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1.
J Midwifery Womens Health ; 67(5): 598-607, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-35841336

RESUMEN

INTRODUCTION: Research suggests that interprofessional education, bringing learners together to learn about, with, and from each other, improves health professions education and can improve health outcomes. Little research has measured outcomes of interprofessional education between midwifery students and obstetrics and gynecology residents. The purpose of this study was to examine self-assessed interprofessional and collaborative competencies among midwifery students and obstetrics and gynecology residents. METHODS: Baseline self-assessed interprofessional and collaborative competencies were compared with follow-up measurements to evaluate learners' experiences over an 11-month study period. Participants were midwifery students and obstetrics and gynecology residents who experienced interprofessional learning activities. The Interprofessional Education Collaborative Competency Self-Assessment Survey (IPEC Survey) and Interprofessional Collaborative Competency Attainment Survey (ICCAS) were used. RESULTS: Of 256 learners at 4 demonstration sites, 223 (87%) completed the baseline, and 121 of 237 eligible learners (51%) completed the follow-up surveys. The IPEC Survey total score (t = 2.31, P = .02) and interaction subscale (t = 2.85, P = .005) and ICCAS score (t = 4.04, P = .001) increased for midwifery students but not obstetrics and gynecology residents on the IPEC Survey (t = 0.32, P = .75) and ICCAS (t = -0.05, P = .96) measures. Midwifery students (87%) and residents (57%) reported improved overall ability to collaborate. Learners responding to 3 open-ended questions valued team-based experiences, including learning how to communicate with each other; appreciated learning each other's education and scope of practice; and recommended skills development including uncommon clinical events, case discussions, and direct clinical care. DISCUSSION: This study advanced knowledge about interprofessional education between midwifery students and obstetrics and gynecology residents. Midwifery students improved in self-assessed interprofessional and collaborative competencies. Most learners reported better interprofessional collaboration skills and were positive about future interprofessional learning. This evaluation approach is available for other programs implementing or extending interprofessional education.


Asunto(s)
Ginecología , Partería , Femenino , Ginecología/educación , Humanos , Educación Interprofesional , Relaciones Interprofesionales , Partería/educación , Embarazo , Estudiantes
2.
Health Equity ; 5(1): 545-553, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34909521

RESUMEN

Objective: Racial and ethnic inequities in perinatal health outcomes are pervasive. Doula support is an evidence-based practice for improving maternal outcomes. However, women in lower-income populations often do not have access to doulas. This study explored community perspectives on doula care to inform the development of a hospital-based doula program to serve primarily low-income women of color. Methods: Four focus groups and four individual interviews were conducted with: (1) women who were pregnant or parenting a child under age 2 (n=20); (2) people who had provided support during a birth in the previous 2 years (n=5); and (3) women who had received doula training (n=4). Results: Participants had generally positive perceptions of doula services. Many aspects of doula support desired by participants are core to birth doula services. Participants identified ways that doulas could potentially address critical gaps in health care services known to impact outcomes (e.g., continuity of care and advocacy), and provide much-needed support in the postpartum period. Responses also suggested that doula training and hospital-based doula programs may need to be adapted to address population-specific needs (e.g., women with substance use disorder and younger mothers). Novel program suggestions included "on call" informational doulas. Conclusions: Findings suggested that women in racial/ethnic minority and lower income groups may be likely to utilize a hospital-based doula program and identified adaptations to traditional doula care that may be required to best meet the needs of women in groups with higher risk of poor maternal health and birth outcomes.

3.
J Midwifery Womens Health ; 65(2): 257-264, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31965745

RESUMEN

Despite areas of excellence, US perinatal care outcomes lag behind most developed countries. In addition, a shortage and maldistribution of health care providers exists. The American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists (ACOG) partnered to obtain funding to develop interprofessional education modules and other learning activities for midwifery students and obstetrics and gynecology residents in 4 demonstration sites. The multidisciplinary 2016 ACOG document Collaboration in Practice: Implementing Team-Based Care was adopted as a framework. Core competencies of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork developed by the Interprofessional Education Collaborative were used to guide the work. Seven modules have been developed including guiding principles, patient-centered care, role clarification, collaborative practice, history and culture, care transition, and difficult conversations. Learners participate in laboratory and simulation activities and work together in clinical care settings. Stakeholder experiences as well as barriers to implementation are discussed. Learning materials and activity descriptions are open resourced and shared on a project website for use by programs interested in implementing an interprofessional curriculum. Ongoing formal evaluation including pilot testing of a program evaluation method is described.


Asunto(s)
Ginecología/educación , Educación Interprofesional , Relaciones Interprofesionales , Partería/educación , Enfermeras Obstetrices/educación , Obstetricia/educación , Competencia Clínica , Comunicación , Curriculum , Femenino , Humanos , Servicios de Salud Materna/normas , Embarazo , Estados Unidos
4.
Nicotine Tob Res ; 22(6): 1046-1050, 2020 05 26.
Artículo en Inglés | MEDLINE | ID: mdl-31063550

RESUMEN

INTRODUCTION: Smokers who use opioids smoke more cigarettes per day (CPD) than non-opioid users, which could be due to the effects of opioids on nicotine metabolism. Moreover, nicotine metabolism increases during pregnancy, potentially making quitting more difficult for pregnant smokers. We examined nicotine metabolism and its association with opioid use (OU) and CPD in pregnant smokers. METHODS: We recruited pregnant women who smoked at least 5 CPD for a clinical trial of smoking cessation. Plasma nicotine metabolite ratio (NMR; trans-3'-hydroxycotinine (3HC)/cotinine)-a biomarker of nicotine metabolism-OU (involving methadone, buprenorphine, fentanyl, oxycodone, or tramadol), and CPD were assessed at baseline. We used linear regression to examine the associations between log-transformed NMR, OU, and CPD, adjusting for race/ethnicity and menthol smoking. RESULTS: Among 129 pregnant smokers, 25 (19%) were opioid users; most were maintained on methadone (n = 14). Compared to non-OU smokers, OU smokers had higher median CPD (10.0 vs. 7.0, p = .0007), serum 3HC (81.0 vs. 42.0 ng/mL, p = .0001), and NMR (0.63 vs. 0.43, p < .0001). In addition, methadone-maintained smokers had a higher median NMR than non-OU smokers (0.66 vs. 0.43, p = .0004). Adjusting for covariates, log-transformed NMR was greater in OU smokers (p = .012), specifically methadone-maintained smokers (p = .024), than non-OU smokers. CONCLUSIONS: Our preliminary results show that OU is associated with a higher NMR in pregnant smokers. A larger study sample is needed to replicate this finding, examine potential mechanisms, and determine its clinical significance. IMPLICATIONS: Among pregnant smokers, we observed that nicotine metabolism was significantly faster among opioid users-the majority of whom were on methadone maintenance-compared to nonusers, which could have implications for smoking cessation. Further studies are needed to replicate this finding, evaluate potential mechanisms, and determine its clinical significance.


Asunto(s)
Analgésicos Opioides/efectos adversos , Biomarcadores/metabolismo , Nicotina/metabolismo , No Fumadores/estadística & datos numéricos , Trastornos Relacionados con Opioides/epidemiología , Fumadores/estadística & datos numéricos , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Trastornos Relacionados con Opioides/sangre , Trastornos Relacionados con Opioides/etiología , Embarazo , Fumar/epidemiología , Cese del Hábito de Fumar/métodos , Adulto Joven
5.
Am J Obstet Gynecol MFM ; 1(1): 10-18, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31380506

RESUMEN

Background: Smoking during pregnancy is a serious public health problem in need of better treatments. Nicotine replacement treatment (NRT) (patch or gum) has not been shown in randomized placebo-controlled trials to be efficacious for smoking cessation during pregnancy. However, the nicotine inhaler may have advantages over other NRTs as it replicates some of the sensory effects of smoking. Objective: The purpose of the study was examine the efficacy and safety of the nicotine inhaler for smoking cessation during pregnancy. We hypothesized that the nicotine inhaler compared to placebo would increase quit rates and reduce smoking during treatment and at the end of pregnancy, result in a higher birth weight and gestational age in the offspring, and reduce the incidence of preterm birth and low birth weight infants. Study Design: We conducted a randomized, double-blind, placebo-controlled trial of the nicotine inhaler for smoking cessation during pregnancy. Pregnant women who smoked ≥5 cigarettes daily received behavioral counseling and random assignment to a 6-week treatment with nicotine or placebo inhaler, followed by a 6-week taper period. Throughout treatment, we assessed tobacco exposure biomarkers, cessation rates, and adverse events. We also obtained information on birth outcomes. The primary outcome was smoking cessation at 32-34 weeks gestation; secondary outcomes were smoking reduction, birth weight and gestational age, and the incidence of preterm birth or low birth weight infants. We compared treatment groups on these measures using t-tests, Fisher's exact tests, and multivariate linear and logistic regression. Results: Participants in the placebo (n=67) and nicotine (n=70) groups were comparable on baseline characteristics, though women in the placebo group reported a higher motivation to quit (p=0.016). Biochemically-validated smoking cessation rates were similar with nicotine and placebo (after 6 weeks of treatment: 4% (3/70) vs. 3% (2/67), respectively, p< 0.99, and at 32-34 weeks gestation: 10% (7/70) vs. 18% (12/67), respectively, p=0.220). Cigarettes per day (CPD) decreased over time in both groups (p< 0.001), with the nicotine inhaler group having a greater decrease than the placebo group two (p=0.022) and six weeks after the quit date (p=0.042), but not at 32-34 weeks gestation (p=0.108). Serum cotinine levels, birth weight, gestational age and reductions in carbon monoxide did not differ by group. However, the incidence of preterm delivery was higher in the placebo than the nicotine group: 15% (10/67) vs. 4% (3/67), respectively, p=0.030). The incidence of delivering a low birth weight infant was also higher in the placebo than the nicotine group: 15% (10/67) vs. 6% (4/67), respectively, p=0.035, but not after adjusting for preterm delivery p=0.268. Conclusions: Although the nicotine inhaler group did not have a higher quit rate during pregnancy than the placebo group, the outcome of preterm delivery occurred less frequently in the nicotine group.


Asunto(s)
Nacimiento Prematuro , Cese del Hábito de Fumar , Femenino , Humanos , Lactante , Recién Nacido , Nebulizadores y Vaporizadores , Nicotina/efectos adversos , Embarazo , Nacimiento Prematuro/epidemiología , Fumadores , Fumar/efectos adversos , Dispositivos para Dejar de Fumar Tabaco
6.
J Midwifery Womens Health ; 64(5): 649-656, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31264777

RESUMEN

Workforce analyses project a need for women's health care providers, especially in maternity care. With a stagnant number of certified nurse-midwife/certified midwife (CNM/CM) education programs, the present production of new CNMs/CMs is not robust enough to meet the growing demand. This article describes an existing but underutilized model for CNM/CM education programs, based in an academic medical center with an existing academic affiliation. Advantages include a federal funding source through the Centers for Medicare and Medicaid Services, lower tuition costs than most current programs, and expanded job satisfaction for CNMs/CMs in clinical practice.


Asunto(s)
Centros Médicos Académicos , Partería/educación , Modelos Educacionales , Acreditación , Curriculum , Educación en Enfermería/economía , Humanos , Massachusetts
7.
Nicotine Tob Res ; 19(5): 585-590, 2017 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-28403454

RESUMEN

INTRODUCTION: Electronic cigarette use is rapidly gaining in popularity. However, little is known about correlates and reasons for electronic cigarette use by women of reproductive age, a group for which the safety and efficacy of electronic cigarette use is of particular interest. METHODS: As part of a clinical trial for smoking cessation, we surveyed pregnant smokers about their lifetime use of electronic cigarettes, previous use of any adjunctive treatments for smoking cessation, and use of electronic cigarettes during pregnancy. We examined associations between electronic cigarette use and participant characteristics. RESULTS: Fifty-three percent (55/103) of participants had previously tried electronic cigarettes. Ever users smoked more cigarettes per day before pregnancy (p = .049), had a greater number of previous quit attempts (p = .033), and were more likely to identify as being Hispanic or non-Hispanic white than never users (p = .027). Fifteen percent of participants (15/103) reported previous use of electronic cigarettes for smoking cessation, which was more common than the use of any specific FDA-approved smoking cessation medication. Fourteen percent of participants (14/103) reported electronic cigarette use during pregnancy, most commonly to quit smoking. A history of substance abuse (p = .043) and more previous quit attempts (p = .018) were associated with electronic cigarette use during pregnancy. CONCLUSIONS: Use of electronic cigarettes to quit smoking may be common in women of reproductive age, including those who are pregnant. More research is needed to determine the risks and benefits of electronic cigarette use in this population of smokers. IMPLICATIONS: This study shows that electronic cigarettes are used by women of reproductive age, including pregnant smokers. The implications of this finding are that there is an urgent need to examine the risks and benefits of electronic cigarette use, especially by pregnant women. The study also shows that electronic cigarettes are commonly used as a smoking cessation aid in women of reproductive age. The greater likelihood of electronic cigarette use compared to proven adjunctive smoking treatments suggests that electronic cigarettes should be examined as a potential aid to cessation in this population.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Mujeres Embarazadas , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Tabaquismo/epidemiología , Adulto , Femenino , Hispánicos o Latinos , Humanos , Embarazo , Investigación , Encuestas y Cuestionarios , Población Blanca , Adulto Joven
8.
J Pregnancy ; 2016: 8984928, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27688913

RESUMEN

This study examined racial/ethnic differences in gestational weight gain (GWG) predictors and association of first-trimester GWG to overall GWG among 271 White women and 300 Latina women. Rates of within-guideline GWG were higher among Latinas than among Whites (28.7% versus 24.4%, p < 0.016). Adjusted odds of above-guideline GWG were higher among prepregnancy overweight (OR = 3.4, CI = 1.8-6.5) and obese (OR = 4.5, CI = 2.3-9.0) women than among healthy weight women and among women with above-guideline first-trimester GWG than among those with within-guideline first-trimester GWG (OR = 4.9, CI = 2.8-8.8). GWG was positively associated with neonate birth size (p < 0.001). Interventions targeting prepregnancy overweight or obese women and those with excessive first-trimester GWG are needed.

9.
J Midwifery Womens Health ; 60(6): 674-81, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26619374

RESUMEN

This article examines the history and present state of the midwife as laborist. The role of the midwife and obstetrician laborist/hospitalist is rapidly evolving due to the need to improve patient safety and provide direct care due to reduced resident work hours, as well as practice demands experienced by community providers and other factors. Models under development are customized to meet the needs of different communities and hospitals. Midwives are playing a prominent role in many laborist/hospitalist practices as the first-line hospital provider or as part of a team with physicians. Some models incorporate certified nurse-midwives/certified midwives as faculty to residents and medical students. The midwifery laborist/hospitalist practices at Baystate Medical Center in Springfield, Massachusetts, are presented as an example of how midwives are functioning as laborists. Essential components of a successful midwife laborist program include interdisciplinary planning, delineation of problems the model should solve, establishment of program metrics, clear practice guidelines and role definitions, and a plan for sustained funding. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.


Asunto(s)
Trabajo de Parto , Partería/tendencias , Enfermeras Obstetrices/tendencias , Enfermeras Practicantes , Obstetricia , Pautas de la Práctica en Enfermería/tendencias , Rol Profesional , Docentes Médicos , Femenino , Humanos , Massachusetts , Obstetricia/educación , Grupo de Atención al Paciente , Embarazo , Recursos Humanos
10.
Women Health ; 55(7): 805-28, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26016948

RESUMEN

Latina women are at high risk of excessive gestational weight gain (GWG) during pregnancy; yet little is known about whether factors related to GWG differ by pre-pregnancy body mass index (BMI) within this population. We conducted in-depth interviews with 62 pregnant Latina women with pre-pregnancy BMIs in the healthy, overweight, and obese ranges, gestational age ≥22 weeks, and GWG for gestational age above Institute of Medicine (IOM) guidelines. Compared to healthy weight and obese women, overweight women least often reported viewing weight as important, making efforts to control their GWG, being aware of the role of diet on GWG, and receiving GWG advice from health-care providers. Among those who received GWG advice, overweight women more often recalled a target GWG above IOM guidelines. Obese women more often reported low acceptance of their GWG, concern about GWG, having received GWG advice from providers, difficulty following providers' dietary advice, and emotional eating as a challenge for controlling GWG. Participants welcomed practical advice to manage GWG. Future interventions to prevent excessive GWG among Latina women should consider differences among women of varying pre-pregnancy BMIs and include multi-level strategies to address psychosocial as well as provider factors.


Asunto(s)
Consejo , Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos , Obesidad/etiología , Relaciones Médico-Paciente , Mujeres Embarazadas/etnología , Atención Prenatal/métodos , Aumento de Peso , Adolescente , Adulto , Índice de Masa Corporal , Femenino , Humanos , Entrevistas como Asunto , Obesidad/etnología , Obesidad/psicología , Embarazo , Complicaciones del Embarazo/psicología , Tercer Trimestre del Embarazo , Mujeres Embarazadas/psicología , Investigación Cualitativa , Factores Socioeconómicos , Adulto Joven
11.
Nicotine Tob Res ; 17(12): 1416-20, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25832883

RESUMEN

BACKGROUND: Smokers may prefer menthol cigarettes to mask the bitter taste of nicotine. Variation in the taste receptor gene, TAS2R38, may contribute to preference for menthol cigarettes. AIMS: To determine whether two common haplotypes of TAS2R38 (proline-alanine-valine [PAV] and alanine-valine-isoleucine [AVI]), which have been associated, respectively, with bitter taste or a lack of bitter taste produced by propylthiouracil, are associated with preference for menthol cigarettes. METHODS: Data on smoking and blood for DNA extraction and genotyping were obtained from 323 pregnant non-Hispanic or Hispanic Caucasian smokers. We genotyped three TAS2R38 single nucleotide polymorphisms (rs713598, rs1726866, and rs10246939) and constructed haplotypes. We examined associations between menthol preference and the frequency and distribution of the AVI and PAV haplotypes among study participants. RESULTS: Participants smoked an average of 16 cigarettes per day before pregnancy. The PAV and AVI haplotype frequencies were 48% and 45%, respectively. Non-Hispanic women were less likely than Hispanic women to smoke menthol cigarettes. As hypothesized, the frequency of the PAV haplotype was greater in menthol than non-menthol smokers in both non-Hispanics (54% vs. 30%; χ(2) = 13.04, P < .001) and Hispanics (53% vs. 25%; χ(2) = 5.77, P = .016). This effect persisted after controlling for potential confounders in multivariate logistic regression. Menthol smokers had a greater number of PAV haplotypes/individual than non-menthol smokers [non-Hispanics odds ratio (OR) = 3.02 (1.56-5.85); P = .001; Hispanics OR = 3.60 (1.23-10.56); P = .020]. CONCLUSIONS: These preliminary data support the hypothesis that a genetic propensity to experience heightened bitter taste perception increases the preference for menthol cigarettes.


Asunto(s)
Comportamiento del Consumidor , Estudios de Asociación Genética , Mentol , Fumar/genética , Percepción del Gusto/genética , Productos de Tabaco , Adulto , Femenino , Estudios de Asociación Genética/métodos , Genotipo , Haplotipos , Humanos , Polimorfismo de Nucleótido Simple/genética , Embarazo , Receptores Acoplados a Proteínas G/genética , Fumar/psicología , Gusto/genética , Tabaquismo/genética , Tabaquismo/psicología , Población Blanca/genética
12.
Am J Addict ; 22(1): 54-9, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23398227

RESUMEN

BACKGROUND AND OBJECTIVES: Pregnant women face considerable barriers to smoking cessation. The purpose of this study was to determine the prevalence of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) and response to smoking cessation treatment in pregnant smokers participating in a randomized, placebo-controlled trial of nicotine gum. METHODS: Participants were 194 low-income, ethnically diverse pregnant smokers. RESULTS: Utilizing a structured interview, 45% and 18% of the subjects met criteria for a lifetime diagnosis of MDD and PTSD, respectively. There was no difference in response to treatment, based on the presence of either of these psychiatric disorders. CONCLUSIONS: Cumulatively, these findings provide evidence of the high degree of unmet mental health needs in pregnant smokers. SCIENTIFIC SIGNIFICANCE: Pregnant women with a history of MDD and PTSD appear to be as likely to benefit from smoking cessation treatment as those without such a history.


Asunto(s)
Trastorno Depresivo Mayor/complicaciones , Complicaciones del Embarazo/tratamiento farmacológico , Fumar/tratamiento farmacológico , Trastornos por Estrés Postraumático/complicaciones , Dispositivos para Dejar de Fumar Tabaco , Adulto , Femenino , Hispánicos o Latinos/psicología , Humanos , Embarazo , Prevalencia
13.
Obstet Gynecol ; 118(3): 683-686, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21860301

RESUMEN

There are three major examples of collaborative programs between certified nurse-midwives (CNMs) and obstetrician-gynecologists at Baystate Medical Center in Springfield, Massachusetts, within the Department of Obstetrics and Gynecology. One program is a midwifery practice that serves a diverse population in a hospital-based office, four neighborhood health centers, and a correctional facility. Another program provides a triage function for patients who present to the hospital with obstetric or gynecologic problems. The third program introduces a team approach to the education of residents with a CNM having primary responsibility for teaching normal obstetrics to first-year residents and medical students in collaboration with attending physicians. Keys to success include an understanding of the principles of collaborative practice, the use of a detailed practice agreement between midwives and attending physicians, keeping open lines of communication, understanding and accepting differing philosophies of practice, and, most importantly, maintaining trust across all levels of providers.


Asunto(s)
Servicios de Salud Materna/organización & administración , Partería/organización & administración , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Obstetricia/organización & administración , Relaciones Médico-Enfermero , Conducta Cooperativa , Femenino , Humanos , Internado y Residencia/organización & administración , Massachusetts , Modelos Organizacionales , Obstetricia/educación , Embarazo
14.
Obstet Gynecol ; 112(4): 859-67, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18827129

RESUMEN

OBJECTIVE: To estimate the safety and efficacy of treatment with 2-mg nicotine gum for smoking cessation during pregnancy. METHODS: Pregnant women who smoked daily received individualized behavioral counseling and random assignment to a 6-week treatment with 2-mg nicotine gum or placebo followed by a 6-week taper period. Women who did not quit smoking were instructed to reduce the number of cigarettes smoked by substituting with gum. Measures of tobacco exposure were obtained throughout the study. RESULTS: Participants in the nicotine (n = 100) and placebo (n = 94) groups were comparable in age, race/ethnicity, and smoking history. Biochemically validated smoking-cessation rates were not significantly higher with nicotine gum compared with placebo (after 6 weeks of treatment: 13% compared with 9.6%, P=.45; at 32-34 weeks of gestation: 18% compared with 14.9%, P=.56). Using a completer analysis, nicotine gum significantly reduced the number of cigarettes smoked per day (nicotine gum: -5.7 [standard deviation (SD)=6.0]; placebo: -3.5 [SD=5.7], P=.035), and cotinine concentration (nicotine gum: -249 ng/mL [SD=397]; placebo: -112 ng/mL [SD=333]; P=.04). Birth weights were significantly greater with nicotine gum compared with placebo (3,287 g [SD=566] and 2,950 g [SD=653], respectively, P<.001). Gestational age was also greater with nicotine-replacement therapy than with placebo (38.9 weeks [SD=1.7] and 38.0 weeks [SD=3.3], respectively; P=.014). CONCLUSION: Although nicotine gum did not increase quit rates, use of nicotine gum increased birth weight and gestational age, two key parameters in predicting neonatal wellbeing.


Asunto(s)
Goma de Mascar , Nicotina/administración & dosificación , Agonistas Nicotínicos/administración & dosificación , Cese del Hábito de Fumar/métodos , Peso al Nacer , Cotinina/orina , Consejo , Método Doble Ciego , Femenino , Humanos , Embarazo , Resultado del Embarazo , Estudios Prospectivos
15.
J Midwifery Womens Health ; 53(4): 376-80, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18586191

RESUMEN

In response to the new standards for resident work hours issued in 2003, Baystate Medical Center in Springfield, MA developed a program for midwifery involvement in resident and medical education. The Obstetrics Team consists of a midwife teaching first-year residents in obstetrics/gynecology and emergency medicine and third-year medical students on the labor and delivery unit. This program has successfully addressed the need for resident and medical education as well as service provision created by reduced resident work hours and provides a useful model for other institutions.


Asunto(s)
Internado y Residencia , Partería/métodos , Obstetricia/educación , Grupo de Atención al Paciente , Enseñanza , Adulto , Femenino , Humanos , Masculino , Partería/organización & administración , Modelos Educacionales , Investigación en Evaluación de Enfermería , Embarazo , Estudiantes de Medicina
16.
J Clin Microbiol ; 43(2): 684-7, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15695664

RESUMEN

Trichomonas vaginalis infection is estimated to be the most widely prevalent nonviral sexually transmitted infection in the world. Wet-mount microscopy is the most common diagnostic method, although it is less sensitive than culture. The OSOM Trichomonas Rapid Test (Genzyme Diagnostics, Cambridge, Mass.) (referred to here as OSOM) is a new point-of-care diagnostic assay for T. vaginalis that uses an immunochromatographic capillary flow (dipstick) assay and provides results in 10 min. The purpose of this study was to determine the test characteristics of OSOM compared to those of a composite reference standard (CRS) comprised of wet-mount microscopy and T. vaginalis culture. This multicenter cross-sectional study enrolled sexually active women > or =18 years of age who presented with symptoms of vaginitis, exposure to T. vaginalis, or multiple sexual partners. Vaginal-swab specimens were obtained for T. vaginalis culture, wet mount, and rapid testing. The prevalence of T. vaginalis in this sample was 23.4% (105 of 449) by the CRS. The sensitivity and specificity of OSOM vaginal-swab specimens were 83.3 and 98.8%, respectively, while wet mount had a sensitivity and specificity of 71.4 and 100%, respectively, compared to the CRS. OSOM performed significantly better than wet mount (P = 0.004) and detected T. vaginalis in samples that required 48 to 72 h of incubation prior to becoming culture positive. The performance of the rapid test was not affected by the presence of coinfections with chlamydia and gonorrhea. The OSOM Trichomonas Rapid Test is a simple, objective test that can be expected to improve the diagnosis of T. vaginalis, especially where microscopy and culture are unavailable.


Asunto(s)
Juego de Reactivos para Diagnóstico , Vaginitis por Trichomonas/diagnóstico , Trichomonas vaginalis/aislamiento & purificación , Vagina/parasitología , Adolescente , Adulto , Animales , Cromatografía , Femenino , Humanos , Inmunoensayo , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Manejo de Especímenes/métodos , Factores de Tiempo , Vaginitis por Trichomonas/parasitología
17.
Obstet Gynecol ; 105(2): 345-51, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15684163

RESUMEN

OBJECTIVE: To provide evidence regarding the safety, efficacy, and acceptability of 200 mg mifepristone followed by home administration of 400 mug oral misoprostol METHODS: The 376 women enrolled in this prospective, open-label, multicenter trial were administered mifepristone in the clinic and were given 2 tablets of 200 mug misoprostol to swallow at home 48 hours later. On day 15, women returned to the clinic for a gynecologic examination. Success was defined as a complete termination without surgical intervention or additional misoprostol by day 21. All participants completed an exit interview before discharge from the study RESULTS: Of the women enrolled, 58.8% had gestations of between 43 and 49 days, 54.7% had had a previous abortion, and 76% had had a previous pregnancy. Of the 354 women included in the efficacy analysis, 324 (91.5%) had a successful termination. The most common adverse effects reported by patients were pain or cramps (93.2%) and nausea (66.6%), followed by weakness (54.7%), headache (46.2%), and dizziness (44.4%). Overall acceptability of the regimen was high, with 63.3% of women reporting that it was very satisfactory and an additional 23% reporting that it was satisfactory CONCLUSION: A regimen of 200 mg mifepristone followed in 48 hours by home administration of 400 mug oral misoprostol is effective, associated with rare severe adverse effects or adverse events, and acceptable for women seeking medical abortion of pregnancies of up to 49 days duration as compared with the regimen currently approved by the Food and Drug Administration. LEVEL OF EVIDENCE: III.


Asunto(s)
Aborto Terapéutico/métodos , Mifepristona/uso terapéutico , Misoprostol/uso terapéutico , Resultado del Embarazo , Administración Oral , Adulto , Terapia Combinada , Dilatación y Legrado Uterino , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Modelos Logísticos , Edad Materna , Embarazo , Probabilidad , Estudios Prospectivos , Medición de Riesgo , Método Simple Ciego , Resultado del Tratamiento
18.
Am J Obstet Gynecol ; 189(3): 644-6, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-14526283

RESUMEN

OBJECTIVES: The study was undertaken to assess the efficacy of a hospital-community rotation in abortion and contraception. STUDY DESIGN: The program was developed and implemented by the Planned Parenthood League of Massachusetts (PPLM) and the Department of Obstetrics and Gynecology at Baystate Medical Center in November 2000. Abortion and contraceptive training is integrated into postgraduate year 3 and includes didactic presentations and 10 mandatory clinical sessions in first trimester abortion care. RESULTS: Five residents complete the program annually. Before rotation, residents report their competence in first-trimester abortion procedure as 2 on a scale of 1 to 5 (1=not at all comfortable, 5=very comfortable). After rotation, the reported competency rating is 4.5 on the same scale. Residents, trainers, and staff report high satisfaction with the program. CONCLUSION: A collaborative hospital-community rotation in abortion and contraception increases residents' clinical competence in these areas and is highly acceptable to residents, faculty, and staff.


Asunto(s)
Aborto Inducido , Relaciones Comunidad-Institución , Anticoncepción , Hospitales , Internado y Residencia , Curriculum , Servicios de Planificación Familiar , Ginecología/educación , Humanos , Obstetricia/educación
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