Involuntary Treatment of Psychosis in Pregnancy.

When a patient with acute psychosis refuses antipsychotic medication despite a clear need for treatment, involuntary medication is often considered. When the patient is both pregnant and acutely unwell, an additional layer of analysis enters the picture. This analysis then also includes the health of the mother and fetus, rights of the mother and fetus, and whose rights take precedence when choosing treatment options in event of a conflict. Antipsychotic agents are frequently the medications prescribed as involuntary treatment. Typical and atypical antipsychotic agents are often used in both emergent and nonemergent situations during pregnancy. Despite a lack of randomized, double-blind, controlled, prospective studies in pregnancy, available data regarding the safety of antipsychotic agents in pregnancy are relatively reassuring. At the same time, the risks of untreated psychosis, for both the mother and the fetus, are not negligible. Such cases merit ethics-related and legal analyses. Forensic psychiatrists involved in such cases need to consider the patient's capacity to make medical decisions and be able to discuss the potential risks, benefits, and alternatives with patients and in court, as part of initiation of involuntary treatment.

Village midwives and their changing roles in Brunei Darussalam: A qualitative study.

BACKGROUND: There are lay midwives worldwide, interchangeably and universally called traditional birth attendants or traditional midwives by organisations such as the World Health Organization and the International Confederation of Midwives. AIM: This study aimed to explore the history of lay midwives (village midwives) in Brunei, describe the evolution from their previous to current roles and determine if they are still needed by women today. METHODS: This qualitative, descriptive study included in-depth, semi-structured interviews with eight women who had received care from village midwives. Data analysis was based on the principles underpinning thematic analysis and used a constant comparative method. FINDINGS: Village midwives have been popular in Brunei since the 1900s, with their major role being to assist women with childbirth. However, since the 1960s, their roles and practices have changed to focus on pre-conception, antenatal, postnatal and women's general healthcare. Traditional practices were influenced by religion, culture and the social context of and within Brunei. DISCUSSION: The major changes in village midwives' roles and practices resulted from the enforcement of the Brunei Midwives' Act in 1956. Village midwives' traditional practices became juxtaposed with modern complementary alternative medicine practices, and they began charging a fee for their services. CONCLUSION: Brunei village midwives are trusted by women, and their practices may still be widely accepted in Brunei. Further research is necessary to confirm their existence, determine the detailed scope and appropriateness of their practices and verify the feasibility of them working together with healthcare professionals.

La protección del embarazo en el Departamento de Salud Valencia La Fe de 2010 a 2013 / Protection of pregnancy in the Department of Health La Fe, Valencia, 2010 to 2013

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Conociendo las Unidades de Saúde Familiar: otro modelo de Medicina de Familia / Knowing the Unidades de Saúde Familiar: another model of family medicine

Las Unidades de Saudé Familiar (USF) suponen un modelo de Atención Primaria desconocido para muchos. Nacidas dentro de la reforma del sistema nacional sanitario portugués, surgen ante la necesidad de proporcionar unos cuidados de salud de calidad a los ciudadanos, mejorando la satisfacción tanto de los propios usuarios como de los profesionales que trabajan en ella. En este artículo trataremos de explicar el funcionamiento de estas USF gracias a la oportunidad que tuvimos los autores del mismo de compartir consulta en la USF de Sao Juliao-Oeiras (AU)

Unidades de Saude Familiar (USF) represent a model of primary care unknown to many people. Born within the reform of the Portuguese national health system, they arise from the need to provide a quality health care to citizens, improving the satisfaction of both users and professionals who work in it. This article will try to explain the working of these USF thanks to the opportunity to share medical consultation that the authors had at the USF-Oeiras Sao Juliao (AU)

Court-ordered caesareans.

Court-ordered caesarean sections are in the news after a number of recent legal decisions authorising surgery for women who lack mental capacity to consent. The decisions have not always been based on good evidence and they raise serious concerns about the protection of the rights of mentally ill women. The authors explain the legal process and question the wisdom of recent judgements.

Targeted interventions for improved equity in maternal and child health in low- and middle-income settings: a systematic review and meta-analysis.

BACKGROUND: Targeted interventions to improve maternal and child health is suggested as a feasible and sometimes even necessary strategy to reduce inequity. The objective of this systematic review was to gather the evidence of the effectiveness of targeted interventions to improve equity in MDG 4 and 5 outcomes. METHODS AND FINDINGS: We identified primary studies in all languages by searching nine health and social databases, including grey literature and dissertations. Studies evaluating the effect of an intervention tailored to address a structural determinant of inequity in maternal and child health were included. Thus general interventions targeting disadvantaged populations were excluded. Outcome measures were limited to indicators proposed for Millennium Development Goals 4 and 5. We identified 18 articles, whereof 15 evaluated various incentive programs, two evaluated a targeted policy intervention, and only one study evaluated an intervention addressing a cultural custom. Meta-analyses of the effectiveness of incentives programs showed a pooled effect size of RR 1.66 (95% CI 1.43-1.93) for antenatal care attendance (four studies with 2,476 participants) and RR 2.37 (95% CI 1.38-4.07) for health facility delivery (five studies with 25,625 participants). Meta-analyses were not performed for any of the other outcomes due to scarcity of studies. CONCLUSIONS: The targeted interventions aiming to improve maternal and child health are mainly limited to addressing economic disparities through various incentive schemes like conditional cash transfers and voucher schemes. This is a feasible strategy to reduce inequity based on income. More innovative action-oriented research is needed to speed up progress in maternal and child survival among the most disadvantaged populations through interventions targeting the underlying structural determinants of inequity.

Leveraging the Affordable Care Act to improve the health of mothers and newborns.

Health insurance in the United States is a patchwork system whereby opportunities for coverage are strongly associated with life circumstances (ie, age, income, pregnancy, parental status). For pregnant women, this situation contributes to unstable coverage before, between, and after pregnancies. The Affordable Care Act has the potential to make coverage for women of reproductive age more stable and create new opportunities to intervene on conditions associated with maternal and neonatal morbidity. In this article, we discuss the health economics of the Affordable Care Act, its implications for maternal and neonatal health, specific challenges associated with implementation, and opportunities for obstetricians to leverage the Affordable Care Act to improve the care of women.