Integrating an eHealth Program for Pregnant Women in Midwifery Care: A Feasibility Study Among Midwives and Program Users

Background

Health messages may have the highest impact if they are given early in life. Therefore, the Dutch Ministry of Health identified pregnant women as a target population and initiated an innovative eHealth program to serve as a communication channel of health messages to pregnant women.

Objective

The aim was to study the feasibility of implementing this eHealth program into standard midwifery care and to investigate use and user perceptions of the online program among pregnant women.

Methods

All midwifery practices in Amsterdam affiliated with the Dutch Organization of Midwives (n = 25) were requested to implement the eHealth program within a pilot study from March to August 2006. Structured interviews were used to study feasibility of implementation among midwives. During the study period, 488 pregnant women registered themselves on the program website, after which monthly emails were sent to them. The emails were tailored to the stage of pregnancy and provided interactive questions plus answers on six topics and links to related websites. User statistics were registered until January 2007, and user perceptions were assessed with electronic questionnaires.

Results

In total, 80% (20/25) of midwifery practices implemented the program. These midwives gave a short oral explanation about the eHealth program to their clients (n = 1382; about 45% of the total number of clients during this period) and handed out an information brochure. After the pilot, 12 midwifery practices were willing to integrate the eHealth program into their standard care procedures. Regarding program usage, 84% (408/488) of the enrolled women accessed health information within the program. They opened 59% (1296/2213) of the quiz emails and accessed, on average, 16 topics (SD 11). Only 35% (143/408) of users used the hyperlinks to visit related websites. Most women perceived the eHealth information as easy to understand (96%; 157/163) and reliable (81%; 130/161), but only 39% (48/153) agreed that the information was available at the right time. Accessing more topics within the quiz emails was associated with a more positive perception of the program (P = .02), but the number of clicks to related websites was not associated with program perception (P = .32). The main improvement suggested by program users was to expand the information within the program.

Conclusions

It is feasible to integrate an innovative eHealth program in standard midwifery care, and about half of the practices would like to continue doing so. Program users accessed a substantial proportion of available health information; however, user perceptions were mixed. Therefore, this eHealth program may be a feasible communication channel to promote a healthy lifestyle to pregnant women after suggested revisions have been carried out.     

Cardiovascular Health Effects of Internet-Based Encouragements to Do Daily Workplace Stair-Walks: Randomized Controlled Trial

Background

Although the hazardous health effects of a sedentary lifestyle are well known, many adults struggle with regular physical activity. Simple and efficient encouragements for increased physical activity are needed.

Objective

To determine the effect on cardiovascular health of email-based encouragements to do daily stair-walks at work together with colleagues among adults in sedentary occupations.

Methods

A single-blind randomized controlled trial was performed at a large administrative company in Copenhagen, Denmark. Participants were 160 office workers (125 women, 35 men; mean age 42 years, SD 10; sitting 89.5% of work time). At baseline, aerobic fitness was 37 mL/min/kg (SD 9), mean blood pressure was 118/79 mmHg (SD 14/9), and mean body mass index (BMI) was 23 kg/m² (SD 4). Participants were randomly assigned (2:1 ratio) to an email group receiving weekly email-based encouragements to walk the stairs for 10 minutes a day or to a control group receiving weekly reminders to continue their usual physical activities. The primary outcome was the change from baseline to 10-week follow-up in aerobic fitness determined from a maximal cycle test. The examiner was blinded to group allocation.

Results

Adherence to the email encouragements was fairly high with 82.7% of the participants performing at least 3 sessions of 10-minute stair-walks per week (mean 3.3, SD 1.3). Mean heart rate reached 167 beats/min (SD 10) during stair-walks. In the intention-to-treat analysis, aerobic fitness increased 1.45 mL/min/kg (95% CI 0.64-2.27) at 10-week follow-up in the email group compared with the control group. In participants with low aerobic fitness at baseline (n=56), aerobic fitness increased 1.89 mL/min/kg (95% CI 0.53-3.24), and systolic and diastolic blood pressure decreased 4.81 mmHg (95% CI 0.47-9.16) and 2.67 mmHg (95% CI 0.01-5.32), respectively, in the email group compared with the control group. Body weight decreased in the email group of those with low aerobic fitness compared with the control group, but this was not statistically significant.

Conclusions

Simple and inexpensive email-based encouragements to do daily stair-walks together with colleagues at work improves cardiovascular health among adults in sedentary occupations. There exists an enormous potential to prevent the hazardous health effects of a sedentary lifestyle through the use of email-based encouragements to do short bouts of physical activity at the workplace.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01293253","term_id":"NCT01293253"}}NCT01293253; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT01293253","term_id":"NCT01293253"}}NCT01293253 (Archived by WebCite at http://www.webcitation.org/6HWG2jw68).     

Women′s expectations and evaluation of a maternal educational program

Objectives:

To identify the expectations of women requesting the maternal education program (ME) and to determine their evaluation of it.

Methods:

a multi-centric observational study was conducted in four hospitals in Spain in 2011 with primiparous women. Socio-demographic and obstetrical variables, among others, were collected through interviews and reviews of medical records. The analysis estimated crude and adjusted odds ratios using logistic regression with a confidence interval of 95%.

Results:

Newborn care was most requested type of content desired by women (80.33%). Eleven and one quarter percent (11.25%) of the women evaluated ME as being of little or no usefulness or benefit. Women appreciated the follow-up care given during pregnancy and childbirth but ME was not noted as influencing the measurement of these processes (p> 0.05).

Conclusions:

Newborn care was the type of subject mainly demanded by the women in the ME program. Women evaluated ME as being a useful program.     

Identification of messenger RNA of fetoplacental source in maternal plasma of women with normal pregnancies and pregnancies with intrauterine growth restriction

Objective:

to quantify placenta-specific RNA in plasma of women carrying foetuses with intrauterine growth restriction and pregnant women with normal pregnancies.

Methods:

8 pregnant women with foetuses with intrauterine growth restriction were studied as well as 18 women with uncomplicated pregnancies in the third pregnancy trimester. Total free RNA was quantified in maternal plasma by spectrophotometry and the gene expression of hPL (Human Placental Lactogen) at the messenger RNA level through technical Real Time-Chain Reaction Polymerase.

Results:

plasma RNA of fetoplacental origin was successfully detected in 100% of pregnant women. There were no statistically significant differences between the values of total RNA extracted from plasma (p= 0.5975) nor in the messenger RNA expression of hPL gene (p= 0.5785) between cases and controls.

Conclusion:

messenger RNA of fetoplacental origin can be detected in maternal plasma during pregnancy.     

Comparison of use and appreciation of a print-delivered versus CD-ROM-delivered, computer-tailored intervention targeting saturated fat intake: randomized controlled trial

Background

Computer-tailored health education, a promising health education technique, is increasingly being delivered interactively, for example, over the Internet. It has been suggested that there may be differences in use and appreciation between print and interactive delivery of computer-tailored interventions, which may influence information processing. This may especially be the case for women, older people, and people of lower socioeconomic status. Knowledge about differences in use and appreciation could help in choosing the appropriate delivery mode for a particular target audience.

Objective

The study investigates a content-identical, computer-tailored intervention addressing saturated fat intake delivered via print or CD-ROM. We analyzed consumer use and appreciation of the feedback information and explored whether possible differences exist among gender, age, and education subgroups.

Methods

Healthy Dutch adults (18-65 years), none of whom were under treatment for hypercholesterolemia, were randomly allocated to receive a computer-tailored program on CD-ROM (n = 151) or in print (n = 141). At baseline, data were collected on gender, age, and education level. One month post-intervention, data were collected on the use (feedback information read, saved, discussed) and appreciation (trustworthiness, perceived individualization, perceived personal relevance, and user-friendliness) of the feedback. Statistical analyses on the use and appreciation items were performed using chi-square tests and independent-samples t tests.

Results

After exclusion of individuals with missing values, a total of 257 and 240 respondents were included in the analyses of the use outcomes of feedback read and saved, respectively. The results indicate that among the total population, the print feedback was read more often than the CD-ROM feedback (95% vs 81%; P = .001) and saved more often than the CD-ROM feedback (97% vs 77%; P < .001). Similar results were found among the gender, age, and education subgroups. After exclusion of individuals who did not read the information and those with missing values, a total of 208-223 respondents were included in the analyses of the use outcome of feedback discussed and the appreciation items. The personal relevance of the print feedback was rated higher than for the CD-ROM-delivered feedback (0.97 vs 0.68; P = .04), but the effect size was small (0.28). These differences in personal relevance were also seen among women (1.06 vs 0.67; P = .04) and respondents aged 35-49 years (1.00 vs 0.58; P = .03), with moderate effect sizes (0.38 and 0.44, respectively).

Conclusions

Despite the possible advantages of interactive feedback, the present study indicates that interactive-delivered feedback was used less and perceived as less personally relevant compared to the print-delivered feedback. These differences in use and appreciation of delivery modes should be taken into consideration when selecting a delivery mode for a specific subgroup in order to optimize exposure.

Trial Registration

ISRCTN 01557410; http://www.webcitation.org/5XMylWleH     

Motivation and satisfaction in GP training: a UK cross-sectional survey

Background

Recruitment to general practice has had periods of difficulty, but is currently going through a phase of relative popularity in the UK.

Aim

To explore motivators for career choice and career satisfaction among UK GP trainees and newly qualified GPs.

Design and setting

Cross-sectional web-based questionnaire of GP trainees and GPs within the first 5 years of qualification in the UK.

Method

All 9557 UK GP trainees and 8013 GPs who were within the first 5 years of qualification were invited to participate by email. Further publicity was conducted via general practice publications and the internet.

Results

Overall, there were 2178 responses to the questionnaire (12.4% response rate, 61.5% women, 61.8% trainees). Levels of satisfaction were high, with 83% of responders stating that they would choose to be a doctor again; of these, 95% would choose to be a GP again. The most frequently cited reason for choosing general practice was ‘compatibility with family life’, which was chosen by 76.6% of women and 63.2% of men (P<0.001). Other reasons given were: ‘challenging medically diverse discipline’ (women 59.8%, men 61.8%, P = 0.350), ‘the one-to-one care general practice offers’ (women 40.0%, men 41.2%, P = 0.570), ‘holistic approach’ (women 41.4%, men 30.1%, P<0.001), ‘autonomy and independence’ (women 18.0%, men 34.8%, P<0.001), ‘communication’ (women 20.6%, men 12.2%, P<0.001), ‘negative experiences in hospital’ (women 12.8%, men 9.8%, P= 0.036), and ‘good salary’ (women 7.8%, men 14.9%, P<0.001).

Conclusion

The most important reason for both women and men choosing general practice as a career in the UK is its compatibility with family life. As such, changes to UK primary care that decrease family compatibility could negatively impact on recruitment.     

Large-Scale Survey Findings Inform Patients’ Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment

Background

Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users’ experiences in using secure email messaging.

Objective

To quantitatively assess veteran patients’ experiences in using secure email messaging in a large patient sample.

Methods

A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations’ Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance.

Results

The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared with individuals with lower reported health literacy. Many respondents (n=328, 40.0%) reported that they would like to receive education and/or felt other veterans would benefit from education on how to access and use the electronic patient portal and secure messaging (n=652, 79.6%).

Conclusions

Survey findings validated qualitative findings found in previous research, such that veterans perceive secure email messaging as a useful tool for communicating with health care teams. To maximize sustained utilization of secure email messaging, marketing, education, skill building, and system modifications are needed. These findings can inform ongoing efforts to promote the sustained use of this electronic tool to support for patient-provider communication.     

Social influence as a driver of engagement in a web-based health intervention

Background

Web-based health interventions can drive behavior change, but their effectiveness depends on participants’ usage. A well-recognized challenge with these interventions is nonusage attrition or weak engagement that results in participants receiving low doses of the intervention, negatively affecting outcomes. We present an approach based on the theoretical concepts of social influence and complex contagion in an effort to address the engagement problem in a specific, commercial, online behavior change intervention.

Objective

To examine the relation between social ties and engagement within a specific online intervention. The aims were (1) to determine whether experiencing the intervention socially influences engagement, such that individuals with social ties show higher engagement than those without ties, and (2) to evaluate whether complex contagion increases engagement—that is, whether engagement increases as the number of ties an individual has in the intervention increases.

Methods

We analyzed observational data from 84,828 subscribed members of a specific Web-based intervention, Daily Challenge. We compiled three measures of engagement for every member: email opens, site visits, and challenge completions (response to action prompts). We compared members with and without social ties within the intervention on each measure separately using 2-tailed independent-sample t tests. Finally, we performed linear regressions with each simple engagement measure as the dependent variable and number of social ties as the independent variable.

Results

Compared with those without social ties, participants with social ties opened more emails (33.0% vs 27.2%, P < .001), visited the website more often (12.6 vs 6.7 visits, P < .001), and reported completing more of the actions they were prompted to perform (11.0 vs 6.1 actions, P < .001). Social ties were significant predictors of email opens (beta = 0.68, P < .001), site visits (beta = 1.52, P < .001), and reported action completions (beta = 1.32, P < .001).

Conclusions

Our initial findings are higher engagement in participants with social ties in the program and are consistent with the view that social influence can drive engagement in a Web-based health intervention.     

A Three Year Retrospective Study on Seroprevalence of Syphilis among Pregnant Women at Gondar University Teaching Hospital,Ethiopia

Background

Sexually transmitted infections (STIs) are a serious public health problem in low income countries, including Ethiopia. Syphilis caused by Treponema pallidum remains a major cause of reproductive morbidity and poor pregnancy outcomes in low income countries. Stillbirth, perinatal death, serious neonatal infection and low-birth weight babies are common among seropositive mothers.

Objective

To assess the seroprevalence of syphilis and risk factor correlates of this infection at Gondar University Teaching Hospital, Ethiopia.

Methods

The study was done on 2385 pregnant women attending the antenatal care clinic (ANC) from January 2009 to December 2011. Data was abstracted from the antenatal care clinic medical database. Chi-square test was used, using SPSS version 16 and significance level was chosen at 0.05 level with a two-tailed test.

Results

Of the total, 69(2. 9%) of pregnant women were confirmed as seropositive for syphilis. Pregnant women with an age group of 21–25 years of old were the most seropositive (3.4%), followed by 26–30 years of old (3.1%). The prevalence of syphilis infection was 3.2% in urban and 2.2% in rural pregnant women. Relatively high prevalence of syphilis infection were identified among students (4.2%) followed by governmental employees (3.8%).

Conclusion

The seroprevalence of syphilis among pregnant women attending ANC is declining. However, syphilis is more prevalent in the young and urban pregnant women. Emphasis on education to young people on STI risk behavioral change and partner follow up and notification for exposure to syphilis and treatment should be given.     

Seroprevalence of cytomegalovirus among pregnant women attending Murtala Mohammed Specialist Hospital Kano,Nigeria

Background

Primary Cytomegalovirus (CMV) infection during pregnancy is a frequent and serious threat to the fetus. As there is no vaccine alternative measures are needed to prevent congenital CMV infection.

Objective

This study determined CMV Immunoglobulin G (IgG) antibody among pregnant women in order to ascertain the immune status of mothers to guide policy makers.

Methods

A semi-structured questionnaire was initially administered to obtain information on demographic details, stage of pregnancy and risk factors. Blood was collected by venipuncture from 180 women attending the antenatal clinic in Murtala Mohammed Specialist Hospital Kano, Kano State, Nigeria. Sera samples were screened using CMV IgG ELISA kit (Dialab, Austria).

Results

Out of 180 pregnant women, 164 (91.1%) were seropositive. Based on stages of pregnancy 6/6(100%), 52/60(86.7%) and 106/114(93.0%) were seropositive among women in the first, second and third trimesters respectively.

Conclusion

Seroprevalence of pregnant women to CMV Ig G is high, hence the need for CMV - IgM screening to know the extent of active infection. There is also need for public enlightenment on the methods of transmission, effective prevention and control strategies.     

Initial and sustained participation in an internet-delivered long-term worksite health promotion program on physical activity and nutrition

Background

Determinants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users.

Objective

In this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied.

Methods

Determinants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website.

Results

Complete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85).

Conclusions

Modest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program.

Trial Registration

ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353     

Rapid screening for co-infection of HIV and HCV in pregnant women in Benin City,Edo State,Nigeria

Background

Human Immunodeficiency virus (HIV) and Hepatitis C virus (HCV) are both major global health concerns as they cause high mortality and morbidity in the developing countries. However, while data exists for the co-infection in other countries, little or no information can be found with regard to the sero-prevalence of HIV and HCV co-infection in Nigeria, albeit in pregnant women attending antenatal care clinics in Benin City, Nigeria.

Objective

The objective of the study was to determine the sero-prevalence of HIV and HCV among pregnant women seeking antenatal care in Benin City.

Methods

In determining the sero-prevalence in a cross-sectional study, 200 pregnant women, aged between 15 and 49 years were screened for HIV and HCV using rapid screening test kits. Using closed ended structured questionnaires; the respondents volunteered socio-demographic information associated with risk factors of HIV and HCV acquisition.

Results

Results indicated sero-prevalence of HIV and HCV in the sampled population was 3% and 5% respectively. Thirty three percent of the pregnant women that were HCV positive were co-infected with HIV-1 infection. HIV sero-prevalence was highest in the age group, 25–29 representing 5.1%, while HCV sero-prevalence was noted highest among the women in the age group 30–34 years, representing 7.9%. Two percent of the pregnant women had equivocal (ambivalent) HIV-1 results.

Conclusion

The study has shown a prevalence of HIV-HCV co-infection among the tested pregnant women in Benin City and more epidemiological surveys are needed in larger scale to decipher the prevalence in other states of Nigeria.     

Likely stakeholders in the prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi

Objectives

To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women''s perceptions towards selected potential HIV prevention efforts

Design

Cross sectional, questionnaire-administered study

Setting

Ante-natal clinics of eleven public health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi

Subjects

A total of 321 pregnant women attending ante-natal clinics

Results

Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse.

Conclusion

Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners.     

Demographic, behavioral, and psychosocial correlates of using the website component of a worksite physical activity and healthy nutrition promotion program: a longitudinal study

Background

Internet-delivered behavior change programs have the potential to reach a large population. However, low participation levels and high levels of attrition are often observed. The worksite could be a setting suitable for reaching and retaining large numbers of people, but little is known about reach and use of Internet-delivered health promotion programs in the worksite setting.

Objective

This study aimed (1) to gain more insight in the use of the website component of a worksite behavior change intervention and (2) to identify demographic, behavioral, and psychosocial factors associated with website use.

Methods

The study was an observational study among participants from 5 workplaces in a cluster randomized controlled trial. At baseline, all participants visited a study website to fill out the baseline questionnaire. Then a physical health check was done followed by face-to-face advice. After this contact, all participants received an email to promote visiting the website to view their health check results and the personal advice based on the baseline questionnaire. In the subsequent period, only participants in the intervention group received monthly email messages to promote website visits and were offered additional Web-based tools (self-monitors and a food frequency questionnaire [FFQ] assessing saturated fat intake) to support their behavior change. Website use was monitored by website statistics registering website access. Complete data were available for 726 employees. Logistic regression analyses were conducted to identify characteristics of employees who visited and used the website.

Results

In total, 43% of the participants visited the website after the email to promote website visits. Participants who were insufficiently physically active were less likely to visit the website (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.45-0.88), whereas individuals with an elevated total cholesterol level visited the website more often (OR 1.44, 95% CI 1.05-1.98). The monthly emails in the intervention group resulted in higher website use during a 3-month period (18% versus 5% in the reference group, OR 3.96, 95% CI 2.30-6.82). Participants with a positive attitude toward increasing physical activity were less likely to visit the website (OR 0.54, 95% CI 0.31-0.93) or to use the self-monitor and FFQ (OR 0.50, 95% CI 0.25-0.99). Female workers visited the website more often to monitor their behavior and to receive advice on fat intake (OR 2.36, 95% CI 1.14-4.90).

Conclusions

Almost half of the participants used the website component of a worksite behavior change program. Monthly emails were a prompt to visit the website, but website use remained low. More women than men used the website to obtain personalized advice for behavior change. No consistently higher participation was found among those with healthier behaviors. This health promotion program did not provide an indication that healthier subjects are more susceptible to health promotion.

Trial Registration

ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353 (Archived by WebCite at http://www.webcitation.org/5smxIncB1)     

Compliance with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India

Background

Anaemia is highly prevalent among pregnant women and iron deficiency is the most important cause. Like many other countries, India has policies to give pregnant women iron supplements. Non-compliance is one important challenging factor in combating anaemia.

Objective

To estimate the compliance for IFA tablets among pregnant women and to study the social factors influencing it.

Methodology

This study included 190 pregnant women seeking ante-natal care in tertiary health centres in the Mangalore city in south India. After Institutional Ethics Committee (IEC) approval, data was collected by personal interview. Missing >2 doses consecutively was considered non-compliance. The data was analyzed using SPSS (Statistical Package for Social Sciences) version 11.5.

Results

The mean age of the study population was 25.8 years (SD: 4.1). Most of the subjects consumed mixed diet and 72.1% belonged to lower socioeconomic status. Overall, compliance with IFA tablets was 64.7%. Compliance increased with the increase in age, birth order and single daily dose. Forgetfulness and both perceived as well as experienced side effects of IFA therapy were the important factors for non-compliance.

Conclusion

There was a moderate level of compliance towards IFA tablets with key social and demographic factors playing an important role.     

Assessment of thyroid function during pregnancy: the advantage of self-sequential longitudinal reference intervals

Introduction

To evaluate clinical value of a new self-sequential longitudinal reference intervals of thyroid function during pregnancy.

Material and methods

We established two different series of reference intervals: self-sequential longitudinal reference intervals (SLRI) and general gestation-specific reference intervals (GSRI). For SLRI, the serum of 301 cases were collected five times in every case throughout the gestation. For GSRI, A total of 1455 subjects included in the study. We collected the serum respectively at various trimesters. We used TSH of both reference intervals to screen 1744 pregnant women, and compared the percentage of potential misclassification.

Results

Both SLRI and GSRI differed substantially from that for non-pregnant women (p < 0.05). There are similar fluctuations of serum TSH, FT4 and TPO-Ab during normal pregnancy. Although there were no significant differences in most reference intervals between SLRI and GSRI. But the IQR of SLRI were usually smaller than GSRI , especially in 1^st trimester. Two hundred and fifty two women (14.4%) at various trimesters whose serum TSH concentration was within SLRI would be misclassified, while 23 women (1.3%) with a TSH concentration outside limit would not be identified. 0.11-3.84% women would got thyroid diseases during pregnancy. Subclinical hypothyroidism is most common maternal thyroid disorders.

Conclusions

The SLRI can reflected the changes of thyroid function realistically, and can be used to decrease the percentage of potential misclassification of thyroid dysfunction during pregnancy. Screening for thyroid dysfunction of pregnant women is recommended and important.     

Iron Deficiency Anaemia in Reproductive Age Women Attending Obstetrics and Gynecology Outpatient of University Health Centre in Al-Ahsa,Saudi Arabia

Background

Iron deficiency is the most common nutritional disorder in the world. The aim of this questionnaire based survey study was to determine the prevalence of iron deficiency anemia in reproductive age women, and their relation to variables such as age, marital status, education with those attending obstetrics and gynecology outpatient of King Faisal University Health Centre in Al-Ahsa in eastern region of Kingdom of Saudi Arabia.

Materials and Methods

This study was conducted for the period of 6 month staring from September 2012 to February 2013. The questionnaire had three sections on personal information: their educational indicators, gynecological clinical history, and hematological indices.

Results

The average age was 25.97±7.17 years. According to the gynecological clinical history of the respondents, 15 (48.4%) respondents were pregnant while 16 (51.6%) were not pregnant. There was significant effect of pregnancy status on Hb level. Majority of the anemic respondents 15/17 were married. Moreover 14/17 anemic women were experiencing severe menstrual bleeding, 11/17 respondents were pregnant. 54.8% of respondents were hemoglobin deficient while 77.4% were found to have low Hct. In 87.1 % of the respondents, transferrin saturation was found to be abnormal.

Conclusion

In this study iron deficiency anemia is quite prevalent in the university community especially among pregnant women. The fetus''s and newborn infant''s iron status depends on the iron status of the pregnant woman and therefore, iron deficiency in the mother-to-be means that growing fetus probably will be iron deficient as well. Thus iron deficiency anemia during pregnancy in well-educated set up needs more attention by the concerned authorities.     

Effect of emailed messages on return use of a nutrition education website and subsequent changes in dietary behavior

Background

At-risk populations can be reached with Web-based disease prevention and behavior change programs. However, such eHealth applications on the Internet need to generate return usage to be effective. Limited evidence is available on how continued usage can be encouraged.

Objective

This analysis tested whether routine email notification about a nutrition education website promoted more use of the website.

Methods

Adults from six rural counties in Colorado and New Mexico, United States (n = 755) participating in a randomized trial and assigned to the intervention group (n = 380) received, over a period of 4 months, email messages alerting them to updates on the website, along with hyperlinks to new content. Update alerts were sent approximately every 5 weeks (each participant received up to 4 messages). Log-ons to the website were the primary outcome for this analysis.

Results

A total of 23.5% (86/366) of the participants responded to at least one email, and 51.2% (44/86) of these participants responded to half of the email messages by logging on to the website. Significantly more log-ons occurred on email notification days compared to all other days (OR = 3.71, 95% CI = 2.72-5.06). More log-ons also occurred just after the notification but declined each day thereafter (OR = 0.97, 95% CI = 0.96-0.98 one day further from mass email). Non-Hispanics (OR = 0.46, 95% CI = 0.26-0.84), older participants (OR = 1.04, 95% CI = 1.04-1.06), and those using the Internet most recently (OR = 0.62, 95% CI = 0.51-0.77) were more likely to log on. Responders to the messages had a more positive change in fruit and vegetable intake (mean change = +1.69) than nonresponders (+0.05), as measured with a food frequency assessment (adjusted Spearman partial correlation coefficient = 0.14, P = .049). Compared to nonresponders, responders were more likely to be non-Hispanic (P = .01), older (P < .001), and had used the Internet more recently (P < .001).

Conclusions

Messages sent by email appeared to promote a modest short-lived increase in use of a disease prevention website by some adults. Those who responded to the messages by logging on to the website may have been influenced to improve their diet.     

Natural coagulation inhibitors and active protein c resistance in preeclampsia

INTRODUCTION:

The etiology of preeclampsia is not fully established. A few studies have shown a relationship between natural coagulation inhibitors and preeclampsia.

OBJECTIVES:

The purpose of this study was to investigate the status of natural coagulation inhibitors and active protein C resistance (APC‐R) in preeclampsia.

PATIENTS AND METHODS:

We studied 70 women with preeclampsia recruited consecutively and 70 healthy pregnant and 70 nonpregnant women as controls. Plasma protein C (PC), free protein S (fPS), antithrombin III (ATIII) and APC‐R were evaluated.

RESULTS:

ATIII values were found to be significantly lower in preeclamptic patients than in the control groups (p< 0.001). Nevertheless, there was no significant difference between the healthy pregnant and nonpregnant women groups (p = 0.141). The fPS values of the preeclamptic and healthy pregnant groups were lower than that of the nonpregnant group (p< 0.001), and the fPS value of the preeclamptic pregnant women was lower than that of healthy pregnant women (p<0.001). The PC value of the preeclamptic pregnant women was lower than that of the control groups (p< 0.001). The PC value of the healthy pregnant women was lower than that of the nonpregnant women (p< 0.001). The mean APC activity values were lower in the preeclamptic patients than that of the control groups (p< 0.001, p< 0.001). The APC‐R positivity rates of the preeclamptic groups were higher than that of the control groups (p<0.001).

CONCLUSIONS:

This study demonstrated that ATIII, fPS, PC values and APC resistance were lower and APC‐R positivity was higher in preeclamptic women than in normal pregnant and nonpregnant women.