Addressing infant mortality through positive youth development opportunities for adolescent girls.

Adolescent girls experience risks prior to pregnancy and giving birth that influence their overall health, and development, as well as community rates of infant mortality. Supporting adolescent girls through positive youth development (PYD) opportunities offers a potential long-term strategy to preventing infant mortality and improving maternal health outcomes. The current study sought to assess state-wide needs, resources and opportunities related to PYD supports for adolescent girls, especially among those most at risk for early pregnancy. A strengths, weaknesses, opportunities and threats (SWOT) analysis guided nine community forums in counties with the highest rates of infant mortality in one large Midwestern state. In total, 368 stakeholders attended the forums and provided insights related to the context of PYD for adolescent girls. Researchers also conducted three focus group with 19 parents/guardians and three focus groups with 25 adolescent girls aged 11-14 to validate the findings from the SWOT analysis. Content analysis was utilised to synthesise the qualitative results. Strengths and opportunities related to PYD for adolescent girls included access to afterschool programming and access to health and mental health services. Weaknesses brought awareness to more systemic problems as all nine counties reported a lack of communication and coordination among youth programs and a need for greater collaboration among youth agencies. Threats included challenges associated with technology and social media, unsafe neighbourhood conditions, and issues of racism, sexism, poverty and discrimination. Findings support the need for a continued focus and priority on improving access, services and supports for adolescent girls to prevent infant mortality and improve their health and well-being. Local, state and national leaders can use the results of this study to promote additional strategies for addressing infant mortality through PYD for adolescent girls.

Using complex adaptive systems theory to guide the transition to DNP nurse anesthesia education.

The opportunities and challenges when transitioning from a master's to DNP in nurse anesthesia education are complemented by using a complex adaptive system (CAS) theory to guide the curricula modifications. Major functional changes included reorganizing the curriculum to incorporate AACN DNP Essentials, COA competencies and integrating the scholarly work of a DNP improvement project. These changes were infused while balancing the intensive clinical requirements of a nurse anesthesia curriculum. Highlights in the DNP curriculum included the driving theory of complex systems, ethical values, leadership development, evidence-based practice and adaptation to emergent situations found in nurse anesthesia practice. Goals were to produce a DNP graduate that is more reliant on strategy and vision rather than only tasks or operations. Using the CAS framework enabled our program to transition and prepare DNP graduates to contribute to improved organizational effectiveness and understand the importance of leading change to positively impact patient outcomes.

Using the Whole School, Whole Community, Whole Child model: implications for practice.

BACKGROUND: Schools, school districts, and communities seeking to implement the Whole School, Whole Community, Whole Child (WSCC) model should carefully and deliberately select planning, implementation, and evaluation strategies. METHODS: In this article, we identify strategies, steps, and resources within each phase that can be integrated into existing processes that help improve health outcomes and academic achievement. Implementation practices may vary across districts depending upon available resources and time commitments. RESULTS: Obtaining and maintaining administrative support at the beginning of the planning phase is imperative for identifying and implementing strategies and sustaining efforts to improve student health and academic outcomes. Strategy selection hinges on priority needs, community assets, and resources identified through the planning process. Determining the results of implementing the WSCC is based upon a comprehensive evaluation that begins during the planning phase. Evaluation guides success in attaining goals and objectives, assesses strengths and weaknesses, provides direction for program adjustment, revision, and future planning, and informs stakeholders of the effect of WSCC, including the effect on academic indicators. CONCLUSIONS: With careful planning, implementation, and evaluation efforts, use of the WSCC model has the potential of focusing family, community, and school education and health resources to increase the likelihood of better health and academic success for students and improve school and community life in the present and in the future.

Pedometer-determined step-count guidelines for afterschool programs.

BACKGROUND: Policies to require afterschool programs (ASPs, 3 PM to 6 PM) to provide children a minimum of 30 minutes of moderate-to-vigorous physical activity (MVPA) exist. With few low-cost, easy-to-use measures of MVPA available to the general public, ASP providers are limited in their ability to track progress toward achieving this policy-goal. Pedometers may fill this gap, yet there are no step-count guidelines for ASPs linked to 30 minutes of MVPA. METHODS: Steps and accelerometer estimates of MVPA were collected concurrently over multiple days on 245 children (8.2 years, 48% boys, BMI-percentile 68.2) attending 3 community-based ASPs. Random intercept logit models and receiver operating characteristic (ROC) analyses were used to identify a threshold of steps that corresponded with attaining 30 minutes of MVPA. RESULTS: Children accumulated an average of 2876 steps (standard error [SE] 79) and 16.1 minutes (SE0.5) of MVPA over 111 minutes (SE1.3) during the ASP. A threshold of 4600 steps provided high specificity (0.967) and adequate sensitivity (0.646) for discriminating children who achieved the 30 minutes of MVPA; 93% of the children were correctly classified. The total area under the curve was 0.919. Children accumulating 4600 steps were 25times more likely to accumulate 30 minutes of MVPA. CONCLUSIONS: This step threshold will provide ASP leaders with an objective, low-cost, easy-to-use tool to monitor progress toward policy-related goals.

Peripheral arterial tone: assessment of microcirculatory function in pregnancy.

OBJECTIVE: Endothelial dysfunction is known to play a key role in the pathogenesis of preeclampsia, but the majority of methods for its detection are too invasive to be used in pregnancy. In this study we report a novel method - peripheral arterial tonometry (PAT) - for examining microcirculatory function in pregnancy. METHODS: One hundred and eighty women with at least two risk factors for preeclampsia were examined at gestational weeks 16 and 28; 80 women were examined at 6-9 months postnatally. Twenty-four women developed preeclampsia or pregnancy-induced hypertension (cases), 156 remained normotensive (controls). PAT was measured using fingertip pneumatic probes; after baseline recordings the study arm was occluded with a blood pressure cuff then released after 5 min, causing reactive hyperaemia. PAT recordings pre and post occlusion were used to generate the reactive hyperaemia index (RHI). RESULTS: RHI was significantly lower at gestational week 28 compared to week 16, both in cases and controls. Baseline pulse amplitude was significantly higher at week 28 compared to week 16. There was no difference in RHI at either week 16 or 28 between cases and controls. Postnatally, there was no difference in RHI between cases and controls, but baseline pulse amplitude was lower in affected women. CONCLUSION: PAT and other methods which rely on flow-mediated dilatation for detection of endothelial dysfunction are less likely to be reliable in later pregnancy, when women are more vasodilated. PAT did not predict the development of hypertensive pregnancy complications, but demonstrated a relative peripheral vasoconstriction in affected women postnatally.

Convergent validity of pedometer and accelerometer estimates of moderate-to-vigorous physical activity of youth.

BACKGROUND: Pedometer step-frequency thresholds (120 steps·min-1, SPM) corresponding to moderate-to vigorous intensity physical activity (MVPA) have been proposed for youth. Pedometers now have internal mechanisms to record time spent at or above a user-specified SPM. If pedometers provide comparable MVPA (P-MVPA) estimates to those from accelerometry, this would have broad application for research and the general public. The purpose of this study was to examine the convergent validity of P-MVPA to accelerometer-MVPA for youth. METHODS: Youth (N = 149, average 8.6 years, range 5 to 14 years, 60 girls) wore an accelerometer (5-sec epochs) and a pedometer for an average of 5.7 ± 0.8 hours·day-1. The following accelerometer cutpoints were used to compare P-MVPA: Treuth (TR), Mattocks (MT), Evenson (EV), Puyau (PU), and Freedson (FR) child equation. Comparisons between MVPA estimates were performed using Bland-Altman plots and paired t tests. RESULTS: Overall, P-MVPA was 24.6 min ± 16.7 vs. TR 25.2 min ± 16.2, MT 18.8 min ± 13.3, EV 36.9 min ± 21.0, PU 22.7 min ± 15.1, and FR 50.4 min ± 25.5. Age-specific comparisons indicated for 10 to 14 year-olds MT, PU, and TR were not significantly different from P-MVPA; for the younger children (5-8 year- olds) P-MVPA consistently underestimated MVPA. CONCLUSIONS: Pedometer-determined MVPA provided comparable estimates of MVPA for older children (10-14 year-olds). Additional work is required to establish age appropriate SPM thresholds for younger children.

Adherence to accelerometer protocols among women from economically disadvantaged neighborhoods.

BACKGROUND: Objective measurement of physical activity with accelerometers is a challenging task in community-based intervention research. Challenges include distribution of and orientation to monitors, nonwear, incorrect placement, and loss of equipment. Data collection among participants from disadvantaged populations may be further hindered by factors such as transportation challenges, competing responsibilities, and cultural considerations. METHODS: Research staff distributed accelerometers and provided an orientation that was tailored to the population group. General adherence strategies such as follow-up calls, daily diaries, verbal and written instructions, and incentives were accompanied by population-specific strategies such as assisting with transportation, reducing obstacles to wearing the accelerometer, tailoring the message to the participant population, and creating a nonjudgmental environment. RESULTS: Sixty women asked to wear the Actigraph GT1M returned the accelerometer, and 57 of them provided sufficient data for analysis (at least 10 hours a day for a minimum of 4 days) resulting in 95% adherence to the protocol. Participants wore the accelerometers for an average of 5.98 days and 13.15 hours per day. CONCLUSIONS: The high accelerometer monitoring adherence among this group of economically disadvantaged women demonstrates that collection of high-quality, objective physical activity data from disadvantaged populations in field-based research is possible.

Promoting recruitment of minority ethnic groups into research: qualitative study exploring the views of South Asian people with asthma.

BACKGROUND: We sought to understand the barriers and facilitators to participation in research from the perspectives of South Asian people with asthma. METHODS: Eight focus groups were conducted in the preferred language of participants. Sampling was purposeful to ensure inclusion of males and females from differing ethnic, linguistic and religious backgrounds. RESULTS: The forming of trusting relationships was described as pivotal to the successful recruitment of minority ethnic groups into research; personalized approaches were likely to be better received than more impersonal written approaches. Notable barriers to participation included: the stigma of being labelled with asthma; concerns surrounding participation in pharmaceutical trials; major time or travel commitments and a failure to show respect by not making information available in minority ethnic languages. Flexibility, in terms of timing, location and respecting of cultural and religious sensitivities around gender segregation, together with the offer of incentives, were highlighted as key factors to promote participation. CONCLUSIONS: The barriers to recruitment are largely surmountable, but these will necessitate the use of resource intensive and more personalized approaches than are commonly employed for the White European origin population. Our proposed model to enhance recruitment is likely to have transferability beyond the field of asthma.

Convergent Validity of Pedometer and Accelerometer Estimates of Moderate-to-Vigorous Physical Activity of Youth.

BACKGROUND: Pedometer step-frequency thresholds (120 steps·min-1, SPM) corresponding to moderate-to-vigorous intensity physical activity (MVPA) have been proposed for youth. Pedometers now have internal mechanisms to record time spent at or above a user-specified SPM. If pedometers provide comparable MVPA (P-MVPA) estimates to those from accelerometry, this would have broad application for research and the general public. The purpose of this study was to examine the convergent validity of P-MVPA to accelerometer-MVPA for youth. METHODS: Youth (N = 149, average 8.6 years, range 5 to 14 years, 60 girls) wore an accelerometer (5-sec epochs) and a pedometer for an average of 5.7 ± 0.8 hours·day-1. The following accelerometer cutpoints were used to compare P-MVPA: Treuth (TR), Mattocks (MT), Evenson (EV), Puyau (PU), and Freedson (FR) child equation. Comparisons between MVPA estimates were performed using Bland-Altman plots and paired t tests. RESULTS: Overall, P-MVPA was 24.6 min ± 16.7 vs. TR 25.2 min ± 16.2, MT 18.8 min ± 13.3, EV 36.9 min ± 21.0, PU 22.7 min ± 15.1, and FR 50.4 min ± 25.5. Age-specific comparisons indicated for 10 to 14 year-olds MT, PU, and TR were not significantly different from P-MVPA; for the younger children (5-8 year- olds) P-MVPA consistently underestimated MVPA. CONCLUSIONS: Pedometer-determined MVPA provided comparable estimates of MVPA for older children (10-14 year-olds). Additional work is required to establish age appropriate SPM thresholds for younger children.

Evaluation of policies to promote physical activity in afterschool programs: are we meeting current benchmarks?

BACKGROUND: Policies now recommend afterschool programs (ASP, 3-6 pm) provide children a minimum amount of physical activity daily. We examined the extent to which children attending ASPs meet existing national and state-level policies that specify expected levels of physical activity (PA). METHODS: Accelerometer-derived physical activity (light and moderate-to-vigorous, MVPA) of 253 children (5-13 years) was compared to policies that recommend varying amounts of PA children should achieve during an ASP. RESULTS: The proportion of children achieving a policy ranged from 0.0% (California 60 min MVPA and North Carolina 20% of daily program time devoted to MVPA), 1.2% (California 30 min MVPA), to 48.2% (National Afterschool Association 30 min light plus MVPA). Random effects logistic models indicated boys (odds ratio [OR] range 2.0 to 6.27) and children from a minority background (Black/Hispanic, OR range 1.87 to 3.98) were more likely to achieve a recommended level of physical activity, in comparison to girls and White children. Neither age nor BMI were related to achieving a policy. CONCLUSIONS: The PA of children attending ASP falls below policy recommended levels; however, these policies were developed in absence of data on expected PA levels during ASPs. Thus, concerted effort towards building a stronger ASP evidence-base for policy refinement is required.