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Adapting an evidence-based HIV prevention intervention for pregnant African-American women in substance abuse treatment  [cached]
Wendee M Wechsberg,Felicia A Browne,Winona Poulton,et al
Substance Abuse and Rehabilitation , 2011,
Abstract: Wendee M Wechsberg1, Felicia A Browne1, Winona Poulton1, Rachel Middlesteadt Ellerson1, Ashley Simons-Rudolph1, Deborah Haller2, 1RTI International,* Research Triangle Park, NC, USA; 2Columbia University College of Physicians and Surgeons, New York, NY, USA, *RTI International is a trade name of Research Triangle InstituteAbstract: An adaptation of an evidence-based, woman-focused intervention designed to reduce HIV risk behaviors was conducted for pregnant, African-American women in substance abuse treatment in North Carolina. The intervention adaptation process included focus groups, expert panels, and the filming of women who spoke about their experiences with pregnancy, drug use, sex risk behaviors, HIV testing and treatment, need for substance abuse treatment, violence, and victimization. The assessment instrument was adapted for pregnant women and the intervention was organized into a 4-session PowerPoint presentation, with an additional session if a woman tested positive for HIV. All sessions and assessment instrument were installed on laptop computers for portability in treatment programs. We pilot tested our adaptation with 59 pregnant African-American women who had used an illicit drug within the past year and were enrolled in substance abuse treatment. At baseline, 41% were currently homeless, 76% were unemployed, 90% had not planned their current pregnancy, and approximately 70% reported drug use since finding out about the pregnancy. This sample of participants rated the intervention sessions and were highly satisfied with their experience, resulting in a mean satisfaction score of 6.5 out of 7. Pregnant African-American women who use drugs need substance abuse treatment that they do not currently access. Woman-focused HIV interventions help to address intersecting risk behaviors and need for treatment prevalent among this vulnerable group.Keywords: African-American woman, HIV prevention pregnancy, drug use, violence, sexual risk
Initial Feasibility and Acceptability of a Comprehensive Intervention for Methamphetamine-Using Pregnant Women in South Africa  [PDF]
Hendrée E. Jones,Bronwyn Myers,Kevin E. O’Grady,Stefan Gebhardt,Gerhard B. Theron,Wendee M. Wechsberg
Psychiatry Journal , 2014, DOI: 10.1155/2014/929767
Abstract: The purpose of the present study was to determine the feasibility, acceptability, and initial efficacy of a women-focused intervention addressing methamphetamine use and HIV sexual risk among pregnant women in Cape Town, South Africa. A two-group randomized pilot study was conducted, comparing a women-focused intervention for methamphetamine use and related sexual risk behaviors to a psychoeducational condition. Participants were pregnant women who used methamphetamine regularly, had unprotected sex in the prior month, and were HIV-negative. Primary maternal outcomes were methamphetamine use in the past 30 days, frequency of unprotected sexual acts in the past 30 days, and number of antenatal obstetrical appointments attended. Primary neonatal outcomes were length of hospital stay, birth weight, and gestational age at delivery. Of the 57 women initially potentially eligible, only 4 declined to participate. Of the 36 women who were eligible and enrolled, 92% completed all four intervention sessions. Women in both conditions significantly reduced their methamphetamine use and number of unprotected sex acts. Therefore, delivering comprehensive interventions to address methamphetamine use and HIV risk behaviors among methamphetamine-using pregnant women is feasible in South Africa. Further testing of these interventions is needed to address methamphetamine use in this vulnerable population. 1. Introduction Substance use during pregnancy is a critical health care concern. In Cape Town, South Africa, high rates of methamphetamine use have been found among women of childbearing age [1–3], including pregnant women [4]. Methamphetamine use is associated with several deleterious short- and long-term physical and psychological effects. A wide variety of physical effects have been associated with methamphetamine use, including respiratory and cardiac problems, palpitations, tremors, convulsions, stroke, and an increased risk of death [5]. Furthermore, its use is associated with risky sexual activities that place women at risk for acquiring HIV [1, 3, 6]. Psychological effects can be pronounced and include hallucinations, delusions, paranoia, and amphetamine psychosis [7]. Methamphetamine use has a high dependence risk and an extended withdrawal period, with frequent relapse. Prenatal stimulant exposure has been associated with being born small for gestational age [8], a risk factor for later developmental problems [9, 10] and poorer neurobehavioral outcomes [11]. Nonetheless, there are no substance use treatment models in South Africa that are tailored to address
Efectividad de una estrategia de intervención educativa para la promoción de la salud con la embarazada Effectiveness of an educational intervention strategy for health promotion in the pregnant woman
Benita Mavel Beltrán González,Magalys Ruiz Iglesias,Ricardo Grau Abalo,Isa álvarez León
Revista Cubana de Salud Pública , 2007,
Abstract: Introducción: se presenta una estrategia de intervención educativa en función de promover la salud de las embarazadas. La investigación se realizó en seis consejos populares del municipio de Ranchuelo en la provincia de Villa Clara con la participación de 32 facilitadores mediante un dise o cuasi experimental. Objetivo: contribuir a mejorar la salud de las embarazadas del municipio Ranchuelo. Métodos: la muestra estuvo constituida por 160 embarazadas distribuidas en dos grupos, uno de intervención y otro de comparación con 80 mujeres cada uno. Se realizó el análisis de los problemas de salud materno infantil a nivel del grupo básico de trabajo así como el diagnóstico educativo con las embarazadas que posibilitó la estructuración de la estrategia de intervención en siete fases. Resultados: se logró la coordinación e interacción de los sectores y organizaciones participantes. Las embarazadas del grupo de intervención se convirtieron en sujetos activos del cuidado de su salud, lo que se manifestó en la disminución del número de mujeres con enfermedades evitables durante la gestación en ese grupo, 19 (23,8 %) en relación con el grupo de comparación, 41 (51,3 %); además, en el grupo de intervención nacieron menos bebes con bajo peso, fue mayor el número de mujeres que amamantaron a su bebé con lactancia materna exclusiva hasta el cuarto mes y donde se apreció una mejor evolución de la relación peso/talla de los hijos en el primer semestre de la vida. Conclusiones: la intervención educativa fue efectiva al cumplirse los objetivos propuestos. Introduction: an educational intervention strategy was presented to promote health in pregnant women. The research work was undertaken in six people′s councils of Ranchuelo municipality in Villa Clara province in which 32 facilitators participated and a quasi-experimental design was used. Objectives: to contribute to improve the pregnant women′s health from Ranchuelo municipality. Methods: the sample was made up of 160 pregnant women divided into two 80-women groups, one was the intervention group and the other was the comparison group. The analysis of maternal/child problems at basic working group level was made as well as the educational diagnosis with pregnant women was performed, which made the structuring of the intervention strategy in seven stages possible. Results: the coordination and interaction of the participating sectors and organizations was successful. The pregnant women in the intervention group became active subjects in caring their health, which was reflected in the reduction of the number of women suffe
Retrosternal abscess after trigger point injections in a pregnant woman: a case report
Faisal Usman, Abubakr Bajwa, Adil Shujaat, James Cury
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-403
Abstract: A 37-year-old African-American woman, who was 20 weeks pregnant, presented to our emergency room with complaints of progressively worsening chest pain and shortness of breath over the course of the last two months. She was undergoing trigger point injections at multiple different sites including the sternoclavicular joint for chest pain and dystonia. Two years previously she had developed a left-sided pneumothorax as a result of this procedure, requiring chest tube placement and subsequent pleurodesis. Her vital signs in our emergency room were normal except for resting tachycardia, with a pulse of 100 beats per minute. A physical examination revealed swelling and tenderness of the sternal notch with tenderness to palpation over the left sternoclavicular joint. Laboratory data was significant for a white blood count of 13.3 × 109/L with 82% granulocytes. A chest radiograph revealed left basilar scarring with blunting of the left costophrenic angle. A computed tomography angiogram showed a 4.7 cm abscess in the retrosternal region behind the manubrium with associated sclerosis and cortical irregularity of the manubrium and left clavicle.Trigger point injection is generally considered very safe. However, there are reported cases of serious complications as a result of this procedure. A computed tomography scan of the chest should strongly be considered in the evaluation of chest pain and shortness of breath of unclear etiology in patients with even a remote history of trigger point injections.Retrosternal abscess is considered to be one of the most dreaded poststernotomy complications. There is a reported high incidence of retrosternal abscess in sternoclavicular joint infections regardless of any history of intravenous drug abuse, underlying illness or immunosuppression [1]. Retrosternal abscess may also develop secondary to mediastinitis, cardiopulmonary resuscitation or sternal bone marrow aspiration. Staphylococcus is the most commonly implicated organism in retro
"Pseudosarcoma" in a pregnant woman
Amarjit Anand, Eva Tsapakis, Ali A Narvani, Ali Alhakim, Steve R Cannon, Eleftherios Tsiridis
World Journal of Surgical Oncology , 2007, DOI: 10.1186/1477-7819-5-7
Abstract: We report a case of IVF in a 16-week pregnant lady affecting the hypothenar eminence of the hand associated with the ulnar artery.The characteristic involvement of muscular arteries and veins by reactive myofibroblastic proliferation in IVF suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. We propose that hormone-related changes associated with pregnancy may play an important role in the aetiopathogenesis of this myofibroblastic lesion.Intravascular fasciitis (IVF) is a term originally described by Patchefsky and Enzinger to describe this distinctive variant of nodular fasciitis [1]. It is a benign, reactive myofibroblastic proliferative lesion that arises from the superficial or deep fascia and involves predominately small to medium-size arteries and/or veins. It presents as a well-defined nodule in the subcutis or muscle. The involvement of muscular vessels can lead to an erroneous assumption of malignant vascular invasion. It is considered to be very rare and since its first description in 1981, only a few isolated cases have been documented in the literature [2-8].In August 2003, a 20-year-old 16-week pregnant mother of one, presented to the orthopaedic outpatient clinic with a 2-month history of a slowly growing painless mass located in the right hypothenar eminence. She was right-hand dominant and a housewife. There was no history of trauma, insect bites or drainage from the area. There was no significant past medical or surgical history. She was not on any prescribed medication. There was no family history of tumours. She denied smoking, alcohol and drug abuse. On examination, a non-tender, firm to palpation, well-demarcated and tethered to the subcutaneous tissues mass, surrounded by mild erythema, and measuring approximately 2.5 cm × 3.0 cm was revealed, in the absence of palpable lymph nodes at the ipsilateral elbow or axilla. There were no other abnormal signs.Haematological and biochemical investigati
Pseudomembranous colitis in a pregnant woman  [PDF]
T Mridula,R R Pai,A M Mathai,B V Tantry,P Adhikari
Kathmandu University Medical Journal , 2010, DOI: 10.3126/kumj.v8i3.6226
Abstract: Pseudomembranous colitis in association with pregnancy has not been well described in English literature. Recent studies show a drastic increase in the incidence and severity of Pseudomembranous colitis in pregnant women, who were once thought to be at low risk. We report here a case of Pseudomembranous colitis in a young healthy immunocompetent pregnant lady. An early suspicion of this entity with the characteristic appearance of pseudomembranes on colonoscopy and histology confirmed the diagnosis enabling prompt treatment and complete recovery without any serious consequences. DOI: http://dx.doi.org/10.3126/kumj.v8i3.6226 Kathmandu Univ Med J 2010;8(3):345-7 ?
Hemorrhagic Valsalva Retinopathy in a Pregnant Woman  [PDF]
Charles Geraud Fredy Nganga Ngabou, Chantal Makita, Bénédicte Diatewa
Case Reports in Clinical Medicine (CRCM) , 2018, DOI: 10.4236/crcm.2018.72008
Abstract: Valsalva retinopathy is caused by a sudden increase in intra-thoracic or abdominal pressure, following forced expiration, with mouth and nose closed (Valsalva maneuver). We report a case of Valsalva retinopathy in a pregnant woman. A 36 years old patient, pregnant at 24 weeks of amenorrhea, who consulted for sudden visual acuity decrease of the left eye, evolving since 24 hours after Valsalva maneuvers to calm down her panic and control her breathing. The refraction has demonstrated a decrease of visual acuity in the left eye to “can see a hand moving”, while the visual acuity remained normal in the right eye. Spontaneous evolution was marked by a fast and progressive reduction of hemorrhage and progressive recovery of vision in the left eye. Valsava retinopathy was first described in 1972 by Thomas Duane. Physical activity is usually found before it occurs. Many situations are usually associated to this occurrence among which: pregnancy, vomiting, weightlifting or trauma. Regression of this hemorrhage without sequelae is usual. But sometimes, we need a Nd:Yag laser treatment or surgery to evacuate the blood.
Ectopic Intrauterine Device in the Bladder of a Pregnant Woman
Zehra Kurdoglu,Kadir Ceylan,Mertihan Kurdoglu,Ayse Guler,Hanim Guler Sahin
Case Reports in Medicine , 2010, DOI: 10.1155/2010/181032
Abstract: Background. Uterine perforation and transvesical migration of an intrauterine device are rare complications. Case. A 28-year-old woman who had an intrauterine device was admitted to our outpatient clinic with complaints of amenorrhea lasting 5 weeks and pelvic pain lasting a year. Transvaginal ultrasonography revealed embedding of the intrauterine device in the bladder. The misplaced device was removed by laparotomy. Conclusion. The followup of intrauterine device localization with transvaginal ultrasonography is essential for early detection of possible serious complications.
A ruptured uterus in a pregnant woman not in labor
D Punguyire, KV Iserson
Pan African Medical Journal , 2011,
Abstract: Reducing maternal mortality constitutes one of the eight Millennium Development Goals. While significant progress has been made, system issues and professional training continue to affect maternal survival, especially when unusual, but deadly, complications arise. This rare case of survival after the rupture of an unscarred uterus in a grand multiparous woman from a remote village in Ghana illustrates how systemic transportation issues and limited access to advanced medical care put women with obstetric complications at risk. The usual clinical presentation of ruptured uteri and methods to prevent this catastrophic event are discussed. This case illustrates the systemic transportation issue that often limits access to prenatal and emergency care throughout much of the developing world and demonstrates how advanced training for emergency nurses and the use of ultrasound diagnosis can expedite difficult diagnoses and lead to maternal survival, even in the most adverse circumstances.
A ruptured uterus in a pregnant woman not in labor
Damien Punguyire,Kenneth Victor Iserson
Pan African Medical Journal , 2011,
Abstract: Reducing maternal mortality constitutes one of the eight Millennium Development Goals. While significant progress has been made, system issues and professional training continue to affect maternal survival, especially when unusual, but deadly, complications arise. This rare case of survival after the rupture of an unscarred uterus in a grand multiparous woman from a remote village in Ghana illustrates how systemic transportation issues and limited access to advanced medical care put women with obstetric complications at risk. The usual clinical presentation of ruptured uteri and methods to prevent this catastrophic event are discussed. This case illustrates the systemic transportation issue that often limits access to prenatal and emergency care throughout much of the developing world and demonstrates how advanced training for emergency nurses and the use of ultrasound diagnosis can expedite difficult diagnoses and lead to maternal survival, even in the most adverse circumstances
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