Perceived Discrimination During Prenatal Care at a Community Health Center.

INTRODUCTION: Discrimination in healthcare is associated with fetal growth restriction, preterm birth, and postpartum depression. A community-based participatory research study was designed to measure perceived discrimination and healthcare quality during prenatal care and delivery by a community health center, where the majority of patients served belong to historically marginalized ethnic and racial groups. METHODS: A 34-question phone survey was administered to women 18 years and older who received prenatal care at the study site during 2020-2021. The primary outcome was perceived discrimination during obstetric care, measured by the 7-question Discrimination in the Medical Setting (DMS) survey. Secondary outcomes included the association of race with perceived discrimination, quality of care, trust of healthcare providers, and perceived control over medical choices. RESULTS: Ninety-seven women completed the survey, 95 of whom were women of color. The sample was dichotomized into Black (n = 49) and non-Black (n = 46). Perceived discrimination for all participants was 21% (20/95), with 31% (15/49) of Black women reporting any discrimination during prenatal care and delivery. Compared to other women of color, Black women reported higher rates of perceived discrimination (31% vs 11%, aOR 3.9 [1.2-12.1], p < 0.05), lower control over health choices (84% vs 98%, aOR 0.1 [0.0-0.8], p < 0.05), and were more likely to perceive lack of respect (12% vs 2%, p = 0.045). CONCLUSION: Although perceived discrimination at this community health center was low compared to prior studies, Black women experienced higher rates of discrimination than other women of color.

Spirituality in Pregnancy.

Spirituality with its impact on health outcomes continues to emerge in the medical literature. This article discusses the role of spirituality in pregnancy, childbirth, and postpartum. It highlights the importance of more fully integrating this concept into births traditionally attended by physicians and midwives in the hospital setting. This discussion covers birthing practices ingrained with culture and spirituality. The article concludes with strategies to elicit and integrate spirituality into routine practice to provide improved health care to patients and to find more fulfillment in the role as birth attendant.

Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization.

BACKGROUND: Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea. OBJECTIVE: Assess the impact of admission testing for toxigenic C. difficile colonization on the incidence of HO-CDI. DESIGN: Pragmatic stepped-wedge Infection Control initiative. SETTING: NorthShore University HealthSystem is a four-hospital system near Chicago, IL. PATIENTS: All patients admitted to the four hospitals during the initiative. INTERVENTIONS: From September 2017 through August 2018 we conducted a quality improvement program where admitted patients had a peri-rectal swab tested for toxigenic C. difficile. All colonized patients were placed into contact precautions. MEASUREMENTS: We tested admissions who: i) had been hospitalized within two months, ii) had a past C. difficile positive test, and/or iii) were in a long-term care facility within six months. We measured compliance with all other practices to reduce the incidence of HO-CDI. RESULTS: 30% of admissions were tested and 8.3% were positive. In the year prior to the initiative (Period 1) there were 63,057 admitted patients when HO-CDI incidence was 5.96 cases/10,000 patient days. During the 12-month initiative (Period 2) there were 62,760 admissions and the HO-CDI incidence was 4.23 cases/10,000 patient days (p = 0.02). There were no other practice or antibiotic use changes. Continuing admission surveillance provided a HO-CDI incidence of 2.9 cases/10,000 patient days during the final 9 months of 2018 (p<0.0001 compared to Period 1), equaling <1 case/1,000 admissions. LIMITATIONS: This was not a randomized controlled trial, and multiple prevention practices were in place at the time of the admission surveillance initiative. CONCLUSION: Admission C. difficile surveillance testing is an important tool for preventing hospital-onset C. difficile infection. REGISTRATION: This quality improvement initiative is registered at ClinicalTrials.gov. The unique registration identifier number is NCT04014608.

Reliability and validity testing of the Creighton Competency Evaluation Instrument for use in the NCSBN National Simulation Study.

AIM: The Creighton Competency Evaluation Instrument (CCEI) was modified from an existing instrument, the Creighton Simulation Evaluation Instrument, for use in the National Council of States Boards of Nursing National Simulation Study (NCSBN NSS). BACKGROUND: The CCEI was developed for the NCSBN NSS for use as the evaluation instrument for both simulation and traditional clinical experiences in associate and baccalaureate nursing programs. METHOD: Five nursing programs assisted with reliability and validity testing of the CCEI. Using a standardized validation questionnaire, faculty rated the CCEI on its ability to accurately measure student performance and clinical competency. Videos scripted at three levels of performance were used to test reliability. RESULTS: Content validity ranged from 3.78 to 3.89 on a four-point Likert-like scale. Cronbach's alpha was > .90 when used to score three different levels of simulation performance. CONCLUSION: The CCEI is useful for evaluating both the simulation and traditional clinical environments.

Assessment of the impact of traditional septic tank soakaway systems on water quality in Ireland.

One of the key threats to groundwater and surface water quality in Ireland is the impact of poorly designed, constructed or maintained on-site wastewater treatment systems. An extensive study was carried out to quantify the impact of existing sites on water quality. Six existing sites, consisting of a traditional septic tank and soakaway system, located in various ranges of subsoil permeabilities were identified and monitored to determine how well they function under varying subsoil and weather conditions. The preliminary results of the chemical and microbiological pollutant attenuation in the subsoil of the systems have been assessed and treatment performance evaluated, as well as impact on local surface water and groundwater quality. The source of any faecal contamination detected in groundwater, nearby surface water and effluent samples was confirmed by microbial source tracking. From this, it can be seen that the transport and treatment of percolate vary greatly depending on the permeability and composition of the subsoil.

Chlamydia trachomatis Infection: Screening and Management.

OBJECTIVE: To review current criteria and rationale for Chlamydia trachomatis screening, testing methods, and treatment of infection. METHODS: Review of the literature. RESULTS: C. trachomatis urogenital infections are an important public health problem. Screening for C. trachomatis in women age 25 and younger and men and women of any age at increased risk allows for the early treatment of disease, avoiding morbidity such as pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain, and reducing health care costs. CONCLUSION: Current screening recommendations are not being implemented satisfactorily. Home-based methods of screening are acceptable and may improve universal screening rates.

Progress of labor in women induced with misoprostol versus the Foley catheter.

OBJECTIVE: To estimate and compare the duration and progress of labor in women induced with misoprostol vs Foley catheter plus oxytocin. STUDY DESIGN: We performed a retrospective cohort study of labor progress among 617 consecutive term pregnancies induced with misoprostol (n = 503) or Foley catheter plus oxytocin (n = 114) who completed the first stage of labor. Labor duration and progress in the entire cohort, and stratified by parity, were compared in multivariable interval-censored regression models adjusting for maternal obesity and birthweight. Repeated-measures analysis with 9th degree polynomial modeling was used to construct average labor curves. RESULTS: Total duration of labor was not significantly different in women induced with misoprostol compared with the Foley catheter (median duration from 1 to 10 cm: 12 vs 14.2 hours, P = .19). Progress from 1 to 4 cm was more rapid with the Foley catheter (median: 3.4 vs 5.6 hours, P < .01), although progress from 4 to 10 cm was slower (median: 6.3 vs 3.6 hours, P < .01). Labor curves demonstrated transition from latent to active labor at about 4 cm cervical dilatation with misoprostol and at 6 cm for the Foley catheter. Similar general patterns were noted for nulliparous and multiparous women, except for a shorter duration of labor with the Foley catheter among multiparous women. CONCLUSION: Induction of labor with the Foley catheter is associated with more rapid initial cervical dilation, but transition to active labor occurs later compared with misoprostol. These differences should be considered in the management of induced labor.

Discussion: 'Abnormal anal cytology in HIV-infected women' by Baranoski et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Baranoski AS, Tandon R, Weinberg J, et al. Risk factors for abnormal anal cytology over time in HIV-infected women. Am J Obstet Gynecol 2012;207:107.e1-8.

Bat incidents at children's camps, New York State, 1998-2002.

From 1998 to 2002, a total of 299 bat incidents were reported at 109 children's camps in New York; 1,429 campers and staff were involved, and 461 persons received rabies treatment. In 53.8% of the incidents, the bat was captured and samples tested negative for rabies virus, which resulted in 61.3% of persons not receiving rabies treatment.