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Objectives In Georgia, 52 % of the primary care service areas outside metropolitan Atlanta have a deficit of obstetric providers. This study was designed to identify factors associated with the likelihood of Georgia's obstetric trainees (obstetrics and gynecology (OB/GYN) residents and certified nurse midwifery (CNM) students) to practice in areas of Georgia that lack obstetric providers and services, i.e. rural Georgia. Methods Pilot-tested electronic and paper surveys were distributed to all of Georgia's OB/GYN residents (N = 95) and CNM students (N = 28). Mixed-methods survey questions assessed characteristics, attitudes, and incentives that might be associated with trainee desire to practice in areas of Georgia that lack obstetric providers and services. Surveys also gathered information about concerns that may prevent trainees from practicing in shortage areas. Univariate and bivariate analyses were performed, and qualitative themes were abstracted from open-ended questions. Results The survey response rate was 87.8 % (108/123). Overall, 24.4 % (19/78) of residents and 53.6 % (15/28) of CNM students expressed interest in practicing in rural Georgia, and both residents and CNM students were more likely to desire to practice in rural Georgia with the offer of any of six financial incentives (P < 0.001). Qualitative themes highlighted trainees' strong concerns about Georgia's political environment as it relates to reproductive healthcare. Conclusions Increasing state-level, rurally-focused financial incentive programs and emphasizing the role of CNMs may alleviate obstetric provider shortages in Georgia., Author(s): Elizabeth A. Smulian[sup.1] , Leilah Zahedi[sup.2] , Julie Hurvitz[sup.2] , Abigail Talbot[sup.1] [sup.2] , Audra Williams[sup.1] [sup.2] , Zoë Julian[sup.1] [sup.2] , Adrienne D. Zertuche[sup.1] [sup.2] [sup.3] , Roger [...]

Objective: To assess differences in two different approaches to early inpatient Edinburgh Postnatal Depression Scale (EPDS) screening (targeted risk factor screening versus universal screening). Methods: Retrospective study of two cohorts delivering from January 2010 to June 2010. Cohort 1 included 5-weeks of consecutive deliveries. Risk factors for a positive EPDS screen were determined by multivariable logistic regression. Cohort 2 included all delivering women in the subsequent 5 months who had the most common risk factor (history of mental illness) for postpartum depression identified from Cohort 1. Results: For Cohort 1 of universal screening ( N = 322), 11 (3.4%) had positive screens with seven (63.6%) having a history of any mental illness yielding the number needed to screen to identify one EPDS positive mother of 29. For Cohort 2 ( N = 215), there were 33 (15.3%) positive screens and the number needed to have a positive screen was 6. Without a history of mental illness, predictive models for a positive screen were poor with the number needed to screen of 80. Conclusions: Early EPDS screening targeted for those with a history of mental illness is an efficient way to identify postpartum women with active mental health problems, but may miss up to 36.4% of potential screen positive women. [ABSTRACT FROM AUTHOR]