Building Capacity for Research and Audit: Outcomes of a Training Workshop for Pacific Physicians and Nurses

Building the research capacity of clinicians in the Pacific Island countries is important in addressing evidence gaps relevant to local policy and clinical practice. This paper aimed to assess the effectiveness of a reproductive health research workshop in increasing research knowledge and intention to perform research amongst a diverse group of clinicians. An online survey of clinicians and stakeholders in the Pacific Islands informed a research workshop curriculum. Physicians and nurses/midwives (n = 28) from six Pacific Island countries were selected as workshop participants as part of a research capacity building program. Questionnaires before after the workshop were used to measure the changes in knowledge, confidence, competence, attitudes and intention to perform research and these were analysed thematically. Sixty-three of 85 (74%) stakeholders and clinicians responded to an online survey, which informed workshop curriculum development. Of the 28 workshop participants, seven were obstetrician-gynaecologists, eight junior physicians and eleven nurses/midwives. The mean pre-test score was 36% (±10) and the post-test was 43% (±6) (p<0.01). By profession, the obstetricians had higher prior research knowledge whereas nurses had a higher knowledge gain after the workshop. Attitude, intention and motivation to perform research was high and the participants learnt that research is important, to start small; to use routinely collected data; to encourage others to do research; and to network regionally. This paper has confirmed that online surveys, in low resource settings, can have an acceptable response rate. It has also shown that a research workshop for a diverse group of clinicians can be effective in increasing knowledge although knowledge gained was more significant amongst nurses/midwives compared to physicians. The other benefits of the research workshop were increased motivation and attitudes for research, which if well supported, should result in an increase in research output in the Pacific Islands. Future evaluation will assess the long-term effectiveness of annual research workshops and mentoring support in improving research performance and evidence utilisation in care

Association between maternal sleep practices and risk of late stillbirth: a case-control study

Objectives To determine whether snoring, sleep position, and other sleep practices in pregnant women are associated with risk of late stillbirth

Going to sleep in the supine position is a modifiable risk factor for late pregnancy stillbirth; findings from the New Zealand multicentre stillbirth case-control study

Objective: Our objective was to test the primary hypothesis that maternal non-left, in particular supine going-to-sleep position, would be a risk factor for late stillbirth (≥28 weeks of gestation). Methods: A multicentre case-control study was conducted in seven New Zealand health regions, between February 2012 and December 2015. Cases (n=164) were women with singleton pregnancies and late stillbirth, without congenital abnormality. Controls (n=569) were women with on-going singleton pregnancies, randomly selected and frequency matched for health region and gestation. The primary outcome was adjusted odds of late stillbirth associated with self-reported going-to-sleep position, on the last night. The last night was the night before the late stillbirth was thought to have occurred or the night before interview for controls. Going to- sleep position on the last night was categorised as: supine, left-side, right-side, propped or restless. Multivariable logistic regression adjusted for known confounders. Results: Supine going-to-sleep position on the last night was associated with increased late stillbirth risk (adjusted odds ratios (aOR) 3.67, 95% confidence interval (CI) 1.74 to 7.78) with a population attributable risk of 9.4%. Other independent risk factors for late stillbirth (aOR, 95% CI) were: BMI (1.04, 1.01 to 1.08) per unit, maternal age ≥40 (2.88, 1.31 to 6.32), birthweight <10th customised centile (2.76, 1.59 to 4.80), and <6 hours sleep on the last night (1.81, 1.14 to 2.88). The risk associated with supine-going-to sleep position was greater for term (aOR 10.26, 3.00 to 35.04) than preterm stillbirths (aOR 3.12, 0.97 to 10.05). Conclusions: Supine going-to-sleep position is associated with a 3.7 fold increase in overall late stillbirth risk, independent of other common risk factors. A public health campaign encouraging women not to go-to-sleep supine in the third trimester has potential to reduce late stillbirth by approximately 9%

Relationship between obesity, ethnicity and risk of late stillbirth: a case control study

<p>Abstract</p> <p>Background</p> <p>In high income countries there has been little improvement in stillbirth rates over the past two decades. Previous studies have indicated an ethnic disparity in the rate of stillbirths. This study aimed to determine whether maternal ethnicity is independently associated with late stillbirth in New Zealand.</p> <p>Methods</p> <p>Cases were women with a singleton, late stillbirth (≥28 weeks' gestation) without congenital abnormality, born between July 2006 and June 2009 in Auckland, New Zealand. Two controls with ongoing pregnancies were randomly selected at the same gestation at which the stillbirth occurred. Women were interviewed in the first few weeks following stillbirth, or at the equivalent gestation for controls. Detailed demographic data were recorded. The study was powered to detect an odds ratio of 2, with a power of 80% at the 5% level of significance, given a prevalence of the risk factor of 20%. A multivariable regression model was developed which adjusted for known risk factors for stillbirth, as well as significant risk factors identified in the current study, and adjusted odds ratios and 95% confidence intervals were calculated.</p> <p>Results</p> <p>155/215 (72%) cases and 310/429 (72%) controls consented. Pacific ethnicity, overweight and obesity, grandmultiparity, not being married, not being in paid work, social deprivation, exposure to tobacco smoke and use of recreational drugs were associated with an increased risk of late stillbirth in univariable analysis. Maternal overweight and obesity, nulliparity, grandmultiparity, not being married and not being in paid work were independently associated with late stillbirth in multivariable analysis, whereas Pacific ethnicity was no longer significant (adjusted Odds Ratio 0.99; 0.51-1.91).</p> <p>Conclusions</p> <p>Pacific ethnicity was not found to be an independent risk factor for late stillbirth in this New Zealand study. The disparity in stillbirth rates between Pacific and European women can be attributed to confounding factors such as maternal obesity and high parity.</p

Demographic characteristics and sleep factors among 164 women who experienced a late stillbirth, between 2012 and 2015, compared to 569 controls.

<p>Demographic characteristics and sleep factors among 164 women who experienced a late stillbirth, between 2012 and 2015, compared to 569 controls.</p

Analysis of going-to-sleep position and late stillbirth stratified by preterm and term gestation.

<p>Analysis of going-to-sleep position and late stillbirth stratified by preterm and term gestation.</p

Late gestation stillbirth risk attributable to potentially modifiable risk factors in this study population.

<p>Late gestation stillbirth risk attributable to potentially modifiable risk factors in this study population.</p