The Birth Education Starts Today Video on Birth Care Options: Evaluation With University Students.

Despite evidence indicating that midwife-attended birth is safe and satisfactory, few U.S. families have credentialed midwives as their birth care providers. In the context of person-centered health care and improving maternity care, we evaluated how an author-constructed video featuring evidence and personal narratives on midwifery care affected attitudes and care preferences/intentions for a hypothetical future birth among university students who had not become parents. Students (114 women, 30 men) completed care attitude and preference items before and after viewing the video. Significant (p < .001) changes indicated significantly improved attitudes toward midwives and out-of-hospital birth and related preferences. We discuss the educational framework of the video and plans to determine whether short-term effects translate into care-seeking behavior across diverse populations.

Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand.

INTRODUCTION: Clinic-based acupuncturists, midwives, and physiotherapists have reported using acupuncture to treat lumbopelvic pain in pregnancy, a common condition that may affect functioning and quality of life. To contribute to the emerging evidence on treatment outcomes, we collected patient-reported pain reduction data from women treated during pregnancy in a no-pay, hospital-based acupuncture service in New Zealand. METHODS: Observational study of patient-reported symptom reduction.The main outcome measure was the MYMOP (Measure Your Medical Outcome Profile), a brief, validated self-report instrument. Open-ended questions on treatment experiences and adverse events were included. RESULTS: Of the 81 women on whom we had complete treatment data, the majority (N = 72, 89%) reported clinically meaningful symptom reduction. Patient-reported adverse events were infrequent and mild. DISCUSSION: Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting. We discuss this study's unique contributions in providing guidance for clinicians who practice acupuncture in pregnancy, including midwives, physiotherapists, and physicians.

University women's and men's mindsets surrounding postcesarean birth: Findings and implications for practice and policy.

BACKGROUND: Nearly twice as many women report preferring vaginal birth after cesarean (VBAC) than actually undergo it. It is unknown whether the preference pattern would hold in childbearing-aged individuals who had not yet been directly influenced by care experiences. We therefore examined postcesarean birth preferences in nulliparous university women and men to provide additional evidence to help advance related policy and practice. METHODS: An online study of 558 university women and 164 men who read a hypothetical postcesarean birth scenario was conducted. Students selected the option they would prefer for themselves or a partner in a similar situation; these data were analyzed descriptively and for gender differences. Students' written rationales were analyzed qualitatively. RESULTS: Of women, 38.2% reported preference for VBAC compared with 47.6% of men (P < .05). Thematic analysis revealed that women and men based their preferences on safety, quality of experience, and other concerns similar to those reported among pregnant women making the decision. Assumptions and misinformation were also noted. CONCLUSION: Given the current primary cesarean rate of ~20%, the current childbearing generation will be facing cesarean and postcesarean birth decisions in appreciable numbers. The relatively high VBAC preference rate reported by our participants, particularly men, is useful in advocating for expanded access and practice. From a constructivist perspective, evidence of young adults' mindsets and misconceptions surrounding postcesarean birth is valuable for developing effective educational interventions.

Teaching University Students About Evidence-Based Perinatal Care: Effects on Learning and Future Care Preferences.

U.S. university students hold generally medicalized views on childbirth, which contrast with evidence indicating that low-intervention birth is safest for most. Therefore, intentional efforts are needed to educate childbearing populations on perinatal care evidence. Toward that aim, this study involved teaching university students in an introductory class (N = 50) about evidence-based perinatal care. Students completed a "future birth plan" and an essay on how their learning affected care preferences. Analyses revealed that students selected evidence-based care components up to 100 times more frequently than what the national data indicate they are used. Students based care selections on evidence, costs, and personal views. Their interest in physiologic birth has important implications for advancing education on perinatal care, practice, and policy.

Fetal health locus of control: Scale properties and applications in preconception health programs.

Preconception health programs have resulted in improved health behaviors among participants and have shown promise in reducing adverse birth outcomes. However, the role of health beliefs in preconception health program outcomes has been overlooked but warrants attention due to reported positive associations between women's views of control over fetal health and health behavior in pregnancy. Towards an ultimate aim of improving preconception health program reach and effectiveness, we examined properties of a fetal health locus of control (FHLC; Labs & Wurtele, 1986) measure in nulliparous, childbearing aged university women and men. Students (n=1467) completed an online survey that included the FHLC subscales maternal, powerful others', and chance control over fetal health. Factor analyses and correlations with related scales supported the soundness of FHLC constructs in both women and men. All participants rated maternal control in fetal health nearly twice as highly as powerful others' and chance. We therefore recommend that FHLC be integrated into preconception health program evaluation as personal agency in fetal health likely has an important role in women's and men's preconception health behavior and health behavior change.

Engaging Practitioners in Advancing Research on Acupuncture in Pregnancy.

OBJECTIVES: Women across the globe seek acupuncture to treat pregnancy concerns. Randomized controlled trials have indicated limited benefits of acupuncture in pregnancy, but field studies involving practitioners are needed to better understand the outcomes of usual care. To advance research on pregnancy acupuncture, this study engaged field-based practitioners to discuss research strategies. SETTINGS/LOCATION: U.S. Pacific Northwest region. DESIGN AND PARTICIPANTS: Live focus group with regional specialized acupuncturists. Content analysis involved research team and interviewees. RESULTS: Practitioners generally focused on patient care, although they discussed valuing research for communicating with patients and biomedical practitioners. To increase research in this area, practitioners proposed partnering with professional organizations, using social media, assuring confidentiality, and designing brief measurement tools. CONCLUSIONS: Practitioners valued evidence for specific uses and proposed several novel research strategies. On the basis of these results, a framework is proposed for building a patient-centered collaboration between research and practice communities that is responsive to paradigmatic preferences and the overarching goals of science.

Patient expectations of acupuncture in pregnancy.

BACKGROUND: Expectations for treatment have been associated with outcomes. Expectations in acupuncture treatment have rarely been addressed, and due to the unique concerns of pregnancy and childbirth, obstetric patients merit special attention. PRIMARY STUDY OBJECTIVE: Assess treatment expectations of acupuncture clinic patients treated for obstetric and related concerns. METHODS/DESIGN: Descriptive follow-up involving a patient-completed survey; chief treatment concern and number of treatment sessions were validated against patient records. PARTICIPANTS: Of 265 former clinic patients, 137 (51.7%) completed the internet survey. MAIN OUTCOME MEASURES: Self-reported demographic variables; responses to open-ended questions on treatment expectations; general treatment variables. RESULTS: Using standard qualitative data analytic strategies, we identified five major treatment expectations, for example, affecting labor and delivery, benefiting the whole system, and treating specific symptoms. LIMITATIONS: Retrospective method and recall bias may have influenced reported expectations. CONCLUSION: Obstetric acupuncture patients' expectations overlap with other subgroups in terms of symptom treatment. They also indicate a distinct interest in taking an active role in childbirth and in replacing conventional interventions, warranting further inquiry into obstetric acupuncture effects and safety in childbearing women.

Characteristics of a U.S. obstetric acupuncture clinic patient sample.

CONTEXT: Most U.S.-based studies on acupuncture treatment for obstetric concerns published in mainstream health journals have been randomized controlled trials, widely considered the "gold standard" for clinical research. However, whether those studies adequately reflect the characteristics and treatment concerns of actual treatment users is as yet unknown. OBJECTIVE: Provide a reference point for advancing U.S. obstetric acupuncture research by (1) describing background and relevant treatment characteristics of an obstetric acupuncture clinic sample and (2) reviewing those characteristics in relationship to existing U.S.-based studies. DESIGN: Descriptive follow-up involving a patient-completed internet survey; chief treatment concern and number of treatment sessions were validated against patient records. PARTICIPANTS: Of 265 former clinic patients, 137 (51.7%) completed the internet survey. MAIN OUTCOMES: Patient referral source and demographics; primary and secondary treatment concerns; number of treatment sessions; and planned birth attendant and setting. RESULTS: The clinic sample's demographics generally aligned with those in existing U.S. studies. However, the chief concern of most clinic patients was labor facilitation compared to two of the seven U.S.-based publications. Clinic patients learned about acupuncture through midwives and family/friends; 28% planned out-of-hospital birth. CONCLUSIONS: This first study on a U.S. obstetric acupuncture clinic sample suggests that an obstetric acupuncture research agenda relevant to current treatment users should increase focus on labor facilitation, involve samples from a wider range of maternal care settings, and continue outreach to ethnic minorities.

Patient-reported benefits of acupuncture in pregnancy.

As U.S. expenditures on acupuncture treatment rise, so does the need to examine specific acupuncture patient subpopulations because their treatment needs and goals vary. This study focused on treatment benefits reported by former obstetric acupuncture patients, which addresses a critical research gap on subjective patient experiences. Of 265 former clinic patients, 137 (51.7%) completed an internet survey with an open-ended question on treatment benefits. Using standard qualitative analytic strategies, we identified five major themes related to benefits, including, for example, treated chief concerns, helped achieve a desired birth experience, and provided holistic benefit. Identified themes and subthemes spoke to benefits of acupuncture on specific pregnancy symptoms and on the birth process. Clinical and research implications for identified themes, including those related to the birth process and birth setting, are discussed.

Research on Acupuncture in Pregnancy and Childbirth: The U.S. Contribution.

BACKGROUND: Along with an increasing use of acupuncture to treat pregnancy and childbirth concerns comes a need to assess the current state of related research, which is a critical step in defining a research agenda. OBJECTIVE: The goal of this article is to analyze the U.S. contribution to obstetric acupuncture research against the backdrop of professional positions and relevant historical events. METHODS: Original obstetric acupuncture research articles published post-1998 (147) and pre-1998 (62) were reviewed. Studies were placed into topical categories (e.g., breech correction, labor, and delivery), and the current authors identified region of study origin, study focus and type, gestational timing of treatment, general study outcomes, and adverse events. U.S. study characteristics were analyzed relative to those of other regions. RESULTS: The number of obstetric acupuncture publications more than tripled from pre- to post-1998, and the United States ranked third (behind the European region and China) in published articles. One case study indicated a serious adverse effect. Most post-1998 U.S. articles focused on pregnancy concerns; those conducted in early pregnancy involved acupressure. Acupuncture benefits varied by study topic. CONCLUSIONS: U.S. studies reflected greater effort toward treating pregnancy-related problems, compared to childbirth and postpartum concerns. The U.S. research contribution is discussed within the context of health care system structure, professional concerns, funding, and the role of conventional biomedical care in advancing a successful research agenda.

Impact of a breast cancer diagnosis on adult children's cognitive and emotional coherence.

The current study examined whether adult children of recently diagnosed breast cancer patients experience heightened general and major stressor-related distress, and identified a potential mediator between these two forms of distress. Unique from other stress studies, the current study proposed a novel intrapsychic construct, the extent to which one understands and recognizes his or her thoughts and feelings related to a major stressor, for which we coined the term cognitive and emotional coherence. Albeit preliminary, findings supported study hypotheses and argue that this construct may represent an important mediator of distress as well as a pivotal target for psychosocial intervention.

Expressive writing intervention for adolescents' somatic symptoms and mood.

The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, distress, and positive psychological functioning were evaluated. Eighth-grade (n=106) students were randomly assigned to write about either an emotional or a neutral topic for 3 consecutive days. Students completed measures of somatic symptoms, medical visits, distress, and positive functioning at baseline, postintervention, and 2 and 6 weeks later. Somatic symptoms and medical visits were unchanged as a result of the intervention. However, significant Time Condition effects indicated that optimism scores increased, negative-affect scores decreased, and positive-affect words in student essays increased in the experimental condition. Expressive writing shows promise as a cost-efficient intervention to address the emotional concerns of young adolescents; further work with clinical populations may lead to even more robust results.

Family structure and the course of steroid-sensitive nephrotic syndrome.

The number of children in nontraditional families is growing. The objective of this study was to determine the effects of family structure on the course of childhood steroid-sensitive idiopathic nephrotic syndrome (SSNS). Sixteen children, 2-15 years of age, with SSNS were enrolled in the study. The effects of family structure (traditional versus nontraditional) on the number of hospitalizations and outpatient visits for the previous 2 years and disease relapses for the preceding year were evaluated. Behavior differences were assessed using the Child Behavior Checklist (CBCL). Of the 16 families, 9 were traditional and 7 nontraditional. Hospitalizations, outpatient visits, and behavior were not different between family groups. However, children from nontraditional homes relapsed 3 times more than children from traditional homes (P=0.003). We conclude that children with SSNS from nontraditional homes may be at risk for more relapses compared with children from traditional families. Heightened support and monitoring is necessary for these children.

Daily reports and pooled time series analysis: pediatric psychology applications.

OBJECTIVE: To apply daily reports and pooled time series analysis (PTSA) to issues in pediatric psychology research. We discuss specific applications for this procedure in analyzing repeated observations for a small sample, including medication effects, caregiving role strain, pain reports, and treatment effects. METHODS: In the PTSA example presented, 20 daily behavior reports were provided by parents of 10 children with steroid-sensitive nephrotic syndrome (SSNS) during high-dose steroid administration and tapering. RESULTS: The full model, including child age, medication dosage, and between-subjects effects, significantly predicted children's aggressive behavior and anxious/depressed behavior. Steroid dosage significantly predicted aggressive, but not anxious/depressed, behavior. CONCLUSIONS: Daily reports analyzed using PTSA provided insight into serious behavioral side effects of steroid medications used to treat SSNS. We discuss the role of pediatric psychologists in addressing medication side effects and other time-related effects detectable using this methodology.

Deceived versus nondeceived participants' perceptions of scientific and applied psychology.

Research examining the possible effects of deceptive research participation on participants' perceptions of psychology has yielded equivocal results. The present study's goal was to clarify the possible effects of participation in mildly deceptive research on participants' impressions of scientific and applied psychology. Participants (N = 112) were randomly assigned to one of six experimental conditions: active groups receiving negative, positive, or no feedback, or passive groups receiving negative, positive, or no feedback. Following participation, participants completed measures of impressions of psychotherapy and psychotherapists, researchers, and instructors. The manipulation did not affect attitudes toward psychology on any of the dependent measures, although gender effects resulted on one measure. Participants in general reported very positive attitudes toward the science and practice of psychology. Recommendations are offered for future research on the effects of more extensive deceptions.