Complementary therapists' motivation to work in cancer/supportive and palliative care: A multi-centre case study

PurposeTo uncover complementary therapists' motivation to work in cancer/supportive and palliative care.MethodThe study employed a multiple case-study design, involving three cancer/supportive and palliative care settings in the North West of England. A questionnaire survey (n = 51) was undertaken, followed by semi-structured interviews with a subgroup of the sample (n = 28).ResultsParticipants had a mean age of 50 years, were predominantly female and had varied career backgrounds, including prior professional experience in healthcare, teaching and private complementary therapy practice. Motivation for working in cancer/supportive and palliative care included vocational drive with a desire to provide individualised treatment and adopt a person centred, empowering and caring approach; disillusionment with conventional care; career development and personal experience of cancer or other serious illness.ConclusionFindings indicated that motivational factors for therapists working in cancer care/supportive and palliative care were varied and highlighted a combination of ‘push and pull’ factors, particularly for therapists who are also health care practitioners. Further research related to volunteering, sustainable services and support and training for therapists is required.     

Evaluation of an HIV/STD Sexual Risk-Reduction Intervention for Pregnant African American Adolescents Attending a Prenatal Clinic in an Urban Public Hospital: Preliminary Evidence of Efficacy

Study ObjectiveTo evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents.DesignA randomized controlled trial. Participants completed baseline and follow-up assessments.SettingAn urban public hospital in the Southeastern U.S.ParticipantsPregnant African-American adolescents (N = 170), 14–20 years of age, attending a prenatal clinic.InterventionIntervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition.Main Outcome MeasuresConsistent condom use.ResultsIntervention participants reported greater condom use at last intercourse (adjusted odds ratio = 3.9, P = 0.05) and consistent condom use (AOR = 7.9, P = 0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex.ConclusionsInterventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.     

Impact of the creation of a specialized clinic for prenatal blood sampling and follow-up care in pregnant women

ObjectiveTo evaluate (1) the effect on gestational diabetes mellitus (GDM) screening rates of having a specialized clinic for pregnant women offering blood sampling and screening for GDM, and (2) the impact on perinatal outcomes of having early GDM screening and follow-up provided by the specialized clinic.MethodsWe performed a retrospective cohort study, based on electronic health records. We compared data from women who delivered during a period when the Blood Sampling in Pregnancy (BSP) clinic was operating (2008–2009; n = 2780) to a time period before the clinic was established (2006–2007; n = 2591). During the 2008–2009 period, we compared data from women who had GDM screening in the first trimester with women who had screening during the second trimester and with women who were not screened.ResultsFollowing the creation of the BSP clinic, overall GDM screening rates reached 72.4% in 2008–2009, compared with 48.9% in 2006-2007 (P < 0.001) and GDM screening was more likely to be performed in the first trimester (36.7% vs. 0.4%; P < 0.001). During the period when the BSP clinic was operating (2008-2009), women who had GDM screening in the first trimester had lower rates of Caesarean section (15.7% vs. 22.1 %; P < 0.001) and neonatal complications (bradycardia: 3.6% vs. 6.8%; P = 0.003; respiratory distress: 9 6% vs 13 2%; P = 0 02; and admission to NICU: 15.4% vs. 26.8%; P < 0.001) than women who did not perform GDM screening.ConclusionIn our population, creation of a clinic offering specialized care to pregnant women improved GDM screening rates. With the support of the BSP clinic, women who had early GDM screening were less likely to undergo Caesarean section and their offspring had fewer perinatal complications.     

Web-Based Education and Attitude to Delivery by Caesarean Section in Nulliparous Women

ObjectiveTo measure the effect of a web-based educational tool on baseline knowledge of the risks and benefits of delivery by Caesarean section in healthy nulliparous women.MethodsWe constructed a web-based educational tool to provide evidence-based information on the potential benefits and risks of CS for healthy nulliparous women in the second trimester. We included women with an uncomplicated singleton pregnancy who were receiving antenatal care at Mount Sinai Hospital. Eligible women logged into the website to undertake a pretest survey. After completing this survey, they received access to the educational tool, followed by a link to a second survey. The surveys collected baseline demographics and assessed participants’ knowledge of the perceived safety and risks of vaginal delivery and CS, their sources of information, and the influence of these sources on their views.ResultsSeventy-three participants completed both surveys. Participants had a high baseline preference (84%) for vaginal delivery. The mean score for knowledge about vaginal delivery and CS increased significantly between the surveys, from 47% to 76% (P < 0. 001). There was no significant change in preference for mode of delivery between the two surveys. In both surveys, more participants responded that they were a “little fearful” or “not fearful at all” of vaginal deliveries. In the second survey, significantly more responded that they were “very fearful” or “fearful” of CS (P < 0.05). Increased knowledge about specific risks of vaginal delivery did not deter participants from preferring a vaginal delivery. However, knowledge of risks associated with CS made them more likely to have “very favourable” or “somewhat favourable” views of vaginal delivery. Ethnicity and country of birth were not found to have a significant effect on preferred mode of delivery.ConclusionsWe demonstrated that a web-based educational tool significantly increased knowledge of the risks and benefits of vaginal delivery and CS. However, the educational intervention did not significantly change preferences.     

The attitudes of pregnant women and midwives towards raised BMI in a maternity setting: A discussion of two repertory grid studies

ObjectivesWeight-related stereotypes may have a detrimental impact on interactions between midwives and pregnant women with a body mass index (BMI) outside the recommended range of 18–30 kg/m². This paper explores the reciprocal construal of midwives and pregnant women with a raised BMI and considers the clinical implications of these constructs.ParticipantsTen pregnant women with a BMI≥30 kg/m² and 11 midwives and from an inner city maternity service were recruited.InterventionParticipants provided information that allowed for the creation of a repertory grid; generating psychological constructs (perceptions or attitudes) identifying similarities and differences between pregnant women and midwives across a BMI range.FindingsMidwives were extremely conscious of being perceived as judgemental. They construed all pregnant women as anxious and vulnerable, but attributed characteristics such as “less health-conscious” and “complacent” to those with a raised BMI. The ideal pregnant woman and ideal midwife were typically construed as more likely to have a BMI of 18–30 kg/m². Pregnant women with a BMI≤18 kg/m² were construed as lacking warmth. While midwives differentiated between the elements based on role, the pregnant women construed the elements according to their BMI. Similarly, they construed those with a BMI≤18 kg/m² as having an undesirable personality, and acknowledged weight-related stereotypes for those with a raised BMI.Clinical ImplicationsIt is possible these constructs impact on the way midwives care for and interact with women. Midwives may be supported through reflective clinical supervision and communication skills training to reduce the perceptions of stigma experienced by women with a raised BMI. It may be beneficial to involve pregnant women with a raised BMI in service development to ensure services meet their needs.     

Influence of early self-diagnosis and treatment of bacterial vaginosis on preterm birth rate

ObjectiveTo assess whether early self-diagnosis and treatment of bacterial vaginosis (BV) could lower the preterm birth rate among a group of Indonesian women.MethodsA randomized controlled trial of 331 pregnant women (14–18 weeks) was conducted. Participants were randomly assigned to either the active model group (n = 176) or the control group (n = 155). Women in the active model group were equipped with a kit to self-evaluate vaginal pH; those with a positive test result were treated with a twice daily dose of 500 mg of metronidazole for 7 days. The primary end point was preterm birth rate.ResultsThere were 6 (3.8%) and 8 (5.4%) preterm births in the active model and control groups, respectively (P = 0.468). No spontaneous abortions were recorded in either group. When compared with the gold standard (Gram staining), the vaginal acidity test had low ability to detect BV, with 88.7% specificity and 36.9% sensitivity. The positive predictive value of the test was 35.0% PPV, while the negative predictive value was 89.4%.ConclusionEarly self-diagnosis and treatment of BV did not reduce the preterm birth rate of the study group.ClinicalTrial.gov number: NCT01232192.     

A pilot randomised controlled trial exploring the effects of antenatal reflexology on labour outcomes

Objectiveto investigate the effects of antenatal reflexology on labour outcomes.Designsecondary analysis of a pilot three-armed randomised controlled trial conducted between July 2012 and September 2013.Settinga large UK inner city hospital maternity department.Participantsninety primiparous women with a singleton pregnancy experiencing low back and / or pelvic girdle pain.Interventionssix weekly 30-minute reflexology treatments compared to sham (footbath) treatments or usual antenatal care only.Measurementslabour outcome data including labour onset, duration of the second stage of labour, epidural and Entonox usage, and mode of delivery. Participant feedback was collected prior to each treatment.Findingslabour outcomes were collected for 61 women (95.3%) who completed the study. The second stage of labour duration data, available for 42 women (62.5%) who had vaginal births, showed a mean reduction of 44 minutes in the reflexology group (73.56 minutes; SD= 53.78) compared to the usual care (117.92 minutes; SD=56.15) (p<0.05) and footbath groups (117.4 minutes; SD=68.54) (p=0.08). No adverse effects were reported.Key conclusionsin this trial antenatal reflexology reduced labour duration for primiparous women who had experienced low back and/ or pelvic girdle pain during their pregnancy, compared with usual care and footbaths.Implications for practicereflexology is suitable for use during pregnancy, is safe and enjoyable and may reduce labour duration. Midwives may wish to recommend reflexology to promote normal childbirth and facilitate women centred care.Trial registrationthis trial was listed with the International Standard Randomised Controlled Trial Number Register (ISRCTN26607527).     

Identification of Postpartum Depression in an Online Community

ObjectiveTo identify the rate of postpartum depression symptoms in an online community. A secondary purpose was to identify women’s experiences when accessing health care services for postpartum depression (PPD).DesignA quantitative, cross-sectional, survey design.SettingThe setting consisted of nine birth clubs from one online community specifically targeted toward new mothers.ParticipantsA convenience sample of 469 mostly married (n = 373), White (n = 401) mothers with a mean age of 29.3 (SD = 5.3) years took part in this study. The majority (n = 433) reported living in the United States with access to health insurance coverage.MethodsThe Edinburgh Postnatal Depression Scale (EPDS) was used to assess depression symptoms. Mothers indicating a previous diagnosis of PPD also completed the Access to Postpartum Depression Care (APDC) questionnaire.ResultsTotal EPDS scores ranged from 0 to 27 with a median of 7.0. Sixteen percent of participants (n = 75) scored > 13, indicating a high risk for developing PPD. Of these 75 mothers, 18 (24%) indicated having thoughts of harming themselves sometimes and five (7%) indicated having these thoughts quite often. Additionally, 76 mothers indicating a previous history of PPD also completed the APDC questionnaire. Findings suggested mothers often received care that did not meet their expectations. Barriers to PPD care included insurance limitations and insensitive comments from their health care providers.ConclusionsThe rate of depression symptoms noted in this Internet-based population is in agreement with published rates. Therefore, findings of this study support further exploration and evaluation of using online platforms for PPD screening.     

Circulating endothelial progenitor cells and placental abruption in women with preeclampsia

ObjectiveAbnormalities in circulating angiogenic factors and endothelial progenitor cells (EPCs) have been reported in patients with preeclampsia and placental abruption. The objective of this study was to determine whether the number of EPCs is altered in patients with placental abruption.DesignA case control study.SettingHiroshima University Hospital in Japan.SamplePregnant Japanese women with preeclampsia (n = 27) and those without any complications (n = 15).MethodThe EPC (CD45^lowCD34⁺CD133⁺ cells) counts were examined using flow cytometry in peripheral blood collected from 27 women with preeclampsia and 15 normal pregnant women. Among the 27 women with preeclampsia, five subsequently developed placental abruption. All subjects were divided into three groups: normal pregnancy (NP, n = 15), preeclampsia without placenta abruption (PE, n = 22) and preeclampsia with placental abruption (PA, n = 5).Main outcome measuresThe EPC counts were measured in pregnant women with preeclampsia who subsequently developed placental abruption.ResultsThe EPC count in the PE group significantly decreased in comparison to that observed in the NP group (620 cells/ml versus 1918 cells/ml, P < 0.01). In the PA group, the EPC count was found to markedly decrease in comparison to that observed in the PE group (221 cells/ml, P < 0.05).ConclusionsThe number of EPCs was found to significantly decrease in preeclamptic women who subsequently developed placental abruption.     

Serum S100B in pregnancy complicated by preeclampsia: A case-control study

BackgroundSerum S100B is a protein produced and released primarily by astrocytes of the Central Nervous System (CNS). Elevated levels of serum S100B are associated with several types of pathological conditions of the brain, including the eclampsia in pregnant women. The aim of this study was to compare serum S100B concentrations in pregnant women with severe and mild preeclampsia (PE) with S100B serum levels in normotensive pregnant women.Material and methodsSerum S100B protein was measured in normotensive pregnant women (n = 15) and in women with mild PE (n = 12) or severe PE (n = 34). The serum S100B level (μg/L) was determined by an luminometric assay.ResultsSixty-one expectant mothers were studied, aged 26.6 ± 8.7 (mean ± SD) years and with a gestational age of 33.3 ± 4.2 weeks. The severe PE group demonstrated higher S100B levels (0.20 ± 0.19), as compared with mild PE (0.07 ± 0.05) or normotensive groups (0.04 ± 0.05).ConclusionElevated serum S100B levels in pregnant women with severe PE suggest that some kind of neural damage and subsequent astrocytic release of S100B is not dependent on the progression from severe preeclampsia to eclampsia.     

La qualité du suivi de la grossesse interfère-elle avec les issues de la grossesse,en Guadeloupe ?

ObjectivesTo assess the rate of pregnant women not having accurate prenatal care utilization. The others goals were to assess the impact of an inadequate quantitative or qualitative prenatal care on obstetrical outcomes.Patients and methodsHistorical cohort study with a prospective data registration. Hospitalised patients at the maternity ward of the University Hospital of Pointe-à-Pitre were eligible if they gave birth after 22 weeks (or ≥ 500 g) at home, outside a maternity ward or in another maternity ward. Early postpartum maternal transfers were included but not medical abortions. The principal outcome was preterm birth (before 37 weeks’ gestation).ResultsPatients without an appointment before 15 weeks or without an appointment each month before their delivery represented 27.4% of women (n = 2344). We stressed more preterm deliveries outside the maternity ward among the group with an inadequate prenatal care utilization vs. the other group (3,89% vs. 0,88%) (p < 0,0001). We did not find any difference concerning the perinatal outcomes among the women with an inadequate quality prenatal care.Discussion and conclusionOur study did not stress a difference concerning perinatal outcomes among women with an inadequate quantitative or qualitative prenatal care utilization.     

Women's Perceptions of Polycystic Ovary Syndrome Following Participation in a Clinical Research Study: Implications for Knowledge,Feelings, and Daily Health Practices

ObjectivePolycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects 6% to 10% of reproductive aged women. It is a poorly understood and often undiagnosed condition that has implications for the health of affected women. We assessed changes in knowledge, feelings, and daily health practices related to PCOS in clinical research study participants.MethodsSixty-eight women who had received counselling and education about PCOS while participating in a clinical research study were invited to complete an online survey that assessed levels of concern, knowledge, healthy dieting, active living, and health care satisfaction before and after the study. Differences and associations between scores were analyzed by paired t tests and Pearson correlation.ResultsForty-three women (63%) completed the survey. After taking part in a clinical research study, participants believed they had increased knowledge of (P < 0.001) and concern about (P = 0.029) the etiology and health consequences of PCOS, better lifestyle practices (P < 0.001), and improved health care satisfaction (P = 0.045). Enhanced knowledge of PCOS was positively associated with changes in concern (P = 0.045), healthy dietary habits (P = 0.04), activity levels (P = 0.003), and health care satisfaction (P < 0.001). After the study, women felt empowered to participate in the management of their condition and communicate with their primary care providers.ConclusionWomen with PCOS felt that they had more knowledge and motivation to implement preventive health strategies after participating in a clinical research study. Education about how PCOS affects their immediate and long-term health enabled women with PCOS to feel physical and psychological benefits and to engage more with their health care providers.     

OS001. Pregnancy outcome in subsequent pregnancies after eclampsia

IntroductionEclampsia in the previous pregnancy may have impact on future reproductive performance of the women. Few studies have been conducted in recent years to review the subsequent pregnancy outcome. In this study women with previous eclampsia were followed up in subsequent pregnancy and outcome was compared with normotensive control group.ObjectivesTo study the risk of recurrence of hypertension and associated complications in subsequent pregnancies following eclampsia.MethodsFifty-three pregnant women with previous history of eclampsia were supervised and delivered in PGIMER, Chandigarh, India (2001 April–2011 March) were studied prospectively. The pregnancy outcome was compared with 106 age and gravida matched controls who had remained normotensive in previous pregnancies. The data analysis was done by Chi-square test and Student ‘t’ test.ResultsAmongst women with previous eclampsia eight women (15%) were found to have underlying chronic hypertension. The incidence of gestational hypertension and pre-eclampsia was 37.7% amongst these women, compared to 7.5% in control group (p = 0.0001). Preterm deliveries mainly due to preterm inductions were higher (32%) amongst women with previous eclampsia compared to 12% amongst controls (p = 0.0004). Incidence of intra uterine growth restriction was significantly higher amongst cases (15% vs 1.5%, p = 0.0003).ConclusionWomen with previous eclampsia have higher incidence of chronic hypertension. These women are at significant risk to develop hypertensive disorders of pregnancy and its related complications. The recurrence of eclampsia is low with aggressive and vigilant antenatal care.     

Neonatal outcome following long-distance air travel for fetoscopic laser coagulation treatment of twin-to-twin transfusion syndrome

ObjectiveTo investigate the impact of undertaking long-distance air travel to a specialized medical center while pregnant in order to undergo fetoscopic laser coagulation (FLC) for twin-to-twin transfusion syndrome (TTTS).MethodsA retrospective cohort study was conducted of women with TTTS who travelled by air (n = 16) or land (n = 61) to the Centre of Perinatal Diagnosis and Microinvasive Fetal Surgery, Mainz, Germany, between January 1, 2006, and December 31, 2010. All women underwent FLC on arrival at the study center. Neonatal outcome, postoperative neonatal survival rates, and rates of adverse effects were recorded.ResultsThe postoperative survival rate for a single twin was 100.0% (n = 16) in the flight group and 98.3% in the land transportation group (n = 60). The postoperative survival rate for both twins was 81.3% in the flight group (n = 13) and 75.4% (n = 46) in the land transportation group. No differences in neonatal outcome or the rate of adverse effects were observed between the 2 groups. No flight-related pregnancy complications were recorded.ConclusionLong-distance air travel to a specialized tertiary care medical center is sufficiently safe to warrant recommendation to pregnant women with TTTS who require FLC.     

The effects of malaria and HIV co-infection on hemoglobin levels among pregnant women in Sekondi-Takoradi,Ghana

ObjectiveTo assess the burden of maternal malaria and HIV among pregnant women in Ghana and to determine the risk of anemia among women with dual infection.MethodsA cross-sectional study was conducted at 4 hospitals in the Sekondi-Takoradi metropolis, Ghana. The study group comprised 872 consenting pregnant women attending prenatal care clinics. Venous blood samples were screened for malaria, HIV, and hemoglobin level. Multivariate logistic regression analysis was performed to determine the association between malaria, HIV, and risk of anemia.ResultsIn all, 34.4% of the study cohort had anemia. Multivariate logistic regression analysis indicated that pregnant women with either malaria (odds ratio 1.99; 95% confidence interval, 1.43–2.77; P = < 0.001) or HIV (odds ratio 1.78; 95% confidence interval, 1.13–2.80; P = 0.014) had an increased risk of anemia. In adjusted models, pregnant women co-infected with both malaria and HIV displayed twice the risk of anemia. The adjusted odds ratio was 2.67 (95% confidence interval, 1.44–4.97; P = 0.002).ConclusionPregnant women infected with both malaria and HIV are twice as likely to be anemic than women with a single infection or no infection. Measures to control malaria, HIV, and anemia during pregnancy are imperative to improve birth outcomes in this region of Ghana.     

Knowledge of Florida nurses and dietitians regarding dietary supplements

BackgroundHealth care professionals should exhibit competency about dietary supplements to support the high number of Americans taking these products.ObjectivesTo evaluate the knowledge of Florida nurses and dietitians regarding dietary supplements.MethodsFlorida nurses (n = 600) and dietitians (n = 600) were randomly selected to participate in a self-reported online survey. The actual knowledge of these professionals regarding nutrient-based and herbal supplements was evaluated by a quiz.ResultsData of 89 dietitians and 64 nurses were analyzed using independent sample t-test and Pearson's correlation. The actual knowledge of both professionals revealed a mean correct score of 12.98 ± 6.16 (maximum score = 30). Dietitians had a significantly greater knowledge of dietary supplements when compared to nurses (P = 0.000). Both professionals were more knowledgeable on nutrient-based supplements than herbal.ConclusionsBoth groups had a fairly low knowledge of side effects of dietary supplements and their interactions with common medications, and seem to require additional education in this area. Focused training can be designed to improve professionals' knowledge about dietary supplements.     

Cardiovascular risk markers in pregnancies complicated by diabetes mellitus or preeclampsia

ObjectiveTo explore biomarkers indicating cardiovascular disease in pregnant women with diabetes or preeclampsia, since these women are at increased risk for future cardiovascular disease.Study designEDTA-plasma from 262 women in gestational week 24–42 (healthy pregnancies n = 71, preeclampsia n = 105, type 2 diabetes n = 17, gestational diabetes n = 61, diabetes with preeclampsia n = 8) was analyzed by immunoassay for neopterin, midregional pro-adrenomedullin (MR-proADM) and C-terminal pro-arginine vasopressin (CT-proAVP). The diabetes groups were also analyzed for midregional pro-atrial natriuretic peptide (MR-proANP), and compared to previously reported MR-proANP concentrations for healthy, normotensive and preeclamptic patients.ResultsIn contrast to preeclampsia, median plasma MR-proANP was not increased in pregnancies complicated by diabetes, but in fact lower, compared to healthy pregnancies. Neopterin was increased in diabetic pregnancies and in late onset preeclampsia, compared to healthy pregnancies. Median plasma MR-proADM was increased in pregnancies complicated by gestational diabetes or preeclampsia, compared to healthy pregnancies. Median plasma MR-proANP was increased in diabetic pregnancies complicated by preeclampsia compared to pregnant women with diabetes only.ConclusionWomen with pregnancies complicated by diabetes mellitus or preeclampsia are at risk for future cardiovascular disease, but differ in circulating cardiovascular biomarker profile. A cardiovascular biomarker profiling during pregnancy might prove helpful in identifying women at risk for future cardiovascular disease, thus enabling targeted prophylactic interventions and follow-up.