Neonatal Outcomes of Infants Born to Pregnant Women With Substance Use Disorders: A Multilevel Analysis of Linked Data.

OBJECTIVE: This study examines the associations of substance use disorders in pregnancy with a set of neonatal outcomes. METHODS: This is a quantitative retrospective study. Three linked datasets of a 10-year period (2007-2016) from New South Wales, Australia, were examined. Pregnant women were identified positive for substance use disorders when at least one hospital admission during pregnancy or delivery had opioid-, or cannabis-, or stimulant-, or alcohol- or two or more of the four substance groups- related ICD-10-AM diagnostic code. As there was a hierarchical structure in the dataset, the adjusted odds ratio (AOR) was estimated using multilevel logistic regression. FINDINGS: Of the 622,640 birth records, 1677 (0.27%) women had opioid-related, 1857 (0.30%) had cannabis-related, 552 (0.09%) had stimulant-related, 595 (0.10%) had alcohol-related and 591 (0.09%) had polysubstance-related ICD-10-AM diagnostic codes. There were significant relationships between opioid use in pregnancy and neonatal health outcomes including preterm birth (AOR 3.2; 95% CI 2.8, 3.7) and admission to the neonatal intensive care unit (NICU) (AOR 10.0; 95% CI 8.8, 11.3). Substance use disorders due to cannabis, stimulants, alcohol or polysubstance were significantly associated with preterm birth, low birthweight, low APGAR score and admission to NICU. Also, alcohol and polysubstance use disorders in pregnancy were found to be significantly associated with stillbirth. CONCLUSION: Results demonstrate that substance use disorders in pregnancy are associated with an increased risk of adverse neonatal outcomes. Early identification of substance use disorders through screening and adherence to pharmacotherapy and other psychosocial interventions could improve neonatal outcomes.

Short-term health outcomes of newborn infants of substance-using mothers in Australia and New Zealand: A systematic review.

AIM: Substance use is not unusual among women of childbearing age. Pregnant women who use a substance and the consequent impacts on a newborn vary across studies and settings. We reviewed New Zealand and Australian literature to examine the short-term health outcomes of newborn of substance-using mothers and their demographic characteristics. METHODS: Five medical/nursing databases and google scholar were searched in April 2017. Studies were considered eligible if they described outcomes of newborn of substance-using mothers. Mixed Methods Appraisal Tool was used for quality assessment of candidate studies. Relevant data were extracted and analyzed using narrative synthesis. Based on data availability, a subset of studies was included in meta-analysis. RESULTS: Although findings of individual studies vary, there are some evidence that the infants born to substance-using mothers were likely to have preterm birth, low birthweight, small-for-gestational age, low Apgar score, and admission to neo-natal intensive care unit. The likelihood of adverse health outcomes was much higher for newborns of polysubstance-using mothers, than newborns of mothers using a single substance. Pregnant women who use illicit substance are predominantly socially disadvantaged, in their twenties and or of Aboriginal descent. CONCLUSION: Infants of substance-using mothers suffer a range of adverse health outcomes. Multidisciplinary and integrated approach of services that ensure supportive social determinants of health may result in a better outcome for newborn and positive behavioral change among mothers.

Sexual harassment and victimization of students: a case study of a higher education institution in South Africa.

INTRODUCTION: Sexual harassment has been identified as a major public health problem that is hidden in most institutions/organizations. OBJECTIVE: This study assessed sexual harassment and victimization of students in a higher institution in South Africa. METHODS: A quantitative, cross-sectional descriptive design was used in this study. The target population was registered students of the higher education institution and the sample size was 342. Questionnaire was used for data collection and data were analyzed using Statistical Package for Social Sciences (SPSS) Version 23.0 program. The basic principles of ethics were duly observed and the ethical clearance certificate was obtained prior to data collection. RESULTS: The findings revealed that 27 (17.3%) of the male and 47 (25.5%) of the female respondents (P = 0.047) had personally experienced unwanted touching. Two (1.3%) male and 5 (2.7%) female students admitted that they have been raped. Seventeen (10.8%) of the males and 19 (10.2%) of the females had been coerced to comply with a sexual relationship on campus. CONCLUSION: This study shows that both male and female students on campus are experiencing different forms of sexual harassment.

Barriers to screening pregnant women for alcohol or other drugs: A narrative synthesis.

BACKGROUND: Maternal alcohol or other drug use during pregnancy is associated with a range of adverse health outcomes for mothers and their unborn child. The antenatal period presents an opportunity for health professionals to offer routine screening for alcohol or other drugs, to then provide intervention and referral for treatment and/or specialised support services. However, literature indicates that limited screening practices currently exist in maternity care settings. AIM: To identify barriers to screening pregnant women for alcohol or other drugs in maternity care settings, from the perspectives of healthcare professionals. METHODS: A comprehensive literature search was conducted in October 2017 to identify relevant studies. Seven databases that index health and social sciences literature, and google scholar, were searched. Eligible articles were subjected to critical appraisal. Extracted data from the eligible studies were synthesised using narrative synthesis. FINDINGS: Nine studies were eligible for this review. The review identified seven key barriers to screening for alcohol or other drugs in pregnancy, namely competing priorities and time constraint; lack of adequate screening skills and clear protocol; relationship between healthcare providers and pregnant women; healthcare providers' perceptions; under-reporting or none/false disclosure; inconclusive evidence regarding the risk of alcohol or other drug use in pregnancy; and concerns about guilt and anxiety. CONCLUSIONS: The narrative review revealed a range of barriers to screening for alcohol or other drugs in pregnancy. Further research in minimising the barriers is required to establish women-centred, evidence-base screening practices.

Standardised alcohol screening in primary health care services targeting Aboriginal and Torres Strait Islander peoples in Australia.

INTRODUCTION AND AIMS: Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHSs) around Australia have been asked to standardise screening for unhealthy drinking. Accordingly, screening with the 3-item AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) tool has become a national key performance indicator. Here we provide an overview of suitability of AUDIT-C and other brief alcohol screening tools for use in ACCHSs. METHODS: All peer-reviewed literature providing original data on validity, acceptability or feasibility of alcohol screening tools among Indigenous Australians was reviewed. Narrative synthesis was used to identify themes and integrate results. RESULTS: Three screening tools-full AUDIT, AUDIT-3 (third question of AUDIT) and CAGE (Cut-down, Annoyed, Guilty and Eye-opener) have been validated against other consumption measures, and found to correspond well. Short forms of AUDIT have also been found to compare well with full AUDIT, and were preferred by primary care staff. Help was often required with converting consumption into standard drinks. Researchers commented that AUDIT and its short forms prompted reflection on drinking. Another tool, the Indigenous Risk Impact Screen (IRIS), jointly screens for alcohol, drug and mental health risk, but is relatively long (13 items). IRIS has been validated against dependence scales. AUDIT, IRIS and CAGE have a greater focus on dependence than on hazardous or harmful consumption. DISCUSSION AND CONCLUSIONS: Detection of unhealthy drinking before harms occur is a goal of screening, so AUDIT-C offers advantages over tools like IRIS or CAGE which focus on dependence. AUDIT-C's brevity suits integration with general health screening. Further research is needed on facilitating implementation of systematic alcohol screening into Indigenous primary healthcare.