Socioeconomic resources moderate the relationship between maternal prenatal obsessive-compulsive symptoms and infant negative affectivity.

Perinatal maternal depression, anxiety, and stress are associated with poor infant outcomes. However, no known study has investigated the effects of perinatal maternal obsessive-compulsive symptomatology on infant outcomes while considering important situational factors such as socioeconomic resources. Therefore, we investigated the effects of prenatal and postnatal obsessive-compulsive symptomatology on infant behavioral reactivity, beyond the effects of postnatal depressive symptomatology, at 6 months of age. It was expected that socioeconomic resources would moderate this relationship. We recruited 125 pregnant women from a Health Professional Shortage Area for mental health and primary care in the Midwest United States and interviewed them at approximately 34 weeks gestation and again at 6 months postnatally. They were administered questionnaires at both time points measuring obsessive-compulsive and depressive symptoms. Infant behavioral reactivity was gathered during 6-month follow-up through behavioral observation coding and maternal-report modalities. Maternal-reported infant negative affectivity at 6 months was related to greater severity of maternal postnatal depressive symptomatology, and socioeconomic resources moderated the relationship between maternal prenatal obsessive-compulsive symptoms and maternal-reported infant negative affectivity. However, neither of these relations was statistically significant when infant reactivity was quantified using behavioral observations.

Hepatitis C Treatment Cascade in a Federally Qualified Health Center.

Hepatitis C (HCV) care cascades have been described in diverse clinical settings, patient populations and countries, highlighting the steps in HCV care where improvements can be made and resources allocated. However, more research is needed to examine barriers to HCV treatment in rural, underserved populations and in Federally Qualified Health Centers (FQHCs). As part of a quality improvement (QI) project, this study aimed to describe and evaluate the HCV treatment cascade in an FQHC serving a large rural patient population in the Western United States. Standardized chart abstraction was utilized to aggregate data regarding patient demographics, the percentage of patients achieving each step in the treatment cascade, and relevant patient (i.e., viral load) and service variables (i.e., whether and when patients received treatment or medication). 389 patients were identified as having HCV and 86% were aware of their diagnosis. Fifty-five percent had their infection confirmed via viral load, 21% were staged for liver disease, 24% received a prescription for treatment, and 19% achieved cure. Compared to national data, the current regional sample had greater rates of diagnosis awareness and access to care, as well as sustained virologic response (SVR), but lower rates of viral load confirmation. Current findings suggest that rural patients living with HCV who receive care at FQHCs struggle to navigate the treatment cascade and achieve a cure, particularly with regard to infection confirmation, liver staging, and prescription. However, compared to national estimates, patients had greater rates of diagnosis awareness/treatment access and SVR.

Relationships among Socioeconomic Status, Dietary Intake, and Stress in Breastfeeding Women.

BACKGROUND: As breastfeeding duration increases, it is important to understand diets of breastfeeding women and other factors salient to maternal/offspring health, including stress. It is important to further consider sociodemographic factors, given their associations with nutritional deficiencies and perceived stress. OBJECTIVE: We cross-sectionally compared breastfeeding women's dietary intakes from a food frequency questionnaire (assessing from pregnancy through 3 months postpartum) with Estimated Average Requirements (EARs). We hypothesized that dietary intake was related to sociodemographic variables and parenting stress. DESIGN: We examined a cohort of predominately breastfeeding women. Food frequency questionnaire results were compared with EARs, the Parenting Stress Index: Short Form, and a demographic questionnaire. PARTICIPANTS/SETTING: Participants included 101 women (of 289 recruited) who breastfed singleton, full-term infants for the first 3 months while using <28 oz formula/wk. The study included community recruitment in rural Oklahoma from 2008 to 2012. STATISTICAL ANALYSES: Mean and standard deviation or frequencies were reported. One-sample t tests compared EARs with mean dietary intakes over the past 12 months. Pearson correlations and one-way analyses of variance explored relationships among dietary, sociodemographic, and stress variables. RESULTS: Twenty-two percent of women did not meet EAR minimum energy recommendations and >40% did not meet protein recommendations. Despite widespread supplement use, some consumed less than the EAR for vitamin E (35%), calcium (22%), and vitamin C (19%). Carbohydrate consumption was positively related to the difficult child scale (r=0.19; P=0.05). Dietary riboflavin (r=-0.19; P=0.05) and vitamin D intake (r=-0.19; P=0.05) were negatively related to the parent-child dysfunction scale. CONCLUSIONS: Despite efforts to enhance education and counseling regarding adequate perinatal nutrition-related practices, even well-educated women may not meet EARs. This poor dietary intake may be associated with parenting stress and have potential long-term implications for child health.