Medication for Opioid Use Disorder During Pregnancy - Maternal and Infant Network to Understand Outcomes Associated with Use of Medication for Opioid Use Disorder During Pregnancy (MAT-LINK), 2014-2021.

Problem: Medication for opioid use disorder (MOUD) is recommended for persons with opioid use disorder (OUD) during pregnancy. However, knowledge gaps exist about best practices for management of OUD during pregnancy and these data are needed to guide clinical care. Period Covered: 2014-2021. Description of the System: Established in 2019, the Maternal and Infant Network to Understand Outcomes Associated with Medication for Opioid Use Disorder During Pregnancy (MAT-LINK) is a surveillance network of seven clinical sites in the United States. Boston Medical Center, Kaiser Permanente Northwest, The Ohio State University, and the University of Utah were the initial clinical sites in 2019. In 2021, three clinical sites were added to the network (the University of New Mexico, the University of Rochester, and the University of South Florida). Persons receiving care at the seven clinical sites are diverse in terms of geography, urbanicity, race and ethnicity, insurance coverage, and type of MOUD received. The goal of MAT-LINK is to capture demographic and clinical information about persons with OUD during pregnancy to better understand the effect of MOUD on outcomes and, ultimately, provide information for clinical care and public health interventions for this population. MAT-LINK maintains strict confidentiality through robust information technology architecture. MAT-LINK surveillance methods, population characteristics, and evaluation findings are described in this inaugural surveillance report. This report is the first to describe the system, presenting detailed information on funding, structure, data elements, and methods as well as findings from a surveillance evaluation. The findings presented in this report are limited to selected demographic characteristics of pregnant persons overall and by MOUD treatment status. Clinical and outcome data are not included because data collection and cleaning have not been completed; initial analyses of clinical and outcome data will begin in 2023. Results: The MAT-LINK surveillance network gathered data on 5,541 reported pregnancies with a known pregnancy outcome during 2014-2021 among persons with OUD from seven clinical sites. The mean maternal age was 29.7 (SD = ±5.1) years. By race and ethnicity, 86.3% of pregnant persons were identified as White, 25.4% as Hispanic or Latino, and 5.8% as Black or African American. Among pregnant persons, 81.6% had public insurance, and 84.4% lived in urban areas. Compared with persons not receiving MOUD during pregnancy, those receiving MOUD during pregnancy were more likely to be older and White and to have public insurance. The evaluation of the surveillance system found that the initial four clinical sites were not representative of demographics of the South or Southwest regions of the United States and had low representation from certain racial and ethnic groups compared with the overall U.S. population; however, the addition of three clinical sites in 2021 made the surveillance network more representative. Automated extraction and processing improved the speed of data collection and analysis. The ability to add new clinical sites and variables demonstrated the flexibility of MAT-LINK. Interpretation: MAT-LINK is the first surveillance system to collect comprehensive, longitudinal data on pregnant person-infant dyads with perinatal outcomes associated with MOUD during pregnancy from multiple clinical sites. Analyses of clinical site data demonstrated different sociodemographic characteristics between the MOUD and non-MOUD treatment groups. Public Health Actions: MAT-LINK is a timely and flexible surveillance system with data on approximately 5,500 pregnancies. Ongoing data collection and analyses of these data will provide information to support clinical and public health guidance to improve health outcomes among pregnant persons with OUD and their children.

Challenges experienced by GPs when providing palliative care in the UK: a systematic qualitative literature review.

BACKGROUND: GPs in the UK will face increased palliative care demands in the coming years. Understanding what makes providing palliative care difficult for GPs is an important step to planning future services, but currently there is an absence of synthesised literature addressing this area. AIM: To identify the range of issues that affect GPs' provision of palliative care. DESIGN & SETTING: A qualitative systematic review and thematic synthesis of studies exploring GPs' experiences of providing palliative care in the UK. METHOD: Four databases (MEDLINE, Embase, Web of Science, and CINAHL [Cumulated Index to Nursing and Allied Health Literature]) were searched on 1 June 2022 to identify relevant primary qualitative literature published between 2008 and 2022. RESULTS: Twelve articles were included in the review. The following four themes were identified that affect GPs' experiences of providing palliative care: lack of resources to support palliative care provision; fragmented multidisciplinary team (MDT) approach; challenging communication with patients and carers; and inadequate training to address the complexities of palliative care. Pressures caused by increasing workloads and a lack of staffing combined with difficulty accessing specialist teams impeded GPs' provision of palliative care. Further challenges were deficiencies in GP training, and a lack of patient understanding or unwillingness to engage in palliative care discussions. CONCLUSION: A multifaceted approach focusing on increased resources, improved training, and a seamless interface between services, including improved access to specialist palliative teams when necessary, is needed to address the difficulties that GPs face in palliative care. Regular in-house MDT discussion of palliative cases and exploration of community resources could generate a supportive environment for GPs.

Step Counts on Weekdays, Weekends, and During Physical Education of Navajo High School Students.

BACKGROUND: Understanding the physical activity patterns of youth is important for the implementation and evaluation of programming and interventions designed to change behavior. To date, little is known about the objectively measured physical activity patterns of Native American youth. Therefore, the purpose of the study was to examine the step counts of Navajo youth during weekdays, weekend days, and physical education classes. METHODS: Participants included 63 high school students (mean age = 15.14 ± 1.37 years). Youth wore a pedometer (Walk-4-Life 2505) for seven consecutive days. Means and standard deviations were calculated for weekdays, weekend days, and physical education. RESULTS: Boys averaged 11,078 ± 4400 steps/weekday compared to 6493 ± 5651 on weekend days. Girls averaged 7567 ± 5614 on weekdays compared to 7589 ± 7712 on weekend days. Both boys (20 %) and girls (26 %) accumulated a large percentage of their weekday step counts from physical education classes. CONCLUSIONS: Findings highlight the importance of additional physical activity opportunities in the community. Youth are falling well short of recommended levels of physical activity with physical education being an important source of physical activity.

The Effects of Single-Family Rooms on Parenting Behavior and Maternal Psychological Factors.

OBJECTIVE: To examine the relationships among special care nursery design, parental presence, breastfeeding, psychological distress, hospital-related stress, and maternal parenting self-efficacy at the infant's discharge from hospital and at 4 months postdischarge. DESIGN: We used a causal comparative design to compare two special care nursery designs: open ward nursery (OW) and single-family room (SFR) nursery. SETTING: Special care nurseries of two tertiary hospitals on the Gold Coast, Australia, with the newly built second hospital replacing the first. PARTICIPANTS: Fifty-six mothers of infants cared for in the special care nurseries (OW, n = 31; SFR, n = 25). METHODS: Participating mothers completed parental presence records during their infants' stays in hospital and completed two surveys, one at discharge and the other at 4 months postdischarge, to measure their psychological distress, hospital-related stress, parenting self-efficacy, and infant feeding method. RESULTS: Mothers with newborns in SFR nurseries spent markedly more time with their newborns, without any more visits or fewer visits, than mothers of newborns in OW nurseries during the first 2 weeks of their newborns' lives. For mothers with low levels of presence, parental role alteration stress was significantly greater for mothers in OW compared with SFR nurseries. Compared with mothers of infants in OW nurseries, mothers of newborns in SFR nurseries were significantly more likely to exclusively breastfeed their newborns at discharge from the hospital and at 4 months postdischarge. CONCLUSION: Compared with mothers with infants in OW nurseries, mothers with infants in SFR nurseries were more likely to be present and to initiate and maintain breastfeeding. Likewise, the SFR nursery was protective against stress related to changes in the parenting role for mothers who had low levels of presence.