Antenatal psychosocial assessment and depression screening in an Australian Private Hospital setting: A qualitative examination of women's perspectives.

BACKGROUND: In Australia, clinical practice guidelines have been developed to support the implementation of antenatal psychosocial assessment and depression screening in routine clinical obstetric care. While there has been widespread uptake of such programs in Australian public hospitals, implementation in private hospitals has been slower. However, the situation in this regard may be changing, with the emergence of examples of midwife delivered screening programs in a number of private hospital settings. At present, patient experiences of these programs are largely unknown. AIM: The aim of this study was to gain feedback from women who participated in the 'Pre-admission midwife appointment' program at an Australian private hospital about their experiences of, and perspectives about, the program. METHODS: Semi-structured interviews were conducted with 20 women (Mage 36.04 years, range 30-48) who had given birth to a child between 9 and 14 months prior to the interview (M = 11.87 months, SD = 1.76) and who had attended the Pre-admission midwife appointment program during the pregnancy. Interviews were transcribed and analysed using an inductive thematic analysis approach with an essentialist-realistic theoretical framework. FINDINGS: Data analysis revealed five major themes: 'increased awareness and support for perinatal mental health issues', 'enhanced quality of care provided at the hospital', 'experience with the midwife impacts perceptions of the program'; 'partners', and 'preparation for the program'. DISCUSSION: This study provides useful information from the perspective of consumers, about a psychosocial assessment and depression screening program at an Australian private hospital. It highlights a number of program benefits for pregnant women, their partners, and the hospital, as well as factors facilitating program success.

Health professional's knowledge and awareness of perinatal depression: results of a national survey.

INTRODUCTION: Postnatal depression affects 14% of women, occurring also antenatally, with potential long-term consequences, making it an important disorder to detect and manage early. In this study we sought to examine knowledge and awareness of perinatal depression in health professionals involved in perinatal care throughout Australia prior to the implementation of a comprehensive screening program, aimed at improving detection and access to appropriate management. METHODS: A random sample of General Practitioners (GPs) and Maternal Child Health Nurses (MCHNs) and Midwives, in regions throughout Australia to be subsequently targeted by a screening and education program, were invited to participate. Responses to a hypothetical vignette and a knowledge questionnaire, as well as details of experience were completed. FINDINGS: Questionnaires were completed by 246 GPs, 338 MCHNs and 569 midwives, with overall response rates; GP's 23%; MCHN's 55% and midwives 57%. Although knowledge level was similar among professional groups, MCHNs had higher levels of awareness of perinatal depression. Both GPs and MCHNs were more likely than midwives to recognize the need for providing help to women with emotional distress. Depression was more likely to be considered postnatally than antenatally in all groups, with GPs most likely to provide this diagnosis. GPs had a significant propensity to recommend antidepressants, and midwives to select non-specific medications. CONCLUSIONS: Health professionals responding to this survey had a high awareness and similar knowledge base. Further education on antenatal depression and the safety risks and alternatives to medication is important for all groups, but particularly important for midwives and GPs. The latter is especially relevant given the preference for women with perinatal depression not to use pharmacological interventions to treat their emotional distress.

Bone sialoprotein promotes bone metastasis of a non-bone-seeking clone of human breast cancer cells.

Bone sialoprotein (BSP) is a major non-collagenous protein in mineralized tissues. BSP is also implied to be involved in tumor metastasis through its unique structure. Using the human breast cancer cell line MDA-231, we established both brain-seeking and bone-seeking cell clones. The brain-seeking cells (MDA4-231BR) showed no bone metastasis in an animal model. In this experiment, MDA-231BR cells were transfected with BSP cDNA and inoculated into the hearts of nude mice. All five nude mice which received BSP-transfected MDA-231BR cells developed bone metastases, while no bone lesions were observed in the control group. Histological examination revealed invasion of tumor cells into the endosteal space and erosion of the bone margin. Some animals were crippled due to large lesions. These results suggest that BSP may impart to breast cancer cells the capacity to metastasize and thus play an important role in bone metastasis of malignant tumors.

Managing menstrual disturbances.

PIP: Changes in menstrual bleeding, the most common side effects of progestin-only contraceptives, can worry women, leading to discontinuation. In fact, menstrual disturbances comprise the main reasons for discontinuing progestin-only contraceptives. Before prescribing these contraceptives, providers should advise women that they are likely to experience changes in menstrual bleeding. They should also guide women to compare the benefits of the contraception with these side effects. The key to user satisfaction and continuation is counseling. Counseling should help women determine what they want and are able to do. The changes in menstrual bleeding for many women have cultural implications (e.g., bleeding restricts women's activities). Providers should first ascertain whether changes in menstrual bleeding are a side effect of progestin-only contraceptives or signify another condition. For example, prolonged bleeding is also a symptom of cancer. Once the provider has eliminated other conditions, he/she should explain to clients that users of progestin-only contraceptives commonly experience menstrual disturbance. Irregular or prolonged bleeding is common during the first 3-6 months of use, then tends to subside. Amenorrhea poses no medical reason to discontinue progestin-only contraceptives. When counseling does not reassure clients or when clients experience prolonged or heavy bleeding, providers can prescribe hormonal treatments and nonsteroidal, anti-inflammatory drugs: one low-dose combined oral contraceptive pill or estrogen once a day for 7-21 days or, if bleeding is more severe, once every 12 hours; 200 mg ibuprofen, or any nonsteroidal anti-inflammatories other than aspirin 3-4 times/ day. Some providers question whether estrogen or ibuprofen should be administered on top of progestin, since the double treatment may cause undesirable side effects. Also some women use progestin-only methods because they can not use estrogen. Iron supplements can treat women susceptible to anemia.^ieng