Promoting the Health of Parents & Children: Addressing Perinatal Mental Health by Building Medical Provider Capacity Through Perinatal Psychiatry Access Programs

Mental health conditions are the most common obstetric complications of the perinatal period, impacting 1 in 5 individuals during pregnancy and the year following pregnancy. Perinatal mental health (PMH) conditions have deleterious effects on the health of perinatal individuals and their children, and are a leading and preventable cause of maternal mortality. Nevertheless, PMH conditions are underrecognized, underdiagnosed, and undertreated. To address these gaps, Massachusetts created the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms to build the capacity of frontline medical providers to address PMH conditions by providing education, consultation, and resources and referrals. MCPAP for Moms has emerged as a successful and scalable model with at least 25 states or organizations implementing or developing similar Perinatal Psychiatry Access Programs. This report summarizes the Perinatal Psychiatry Access Program model and its individual and national impact

The Accuracy of Recalled versus Measured Pre-Pregnancy Weight for the Calculation of Pre-Pregnancy Body Mass Index

Background: In 2009, the Institute of Medicine (IOM) published gestational weight gain (GWG) guidelines with the goal of optimizing maternal and fetal outcomes. GWG recommendations are specific to pre-pregnancy body mass index (BMI): 28-40 lbs for underweight (UW; BMI2), 25-35 lbs for normal weight (NW; 18.5≤BMI/m2), 15-25 lbs for overweight (OW; 25 ≤BMI/m2), and 11-20 lbs for obese (OB; BMI≥30 kg/m2) women. With upwards of 50% of pregnancies in the U.S. unplanned, measured pre-pregnancy weight is often unavailable in clinical and research settings. Evaluating the accuracy of recalled pre-pregnancy weight early in prenatal care is important in order to establish accuracy of pre-pregnancy BMI calculations in order to counsel about GWG accurately. Objective: To examine differences in recalled versus measured pre-pregnancy weight and to examine factors associated with accuracy of recalled weights. Methods: Medical record review of 1,998 randomly selected pregnancies. Eligible women received prenatal care in faculty and resident clinics at UMass Memorial Health Care (UMMHC), delivered between January 2007 and December 2012, and had available both: (1) a measured weight within one year of conception and (2) a pre-pregnancy weight self-reported at first prenatal visit. Data were obtained from the UMMHC paper or electronic prenatal record and the Allscripts EMR. We calculated the difference in weights as recalled pre-pregnancy weight minus most recent measured weight within one year of conception. Subjects were excluded if they received care at a non-faculty or non-resident practice, charts not available after three separate retrieval attempts, both weights of interest not available, or if measured weight occurred at a prenatal visit for a prior pregnancy. For women with more than one pregnancy during the study time frame, one was randomly selected for inclusion in the analytic data set. Results: Of the 1,998 pregnancy charts reviewed, 400 records met eligibility criteria and were included in this analysis. Women were mean age 29.7 (SD: 6.2) years, 69.3% multigravida, 64.4% non-Hispanic white, 65.2% married, and 62.4% had a college or greater education. Based on recalled weight, 3.3% of women were underweight, 46.6% were normal weight, 25.9% overweight, and 24.2% obese. 63% received care in the faculty obstetric clinic. Recorded recalled weights were mean 2.4 (SD: 11.1) pounds lower than measured pre-pregnancy weight. This difference did not differ by age, location of care, pre-pregnancy BMI, marital status, race/ethnicity, primary language, gravity, education, or time between measured weight and conception, in unadjusted and adjusted models. For 88.7% of women, calculating pre-pregnancy BMI based on weight measured up to a year prior to conception or based on recalled pre-pregnancy weight reported at the first prenatal visit resulted in the same classification of pre-pregnancy BMI. Conclusion: Prenatal care providers may calculate pre-pregnancy BMIs using recalled pre-pregnancy weights early in prenatal care and use such calculated BMIs to accurately provide GWG recommendations regardless of demographic variables, gravity, or location of care

Demographic Characteristics Associated with the Presence of Recalled and Measured Prepregnancy Weights

Background: Gestational weight gain within prepregnancy BMI-specific Institute of Medicine (IOM) recommended ranges are associated with good outcomes for both mother and baby. Availability of measured prepregnancy weight, recalled prepregnancy weight or measured weight at first prenatal visit if the former two weights are not available, influences the accuracy of provider recommendations for gestational weight gain. Objective: The purpose of this study is to examine demographic characteristics associated with the presence of recalled prepregnancy weight and measured prepregnancy weight in the prenatal care medical record. Methods: Medical record review of 1,998 randomly selected pregnancies, of which 1,911 met inclusion criteria of delivery between January 2007 and December 2012 and receipt of prenatal care in faculty and resident clinic sites at UMass Memorial Health Care (UMMHC). Subjects\u27 paper prenatal chart and electronic record (AllScripts and QS prenatal EMR) were fully abstracted if available and contained both: (1) a recorded measured weight within one year of conception, and (2) a self-reported prepregnancy weight obtained at first prenatal visit. Additionally, exclusion criteria included those pregnancies with only prenatal weights recorded one year prior to conception for index pregnancy. For women with multiple pregnancies during the study time period, one pregnancy was randomly selected for inclusion in study analyses. Demographic data was abstracted for all available charts regardless of presence or absence of weights of interest. Demographic characteristics considered were age (15-29, 20-24, 25-29, 30-34, 35+ years), prepregnancy BMI calculated based on recalled height and weight (underweight: BMI2, normal weight: 18.5≤ BMI/m2, overweight: 25≤BMI/m2, and obese: 30 kg/m2≤BMI), race/ethnicity (non-Hispanic white vs. other race/ethnicity), marital status (not married vs. married), primary language (non-English vs. English), gravidity (1, 2, 3+), education (high school diploma or less, some college, 4 year college or more) and prenatal care site (faculty vs. resident obstetric clinic). Logistic regressions were performed to calculate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) and adjusted analyses controlled for demographics. Results: Of the 1911 pregnancies meeting initial inclusion criteria, 1711 (89.5%) had charts available for abstraction; fifty-three subjects had multiple pregnancies of which only one was included in analyses resulting in an analytic sample of 1656 pregnancies. Of these, 511 (30.9%) were missing a recalled prepregnancy weight at first prenatal visit, 711 (42.9%) had the recalled prepregnancy weight but did not have a measured weight; and only 434 (26.2%) had both weights of interest. Overweight women had decreased odds of having a recalled weight compared to women of normal weight (aOR 0.75; 95% CI 0.56-1.00). Additionally, women with ≥4 years of college compared to those with ≤ high school diploma (aOR 0.54; 95% CI 0.40-0.73), and those receiving care in the faculty compared to the resident clinics (aOR 0.48; 95% CI 0.35-0.65) had decreased odds of having a recalled weight available in the chart. Among women with available recalled prepregnancy weight (n=1101), 390 (35.4%) also had a documented measured weight within one year of conception and 711 (64.6%) did not. Women who were not married (aOR 0.54; 95% 0.39-0.76) had decreased odds of having a measured weight, whereas those receiving care in the faculty compared to resident clinics had greater odds (aOR 1.79; 95% CI 1.26-2.53) of having a measured weight within one year of conception available in their charts. Conclusions: Our results suggest that approximately 25% of women have both recalled weight at first prenatal visit and at least one weight measured within one year of conception in their medical records. Prepregnancy BMI, education, and prenatal care site were associated with presence or absence of recalled weight. Similarly, amongst those with recalled weight, martial status and prenatal care in faculty practice where associated with decreased and increased odds respectively of having a measured weight within one year of conception. We can use this information to help practitioners target women for which greater efforts are needed to provide accurate IOM-recommended BMI-specific gestational weight gain guidelines. This may be utilized to discern patterns of health care access in this patient population

Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial

BACKGROUND: Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs. OBJECTIVE: The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity. METHODS: Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome. RESULTS: Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time. CONCLUSIONS: Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15530

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

A NARRATIVA DE FUNDAÇÃO: IRACEMA, MACUNAÍMA E VIVA O POVO BRASILEIRO

The present paper seeks to analyze the defense strategy of the colonial populating in the Capitania of Pernambuco through the establishment of Indian settlements in the areas where there was a higher incidence of attacks by palmaristas in the seventeenth century. Besides the various interests of colonial agents connected to the work of the natives in the villages, in times of war, the colonial villages also took on the function of military encampment, sheltering soldiers from the expeditions and serving as walls that prevented the advance of enemy forces. Thus, the present study also seeks to identify the villages that served this purpose. We use as sources administrative correspondence found in the main documental collections related to the colonial period of Brazil, as well as reports from chroniclers and colonial maps, analyzed and problematized through the reflections made by colonial Indian historiography. Keywords: Indian settlements. Military encampment. Palmaristas.El presente artículo pretende analizar la estrategia de defensa de los asentamientos coloniales en la Capitanía de Pernambuco a través del establecimiento de aldeas indígenas en las zonas donde había una mayor incidencia de ataques de palmaristas en el siglo XVII. Además de los diversos intereses de los agentes coloniales vinculados al trabajo de los nativos en las aldeas, en tiempos de guerra, las aldeas coloniales también asumían la función de campamentos militares, albergando a los soldados de las expediciones y sirviendo de murallas que impedían el avance de las fuerzas enemigas. Por ello, el presente estudio también pretende identificar las aldeas que sirvieron para este fin. Utilizamos como fuentes la correspondencia administrativa encontrada en los principales fondos documentales relacionados con el período colonial de Brasil, así como informes de cronistas y mapas coloniales, analizados y problematizados a través de las reflexiones realizadas por la historiografía indígena colonial. Palabras clave: Aldeas indígenas. Campamentos militares. Palmaristas.O presente artigo busca analisar a estratégia de defesa das povoações coloniais na Capitania de Pernambuco através do estabelecimento de aldeamentos indígenas nas áreas onde ocorriam maior incidência de ataques dos palmaristas no século XVII. Além dos vários interesses de agentes coloniais ligados ao trabalho de nativos aldeados, em tempos de guerra, os aldeamentos coloniais assumiam também a função de arraiais militares, abrigando soldados das expedições e servindo como muralhas que impediram o avanço de forças inimigas. Dessa forma, o presente estudo busca também identificar os aldeamentos que serviram a este propósito. Usamos como fontes correspondências administrativas encontradas nos principais acervos documentais relativos ao período colonial do Brasil, bem como relatos de cronistas e mapas coloniais, analisados e problematizados por meio das reflexões feitas pela historiografia indígena colonial. Palavras-chave: Aldeamentos indígenas. Arraiais militares. Palmaristas

Deadly Delays: Maternal Mortality in Peru: A Rights-Based Approach to Safe Motherhood

Report summary: Peru\u27s persistently high maternal mortality ratio, the second highest in South America, dramatically illustrates systemic inequities that ravage the overall society and in turn reflect systematic violations of human rights and vast disparities in the health care system

Association of peripartum synthetic oxytocin administration and depressive and anxiety disorders within the first postpartum year

BACKGROUND: Due to its potent effects on social behavior, including maternal behavior, oxytocin has been identified as a potential mediator of postpartum depression and anxiety. The objective of this study was to examine the relationship between peripartum synthetic oxytocin administration and the development of depressive and anxiety disorders within the first year postpartum. We hypothesized that women exposed to peripartum synthetic oxytocin would have a reduced risk of postpartum depressive and anxiety disorders compared with those without any exposure. METHODS: Population-based data available through the Massachusetts Integrated Clinical Academic Research Database (MiCARD) were used to retrospectively (2005-2014) examine this relationship and calculate the relative risk of peripartum synthetic oxytocin for the development of postpartum depressive and anxiety disorders in exposed (n = 9,684) compared to unexposed (n = 37,048) deliveries. RESULTS: Among deliveries to women with a history of prepregnancy depressive or anxiety disorder, exposure to peripartum oxytocin increased the risk of postpartum depressive or anxiety disorder by 36% (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.20-1.55). In deliveries to women with no history of prepregnancy depressive or anxiety disorder, exposure to peripartum oxytocin increased the risk of postpartum depressive or anxiety disorder by 32% compared to those not exposed (RR: 1.32; 95% CI: 1.23-1.42). CONCLUSIONS: Contrary to our hypothesis, results indicate that women with peripartum exposure to synthetic oxytocin had a higher relative risk of receiving a documented depressive or anxiety disorder diagnosis or antidepressant/anxiolytic prescription within the first year postpartum than women without synthetic oxytocin exposure