Perceived barriers to Chagas disease screening among a diverse group of prenatal care providers

Background Chagas disease is a vector borne infection of poverty endemic to Latin America which affects an estimated 40,000 women of child-bearing age in the United States (US). In the US Chagas disease is concentrated among individuals who have lived in endemic areas. Prenatal diagnosis and treatment are needed to prevent congenital transmission. The objective of this study was to assess perceived barriers to Chagas disease screening among prenatal care providers in Obstetrics/Gynecology and Family Medicine Departments of a tertiary care safety-net hospital caring for a significant at-risk population. Methodology/Principal findings An anonymous survey was distributed to 178 Obstetrics/Gynecology and Family Medicine practitioners. Of the 66 respondents, 39% thought Chagas screening was very important, and 48% somewhat important as a public health initiative. One third judged screening patients during clinic visits as very important. Most respondents (64%) reported being familiar with Chagas disease. However, only 32% knew how to order a test and only 22% reported knowing what to do if a test was positive. Conclusions/Significance These findings will be incorporated into measures to facilitate full implementation of Chagas screening, and can inform initiatives at other centers who wish to address this deeply neglected infection among their patient families. Greater integration of information on Chagas disease screening and treatment in medical and nursing education curricula can contribute to addressing this disease with the focus that its potentially fatal sequelae merit.

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A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California

PLoS ONE ◽

10.1371/journal.pone.0249419 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249419

Author(s):

Elaine Y. L. Chan ◽

Carolyn Smullin ◽

Stephanie Clavijo ◽

Melissa Papp-Green ◽

Eunhee Park ◽

...

Keyword(s):

Prenatal Care ◽

Congenital Syphilis ◽

The United States ◽

Qualitative Assessment ◽

Kern County ◽

Care Providers ◽

Structural Barriers ◽

Care Access ◽

Prenatal Care Providers ◽

In Pregnancy

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients’ social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

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Georgia Prenatal Care Providers’ Perceptions of Barriers to Sexually Transmitted Disease Screening

Southern Medical Journal ◽

10.1097/01.smj.0000083859.84394.b7 ◽

2003 ◽

Vol 96 (9) ◽

pp. 845-849 ◽

Cited By ~ 5

Author(s):

Rheta S. Barnes ◽

Lynda A. Anderson ◽

Joanna S. Weisbord ◽

Emilia Koumans ◽

Kathleen E. Toomey

Keyword(s):

Prenatal Care ◽

Sexually Transmitted Disease ◽

Transmitted Disease ◽

Disease Screening ◽

Care Providers ◽

Sexually Transmitted ◽

Prenatal Care Providers

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Abstract 090: Armenian Ethnicity: An Independent Risk Factor for Positive Exercise Treadmill Tests

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.090 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Ara H Rostomian ◽

Daniel Sanchez ◽

Jonathan Soverow

Keyword(s):

Risk Factors ◽

Los Angeles ◽

Multivariate Logistic Regression Analysis ◽

Safety Net ◽

The United States ◽

World Health ◽

Limited Information ◽

Safety Net Hospital ◽

Exercise Treadmill ◽

History Of

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

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Should prenatal care providers offer pregnancy options counseling?

BMC Pregnancy and Childbirth ◽

10.1186/s12884-018-2012-x ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Nancy F. Berglas ◽

Valerie Williams ◽

Katrina Mark ◽

Sarah C. M. Roberts

Keyword(s):

Prenatal Care ◽

Care Providers ◽

Prenatal Care Providers

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Lessons from prenatal care provider-based recruitment into the National Children’s Study

Pediatric Reports ◽

10.4081/pr.2015.6056 ◽

2015 ◽

Vol 7 (3) ◽

Cited By ~ 1

Author(s):

James M. Robbins ◽

Melissa D. Bridges ◽

Elizabeth M. Childers ◽

Roseanne M. Harris ◽

Pearl A. McElfish

Keyword(s):

Prenatal Care ◽

Care Providers ◽

Recruitment Method ◽

Equivalent Number ◽

Prenatal Care Providers ◽

Status Number ◽

Public Clinics ◽

Benton County ◽

Birth Records ◽

Successes And Challenges

In response to recruitment difficulties experienced by the National Children’s Study, alternatives to the door-to-door recruitment method were pilot tested. This report describes outcomes, successes, and challenges of recruiting women through prenatal care providers in Benton County, Arkansas, USA. Eligible women residing in 14 randomly selected geographic segments were recruited. Data were collected during pregnancy, at birth, and at 3, 6, 9, 12, 18, and 24 months <em>postpartum</em>. Participants were compared to non-enrolled eligible women through birth records. Of 6402 attempts to screen for address eligibility, 468 patients were potentially eligible. Of 221 eligible women approached to participate, 151 (68%) enrolled in the 21-year study. Enrolled women were similar to non-enrolled women in age, marital status, number of prenatal care visits, and gestational age and birth weight of the newborn. Women enrolled from public clinics were more likely to be Hispanic, lower educated, younger and unmarried than those enrolled from private clinics. Sampling geographic areas from historical birth records failed to produce expected equivalent number of births across segments. Enrollment of pregnant women from prenatal care providers was successful.

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Rethinking Obesity Counseling: Having the French Fry Discussion

Journal of Obesity ◽

10.1155/2014/525021 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Jonathan Bonnet ◽

Aaron George ◽

Pippa Evans ◽

Mina Silberberg ◽

Diana Dolinsky

Keyword(s):

Family Medicine ◽

Fast Food ◽

Primary Care Providers ◽

Perceived Barriers ◽

Care Providers ◽

Fast Foods ◽

French Fry ◽

Targeted Interventions ◽

Well Child Visit ◽

Child Visit

Childhood obesity is a complex problem that warrants early intervention. General recommendations for obesity prevention and nutrition counseling exist. However, these are notably imprecise with regard to early and targeted interventions to prevent and treat obesity in pediatric populations. This study examines family medicine primary care providers’ (PCPs) perceived barriers for preventing and treating pediatric obesity and their related practice behavior during well-child visits.Methods.A written survey addressing perceived barriers and current practices addressing obesity at well-child visits were administered to PCPs at eleven family medicine clinics in the Duke University Health System.Results.The most common perceived barriers identified by PCPs to prevention or treatment of obesity in children were families not getting enough exercise (93%) and families too often having fast food meals (86%). Most PCPs do not discuss fast foods at or prior to the twelve-month well-child visit. The two-year visit is the first well-child visit at which a majority of PCPs (68%) discuss fast food.Conclusion.No clear consensus exists as to when PCPs should discuss fast food in early well-child checks. Previous research has shown a profound shift in children’s dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Consideration should be given to having a “French Fry Discussion” at every twelve-month well-child care visit.

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Supporting families managing parental mental illness: Challenges and resources

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217418791444 ◽

2018 ◽

Vol 53 (5-6) ◽

pp. 361-370 ◽

Cited By ~ 2

Author(s):

Michelle D Sherman ◽

Stephanie A Hooker

Keyword(s):

Mental Health ◽

Mental Illness ◽

Family Medicine ◽

Health Care Providers ◽

Mental Health Problems ◽

Family Members ◽

The United States ◽

Parental Mental Illness ◽

Care Providers ◽

Treatment Needs

Over five million children in the United States have a parent living with a serious mental illness. These offspring are at higher risk for developing mental health problems themselves due to a complex interplay of biological, psychological, and psychosocial factors. Life with a parent with psychiatric symptoms can be scary, confusing, overwhelming, and sad; children often blame themselves for their parent’s problems, find their parent’s behavior embarrassing, and struggle to explain the illness to their friends. Unfortunately, these children’s needs and experiences are often ignored by overwhelmed parents, worried family members and relatives, separate mental health systems of care for adults and children that often fail to coordinate care, and even well-intentioned health-care providers. Family medicine teams have an opportunity to detect and support these families in unique ways. We offer four recommendations for family medicine teams to help families managing parental mental illness including assessing functioning, treatment needs, and impacts on each family member; educating all family members about mental illness; instilling hope, noting the range of effective treatments for mental illness; and encouraging the use of supports and referral options. Providers can leverage family members’ strengths, work with community-based resources, and offer continuity to these families, as they struggle with an oftentimes chronic, relapsing disease that has ripple effects throughout the family system.

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