Antenatal depression screening and psychosocial assessment in an Australian private hospital: An evaluation.

BACKGROUND: Universal mental health screening and psychosocial assessment during pregnancy have been recommended as best practice, but uptake of universal programs in the private hospital system has been slow. AIM: The aim of this study was to evaluate the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS: In this mixed-methods design study, PMAP interview data were collected for a consecutive series of 485 women who attended the PMAP during a 10-month period. Women also completed two postnatal telephone interviews (10 weeks and 9 months postpartum). The interviews involved depression screening and questions about the program. RESULTS: Of the 485 participants, 4.1% screened positive for depression on the Edinburgh Postnatal Depression Scale. In total, 19% were identified as currently suffering from, or at risk of developing, perinatal mental health issues; referrals to support services were provided for the 13% who were not already linked in with appropriate supports. All women displayed a decrease in depressive symptom severity from pregnancy to 10 weeks and 9 months postpartum. The PMAP was viewed positively by consumers, with >93% viewing the program as helpful and >98% saying that they would recommend the program to others. Additional program benefits identified included opportunities to gain practical information and prepare for motherhood and to think/reflect on their emotional well-being. CONCLUSIONS: Given the observed rates of psychosocial risk among this sample, related referral opportunities and positive consumer feedback, we recommend other Australian private hospitals consider implementing PMAP or similar programs.

Patterns of psychiatric admission in Australian pregnant and childbearing women.

PURPOSE: The early postnatal period is a time of increased risk for psychiatric admission. However, there is scope to further examine if this increase in risk extends to the entire perinatal period (pregnancy and first postnatal year), and how it compares to admission outside of the perinatal period. METHODS: Data were linked across birth and hospital admission registers from July 2000 to December 2009. The study cohort, consisting of all pregnant and childbearing women with a psychiatric history, was divided into two groups: case women (at least one perinatal principal psychiatric admission in the study period) (38%) and comparison women (no perinatal principal psychiatric admissions) (62%). Outcomes were admission rate and length of stay adjusted for diagnosis, socio-demographic factors and timing of admission. RESULTS: Antenatal and postnatal admissions rates were both higher than non-perinatal admission rates for case women for all diagnoses. There was little evidence that women with perinatal admissions were at an increased risk of admissions at other times. Socially disadvantaged women had significantly fewer and shorter admissions than their respective counterparts. CONCLUSIONS: The entire perinatal period is a time of increased risk for admission across the range of psychiatric disorders, compared to other times in a woman's childbearing years. Reduced admission rate and length of stay for socially disadvantaged women suggest lack of equity of access highlighting the importance of national perinatal mental health policy initiatives inclusive of disadvantaged groups.

Health professional perspectives on an antenatal mental health screening program in a private hospital.

BACKGROUND: Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged. AIMS: This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney. MATERIALS AND METHODS: Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis. RESULTS: Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement. CONCLUSIONS: Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.

Mechanically facilitated micro-fluid mixing in the organ of Corti.

The cochlea is filled with two lymphatic fluids. Homeostasis of the cochlear fluids is essential for healthy hearing. The sensory epithelium called the organ of Corti separates the two fluids. Corti fluid space, extracellular fluid space within the organ of Corti, looks like a slender micro-tube. Substantial potassium ions are constantly released into the Corti fluid by sensory receptor cells. Excess potassium ions in the Corti fluid are resorbed by supporting cells to maintain fluid homeostasis. Through computational simulations, we investigated fluid mixing within the Corti fluid space. Two assumptions were made: first, there exists a longitudinal gradient of potassium ion concentration; second, outer hair cell motility causes organ of Corti deformations that alter the cross-sectional area of the Corti fluid space. We hypothesized that mechanical agitations can accelerate longitudinal mixing of Corti fluid. Corti fluid motion was determined by solving the Navier-Stokes equations incorporating nonlinear advection term. Advection-diffusion equation determined the mixing dynamics. Simulating traveling boundary waves, we found that advection and diffusion caused comparable mixing when the wave amplitude and speed were 25 nm and 7 m/s, respectively. Higher-amplitude and faster waves caused stronger advection. When physiological traveling waves corresponding to 70 dB sound pressure level at 9 kHz were simulated, advection speed was as large as 1 mm/s in the region basal to the peak responding location. Such physiological agitation accelerated longitudinal mixing by more than an order of magnitude, compared to pure diffusion. Our results suggest that fluid motion due to outer hair cell motility can help maintain longitudinal homeostasis of the Corti fluid.

Antenatal psychosocial assessment and depression screening in a private hospital.

BACKGROUND: It has been recommended that psychosocial assessment (including depression screening) be integrated into routine antenatal care across Australia, but implementation in the private sector has lagged. AIMS: This study aimed to report preliminary outcomes associated with an antenatal psychosocial assessment and depression screening program implemented at an Australian private obstetric hospital setting and to report characteristics and correlates of elevated depression symptoms in this sample. MATERIALS AND METHODS: A total of 993 pregnant women (mean ± SD gestational age 27.9 ± 6.7 weeks) participated in a structured psychosocial assessment interview and completed the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Six per cent of participants scored ≥13 on the EPDS. Psychosocial correlates of antenatal depressive symptoms included low income, history of pregnancy termination, poor practical support, lack of confidence and history of depression. Almost 1 in 10 of the total sample was referred for further assessment and clinical support. CONCLUSIONS: The prevalence of clinically significant antenatal depressive symptoms in this sample highlights the importance of antenatal depression screening for all women, including those who choose to access private obstetric care.

Practice Guidelines for Cardiovascular Fitness and Strengthening Exercise Prescription After Burn Injury.

The objective of this review was to systematically evaluate the available clinical evidence for the prescription of strength training and cardiovascular endurance exercise programs for pediatric and adult burn survivors so that practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. Summary recommendations were made after the literature was retrieved by systematic review, was critically appraised by multiple authors and the level of evidence determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Although gaps in the literature persist and should be addressed in future research projects, currently, strong research evidence supports the prescription of strength training and aerobic conditioning exercise programs for both adult and pediatric burn survivors when in the presence of strength limitations and/or decreased cardiovascular endurance after evaluation.

The effect of storage conditions on sample stability in the routine clinical laboratory.

BACKGROUND: 'Add-on' tests are often requested for samples already in the laboratory. This study was carried out to assess the stability of common analytes in uncapped samples stored in different conditions, and therefore their suitability for 'add-on' requests. METHODS: Storage conditions evaluated included initial storage at room temperature for 16 hours, followed by storage at 4℃ (Group 1: current conditions employed in the laboratory), compared with storage at 4℃ immediately following analysis (Group 2: optimum storage conditions). RESULTS: Some analytes were not suitable for 'add-ons' when samples were stored in either storage condition, whereas some were suitable for 'add-ons' irrespective of storage condition. Storage conditions influenced the suitability of 'add-on' tests for a proportion of analytes including urea, amylase, total protein, alkaline phosphatase, adjusted calcium, lactate dehydrogenase, triglycerides, HDL cholesterol and total cholesterol; these analytes were stable in optimum conditions (Group 2) but not in current conditions (Group 1). CONCLUSIONS: 'Add-on' tests can only be safely performed on a proportion of routine analytes. For some analytes, storage conditions affect their suitability for delayed analysis.

Clinical and analytical evaluation of an immunoturbidimetric heart-type fatty acid-binding protein assay.

BACKGROUND: Heart-type fatty acid-binding protein (H-FABP) is a low molecular weight protein involved in the intracellular uptake and buffering of long chain fatty acids in the myocardium. It is an early marker for ACS. We have evaluated the Randox Laboratories immunoturbidimetric assay on a Siemens Advia 1800 analyzer. The assay employs latex particles coated with mouse monoclonal anti-HFABP antibodies to generate turbidity. METHODS: We used redundant patient samples and pools to assess precision, functional sensitivity, limit of detection, linearity, recovery of recombinant H-FABP and interference. We evaluated the 99th centile values and compared H-FABP with troponin in samples routinely received from chest pain patient samples. RESULTS: Precision was typically < 10% and 12.5% at all concentrations for within and between batches. The functional sensitivity was 2.4 µg/L. The assay was linear on dilution over the range 2.76-115 µg/L. Recovery of recombinant H-FABP was approximately 20-25%. No interference was seen with haemoglobin concentrations <1.5 g/L, bilirubin < 250 µg/L and triacylglycerol < 5 mmol/L or rheumatoid factor. The 99th centile value in a reference population with eGFR > 60mL/min/1.73m(2) was 9.1 µg/L with no significant gender difference. H-FABP was measured in routine clinical samples (N = 1310) received for troponin I measurement. Using Siemens TnI > 50 ng/L as an indicator of myocardial damage, the ROC area under curve for H-FABP was 0.82. CONCLUSIONS: The immunoturbidimetric H-FABP assay is robustly designed and shows good analytical performance. It is therefore well suited for use in a routine clinical laboratory.