Obstetricians' prescribing practices for pain management after delivery.

Aim: To examine postpartum opioid prescribing practices. Materials & methods: Obstetricians were interviewed about opioids: choice of opioid, clinical factors considered when prescribing, thoughts/beliefs about prescribing, and typical counseling provided. Inductive thematic analyses were used to identify themes. Results: A total of 38 interviews were analyzed. Several key points emerged. The choice of opioid, dosing and number of pills prescribed varied widely. The mode of delivery is the primary consideration for prescribing opioids. All providers would prescribe opioids to breastfeeding women. Some providers offered counseling on nonopioid treatment of pain. Discussion: At two large tertiary centers in Pennsylvania, the 38 physicians interviewed wrote 38 unique opioid prescriptions. Patient counseling addressed short-term pain management, but not the chronic overuse of opioids.

We wanted to look at the way opioid pain drugs are provided to mothers after the birth of their children and see what doctors tell mothers about the pain drugs. We interviewed doctors and asked which opioid pain drug they would choose, what made them prescribe the drug, the thoughts about giving mothers the drug and what they told the mothers about the drug. We then looked at all the responses to look for patterns in how doctors gave pain drugs to mothers. Our team interviewed 38 doctors. Some key points were seen; first is that the choice of opioid pain drug, dose and number of pills prescribed was different from doctor to doctor; second is that whether the baby was delivered vaginally or by cesarean was the main factor upon which doctors based their decisions for giving opioid pain drugs. Whether a mother was taking medications that help with addiction, the doctor's assessment of the mother's pain and the doctor's thoughts on the mother's risk of opioid addiction were also considered. All doctors would give opioid pain drugs to breastfeeding mothers. Finally, some doctors talked to mothers about using other medications for pain, but not about the overuse of opioid pain drugs. At our two hospital centers in Pennsylvania, the 38 doctors gave opioid pain drugs to mothers in 38 different ways. Doctors said that opioids are necessary after cesarean, but not after vaginal birth, unless there is a problem. A mother's history and social situation inform decision making. Doctors talk to mothers about short-term pain, but not about the overuse of opioid pain drugs.

Academic and emotional functioning in early adolescence: longitudinal relations, patterns, and prediction by experience in middle school.

Adopting a motivational perspective on adolescent development, these two companion studies examined the longitudinal relations between early adolescents' school motivation (competence beliefs and values), achievement, emotional functioning (depressive symptoms and anger), and middle school perceptions using both variable- and person-centered analytic techniques. Data were collected from 1041 adolescents and their parents at the beginning of seventh and the end of eight grade in middle school. Controlling for demographic factors, regression analyses in Study 1 showed reciprocal relations between school motivation and positive emotional functioning over time. Furthermore, adolescents' perceptions of the middle school learning environment (support for competence and autonomy, quality of relationships with teachers) predicted their eighth grade motivation, achievement, and emotional functioning after accounting for demographic and prior adjustment measures. Cluster analyses in Study 2 revealed several different patterns of school functioning and emotional functioning during seventh grade that were stable over 2 years and that were predictably related to adolescents' reports of their middle school environment. Discussion focuses on the developmental significance of schooling for multiple adjustment outcomes during adolescence.