Changes in Bone Mineral Density and Serum Lipids across the First Postpartum Year: Effect of Aerobic Fitness and Physical Activity.

This study evaluated the changes in bone mineral density (BMD) and serum lipids across the first postpartum year in lactating women compared to never-pregnant controls, and the influence of physical activity (PA). The study also explored whether N-telopeptides, pyridinoline, and deoxypyridinoline in urine serve as biomarkers of bone resorption. A cohort of 18 initially lactating postpartum women and 16 never pregnant controls were studied. BMD (dual energy X-ray absorptiometry), serum lipid profiles, and PA (Baecke PA Questionnaire) were assessed at baseline (4-6 weeks postpartum), 6 months, and 12 months. Postpartum women lost 5.2 ± 1.4 kg body weight and BMD decreased by 1.4% and 3.1% in the total body and dual-femur, respectively. Furthermore, BMDdid not show signs of rebound. Lipid profiles improved, with increases in high-density lipoprotein-cholesterol (HDL-C) and decreases in low-density lipoprotein cholesterol (LDL-C) and the cholesterol/HDL-C ratio at 12 months (vs. baseline). These changes were not influenced by lactation, but the fall the Cholesterol/HDL-C ratio was influenced by leisure-time (p = 0.051, time X group) and sport (p = 0.028, time effect) PA. The decrease in BMD from baseline to 12 months in total body and dual femur, however, was greater in those who continued to breastfeed for a full year compared to those who stopped at close to 6 months. Urinary markers of bone resorption, measured in a subset of participants, reflect BMD loss, particularly in the dual-femur, and may reflect changes bone resorption before observed changes in BMD. Results provide support that habitual postpartum PA may favorably influence changes in serum lipids but not necessarily BMD. The benefit of exercise and use of urinary biomarkers of bone deserves further exploration.

Clinical Issues-October 2021.

Parental presence protocols Key words: anxiety reduction, parental presence, pediatric patients, induction, emergence. Music in the OR Key words: music intervention, headphones, patient anxiety, music selection, personal music delivery device. Transfusion regulations Key words: blood transfusion, documentation requirements, blood product administration, plasma. Clinical blood product transfusions Key words: adverse transfusion reaction, patient assessment, patient blood management, incompatibility, blood products.

Suicide detection and treatment in a nurse-led, interprofessional primary care practice: A 2-year report of quality data.

ABSTRACT: Analysis of 2 years of quality improvement data after the implementation of a suicidality screening and treatment protocol in a primary care setting found that among 1,733 patients, 149 had suicidal ideation. Among the 112 of those patients who remained in care, more than half presented with only nonpsychiatric complaints. Primary care practices may be viable tools to combat the nation's suicide epidemic.

Appetite-Regulating Hormones in Human Milk: A Plausible Biological Factor for Obesity Risk Reduction?

BACKGROUND: Human milk contains appetite-regulating hormones that may influence infant growth and obesity risk. RESEARCH AIMS: We evaluated whether leptin, peptide tyrosine-tyrosine (PYY), glucagon-like peptide-1 (GLP-1), and ghrelin concentrations in human milk (1) changed during feeding (from foremilk to hindmilk) and during the first 6 months of infancy; (2) were explained by maternal factors; and (3) were associated with infant anthropometrics and growth. METHODS: Mother-infant dyads (N = 22) participated. Samples of foremilk and hindmilk at 1 month postpartum were collected and analyzed for leptin, PYY, GLP-1, and ghrelin via radioimmunoassay and milkfat percentage estimated via creamatocrit. Samples were also collected in mothers (n = 15) who breastfed through 6 months. Anthropometrics were obtained on all mother-infant dyads at 1 month and all infants at 6 months and 12 months. RESULTS: At 1 month, milk GLP-1 and milkfat concentration increased from foremilk to hindmilk (p ≤ .05) while leptin and PYY concentrations remained stable during feeding. Milk hormone concentrations and milkfat tended to decline overtime, with lower leptin, PYY, and ghrelin at 6 months versus 1 month (p < .05). At 1 month, milk leptin and milkfat content were associated with maternal markers of adiposity (r = 0.49-0.78, p < .001); whereas, milk PYY was correlated with maternal serum PYY concentration (r = 0.672, p = .001). Average 1-month milk concentrations of GLP-1 and leptin were negatively associated with weight-for-age z-scores at 6 months (r = -0.46, p < .05) and 12 months (r = -0.49, p < .05), respectively. CONCLUSION: The content of certain appetite-regulating hormones in human milk may be influenced by maternal factors and play a role in infant growth; much needs to be learned about their role in the obesity protection of breastfed infants.

Clinical Issues-May 2020.

Using Failure Modes and Effects Analysis to improve special-order implant procurement Key words: Failure Modes and Effects Analysis (FMEA), implant procurement, special-order implant, risk profile number (RPN), interdisciplinary teamwork. Heat stress among perioperative personnel Key words: heat stress, environmental conditions, task performance, surgical tasks, OR temperature. Venous thromboembolism prevention for bariatric surgery patients Key words: venous thromboembolism (VTE), prophylactic measures, bariatric surgery, risk factors, prevention protocol. Disinfecting case carts using ultraviolet light systems Key words: environmental cleaning, decontamination, case cart, ultraviolet (UV) light system, pulsed xenon.

Do Lactation-Induced Changes in Ghrelin, Glucagon-Like Peptide-1, and Peptide YY Influence Appetite and Body Weight Regulation during the First Postpartum Year?

To determine whether fasting and meal-induced appetite-regulating hormones are altered during lactation and associated with body weight retention after childbearing, we studied 24 exclusively breastfeeding women (BMI = 25.2 ± 3.6 kg/m(2)) at 4-5 weeks postpartum and 20 never-pregnant controls (BMI = 24.0 ± 3.1 kg/m(2)). Ghrelin, PYY, GLP-1, and appetite ratings were measured before/and 150 minutes after a standardized breakfast and 60 minutes after an ad libitum lunch. Body weight/composition were measured at 6 and 12 months. Fasting and area under-the-curve responses for appetite-regulating hormones did not differ between lactating and control groups; ghrelinacyl, however, tended to track higher after the standardized breakfast in lactating women and was higher (p < 0.05) after the ad libitum lunch despite a 24% higher energy intake (p < 0.05). By 12 months, lactating women lost 5.3 ± 2.2 kg (n = 18), whereas control women (n = 15) remained weight stable (p = 0.019); fifteen of the lactating women returned to within ±2.0 kg of prepregnancy weight but three retained >6.0 kg. The retainers had greater (p < 0.05) postmeal ghrelin rebound responses following breakfast. Overall these studies do not support the hypothesis that appetite-regulating hormones are altered during lactation and associated with postpartum weight retention. Altered ghrelin responses, however, deserve further exploration.