Examining clinical indications for cesarean section in a university hospital in Karachi, Pakistan

Background and objectives: Current research reports that Pakistan exceeds the recommended percent of deliveries via cesarean sections, including both emergent and non-emergent. In order to better understand the high rate of cesarean sections in Pakistan we examined the medical and non-medical indications of these surgeries at a private university hospital in Karachi. Methods: A retrospective analysis of patient medical record data was conducted from January 1st, 2018 to March 31st, 2018. The data collected was analyzed using SPSS 25. Results: The total number of deliveries during the period was n= 1,211, out of which n=602 (49.70%) were CS. The top five indications for CS were: repeat CS n=199 (44.20%), failure to progress n=58 (12.90%), abnormal lie n=42 (9.30%), fetal distress n=37 (8.20%), and fetal growth restriction n= 21 (4.70%). Conclusion: This study contributes to a broader understanding of the indications of cesarean section rates in the developing world. This information can be used to improve infant and maternal health by reducing the complications associated with operative deliveries

Examining the Experiences of US Dentists during the First Wave of the COVID-19 Pandemic: Implications for Policy and Practice

(1) Background: As an emerging topic, no known study to date has described interviews with US dentists regarding their experiences during the beginning of the coronavirus disease 2019 (COVID-19) with regard to office closures and their implications for both the dentists and the patients they serve, especially among dentists in their first decade of work and new to practice ownership roles. Therefore, the purpose of this study was to describe the experiences of early-career US dentists during the initial stages of the COVID-19 pandemic. (2) Methods: This study utilized a semi-structured interview protocol and employed qualitative descriptive methodology. SPSS 26 and NVivo12 were utilized for data analysis. (3) Results: In April 2020, a total of 12 early-career US dentists completed the interview study protocol. The study sample majority was male (67%), with a mean age of 32 (range = 30–37) and an average of 6 years of dental practice experience (range = 5–10). Participants completed phone interviews with the research team. In summary, three organizing themes emerged: (1) Dentistry during COVID-19: Experiences during the first wave, (2) Long-term concerns regarding COVID-19, and (3) COVID-19 professional communication and dental research. (4) Conclusions: The chief findings of this study are dentists’ long-term concerns for the profession post-COVID-19. Research must still determine how to best prepare for future infectious disease outbreaks with regards to safeguarding the health of the dental workforce and maintaining the oral health of patient populations

Examining the Experiences of US Dentists during the First Wave of the COVID-19 Pandemic: Implications for Policy and Practice

(1) Background: As an emerging topic, no known study to date has described interviews with US dentists regarding their experiences during the beginning of the coronavirus disease 2019 (COVID-19) with regard to office closures and their implications for both the dentists and the patients they serve, especially among dentists in their first decade of work and new to practice ownership roles. Therefore, the purpose of this study was to describe the experiences of early-career US dentists during the initial stages of the COVID-19 pandemic. (2) Methods: This study utilized a semi-structured interview protocol and employed qualitative descriptive methodology. SPSS 26 and NVivo12 were utilized for data analysis. (3) Results: In April 2020, a total of 12 early-career US dentists completed the interview study protocol. The study sample majority was male (67%), with a mean age of 32 (range = 30–37) and an average of 6 years of dental practice experience (range = 5–10). Participants completed phone interviews with the research team. In summary, three organizing themes emerged: (1) Dentistry during COVID-19: Experiences during the first wave, (2) Long-term concerns regarding COVID-19, and (3) COVID-19 professional communication and dental research. (4) Conclusions: The chief findings of this study are dentists’ long-term concerns for the profession post-COVID-19. Research must still determine how to best prepare for future infectious disease outbreaks with regards to safeguarding the health of the dental workforce and maintaining the oral health of patient populations

An Examination of the Relationship between Household Food Insecurity and WIC Participation

Thesis (Ph.D.)--University of Washington, 2015Over the last decade, a growing number of American families have struggled to put food on the table. The most recent USDA ERS report, released September 2012, estimates that a record one in five children, over sixteen million in total, currently live in food insecure homes throughout the country. Household food insecurity, defined as not having ‘access to enough food for an active, healthy life,’ is a key indicator of population health and has been recognized as an important area for improvement by initiatives such as Healthy People 2020. Improving access to healthy foods is a cornerstone of many public health programs including SNAP, TANF and the Special Supplemental Nutrition Program for Women, Infants and Children, WIC. WIC’s mission is to safeguard the health of low-income maternal-child populations who are at nutrition risk by providing resources such as nutritious foods, nutrition counseling and health care referrals. As a federally mandated program, WIC is uniquely positioned to not only impact the experience of food insecurity but also improve the life course health of vulnerable maternal-child populations in the US. While research to date supports the notion that participation in WIC has a dose-dependent effect on household food insecurity among participating families, WIC participation rates, defined as participation among eligible families, and coinciding rates of household food insecurity, had yet to be examined. The purpose of this study was to explore the presence and nature of a cross-sectional and longitudinal relationship between state-level household food insecurity rates and WIC participation rates over time. The first aim was to examine the relationship between annual state-level household food insecurity and WIC participation rates cross-sectionally from 2000-2010, controlling for relevant sociodemographic characteristics. The second aim was to examine the relationship between annual state-level household food insecurity and WIC participation rates longitudinally from 2000-2010, controlling for relevant sociodemographic characteristics and national economic trends. This study was an exploratory analysis of existing secondary data. Data sources included the Current Population Survey, WIC administrative files, and US Census. I used a pooled time-series regression model to examine the associations between household food insecurity rates, WIC participation rates, and sociodemographic characteristics. I examined the longitudinal association between household food insecurity and WIC participation with a pooled time-series regression model and marginal effects equations using a linked state-level dataset for years 2000 through 2010, first described in my cross-sectional analysis. The cross-sectional analysis uncovered a complicated relationship between household food insecurity and WIC participation dependent upon the state sociodemographic characteristics, namely the proportions of Hispanic and/or Foreign-Born populations and the rates of teenage and unmarried pregnancies. The longitudinal analysis expanded upon the understanding of the relationship between household food insecurity and WIC participation rates by examining the presence and nature of this relationship over time. A normalized pattern of association, where a change in state-level food insecurity was associated with a similar change in WIC participation, was evident during periods 2000, 2001 and 2010. In contrast, the non-recessionary period from 2002-2006 and Great Recession from 2007-2009 disrupted this pattern. During 2002-2006 and 2007-2009, a state-level change in food insecurity did not elicit a measurable change in WIC participation. This work adds to the overall understanding of the relationship between state-level maternal-child food and nutrition needs and the current public health system’s ability to meet these needs. This research supports public health programming’s ability to positively influence the lives of low-income, vulnerable maternal-child populations in the US struggling with food insecurity. Overall, it is hoped that this evidence of the relationship between food insecurity and WIC participation will encourage consideration of state-level sociodemographic characteristics and national economic climate in the planning and implementation of public health services intended to reduce food insecurity and improve maternal-child health over time

Shared Decision Making: Effects of an Online Education Session on Knowledge Attitudes and Adaptability Skills

Background: Shared decision making (SDM) is beneficial for interprofessional teams but also challenging to implement correctly. Oncology nurses are at the forefront of patients’ treatment and, therefore, one of the most essential components of the SDM process.Objectives: The aim of this pilot study was to examine the effects of a one-hour web-based SDM education session on self-reported knowledge, attitudes, adaptability, and communication skills related to SDM among oncology nurses.Methods: Using the ADDIE (analysis, design, development, implementation, and evaluation) theoretical framework, this study used a post-test–only, single-group, nonexperimental design.Findings: This study provides preliminary evidence that a one-hour web-based SDM education session is acceptable and has positive effects on oncology nurses’ self-reported knowledge, attitudes, adaptability, and communication skills. More research is warranted to validate these findings

Food Access Patterns and Barriers among Midlife and Older Adults with Mobility Disabilities

We examined where midlife and older adults with a mobility disability accessed food outside the home in King County, Washington, USA, how they travelled to these food destinations, and facilitators and barriers to food access using qualitative interviews. Thirty-five adults aged ≥50 years with a mobility disability (defined as use of an assistive device for mobility) were interviewed. Supplemental objective information was obtained from a Global Positioning System device worn by participants for 3 days. Participants primarily accessed food at grocery stores, restaurants, and coffee shops/cafés. The most common transportation modes were walking, obtaining a ride from friends, motorized chair/scooter, and public transit. Location and proximity of food destinations were factors affecting participants’ ability to access these destinations. Adequate space, ease of entry, available amenities such as restrooms, and helpful people were facilitators for participants to access food outside the home

Racial Differences in Breastfeeding Initiation Among Participants in a Midwestern Public Health District

Purpose: Although variations in breastfeeding initiation are well documented, the contributing role of maternal race remains poorly understood, especially among the multiracial—two or more races—population. The purpose of this study is to examine differences in breastfeeding initiation among a racially and ethnically diverse population of low-income women. Methods: Participants for this study (n=1010) were enrolled in the supplemental nutrition program for women, infant, and children and concurrently enrolled in a perinatal depression registry at a public health clinic in the Midwest. Race was obtained from medical records. Breastfeeding initiation was gathered through a clinical interview during the first postpartum visit. Logistic regression was conducted using STATA 14.2. Results: Sixty-eight percent of study participants reported breastfeeding initiation. The bivariate analysis demonstrated that there were significant differences in rates of breastfeeding initiation by race/ethnicity. The logistic regression models showed that after adjusting for maternal education, age, income, nativity, parity, body mass index, and antenatal smoking, Black (odds ratio [OR] 0.47; confidence interval [95% CI] 0.34–0.66), multiracial (OR 0.21; 95% CI 0.07–0.65), and Latina women (OR 0.48; 95% CI 0.26–0.86) were significantly less likely to initiate breastfeeding compared with White women. Conclusion: These findings highlight the need for further understanding of the underlying barriers to the initiation of breastfeeding among low-income Black, multiracial, and Latina women. Moreover, breastfeeding should remain a priority for intervention and policy development, particularly among racially and ethnically diverse low-income women

Data_Sheet_1_Mental health disparities in Latinx immigrant communities residing in the United States during COVID-19: Implications for policy and practice.docx

ObjectivesStudies have demonstrated that Latinx populations face significant health disparities in access to mental health care. The objective of this study was to describe the impact of the COVID-19 pandemic on the mental health needs of Latinx families, from the perspectives of direct service providers working with Latinx communities.MethodsTwenty-one semi-structured interviews were conducted virtually with direct service providers to the Latinx community from August to October 2020. Interviews were transcribed verbatim and analyzed using thematic analysis.ResultsTwo-thirds of providers were female, with a median age of 33 years, and provided direct services to Latinx clients and had extensive experience working with immigrant families, particularly in Massachusetts. Key themes identified describing the impact of COVID-19 on the mental health needs of Latinx families included: (1) exacerbation of mental health symptoms, (2) financial stressors, (3) preoccupation regarding transnational lives, (4) secondary needs becoming more salient, and (5) immigration status as a main driver of inequality.ConclusionsOur findings highlight the importance of focusing on the mental health needs of Latinx immigrants and ensuring their access to mental health services. Telehealth seems to be a potential tool that promotes mental health access among Latinx clients. Future research needs to continue investigating the role of telehealth in decreasing mental health access disparities.</p

WIC Staff Views and Perceptions on the Relationship between Food Insecurity and Perinatal Depression

Food insecurity and perinatal depression are significant public health concerns for perinatal services, however descriptive research examining their association is limited. The purpose of this study was to examine the views and perspectives of staff from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program on the relationship between food insecurity and perinatal depression among their WIC clients. Four, semi-structured focus groups with WIC staff (n = 24) were conducted across four diverse nonmetropolitan public health districts in Midwestern counties in the United States. WIC staff included social workers, nurses, nutritionists and ancillary staff. All interviews were audio-recorded, transcribed, and verified, and data were organized using NVivo 11.4.2. Thematic networking analysis was employed as the qualitative analysis to identify organizing themes. Three themes emerged including (1) depression experienced by clients; (2) food insecurity experienced by clients; and (3) barriers preventing clients from accessing services for themselves and their children. Research on food insecurity and perinatal depression is sparse, with fewer studies having included health staff of low-income women. Our findings suggest that the association between food insecurity and mental health needs among WIC clients is a significant public health issue to which policy change and interventions are required