Physician personal breastfeeding experience and clinical care of the breastfeeding dyad.

BACKGROUND: Prior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies. METHODS: We conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?" RESULTS: Of 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding. CONCLUSIONS: Well-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

Intimate Partner Violence Against Low-Income Women in Mexico City and Associations with Child School Attendance: A Latent Class Analysis Using Cross-sectional Data.

INTRODUCTION: Few studies have investigated how intimate partner violence (IPV), and patterns of IPV experiences, may impact children's school attendance in low- and middle-income countries. METHODS: Using baseline data from a sub-sample of 659 women in Mexico City enrolled in a randomized controlled trial who reported having a child under age 18 and in school, multilevel latent class analysis (LCA) was used to classify women based on their reported IPV experiences. Multilevel risk regression analyses examined associations between latent class membership and IPV-related disruptions in children's schooling. Latent classes were identified in a prior study. RESULTS: Overall, 23.3% of women reported their child's school attendance was disrupted due to IPV. LCA identified four distinct classes of IPV experiences: Low Physical and Sexual Violence (39.1%); Low Physical and High Sexual Violence class (14.8%), High Physical and Low Sexual Violence and Injuries (36.5%); and High Physical and Sexual Violence and Injuries (9.6%). Compared with women in the Low Physical and Sexual Violence class, women in the High Physical and Sexual Violence and Injuries class and women in the High Physical and Low Sexual Violence and Injuries class were at greater risk of IPV disrupting children's school attendance (ARR 3.39, 95% CI 2.34, 4.92; ARR 2.22, 95% CI 1.54, 3.19, respectively). No other statistically significant associations emerged. DISCUSSION: High disruptions in children's school attendance due to IPV were reported and were differentially related to patterns of IPV experiences. Findings underscore the need to understand underlying mechanisms. Future work integrating both violence against women and violence against children is needed.

Adolescent and emerging adults' evaluation of a Facebook site providing sexual health education.

OBJECTIVE: To explore participants' evaluation of an online sexual health intervention posted on Facebook and identify appealing and effective ways to present sexual health content to adolescents and emerging adults (AEAs). DESIGN AND MEASURES: A qualitative approach using peer moderated focus groups was used to elicit reflections on the Facebook site's content, appeal, and ease of navigation. Focus group discussions were transcribed, coded, and analyzed for themes using conventional content analysis. Demographic data were analyzed with SPSS. SAMPLE: Participants (n = 63) were recruited from a Midwestern university and both an urban and rural high school. Eight focus groups were conducted. RESULTS: Participants reported significant concerns with the stigma associated with having sexual health conversations with parents, peers or providers. Participants thought the Facebook site provided reliable sexual health information, was not condescending, and was more visually appealing than other sites frequented by technology-proficient AEA. AEAs suggested developing an independent sexual health education website. CONCLUSION: Findings demonstrate the importance for having accurate and reliable sexual health information available on the internet. The use of visually appealing social media to communicate sexual health content that is interactive, informative, and user-friendly and meets the educational needs of AEA in the Midwest is recommended.

Hospital breastfeeding support and exclusive breastfeeding by maternal prepregnancy body mass index.

Overweight and obese mothers in the United States have disproportionately lower rates of exclusive breastfeeding than mothers of normal weight. The Ten Steps to Successful Breastfeeding (Ten Steps), a series of evidence-based practices designed to support breastfeeding initiation, duration, and exclusivity, demonstrate effectiveness at the population level. It is unknown, however, whether they are consistently provided to women across all maternal body mass index (BMI) categories. We sought to determine whether pre-pregnancy BMI is associated with the implementation and effectiveness of the Ten Steps. We used data from Listening to Mothers III, a cross-sectional survey administered to a sample of mothers who delivered in U.S. hospitals between July 2011 and June 2012. Measures of the Ten Steps were based on maternal self-report on Listening to Mothers III. Our analytic sample was limited to mothers of term infants intending to breastfeed (N = 1,506, weighted). We conducted chi-square testing and constructed weighted multivariable logistic regression models to account for potential confounders. Results suggest that two practices (i.e., holding their babies skin-to-skin for the first time and being encouraged to breastfeed on demand) were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin-to-skin significantly less often than other mothers. Thus, interventions aimed at helping mothers with obesity to hold their babies skin-to-skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.

Hospital practices to promote breastfeeding: The effect of maternal age.

BACKGROUND: Breastfeeding rates are disproportionately low among young mothers in the United States. Although the use of hospital practices to promote breastfeeding is widely supported, the extent to which these practices help explain breastfeeding disparities by maternal age is unclear. Accordingly, we aimed to explore how maternal age may affect (1) receipt of hospital practices and (2) associations between these practices and exclusive breastfeeding. METHODS: Data were derived from participants (n = 1598) of Listening to Mothers III, a national survey administered to mothers of singleton births in United States hospitals from July 2011 to June 2012. We used multivariable logistic regression models and interaction terms to examine maternal age as an effect modifier. RESULTS: Compared with mothers aged 30 and older, mothers aged 18-19 had lower odds of reporting that nurses helped them initiate breastfeeding when ready (OR 0.59 [95% CI 0.35-0.99]), they roomed-in with their baby (OR 0.32 [95% CI 0.19-54]) and they did not receive a pacifier (OR 0.53 [95% CI 0.32-0.90]). Many associations with breastfeeding were stronger among mothers aged 18-19 and 20-24 than mothers aged 25-29 and 30 and older. Additionally, compared with receiving a pacifier, not receiving a pacifier was associated with greater odds of exclusive breastfeeding at 1 week among mothers aged 30 and older (OR 1.47 [95% CI 1.02-2.11]) but lower odds among mothers aged 18-19 (OR 0.26 [95% CI 0.10-0.70]). CONCLUSIONS: Hospital practices to promote breastfeeding may be differentially implemented by maternal age. Encouraging teenage mothers to room-in with their babies may be particularly important for reducing breastfeeding disparities. Pacifier use among babies of teenage mothers requires further exploration.

Exploring Trajectories and Predictors of Depressive Symptoms Among Young Couples During Their Transition to Parenthood.

Objectives Young parents may be particularly vulnerable to poor mental health during the postpartum period. Little research exists, however, to adequately describe trajectories of depressive symptoms during their transition to parenthood, particularly among young fathers. Therefore, we aim to explore trajectories of depressive symptoms from pregnancy through 1 year postpartum among young expectant mothers and their partners. Methods Data are derived from a longitudinal cohort of pregnant adolescent females (ages 14-21; n = 220) and their male partners (n = 190). Multilevel regression models examined the impact of time on depressive symptoms, and generalized linear regression models examined predictors of experiencing elevated depressive symptoms. Results Depressive symptoms significantly decreased from pregnancy through 1 year postpartum among young females. Overall, depressive symptoms did not significantly change over time among young males. Predictors of elevated depressive symptoms common across genders included social support and relationship satisfaction. Marijuana use resulted in almost twice the odds of experiencing elevated depressive symptoms among young fathers (OR 1.82; 95 % CI 1.04, 3.20). Conclusion for Practice Providing strategies for strengthening social support networks among young parents may be an effective way to improve mental health among young parents, particularly during this period of potential social isolation. Additionally, providing tools to strengthen relationships between partners may also be effective for both young mothers and fathers. Substance use may be a marker for depressive symptoms among young fathers and thus screening for substance use could be important to improving their mental health. Future research is needed to better understand how IPV affects mental health, particularly among young fathers.

Hospital strategy uptake and reductions in unplanned readmission rates for patients with heart failure: a prospective study.

BACKGROUND: Despite recent reductions in national unplanned readmission rates, we have relatively little understanding of which hospital strategies are most associated with changes in risk-standardized readmission rates (RSRR). OBJECTIVE: We examined associations between the change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies over 12-18 months in a national sample of hospitals. DESIGN: We conducted a prospective study of hospitals using a Web-based survey at baseline (November 2010-May 2011, n = 599, 91.0% response rate) and 12-18 months later (November 2011-October 2012, n = 501, 83.6% response rate), with RSRR measured at the same time points. The final analytic sample included 478 hospitals. PARTICIPANTS: The study included hospitals participating in the Hospital-to-Home (H2H) and State Action on Avoidable Rehospitalizations (STAAR) initiatives. MAIN MEASURES: We examined associations between change in hospital 30-day RSRR for patients with heart failure and the uptake of strategies previously demonstrated to have increased between baseline and follow-up, using unadjusted and adjusted linear regression. KEY RESULTS: The average number of strategies taken up from baseline to follow-up was 1.6 (SE = 0.06); approximately one-quarter (25.3%) of hospitals took up at least three new strategies. Hospitals that adopted the strategy of routinely discharging patients with a follow-up appointment already scheduled experienced significant reductions in RSRR (reduction of 0.63 percentage point, p value < 0.05). Hospitals that took up three or more strategies had significantly greater reductions in RSRR compared to hospitals that took up only zero to two strategies (reduction of 1.29 versus 0.57 percentage point, p value < 0.05). Among the 117 hospitals that took up three or more strategies, 93 unique combinations of strategies were used. CONCLUSIONS: Although most individual strategies were not associated with RSRR reduction, hospitals that took up any three or more strategies showed significantly greater reduction in RSRR compared to hospitals that took up fewer than three strategies.

Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan.

BACKGROUND: Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan. METHODS: Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007-December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models. RESULTS: Of 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 % confidence interval (CI) 67.9-125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3-44.6) and 1.5/100 p-y (95 % CI 0.6-3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR) = 0.53, 95 % CI 0.31-0.92), while duration of injecting (AHR = 1.09, 95 % CI 1.01-1.18/year) and sharing syringes (AHR = 10.09, 95 % CI 1.01-100.3) independently predicted HIV infection. CONCLUSION: There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support.

Emotion Expression and Substance Use in Newly Parenting Adolescents and Young Adults.

OBJECTIVE: Deficits in emotion expression skills have been associated with alcohol and substance use, but the mechanisms through which these associations occur are not well understood. The current study investigated (a) associations between emotion expression and substance use (i.e., alcohol, cigarettes, and marijuana) in newly parenting adolescents and young adults and (b) whether symptoms of depression and stress mediate these associations in young mothers and fathers. METHODS: Participants recruited from obstetrics and gynecology clinics completed the Center for Epidemiological Studies-Depression Scale, Perceived Stress Scale, Emotion Expression Scale for Children, and substance use items. RESULTS: Path analysis indicated that lower emotion expression at 6 months postpartum was significantly associated with more alcohol and marijuana use at 12 months postpartum for males but not females. Also among males, stress levels at 6 months postpartum partially mediated associations between emotion expression and alcohol and marijuana use at 12 months postpartum. CONCLUSIONS: Findings suggest that poor emotion expression skills are related to more substance use in young fathers, and levels of stress may partially account for this association.

Mental Health Utilization Among Diverse Parenting Young Couples.

Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.

The impact of future expectations on adolescent sexual risk behavior.

Rates of STIs, HIV, and pregnancy remain high among adolescents in the US, and recent approaches to reducing sexual risk have shown limited success. Future expectations, or the extent to which one expects an event to actually occur, may influence sexual risk behavior. This prospective study uses longitudinal data from the National Longitudinal Survey of Youth 1997 (n = 3,205 adolescents; 49.8% female) to examine the impact of previously derived latent classes of future expectations on sexual risk behavior. Cox regression and latent growth models were used to determine the effect of future expectations on age at first biological child, number of sexual partners, and inconsistent contraception use. The results indicate that classes of future expectations were uniquely associated with each outcome. The latent class reporting expectations of drinking and being arrested was consistently associated with the greatest risks of engaging in sexual risk behavior compared with the referent class, which reported expectations of attending school and little engagement in delinquent behaviors. The class reporting expectations of attending school and drinking was associated with having greater numbers of sexual partners and inconsistent contraception use but not with age at first biological child. The third class, defined by expectations of victimization, was not associated with any outcome in adjusted models, despite being associated with being younger at the birth of their first child in the unadjusted analysis. Gender moderated specific associations between latent classes and sexual risk outcomes. Future expectations, conceptualized as a multidimensional construct, may have a unique ability to explain sexual risk behaviors over time. Future strategies should target multiple expectations and use multiple levels of influence to improve individual future expectations prior to high school and throughout the adolescent period.

School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial.

BACKGROUND: Armed conflicts are associated with a wide range of impacts on the mental health of children and adolescents. We evaluated the effectiveness of a school-based intervention aimed at reducing symptoms of posttraumatic stress disorder, depression, and anxiety (treatment aim); and improving a sense of hope and functioning (preventive aim). METHODS: We conducted a cluster randomized trial with 329 children in war-affected Burundi (aged 8 to 17 (mean 12.29 years, standard deviation 1.61); 48% girls). One group of children (n = 153) participated in a 15-session school-based intervention implemented by para-professionals, and the remaining 176 children formed a waitlist control condition. Outcomes were measured before, one week after, and three months after the intervention. RESULTS: No main effects of the intervention were identified. However, longitudinal growth curve analyses showed six favorable and two unfavorable differences in trajectories between study conditions in interaction with several moderators. Children in the intervention condition living in larger households showed decreases on depressive symptoms and function impairment, and those living with both parents showed decreases on posttraumatic stress disorder and depressive symptoms. The groups of children in the waitlist condition showed increases in depressive symptoms. In addition, younger children and those with low levels of exposure to traumatic events in the intervention condition showed improvements on hope. Children in the waitlist condition who lived on their original or newly bought land showed improvements in hope and function impairment, whereas children in the intervention condition showed deterioration on these outcomes. CONCLUSIONS: Given inconsistent effects across studies, findings do not support this school-based intervention as a treatment for posttraumatic stress disorder and depressive symptoms in conflict-affected children. The intervention appears to have more consistent preventive benefits, but these effects are contingent upon individual (for example, age, gender) and contextual (for example, family functioning, state of conflict, displacement) variables. Results suggest the potential benefit of school-based preventive interventions particularly in post-conflict settings. TRIAL REGISTRATION: The study was registered as ISRCTN42284825.

The impact of health education transmitted via social media or text messaging on adolescent and young adult risky sexual behavior: a systematic review of the literature.

Despite the increased use of social media and text messaging among adolescents, it is unclear how effective education transmitted via these mechanisms is for reducing sexual risk behavior. Accordingly, we conducted a systematic review of the literature to examine the effectiveness of social media and text messaging interventions designed to increase sexually transmitted disease (STD) knowledge, increase screening/testing, decrease risky sexual behaviors, and reduce the incidence of STDs among young adults aged 15 through 24 years. Eleven studies met our inclusion criteria. Most of the included studies used a control group to explore intervention effects and included both young men and women. Sample sizes ranged from 32 to 7606 participants, and follow-up periods ranged between 4 weeks and 12 months. These studies provide preliminary evidence indicating that social media and text messaging can increase knowledge regarding the prevention of STDs. These interventions may also affect behavior, such as screening/testing for STDs, sexual risk behaviors, and STD acquisition, but the evidence for effect is weak. Many of these studies had several limitations that future research should address, including a reliance on self-reported data, small sample sizes, poor retention, low generalizability, and low analytic rigor. Additional research is needed to determine the most effective and engaging approaches for young men and women.

Bringing your baggage to bed: associations of previous relationship experiences with sexual risk.

Delaying sexual intercourse after initiating a relationship (i.e., increasing the presexual period) and delaying unprotected sex can reduce HIV/STI risk. Past relationship and risk experiences may influence sexual decisions in a current relationship. We examined how past relationship and risk experiences of both members of 296 young pregnant couples influenced length of presexual period and time to unprotected sex. Forty-six percent of couples had sex within the first month of seeing each other and had unprotected sex within 1 month of having sex. Length of presexual period and time to unprotected sex were significantly shorter in their current relationship than their previous relationship for both men and women (all p < 0.05). Female past relationship and risk factors were more strongly associated with length of presexual relationship than male past relationship and risk factors. Both male and female past relationship and risk factors were associated with time to unprotected sex.

The role of parenting in affecting the behavior and adaptive functioning of young children of HIV-infected mothers in South Africa.

Prior investigations suggest that maternal HIV/AIDS poses significant challenges to young children. This study investigates the relationships between mothers' psychological functioning, parenting, and children's behavioral outcomes and functioning in a population of women living with HIV (N = 361) with a child between the ages of 6 and 10 years in Tshwane, South Africa. Utilizing path analysis, findings revealed that maternal depression is related to increased parenting stress and parent-child dysfunction, maternal coping is related to parenting style, and maternal coping, parenting style and stress, and parent-child dysfunction are associated with children's behavior and functioning, with parenting emerging as an important mediator. These findings suggest that interventions for women living with HIV and their children should not only address maternal psychological functioning (depression and coping), but should also focus on parenting, promoting a positive approach.

Strategies to reduce hospital 30-day risk-standardized mortality rates for patients with acute myocardial infarction: a cross-sectional and longitudinal survey.

BACKGROUND: Survival rates after acute myocardial infarction (AMI) vary markedly across U.S. hospitals. Although substantial efforts have been made to improve hospital performance, we lack contemporary evidence about changes in hospital strategies and features of organizational culture that might contribute to reducing hospital AMI mortality rates. We sought to describe current use of several strategies and features of organizational culture linked to AMI mortality in a national sample of hospitals and examine changes in use between 2010 and 2013. METHODS: We conducted a cross-sectional survey of 543 hospitals (70% response rate) in 2013, and longitudinal analysis of a subsample of 107 hospitals that had responded to a survey in 2010 (67% response rate). RESULTS: Between 2010 and 2013, the use of many strategies increased, but the use of only two strategies increased significantly: the percentage of hospitals providing regular training to Emergency Medical Service (EMS) providers about AMI care increased from 36% to 71% (P-value < 0.001) and the percentage of hospitals using computerized assisted physician order entry more than doubled (P-value < 0.001). Most, but not all, hospitals reported having environments conducive to communication, coordination and problem solving. CONCLUSIONS: We found few significant changes between 2010 and 2013 in hospital strategies or in key features of organizational culture that have been associated with lower AMI mortality rates. Findings highlight several opportunities to help close remaining performance gaps in AMI mortality among hospitals.

Empowerment and use of antenatal care among women in Ghana: a cross-sectional study.

BACKGROUND: Empowerment among women in the context of a romantic relationship may affect the use of reproductive healthcare services; however, current literature examining this association is limited and inconsistent. We therefore aimed to examine the relationship between several measures of empowerment and use of inadequate antenatal care among women in Ghana. METHODS: We conducted a cross-sectional study using data from a nationally representative cohort of women in Ghana. Our analytic sample was limited to non-pregnant women who had been pregnant and involved in a relationship within the last 12 months. We used multivariable logistic regression to assess the associations between empowerment and inadequate use of antenatal care and interaction terms to assess moderation by education. RESULTS: Approximately 26% of women received inadequate antenatal care. Multivariable analysis indicated that having experienced physical abuse in the past year was directly associated with inadequate use of antenatal care (OR = 5.12; 95% CI = 1.35, 19.43) after adjusting for socio-demographic characteristics. This effect was particularly pronounced among women with no formal education and was non-significant among women with at least some formal education (P-value for interaction <0.001). CONCLUSIONS: Results suggest that improving use of reproductive health care services will require reducing partner abuse and enhancing empowerment among women in Ghana and other low-income countries, particularly among those with no formal education. Furthermore, the involvement of male partners will be critical for improving reproductive health outcomes, and increasing education among girls in these settings is likely a strong approach for improving reproductive health and buffering effects of low empowerment among women.

"Love hurts": romantic attachment and depressive symptoms in pregnant adolescent and young adult couples.

OBJECTIVE: The current study investigates the relationship between romantic attachment style and depressive symptoms between both members of pregnant adolescent and young adult couples. METHOD: Participants were 296 pregnant young females (mean age = 18.7) and their male partners (mean age = 21.3; 592 total participants) who were recruited from obstetrics and gynecology clinics in Connecticut. The dimensions of avoidant and anxious romantic attachment were assessed using the Experiences in Close Relationships Inventory. Depressive symptoms were measured using the Center for Epidemiological Studies-Depression Scale. RESULTS: Results showed that avoidant attachment and anxious attachment were significantly positively related to depressive symptoms. Multilevel modeling for partner effects revealed that anxious attachment and depressive symptoms in partners were significantly positively associated with depressive symptoms CONCLUSION: Findings underscore the importance of considering couples-based approaches to supporting the transition to parenthood and developing the necessary self and relationship skills to manage attachment needs and relationship challenges.

Global health education programming as a model for inter-institutional collaboration in interprofessional health education.

While global health (GH) opportunities have expanded at schools of medicine, nursing, and public health, few examples of interprofessional approaches to GH education have been described. The elective GH program at our university serves as an important opportunity for high-quality interprofessional education. We undertook a qualitative study to examine the experience of student, faculty and administrative leaders of the program. We used content analysis to code responses and analyze data. Among the leadership, key themes fell within the categories of interprofessional education, student-faculty collaboration, professional development, and practical considerations for the development of such programs. The principles described could be considered by institutions seeking to develop meaningful partnerships in an effort to develop or refine interprofessional global health education programs.

Identifying patients at increased risk for unplanned readmission.

BACKGROUND: Reducing readmissions is a national priority, but many hospitals lack practical tools to identify patients at increased risk of unplanned readmission. OBJECTIVE: To estimate the association between a composite measure of patient condition at discharge, the Rothman Index (RI), and unplanned readmission within 30 days of discharge. SUBJECTS: Adult medical and surgical patients in a major teaching hospital in 2011. MEASURES: The RI is a composite measure updated regularly from the electronic medical record based on changes in vital signs, nursing assessments, Braden score, cardiac rhythms, and laboratory test results. We developed 4 categories of RI and tested its association with readmission within 30 days, using logistic regression, adjusted for patient age, sex, insurance status, service assignment (medical or surgical), and primary discharge diagnosis. RESULTS: Sixteen percent of the sample patients (N=2730) had an unplanned readmission within 30 days of discharge. The risk of readmission for a patient in the highest risk category (RI<70) was >1 in 5 while the risk of readmission for patients in the lowest risk category was about 1 in 10. In multivariable analysis, patients with an RI<70 (the highest risk category) or 70-79 (medium risk category) had 2.65 (95% confidence interval, 1.72-4.07) and 2.40 (95% confidence interval, 1.57-3.67) times higher odds of unplanned readmission, respectively, compared with patients in the lowest risk category. CONCLUSION: Clinicians can use the RI to help target hospital programs and supports to patients at highest risk of readmission.