Third-Trimester Ultrasound Diagnosis of Large for Gestational Age and Risk of Cesarean Delivery.

OBJECTIVE: Determine if knowledge of a third-trimester ultrasound diagnosis of large for gestational age (LGA) independently increases the risk of cesarean delivery (CD). STUDY DESIGN: Historical cohort comparing CD rate among patients diagnosed with an LGA fetus on a clinically indicated ultrasound from January 2017 to July 2021 with those without an LGA diagnosis at 34 weeks or later. LGA was defined as an ultrasound-estimated fetal weight greater than or equal to the 90th percentile for the gestational age. Univariate analysis was performed to identify significant confounding variables and was utilized as covariates for binary regression with CD rate as the primary outcome, and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated. Nulliparous term singleton vertex (NTSV) and multiparous CD rates were also compared. RESULTS: There were 447 patients diagnosed with an LGA fetus and 1971 patients without an LGA diagnosis on third-trimester ultrasound. The positive predictive value of LGA diagnosis was 50.1% and the false positive rate was 10.6%. Patients with a diagnosis of LGA had higher AOR of CD (OR 2.11, 95% CI 1.56-2.83), and higher AOR of NTSV CD (OR 1.88, 95% CI 1.14-3.13) compared with those without an LGA diagnosis. There was no difference in the rates of non-medically indicated CD, multiparous primary CD, and attempted and successful TOLAC. CONCLUSION: Our results suggest third-trimester ultrasound diagnosis of LGA independently increases odds of CD, specifically among nulliparous patients, and the potential bias may be one factor contributing to excessive CDs and NTSV CDs.

Examining no-show rates in a community health centre in the United States.

The purpose of this research was to examine patient characteristics that may be associated with appointment no-show rates, and to explore patients' perspectives of missed appointments at a community health centre that primarily serves low-income individuals. This mixed-method, cross-sectional study is based upon data collected from a community health centre in Southeastern Tennessee in the United States that provided preventative medical, behavioural health and dental care. Authors utilised de-identified electronic health record (EHR) information on no-show occurrence and sociodemographic characteristics of all patients served by the clinic (n = 1,243), as well as completed mixed method patient interviews a sub-sample of those receiving service from the clinic (n = 30). EHR data were pulled from clinic visits occurring during July-November 2017, and patient interviews were completed January-March 2018. Measures were developed by the authors and clinic administrators after a thorough review of existing literature. HER data demonstrated an association between higher no-show rate and younger patients was identified and Black or African American patients had higher no-show rate than White patients. However, no differences in no-show rate existed between male and female participants or when examining patients' location. Based on interview data, patients were generally satisfied with their services or providers, but some indicated dissatisfaction. Patients typically missed appointments due to personal issues and societal barriers. Findings support the need for clinics to consider ways to support patients facing competing demands for their time or those facing more resource constraints. Recommendations for research include examining long-term health outcomes of clients who are experiencing no-shows. Changes in practice or procedures were also noted, such as providing transportation, elevating awareness and access to social services, ensuring that that social care workers are reaching out to clients with higher no-shows and educating clients on the importance of preventative care.

Examining the Impact of COVID-19 on Parental Stress: A Study of Foster Parents.

Purpose: The overarching purpose of this exploratory study was to understand how foster parents' parenting-related stress levels have changed over the course of the COVID-19 pandemic, including the role of sociodemographic characteristics in exacerbating risk for increased stress. Method: Participants were electronically surveyed about their pre- and post-pandemic parenting-related stress, using an adapted version of the parenting stress scale. Results: Nine-hundred and ninety foster parents (N = 990) participated in the study. Overall, foster parents reported significant increases along three specific domains of stress-namely, parenting stress, lack of control, and parental satisfaction (reverse-scored). Analyses for group differences on the post-only scores indicated that foster parents who are not married, or who report poorer mental health (i.e., "good", versus "very good" or "excellent") or financial circumstances (i.e., as indicated by not reliably having more income than expenses) may face increased risk for exacerbated stress during this pandemic. Discussion: Findings from this study indicate that parental stress-levels among foster parents have increased since the start of COVID-19. These findings are not only troubling for foster caregivers, but may also have implications for the youth in their care. Ultimately, results from this study indicate the need to better support foster parents, in general, and during public health crises, specifically.

Quality improvement: patient education for management of hypertension in pregnancy.

Objective: To assess the effectiveness of interactive education tools for hypertension in pregnancy.Two interactive education tools were introduced.Methods: Pregnant women with hypertension completed questionnaires before (Pre-I) and after)Post-I) the intervention.Providers rated satisfaction and effectiveness of the education methods.Results: The Post-I group (N=45) showed slight improvement on both Perceived (4.5±0.7) and Actual knowledge (2.2 ± 1.0) compared to the Pre-I group (N=45; Perceived: 4.2±1.0; Actual: 1.7±1.3; p<.05) .Providers reported higher satisfaction after the intervention (2.6±1.1 vs 4.1±0.7; p <.001).iscussion: The intervention increased patients' knowledge and providers rating of patient knowledge, and decreased the time needed for patient education.

Processing the Removal and Managing the Moves or Removals of Foster Children: A Qualitative Exploration of Foster Parents' Experiences.

Foster parents are crucial to the function of the child welfare system. Despite developments in research related to the grief and loss of foster parents, more research would be helpful in building a stronger understanding and knowledge base for helping foster parents manage the removals of foster children in their home. This study included ten foster parents from the United States and explored their experience with loss and the stress associated with the expected or unexpected removal of a foster child from their home. The findings of the data analysis yielded three overarching themes: (1) managing or coping with ambiguous loss; (2) systemic impacts of a move or removal on a family; (3) need for helpful preparation or support for dealing with the loss of foster child. Implications include better preparation and support for foster parents dealing with moves and removals of foster children, as well as considering less abrupt removals of children from foster homes.

Health Outcomes of Medically and Economically Vulnerable Adults: A Comparison of Former Foster Youth and Nonfoster Youth.

Medically and economically vulnerable adults experience various challenges that can impact their health. Within this vulnerable population, there may be individuals who are even more vulnerable, those who have a history of involvement with the foster care system. The purpose of this study was to evaluate the difference of reported health-related problems between adults with previous foster care experience and other vulnerable adults. Physical, mental, and relational health was evaluated in this study. Practice and policy implications for mental health and medical professionals are discussed.

Child behaviors as a moderator: Examining the relationship between foster parent supports, satisfaction, and intent to continue fostering.

Foster parents need access to supports and resources in order to be satisfied with their caregiving role and continue providing foster care services. However, they often experience multiple demands in their role as a substitute caregiver that could lead to stress. Child behaviors especially may be a significant factor when considering sources of strain and may be a potential risk factor for negative outcomes such as dissatisfaction or the decision to discontinue providing foster care. The purpose of this study was to examine whether child disruptive behaviors moderated or influenced the nature or strength of the relationship between foster parent supports and satisfaction as a caregiver as well as intent to continue fostering. The sample consisted of 155 licensed foster caregivers from across the United States. Child behaviors served as a significant moderator between some types of supports and satisfaction. Implications for future research, practice, and policy are discussed.