Labor unit culture and attitudes toward supporting vaginal birth-The Swedish version of the labor culture survey (S-LCS)-Psychometric properties.

BACKGROUND: In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners. METHODS: A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS. RESULTS: A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians. CONCLUSIONS: The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.

Preconception, Interconception, and reproductive health screening tools: A systematic review.

OBJECTIVE: To identify and describe the standardized interconception and preconception screening tools for reproductive health needs that are applicable in general outpatient clinical practice. DATA SOURCES AND STUDY SETTING: This systematic review identifies research on pregnancy intention screening and counseling tools, and standardized approaches to preconception and interconception care. We focus on tools designed for clinical settings, but also include research tools with potential for clinical implementation. These tools may include a component of contraceptive counseling, but those focusing solely on contraceptive counseling were excluded. Data were collected from studies done in the United States between January 2000 and March 2022. STUDY DESIGN: We performed a systematic literature search to generate a list of unique tools, assessed the quality of evidence supporting each tool, and described the peer-reviewed clinical applications of each. We used the Mixed Methods Appraisal Tool to appraise the quality of individual studies. DATA COLLECTION/EXTRACTION METHODS: We searched PubMed, Web of Science, and CINAHL databases for standardized preconception and interconception health screening tools published in English from January 2000 through March 2022. We used keywords "preconception care," "interconception care," "family planning," "contraception," "reproductive health services," and "counseling." Utilizing the Preferred Reporting Items for Systematic Reviews guidelines, we screened titles and abstracts to identify studies for full text review. PRINCIPAL FINDINGS: The search resulted in 15,399 studies. After removing 4172 duplicates, we screened 11,227 titles/abstracts and advanced 207 for full-text review. From these, we identified 53 eligible studies representing 22 tools/standardized approaches, of which 10 had evidence from randomized clinical trials. These ranged widely in design, setting, and population of study. CONCLUSIONS: Clinicians have a choice of tools when implementing standard reproductive screening services. A growing body of research can inform the selection of an appropriate tool, and more study is needed to establish effects on long-term patient outcomes.

Applicant Evaluation of Residency Programs in a Virtual Format: A Mixed-Methods Study.

BACKGROUND AND OBJECTIVES: The first all-virtual residency application cycle took place in 2021. Virtual programming can reduce cost, time, and travel burden; these may be especially beneficial to applicants with fewer resources and those from underrepresented backgrounds (URM). Little is known about how applicants evaluate key ranking factors, especially in a virtual format. This study aimed to assess how applicants evaluated programs in the virtual cycle. METHODS: We surveyed 271 fourth-year students at three Chicago medical schools after rank-list submission and prior to receiving match results in March 2021. The survey included questions on online content and importance of different ranking factors as well as open-ended questions on how participants evaluated their most important factors. We analyzed quantitative data using descriptive statistics and χ2 tests. We analyzed qualitative data using thematic content analysis. RESULTS: Applicants cited goodness of fit, geographic location, program reputation, fellowship opportunities, and work/life balance as the top-five most important factors. URM applicants were more likely to prioritize diversity at institution or location (P<.0001). Interactions with residents and faculty and opportunities to observe interprogram dynamics were key to assessing fit but were often limited by the virtual format. Additional emergent themes provided recommendations for future cycles. Program websites and videos were rated as the most important online content types. CONCLUSIONS: This study provides information about how applicants evaluated the factors they deemed most important in assessing and ranking programs, which can help residency programs improve their recruitment efforts.

PURL: USPSTF expands options for cervical cancer screening.

Women ages 30 to 65 years now have a third cervical cancer screening option.