Lifestyle Modification Interventions in Pregnancy to Reduce Recurrent Gestational Diabetes

Lifestyle Modification Interventions in Pregnancy to Reduce Recurrent Gestational Diabetes Mellitus (GDM). Abstract Background:In the epidemiologic context of explosion in maternal obesity, the incidence of GDM has significantly increased worldwide. Macrosomia is the most common complication in GDM and the main factor linked to other neonatal complications. Studies suggest that pregnant women with a history of GDM are at increased risk of recurrence. Aim/Objectives: The primary aim is to determine if lifestyle modification interventions, from the start of pregnancy, will reduce GDM recurrence. Additional objectives include developing written guidelines for implementation of lifestyle modifications to reduce GDM recurrence at my current practice. Methods: The targeted population is pregnant women receiving antenatal care at Women First OB/GYN Clinic in Reston, Virginia. The study population will comprise of 8-15 pregnant women with previous history of GDM. The intervention begins with reviewing patient charts for those with a history of GDM, and baseline information on participants. Institute of Medicine pregnancy weight chart will be use to assess appropriate weight gain. Monthly medical nutritional therapy will be arranged; monthly one-on-one counseling will be scheduled. The PRECEDE-PROCEED model will provide the structural framework for developing the lifestyle modifications intervention. Paired t-test will be used to analyze data. Conclusion: Successful implementation of the program has the potential of reducing GDM recurrence by promoting adherence to programs that encourage appropriate weight gains in pregnancy. It will also lead to improved maternal and offspring health by reducing neonatal and perinatal mortality and morbidity rates of our patients

The Effects of Peer-Tutoring in Social Skills Development Groups for Antisocial Children

Sixteen children in grades 1–6, displaying antisocial behavior, as judged by teachers, guidance counsellors, principals and parents, participated in an 18 week social skills training program. The effectiveness of the program was assessed using a pre-test, post-test non-equivalent comparison group design and a multiple baseline analysis of individual children’s daily positive and negative behavior as rated by teachers. The comparison group consisted of 16 social skilled children, as judged by teachers, guidance counsellors and principals. Results indicated that the antisocial children had as much knowledge of social skills as socially skilled children before the intervention program began and they gained even more knowledge after participating in the program. The pre-post tests showed little improvement in the overall behavior of the children who participated in the program. However, the daily report data indicated that specific negative behaviors significantly decreased during the program. Results were discussed in terms of the need for a more intensive, long-term intervention program focusing on the child&38217;s natural environment to modify the child’s overall behavior

Taking HIV testing to families: designing a family-based intervention to facilitate HIV testing, disclosure and intergenerational communication

Introduction: Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents and adults who are not accessing health facilities. While home based counseling and testing has been succesfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated. Methods: The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention. Results: The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed and older families). There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored. Conclusion: This paper maps the process for adapting a novel and largely successful home-based counseling and testing intervention for use with families. Expanding the successful home-based counseling and testing model to capture children, adolescents and men could have significant impact if the pilot is successful and scaled-up

The Health Status and Unique Health Challenges of Rural Older Adults in California

Examines the demographics, health, and levels of physical activity and food insecurity of rural seniors compared with those of urban and suburban seniors. Outlines environmental and social risk factors that require context-specific policies and programs

Detach Yourself:The Positive Effect of Psychological Detachment on Patient Safety in Long-Term Care

OBJECTIVES: Delivering health care is emotionally demanding. Emotional competencies that enable caregivers to identify and handle emotions may be important to deliver safe care, as it improves resilience and enables caregivers to make better decisions. A relevant emotional competence could be psychological detachment, which refers to the ability to psychologically detach from work and patients in off-duty hours. The objective of this study was to examine the relationship between psychological detachment and patient safety. In addition, the ability of teams to create a safe environment to discuss errors and take personal risks, i.e., psychological safety, was explored as an underlying condition for psychological detachment. METHODS: A total of 1219 caregivers (response rate = 44%) from 229 teams in two long-term care organizations completed a survey on psychological safety and psychological detachment at T0. Team managers rated patient safety of those teams at two points in time (T0 and T1). RESULTS: Two-level regression analysis showed that both psychological safety (β = 0.72, P < 0.01) and psychological detachment (β = 0.54, P < 0.05) relate directly to patient safety. Psychological safety relates positively to psychological detachment (β = 0.48, P < 0.01) but was, however, not an underlying condition. CONCLUSIONS: Perceived patient safety is enhanced by emotional competencies, at individual level by psychological detachment and at team level by psychological safety. Caregivers should be aware of the important influence emotional competencies have on patient safety and be trained to develop these competencies. Future research should focus on exploring underlying conditions for emotional competencies

“If you are circumcised, you are the best”: understandings and perceptions of voluntary medical male circumcision among men from KwaZulu-Natal, South Africa.

While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men’s decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them

Resilient, recovering, distressed: A longitudinal qualitative study of parent psychosocial trajectories following child critical injury

Introduction The psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury. Methods Semi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time. Findings Three parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child’s injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time; recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months; and distressed trajectory where parents experienced significant psychosocial disruption due to their child’s injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented. Conclusions This is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families’ psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child’s admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum

A Delicate Balance - Adaptive Design and Team Learning in the Operating Theatre

__Abstract__ Since the publication of the Institute of Medicine (IOM) study “To Err is human”, followed by “Crossing the Quality Chasm” two years later, patient safety has become an important concern for all involved: patients, professionals and health care organisations (Bleich, 2005; Kohn, 2000). Over the last 10 years, significant improvements have been made and many innovative initiatives resulted in enhanced patient safety. At both national and international level checklists and performance indicators were developed,