Taking a patient-oriented approach in exercise interventions for pregnant women: a commentary

Taking a patient-oriented approach to developing lifestyle interventions includes incorporating the patient into the program’s design, delivery, and evaluation. This commentary assumes that a patient-oriented approach has not yet been implemented and tested in exercise-based interventions designed for pregnant women. We outline and define a patient-oriented approach to conduct exercise-based research and review previous physical activity interventions designed for pregnant women to determine whether a patient-oriented approach was applied. In addition, pregnant women living with obesity may have unique barriers to engaging in prenatal exercise interventions that have not been previously addressed, such as having experienced weight stigma before pregnancy in healthcare and fitness settings. We propose suggestions for future trials to effectively take a patient-oriented approach when designing and implementing prenatal exercise interventions to address patient-informed barriers and incorporate suggested facilitators for physical activity. Given that prenatal activity levels are low and pregnant women may have unique barriers to engaging in exercise interventions, a patient-oriented approach may be an effective strategy to improve inclusivity and equity and, as a result, increase uptake and adherence to the intervention.     

Differences in patient perceptions of integrated care among black,hispanic, and white Medicare beneficiaries

ObjectiveThis study sought to identify potential disparities among racial/ethnic groups in patient perceptions of integrated care (PPIC) and to explore how methodological differences may influence measured disparities.Data SourceData from Medicare beneficiaries who completed the 2015 Medicare Current Beneficiary Survey (MCBS) and were enrolled in Part A benefits for an entire year.Study DesignWe used 4‐point measures of eight dimensions of PPIC and assessed differences in dimensions among racial/ethnic groups. To estimate differences, we applied a “rank and replace” method using multiple regression models in three steps, balancing differences in health status among racial groups and adjusting for differences in socioeconomic status. We reran all analyses with additional SES controls and using standard multiple variable regression.Data Collection/Extraction MethodsNot applicable.Principal FindingsWe found several significant differences in perceived integrated care between Black versus White (three of eight measures) and Hispanic versus White (one of eight) Medicare beneficiaries. On average, Black beneficiaries perceived more integrated support for self‐care than did White beneficiaries (mean difference = 0.14, SE = 0.06, P =.02). Black beneficiaries perceived more integrated specialists’ knowledge of past medical history than did White beneficiaries (mean difference = 0.12, SE = 0.06, P =.01). Black and Hispanic beneficiaries also each reported, on average, 0.18 more integrated medication and home health management than did White beneficiaries (P <.01 and P <.01). These findings were robust to sensitivity analyses and model specifications.ConclusionsThere exist some aspects of care for which Black and Hispanic beneficiaries may perceive greater integrated care than non‐Hispanic White beneficiaries. Further studies should test theories explaining why racial/ethnic groups perceive differences in integrated care.     

Collaborative working in health and social care: Lessons learned from post-hoc preliminary findings of a young families’ pregnancy to age 2 project in South Wales,United Kingdom

Children of young and socially disadvantaged parents are more likely to experience adverse outcomes. In response to this, a unique young families’ project in Swansea, UK, was created, which drew together a team of multi-agency professionals, to support people aged 16–24 from 17 weeks of pregnancy throughout 1,001 days of the child's life. The aim of the JIGSO (the Welsh word for Jigsaw) project is for young people to reach their potential as parents and to break the cycle of health and social inequality. This evaluation analysed routinely collected data held by the project from January 2017 to December 2018 exploring health and social outcomes, including smoking and alcohol use in pregnancy, breastfeeding, maternal diet and social services outcomes. Outcomes were compared to local and national averages, where available. Data relating to parenting knowledge and skills were available via records of 10-point Likert scales, one collected at the start of the JIGSO involvement and one around 4–6 months later. Findings showed higher than average levels of breastfeeding initiation and lower smoking and alcohol use in pregnancy. Parents also reported enhanced knowledge and confidence in their child care skills, as well as improved family relationships. Parents with high levels of engagement with JIGSO also appeared to have positive outcomes with Social Services (their child's name was removed from child protection register or their case was closed to social services). This was a post-hoc evaluation, not an intervention study or trial, and thus findings must be interpreted with caution. Despite this, the findings are promising and more prospective research exploring similar services is required.     

Chlorhexidine susceptibility and Eagle effect in planktonic cells and biofilm of nosocomial isolates

European Journal of Clinical Microbiology & Infectious Diseases - The aim of this study is to evaluate the chlorhexidine gluconate (CHG) susceptibility in both planktonic cells and biofilm of...     

{alpha}-Amylase hypersensitivity in non-exposed millers

Occupational hypersensitivity to -amylase among bakers and workersin the pharmaceutical industry has been described. We presentthe results of skin tests and in vitro methods used to assess-amylase sensitivity in 259 millers. There was no occupationalcontact with the enzyme in this population. Positive skin teststo this allergen were obtained in 16 subjects (6.18 per cent),specific IgE values were found in seven subjects (2.7 per cent),specific IgG was detected on 45 workers (17.37 per cent) andhigh values for IgG (>2.5 absorbance units) were found in12 subjects (4.63 per cent). Furthermore, specific IgE and IgGcould be determined in several sera by immunoblotting. All these facts suggested that millers were sensitized to Aspergillusoryzae -amylase, although the allergen was not used by theseworkers. A cross-reaction cannot be excluded; however, it isthe authors' opinion that wheat or wheat flour is a naturalsubstrate for fungi and that the moulds that grow on cerealsor cereal-derived by-products need to secrete amylases to supporttheir own development. Hence the workers may be indirectly sensitizedto amylases.     

Skin-prick tests for hypersensitivity to {alpha}-amylase preparations

Twenty-five asthmatic subjects with suspected -amylase hypersensitivitywere studied by skin-prick tests, a capture ELISA, immunoblottingand bronchial provocation tests. At the same time, differentamylases were analysed by SDS-PAGE and immunoblotting usinga polyclonal rabbit antiserum. Eight patients showed a positivebronchial response to amylase. Seven of them had positive skin-pricktests, with this method being the most sensitive approach fordiagnosis. However, in four cases, skin tests were also positivealthough the patients had a negative provocation test, thusdemonstrating that skin tests are not specific. ELISA and blottingshowed similar results in terms of sensitivity and specificity.The enzymes used by the workers included several antigens besides-amylase. The rabbit antiserum to -amylase detected a proteinin a wheat flour extract. In one case, the IgE antibodies werespecific only for a contaminant of lower molecular weight thanamylase. These facts suggest that proteins from the culturemedium could be responsible for some cases of amylase hypersensitivity,making the diagnosis difficult. The presence of amylase in anotherenzymatic extract, a protease produced by Aspergillus oryzae,was proved by means of skin tests and immunoblotting, thus demonstratingthe allergenic properties of this enzymatic preparation.