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.

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.

Effect of elevation on intravenous extravasations.

Nursing interventions used to treat intravenous extravasations (infiltrations) generally include application of warmth or cold, elevation, and no treatment. In this article, the effect of elevation on infiltrations of 0.45% sodium chloride and 3% saline made intentionally into healthy volunteers is reported. Elevation had no effect on pain, surface area of induration, or volume of infiltrate remaining as quantified by magnetic resonance imaging. A comparison of these data with previously published findings concerning the effect of warmth versus cold on infiltrations shows that no one treatment is better overall in decreasing the symptoms or speeding re-absorption of the infiltrate.

Differences among intravenous extravasations using four common solutions.

A frequent complication of intravenous therapy is extravasation (infiltration) of the infused fluid into the interstitial tissues. This study compares infiltrates intentionally made using different IV solutions regarding surface assessment and the volume of infiltrate as quantified by magnetic resonance imaging. Solutions differed significantly concerning pain, surface area of induration, and volume at the site of infiltration.

Anticipatory guidance for the adolescent. Parents' concerns.

Parents' opinions regarding anticipatory guidance for adolescents have not been adequately investigated. In this study, 932 parents of adolescents completed a computerized questionnaire listing 30 common psychosocial-medical concerns of adolescence. Respondents were asked how important it is for private pediatricians to discuss these topics with their teenagers during regular checkups. Ten items were rated important by > or = 90% of parents, 22 items by > or = 80%, and 29 items by > or = 66%. Heeding parents' expectations and concerns, pediatricians should incorporate discussions of psychosocial-medical issues as a meaningful component of routine adolescent health care.

Effect of warm and cold applications on the resolution of i.v. infiltrations.

Differences in pain intensity, surface area measurements of induration and erythema, and interstitial fluid volume when warm versus cold applications were randomly made to an intentional intravenous infiltrate of 5 mL of a designated solution were examined. Three solutions were used: 1/2 saline (154 mOsm), normal saline (308 mOsm), and 3% saline (1027 mOsm). Differences in volume were determined by magnetic resonance imaging (MRI) at three intervals postinfiltration. The sample was 18 healthy adults between 20 and 45 years. There was no difference in remaining infiltrate when 1/2 saline or normal saline were used, but a significant (p < .001) difference was found with 3% saline. For all solutions there was a significant (p < .001) difference in the volume of infiltrate remaining when warmth was applied and this effect held across MRI readings and solutions. Pain intensity did not differ by treatment but a significant (p < .005) difference was found by solution, with 3% saline producing the greatest difference. Erythema was absent with all solutions. Surface induration was affected by solution and decreased over time (p = .001). There was no effect of warmth or cold on surface area induration.

The cervical cap: a barrier contraceptive.

PIP: The cervical cap may eventually prove to be a safe, satisfactory, noninvasive, and nonhormonal contraceptive alternative for women in the US. The cap is currently approved for investigational use only, and is available from a limited number of providers. The Prentif cavity rim cap is the most commonly used and is available in 4 sizes. The soft rubber device is thimble shaped, approximately 1 1/4 inches long, with a narrow groove along the inner surface that creates a suction seal when fitted over the cervix. The inability to match cap and cervical circumferences precisely is a recognized drawback. Theoretically, the cap alone should prevent sperm entry into the uterus, however, the use of a spermicide placed in the dome before insertion is recommended. The cap's effectiveness is not yet documented. Estimates from a 1953 study of 143 users were 92.4/100 women years of use for use effectiveness, and the theoretical effectiveness is believed to be more than 98%. Failures with the cap may result from a variety of reasons, particularly dislodgement. The advantage of the cap over other barrier methods is that it can be inserted any time prior to intercourse and left in place longer. The ideal safety period for placement has not been validated, but a range of 1-7 days has been recommended. The length of time the spermicide remains effective and the cervical effects of prolonged contact are of prime concern. The cap may be used by some women who cannot be properly fitted for a diaphragm due to vaginal or uterine anomalies. Sexual arousal and orgasmic response are reported by some cap users to be more pleasurable with the cap than with the diaphragm. Reported problems with use include discomfort during intercourse and improper fit during some days of the menstrual cycle. Contraindications for use include cervical inconsistencies, infection, allergy to the spermicide or the rubber, and inability to learn proper insertion and removal techniques. Insertion and removal may be difficult, and clients should be given sufficient time to practice. Cap placement needs to be checked manually after insertion and intercourse. With proper use, cleaning, and storage, the cap will last for several years. Instruction in use requires a significant amount of the practioner's time and methods must be sensitive to the client's needs. Attitudes of practitioners and other staff may impact on the acceptability of this method. Additional research is needed on the characteristics of cap users, partners' attitudes, the need to use spermicides, the length of time of spermicidal effectiveness and cap effectiveness rates. Further development of instructional methodologies is needed.^ieng