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

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

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

Examining trends in nonâ fatal strangulation among sexual assault survivors seeking Sexual Assault Nurse Examiner care from 2002 to 2017

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154499/1/ijgo13058_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154499/2/ijgo13058.pd

What are we missing? Risk behaviors among Arabâ American adolescents and emerging adults

Background and purposeResearch on Arabâ Americans as a distinct ethnic group is limited, especially when considering the health of Arabâ American youth. This study describes health risk (substance use, violence); health promotive behaviors (hope, spirituality); and sexual activity (oral, vaginal, anal sex) of Arabâ American adolescents and emerging adults (aged 15â 23) within their life context, as well as the association between these behaviors.MethodsA secondary analysis of data on a subset of Arabâ American participants obtained from a randomizedâ control trial was utilized to conduct mixed methods analyses. Qualitative analyses completed on the openâ ended questions used the constant comparative method for a subsample (n = 24) of participants. Descriptive quantitative analyses of survey data utilized bivariate analyses and stepwise logistic regression to explore the relation between risk behaviors and sexual activity among the full sample (n = 57).ConclusionsQualitative analyses revealed two groups of participants: (a) multiple risk behaviors and negative lifeâ events, and (b) minimal risk behaviors and positive lifeâ events. Quantitative analyses indicated older youth, smokers, and those with higher hope pathways were more likely to report vaginal sex.Implications for practiceThe unique cultural and social contexts of Arabâ American youth provide a framework for recommendations for the prevention of risk behaviors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134166/1/jaan12352.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134166/2/jaan12352_am.pd

Maternity waiting homes as part of a comprehensive approach to maternal and newborn care: a cross-sectional survey

Abstract Background Increased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns. Methods A cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data. Results The use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH. Conclusions This is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes. Trial registration National Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.https://deepblue.lib.umich.edu/bitstream/2027.42/152216/1/12884_2019_Article_2384.pd

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

A scoping review on community mobilisation for maternal and child health in sub-Saharan Africa: Impact on empowerment

This review integrates evidence on community mobilisation (CM) for maternal and child health in sub-Saharan Africa (SSA) to identify the impact on empowerment. For the purposes of this review we use the following definition of CM: ‘a capacity-building process through which community members, groups or organizations plan, carry out and evaluate activities on a participatory and sustained basis to improve their health and other conditions, either on their own initiative or stimulated by others’, [Howard-Grabman, L., Storti, C., Hummer, P., Pooler, B., & Geneva: USAID (2007). Demystifying community mobilization: An effective strategy to improve maternal and newborn health. Retrieved from http://pdf.usaid.gov/pdf_docs/pnadi338.pdf, p. 5]. A scoping review was chosen to conduct a search and analysis of the literature due to the broad, complex nature of the topic. The search yielded 136 articles, and 19 met the inclusion criteria. This review illustrates CM as an important research process for engaging the community, ensuring that interventions are meeting the needs of the community, take context into account and are sustainable. Community mobilisation was associated with positive behaviour change and/or health outcomes. However, community mobilisation was not defined or operationalised consistently among the identified studies. Empowerment was also not defined, measured, or reported on in the articles. This review provides recommendations for the reporting of CM and its influence on empowerment in communities in sub-Saharan Africa