Insights Into the Employability of Midwifery Graduates. A Case Study of the International Hellenic University.

Background: This study examines the employability and career trajectories of International Hellenic University's (IHU) midwifery students who graduated between 2016 to 2021, with a focus on undergraduate curriculum changes. Objective: To comprehensively examine the post-graduation journey of recent IHU Midwifery graduates. This includes shedding light on their employment trajectories, satisfaction levels, and the practical application of academic knowledge. Through this exploration, the study seeks to inform educational strategies to ensure alignment with the evolving needs of midwifery professionals in Greece. Methods: Online questionnaires that explored post-graduation experiences, perspectives on the study program, and future plans. The questionnaires consisted of a mix of open and closed-ended questions and were completed by 273 recipients. The study was conducted from May to September 2023, with participant anonymity maintained. Statistical analysis was performed using SPSS. Results: This study revealed differences between graduates of the 'old' and 'new' midwifery undergraduate curriculum. There were notable variations in the perceived impact of the six-month internship on employment. The study also highlighted the impact of the COVID-19 pandemic on educational experiences, emphasizing the nuanced challenges faced during clinical practice, practical training, and simulation training. Finally, the self-employed professionals and those employed in the public sector expressed higher satisfaction with the alignment of their employment with their undergraduate studies, than their counterparts in the private sector (p=0.038). Conclusions: Our study offers valuable insights into job placement, knowledge sufficiency, and the impact of the pandemic on midwifery undergraduate education. These findings can guide tailored strategies for improved education and holistic professional development, ultimately enhancing maternal and neonatal care.

The Value of Non-invasive Electrocardiography in Assessing Fetal Status at Term Delivery.

Background: The electrocardiograph (ECG) is efficient method for the accurate assessment of fetal heart rate. The barriers for accurate assessment are maternal heart rate, uterine contractions and abdominal muscles. Although previous monitoring methods have struggled to overcome these barriers, recent advances have led to a greater degree of success for listening and recording pulse-by-pulse fetal heart rate. Objectives: A prospective cohort study evaluating the use, reliability and safety of non-invasive electrocardiography, in conjunction with Fetal Heart Rate parameters such as, Short Term Variability (STV) together with umbilical cord PH and Apgar score, during the active phase of childbirth. Methods: A total of 41 women with single, normal, full-term pregnancies had systematic obstetric monitoring with Monica AN24. 20 had only monitoring and 21 also had and arterial blood flow measurements. pH was measured and correlated with neonatal Apgar score at 1 and 5 min. The study also included a questionnaire about the safety and usability of obstetric monitoring. Statistical analysis was done using IBM SPSS v. 26.0. Results: Mean age was 28.8 years, (SD ± 6.153). Electrocardiogram recordings (ECG) were classified as normal (71%) and suspicious (29%). Baseline between ECGs was different (p = 0.025) similarly for Short term variability (STV) (p <0.0001). BMI did not differentiate SVT rates. Only high acceleration (p <0.029) and small slowdowns had a statistically significant difference between normal and suspected cardiographs (p <0.029). APGAR score did not differ, whereas the umbilical cord pH was different in normal ECGs compared to the suspect (p = 0.012) and STV was also differentiated. A usability and safety survey was conducted after recording with MONIKA AN24, and the response to whether they would accept recording with the device again, was positive for 96% of the 30 responders. Conclusion: The present study shows that the use of electrocardiography in obstetrics allows to draw conclusions about the fetal hematopoiesis and oxygenation status. This method could be clinically applied and be an important tool for further screening in embryos that may be hypoxic and to decide whether to continue with a vaginal or cesarean delivery, thereby achieving the goal of reducing perinatal morbidity and mortality.

Effectors of Pregorexia and Emesis among Pregnant Women: A Pilot Study.

During pregnancy, women tend to improve their lifestyle habits and refine their dietary intake. Quite often, however, these dietary improvements take an unhealthy turn, with orthorexia nervosa (ON) practices being apparent. The aim of the present pilot cross-sectional study was to assess the prevalence of ON tendencies and the incidence of pica and record diet practices in a sample of pregnant women. A total of 157 pregnant women were recruited through private practice gynecologists during the first months of 2021. Nutrition-related practices were recorded, orthorexic tendencies were assessed using the translated and culturally adapted Greek version of the ORTO-15 questionnaire, pica practices were evaluated with a binary question and nausea and emesis during pregnancy (NVP) was evaluated using the translated modified Pregnancy-Unique Quantification of Emesis and Nausea (mPUQE). Only two women reported pica tendencies, with ice and snow being the consumed items. The majority (61.1%) of women reported improving their diet since conception was achieved. Folic acid and iron oral nutrient supplements (ONS) were reportedly consumed by the majority of participants (87.9% and 72.6%, respectively) and 9.6% reported using herbal medicine products. The ORTO-15 score was reduced with tertiary education attainment, ART conception, being in the third trimester of pregnancy, consumption of folic acid and MV supplements and was only increased among women who were at their first pregnancy. The majority of participants experienced severe NVP and the remaining experienced moderate NVP. NVP was associated with lower hemoglobin levels, lack of supplementary iron intake, avoidance of gluten-containing foods, as well as with increased gestational weight gain. The results highlight the need to screen pregnant women for disturbed eating behaviors and nutrition-related problems, in order to ensure a healthy pregnancy outcome.

Plasma Ceramide Concentrations in Full-Term Pregnancies Complicated with Gestational Diabetes Mellitus: A Case-Control Study.

Ceramides, a sphingolipid group that acts as a messenger in cellular differentiation, proliferation, apoptosis and senescence, have been associated with cardiovascular disease and type 2 diabetes. The evidence for an association between ceramides and gestational diabetes mellitus (GDM) is scarce. This case-control study aimed to compare women with GDM with healthy, pregnant women in terms of plasma ceramide concentrations at the time of delivery. Ninety-two pregnant women were included in this case-control study, 29 in the GDM group and 63 in the control group. All women were admitted to a tertiary academic hospital for a full-term delivery. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was applied for the quantification of four molecular ceramides, namely Cer d18:1/16:0 (Cer16:0), Cer d18:1/18:0 (Cer18:0), Cer d18:1/24:0 (Cer24:0) and Cer d18:1/24:1 (Cer24:1) in plasma samples. The raw chromatographic data obtained from the LC-MS/MS analysis were processed using Analyst SCIEX (AB Sciex Pte. Ltd., USA). In a univariate statistical analysis, Cer24:0 concentration was significantly lower in the GDM group compared with the control group (p = 0.01). The present study demonstrated lower Cer24:0 concentrations in pregnancies complicated by GDM. Further prospective studies are required to enhance the results of this study.

Effect of Exercise on the Resting Metabolic Rate and Substrate Utilization in Women with Gestational Diabetes Mellitus: Results of a Pilot Study.

Regular physical activity during pregnancy has a positive effect on the mother and fetus. However, there is scarce data regarding the effect of exercise in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present parallel, non-randomized, open-label, pilot, clinical study was to examine the effect of two exercise programs on the resting metabolic rate (RMR) and substrate utilization in pregnancies complicated by GDM, compared with usual care (advice for the performance of exercise). Forty-three pregnant women diagnosed with GDM between the 24th and 28th gestational week, volunteered to participate. Three groups were formed: Usual care (n = 17), Walking (n = 14), and Mixed Exercise (n = 12). The Usual care group was given advice on maintaining habitual daily activities without any additional exercise. The Walking group exercised regularly by walking, in addition to the habitual daily activities. Finally, the Mixed Exercise group participated in a program combining aerobics and strength exercises. Training intensity was monitored continuously using lightweight, wearable monitoring devices. The Walking and Mixed Exercise groups participated in the training programs after being diagnosed with GDM and maintained them until the last week of gestation. RMR and substrate utilization were analyzed using indirect calorimetry for all participants twice: between 27th and 28th gestational week and as close as possible before delivery. No differences were observed between groups regarding body composition, age, and medical or obstetrical parameters before or after the exercise programs. RMR was increased after the completion of the exercise interventions in both the Walking (p = 0.001) and the Mixed Exercise arms (p = 0.002). In contrast, substrate utilization remained indifferent. In conclusion, regular exercise of moderate intensity (either walking, or a combination of aerobic and strength training) increases RMR in women with GDM compared to the lack of systematic exercise. However, based on the present, pilot data, these exercise regimes do not appear to alter resting substrate utilization.

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants.

Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.

Orthorexia nervosa: replication and validation of the ORTO questionnaires translated into Greek in a survey of 848 Greek individuals.

PURPOSE: The present study aimed to validate the ORTO-15 questionnaire for orthorexia nervosa (ON), translated by our group into the Greek language, and replicate the findings of the recently proposed 6-item ORTO-R. METHODS: The tool was translated into the Greek language (ORTO-15-GR) using the forward-backward-forward method. A total of 848 adults participated in the validation study by filling in the questionnaires and providing general characteristics (age, gender, educational level, body weight, and height). The internal consistency of the tool was assessed by the omega (ω) coefficient, and confirmatory factor analyses (CFA) examined its factorial structure. Using the original six items of the ORTO-15 tool, a separate CFA model examined the factorial structure of the proposed ORTO-R tool. Furthermore, regression models tested the association of ORTO-R with study variables. RESULTS: For ORTO-15-GR, the omega coefficient was 0.70 and for the ORTO-R 0.65. For the latter, the CFA revealed acceptable goodness-of-fit (standardized factor loadings from 0.36 to 0.64); however, all ORTO-15 models were characterized by a poor fit. In addition, there was a negative association between ORTO-R score and female gender, body mass index (BMI), and having a nutrition-related health problem. CONCLUSION: The replication of ORTO-R indicates that it is a reliable tool in the field of ON. Therefore, the use of a 6-item questionnaire for ON assessment appears promising in research and clinical settings.

Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action.

Health problems of women experiencing homelessness are driven either from the usual background characteristics of this population, or from the homeless lifestyle. Apart from poverty and unemployment, transition to homelessness is often associated with substance abuse, history of victimization, stress, poor mental health and human immunodeficiency virus (HIV). Water insecurity can undermine bodily hygiene and dental health, posing a greater risk of dehydration and opportunistic infections. Exposure to extreme environmental conditions like heat waves and natural disasters increases morbidity, accelerates aging, and reduces life expectancy. Nutrition-wise, a high prevalence of food insecurity, obesity, and micronutrient deficiencies are apparent due to low diet quality and food waste. Poor hygiene, violence, and overcrowding increase the susceptibility of these women to communicable diseases, including sexually transmitted ones and COVID-19. Furthermore, established cardiovascular disease and diabetes mellitus are often either undertreated or neglected, and their complications are more widespread than in the general population. In addition, lack of medical screening and contraception non-use induce a variety of reproductive health issues. All these health conditions are tightly related to violations of human rights in this population, including the rights to housing, water, food, reproduction, health, work, and no discrimination. Thus, the care provided to women experiencing homelessness should be optimized at a multidimensional level, spanning beyond the provision of a warm bed, to include access to clean water and sanitation, psychological support and stress-coping strategies, disease management and acute health care, food of adequate quality, opportunities for employment and support for any minor dependants.

TIMER: A Clinical Study of Energy Restriction in Women with Gestational Diabetes Mellitus.

Medical nutrition therapy is an integral part of gestational diabetes mellitus (GDM) management; however, the prescription of optimal energy intake is often a difficult task due to the limited available evidence. The present pilot, feasibility, parallel, open-label and non-randomized study aimed to evaluate the effect of a very low energy diet (VLED, 1600 kcal/day), or a low energy diet (LED, 1800 kcal/day), with or without personalized exercise sessions, among women with GDM in singleton pregnancies. A total of 43 women were allocated to one of four interventions at GDM diagnosis: (1) VLED (n = 15), (2) VLED + exercise (n = 4), (3) LED (n = 16) or (4) LED + exercise (n = 8). Primary outcomes were gestational weight gain (GWG), infant birth weight, complications at delivery and a composite outcomes score. Secondary outcomes included type of delivery, prematurity, small- for-gestational-age (SGA) or large-for-gestational-age (LGA) infants, macrosomia, Apgar score, insulin use, depression, respiratory quotient (RQ), resting metabolic rate (RMR) and middle-upper arm circumference (MUAC). GWG differed between intervention groups (LED median: 12.0 kg; VLED: 5.9 kg). No differences were noted in the type of delivery, infant birth weight, composite score, prevalence of prematurity, depression, RQ, Apgar score, MUAC, or insulin use among the four groups. Regarding components of the composite score, most infants (88.4%) were appropriate-for-gestational age (AGA) and born at a gestational age of 37-42 weeks (95.3%). With respect to the mothers, 9.3% experienced complications at delivery, with the majority being allocated at the VLED + exercise arm (p < 0.03). The composite score was low (range 0-2.5) for all mother-infant pairs, indicating a "risk-free" pregnancy outcome. The results indicate that adherence to a LED or VLED induces similar maternal, infant and obstetrics outcomes.

Guidelines for Medical Nutrition Therapy in Gestational Diabetes Mellitus: Systematic Review and Critical Appraisal.

BACKGROUND: Medical nutrition therapy is the cornerstone of gestational diabetes mellitus treatment. However, guidelines often present contradictory guidance to health care practitioners. OBJECTIVE: To systematically review and critically appraise medical nutrition therapy guidelines for treating patients with gestational diabetes mellitus. DESIGN: We searched Medline, the Cochrane Library, Guidelines International Network, and Google Scholar to retrieve clinical practice guidelines (CPGs) for medical nutrition therapy in gestational diabetes mellitus from professional or governmental organizations, published in English, between January 1, 2007, and November 24, 2018. CPGs were reviewed and appraised using the Appraisal of Guidelines, Research, and Evaluation II instrument. RESULTS: Of 1,286 retrieved articles, 21 CPGs fulfilled the inclusion criteria. CPGs of the Academy of Nutrition and Dietetics, Diabetes Canada, and Malaysia Health Technology Assessment Section received the greatest overall scores and the highest scores concerning rigor of recommendations development. Many CPGs failed to involve multidisciplinary teams in their development, including patients, and often, dietitians. Applicability of the recommendations was low, lacking facilitators and tools to enhance implementation. Many CPGs demonstrated low editorial independence by failing to disclose funding and competing interests. More medical nutrition therapy recommendations were incorporated in the Academy of Nutrition and Dietetics and Malaysia Health Technology Assessment Section CPGs. The Malaysia Health Technology Assessment Section, Diabetes Canada, Academy of Nutrition and Dietetics, and Endocrine Society guidelines were recommended by the review panel herein without modifications. Overall, the CPGs suggested the consumption of adequate protein and the selection of foods with low glycemic index, divided into three main meals and two to four snacks. Weight gain recommendations were mostly based on the Institute of Medicine body mass index thresholds. CONCLUSIONS: With few exceptions, the main developmental limitations of the appraised CPGs involved low rigor of recommendations development, lack of multidisciplinary stakeholder involvement, low applicability, and inadequate editorial independence. This indicates a need for developing more clear, unbiased, practical, and evidence-based CPGs.

Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations.

OBJECTIVE: Τo summarize and present the main guidelines for exercise during normal pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM). METHODS: Relevant guidelines were retrieved through the electronic databases PubMed (MEDLINE), CENTRAL (Cochrane), and Embase; reference sections of the retrieved publications; proceedings of the main congresses in the field; and websites of relevant organizations published during the years 2000-2018. RESULTS: All guidelines recommend aerobic training from 60 to 150 min/week, with an upper limit of 30 min/day. Exercise is safe, even on a daily basis. Resistance exercise is suggested by five national guidelines (Australia, Canada, Denmark, Norway, and the UK). Discrepancies exist regarding the recommended intensity of exercise. Canada, Japan, Spain, and the UK use both objective (heart rate and maximum oxygen consumption) and subjective criteria (Borg's Scale and talk test) to determine the effectiveness and safety of exercise. Only Canada provides specific recommendations, according to the woman's age and level of physical condition. Women with GDM on no insulin treatment do not need to take extra precautions during exercise. However, due to their condition of hyperglycemia, they must comply with the recommendation issued for type 2 diabetes. The prescription and supervision of exercise should be carried out in a similar way as for uncomplicated pregnancies. Finally, women with GDM on insulin treatment need to follow the same recommendations as for those for pregnant women with type 1 diabetes. CONCLUSION: Health professionals must be informed about the correct planning and execution of physical exercise programs so as to safely achieve the maximum effectiveness of exercise-induced health-related benefits in pregnant women.

Regulation of basal metabolic rate in uncomplicated pregnancy and in gestational diabetes mellitus.

Basal metabolic rate (BMR) is one of the major components of total energy expenditure (TEE). It is affected by various factors, such as body weight, body composition, age, race/ethnicity, gender, biochemical parameters, physical activity, and health status. Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy and it increases the risk for health complications, such as stillbirth, diabetes mellitus, and cardiovascular disease in later life. Both BMR and GDM have been linked with gestational weight gain (GWG), a fact suggesting a possible association between them. However, assessing BMR is a complex procedure, which becomes more complicated when additional parameters, such as pregnancy and GDM, are taken into consideration. The present review summarizes the current knowledge on factors affecting BMR and its regulation in relation to pregnancy and GDM. Future research addressing these associations should thoroughly consider other factors that affect BMI when designing such studies and/or discussing the BMR outcome results.

Comments on gestational diabetes mellitus: from pathophysiology to clinical practice.

Gestational diabetes mellitus (GDM) is a topic of major interest, as it affects up to 16% of pregnant women and may lead to adverse pregnancy outcomes, which, however, are preventable by appropriate treatment. The aim of the present study was to discuss basic concepts and to critically appraise recent updates on practical issues in the field of GDM. GDM pathophysiology, long-term complications including "fetal programming" and GDM diagnosis are discussed, while clinical practice guidelines on follow-up, medical nutrition therapy, oral hypoglycemic agents and insulin treatment are also reviewed. GDM comprises a serious yet preventable public health problem and prevention by lifestyle changes, early detection and adequate treatment can lead to better health outcomes for both mothers with GDM and their offspring.