Prenatal Clients Research Articles

Chlamydia trachomatis infection among Hispanic women in the California-Mexico border area, 1993: establishing screening criteria in a primary care setting.

Chlamydia prevalence and transmission patterns in California-Mexico border communities are unknown, and selective screening strategies for Hispanic populations have not been evaluated. To determine chlamydia prevalence among Hispanic women in the California-Mexico border area and established screening criteria. This was a cross-sectional prevalence survey of family planning/prenatal Hispanic clients (n = 2378) in San Diego and Imperial Counties, California, and Tijuana, Mexico. Overall, chlamydia prevalence was 3.2% (3.3% in California; 2.1% in Mexico). Women born in Mexico or those who visited Mexico for at least 1 week in the recent past had a prevalence rate similar to women without those characteristics. Multivariate analysis showed that young age (less than 25 years old), unmarried status, or having clinical signs of a chlamydia syndrome (primarily cervicitis) or vaginosis independently predicted chlamydia infection. Applying minimum screening criteria recommended by the Centers for Disease Control would require screening less than half of the clients. However, only 69% of infections would be identified. Using survey-based criteria (less than 25 years old, unmarried, and clinical signs of a chlamydia syndrome) would require screening 64% of clients, but would identify 92% of those infected. Chlamydia prevalence among Hispanic women seeking reproductive healthcare was similar (< 5%) on both sides of the California-Mexico border. Among Hispanic women, using easily obtained demographic data (age and marital status) and clinical signs (primarily cervicitis), an effective selective screening strategy can be implemented.

Determining intensity of need of high-risk maternal and infant clients.

Sound funding decisions by policymakers require data that relate health care services to both client need and client outcome. However, client need for care is not easy to express quantitatively, particularly in the realm of preventive and health promotion services. Application of the Community Health Intensity Rating Scale (CHIRS) with high-risk infants and prenatal clients revealed that differences in intensity of need, particularly in contextual and behavioral domains, helped to explain variation in amount of care received. The CHIRS holds promise of providing the language and measurement with which to articulate client need as the basis for cost-effective multidisciplinary care.

Lactation education practice and procedure: information and support offered to economically disadvantaged women.

Seventy-five agencies providing services to a large percentage of economically disadvantaged pregnant women returned mailed survey questionnaires. These surveys described the timing and nature of lactation education available to clients of the respondent agencies. Lactation education was most frequently introduced at 16-week gestation. Fifty-seven (76%) of the respondents stated that lactation education was offered to all clients at least once during pregnancy, and 23 (31%) stated that all prenatal clients were expected to attend breastfeeding classes, regardless of stated feeding choice. Respondents generally agreed that breastfeeding should be encouraged if a woman is undecided about feeding issues, but they were less definite concerning active encouragement of breastfeeding to women who had made another feeding choice. These findings may facilitate the effort to increase initiation of breastfeeding by examining education practices and provider attitudes that may foster or hinder breastfeeding adoption in this client population.

Standards of care for high-risk prenatal clients: the community nurse case management approach.

The New Mexico Families FIRST project seeks to reduce maternal and infant morbidity and mortality through a nursing case management approach. The responsibilities of this community nurse include outreach, education, and care coordination of Medicaid-eligible high-risk pregnant women and their children. The standards of care for these families are derived from a screening tool that identifies medical, demographic, environmental, and psychosocial risks. Although evaluation of the nurse role and the tools used to identify and care for these women and children has not been completed, sharing the developmental stages of the process should facilitate similar endeavors.

What Pregnant Women Want to Know: A Comparison of Client and Provider Perceptions

To compare client and health-care provider perceptions concerning health topics. A survey conducted at the first prenatal visit asked women to indicate levels of interest in 38 topics. Providers answered the same survey, indicating perceptions of clients' interests. A prenatal clinic and a private office, both in an inner city area. Two groups of prenatal clients (n = 135 private care and n = 250 public care) and their health-care providers (n = 32 nurses and physicians). Significant differences were found (p < .01 for four topics, p < .05 for six topics) between the clients' interests and the providers' perceptions. Women in private and public care differed significantly (p < .01) in their levels of interest. Interest was significantly affected by parity, but not maternal education. Nurses and other health professionals should be aware of the range of topics in which clients express interest. This study suggests that site of care and parity should be considered when developing prenatal health education.

Smoking During Pregnancy: Prevalence, Effects, and Intervention Strategies

Smoking prevalence rates have been declining in the United States, but an estimated 25 percent of pregnant women continue to smoke. Smoking during pregnancy is considered one of the leading, preventable causes of low birthweight. Research attributes 21 to 39 percent of low birthweight to smoking during pregnancy, although the exact mechanism of the effect is not completely understood. Several well-designed studies have shown that pregnant smokers are more likely to stop smoking if they are provided with systematic interventions. This overview describes adverse consequences, prevalence, possible mechanisms of action, and prenatal smoking-cessation programs that have proved effective. A five-step approach is outlined for clinicians who want to counsel their prenatal clients.

Illness as an educational opportunity

To compare client and health‐care provider perceptions concerning health topics.A survey conducted at the first prenatal visit asked women to indicate levels of interest in 38 topics. Providers answered the same survey, indicating perceptions of clients' interests.A prenatal clinic and a private office, both in an inner city area.Two groups of prenatal clients (n =135 private care and n =250 public care) and their health‐care providers (n =32 nurses and physicians).Significant differences were found (p &lt; .01 for four topics, p &lt; .05 for six topics) between the clients' interests and the providers' perceptions. Women in private and public care differed significantly (p &lt; .01) in their levels of interest. Interest was significantly affected by parity, but not maternal education.Nurses and other health professionals should be aware of the range of topics in which clients express interest. This study suggests that site of care and parity should be considered when developing prenatal health education.

The effectiveness of public health nursing services to prenatal clients: an integrated review.

The effectiveness of public health nursing interventions with prenatal clients was summarized from 17 studies, conducted between 1963 and 1988, that were identified through a comprehensive reference search. The review indicated that public health nursing interventions can increase birthweight, and the use of prenatal medical services, nutritional services, and childbirth classes. Because of methodological problems, however, it is difficult to conclude with certainty that such interventions make a significant difference in client outcomes. These problems included lack of construct validity, lack of specification of interventions, small convenience samples, lack of power to detect small treatment effects, nonexperimental research designs, lack of reliability information, and self-selection and history biases. To overcome these problems, the authors suggest the use of conceptual frameworks, power calculations prior to initiation of research, experimental or quasiexperimental designs, replication of research with different populations, and the calculation and reporting of reliability information.

Hepatitis B the nurse-midwife's role in management and prevention

The hepatitis B carrier rate among the Indochinese refugees in the United States is 12 to 15%. Approximately 30 to 40% of these carriers are highly infectious. A mother who is an infectious carrier has almost a 100% chance of infecting her newborn. In view of this, unless proper precautions are taken, four of every one hundred Southeast Asian newborns will be infected with the Hepatitis B virus. Once infected, the newborn will have an 80 to 90% chance of becoming a carrier. A significant number of these carriers will die of cirrhosis and primary hepatocellular carcinoma as adults. In addition, health care providers are placed at risk when contaminated with the body fluids of carriers. Through an understanding of the serologic markers, a nurse-midwife can identify those prenatal clients who are at risk for transmitting hepatitis B. Once identified, the necessary preventative measures can be taken to interrupt the disease process in the newborn and protect health care personnel.