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OBJECTIVE To evaluate the feasibility of an mHealth-supported breastfeeding peer counselor intervention implemented in rural India and the preliminary impact of the intervention on maternal breastfeeding behaviors, including exclusive breastfeeding (EBF). METHODS In this quasi-experimental pilot study, participants received either the intervention plus usual care (n = 110) or usual care alone (n = 112). The intervention group received nine in-home visits during and after pregnancy from peer counselors who provided education about and support for EBF and other optimal infant feeding practices and were aided with an mHealth tool. The control group received routine prenatal and postnatal health education. Progress notes and surveys were used to assess feasibility. Logistic regression models were used for between-group comparisons of optimal infant feeding outcomes, including EBF for 6 months. RESULTS The intervention was delivered as intended, maintained over the study period, and had high acceptability ratings. There were statistically significant differences in all outcomes between groups. The intervention group had a significantly higher likelihood of EBF at 6 months compared to the control group (adjusted odds ratio 3.57, 95% confidence interval 1.80-7.07). CONCLUSION Integration of mHealth with community-based peer counselors to educate women about EBF is feasible and acceptable in rural India and impacts maternal breastfeeding behaviors.

Introduction Advanced practice registered nurses (APRNs) are in an excellent position to address the high rates of unintended pregnancy in the United States by providing long-acting reversible contraceptives (LARCs). These methods are significant in their effectiveness in preventing pregnancy in individual women and in having population-level effects on unintended pregnancy. The aim of this study was to learn more about APRN practices around long-acting reversible contraception and influences on those practices. Methods A cross-sectional survey of APRNs who provide women's health services was conducted during the summer of 2015 using an existing adapted instrument with items on personal and patient characteristics, opinions, practices, and training around LARC methods. Zero-inflated Poisson regression models were conducted to study the factors that influenced the number of LARC insertions in the past year. Results While 84% of the 390 respondents were inserting intrauterine devices (IUDs) and 77% single-rod implants, only 16% of these were inserting more devices than 5 years earlier. The most significant predictor of placement of these contraceptives was the clinical practice of requiring only one visit for completion. Discussion National guidelines and recommendations have been in place for several years stating that women should be able to receive the contraceptive method of their choice in just one clinic visit. Women's access to LARCs from APRNs may be less than optimal. Additional research is needed to understand if the limitations in accessibility of this important reproductive health service are a function of clinician practices or clinic policies.

This study involved interviews with 42 women from the National Guard about their experiences of coping during reintegration into civilian life. Data were analyzed using techniques of conventional content analysis. The 1st theme that emerged regarded barriers to seeking and accessing care (institutional barriers, personal barriers, and stigma). The 2nd theme, coping strategies, consisted of 4 categories (seeking or gaining professional help, seeking social support, using routine activities, and using aspects of religion/spirituality). Implications for clinical work with returning female soldiers are discussed.

This chapter is a description of the utilization of SoTL concepts and Brookfield's Critical Incident Questionnaire in an evidence-based medicine course in physician assistant education.

INTRODUCTION: The knowledge and attitudes that lead to nonuse of contraception are not well understood. The goal of this study was to determine whether an association exists between contraceptive use and specific knowledge and attitudinal factors. METHODS: We conducted a secondary analysis of data from a nationally representative telephone survey of 897 unmarried women aged 18 to 29 years to examine the relationship between contraceptive use and comprehensive sex education attitude toward pregnancy prevention perceived infertility distrust toward the health care system or contraception and moral attitude toward contraception. RESULTS: Both ever having made a visit to a physician or clinic for womens health care and ever having used any method of contraception to prevent pregnancy were significantly impacted by more comprehensive sex education and less likelihood to view contraception as morally wrong. Consistent with other research we found no association between the desire to avoid pregnancy and contraceptive use. We found an association between health system distrust and contraceptive use but health system distrust did not predict contraceptive use. DISCUSSION: Our findings show that contraceptive use among a sample of young women is influenced by previous contraceptive education and moral attitudes toward contraception. Clinicians should be cognizant of these realities which may need to be addressed in both clinical and nonclinical venues. (c) 2014 by the American College of Nurse-Midwives.

OBJECTIVE: A qualitative study among female Veterans from recent conflicts was conducted to explore the women's experiences and potential suicide risk factors according to the Interpersonal Psychological Theory of Suicide, including burdensomeness, failed belongingness, and acquired ability. METHODS: The presented paper is an extension of published work by Brenner et al. (2008) regarding mostly male combat Veterans. The methodology employed was qualitative descriptive with hermeneutic hues (Sandelowski, 2000). Interviews were conducted with 19 women, aged 24-52 years, all of whom had been deployed to combat zones in Iraq and/or Afghanistan. RESULTS: Transcripts were reviewed and themes emerged regarding women being a minority within their environment and deployment-related stressors. These experiences seemed to influence participants' views of the world and ways of coping. CONCLUSIONS: Among the interviewed female Veterans, preliminary support was provided for Joiner's concepts. Therapeutic strategies for applying themes to clinical practice (e.g., peer support, family therapy, interventions aimed at increasing distress tolerance) are provided. Language: en

PURPOSE: Determine availability of emergency contraception (EC) at rural and urban pharmacies in Kansas. METHODS: A sample of 201 Kansas pharmacies was selected using a random integer generator. We measured ability to dispense EC within 24 hours and whether it was in stock at the time of the survey call. We examined EC availability based on geographic differences and pharmacy type. FINDINGS: Of the sample 186 pharmacists agreed to be interviewed. Of these 19% (n = 36) were unable to provide EC within 24 hours. There were essentially no differences in availability of EC between rural (75% could dispense in 24 hours) and urban pharmacies (85% could dispense in 24 hours) (P= .105). Corporate pharmacies were more likely to be able to provide EC within 24 hours compared to independent pharmacies (OR = 3.79 CI 1.71-8.43). Thirty-one percent (n = 57) of pharmacists did not carry EC at the time of the survey call. With this sample urban pharmacies were more than twice as likely to report carrying EC compared to rural pharmacies (OR = 2.47 CI 1.31-4.68) and corporate pharmacies were also more likely to report carrying EC compared to independent pharmacies (OR = 7.77 CI 3.72-16.21). CONCLUSIONS: In a sample of Kansas pharmacies there were no differences between rural and urban pharmacies in 24-hour EC availability; however there were differences in those who stocked EC at the time of the survey call. Corporate pharmacies were more likely to dispense EC within 24 hours and have it in stock compared to independent pharmacies suggesting differences in availability of EC. (c) 2012 National Rural Health Association.

Mounting evidence supports a connection between periodontal disease and coronary heart disease, ischemic stroke, and diabetes. This theoretically grounded study examines the knowledge, attitudes, and screening and referral behaviors of primary care nurse practitioners (NPs) in relation to the periodontal disease-systemic link.A questionnaire based on the theory of planned behavior was administered to 200 primary medical care providers, mostly NPs, to determine their practice behaviors, attitudes, opinions, and knowledge regarding the periodontal disease-systemic link. A total of 137 partially and fully complete questionnaires were used for data analyses. Data were analyzed for the reported frequency of screening for periodontal disease and the knowledge of the relationship between periodontal and systemic disease. Oblimin rotation was used to explore the underlying factor structure of 10 practice-behavior items. Bivariate analyses were conducted to determine which factor subscales and demographic characteristics were significantly associated with screening and referral behaviors.Twenty-two percent of the respondents reported that they always or routinely screened patients for periodontal disease. When providers felt good about their training and continuing education (attitude), they were significantly more likely to screen patients for periodontal disease. If providers believed it was within their scope of practice (social norm) to screen for periodontal disease, and they had control over the establishment of office protocols (control), the likelihood of screening for periodontal disease increased.Professional and social norms, the perceived control over one's practice site, and reimbursement were significantly related to NPs engaging in periodontal screening and the subsequent referral for care. These results support the importance of interprofessional and collaborative education between medicine/nursing and dentistry.

Despite the strong interest of international health agencies, worldwide maternal mortality has not declined substantially over the past 10 years. Postpartum hemorrhage (PPH) is the most common cause of maternal death across the world, responsible for more than 25% of deaths annually. Although effective tools for prevention and treatment of PPH are available, most are not feasible or practical for use in the developing world where many births still occur at home with untrained birth attendants. Application of many available clinical solutions in rural areas would necessitate substantial changes in government infrastructure and in local culture and customs surrounding pregnancy and childbirth. Before treatment can be administered, prompt and accurate diagnosis must be made, which requires training and appropriate blood measurement tools. After diagnosis, appropriate interventions that can be applied in remote settings are needed. Many uterotonics known to be effective in reducing PPH in tertiary care settings may not be useful in community settings because they require refrigeration and/or skilled administration. Moreover, rapid transfer to a higher level of care must be available, a challenge in many settings because of distance and lack of transportation. In light of these barriers, low-technological replacements for treatments commonly applied in the developed-world must be utilized. Community education, improvements to emergency care systems, training for birth attendants, misoprostol, and Uniject™ have shown promise as potential solutions. In the short term, it is expedient to capitalize on practical opportunities that utilize the existing strengths and resources in each community or region in order to implement appropriate solutions to save the lives of women during childbirth.

Background: Use of herbs and nutritional supplements (known as naturoceuticals) is increasing in the USA, with about 50% of Americans taking naturoceuticals and spending over $10 billion per year for them. This raises concerns regarding their use instead of proven therapies, their side effects, and drug interaction potential. Hypothesis: The study sought to characterize cardiology patients who used supplements and to examine whether their use was diagnosis or doctor dependent, whether it affected patients' compliance, and what supplements were used. Methods: In all, 187 patients attending our cardiology clinic were interviewed, examined, and followed for up to 1 year. The users and nonusers of naturoceuticals were compared. Results: Supplements were used in 106 patients (an average of 3.1 naturoceutical per patient). There were no significant differences in their use by gender, age, primary care doctor specialty, or cardiovascular medications prescribed (except for statins). Patients with a history of myocardial infarction, coronary revascularization, hyperlipidemia, and a family history of coronary artery disease were more likely to use the supplements. Average low-density lipoprotein (106 vs. 108 mg/dl), average blood pressure (132/77 vs. 138/78 mmHg), and average hemoglobin (Hb)A1c (8.7 vs. 7.7%) showed no statistically significant differences between users and nonusers. Patients most commonly took multivitamins, vitamin E, vitamin C, vitamin B, folate, garlic, calcium, coenzyme Q10, and gingko. Conclusion: This study indicates that naturoceutical use is widespread among cardiovascular patients and it is difficult to predict clinically who the users are. Fortunately, according to our limited compliance measures, it appears that the naturoceutical use has not affected patients' compliance with traditional medications. Also, possibly a detrimental interaction potential between traditional medications and naturoceuticals has been demonstrated.

A study of resiliency was conducted among 236 urban juvenile detainees. Findings reveal that resiliency processes related differently to risk and protective factors, differed among ethnic groups, and varied by age and gender among juvenile detainees.