Shared Decision Making and Decisional Conflict in Women with Postpartum Depression

Despite well documented adverse outcomes related to untreated postpartum depression, many women face difficulty accessing care. A woman’s experience of conflict related to appraising treatment options that align with both her needs and her values can contribute to delays or barriers to seeking and accessing effective treatment. Shared decision making is the cornerstone of a collaborative patient-provider relationship and has been shown to decrease patient’s experience of decisional conflict. This cross-sectional web-based survey examined the relationship between shared decision making and decisional conflict for postpartum women experiencing depressive symptoms at an urban counseling center in Nashville, TN. Data were collected between October and December 2019. Decisional conflict was measured using the Decisional Conflict Scale. Perception of shared decision making was measured using the Shared Decision-Making Questionnaire (SDMQ-9). A total of 169 women completed the online survey. Of the 121 women who reported symptoms of postpartum depression, less than half were currently engaged in care for PPD, Of the 48 women who were engaged in care, there was a significant negative correlation between shared decision making and decisional conflict, p\u3c.05, Pearson’s r = -.287. Results of this study confirm finding of existing research that many women who are experiencing symptoms of PPD are not engaging in care. However, when women engage in care that reflects the principles of shared decision-making, they experience less decisional conflict. Providers who practice shared decision making in their care of women with postpartum depression may improve treatment engagement as well as myriad health outcomes for women and children. Keywords: Postpartum Depression, Women, Decisional Conflict, Shared Decision Makin

The Lyman Alpha Reference Sample: III. Properties of the Neutral ISM from GBT and VLA Observations

We present new H I imaging and spectroscopy of the 14 UV-selected star-forming galaxies in the Lyman Alpha Reference Sample (LARS), aimed for a detailed study of the processes governing the production, propagation, and escape of Ly$\alpha$ photons. New H I spectroscopy, obtained with the 100m Green Bank Telescope (GBT), robustly detects the H I spectral line in 11 of the 14 observed LARS galaxies (although the profiles of two of the galaxies are likely confused by other sources within the GBT beam); the three highest redshift galaxies are not detected at our current sensitivity limits. The GBT profiles are used to derive fundamental H I line properties of the LARS galaxies. We also present new pilot H I spectral line imaging of 5 of the LARS galaxies obtained with the Karl G. Jansky Very Large Array (VLA). This imaging localizes the H I gas and provides a measurement of the total H I mass in each galaxy. In one system, LARS 03 (UGC 8335 or Arp 238), VLA observations reveal an enormous tidal structure that extends over 160 kpc from the main interacting systems and that contains $>$10$^9$ M$_{\odot}$ of H I. We compare various H I properties with global Ly$\alpha$ quantities derived from HST measurements. The measurements of the Ly$\alpha$ escape fraction are coupled with the new direct measurements of H I mass and significantly disturbed H I velocities. Our robustly detected sample reveals that both total H I mass and linewidth are tentatively correlated with key Ly$\alpha$ tracers. Further, on global scales, these data support a complex coupling between Ly$\alpha$ propagation and the H I properties of the surrounding medium.Comment: Preprint form, 16 figures, accepted in Ap

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030