) or standard, individual care (n = 120) at their first ANC visit. Principal outcome measures included intent to use family planning immediately postpartum and use of a modern family planning method at one-year postpartum. Additionally, data were collected on intended and actual length of exclusive breastfeeding at one-year postpartum. Pearson chi-square tests were used to test for statistically significant differences between group and individual ANC groups. Odds ratios and adjusted odds ratios were calculated using logistic regression. Results Women who participated in group ANC were more likely to use modern and non-modern contraception than those in individual care (59.1% vs. 19%, p < .001). This relationship improved when controlled for intention, age, religion, gravida, and education (AOR = 6.690, 95% CI: 2.724, 16,420). Women who participated in group ANC had higher odds of using a modern family planning method than those in individual care (AOR = 8.063, p < .001). Those who participated in group ANC were more likely to exclusively breastfeed for more than 6 months than those in individual care (75.5% vs. 50%, p < .001). This relationship remained statistically significant when adjusted for age, religion, gravida, and education (AOR = 3.796, 95% CI: 1.558, 9.247). Conclusions Group ANC has the potential to be an effective model for improving the uptake and continuation of post-partum family planning up to one-year. Antenatal care presents a unique opportunity to influence the adoption of postpartum family planning. This is the first study to examine the impact of group ANC on family planning intent and use in a low-resource setting. Group ANC holds the potential to increase postpartum family planning uptake and long-term continuation. Trial registration Not applicable. No health related outcomes reported.https://deepblue.lib.umich.edu/bitstream/2027.42/146750/1/12978_2018_Article_644.pd

Maternity waiting homes as an intervention to increase facility delivery in rural Zambia

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150534/1/ijgo12864_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150534/2/ijgo12864.pd

Maternity waiting homes as a costâ effective intervention in rural Liberia

ObjectiveTo analyze the costâ effectiveness of maternity waiting homes (MWHs) in rural Liberia by examining the cost per life saved and economic effect of MWHs on maternal mortality.MethodsA costâ effectiveness analysis was used to evaluate costs and economic effect of MWHs on maternal mortality in rural Liberia to guide future resource allocation. A secondary data analysis was performed based on a prior quasiâ experimental cohort study of 10 rural primary healthcare facilities, five with a MWH and five without a MWH, that took place from October 30, 2010 to February 28, 2015.ResultsCalculations signified a low cost per year of life saved at MWHs in a rural district in Liberia. Total populationâ adjusted number of women’s lives saved over 3 years was 6.25.ConclusionWhile initial costs were considerable, over a period of 10 or more years MWHs could be a costâ effective and affordable strategy to reduce maternal mortality rates in Liberia. Discussion of the scaling up of MWH interventions for improving maternal outcomes in Liberia and other lowâ and middleâ income countries is justified. Findings can be used to advocate for policy changes to increase the apportionment of resources for building more MWHs in low resource settings.Maternity waiting homes are an affordable and highly costâ effective strategy to decrease maternal mortality in Liberia.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149550/1/ijgo12830.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149550/2/ijgo12830_am.pd

Postpartum physical intimate partner violence among women in rural Zambia

ObjectiveTo examine the demographic characteristics and mental health of women in rural Zambia who experienced physical intimate partner violence (IPV) postpartum.MethodsThe present secondary analysis was conducted using baseline data from an impact evaluation of a maternity waiting home intervention in rural Zambia. A quantitative household survey was conducted over 6 weeks, from midâ April to late May, 2016, at 40 rural health facility catchment areas among 2381 postpartum women (13 months after delivery; age â ¥15 years).ResultsA total of 192 (8.1%) women reported experiencing any type of physical IPV in the preceding 2 weeks; 126 had experienced severe physical IPV (had been kicked, dragged, beat, and/or choked by a husband or partner). High levels of depression were recorded for 174 (7.3%) women in the preceding 2 weeks. Being a female head of household was associated with an increased likelihood of experiencing severe physical IPV (aOR 2.64, 95% CI 1.70â 4.10). Women with high depression scores were also at an increased risk of experiencing any physical IPV (aOR 17.1, 95% CI 8.44â 34.9) and severe physical IPV (aOR 15.4, 95% CI 5.17â 45.9).ConclusionFuture work should consider the implications of government and educational policies that could impact the screening and treatment of pregnant women affected by all forms of physical IPV and depression in rural Zambia.Postpartum physical intimate partner violence among women in rural Zambia was associated with being a female head of household and high levels of depression.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146407/1/ijgo12654.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146407/2/ijgo12654_am.pd