Primary care nurse practitioner practices to lower type 2 diabetes risks in women with a history of gestational diabetes mellitus.

BACKGROUND: Women with a gestational diabetes mellitus (GDM) history have increased lifetime type 2 diabetes (T2D) risk, with 16 times greater risk 3 to 6 years after the pregnancy, compared with women without GDM. Offspring from diabetes-complicated pregnancies also face increased health risks. PURPOSE: The study purpose was to describe the primary care practices of nurse practitioners (NPs) aimed at reducing T2D-related health risks in women with a history of GDM. METHODOLOGY: Florida-licensed primary care NPs (n = 47) completed a 57-item online survey that included an 8-item scale about recommended practices to reduce T2D risks for women with GDM history. Descriptive statistics, Chi Square test, and Fisher exact test were conducted. RESULTS: Most (67%) participants "often/always" screened for T2D every 1-3 years per guidelines, but only 31.8% "often/always" advised about pregnancy planning/preconception T2D assessment. Compared with "none" or ≤2 hours of GDM care education, participants with >2 hours were more likely (p < .05) to "often/always" perform five recommended practices: 1) counsel about increased T2D risks; 2) educate about self-advocacy for T2D screening; 3) T2D screening every 1-3 years; 4) counsel about breastfeeding to reduce T2D risk; and 5) discuss postpartum weight loss and increased physical activity to lower T2D risk. CONCLUSION: Findings indicate inconsistent care practices and suggest that >2 hours of education about care of women with GDM history may increase primary care NPs performing recommended practices to reduce T2D risks and prevent health problems for women and future offspring. IMPLICATIONS: Nurse practitioner education is needed involving care of women with GDM history to mitigate risks for T2D.

Feasibility of parents promoting fruit-infused water to reduce preschool children's sugar-sweetened beverage consumption.

Background: Increasing water and decreasing sugar-sweetened beverage (SSB) consumption in preschoolers provide a strategy to reduce lifelong obesity risks. Aim: To determine feasibility/acceptability and examine preliminary findings of an innovative intervention for preschooler parents to promote fruit-infused water (FIW) to decrease SSB intake. Methods: Fourteen parents of preschoolers completed a pre-intervention survey, attended a presentation with a FIW demonstration/taste-testing, received pitchers/strainers, cutting boards, and FIW recipes/instructions, and received 8 supportive text messages over one month. Feasibility/acceptability was determined from analyzing parents' responses about participating. Descriptive statistics were conducted to analyze pre-/post-intervention survey data. Results: Three themes emerged: "Healthy Option Alternative"; "Feasible to Make FIW at Home"; and "Benefits for Parents". Preliminary findings from ten parents completing both pre-/post-intervention surveys indicated a decrease in preschoolers' total SSB amount/kcal intake, and an increase in parent self-efficacy and FIW knowledge/consumption. Conclusion: Preliminary findings provide valuable feasibility/acceptability information to guide a larger future study.

Implementation of a school-based Fitbit program for youth with Autism Spectrum Disorder: A feasibility study.

BACKGROUND: School settings may be optimal for physical activity interventions for youth with Autism Spectrum Disorder (ASD). Additionally, consumer-based fitness trackers may encourage youth with ASD to increase their physical activity levels, however, no studies have examined whether a fitness tracker program would be feasible in youth with ASD. OBJECTIVE: To examine the feasibility of a 12-week school-based Fitbit© program for youth with ASD. METHODS: Six classroom teachers and their students (n = 45) were provided with Fitbit fitness trackers to wear over 12-weeks. Classroom teachers monitored student tracker use and completed open-ended surveys to describe both their experience and their students' experience with the fitness trackers. RESULTS: Out of the 45 eligible students, 42 (94%) opted to participate in the study. All six teachers and 32 (76%) of the 42 students wore the fitness tracker daily over 12 weeks. Teachers reported that students were most interested in tracking their daily steps, and the short batter life, and account set-up were the biggest challenges to students. All six teachers felt that this program could have long-term sustainability, especially if tracker use could be incorporated into school curriculum and classroom activities. CONCLUSIONS: A school-based Fitbit program appears to be both feasible, and well-accepted by students with ASD. Future work should evaluate the preliminary efficacy of this type of program.

Comparison of Clinical Options: High-Fidelity Manikin-Based and Virtual Simulation.

BACKGROUND: Minimal evidence compares nursing student outcomes when replacing clinical hours with manikin-based high-fidelity patient simulation (HFPS) or virtual simulation. PURPOSE: The study aims were to compare differences in outcomes: (1) between 2 intervention groups (HFPS or virtual simulation) when replacing 25% of pediatric/obstetrics clinical hours and (2) pass/fail for clinical practice between the intervention groups and a face-to-face clinical group (control). METHODS: A quasi-experimental study was conducted to determine differences in knowledge between intervention groups participating in 6 pediatric/obstetrics simulation scenarios. RESULTS: No differences in composite knowledge were found between simulation groups (P = .319). There also was no difference in clinical practice pass/fail among the groups. CONCLUSIONS: HFPS and virtual simulation were equally effective in achieving learning goals.

A Florida public health-based endocrine clinic for low-income pregnant women with diabetes.

OBJECTIVES: To evaluate pregnancy outcomes of low-income women with diabetes-complicated pregnancies who received care from an embedded, public health-based endocrine specialty clinic (ESC) in Florida. DESIGN: This program evaluation used retrospective chart data to analyze client characteristics, pre-program and during-program glycemic control, and pregnancy outcomes of women enrolled in a prenatal ESC. SAMPLE: Ninety-two low-income, pregnant women with type 1/type 2 diabetes or gestational diabetes (GDM) comprised this racially/ethnically diverse sample. VARIABLES/ANALYSIS: Neonatal outcomes included frequencies of prematurity, hypoglycemia, hyperbilirubinemia, and birth weight-for-gestational-age categories. Differences in maternal HbA1C at program entry and mean HbA1C during ESC care were determined by a Wilcoxon and paired sample t test. RESULTS: HbA1C levels during ESC care (6.9 ± 1.4) were less than program entry HbA1C levels (7.9 ± 1.8) for women with pregestational diabetes (Z = -3.364, p = .001). Among women with GDM, mean HbA1C values during ESC care (5.5 ± 0.4) did not significantly differ (t(51) = -0.532, p > .05) from program entry HbA1C levels (5.5 ± 0.5), suggestive of glycemic goal achievement. No neonatal hypoglycemia or hyperbilirubinemia cases were observed in both groups. Approximately 11% of births were preterm, and 16% of neonates were large-for-gestational-age. CONCLUSIONS: A public health-based ESC for low-income pregnant women with diabetes may positively affect pregnancy outcomes.

Early Recognition of Pediatric Sepsis Simulation Checklist - An Exploratory Study.

PURPOSE: To report on the modification and exploration of a 21-item Early Detection of Pediatric Sepsis Assessment Checklist aimed at improving nursing students' recognition of key factors that contribute to early detection of sepsis in pediatric patients through clinical simulation. DESIGN AND METHODS: One hundred and thirty-one undergraduate, pre-licensure nursing students were evaluated using the adapted 21-item Early Detection of Pediatric Sepsis Assessment Checklist in simulation using high-fidelity manikins. Categorical Principle Component Analysis was used to evaluate for factor structure, with items accounting for <0.20 of the variance were dropped from the loadings. RESULTS: Two factors emerged from the analysis: assessment and deterioration, accounting for 68% of the variance. Factor one, assessment, contained nine items (α = 0.77; λ = 3.36). Factor two, deterioration, contained seven items (α = 0.72; λ = 2.85). Five items did not load and were dropped from the factor structure, resulting in a 16-item checklist. CONCLUSIONS: Two factors emerged from the analysis which is key to improving the early detection of pediatric sepsis. Assessment, factor one, accounted for the nursing students' central skills of recognizing baseline vital signs and timely medication administration. Deterioration, factor two, contained items reflecting the recognition of changes from baseline that require action. Conceptually, these factors reflect the most central points in the early detection of signs in pediatric patients at risk for sepsis. PRACTICE IMPLICATIONS: This checklist forms a valuable tool to assess the knowledge of pre-licensure students and may possibly be extended as a tool to assess the clinical readiness and performance of new graduates through the safety and supervision allotted by simulation.

Helping With Meal Preparation and Children's Dietary Intake: A Literature Review.

Most children and adolescents do not meet dietary recommendations that may result in poor diets contributing to obesity. This systematic literature review was conducted to examine associations between helping with meal preparation at home and dietary quality, intake of specific foods, and/or dietary-related perceptions among youth. A search of databases using key terms was conducted for studies meeting criteria. This literature review included 15 studies using a cross-sectional descriptive design, with two studies also including a longitudinal design. Data were self-reported (or parent-reported) using various surveys and/or interviews. Study findings supported positive associations between youth involvement in home meal preparation and improvement in overall dietary quality, increased consumption of fruits and vegetables, greater preference for vegetables, and higher self-efficacy for cooking and choosing healthy foods. Further research is needed to develop efficacious meal preparation interventions involving parents and their children to promote this mealtime behavior with many potential health benefits.

Impact of mobile apps to combat obesity in children and adolescents: A systematic literature review.

PURPOSE: This review examines the impact of mobile app technology on obesity-related anthropometric, psychosocial, and behavioral outcomes in children and adolescents. CONCLUSIONS: Nine research articles retrieved from a systematic review of the literature met criteria. Evidence is limited and mixed, but argues for an impact of mobile app use on motivation and goal-setting behavior, and supports further study of the impact on childhood obesity-related outcomes such as attitudes, perceptions, physical activity, and dietary habits. PRACTICE IMPLICATIONS: Nurses can use this evidence to discuss potential benefits of health promotion mobile apps with parents, children, and adolescents to combat childhood obesity.

Reliability and Validity of a Tool to Measure School Nurse Perceptions and Practices Associated With Childhood Obesity Prevention.

BACKGROUND AND PURPOSE: Childhood obesity prevention (COP) should include increasing school nurse involvement. Measurements of school nurse perceptions influencing COP practices are limited. The purpose of this study is to evaluate the reliability and validity of 5 measures of school nurse COP practices and perceptions. METHODS: A 70-item anonymous survey was completed by 171 Florida registered nurse (RN) school nurses and tested for reliability and validity. RESULTS: Internal reliability was acceptable with Cronbach's alphas ranging from .81 to .94. Uncertain to adequate test-retest reliability was determined by correlation coefficients (r = .55-.78). Significant correlations (p < .05) based on hypothesized relationships provided moderate support for construct validity. CONCLUSIONS: Results support use of these scales in research with targeted school nurse populations to promote COP practices.

Childhood obesity prevention: a review of school nurse perceptions and practices.

PURPOSE: The purpose of this review is to examine key school nurse perceptions that may promote or deter school nurse involvement in childhood obesity prevention (COP) practices. CONCLUSIONS: Ten research articles were identified through a systematic review of the literature. School nurse participation in COP is inconsistent, and this variation is not well understood. Some variations in COP practices may be explained by differences in self-efficacy, perceived benefits, and perceived barriers. PRACTICE IMPLICATIONS: Efforts are needed to develop and implement interventions and policies to modify those perceptions that may promote school nurse active engagement in COP practices.

Influence of perceptions on school nurse practices to prevent childhood obesity.

Comprehensive childhood obesity prevention (COP) strategies should include increasing school nurse involvement. This study was conducted to determine the influence of key school nurse perceptions (self-efficacy, perceived benefits, and perceived barriers) on participation in COP practices at the individual child and school level. Florida registered nurse (RN) school nurses (n = 171) anonymously completed online or paper questionnaires. Linear regression analyses identified a model of self-efficacy with perceived benefits and barriers that explained 12% and 9.1% (p < .001) of variance in child-level and school-level COP practices, respectively. Self-efficacy explained the most variance in both models (p < .001). Mediation testing identified perceived barriers as a partial mediator of the influence of self-efficacy on child-level practices. These findings support interventions and policy changes to increase self-efficacy and reduce perceived barriers to promote school nurse involvement in preventing childhood obesity.

Global prevalence of overweight and obesity in preschoolers.

Twenty-three studies reporting cross-sectional and longitudinal data were conducted in 14 different countries between 1998 and 2008. The number of preschool age children totaled more than 43,837 with one study not reporting a sample size. Studies used both international (i.e., International Obesity Task Force (IOTF), World Health Organization (WHO)) and national reference standards (i.e., United States - Centers for Disease Control and Prevention (CDC), Spain - SRS, Italy - Luciano) to classify children as overweight or obese. Within the same sample the percentage of children classified in these categories often showed a 1.5- to 2-fold difference in the prevalence of overweight/obesity with greatest differences in the between country-specific standards (CDC vs. Luciano). WHO percentages frequently exceeded the IOTF percentages. The prevalence of overweight/obese children escalated with increasing age from 2-5 years in both boys and girls with girls showing higher frequencies in 2/3rds of the 72 sex-paired comparisons. The results indicate a recent high prevalence of overweight and obesity in middle and high income countries, among both well-off and lower income segments of populations, in both rural and urban areas, and among all ethnic and racial groups represented. Because a high proportion of preschool overweight/ obese children will continue to increase their adiposity and are at risk for the early onset of metabolic syndrome, cardiovascular disease, type 2 diabetes, musculoskeletal disorders and behavioral problems, concerted public health efforts are needed to coordinate culturally-appropriate parental and caregiver education, home lifestyle changes, dietary and exercise modifications that will reverse the current trajectory.