State anxiety in pregnancies affected by obstetric complications: A systematic review.

BACKGROUND: Maternal mental health status remains an important area of study due to its influence on maternal health outcomes. Past reviews on anxiety in pregnancy have included multiple mental health diagnoses and pre-existing conditions. A systematic review was performed to understand maternal state anxiety during pregnancies affected by obstetrical complications. METHODS: A systematic search of electronic databases was performed including quantitative, primary studies in the English language. The population of interest was women whose pregnancies were affected by maternal and/or fetal obstetric (not pre-existing) complications with state anxiety as the outcome. Twenty-six studies met the inclusion and methodological criteria and were included in the review. RESULTS: The review revealed that 20% to 100% of women experiencing pregnancies affected by obstetric complications had high levels of state anxiety, and these rates are negatively influenced by complication type and severity, demographic characteristics, and maternal perceptions and expectations. Overall, antenatal state anxiety was shown to improve over the course of the pregnancy, though levels remained above clinical thresholds. LIMITATIONS: This review was based only on English peer-reviewed articles, many of which used convenience sampling with homogenous samples, limiting generalizability. Additional limitations include how anxiety prevalence was aggregated due to differences in measurement across studies. CONCLUSIONS: Anxiety is prevalent among women experiencing pregnancies affected by obstetric complications. Based on this review, we recommend that all women treated for obstetric complications are screened for anxiety; facilitating detection, referral, and treatment, ultimately contributing to optimal maternal outcomes.

Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy.

Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as "low support" and "high support" based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19-17.15) times as likely to report a "high support" network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections.

The Personal Social Networks of Resettled Bhutanese Refugees During Pregnancy in the United States: A Social Network Analysis.

Women comprise 50% of the refugee population, 25% of whom are of reproductive age. Female refugees are at risk for experiencing significant hardships associated with the refugee experience, including after resettlement. For refugee women, the strength of their personal social networks can play an important role in mitigating the stress of resettlement and can be an influential source of support during specific health events, such as pregnancy. A personal social network analysis was conducted among 45 resettled Bhutanese refugee women who had given birth within the past 2 years in the Akron Metropolitan Area of Northeast Ohio. Data were collected using in-depth interviews conducted in Nepali over a 6-month period in 2016. Size, demographic characteristics of ties, frequency of communication, length of relationship, and strength of connection were the social network measures used to describe the personal networks of participants. A qualitative analysis was also conducted to assess what matters were commonly discussed within networks and how supportive participants perceived their networks to be. Overall, participants reported an average of 3 close personal connections during their pregnancy. The networks were comprised primarily of female family members whom the participant knew prior to resettlement in the U.S. Participants reported their networks as "very close" and perceived their connections to be supportive of them during their pregnancies. These results may be used to guide future research, as well as public health programming, that seeks to improve the pregnancy experiences of resettled refugee women.

Influenza Vaccine Uptake, Hand Hygiene Practices, and Perceived Barriers in Decision Making.

The annual costs of influenza are in the billions of dollars, with employers bearing substantial burdens. Yet, influenza vaccine uptake is sub-optimal. A random survey was administered to employees at a Midwestern public university using mixed quantitative and qualitative methods to identify the rate, characteristics, and barriers of self-reported flu vaccine uptake during March-April of 2012. The lowest uptake was among adults, ages 18 to 49 (29.8%), even though they are included in universal recommendations. Multiple regression analysis adjusted for demographic confounders showed an increase in self-identified protective hand hygiene behavior among those who reported influenza vaccine uptake compared with those who did not. Qualitative thematic analysis revealed contextual accounts of why vaccine uptake was declined including structural, perceptual, and knowledge barriers. Implementation and evaluation of novel multicomponent worksite vaccine interventions tailored to reach young and middle-aged employees including utilization of risk communication is needed to facilitate increased uptake.

Using a qualitative approach for understanding hospital-affiliated integrated clinical and fitness facilities: characteristics and members' experiences.

BACKGROUND: With health care shifting away from the traditional sick care model, many hospitals are integrating fitness facilities and programs into their clinical services in order to support health promotion and disease prevention at the community level. Through a series of focus groups, the present study assessed characteristics of hospital-affiliated integrated facilities located in Northeast Ohio, United States and members' experiences with respect to these facilities. METHODS: Adult members were invited to participate in a focus group using a recruitment flyer. A total of 6 focus groups were conducted in 2013, each lasting one hour, ranging from 5 to 12 participants per group. The responses and discussions were recorded and transcribed verbatim, then analyzed independently by research team members. Major themes were identified after consensus was reached. RESULTS: The participants' average age was 57, with 56.8% currently under a doctor's care. Four major themes associated with integrated facilities and members' experiences emerged across the six focus groups: 1) facility/program, 2) social atmosphere, 3) provider, and 4) member. Within each theme, several sub-themes were also identified. A key feature of integrated facilities is the availability of clinical and fitness services "under one roof". Many participants remarked that they initially attended physical therapy, becoming members of the fitness facility afterwards, or vice versa. The participants had favorable views of and experiences with the superior physical environment and atmosphere, personal attention, tailored programs, and knowledgeable, friendly, and attentive staff. In particular, participants favored the emphasis on preventive care and the promotion of holistic health and wellness. CONCLUSIONS: These results support the integration of wellness promotion and programming with traditional medical care and call for the further evaluation of such a model with regard to participants' health outcomes.

Outcomes of a pilot hand hygiene randomized cluster trial to reduce communicable infections among US office-based employees.

OBJECTIVE: To determine the effectiveness of an office-based multimodal hand hygiene improvement intervention in reducing self-reported communicable infections and work-related absence. METHODS: A randomized cluster trial including an electronic training video, hand sanitizer, and educational posters (n = 131, intervention; n = 193, control). Primary outcomes include (1) self-reported acute respiratory infections (ARIs)/influenza-like illness (ILI) and/or gastrointestinal (GI) infections during the prior 30 days; and (2) related lost work days. Incidence rate ratios calculated using generalized linear mixed models with a Poisson distribution, adjusted for confounders and random cluster effects. RESULTS: A 31% relative reduction in self-reported combined ARI-ILI/GI infections (incidence rate ratio: 0.69; 95% confidence interval, 0.49 to 0.98). A 21% nonsignificant relative reduction in lost work days. CONCLUSIONS: An office-based multimodal hand hygiene improvement intervention demonstrated a substantive reduction in self-reported combined ARI-ILI/GI infections.

Coalitions for impacting the health of a community: the Summit County, Ohio, experience.

Community coalitions have the potential to catalyze important changes in the health and well-being of populations. The authors demonstrate how communities can benefit from a multisector coalition to conduct a community-wide surveillance, coordinate activities, and monitor health and wellness interventions. Data from Summit County, Ohio are presented that illustrate how this approach can be framed and used to impact community health positively across communities nationwide. By jointly sharing the responsibility and accountability for population health through coalitions, communities can use the Health Impact Pyramid framework to assess local assets and challenges and to identify and implement programmatic and structural needs. Such a coalition is well poised to limit duplication and to increase the efficiency of existing efforts and, ultimately, to positively impact the health of a population.