Outcomes of Childbirth Education for Women With Pregnancy Complications.

The purpose of this study was to examine associations between pregnancy outcomes and childbirth education, identifying any outcomes moderated by pregnancy complications. This was a secondary analysis of the Pregnancy Risk Assessment Monitoring System, Phase 8 data for four states. Logistic regression models compared outcomes with childbirth education for three subgroups: women with no pregnancy complications, women with gestational diabetes, and women with gestational hypertension. Women with pregnancy complications do not receive the same benefit from attending childbirth education as women with no pregnancy complications. Women with gestational diabetes who attended childbirth education were more likely to have a cesarean birth. The childbirth education curriculum may need to be altered to provide maximum benefits for women with pregnancy complications.

Outcomes of Childbirth Education in PRAMS, Phase 8.

OBJECTIVE: To determine if childbirth education is associated with improved outcomes for national maternal child health goals in the United States. METHODS: This was a secondary analysis of PRAMS data. The sample was limited to survey respondents who answered a question "During your most recent pregnancy, did you take a class or classes to prepare for childbirth and learn what to expect during labor and delivery?" The outcomes included nine national objectives from Title V and Healthy People. Logistic regression models were built with control for characteristics associated with attending childbirth education. Odds ratios were converted to adjusted risk ratios for interpretation. Stratification by maternal race/ethnicity and use of Medicaid identified opportunities for improvement in childbirth education. RESULTS: Of the 2,256 eligible respondents, 936 (41.5%) attended childbirth education. Attending childbirth education was associated with reduced likelihood of primary cesarean (ARR 0.79), increased attendance at postpartum visit (ARR 1.06), use of birth control (ARR 1.07), safe infant sleep (Back to Sleep ARR 1.04; Sleep on Own 1.12), and breastfeeding (Ever breastfeed ARR 1.08; still breastfeeding ARR 1.15). No association was found for LARC use or postpartum depression. Not all benefits of childbirth education were apparent for all racial/ethnic groups, nor for those with Medicaid insurance. CONCLUSIONS FOR PRACTICE: Childbirth education is a community intervention that may help achieve population maternal and child health goals.

Sociodemographic Disparities in Utilization of Childbirth Education.

Childbirth education is a preventive intervention intended to improve maternal and neonatal outcomes that is complementary to antenatal health visits. It is not currently known if disparities in access to childbirth education plays a role in maternal and newborn health disparities in the United States. In this study, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to identify disparities in utilization of childbirth education. We identified lower odds of utilization of childbirth education for pregnant people with lower socioeconomic status, including use of Medicaid, and rural residence. Our analysis indicates that characteristics that reduce access to maternal health care also reduce access to childbirth education. This finding has important implications for communities that use childbirth education as a way to help reduce disparities in maternal or newborn outcomes.

A Project to Improve Postpartum Depression Screening Practices Among Providers in a Community Women's Health Care Clinic.

OBJECTIVE: The purpose of this project was to improve health care providers' postpartum depression (PPD) knowledge and screening practices with the implementation of a standardized screening tool. DESIGN: The plan-do-study-act model was used as a framework to measure and implement a practice change aimed at universal screening for PPD. SETTING/LOCAL PROBLEM: Health care providers' screening practices for PPD were inconsistent and lacked use of a standardized screening tool at a southwestern U.S. community women's health care clinic serving minority women of lower socioeconomic status. PARTICIPANTS: Health care providers at a community women's health care clinic. INTERVENTION/MEASUREMENTS: A single educational in-service was presented to health care providers regarding preventive PPD screening practices and documentation recommendations. Measurements included pre- and post-education questionnaire results and electronic health record chart reviews. RESULTS: PPD screening documentation rates increased from 56% to 92.7% (p < .5). CONCLUSION: PPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women's health care clinic.

Is There a Relationship Between Gestational Diabetes and Perinatal Depression?

Perinatal depression (PND) is one of the leading complications associated with childbirth. Early detection and treatment of depression, particularly during the perinatal period, is essential for the promotion of positive maternal-child outcomes. Gestational diabetes mellitus (GDM) has been suggested as a confounding factor associated with PND. Concerns associated with PND include interference with maternal-newborn bonding and long-term effects of neurobehavioral consequences. An exemplar case describing one woman's experience with GDM and her subsequent complications associated with PND is presented to discuss maternal depression and its plausible association with GDM. Recommendations include universal screening with the validated Edinburgh Postnatal Depression Scale screening tool during the early perinatal period to reduce incidence of maternal-newborn complications associated with PND and promote underpinnings for best practice.

Systematic review of peer education intervention programmes among individuals with type 2 diabetes.

AIMS AND OBJECTIVES: To systematically review published randomised controlled trials of peer education interventions among adults with type 2 diabetes. BACKGROUND: Systematic reviews have shown mixed results for peer support interventions to improve diabetes self-management. Given the effectiveness of diabetes education by healthcare professionals, peer education interventions may be a useful alternative approach. This review addressed that gap. DESIGN: Systematic review. METHOD: A systematic search of published randomised controlled trials between 2006-2016 was conducted using the keywords diabetes, type 2 diabetes, randomised controlled trials, self-management, peer education and peer support. The methodological quality of each study was assessed using the Jadad scale. RESULTS: Seven studies were included in the final review, and the Jadad scores ranged from 8-10 of a possible 13 points. There was no consistent design, setting, or outcome measurement among the studies. There were two types of peer education interventions compared to traditional diabetes education: face-to-face or a combination of face-to-face and telephone/texting. The most common clinical outcome measure was HbA1c. Two of six studies showed statistically significant improvement in HbA1c between intervention and control groups. An increase in diabetes knowledge was also statistically significant in two of five studies. CONCLUSION: Peer education could be successful in improving clinical outcomes. No evidence was found indicating that healthcare provider education was superior in regard to clinical knowledge or behavioural or psychological outcome measures than peer education. HbA1c was statistically significantly lower in some peer education groups compared to control groups. RELEVANCE TO CLINICAL PRACTICE: There is evidence that peer education can be useful in achieving positive clinical outcomes such as decreasing HbA1c levels and increasing diabetes knowledge. A certified diabetes educator or a trained healthcare professional should not be overlooked though when using peer educators.

Web-based interventions among adults: Relevance to anthropometric indicators

@#<p style="text-align: justify;"><strong>PURPOSE:</strong> Web-based interventions offer low cost and practical strategies to promote self-care for adult individuals with various health conditions and status issues around the globe. The purpose of this review was to summarize the current recent literature in  examining  the  effectiveness  of  web-based  interventions  to  promote  healthy lifestyles related to anthropometric measurements in adult individuals with various health conditions and status.<br /><strong>DESIGN:</strong> A systematic review of literature was conducted.   Search of the literature was employed to web-based intervention studies in refereed journals written in the English  language.  The  databases  searched  were  PubMed,  Ovid  MEDLINE, CINAHL,  and  Google  Scholar,  with  a  search  period  of  2004-2014.In addition to these databases, a manual search was also used.  <br /><strong>METHODS:</strong> All studies were examined by three reviewers for eligibility using the Jadad scoring  system.Thirteen randomized controlled trial (RCT) studies (n=13)  met criteria in this review and revealed significant associations between the utilization of web-based health promotion interventions on anthropometric measurements in adult populations with health related conditions.<br /><strong>FINDINGS:</strong> Seven  studies  reported  overall  positive  changes  in  the  participants' anthropometric measurements at the completion of each study. Four out of seven studies reported that adult participants' in the intervention groups had greater weight loss  as  compared  to  the  control  groups.  In  addition,  one  study  out  of  the  seven studies reported a larger reduction in BMI of the participants in the intervention group.Two studies out of 13 studies reported positive changes in BMI, waist circumference,body fat, and waist-hip-ratio in the control groups.  <br /><strong>CONCLUSIONS:</strong>The outcomes from this review may prove useful information of effectiveness of web-based interventions relative to physiological outcomes such as anthropometric measurements. These programs can inform transformative practice and improvement of global health.  </p>

Polypharmacy in Older Adults.

Polypharmacy, by definition, is the concurrent use of several different medications consumed by a person. Often these multiple medications are in the same class and are used to treat more than one chronic condition. Older individuals are often faced with issues of polypharmacy due to multiple chronic conditions and multiple providers. The risks associated with polypharmacy can lead to increased adverse effects, falls, and decreased risk of medication compliance. This paper will discuss the issues surrounding polypharmacy and provide a case example to illustrate the significance of this problem.

Academic Outcome Measures of a Dedicated Education Unit Over Time: Help or Hinder?

Critical thinking, nursing process, quality and safety measures, and standardized RN exit examination scores were compared between students (n = 144) placed in a dedicated education unit (DEU) and those in a traditional clinical model. Standardized test scores showed that differences between the clinical groups were not statistically significant. This study shows that the DEU model is 1 approach to clinical education that can enhance students' academic outcomes.