Is perinatal substance abuse falling through the cracks?

OBJECTIVES: Perinatal substance abuse (PSA) is associated with increased risk of prematurity, low birth weight, neonatal abstinence syndrome, behavioral issues and learning difficulties. It is imperative that robust care pathways are in place for these high-risk pregnancies and that staff and patient education are optimized. The present study explores the knowledge and attitudes of healthcare professionals toward PSA to identify knowledge gaps to enhance care and reduce stigma. METHODS: This is a cross-sectional study using questionnaires to survey healthcare professionals (HCPs) working in a tertiary maternity unit (n = 172). RESULTS: The majority of HCPs were not confident in the antenatal management (75.6%, n = 130) or postnatal management (67.5%, n = 116) of PSA. More than half of HCPs surveyed (53.5%, n = 92) did not know the referral pathway and 32% (n = 55) did not know when to make a TUSLA referral. The vast majority (96.5%, n = 166) felt that they would benefit from further training, and 94.8% (n = 163) agreed or strongly agreed that the unit would benefit from a drug liaison midwife. Among study participants, 54.1% (n = 93) agreed or strongly agreed that PSA should be considered a form of child abuse and 58.7% (n = 101) believe that the mother is responsible for damage done to her child. CONCLUSIONS: Our study highlights the urgent need for increased training on PSA to enhance care and reduce stigma. It is imperative that staff training, drug liaison midwives and dedicated clinics are introduced to hospitals as a matter of high priority.

Anxiety in a Specialist Perinatal Mental Health Service: patient characteristics, management, and outcomes.

OBJECTIVES: To outline characteristics of patients with anxiety diagnoses attending a Specialist Perinatal Mental Health Service (SPMHS) in Ireland, the mental health care received by those patients, mental health and obstetric outcomes for those patients, and immediate neonatal outcomes for their babies. METHODS: A retrospective chart review was conducted of patients with antenatal anxiety diagnoses who attended the SPMHS in University Maternity Hospital Limerick, from initiation of the service to the end of its first year. RESULTS: Data were collected on 100 patients, 81 with a mental health diagnosis prior to attending the SPMHS, 32 with prior engagement with psychiatry, and 23 with a previous perinatal diagnosis. The mean age of patients was 32.4 (19-47, std 6.158). Beyond initial assessment, the Mental Health Midwife was involved in the care of 61% of patients, more than any other specialty including psychiatry. Twenty-seven patients had psychiatric medication either started or altered by the SPMHS. The most common reason for eventual discharge was that patients were well. Two patients presented in mental-health-related crisis to emergency services and one patient was admitted to an acute psychiatric ward. CONCLUSIONS: Patients attending the SPMHS for anxiety spanned a broad spectrum of demographics and diagnoses and received varied set of interventions. A significant proportion of patients had a primary diagnosis of Pregnancy-related anxiety. The Mental Health Midwife played a key role in management of these patients. Though rates of mental health crises and admissions were low, the absence of a Mother and Baby Unit in Ireland was highlighted.

Impact of an educational workshop upon psychiatrists' attitudes towards delirium care.

OBJECTIVES: Improving knowledge about delirium care is a key target for health care. We describe the implementation of a four-part workshop focusing upon key aspects of delirium care. METHODS: Attitudes towards and understanding of delirium diagnosis and management amongst psychiatrists were surveyed before and immediately after an educational workshop. RESULTS: There were 62 participants. Pre-workshop, delirium was rated highly relevant to psychiatry. Overall level of confidence in diagnosis was modest, with the behavioural and psychological symptoms of dementia considered the most challenging differential diagnosis. Only nine participants (15%) correctly identified DSM-5 delirium criteria. Preferred assessment of attention varied with six different approaches endorsed. Confidence was higher for managing hyperactive compared with hypoactive delirium (p<0.001). Pharmacotherapy was more frequently endorsed for hyperactive compared with hypoactive presentations, with haloperidol the most popular agent (p<0.001). A total of 41 (66%) participants completed post-workshop assessments. Post-workshop, there were significant increases to the perceived relevance of delirium (p = 0.003), confidence in overall diagnosis (p<0.001) accuracy of awareness of DSM-5 criteria (p<0.001), and confidence in treating different presentations (p<0.001). The Months Backward Test was the preferred bedside test of attention (38/40 respondents). CONCLUSIONS: This interactive educational intervention impacted positively upon knowledge and attitudes amongst psychiatrists towards key aspects of delirium care. Further investigation can examine the impact upon longer term knowledge and behaviour.

The significance of breastfeeding on sleep patterns during the first 48 hours postpartum for first time mothers.

Postpartum women sleep less during the early days following delivery. Long-term sleep disturbance and fatigue can have significant implications for physical and mental health, relationships, employment and parental competence. Most studies focus on the quality and quantity of maternal sleep between weeks one and six postpartum. We explored sleep patterns and reasons for wakefulness of first-time mothers immediately following delivery. Thirty first-time mothers completed a postnatal sleep questionnaire, detailing their total sleep time (TST), the reasons for being awake and their level of fatigue. The logs were completed in real time during the first 48 h postpartum, while they were still in a hospital environment. The data collected from the mothers in the study indicated that the mean TST in the first 48 h was 9.7 h. Of the factors explored only breastfeeding influenced the TST. Breastfeeding women slept on average 2.6 h longer than women who bottle-fed (p = .042). Impact statement What is already known on this subject: Childbearing affects women's sleep in many ways. Hormonal changes during pregnancy and postpartum as well as physiological and anatomical alterations, and the process of adaptation to the new parent's responsibilities contribute to changes in sleep architecture. Since first study of sleep and pregnancy published in 1968 there have been very few publications addressing maternal sleep postpartum. Most studies which have focussed on quality of maternal sleep in the first 6-months postpartum period describe the relationships between poor maternal sleep and postpartum depression and other mental health outcomes. What the results of this study add: We explored sleep patterns and reasons for wakefulness of first-time mothers immediately following delivery while they remained in the hospital environment. We found that environmental factors such as background noise, shared rooms, type of delivery, feeding and worrying about the neonate did not influence the total sleep time, however, the main outcome of our study is that breastfeeding promotes maternal sleep. What the implications are of these findings for clinical practice and/or further research: We believe that this study would be of interest to many obstetricians, general practitioners, nurses and midwives as well as to the general public. Appropriate counselling of patients early in postnatal period can improve their sleep patterns and reduce the risk of depression and other abnormal physical, psychological and social outcomes.

Issuing donor cards in a single center in Iran: results of the first 3 years.

INTRODUCTION: Issuing an organ donation card has become a goal for procurement units to solve the organ shortage. The number of issued cards is an index of the attitudes or even actions of communities toward brain-dead donations. In the present study, we have reported the characteristics of issuing organ donation cards in a single organ procurement unit in Iran. MATERIALS AND METHODS: This retrospective study used an organ donation willingness database for 3 years after launching the unit. We used the registration data of the first 3 years of its activity from August 1, 2005, to July 31, 2008. For each organ donation volunteer, we extracted demographic data, organs to be donated, and source of their knowledge about the organ donation card system. RESULTS: During the study period, donor cards were issued to 172,290 volunteers; a monthly mean of 4785 registries. Among the total volunteers, 54.2% were females: with 50.7% between 21 to 30 years, 35.2% with an educational level less than a high school diploma, and 35.7% introduced by their friends. The volunteers were more willing to donate heart, kidney, liver, lung, and tissue donations, respectively. Out of the total number of volunteers, 94.1% were willing to donate all organs. An increasing trend was seen in the donation cards issued during the study period. CONCLUSION: Following 3 years of activity, a single center has issued nearly 200,000 cards. The rate at which organ donor cards are issued is increasing, which puts emphasis on establishment of funding for other organ procurement units. This information may be useful to program the field of brain-dead donations in this country.