Measurement of Health-Related Quality of Life from Conception to Postpartum Using the EQ-5D-5L Among a National Sample of US Pregnant and Postpartum Adults.

BACKGROUND: During pregnancy, physiological changes occur from conception to birth. We assessed the health-related quality of life (HRQoL) throughout pregnancy and postpartum using the EQ-5D-5L. METHODS: Between May and July 2021 (wave 1) and December 2021 and April 2022 (wave 2), we conducted a series of cross-sectional, national online surveys of 5250 pregnant and postpartum United States (US) adults. The survey included the EQ-5D-5L, EQ visual analog scale (EQ VAS), items measuring respondents' sociodemographic and health information, last menstrual period, estimated date of delivery, and date of pregnancy end (if postpartum). We examined monthly EQ-5D-5L items, utility values, and EQ VAS scores during pregnancy and postpartum. We used quantile regression adjusted for calendar month of last menstrual period to estimate changes in HRQoL at different time points of pregnancy and postpartum. RESULTS: There was a steady increase in the frequency of respondents reporting health-related problems and a decline in EQ-5D-5L utility values from early pregnancy until the ninth month of pregnancy (ß = - 0.21; standard error [SE] 0.02; P < 0.001), followed by a 0.10 (SE 0.02; P < 0.001) unit increase in values during the first postpartum month and a stabilization during the remainder of the postpartum period (ß = 0.02; SE 0.02; P = 0.214). The median EQ-5D-5L utility value was lowest during the ninth month of pregnancy (median 0.78 [interquartile range 0.30]). CONCLUSIONS: HRQoL as measured by EQ-5D-5L varies across pregnancy, indicating progressive declines throughout pregnancy and a return to first trimester values during the first month postpartum. Studies involving HRQoL measurement in pregnant people should account for the stage of pregnancy in their estimates.

"Holding Space": A Phenomenological Exploration of Mindfulness-Based Practice With Veterans Who Have Experienced Trauma.

The current phenomenological study examined the lived experiences of Veterans who completed a 4-month mindfulness program. One-on-one interviews were conducted with 12 Veterans using a Socratic method of interviewing, which yielded rich contextual narratives. Analysis was guided by a hermeneutic process to disclose concealed meanings. Findings demonstrate how holding space allowed deep healing and are presented under two distinct themes: It's a We Thing! encompasses what being in a community with nonjudgmental others afforded participants; and Quiet Your Mind, Quiet Yourself, Your Body is related to how practices of mindfulness taught participants to cope with daily challenges. Nurses working with Veterans may use mindfulness and peer support interventions to help transform trauma into profound healing and help Veterans find new meaning in life. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 47-55.].

COVID-19 vaccine acceptance and coverage among pregnant persons in the United States.

Pregnant persons are at higher risk of severe COVID-19. Although vaccination is recommended, COVID-19 vaccination rates are lower among pregnant persons compared to the non-pregnant population. We aimed to evaluate acceptance of any dose of COVID-19 vaccine during pregnancy. A national online cross-sectional survey of US adults who were pregnant between December 2020 and July 2021 was used to measure COVID-19 vaccine behaviors, attitudes, and beliefs. Post-stratification weighting was used to ensure representativeness to the US population. Marginal log-binomial models were used to estimate adjusted prevalence ratios (aPR) of COVID-19 vaccine acceptance, accounting for sociodemographic factors. Of 5,660 who responded to survey advertisements, 2,213 met eligibility criteria and completed the survey; 55.4% of respondents received or planned to receive COVID-19 vaccine prior to or during pregnancy, 27.0% planned to vaccinate after pregnancy, 8.8% were unsure and 8.7% had no plans to vaccinate. Individuals were more likely to receive or plan to receive COVID-19 vaccine if they had group prenatal care (aPR 1.57; 95% CI 1.40, 1.75), were employed in a workplace with a policy recommending vaccination (aPR 1.15; 95% CI 1.06, 1.26), and believed COVID-19 vaccines are safe (aPR 2.86; 95% CI 2.49, 3.29). Pregnant persons who were recommended COVID-19 vaccination by their healthcare provider less commonly reported concerns about vaccine safety (35.5% vs 55.9%) and were more likely to accept COVID-19 vaccines (aPR 1.52; 95% CI 1.31, 1.76). COVID-19 vaccine acceptance during pregnancy is not universal and public health intervention will be needed to continue to increase vaccine coverage.

'Chimwemwe Mu'bereki' (Joyful Motherhood): Closing the Gap in Unmet Need for Home Based Nurse Midwifery Care in High Risk Infants and Postpartum Women in Malawi.

INTRODUCTION: Although decreasing, maternal and infant mortality remain high in Malawi with and estimated 359 per 100,000 live births for maternal mortality ratios, and 22.4 per 1000 live births for infant mortality. Joyful Motherhood (JM), or Chimwemwe mu'bereki, is a Malawian nonprofit organization, founded by a US midwife in 2008, which provides home-based care to high-risk, critically ill postpartum women and infants in rural villages of Lilongwe, Malawi. JM employs 3 nurse-midwives who perform all community visits. Women served include, but are not limited to, those who experienced postpartum complications such as severe anemia, sepsis, eclampsia, or ruptured uterus, and complications related to HIV/AIDs. Infant clients include premature, low birth weight, multiples, and orphans who lost their mother in childbirth. All are enrolled for up to 2 years. The purpose of this mixed-methods descriptive study was to evaluate the home visit nurse-midwife programs of JM. There were 2 aims: (1) analyze descriptive data regarding clients served and (2) gain an understanding of the value of JM's services through the perspective of women and caregivers served. Research questions include: How many infants and women have been served since program inception? What are the infant and maternal mortality rates of JM's clients? How has JM's services benefitted clients served? METHODS: Number of enrolled clients, annual visits made, and deaths were tracked by nurse-midwives providing care and transferred to Microsoft Excel on a monthly basis by the program manager. Cumulative numbers and rates were calculated. Qualitative data were collected via one-on-one interviews and focus groups using a Chichewa interpreter and were digitally audiorecorded and transcribed. RESULTS: From inception of program to July 2019, a total of 490 women and 1300 infants were served. Between October 2013 and July 2020, the infant mortality rate was 4.5% (46/1014) and maternal mortality rate was 1.4% (6/425). Twelve interviews and 2 focus groups were conducted to assess program effectiveness. Narratives revealed overwhelming gratitude for services provided. Participants expressed desperation when seeking care for family members unsuccessfully before being enrolled in JM. Many shared the infant visits were key in well-being and survival of their child into early childhood. Themes include: tough times; very grateful for these gifts; encouraging us to care; and advise others. DISCUSSION: JM's success for over 10 years demonstrates it is a viable model for unmet home care for high-risk infants and postpartum women in Malawi. Financial challenges prevent scaling up of services and expansion of clientele. Efforts to improve data collection are ongoing including future plans to launch a new mobile electronic record app to use on smart phones.

Youth Experiences of Parent Incarceration: Doing Time From Both Sides.

In 2015-2016, an estimated 6 million children in the United States had at least one parent incarcerated. Children of incarcerated parents experience physical, mental, social, and economic consequences, including migraines, asthma, depression, anxiety, posttraumatic stress disorder, school dropout, and homelessness. The purpose of the current phenomenological study was to gain an in-depth understanding of the experiences of youth who have or have had an incarcerated parent. Narratives were gathered from a sample of 15 individuals ages 13 to 19 attending a 1-year long workshop entitled Peace Makers. The rich text revealed shared experiences of disrupted homes, unfulfilled visits and promises, and social isolation captured by the following themes: At Home No More; "To Feel Her…Kiss Her Cheek"; "Waiting at the Door"; and "Trapped in an Isolation Box." Care providers must develop an empathic understanding of affected youth to facilitate healing, restore dignity, and advocate for their rights. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 22-29.].

Increasing Empathy and Conflict Resolution Skills through Nonviolent Communication (NVC) Training in Latino Adults and Youth.

BACKGROUND: Children of Latino immigrants often are torn between their native homes and new communities. Having supportive interpersonal relationships increases resilience to delinquent and violent behaviors stemming from immigration challenges. Communication fostering empathy may improve conflict resolution and supportive relationships. OBJECTIVES: Community-based participatory research (CBPR) was conducted to evaluate the impact of nonviolent communication (NVC) trainings in Latino adults and youth. METHODS: Four sessions in NVC were provided by bilingual Latino trainers for Latino adults and youth. Pre- and post-training focus groups evaluated effectiveness of training. RESULTS: Three themes emerged from adult post training focus groups-enter the others' shoes, making a change, and learning in community. The youth reflected on new ways to manage conflict and understand emotions. LESSONS LEARNED: Research team embedded in community increased success. However, inconsistent participant attendance precluded quantitative analyses. CONCLUSION: Seeds were planted in this Latino community for future potential projects.

Nurses, formerly incarcerated adults, and Gadamer: phronesis and the Socratic dialectic.

This paper describes the first phase of an ongoing education and research project guided by three main intentions: (1) to create opportunities for phronesis in the classroom; (2) to develop new understandings about phronesis as it relates to nursing care generally and to caring for specific groups, like formerly incarcerated adults; and (3) to provide an opportunity for formerly incarcerated adults and graduate nursing students to participate in a dialectical conversation about ethical knowing. Gadamer's writings on practical philosophy, phronesis, and the Socratic dialectic provide the philosophical foundation and framework for the project. The first phase in the project was a 4-h class within a graduate-level health promotion course during which 30 nursing students and three formerly incarcerated panelists engaged in a dialectic conversation about what it means to care for formerly incarcerated adults in a meaningful way. After the class, two focus groups were conducted, one with the students and one with the formerly incarcerated panelists. Findings articulated participants' prejudices and assumptions prior to the class, expanded sense of phronesis, and ability to consider nursing practice within a larger ethical framework. Panelists and students left the class with a deeper understanding of one another and expressed an openness towards continued dialectic conversations together. Use of the Socratic dialectic within nursing curricula reflects a current and critical trend in nursing education to bring non-epistemologic forms of knowledge into the classroom.

Nonviolent communication: a dialogical retrieval of the ethic of authenticity.

Charles Taylor called for a retrieval of the ethic of authenticity that has been distorted in modern notions of autonomy and self-fulfillment. Via exchanges with others who matter to us, he proposed that human identities develop through the use of rich language draped in shared horizons of significance. The fostering of these dialogical ties beyond purely instrumental purposes, along with the recognition of the human dignity in all, may avert the fallen ideal of authenticity. Nonviolent communication affords the skillful dialogue with others cradled in a shared sense of significance and supports the development of a meaningful identity-one that is formed through the realization of what exists beyond the self. The purpose of this article is to argue that nonviolent communication facilitates the retrieval of the ethic of authenticity. Narratives from nursing students' journals on the use of nonviolent communication skills will be used to support the argument.

'Chaos, restitution and quest': one woman's journey through menopause.

Menopause, a natural stage in a woman's reproductive life, is not an illness; yet some women experience severe enough symptoms to cause a breakdown in the body similar to illness or other major health disruptions. As part of a larger narrative analysis investigation of distress during menopause, this case study presents one woman's transformational journey through menopause, analysed through Frank's health and illness narratives - chaos, restitution and quest. The narratives were retranscribed using Labov's elements of a true story and Gee's poetic restructuring. This report of one woman's experience of distress during the menopause transition describes a poetic chaos narrative of incessant night sweats resulting in a loss of physicality and a deep-rooted belief in self-healing; a restitution narrative of restored health that mandated the surrender to a new healing discourse, experienced simultaneously as a victory and a defeat; and a quest narrative of seeking meaning, insight and new-found values and identities.

The composite first person narrative: Texture, structure, and meaning in writing phenomenological descriptions.

This paper illustrates the use of composite first person narrative interpretive methods, as described by Todres, across a range of phenomena. This methodology introduces texture into the presently understood structures of phenomena and thereby creates new understandings of the phenomenon, bringing about a form of understanding that is relationally alive that contributes to improved caring practices. The method is influenced by the work of Gendlin, Heidegger, van Manen, Gadamer, and Merleau-Ponty. The method's applicability to different research topics is demonstrated through the composite narratives of nursing students learning nursing practice in an accelerated and condensed program, obese female adolescents attempting weight control, chronically ill male parolees, and midlife women experiencing distress during menopause. Within current research, these four phenomena have been predominantly described and understood through quantified articulations that give the reader a structural understanding of the phenomena, but the more embodied or "contextual" human qualities of the phenomena are often not visible. The "what is it like" or the "unsaid" aspects of such human phenomena are not clear to the reader when proxies are used to "account for" a variety of situated conditions. This novel method is employed to re-present narrative data and findings from research through first person accounts that blend the voices of the participants with those of the researcher, emphasizing the connectedness, the "we" among all participants, researchers, and listeners. These re-presentations allow readers to develop more embodied understandings of both the texture and structure of each of the phenomena and illustrate the use of the composite account as a way for researchers to better understand and convey the wholeness of the experience of any phenomenon under inquiry.

Silence, stigma, and shame: a postmodern analysis of distress during menopause.

Because of the complexity of a midlife woman's life and the variation of the manifested symptoms of menopause, much remains inconclusive regarding the experience of distress during the menopause transition. The purpose of this narrative analysis study was to examine experiences of distress during the menopause transition using a postmodern feminist framework. Findings include experiences of shame related to symptom experience and prevailing social discourses on menopause and aging. Clinicians must be cautioned of the potential for silencing and withdrawal in women who may not be receiving adequate support, and must advocate for more choices for midlife women.

The effects of perceived stress and attitudes toward menopause and aging on symptoms of menopause.

INTRODUCTION: As part of a longitudinal study of midlife women, the aim of this investigation was to describe the intensity of menopausal symptoms in relation to the level of perceived stress in a woman's life and her attitudes toward menopause and aging. METHODS: Data were collected on 347 women between 40 and 50 years of age in Northern California who began the study while premenopausal. Women self-identified as African American, European American, or Mexican/Central American. Data collected over three time points in the first 12 months were used for this analysis. An investigator-developed tool for the perception of specific types of stress was used. Attitudes toward menopause and aging were measured using the Attitudes Toward Menopause and Attitude Toward Aging scales. Attitudes toward aging and menopause, perceived stress, and income were related to intensity of symptoms. RESULTS: There was no ethnic group difference in perceived stress or attitude toward menopause. However, European and African Americans had a more positive attitude toward aging than Mexican/Central Americans. DISCUSSION: A lower income, higher perceived stress, a more negative attitude toward aging, and a more positive attitude toward menopause influenced menopausal symptom experience.

Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya.

OBJECTIVE: The objective of this study was to assess the risk factors for and persistence of Mycoplasma genitalium (MG) in a highly exposed female population in Kenya. STUDY DESIGN: Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age, were enrolled. Every 2 months, cervical samples were collected for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by polymerase chain reaction. RESULTS: At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5-4.0), GC (HR = 2.0; 95% CI = 1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and >or=7 months, respectively. CONCLUSION: The high incidence of MG, greater than that for both CT (14.0%) and GC (8%), association with common sexually transmitted infection risk factors, and persistence in the female genital tract supports its role as a common sexually transmitted infection in Kenyan women.