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Please cite this paper as: Sword W, Kurtz Landy C, Thabane L, Watt S, Krueger P, Farine D, Foster G. Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study. BJOG 2011;118:966-977. To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge. A prospective cohort study. Eleven hospitals in Ontario, Canada. A total of 2560 women ≥16 years of age who delivered singleton, live infants at term. Women completed a questionnaire in hospital and 74% ( n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression. Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression. Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73-10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46-6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99-4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19-2.80); urinary incontinence (OR 1.79; 95% CI 1.06-3.03); multiparity (OR 1.59; 95% CI 1.22-2.08); low mental health functioning (OR 1.20; 95% CI 1.15-1.25); low subjective social status (OR 1.16; 95% CI 1.02-1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03-1.22); low social support (OR 1.06; 95% CI 1.03-1.09); and low physical health functioning (OR 1.03; 95% CI 1.003-1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed. Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression. [ABSTRACT FROM AUTHOR]

PURPOSE: This paper examines baccalaureate nursing students' beliefs about the relationship between poverty and health, and the factors that influence these beliefs. BACKGROUND: The relationship between poverty and health is well established, and poverty remains a persistent problem in many industrialized nations. Nurses' understanding of how poverty influences health will affect how they interact with individual clients as well as the strategies they employ to address poverty-related issues. No studies have examined nursing students' understandings of how poverty influences health and the factors that influence that understanding. METHODS: A cross-sectional survey of a random sample (n = 740) of basic baccalaureate nursing students was conducted in three Canadian universities in 2000. Students completed a 59-item questionnaire eliciting data on demographic variables, personal and educational exposure to poverty, beliefs about the relationship between poverty and health (myth, drift, behavioural, structural), and attitudes to poverty. RESULTS: Students were most likely to adhere to a structural explanation of the relationship between poverty and health. Very little of the variance in myth and drift explanations was accounted for by course or personal exposure, programme level, age, and attitudes toward poverty. Greater course exposure and more positive attitudes toward the poor predicted support for the structural explanation. Support for the behavioural explanation was influenced by attitudes toward the poor and, to a lesser extent, by course exposure, age, and programme level. CONCLUSION: Students would benefit from greater exposure to poverty through coursework that emphasizes the structural factors contributing to poverty and its negative health consequences. Classroom experience should be complemented with clinical placements that provide students with opportunities to interact with families living in poverty and to work collaboratively with others to address the causes and consequences of poverty at community and policy levels. [ABSTRACT FROM AUTHOR]

The grounded theory study discussed in this article provides a theoretical explanation of prenatal care use among women of low income. The author recruited 26 women from two communities in Ontario, Canada, to participate in an individual or focus group interview and analyzed data using descriptive coding, interpretive coding, and constant comparison. Perceptions of the health care system were identified as important influences on usage behavior. This broad theme included two subthemes: (a) program and service attributes and (b) service provider characteristics. Within each subtheme, both barriers to and facilitative factors for prenatal care became apparent. The author examined relationships among categories to identify a unifying construct. Taking care of self emerged as the central phenomenon that explained usage behavior. Women weigh the pros and cons when deciding whether to access prenatal care, and then take charge, ultimately making a decision in terms of its meaning for self. [ABSTRACT FROM AUTHOR]

This paper critically examines the notion of barriers as conceptualized in the literature and suggests an expanded orientation to more fully appreciate its complexity. This alternative approach not only takes into account factors and processes relevant to the individual that create constraints to utilization, but also acknowledges influences on the design and delivery of health care. These latter considerations determine the availability and characteristics of programmes and services that may or may not encourage or enable participation by persons of low income. A socio-ecological model is proposed that compels health care practitioners and researchers to acknowledge the many influences on utilization behaviour. The literature on barriers to prenatal care is subsequently reviewed and evaluated, with consideration given to the range of behavioural determinants suggested by the model. Finally, a case is made for qualitative methods for inquiry to further enhance knowledge about factors and processes influencing use of the health care system, including prenatal care. It is argued that these approaches lead to enhanced appreciation of behaviour as a social product and are consistent with the ideology of health promotion. [ABSTRACT FROM AUTHOR]

In a qualitative study, the researcher's curiosity, relationships with participants, and conceptual lenses through which data are gathered and interpreted have significant bearing on the research. This reflective account of the author's experiences conducting a study of prenatal care use among low-income women reveals the necessarily personal nature of her work. She address some of her motives for carrying out the study, feelings that arose during interactions with participants and responses to those feelings, challenges in managing her role as researcher, and strategies to make meaning of gathered data. The author makes explicit how her self was a significant influence on the process of inquiry. Locating oneself in the research endeavor in this manner is essential for establishing a context within which others can appreciate the evolving search for new understanding and the creation of a final research product. [ABSTRACT FROM AUTHOR]

The shift in emphasis to community-based health care necessitates that opportunities be provided for nursing students to acquire an understanding of the complex nature of health. A qualitative study was used to demonstrate the benefits accrued by junior baccalaureate nursing students in non-traditional community settings. Key themes that emerged from data analysis included definitions of health and illness as context specific, and environmental factors influencing health. The study demonstrated that learning experiences with diverse communities can broaden students' perspectives and understanding of health behaviours. Students gained an appreciation of the sociocultural variation in meanings of health and illness as well as of the social and political dimensions of health. [ABSTRACT FROM AUTHOR]

Background: Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED) postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA) postpartum women's health, health service needs and utilization patterns. Methods: Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000) who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use. Results: When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01-2.18)], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35-0.67)], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64-4.4)]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47-3.40)]. Conclusion: Although SED women experienced poorer mental and overall health they reported similar health service needs and utilization patterns to more SEA women. The results can assist policy makers, health service planners and providers to develop and implement necessary and accessible services. Further research is needed to evaluate SED postpartum women's health service needs and barriers to service use. [ABSTRACT FROM AUTHOR]

AIM: To test the validity of The Newcastle Satisfaction with Nursing Scales as measures of patient satisfaction with nursing care in an inpatient postpartum unit. BACKGROUND: The Newcastle Satisfaction with Nursing Scales (Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale) were developed to measure the satisfaction of medical-surgical inpatients with nursing care. METHODS: The Newcastle Satisfaction with Nursing Scales were administered by interviewers to 189 postpartum women prior to hospital discharge. We tested the construct validity of the scales by making five a priori predictions: mothers who were more satisfied would be more likely to have one nurse caring for them and to recommend the postpartum unit to a friend. We also predicted that the Experience of Nursing Care and Satisfaction with Nursing Care Scales would be positively correlated with each other, with a global question about satisfaction with nursing care, and with a global question about satisfaction with overall postpartum stay. RESULTS: Four of the five a priori predictions were supported by the data. The mean Newcastle Satisfaction with Nursing Scale scores of mothers who would recommend the unit to a friend were higher (more satisfied) than those who would not (P < 0.001). The Experience of Nursing Care Scale and Satisfaction with Nursing Care Scale were positively and significantly correlated with each other (r = 0.9, P < 0.001). There was a positive and significant correlation between the scales and global ratings of nursing care (Experience Scale r = 0.79, P < 0.001; Satisfaction Scale r = 0.82, P < 0.001) and overall postpartum stay (Experience Scale r = 0.64, P < 0.001; Satisfaction Scale r = 0.68, P < 0.001). CONCLUSION: The Newcastle Satisfaction with Nursing Scales are valid measures of maternal satisfaction with inpatient postpartum nursing care. [ABSTRACT FROM AUTHOR]

Perinatal mental healthcare in Canada is characterized by under-diagnosis and under-treatment. Approaches to mental health screening can influence pregnant women’s uptake of treatment services. Objective To determine the acceptability of mental health screening in Canadian pregnant women. This cross-sectional survey used the Barriers and Facilitators of Mental Health Screening Survey. The study included pregnant women who read/spoke English. The survey was administered via computer-tablet to women recruited from prenatal classes and maternity clinics in Alberta. Analyses included descriptive statistics and multivariable regression. Respondents (n=459, 92% participation) were largely 25-34 years old (89%), Caucasian (83%), and partnered (95%). Almost two-thirds of women indicated they expected to be asked about mental health, with 35% reporting their provider asked. The majority (99.8%) indicated that they could be honest with their provider about their mental health if asked and 99.3% of those asked reported they were comfortable with screening. Women indicated a strong preference for routine screening, but identified sporadic assessment as threatening. Women were more likely to report screening as positive if: 1) they had been treated previously for depression/anxiety; or 2) they identified barriers to screening as: a) feeling worried that their concerns were unimportant to their provider; or b) feeling that their provider did not have time to talk about mental health. Women were less likely to report screening as positive if they expected their provider to ask about their mental health. Findings confirm women’s acceptability of routine prenatal mental health assessment. Results will inform decision-making regarding routine perinatal mental healthcare. [ABSTRACT FROM AUTHOR]