The Online Sharing of Instagram Images for Rheumatoid Arthritis.

Social media use related to chronic disease has become pervasive, yet little research has been done to examine how social media is currently used by healthcare consumers or how to best use various social media platforms to improve health outcomes. The purpose of this study was to gain an understanding of Instagram use for image sharing related to #rheumatoidarthritis. A visual ethnography approach using content analysis was completed. Images for analysis (n = 106) were randomly selected, using the Instagram public search feature, during seven distinct periods. Content analysis, conducted by two coders, was used to identify categories and provide a sentiment analysis of the images. Approximately 75% of the images were determined to be positive by both coders. Social interaction and self-expression were the most frequently identified categories, suggesting that individuals use Instagram primarily for sharing awareness, sharing encouragement, and self-expression regarding rheumatoid arthritis. This finding is consistent with the use of Instagram for social networking and self-promotion. This study reveals new insights about how Instagram serves as a social, personal, and health-related information sharing platform particularly for those who may be socially isolated due to rheumatoid arthritis.

Prelicensure Employment and Student Nurse Self-Efficacy.

There is a lack of literature regarding how prelicensure employment affects self-efficacy in nursing practice. The purpose of this study was to examine the relationship among prelicensure employment and self-efficacy in nursing practice of senior student nurses. Healthcare experience was identified as the best predictor of positive self-efficacy in managing an assignment of three and four patients. Findings of this study provide insight for providing orientation for newly licensed nurses regarding their readiness to practice.

Stress, depression, social support, and eating habits reduce diet quality in the first trimester in low-income women: a pilot study.

Maternal diet quality influences birth outcomes. Yet, little research exists that assesses women's diet quality during the first trimester of pregnancy, a crucial time of placental and fetal development. This cross-sectional study, describing diet quality and its relationship with stress, depression, social support, and eating habits in the first trimester, may identify low-income women needing intensive dietary intervention. Seventy-one low-income women completed validated instruments measuring stress, depression, social support, and eating habits; had their height and weight measured; received training on portion-size estimation; and completed three 24-hour dietary recalls (1 weekend day and 2 nonconsecutive weekdays) from July 2009 to February 2010. Comparative and correlational analyses were done. Women with diet quality scores below the median (n=35) had more depression (9.6±5.1 vs 6.7±5.1) and stress (22.1±5.4 vs 19.3±4.8) and less control over meal preparation (5.0±1.5 vs 4.2±1.5) and support from others (52.0±12.0 vs 57.4±7.2) than did women with high diet quality scores (n=36). Diet quality was negatively related to depression (r=-0.41), stress (r=-0.35), skipping meals (r=-0.41), and control over meal preparation (r=-0.33), and positively related to support from others (r=0.38). Low-income women experiencing life stressors represent an at-risk group for low diet quality and may need intensive dietary intervention before and during pregnancy. More research designed to improve diet quality in low-income pregnant women is needed.

Postpartum health promotion interventions: a systematic review.

BACKGROUND: The postpartum period is a time of significant transition when women may discontinue positive health behaviors adopted during pregnancy. Little is known about the effectiveness of health promotion interventions targeting postpartum women. OBJECTIVE: The aim of this study was to synthesize the published evidence from randomized controlled trials conducted in the United States on the effectiveness of interventions promoting maternal health in the first year after childbirth. METHODS: Studies conducted in the United States and published from 1999 through May 2011 were identified in MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO and reviewed. RESULTS: Eleven studies were identified measuring health promotion behaviors as an outcome. Nine of the 11 targeted at-risk groups. Methodological problems included incomplete description of the intervention, steps taken to ensure representativeness of the sample, and identification and control of potential confounders. Diverse aspects of health promotion were addressed, the length of participant involvement differed, and the effectiveness of the interventions varied. DISCUSSION: Further research is needed to design interventions focused on promoting health in the general population of postpartum mothers.

Relationships among maternal nutrient intake and placental biomarkers during the 1st trimester in low-income women.

PURPOSE: Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester. METHODS: A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy. RESULTS: The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024]. CONCLUSIONS: Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.

Ethnic-specific weight-loss interventions for low-income postpartum women: findings and lessons.

Promoting weight loss among overweight low-income postpartum women has proven difficult. The study's aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo (n = 23), African American (n = 25), and Hispanic low-income postpartum women (n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated significantly with self-efficacy (Spearman r = .50) for White/Anglo women and self-efficacy (Spearman r = -.48) and perceived stress (Spearman r = .48) for African American women. In follow-up interviews, women felt interventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control groups (mailed interventions later) were generally more pleased with their assignment than intervention groups.

Predictors of dietary quality in low-income pregnant women: a path analysis.

BACKGROUND: Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. OBJECTIVE: The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. METHOD: A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. RESULTS: The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (ß = .36) and a direct (ß = -.23) and indirect effect on dietary quality (ß = -.30). Poor eating habits had a direct effect on dietary quality (ß = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (ß = .39) and nutritional knowledge (ß = .18) and an indirect effect on dietary quality (total effect, ß = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. DISCUSSION: Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

The distribution of weight-related risks among low-income women during the first postpartum year.

OBJECTIVE: To describe the distribution of weight-related risks (weight retention and overweight/obese status) during the first postpartum year and determine if risk distributions differ by race/ethnicity, time, age, or parity. DESIGN: Secondary analysis of a longitudinal data set from 1- to 3-days to 12-months postpartum. SETTING: Initial recruitment was from a community hospital. PARTICIPANTS: Two hundred and forty-seven (White, African American, or Hispanic) low-income women. RESULTS: At 1- to 3-days postpartum weight-related risks were distributed as follows: 6.1% no risk, 17.0% significant postpartum weight retention, 12.1% overweight/obese, and 64.8% both weight-related risks; at 12 months, the distribution was 32.4%, 8.9%, 16.6%, and 42.1%, respectively. Distributions differed by race/ethnicity at 6-months (χ² =16.1, p=.013) and 12-months postpartum (χ² =19.7, p=.003). Having both weight-related risks (vs. not) at 12 months was 3.1 (odds ratio [OR]) times more likely (95% confidence interval [CI], 1.6, 6.2) for African American and 2.4 (OR) times more likely (95% CI[1.3, 4.6]) for Hispanic than White women. Having two risks decreased significantly only between 1 to 3 days and 6 weeks (p = .000). Maternal parity, but not age, was associated with weight-related risk distributions on four of five time points. CONCLUSION: Despite changes in the weight-related risk distributions from 1- to 3-days to 6-weeks postpartum, the proportion of African American and Hispanic women with weight-related risk (especially having two weight-related risks) remains high at 12-months postpartum.

Exploring relationships among psychosocial status, dietary quality, and measures of placental development during the first trimester in low-income women.

PURPOSE: To examine the relationships between maternal psychosocial factors and dietary quality and explore the relationships among dietary quality and selected biomarkers of nutrition and placental development. METHOD: A cross-sectional design in 18 low-income, pregnant women. RESULTS: Partner support was positively related to vegetable intake (r = .54) and negatively related to intake of iron (r = -.68) and grains (r = -.67). Emotional eating in response to anger was negatively related to intake of iron-(r /it> = -.53) and folate-rich (r = -.75) foods, and emotional eating in response to anxiety was negatively related to intake of folate-rich foods (r = -.51). Depressed women had an increased intake of calcium-rich foods (r = .60). Levels of vascular endothelial growth factor (VEGF) were negatively related to depression (r = -.56) and intake of foods high in calcium (r = -.53) and iron (r = -.34) but positively related to serum calcium levels (r = .60). VEGF was negatively relationship to soluble fms-like tyrosine kinase 1 (sFlt-1; r = -.56). Placental growth factor had a negative relationship with maternal serum levels of albumin (r = -.61) and calcium (r = -.65). CONCLUSIONS: Low-income pregnant women who eat to cope with anger and anxiety may have an inadequate intake of nutrients that contribute to positive pregnancy outcomes. Placental development in the early weeks of pregnancy may be influenced by maternal psychosocial and nutritional status. More research is needed to explore the relationship of dietary quality and placental development in the first trimester of pregnancy.

Ethnic-specific perceptions of altered control among American women: implications for health promotion programs after pregnancy.

This study describes some ethnically diverse psychosocial and behavioral contexts that influence low-income postpartum women's ability to focus on their health. Content analysis was conducted on data from ethnically concordant focus groups of low-income American Anglo, African American, and Hispanic women 12 to 24 months postpartum. All women described altered sense of "perceived control" as the context contributing to their postpartum health status, but sources and management of this perception varied by ethnicity. Effective health promotion interventions may include self-image building activities, stress management strategies and interventions that include family members but should address unique ethnic-specific contexts of low-income mothers.

Eating at fast-food restaurants and dietary quality in low-income pregnant women.

Little is known about how fast-food consumption affects dietary quality in women during the first trimester of pregnancy, which may adversely affect pregnancy outcomes. An observational design compared high versus low frequency of fast-food consumption in low-income pregnant women (N = 50) during the first trimester. Although high-frequency fast-food consumers ate significantly more vegetables, they also consumed more gravies, less fruit, and more daily calories, with a higher percentage of total calories from fats. Those with high-frequency fast-food consumption were more likely to be obese, depressed, and stressed and they skipped more meals. In addition, the combination of depression, stress, and emotional eating depression and anxiety subscale scores explained 45% of the variance in dietary quality. High frequency of fast-food consumption contributed to poor dietary quality and excessive caloric intake, which may lead to excessive gestational weight gain.

Dental health, acidogenic meal, and snack patterns among low-income women during early pregnancy: a pilot study.

INTRODUCTION: The objectives of this study were to collect preliminary data related to self-reported dental problems, dental health-related nutrient intake, and acidogenic meal and snack composition intake during early pregnancy in low-income women and to assess the feasibility of current research methods for use in a larger study. METHODS: Low-income women (n = 13) in the first trimester of pregnancy participated in this study. Pregnant women completed a demographic questionnaire, participated in three 24-hour dietary recalls, and answered several questions related to their oral health status and frequency of dental visits. RESULTS: Preliminary data suggest that women in this study were susceptible to dental problems and consumed acidogenic meals and snacks. Protocol data suggest that it is feasible to implement current research protocols, with adaptations, for use in a larger study. DISCUSSION: Health care professionals should assess low-income pregnant women in early pregnancy for dental problems and acidogenic meal and snack patterns and provide referrals to appropriate health professionals and community health services.

Foundations for social justice-based actions in maternal/infant nursing.

The purpose of this article is to discuss health disparities and inequities and their most significant effects on maternal/infant health. A literature background on the social context of justice and distinct ethical theories is provided. Different ethical approaches to guide interventions that can improve the health of mothers and infants are presented. By adopting an ethical framework of social justice, nurses can better understand and thus influence outcomes and ameliorate health disparities and inequalities.

Altered perceptions of personal control about retained weight and depressive symptoms in low-income postpartum women.

Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income women's experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Women's experiences indicated altered personal control related to retained postpartum weight and depressive feelings. Retained weight negatively affected self-esteem and family functioning. Depression left women feeling isolated yet reluctant to seek help. These findings could provide the basis for health promotion interventions relevant to this population.

An investigation of nursing competence and the competency outcomes performance assessment curricular approach: senior students' self-reported perceptions.

This study was designed to measure the construct of competence as perceived by nursing students in different programs of study. An exploration of a competence-based curricular model was undertaken to determine if there are distinguishing differences between schools that have formally adopted Dr. Carrie Lenburg's Competency Outcomes Performance Assessment (COPA) model as a curricular guide and those who have do not have a formal competence model guiding the curriculum. The Six-Dimension Scale of Nursing Performance (6-D Scale) was used to evaluate nursing competence. Using a purposive sample, senior nursing students (N = 391) from three different types of nursing programs (baccalaureate, associate [ADN], and diploma) were surveyed. Students completed a two-part questionnaire that included the 6-D Scale, demographic questions, and a researcher-generated questionnaire designed to measure competency-based learning and evaluation. Faculty (n = 101) from these same programs were also surveyed. The results revealed that students from COPA and non-COPA schools reported slightly lower scores in three subscales: teaching/collaboration, critical care, and leadership. Significant curricular differences as defined by the Klein Scales were found between COPA and non-COPA senior students, with 17% to 30% of the variance explained for the COPA students. The findings reflect that baccalaureate students reported significantly lower 6-D Scale scores in multiple areas when compared to diploma and ADN students. Enhancement of student learning and curricular revisions designed to improve leadership and technical expertise are suggested by the findings of this study.

Maternal predictors of toddler health status.

PURPOSE: The purposes of this study were to examine the relationships among maternal and environmental variables in the first 6 months postpartum and toddler health status, and to identify predictors of toddler health. DESIGN AND METHODS: A secondary analysis was conducted on an existing dataset of a longitudinal parent-child survey. RESULTS: Maternal stress predicted 8% of the variance in child health status at 18 months of age. Children in nonparental care more than 20 hr per week were perceived as less healthy. PRACTICE IMPLICATIONS: Pediatric nurses should assess levels of maternal stress in the early months postpartum and anticipate poorer health status in toddlers who spend more than 20 hr per week in nonparental care.

Nutrition and mental health in early pregnancy: a pilot study.

A pilot study was conducted to explore the dietary quality and maternal psychosocial status during the early weeks of pregnancy in a convenience sample of women (N = 13) recruited from two Planned Parenthood Clinics. Women were between 19 and 31 years of age, having their first pregnancy, and were on average 7 weeks pregnant. Average caloric intake was 2653 kcal/day consisting of 34% fat. Six of the women had inadequate intake of calcium (x = 800 mg) and 11 had low iron intake (x = 20 mg). Dietary Quality Index-Pregnancy scores were below recommendations and six women had scores indicating a major depression. Dietary intakes of these low-income women early in pregnancy did not meet recommendations for pregnancy. Identifying factors that are related to poor dietary intake, such as low-income and the presence of depression, in early pregnancy may promote timely recognition of women in need of comprehensive monitoring throughout the pregnancy.

The feasibility of personal digital assistants (PDAs) to collect dietary intake data in low-income pregnant women.

OBJECTIVES: To determine the feasibility of using personal digital assistant (PDA)-based technology for tracking and analysis of food intake in low-income pregnant women. DESIGN: Descriptive. Participants provided an initial 24-hour dietary recall and recorded their food intake using a PDA-based software program for 2 days. SETTING: Recruitment occurred during the prenatal intake visit at a health department-sponsored Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic. PARTICIPANTS: Nonprobability sampling was used to recruit 10 women. VARIABLE MEASURED: Demographics and a satisfaction rating scale for the 2 food recording methods. A Healthy Eating Index (HEI) was calculated for each food record. ANALYSIS: Scores of the satisfaction rating scales were summarized. Paired t tests were used to analyze differences in HEIs obtained from the participants' 24-hour recall and PDA-based food records. RESULTS: The PDA was significantly easier to use compared to the 24-hour recall, and no significant differences in ease of remembering food intake between these methods was noted. Most women liked the PDA and felt it was more accurate than 24-hour recalls. Results showed no significant difference in mean HEI scores between food records from 24-hour recall to PDA. CONCLUSIONS AND IMPLICATIONS: PDA-based software may be an acceptable method for obtaining food records to provide more accurate assessments of dietary intake in this vulnerable population.

Healthy eating during pregnancy: determinants and supportive strategies.

This article provides a review of the determinants of healthy eating in pregnancy by synthesizing current research findings and offers strategies to promote healthy eating during pregnancy. This article is guided by the ecological model for health promotion that suggests the determinants of healthy eating as intrapersonal or collective determinants of food choices and public policies that support healthy eating during pregnancy. Community health nurses can apply this model to gain insights into identifying gaps in practice and to prioritize action strategies to guide program development and interventions designed to support healthy eating by all pregnant women.