Exploration of Diet Quality by Obesity Severity in Association with Gestational Weight Gain and Distal Gut Microbiota in Pregnant African American Women: Opportunities for Intervention.

OBJECTIVE: To conduct an exploratory examination of dietary patterns and quality during pregnancy in African-American women who were class I, II, or III obese, and those women with normal pre-pregnancy body mass index (pBMI), as well to identify dietary factors associated with GWG, and changes in the distal gut microbiome. African American women represent the largest group affected by pre-pregnancy obesity, a risk factor for several adverse birth outcomes. METHODS: This prospective study investigated the association between diet, distal gut microbiome, and GWG among African-American women (n = 21) with obesity (n = 15) compared to women with a normal pre-pregnancy body mass index (pBMI) (n = 6) at two time points, 27-29 and 37-39 weeks gestation. Dietary patterns associated with obesity severity and GWG gain were assessed using Welch's T-test and Mann-Whitney U. The association between the gut microbiome and dietary patterns was assessed using a regression-based kernel association test and the adaptive microbiome-based sum of powered score test. RESULTS: In early pregnancy, dietary intake of Total Fruits and Greens and Beans was significantly different between pBMI and GWG groups; significance was 0.022 and 0.028 respectively. Women with Class II/III obesity and those with GWG above guidelines had Healthy Eating Index (HEI) scores below 50, meeting less than 75% of dietary guidelines, and did not meet recommendations for fruit and vegetable or fiber intake. We found no significant associations between the microbiome composition and diet (HEI Scores). CONCLUSIONS FOR PRACTICE: Overall, the results indicate that women with pBMI obesity are not meeting minimum dietary guidelines for nutrient intakes during pregnancy, specifically fruits, vegetables, and fiber, regardless of GWG. Interventions for African-American women with pre-pregnancy obesity, with a focus on increasing consumption of fruits and vegetables, would be beneficial to control GWG and improve birth outcomes.

A model for upscaling global partnerships and building nurse and midwifery capacity.

AIM: To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. BACKGROUND AND INTRODUCTION: Nurses and midwives across nations need skills reaching beyond the bedside and unit level in today's complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. DISCUSSION: This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. CONCLUSION AND IMPLICATIONS FOR NURSING: Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. IMPLICATION FOR NURSING POLICY: Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions.

Midwives in India: a delayed cord clamping intervention using simulation.

BACKGROUND: Iron deficiency is a prevalent health problem in India affecting women and newborns. Delayed umbilical cord clamping at birth is a safe and effective means for increasing serum iron levels in newborns up to 6 months of age. AIM: The study aim was to increase the utilization of delayed cord clamping in a group of midwives working in Hyderabad, India. METHODS: A single group pre- and post-test design was used to evaluate knowledge, beliefs and practice before and after a delayed cord clamping intervention including follow-up at 10 months after the original intervention. The intervention included lectures and simulation. RESULTS: Results show significant increases in knowledge and positive beliefs about the practice of delayed cord clamping. Simulation was effective for eliciting important feedback related to learning. LIMITATIONS: Results represent a small group of midwives working with a non-profit foundation in Southern India. Language discordancy and cultural norms in this group of midwives may have influenced results. CONCLUSIONS: Knowledge, beliefs and practice related to delayed cord clamping were all significantly improved after the intervention. The Knowledge to Action framework using simulation is an effective cross-cultural method for implementing education about evidence-based practice. Midwives are invested in learning practices that promote public health. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Changing institutional policy may have limitations without first considering normative practice. Using simulation combined with institutional health policy appears to result in significant uptake of practice change. Qualitative studies exploring the interconnections between cultural norms and decision making may be informative about promoting practice change particularly in this setting. Upscaling midwifery has been recommended to improve maternal and child health in India.

Gestational weight gain and preterm birth in obese women: a systematic review and meta-analysis.

BACKGROUND: Prepregnant obesity is a global concern and gestational weight gain has been found to influence the risks of preterm birth. OBJECTIVE: To assess the relationship between gestational weight gain and risk for preterm birth in obese women. SEARCH STRATEGY: Four electronic databases were searched from 18 February through to 28 April 2015. SELECTION CRITERIA: Primary research reporting preterm birth as an outcome in obese women and gestational weight gain as a variable that could be compared to the 2009 Institute of Medicine's recommendations. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trials for inclusion. The Newcastle Ottawa Scale was used to assess study bias. MAIN RESULTS: Our search identified six studies meeting the inclusion criteria; five were conducted in the USA and one in Peru. Four studies with a total of 10 171 obese women were meta-analysed. Significant heterogeneity was found between studies in the pooled analysis. Results for indicated preterm birth in obese women with gestational weight gain above the Institute of Medicine's recommendations showed increased risk (adjusted odds ratio 1.54; 95% CI 1.09-2.16). CONCLUSIONS: Available science on this topic is limited to special populations of obese pregnant women. Generalisable research is needed to assess the variation in risk for preterm birth in obese women by differences in gestational weight gain and class of obesity controlling for significant variables in the pathway to preterm birth. This research has the potential to illuminate new science impacting preterm birth and interventions for prevention.

Why girls smoke: a proposed community-based prevention program.

OBJECTIVES: To review the literature on reasons teenage girls start smoking and to identify the role and opportunities for nurses to have an impact on this public health problem. In addition, a proposed smoking prevention program targeted to teenage girls is presented. DATA SOURCES: Information was gathered from professional journals and texts and from MEDLINE and PROQUEST. Keywords used in the searches were smoking prevention, tobacco use, smoking and adolescents, teenage girls and smoking, health education and smoking, and smoking prevention programs. DATA SYNTHESIS AND CONCLUSIONS: Smoking initiation in teenage girls is a problem with ramifications for individual health as well as for public health. Although the literature demonstrates the rising incidence of smoking in teenage girls and evidence suggests the reasons girls start smoking differ from those of their male counterparts, a dearth of information on smoking prevention programs exists for this population. It is reasonable to assume that the best practices for adolescent smoking prevention can be applied to programs specifically for girls, along with efforts to address social influences, self-image, and self-esteem, which may be particularly important to teenage girls. The theory of reasoned action provides a framework for prevention strategies that target the behavioral beliefs and attitudes that influence teenage girls to smoke. Nurses can educate themselves about contributing factors that lead teenage girls to start smoking. Implementing this knowledge into nursing practice in a variety of settings could help meet the Healthy People 2010 goals of reducing teenage smoking to 16%.

Intrapartum pain: pharmacologic management.

Even with the tremendous therapeutic benefit of nonpharmaceutical pain relief measures for laboring women, pharmaceutical therapies often are needed. Nurses and other health care providers need to be familiar with the differing pharmaceutical properties of commonly prescribed pain-relieving drugs. The pharmaceutical properties of sedatives and hypnotics, opioids, and local anesthetic agents used to relieve pain during labor and delivery are reviewed. Individualization of drug therapy and maximal therapeutic effects result when the health care provider is informed about the pharmaceutical properties of analgesic and anesthetic agents so that a wise choice can be made.

Pharmacologic management of common gastrointestinal health problems in women.

A wide variety of drugs are available for the treatment of common gastrointestinal health problems in women, including minor or serious as well as acute or chronic conditions. The midwife needs to be current in the pharmacology of over-the-counter as well as prescriptive agents for both pregnant and nonpregnant women. The drug classifications reviewed in this article include antacids, H2 receptor antagonists, antimicrobials, proton pumps, antiemetics, emetics, cholinergics, laxatives, prokinetics, and antidiarrheals. In addition, the physiologic principles are reviewed to enhance the understanding of how these drugs work.

Pharmaceutical preparations. A review of drugs commonly used during the neonatal period.

Certified nurse-midwives, whose responsibility includes care of the newborn in the first days of life, should be well versed in the commonly used pharmaceutical preparations in the neonatal period. This article reviews therapeutic uses and the pharmacodynamics of vitamin K, as well as the neonatal eye preparations for prophylaxis of infections (silver nitrate, tetracycline, and erythromycin ophthalmic ointments). Preparations used in caring for the umbilical cord, as well as the commonly prescribed antibiotics ampicillin and gentamicin, are discussed. The narcotic antagonist naloxone is also reviewed, along with commonly used medications for colic and thrush. The etiology and clinical conditions that require the application of these medications are considered.

Prescriptive authority for advanced nurse practitioners: a blue-print for action.

The pursuit of prescriptive authority is a priority on the legislative agenda of nurse practitioners nationwide. This article describes the legal avenues that have been used by nurse practitioners in 35 states to obtain prescriptive authority. Because prescriptive authority is state regulated, the legislative process for obtaining prescriptive authority differs from state to state. A step by step outline is provided to guide the nurse practitioner through the legislative process from the initial planning stages to the time when a bill is introduced to the state legislature and the follow through until it becomes law.