The prevalence of documented cardiovascular-related pregnancy complications: cross-sectional study in an academic primary care centre.

BACKGROUND: Pregnancy and the postpartum period offer a unique opportunity to identify patients with risk factors leading to premature cardiovascular disease (CVD), which often go unrecognised. AIM: This study investigates self-reported prevalence of CVD-related pregnancy complications and its documentation in electronic medical records (EMRs) in an academic family health team (AFHT). DESIGN & SETTING: A retrospective cross-sectional survey conducted from 2016 to 2017 in an AFHT. METHOD: The survey assessed self-reported pregnancy complications and obstetric histories of adult females. EMRs of responders who provided consent were appraised for documented pregnancy complications, and management of traditional cardiovascular risk factors post-pregnancy. RESULTS: Out of 211 responders, 28% (n = 60) had at least one pregnancy complication reported in the survey and/or in the EMR, of which 67% (n = 40) had the complication documented in their EMR. The most prevalent complications were preterm birth (PTB; 12%, n = 25), hypertensive disorders of pregnancy (HDP; 10%, n = 22), and gestational diabetes mellitus (GDM; 7%, n = 14). Twenty-nine per cent (n = 4) of the patients with GDM had a 75 g oral glucose tolerance test result documented post-pregnancy. Of those with HDP, 36% (n = 8) had body mass index and 50% (n = 11) had a blood pressure measurement recorded after delivery. CONCLUSION: There has been a significant lack of documentation of pregnancy-related cardiovascular risk factors and subsequent management, introducing a missed opportunity for early cardiovascular intervention. Adequate documentation of pregnancy complications in the EMR and better transitions in care between obstetric and primary care teams could potentially enable clinicians to intervene early and better manage females at increased risk of CVD.

Three-year review of a capacity building pilot for a sustainable regional network on food, nutrition and health systems education in India.

BACKGROUND: In Kolkata (India), there are high rates of malnourished children (45.9%) under the age of three, impacting growth, organ development, function, and cognition. Mothers have a major role to play during this crucial development stage, with research showing nutrition knowledge, attitudes and practices (KAP) of mothers are important determinants of childhood malnutrition. AIMS: To document 3 years of capacity building towards a sustainable nutrition education network in Kolkata, India, while assessing the ability to perform data collection in the form of needs assessments, impact assessments and capacity reviews. METHODS: Descriptive review and analysis of engagement and impact from 3 years of work by the NNEdPro Global Centre for Nutrition and Health, initiating locally led nutrition education interventions. Mapping to the Indian National Nutrition Strategy was also performed to review adherence to nationwide priorities surrounding nutrition and determine the wider application potential of the network. RESULTS: Two simultaneous projects were taken forward by a team of local healthcare professionals and student champions. Project 1-medical college workshops for medical student nutrition education with added focus on underserved populations, Project 2-preparation for a 'Mobile Teaching Kitchen' (MTK) in marginalised communities to empower local women as nutrition educators.Data collection methods used for analysing markers of impact and sustainability were semi-structured interviews of the community members, and KAP questionnaires to assess response to educational sessions. CONCLUSION: With local support it is possible to create and sustain fieldwork for an extended period with meaningful outputs and impact. This initiative demonstrates that it is possible to use healthcare professionals, students and volunteers with low-intensity training and a low-cost approach to produce action research with considerable impact and results in rapid, reliable and robust manner.

'Bhavishya Shakti: Empowering the Future': establishing and evaluating a pilot community mobile teaching kitchen as an innovative model, training marginalised women to become nutrition champions and culinary health educators in Kolkata, India.

BACKGROUND: Malnutrition is a global emergency, creating an overlapping burden on individual, public and economic health. The double burden of malnutrition affects approximately 2.3 billion adults worldwide. Following 3 years of capacity building work in Kolkata, with assistance of local volunteers and organisations, we established an empowering nutrition education model in the form of a 'mobile teaching kitchen (MTK)' with the aim of creating culinary health educators from lay slum-dwelling women. AIMS: To evaluate the piloting of a novel MTK nutrition education platform and its effects on the participants, alongside data collection feasibility. METHODS: Over 6 months, marginalised (RG Kar and Chetla slums) women underwent nutrition training using the MTK supported by dietitians, doctors and volunteers. Preintervention and postintervention assessments of knowledge, attitudes and practices (KAP), as well as anthropometric and clinical nutritional status of both the women and their children were recorded. The education was delivered by a 'See One, Do One, Teach One' approach with a final assessment of teaching delivery performed in the final session. RESULTS: Twelve women were trained in total, six from each slum. Statistically significant improvements were noted in sections of KAP, with improvements in nutrition knowledge (+4.8) and practices (+0.8). In addition, statistically significant positive changes were seen in 'understanding of healthy nutrition for their children' (p=0.02), 'sources of protein rich food' (p=0.02) and 'not skipping meals if a child is ill' (p≤0.001). CONCLUSION: The MTK as a public health intervention managed to educate, empower and upskill two groups of lay marginalised women into MTK Champions from the urban slums of Kolkata, India. Improvements in their nutrition KAP demonstrate just some of the effects of this programme. By the provision of healthy meals and nutritional messages, the MTK Champions are key drivers nudging improvements in nutrition and health related awareness with a ripple effect across the communities that they serve. There is potential to upscale and adapt this programme to other settings, or developing into a microenterprise model, that can help future MTK Champions earn a stable income.

Catecholamine-induced reverse takotsubo cardiomyopathy.

Takotsubo cardiomyopathy is a syndrome characterized by transient left ventricular systolic and diastolic dysfunction, similar to an acute myocardial infarction but in the absence of significant obstructive epicardial coronary artery disease. This disease manifests predominantly in postmenopausal women in the presence of stressful triggers. We present a case of reverse takotsubo cardiomyopathy involving apical sparing, resulting from an iatrogenic overdose of epinephrine in a young man who was treated for anaphylaxis and angioedema.

Initiation of Hippo signaling is linked to polarity rather than to cell position in the pre-implantation mouse embryo.

In the mouse embryo, asymmetric divisions during the 8-16 cell division generate two cell types, polar and apolar cells, that are allocated to outer and inner positions, respectively. This outer/inner configuration is the first sign of the formation of the first two cell lineages: trophectoderm (TE) and inner cell mass (ICM). Outer polar cells become TE and give rise to the placenta, whereas inner apolar cells become ICM and give rise to the embryo proper and yolk sac. Here, we analyze the frequency of asymmetric divisions during the 8-16 cell division and assess the relationships between cell polarity, cell and nuclear position, and Hippo signaling activation, the pathway that initiates lineage-specific gene expression in 16-cell embryos. Although the frequency of asymmetric divisions varied in each embryo, we found that more than six blastomeres divided asymmetrically in most embryos. Interestingly, many apolar cells in 16-cell embryos were located at outer positions, whereas only one or two apolar cells were located at inner positions. Live imaging analysis showed that outer apolar cells were eventually internalized by surrounding polar cells. Using isolated 8-cell blastomeres, we carefully analyzed the internalization process of apolar cells and found indications of higher cortical tension in apolar cells than in polar cells. Last, we found that apolar cells activate Hippo signaling prior to taking inner positions. Our results suggest that polar and apolar cells have intrinsic differences that establish outer/inner configuration and differentially regulate Hippo signaling to activate lineage-specific gene expression programs.