Women's perspectives on falls and fall prevention during pregnancy.

BACKGROUND: Falls are the leading cause of unintentional injury in women. During pregnancy, even a minor fall can result in adverse consequences. Evidence to inform effective and developmentally appropriate pregnancy fall prevention programs is lacking. Early research on pregnancy fall prevention suggests that exercise may reduce falls. However, acceptability and effectiveness of pregnancy fall prevention programs are untested. PURPOSE: To better understand postpartum women's perspective and preferences on fall prevention strategies during pregnancy to formulate an intervention. METHODS: Focus groups and individual interviews were conducted with 31 postpartum women using descriptive qualitative methodology. Discussion of falls during pregnancy and fall prevention strategies was guided by a focus group protocol and enhanced by 1- to 3-minute videos on proposed interventions. Focus groups were audio recorded, transcribed, and analyzed using NVivo 10 software. RESULTS: Emerging themes were environmental circumstances and physical changes of pregnancy leading to a fall, prevention strategies, barriers, safety concerns, and marketing a fall prevention program. Wet surfaces and inappropriate footwear commonly contributed to falls. Women preferred direct provider counseling and programs including yoga and Pilates. IMPLICATIONS: Fall prevention strategies tailored to pregnant women are needed. Perspectives of postpartum women support fall prevention through provider counseling and individual or supervised exercise programs.

Using a life course model to examine racial disparities in low birth weight during adolescence and young adulthood.

INTRODUCTION: This study examined relationships between health, social, environmental, and economic factors during adolescence and the subsequent risk of giving birth to a low-birth-weight (LBW) infant, to inform strategies for reducing racial disparities in LBW. METHODS: Data were derived from the National Longitudinal Study of Adolescent Health. A sample of 1213 adolescents, reporting on first pregnancies, was created with 35% black, non-Hispanic (black) and 65% white, non-Hispanic (white) participants. Independent variables were from the domains of individual characteristics, health status, access to care, and social environment. The dependent variable was low birth weight. Overall and race-specific logistic regression models were estimated. RESULTS: Black women had 1.9 times the odds of giving birth to an LBW infant as white women. Factors associated with LBW differed between black women and white women. Black women with a history of hypertension were 6 times more likely to have an LBW infant. Intimate partner support during prenatal care was protective for black women. Factors associated with an increased risk of giving birth to an LBW infant for white women included an intergenerational pattern of LBW, low body mass index during adolescence, and smoking during pregnancy. Socioeconomic factors during adolescence did not predict the odds of having an LBW infant for either group, except for white women whose parents had less than a high school education and black women living in medium-poverty neighborhoods. DISCUSSION: Findings suggest that strategies to reduce racial disparities should address the specific needs of the population being served over the life course.

Behind closed doors: school nurses and sexual education.

School nurses can play a key role in providing sexual education in schools. However, they often face barriers from the school administration and concerned parents. Additionally, school nurses may have limited formal preparation in managing sexual health issues. This study used a descriptive qualitative method to explore the school nurses' experiences with facilitators and barriers to providing sexual education. Eighteen nurses from 12 Massachusetts high schools were interviewed. Results showed that the school nurses do not provide formal sexual education at their schools but frequently conduct informal sessions. School nurses reported that students needed more sexual health information, yet there was no collaboration with the school health teachers. Common barriers included lack of privacy and time, confidentiality issues, and fear of conflict. Nurses working in communities with high teen pregnancy rates reported more barriers. The findings can inform the development of policies and practices for sexual education by school nurses.

Health reform policy initiatives to promote older women's health.

Currently, women's health care is receiving more attention in health policy discussions. This article reviews aspects of the Patient Protection and Affordable Care Act (PPACA) that seek to improve the health and health care services for older women. Increased access to evidence-based screening assessments for women with Medicare will enhance both the prevention and treatment of acute and chronic diseases. PPACA also contains provisions to expand the gerontological nursing workforce to meet the needs of the rapidly growing population of Medicare-eligible women. Evolving models of care, such as community-based care, shared financial risks, and care coordination, are the current focus of best practice research by the Center of Medicare & Medicaid Innovation. The financing and provision of long-term care is a major issue for women, who represent the majority of adults older than 85. The overarching aim of the new PPACA Medicare changes is to create affordable, quality health care systems that meet the needs of women as they age.