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ABSTRACT: The present literature review was conducted to determine what information has been published on the topic of undocumented pregnant migrants. Scientific databases and gray literature sources were searched for articles published between January 1967 and September 2010. Eighty-seven articles met the inclusion criteria and were reviewed. A final sample of 23 articles was included in the review. Existing evidence suggests that pregnant undocumented migrants living in Western societies tend to be younger, unmarried, and more likely to be employed in the domestic sector than documented migrants and permanent residents. They have less access to prenatal care and consult later in pregnancy than controls. Findings concerning delivery and birth outcomes are conflicting and subject to several biases. Little has been published on programs to address the needs of undocumented pregnant women living in Western countries. More research on the particular health and social issues faced by these women is needed.
Journal of Immigrant and Minority Health 03/2012; · 1.16 Impact Factor
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ABSTRACT: A pocket guide on management of substance use during pregnancy was developed by a group of Canadian care providers. One hundred and fifteen family medicine residents in 6 Canadian teaching sites were randomized to receive either the pocket guide or a paper summary on similar clinical topics, based on UpToDate, a comprehensive Web-based resource. At baseline, both groups completed a survey containing questions on beliefs, attitudes, experience, and training on pregnancy and substance use. Participants then answered 28 multiple choice questions about substance use in pregnancy, using either the pocket guide or UpToDate. Finally participants were asked to rate ease of use for the 2 resources. The results showed that the pocket guide group had higher knowledge scores than the UpToDate group overall and at each study site (61.27% vs. 42.86%, P < .001). The residents found the pocket guide easier to use than UpToDate (mean = 2.73 vs. 4.36, P < .001), and were more likely to want to use it again (96% for pocket card, 78% for UpToDate, P = .005). It is concluded that the pocket guide is a practical source of clinical information at point of care, particularly for "orphan" subjects such as substance use in pregnancy.
Substance Abuse 10/2011; 32(4):175-9. · 1.33 Impact Factor
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ABSTRACT: To assess the adequacy of prenatal care and perinatal outcomes for uninsured pregnant women at two primary care centres in Canada.
We conducted a retrospective case comparison study of uninsured women presenting for prenatal care between 2004 and 2007 (n = 71). Control subjects (n = 72) were chosen from provincially insured women presenting for prenatal care during the same period. A modified Kotelchuck Index was used to assess adequacy of care. Frequency of routine prenatal testing (blood tests, ultrasound, cervical swabs, Pap testing, and genetic screening) was compared. Perinatal outcomes assessed included gestational age and birth weight.
Uninsured pregnant women presented for initial care 13.6 weeks later than insured women (at 25.6 weeks vs. 12.0 weeks, P < 0.001). Uninsured women had fewer blood tests (93.7% vs. 100%, P = 0.045), ultrasound screenings (82.5% vs. 98.4%, P = 0.003), cervical swabs (69.8% vs. 85.2%, P = 0.04), Pap tests (38.1% vs. 75.4%, P < 0.001), genetic screenings (12.7% vs. 44.3%, P < 0.001), and visits with health care providers (6.6 vs. 10.7, P = 0.05). Using a modified Kotelchuck Adequacy of Prenatal Care Utilization Index, uninsured women were more likely to be categorized as receiving "inadequate care" (uninsured 61.9% vs. insured 11.7%, P < 0.001).
This study begins to document the care of uninsured pregnant women in Canada. Women in this category presented late for prenatal care, were less likely to have adequate screening tests, and were more likely to receive "inadequate care" as defined by the modified Kotelchuck Index. This information may be valuable in helping to plan programs to improve access to timely and adequate medical care for uninsured pregnant women.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 03/2011; 33(3):235-43.
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George Carson,
Lori Vitale Cox,
Joan Crane,
Pascal Croteau, Lisa Graves,
Sandra Kluka,
Gideon Koren,
Marie-Jocelyne Martel,
Deana Midmer,
Irena Nulman,
Nancy Poole,
Vyta Senikas,
Rebecca Wood,
Society of Obstetricians and Gynaecologists of Canada
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ABSTRACT: to establish national standards of care for the screening and recording of alcohol use and counselling on alcohol use of women of child-bearing age and pregnant women based on the most up-to-date evidence.
published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in May 2009 using appropriate controlled vocabulary (e.g., pregnancy complications, alcohol drinking, prenatal care) and key words (e.g., pregnancy, alcohol consumption, risk reduction). Results were restricted to literature published in the last five years with the following research designs: systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment (HTA) and HTA-related agencies, national and international medical specialty societies, clinical practice guideline collections, and clinical trial registries. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. The quality of evidence was evaluated and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care.
the quality of evidence was rated using the criteria described by the Canadian Task Force on Preventive Health Care (Table 1).
the Public Health Agency of Canada and the Society of Obstetricians and Gynaecologists of Canada. ENDORSEMENT: these consensus guidelines have been endorsed by the Association of Obstetricians and Gynecologists of Quebec; the Canadian Association of Midwives; the Canadian Association of Perinatal, Women's Health and Neonatal Nurses (CAPWHN); the College of Family Physicians of Canada; the Federation of Medical Women of Canada; the Society of Rural Physicians of Canada; and Motherisk. SUMMARY STATEMENTS: 1. There is evidence that alcohol consumption in pregnancy can cause fetal harm. (II-2) There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. (III) 2. There is insufficient evidence to define any threshold for low-level drinking in pregnancy. (III) 3. Abstinence is the prudent choice for a woman who is or might become pregnant. (III) 4. Intensive culture-, gender-, and family-appropriate interventions need to be available and accessible for women with problematic drinking and/or alcohol dependence. (II-2).
1. Universal screening for alcohol consumption should be done periodically for all pregnant women and women of child-bearing age. Ideally, at-risk drinking could be identified before pregnancy, allowing for change. (II-2B) 2. Health care providers should create a safe environment for women to report alcohol consumption. (III-A) 3. The public should be informed that alcohol screening and support for women at risk is part of routine women's health care. (III-A) 4. Health care providers should be aware of the risk factors associated with alcohol use in women of reproductive age. (III-B) 5. Brief interventions are effective and should be provided by health care providers for women with at-risk drinking. (II-2B) 6. If a woman continues to use alcohol during pregnancy, harm reduction/treatment strategies should be encouraged. (II-2B) 7. Pregnant women should be given priority access to withdrawal management and treatment. (III-A) 8. Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for termination of pregnancy. (II-2A).
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 08/2010; 32(8 Suppl 3):S1-31.
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ABSTRACT: Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004-2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.
Substance Use & Misuse 03/2009; 44(4):548-68. · 1.10 Impact Factor
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Lisa Graves
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ABSTRACT: The wounded healer remains easily hidden in a profession that implicitly, and at times actively, encourages a denial of illness. The wounded healer is, at the very least, less likely to encourage healthy habits in patients, and at the very worst, can become an impaired physician. In training, however, the wounded healer can be identified and treated before entering clinical practice. It would seem, then, that medical school and residency is an optimal time to identify and treat the wounded healer.
Medical Teacher 04/2008; 30(2):217-9. · 1.22 Impact Factor
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ABSTRACT: Hepatitis C prevention counselling and education are intended to increase knowledge of disease, clarify perceptions about vulnerability to infection, and increase personal capacity for undertaking safer behaviours. This study examined the association of drug equipment sharing with psychosocial constructs of the AIDS Risk Reduction Model, specifically, knowledge and perceptions related to hepatitis C virus (HCV) among injection drug users (IDUs). Active IDUs were recruited between April 2004 and January 2005 from syringe exchange and methadone maintenance treatment programs in Montreal, Canada. A structured, interviewer-administered questionnaire elicited information on drug preparation and injection practices, self-reported hepatitis C testing and infection status, and AIDS Risk Reduction Model constructs. Separate logistic regression models were developed to examine variables in relation to: (1) the sharing of syringes, and (2) the sharing of drug preparation equipment (drug containers, filters, and water). Among the 321 participants, the mean age was 33 years, 70% were male, 80% were single, and 91% self-identified as Caucasian. In the multivariable analyses, psychosocial factors linked to syringe sharing were lower perceived benefits of safer injecting and greater difficulty to inject safely. As with syringe sharing, the sharing of drug preparation equipment was associated with lower perceived benefits of safer injecting but also with low self-efficacy to convince others to inject more safely. Interventions should aim to heighten awareness of the benefits of risk reduction and provide IDUs with the skills necessary to negotiate safer injecting with their peers.
Social Science [?] Medicine 02/2008; 66(2):211-20. · 2.70 Impact Factor
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ABSTRACT: To systematically review studies examining the relationship between hyperemesis gravidarum and Helicobacter pylori (H pylori) infection.
A 1966 to January 2007 search using MEDLINE/PubMed, EMBASE, and Web of Science included MeSH terms: "Helicobacter pylori," "Helicobacter infections," "hyperemesis gravidarum," and the text words "nausea," "vomit," "pregnancy," and "Helicobacter." References of selected papers were examined for additional relevant studies.
We evaluated studies investigating a relationship between hyperemesis gravidarum and H pylori infection. Studies were included in which the diagnosis of hyperemesis gravidarum was made at or before entry into the study, and H pylori diagnosis was made by serum antibody sample, gastric biopsy, saliva test, or stool sample. The search produced 169 titles; 22 were reviewed in further detail.
Fourteen case-control studies met established criteria, involving 1,732 participants and controls tested for H pylori infection. Studies were evaluated according to patient demographics and study methodology (case definition, exclusion criteria, H pylori testing). An estimate of the odds ratios with 95% confidence intervals was calculated by using a random effects model for dichotomous variables with review article software. Ten studies showed a significant association between hyperemesis gravidarum and H pylori infection. Odds ratios varied from 0.55 to 109.33; three results were less than 1.0. Tests for heterogeneity applied to several subgroups were considerable with values above 75% for all groups.
An association between hyperemesis gravidarum and H pylori infection is suggested by this systematic review. However, the considerable heterogeneity among studies highlights study limitations.
Obstetrics and Gynecology 10/2007; 110(3):695-703. · 4.73 Impact Factor
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ABSTRACT: To identify factors associated with using sterile drug injection equipment by injection drug users (IDUs).
275 IDUs were recruited from syringe exchange programs in Montreal, Canada in 2004-2005. A structured, interviewer-administered questionnaire collected information about demographics, drug injection practices, self-reported HIV and hepatitis C virus (HCV) status, and harm reduction behaviours. Logistic regression was used to model variables in relation to the use of sterile syringes, containers, filters, and drug preparation water.
Sterile syringes, containers, filters, and water were used for at least half of injecting episodes by 95%, 23%, 23%, and 75% of subjects, respectively. In multivariate analysis, users of sterile syringes had higher odds of being older and injecting alone, and were less likely to report problems obtaining sterile syringes and requiring or providing help with injecting. Using sterile filters was associated with having at least high school education, injecting heroin, and injecting alone. In addition to the factors associated with filters, users of sterile containers were more likely to be HCV-negative and older. Using sterile water was associated with daily injecting and being HCV-negative.
Improving the uptake of sterile drug preparation equipment among IDUs could be aided by considering drug-specific risks, such as drug of choice and injecting context, while reinforcing existing messages on safer injecting. The association between sterile equipment use and HCV-negative status may be representative of an established subgroup of safer injectors who have remained free of infection because of consistent safe injecting practices.
The International journal on drug policy 06/2007; 18(3):204-12. · 2.54 Impact Factor
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ABSTRACT: True umbilical cord knots are rare, but may be associated with intrapartum fetal distress and perinatal complications.
This report describes a pregnancy complicated by intrauterine growth restriction and oligohydramnios. The labour was complicated by a non-reassuring fetal heart rate tracing. Four umbilical cord knots were discovered at the time of delivery. The baby's neonatal course was uncomplicated.
There is currently no reliable method of detecting umbilical cord knots using ultrasound or colour Doppler flow studies. Cord knots may be responsible for fetal compromise during labour and delivery.
Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 02/2006; 28(1):32-5.
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ABSTRACT: To assess participant perception of an integrated model of care for substance abuse in pregnancy.
Focus groups were employed for this qualitative study.
Two Family Medicine Units, 1 in Toronto and 1 in Montreal, where integrated care for licit and illicit substance abuse in pregnancy is provided by a team of doctors, nurses, nurse practitioners, and social workers.
Women who had received addiction and prenatal care at 1 of the 2 sites.
Women were asked to discuss their experiences of care in focus groups.
Five central themes emerged: judgment, physician-patient communication, team communication, support groups, and self-responsibility.
Women felt more comfortable with provider teams that shared a consistent nonjudgmental attitude.
Journal of Obstetric Gynecologic & Neonatal Nursing 39(1):46-52. · 1.03 Impact Factor
