A Tri‐Service Perspective on the Implementation of a Centering Pregnancy Model in the Military

With the rising cost of health care, group prenatal care has come into the forefront as a viable, evidence‐based option for care delivery. In this article, the authors from three different branches of service (Army, Navy, Air Force) review the strategies and challenges of implementing a centering pregnancy model at military treatment facilities.     

Hospital‐Based Perinatal Nurses Identify the Need to Improve Nursing Care of Adolescent Mothers

ObjectiveTo determine whether hospital‐based perinatal nurses with expertise in adolescent mother‐friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses’ capacity to provide adolescent mother‐friendly care. Design/Setting/Participants: A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city.MethodsPerinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty‐seven of 34 potential key informants completed the survey.ResultsKey informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer‐group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital‐based perinatal nurses lack adequate knowledge of community‐based resources for adolescent mothers, educational programs related to adolescent mother‐friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them.ConclusionA minority of perinatal nurses have expertise in adolescent mother‐friendly care. There is a need for perinatal unit‐level interventions to support the development of nurses’ skills in caring for adolescent mothers and their knowledge of community‐based resources. Peer mentoring and self‐reflective practice are promising strategies.     

Hemabate® for the Management of Post-partum Haemorrhage in a Rural Hospital

Objective: Hemabate® (15-methyl-prostaglandin F_2α) is a relatively new and effective medication for the control of post-partum haemorrhage (PPH). The authors review the literature on the management of PPH, describe their experience with this medication and present the results of a survey of Northern Ontario obstetrical services.Quality of Evidence: numerous studies have demonstrated the effectiveness of Hemabate® for the management of PPH. Despite recommendations regarding its appropriate use in the Advances in Labour and Risk Management (ALARM)¹ and Advanced Life Support in Obstetrics (ALSO)² course guidelines, as well as published reports in the Journal of the Society of Obstetricians and Gynaecologists of Canada (SOGC),^3,4 the availability of this medication is somewhat limited in the rural hospitals we surveyed in Northern Ontario.Main Message: Hemabate® is a safe, effective drug for the management of PPH when oxytocin and manual massage and evacuation of the uterus have failed. It is especially useful in rural settings where access to resources may be limited.Conclusion: the authors recommend the more widespread availability and use of Hemabate®, particularly in rural settings.     

Implementation of Evidence‐Based HIV Interventions for Young Adult African American Women in Church Settings

ObjectiveTo assess the barriers and facilitators to using African American churches as sites for implementation of evidence‐based HIV interventions among young African American women.DesignMixed methods cross‐sectional design.SettingAfrican American churches in Philadelphia, PA.Participants142 African American pastors, church leaders, and young adult women ages 18 to 25.MethodsMixed methods convergent parallel design.ResultsThe majority of young adult women reported engaging in high‐risk HIV‐related behaviors. Although church leaders reported willingness to implement HIV risk‐reduction interventions, they were unsure of how to initiate this process. Key facilitators to the implementation of evidence‐based interventions included the perception of the leadership and church members that HIV interventions were needed and that the church was a promising venue for them. A primary barrier to implementation in this setting is the perception that discussions of sexuality should be private.ConclusionImplementation of evidence‐based HIV interventions for young adult African American women in church settings is feasible and needed. Building a level of comfort in discussing matters of sexuality and adapting existing evidence‐based interventions to meet the needs of young women in church settings is a viable approach for successful implementation.     

Stages of Change in the Trajectory of Postpartum Weight Self‐Management

ObjectiveTo identify women's patterns of readiness to engage in weight self‐management behaviors during the postpartum period.DesignProspective, longitudinal design with repeated measures, guided by the transtheoretical model of behavior change (TTM).SettingA tertiary perinatal center in an urban setting in the midwestern United States with approximately 3,000 births annually.ParticipantsOne hundred ninety‐one (191) adult postpartum women.MethodsParticipants were surveyed in person during their postpartum hospitalizations, and by telephone at 4 and 8 weeks postpartum using the Stages of Change for Weight Management (SOCWM) and the Decisional Balance for Weight Management (DBWM) tools.ResultsThere was a significant effect of time on stage of change for women in the postpartum period, with women in a higher stage of change at 8 weeks than during the postpartum hospitalization. There were no significant differences in stage of change at any of the three time points by prepregnant weight category or by race. Nearly one half of the sample was in the contemplation stage during the postpartum hospitalization, and more than 80% were in action or maintenance stages by 8 weeks postpartum.ConclusionsThe early postpartum period is an opportune time to influence stage of change in women's weight management behaviors. Assessment of readiness to engage in or continue weight management behaviors will allow providers to use stage‐matched interventions guided by the TTM to facilitate women's self‐management of weight.     

Perspectives of Hospital‐Based Nurses on Breastfeeding Initiation Best Practices

ObjectiveTo assess the variation in breastfeeding knowledge and practices of registered nurses in hospital women and family‐care units and the informal and formal hospital policies related to the initiation and support of breastfeeding.DesignThis qualitative study employed a focus group approach to solicit perceptions of hospital‐based nurses regarding breastfeeding best practices.SettingEight state hospitals stratified by socioeconomic status (SES) and size served as settings to recruit participants for this study.ParticipantsForty female registered nurses from labor and delivery (n=9), postpartum (n=13), labor and delivery/recovery/postpartum care (LDRP) (n=12) and neonatal intensive care unit (NICU) (n=6) constituted eight focus groups.ResultsThe majority of nurses reported being knowledgeable of evidence‐based best practices related to breastfeeding initiation. However, in non‐Baby Friendly/Baby Friendly Intent (non‐BF/BFI) settings, nurses' knowledge often was not in accordance with current best practices in breastfeeding initiation, and reported hospital policies were not based upon evidence‐based practices. Barriers to best practices in breastfeeding initiation included hospital lactation policies (formal and informal), nurses' limited education in breastfeeding initiation best practices, high rates of surgical delivery, and lack of continuity of care with the transition of responsibility from one nurse to another from labor and delivery to transition care to postpartum care.ConclusionsA significant disparity between nurses' intention to support breastfeeding and their knowledge suggests a need for education based on the World Health Organization Baby Friendly standards for nurses at non‐BF/BFI hospitals. A significant barrier to supporting breastfeeding is lack of hospital policy and inappropriate or outdated policy.     

Factor structure of the Chinese version of the 12‐item General Health Questionnaire (GHQ‐12) in pregnancy

The GHQ‐12 is a widely used instrument designed to detect psychological disturbance in a wide variety of clinical groups. The Chinese version of the GHQ‐12 is widely used in Hong Kong to screen women during pregnancy and in the postnatal period. Recent evaluations of this instrument in pregnancy and in the postnatal period have suggested the instrument may be unsuitable for screening for psychological distress in this clinical group due to differences in case detection rates as a function of alternative scoring methods. However, a more fundamental issue regarding this instrument concerns reported inconsistencies and ambiguities in the factor structure of the instrument. The current investigation explored the underlying factor structure of this instrument using exploratory factor analysis and confirmatory factor analysis in Chinese women during the third trimester of pregnancy. The GHQ‐12 was found to be internally consistent; however, two‐ and three‐factor models offered superior fit to the data compared to the presumed uni‐dimensional structure. The claim that the GHQ‐12 is a uni‐dimensional measure of psychological distress was not supported. Further research is necessary to determine if the underlying multi‐dimensional factor structure of the GHQ‐12 in pregnancy may impact on case detection accuracy and instrument validity.     

Psychometric Properties of the Iranian Version of the Female Sexual Distress Scale‐Revised in Women

IntroductionSeveral tools for the assessment of sexuality‐related distress are now available. The Female Sexual Distress Scale (FSDS) and its revised version (FSDS‐R) are extensively validated and among the most widely used tools to measure sexually related personal distress.AimThe aim of the study was to determine the psychometric properties of the Iranian version of the FSDS‐R in a population sample of Iranian women.MethodsA total of 2,400 married and potentially sexually active women were recruited and categorized into three groups including (i) a healthy control group; (ii) a group of women with hypoactive sexual desire disorder (HSDD); and (iii) a group of women suffering from other female sexual dysfunction (FSD). Participants were asked to complete a set of questionnaires including the Iranian version of the Female Sexual Function Index (FSFI‐IV), the FSDS‐R, and the Hospital Anxiety and Depression Scale.Main Outcome MeasuresSexuality‐related distress and FSD as assessed by the Iranian version of the FSDS‐R and the FSFI‐IV are the main outcome measures.ResultsInternal consistencies and test–retest reliability of the FSDS‐R across the three assessments points for the three groups were >0.70. The FSDS‐R correlated significantly with anxiety, depression, and the FSFI total score. Significant differences in the FSDS‐R scores were found between healthy women, women with HSDD, and women with other types of FSD. Factor analysis of the FSDS‐R yielded a single‐factor model with an acceptable fit.ConclusionsThe Persian version of the FSDS‐R is a valid and reliable instrument for the assessment of sexuality‐related distress in Iranian women and can be used to screen patients with HSDD. Azimi Nekoo E, Burri A, Ashrafti F, Fridlund B, Koenig HG, Derogatis LR, and Pakpour AH. Psychometric properties of the Iranian version of the Female Sexual Distress Scale‐Revised in women. J Sex Med 2014;11:995–1004.     

Effect of Intracavernous Administration of Angiopoietin‐4 on Erectile Function in the Streptozotocin‐Induced Diabetic Mouse

IntroductionErectile dysfunction (ED) is a highly prevalent complication of diabetes, and the severity of endothelial dysfunction is one of the most important factors in reduced responsiveness to oral phosphodiesterase type 5 inhibitors.AimTo study the effects of human angiopoietin‐4 (Ang‐4) protein on erectile function in diabetic mice.MethodsDiabetes was induced by intraperitoneal injection of streptozotocin into 8‐week‐old C57BL/6J male mice. At 8 weeks after the induction of diabetes, the animals were divided into four groups: control nondiabetic mice and diabetic mice receiving two successive intracavernous injections of phosphate buffered saline (days ?3 and 0), a single intracavernous injection of Ang‐4 protein (day 0), or two successive intracavernous injections of Ang‐4 protein (days ?3 and 0).Main Outcome MeasuresOne week after treatment, we measured erectile function by electrical stimulation of the cavernous nerve. The penis was harvested and stained with hydroethidine or antibodies to Ang‐4, platelet/endothelial cell adhesion molecule‐1, and phosphorylated endothelial nitric oxide synthase (eNOS). We also determined the differential expression of Ang‐4 in cavernous tissue in the control and diabetic mice. The effect of Ang‐4 protein on the phosphorylation of Tie‐2, Akt, and eNOS was determined in human umbilical vein endothelial cells (HUVECs) by Western blot.ResultsThe cavernous expression of Ang‐4 was downregulated in diabetic mice; Ang‐4 was mainly expressed in endothelial cells. Local delivery of Ang‐4 protein significantly increased cavernous endothelial content, induced eNOS phosphorylation, and decreased the generation of superoxide anion and apoptosis in diabetic mice. Ang‐4 protein strongly increased the phosphorylation of Tie‐2, Akt, and eNOS in HUVECs. Repeated intracavernous injections of Ang‐4 induced significant restoration of erectile function in diabetic mice (87% of control values), whereas a single intracavernous injection of Ang‐4 protein elicited modest improvement.ConclusionsCavernous endothelial regeneration by use of Ang‐4 protein may have potential for the treatment of vascular disease‐induced ED, such as diabetic ED. Kwon M‐H, Ryu J‐K, Kim WJ, Jin H‐R, Song K‐M, Kwon K‐D, Batbold D, Yin GN, Koh GY, and Suh J‐K. Effect of intracavernous administration of angiopoietin‐4 on erectile function in the streptozotocin‐induced diabetic mouse. J Sex Med 2013;10:2912–2927.     

Sexual Function in the Late Postmenopause: A Decade of Follow‐Up in a Population‐Based Cohort of Australian Women

IntroductionThere is a paucity of longitudinal studies assessing sexual function of women in the late postmenopause.AimThis study aims to describe sexual function of women in the late postmenopause and to investigate change from early postmenopause.MethodsCross‐sectional analysis of 2012/13 and longitudinal analysis from 2002/04 of the population based, Australian cohort of the Women's Healthy Ageing Project, applying validated instruments: Short Personal Experience Questionnaire (SPEQ), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Geriatric Depression Scale, and California Verbal Learning Test.Main Outcome MeasuresSexual activity, SPEQ, and FSDS.ResultsTwo hundred thirty women responded (follow‐up rate 53%), mean age was 70 years (range 64–77), 49.8% were sexually active. FSDS scores showed more distress for sexually active women (8.3 vs. 3.2, P < 0.001). For 23 (23%) sexually active and for five (7%) inactive women, the diagnosis of female sexual dysfunction could be made. After adjustment, available partner (odds ratio [OR] 4.31, P < 0.001), no history of depression (OR 0.49, P = 0.036), moderate compared with no alcohol consumption (OR 2.43, P = 0.019), and better cognitive function score (OR1.09, P = 0.050) were significantly predictive for sexual activity. Compared with early postmenopause, 18% more women had ceased sexual activity. For women maintaining their sexual activity through to late postmenopause (n = 82), SPEQ and FSDS scores had not changed significantly, but frequency of sexual activity had decreased (P = 0.003) and partner difficulties had increased (P = 0.043). [Correction added on 10 July 2014, after first online publication: Mean age of respondents was added.]ConclusionsIn late postmenopause, half of the women were sexually active. Most important predictors were partner availability and no history of depression. However, being sexually active or having a partner were associated with higher levels of sexual distress. Compared with early postmenopause, sexual function scores had declined overall but were stable for women maintaining sexual activity. Further research into causes of sexual distress and reasons for sexual inactivity at this reproductive stage is warranted. Lonnèe‐Hoffmann RAM, Dennerstein L, Lehert P, and Szoeke C. Sexual function in the late postmenopause: A decade of follow‐up in a population‐based cohort of Australian women. J Sex Med 2014;11:2029–2038.