The Relationship Between Yoga Practice Dosage and Perceived Stress, Anxiety, and Self-reported Health Among Breast Cancer Survivors Who Practice Yoga.

The aim of this anonymous online study was to explore the yoga practice of breast cancer survivors to determine if yoga dosage (frequency and duration of practice) was related to stress, anxiety, and self-reported health in female survivors. Participants were recruited from online breast cancer support groups during a 3-month period (June-September 2019). Demographic information, stage and treatment of breast cancer, and frequency of yoga participation, including a home yoga practice were reported. Measures include the Perceived Stress Scale, State-Trait Anxiety Inventory, and self-reported health. Cumulative yoga dosage was calculated. Thirty-five women participated (mean age = 55 years) and were divided into low and high yoga dosage groups based on the sample distribution. Low dosage of yoga was operationally defined as a cumulative dosage that fell within the lowest quartile (≤25%). Findings indicated no difference between the low-dosage group compared with the high-dosage group for perceived stress and self-reported health; but the high dosage yoga group had lower state anxiety scores (P < .05). All participants reported good self-reported health. These findings contribute to our knowledge of the psychosocial aspects of breast cancer survivorship and raise questions for further research quantifying the therapeutic dosing of yoga practice.

"Yes, I can bond." Reflections of autistic women's mothering experiences in the early postpartum period.

BACKGROUND: Autism is a neurodevelopmental condition affecting communication and social interaction. Much of the research regarding childbirth and motherhood is focused on non-autistic women. Autistic mothers may experience challenges communicating their needs to health care professionals and find aspects of the hospital environment distressing, indicating a need for more informed practice. OBJECTIVE: To describe the experiences of autistic women bonding with their newborns after delivery in an acute care setting. DESIGN: The study used a qualitative interpretative description design with data analysis using the method described by Knafl and Webster. The study explored the women's childbirth experiences in the early postpartum period. METHOD: Interviews were conducted using a semi-structured interview guide. The women were interviewed in a setting of their choosing and included in person meetings, meetings over Skype, over the telephone, or via Facebook messenger. Twenty-four women ages 29-65 years participated in the study. The women were from the United States, the United Kingdom, and Australia. All women gave birth to a healthy term newborn in an acute care setting. RESULTS: Three major themes emerged from the data: having difficulty communicating, feeling stressed in an uncertain environment, and being an autistic mother. CONCLUSION: The autistic mothers in the study expressed love and concern for their babies. Some women described needing more time to recover physically and emotionally before assuming care of the newborn. The stress of childbirth left them exhausted and the demands of caring for a newborn could be overwhelming for some women. Miscommunication during labor affected some of the women's ability to trust the nurses caring for them and, in two cases, left the women feeling judged as mothers.

Where are nurse-scientists? Academic nursing research at critical crossroads.

BACKGROUND: Academic nursing research is at a critical impasse after the great retirement and resignation during COVID-19. Sustaining and replenishing senior nurse-scientist faculty that are clinical experts with real-world clinical practice is critical. Leveraging the mission of nursing scholarship within the business of building and sustaining externally funded research enterprises in schools of nursing presents conundrums, especially with persistent nursing faculty vacancies. PURPOSE AND METHODS: Through a lens of intersectionality within the context of academic bias and nursing education regulation, we address challenges in NIH funding for nurse-scientist faculty. Publicly available data reveal equity, inclusion, and advancement issues that make it an unequal playing field for nurse-scientist faculty if expected to achieve similar NIH funding as faculty in schools of public health and medicine. DISCUSSION: Understanding research enterprises requires appreciation of the complex interplay between academic nursing units, university infrastructures, and academic budgetary models. Creative support for both nursing deans and their faculty is needed.

Introducing the Postpartum Toolkit: An Examination of the Feasibility, Acceptability and Pilot Efficacy of an Online Clinical Tool to Enhance Postpartum Functioning and Emotional Wellbeing.

During the postpartum period, a birth parent's level of functioning (ability to perform the activities and roles required to maintain wellbeing) is critical in determining the health of parents and their infants. However, existing approaches to support postpartum parents are insufficient, especially in the United States, and these individuals face barriers to care. The utilization of internet-based intervention may be an effective solution allowing access to resources for this population. In this study, we developed a patient-centered online tool to bolster postpartum functioning, and collected data on the feasibility, acceptability, and initial impact of this tool on functioning and emotional wellbeing. Data collection took place between February and June 2021 from a sample of 124 individuals who were within the first ten months postpartum and living in the US. Results suggest that the tool is acceptable, though there are barriers to feasibility of use. Additionally, pilot-efficacy data suggest that this tool may be effective in improving postpartum emotional wellbeing, though further controlled testing is warranted. A future iteration of the tool that incorporates participant feedback to improve feasibility of use could prove an effective means of delivering support to an at-risk population.

Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits.

OBJECTIVE: To examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits. DESIGN: Exploratory descriptive secondary analysis of existing individual-level and neighborhood-level data. SETTING: Philadelphia, Pennsylvania, United States. PARTICIPANTS: Women who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264). METHODS: We retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses. RESULTS: We found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women's glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]). CONCLUSION: It is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.

Knowledge of and Attitudes Toward Perinatal Home Visiting in Women with High-Risk Pregnancies.

INTRODUCTION: Published research indicates that some perinatal home visiting programs are highly effective. However, there is a dearth of information regarding how these services apply to women experiencing a high-risk pregnancy. The aim of this study was to determine the potential acceptability of home visiting services within this vulnerable population and identify what services women want. METHODS: Four focus groups (N = 32) were conducted with a population of low-income, pregnant individuals in medically underserved central Georgia (United States). Participants were evaluated based on their current exposure to home visiting, receptiveness to home visiting, and reasons for apprehension regarding home visiting. RESULTS: The results of this study were mixed, with women expressing both interest in and reluctance about home visiting programs. Themes of distrust and fear of judgment or persecution existed. Women also varied with regard to what home visiting services they would like offered. Those discussed included assistance with maternal or infant medical needs, maternal function tasks, household tasks, and child care. DISCUSSION: Home visiting programs can be effective for improving maternal and child health outcomes. However, not all home visiting programs effectively reach their target population. More research is needed to determine what women who have high-risk conditions during pregnancy want help with and how to increase receptiveness. The results of this study could be informative to health care providers who treat persons with high-risk conditions in identifying adjunctive services for those in need of additional support.

Maternal Functioning and Depression Scores Improve Significantly With Participation in Visiting Moms® Program.

BACKGROUND: Postpartum depression is the most common complication of childbearing can affect the entire family unit. Health professionals must strive to identify and develop effective, feasible solutions for women during this critical period. AIMS: To determine whether postpartum maternal functioning (as measured by the Barkin Index of Maternal Functioning) and depression symptoms (as measured by the Patient Health Questionnaire-9) were improved after participation in the Visiting Moms program. METHOD: Paired data were collected from women at program intake and after completion of the Visiting Moms program. Visiting Moms provides services through eastern and central Massachusetts and was designed to support new mothers throughout the infant's first year of life. The study population was composed of adult women living in the Jewish Family and Children's Services geographic catchment area, who enrolled in Visiting Moms between January 1, 2013, and December 31, 2015. Descriptive statistics were calculated for all 402 women enrolled in this timeframe. Utilizing a pretest/posttest design, paired t tests were performed for the Barkin Index of Maternal Functioning (n = 149) and for the Patient Health Questionnaire-9 (n = 156), where women had complete scores at both intake and completion, to determine the program's potential impact on depressive symptoms and functional status. RESULTS: Functioning and depression scores were significantly improved after participation in the program. CONCLUSIONS: Visiting moms, and similar programs, aimed at delivery of enhanced social support, may be effective in promoting mental and emotional wellness among new mothers who are require additional support in the postpartum period.

Promotion of Maternal-Infant Mental Health and Trauma-Informed Care During the COVID-19 Pandemic.

The COVID-19 pandemic has led to disruptions in health care in the perinatal period and women's childbirth experiences. Organizations that represent health care professionals have responded with general practice guidelines for pregnant women, but limited attention has been devoted to mental health in the perinatal period during a pandemic. Evidence suggests that in this context, significant psychological distress may have the potential for long-term psychological harm for mothers and infants. For infants, this risk may extend into early childhood. In this commentary, we present recommendations for practice, research, and policy related to mental health in the perinatal period. These recommendations include the use of a trauma-informed framework to promote social support and infant attachment, use of technology and telehealth, and assessment for mental health needs and experiences of violence.

High Ambient Temperature and Infant Mortality in Philadelphia, Pennsylvania: A Case-Crossover Study.

OBJECTIVE: To quantify the association between heat and infant mortality and identify factors that influence infant vulnerability to heat. METHODS: We conducted a time-stratified case-crossover analysis of associations between ambient temperature and infant mortality in Philadelphia, Pennsylvania, during the warm months of 2000 through 2015. We used conditional logistic regression models to estimate associations of infant mortality with daily temperatures on the day of death (lag 0) and for averaging periods of 0 to 1 to 0 to 3 days before the day of death. We explored modification of associations by individual and census tract-level characteristics and by amounts of green space. RESULTS: Risk of infant mortality increased by 22.4% (95% confidence interval [CI] = 5.0%, 42.6%) for every 1°C increase in minimum daily temperature over 23.9°C on the day of death. We observed limited evidence of effect modification across strata of the covariates. CONCLUSIONS: Our results contribute to a growing body of evidence that infants are a subpopulation that is particularly vulnerable to climate change effects. Further research using large data sets is critically needed to elucidate modifiable factors that may protect infants against heat vulnerability.

MSN perceptions of practice-based problems and research-based interventions.

BACKGROUND: Although faculty design Master of Science in Nursing courses to help students acquire knowledge in practice, evidence gaps exist in the literature. The purpose of this study was to describe problems identified by practicing graduate nursing students, match them with themes from the National Institute of Nursing Research, determine if sufficient published literature exists to guide research-based interventions, and identify gaps. METHOD: Using the National Institute's research themes as the framework, 215 de-identified student papers were selected using two courses-a research methods/biostatistics and an ethics course. The Krippendorff method was used to identify practice-based problems and research-based interventions with gaps in the literature. DISCUSSION: Students identified pain, sleep difficulties, delirium, falls, hospital-acquired infections, noise, hypothermia, and stress as priority practice-based problems. CONCLUSION: A lack of clear or administratively enforced clinical guidelines or educational strategies was identified as an area with information gaps in the literature.

A Practice-Based Research Database to Study Perinatal Nurse Home Visiting to Pregnant Women With Diabetes.

BACKGROUND AND AIMS: Accumulation of real-world evidence from practice-based perinatal nurse home visits to pregnant women with diabetes prompted this translational perinatal health disparities research. Given the global diabetes epidemic, this academic-community partnered research team is studying the utilization, processes, and outcomes of this understudied model of perinatal nurse home visiting that provide home-based enhanced diabetes care to pregnant women. Because the nursing records provide the rich source of data for the study, our aim is to provide an in-depth description of the Philadelphia Pregnancy and Diabetes Home Visiting (PPD-HV) research database developed from data in the longitudinal nursing records. METHODS: This descriptive study uses retrospective data abstracted from paper-based perinatal nurse home visiting clinical records to create the PPD-HV, a HIPAA compliant, secure REDCap electronic research database. The sample includes 248 urban, pregnant women with diabetes who received a total of 1,644 home visits during the year 2012. The setting was Philadelphia, a large metropolitan city in the northeastern part of the United States. The PPD-HV database followed the information fields of the paper-based clinical nursing forms, which were originally designed by following the Omaha System to guide documenting the nursing process used in caring for patients in their homes. RESULTS: Using REDCap, the PPD-HV research database is robust with 239 variables and captures longitudinal clinical nursing data. Among the pregnant women with diabetes receiving nurse home visits, the mean age was 30.7 years, most were single, and had given birth to other children. LINKING EVIDENCE TO ACTION: Real-world clinical nursing practice data provide a rich source of research data to advance understandings about this model of enhanced diabetes care and the pregnant women with diabetes receiving the care. Considering the global epidemic of diabetes, this is a perinatal nurse home visiting model to replicate and evaluate.

Beyond bus fare: deconstructing prenatal care travel among low-income urban mothers through a mix methods GIS study.

OBJECTIVE: Guided by critical theory, this study illustrates the value of interpretative mapping to deconstruct bus travel to publicly funded prenatal care in a city marked by health and social inequities. METHODS: This mixed methods study used GIS maps based on 61,305 births to study the known barrier of transportation to prenatal care among urban mothers most at risk for preterm birth. RESULTS: Among 350 census tracts, 36 census tracts had preterm rates between 25 -36.9%. Modeling travel time for the case vignette for routine prenatal care took 21 visits to different geographically located facilities. This burden increased to 32 visits if the case vignette was high-risk. CONCLUSIONS: Interpretative GIS mapping is an important tool to ground truth spatially linked data into real world meanings. Promoting optimal health requires innovative and feasible approaches that take into consideration daily maternal functioning as pregnant mothers care for their children and themselves.

Family Care Curriculum: A Parenting Support Program for Families Experiencing Homelessness.

Purpose In the United States, families with children characterize the fastest growing portion of the homeless population. Parenting for families experiencing homelessness presents unique challenges since families facing homelessness are disproportionately more likely to experience a myriad of interpersonal and contextual stressors that heighten the risk of parents engaging in suboptimal parenting approaches. This article describes the development and implementation of the Family Care Curriculum (FCC) train-the-trainer parenting support program specifically designed to support positive parenting in families experiencing homelessness. Description The FCC is a 6-week theory-based parenting intervention aimed to create positive shifts in parental attitudes to enhance sensitive and nurturing parenting and positive parent-child relationships. FCC assists parents in reflecting on how their own experiences contribute to some of their parenting beliefs, patterns, and behaviors. Parents are coached to imagine and understand the emotions, attachment, and developmental needs behind their children's behaviors so they can maintain empathic and nurturing parenting responses in the context of cumulative and chronic stress. Parents are supported through learning to engage in self-care. A unique and important feature of the FCC is the inclusion of a culturally sensitive approach that takes into consideration the effects of racism, classism, and oppression on parent-child relationships. Conclusion FCC was designed, implemented, and championed by expert providers in the fields of family therapy, social work, and pediatrics to support parents experiencing homelessness. FCC adds to the body of effective attachment-based, trauma-informed, and culturally sensitive parenting interventions for improving parent-child relations and family health amongst vulnerable populations.

Using Geographic Information Systems to Visualize Relationships Between Perinatal Outcomes and Neighborhood Characteristics When Planning Community Interventions.

OBJECTIVE: To describe maternal morbidity, birth outcomes, and neighborhood characteristics of urban women from a racially segregated city with the use of a geographic information system (GIS). DESIGN: Exploratory neighborhood-level study. Existing birth certificate data were linked and aggregated to neighborhood-level data for spatial analyses. SETTING: Southern city in New Jersey. SAMPLE: Women and their 7,858 live births that occurred between 2009 and 2013. METHODS: Secondary analyses of extant sources were conducted. Maternal health and newborn birth outcomes were geocoded and then aggregated to the neighborhood level for further exploratory spatial analyses through our GIS database. An iterative process was used to generate meaningful visual representations of the data through maps of maternal and infant health in 19 neighborhoods. RESULTS: The racial and ethnic residential segregation and neighborhood patterns of associations of adverse birth outcomes with poverty and crime were illustrated in GIS maps. In 43% of the births, women had a documented medical risk. Significantly more preterm births occurred for Black women (p < .01) and women older than 35 years of age (p = .01). The rate of diabetes was greater in Hispanic women, and the rate of pregnancy-related hypertensive disorders was greater in Black women. CONCLUSION: Data-driven maps can provide clear evidence of maternal and infant health and health needs based on the neighborhoods where mothers live. This research is important so that maternity care providers can understand contextual factors that affect mothers in their communities and guide the design of interventions.

Semantic Assessment of the Barkin Index of Maternal Functioning in a Medically Underserved Obstetric Population.

PURPOSE: This study aims to evaluate the fitness of the Barkin Index of Maternal Functioning (BIMF) for postpartum functional assessment in a low-income obstetric population in medically underserved, Central Georgia (USA). DESIGN AND METHODS: Cognitive interviewing, a best practices approach to instrument development and validation, was performed on 24 new mothers. FINDINGS: The BIMF was comprehensible to this population of disadvantaged women. PRACTICE IMPLICATIONS: The BIMF has broad appeal due to its comprehensibility, patient-centered assessment style, and psychometric profile. Method of questionnaire administration and characteristics of the study and/or patient population should routinely be considered when implementing any type of self-reported health screening.

Perinatal Nurse Home Visiting Referral Patterns Among Women With Diabetes and Hypertension in Philadelphia.

OBJECTIVE: To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension. DESIGN: Secondary data analysis. SETTING: Philadelphia, PA. PARTICIPANTS: Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension. METHODS: Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health. RESULTS: During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean number of 8.8 authorized visits (standard deviation = 8). Associated with more authorized visits was having Medicaid as the insurance type and medical diagnoses that included hypertension (p < .01). Philadelphia prevalence rates for diabetes and hypertension varied by race and ethnicity (p < .001); Asian mothers had the greatest rates for diabetes and Black mothers the greatest rates for hypertension. CONCLUSION: Various models of home visiting programs exist to improve maternal and child health outcomes. Because maternal morbidity and mortality rates are rising in the United States, further research about perinatal nurse home visiting programs for pregnant women with diabetes and hypertension is warranted.

Exploratory Study of Childbearing Experiences of Women With Asperger Syndrome.

Increasing numbers of girls have been diagnosed with Asperger syndrome and other autism spectrum disorders (ASDs) over the past two decades; therefore, more women with ASDs are entering the childbearing phase of their lives. Little is known about the childbearing experiences of women with ASDs. This qualitative study describes the childbearing experiences of eight women with Asperger syndrome. Four major themes emerged: Processing Sensations, Needing to Have Control, Walking in the Dark, and Motherhood on My Own Terms. Clinicians can provide sensitive, individualized care by asking women with Asperger syndrome about their specific sensory experiences, counseling them about coping strategies for sensory intrusions, providing targeted support, and modifying the clinical environment to decrease distressing stimuli.

Human papillomavirus vaccination uptake and completion as a preventive health measure among female adolescents.

BACKGROUND: National coverage for the human papillomavirus (HPV) vaccine falls short of the targeted goals for Healthy People 2020 with disparities in completion rates noted in minority adolescent female populations. The purpose of this study was to provide a review of the literature on HPV vaccination uptake and completion rates among female minority adolescents as well as a discussion of the financial and policy dimensions of HPV vaccination with implications that impact uptake and completion rates. METHODS: By reviewing the literature, the authors show that the two human papillomavirus (HPV) vaccines, Gardasil and Cervarix, have presented unprecedented opportunities to prevent morbidity and mortality from cervical cancer. CONCLUSION: The authors recommend that nurses and advanced practice nurses take an active role at the point of care to educate families about HPV vaccination. Nursing interventions for practice changes are provided to improve vaccination initiation and completion rates in disadvantaged populations.