Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index

Objective To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care. Methods We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost‐effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG avoided, cost per case of excessive GWG averted, and cost per case of LGA averted. Results Total mean cost including intervention and health care utilisation was €3745 in the intervention group and €3471 in the control group (mean difference €274, P = 0.08). The ICER was €2914 per QALY gained. Assuming a ceiling ratio of €45,000, the probability that the intervention was cost‐effective based on QALYs was 79%. Cost per kg of GWG avoided was €209. The cost-effectiveness acceptability curve (CEAC) for kg of GWG avoided reached a confidence level of 95% at €905, indicating that if one is willing to pay a maximum of an additional €905 per kg of GWG avoided, there is a 95% probability that the intervention is cost-effective. Costs per case of excessive GWG averted and case of LGA averted were €2117 and €5911, respectively. The CEAC for case of excessive GWG averted and for case of LGA averted reached a confidence level of 95% at €7090 and €25,737, respectively. Conclusions Results suggest that a mobile-health lifestyle intervention could be cost-effective; however, a better understanding of the short- and long-term costs of LGA and excessive GWG is necessary to confirm the results

CV20016

This report provides the main results and findings of the nineteenth annual underwater television survey on the Aran, Galway Bay and Slyne head Nephrops grounds, ICES assessment area; Functional Unit 17. The survey was multi-disciplinary in nature collecting UWTV, CTD and other ecosystem data. In 2020 a total of 44 UWTV stations were successfully completed, 34 on the Aran Grounds, 5 on Galway Bay and 5 on Slyne Head patches. The mean burrow density observed in 2020, adjusted for edge effect, was medium at 0.29 burrows/m². The final krigged burrow abundance estimate for the Aran Grounds was 359 million burrows with a CV (Coefficient of Variance; relative standard error) of 4%. The final abundance estimate for Galway Bay was 27 million and for Slyne Head was 7 million, with CVs of 13% and 4% respectively. The total abundance estimates have fluctuated considerably over the time series. The 2020 combined abundance estimate (394 million burrows) is 20% lower than in 2019, and it is below the MSY Btrigger reference point (540 million burrows). Using the 2020 estimate of abundance and updated stock data implies catches between 443 and 508 tonnes in 2021 that correspond to the F ranges in the EU multi annual plan for Western Waters, assuming that discard rates and fishery selection patterns do not change from the average of 2017–2019. Virgularia mirabilis was the only sea-pen species observed on the UWTV footage. Trawl marks were present at 7% of the Aran stations surveyed

An Observational Analysis of Meal Patterns in Overweight and Obese Pregnancy

Background Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI. Aim To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes. Methods Prospective, observational analysis of pregnant women (n = 143) (BMI 25–39.9 kg/m2). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks’ gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry. Results Three meal pattern categories were identified: ‘main meal dominant’ (3 main eating occasions + 0–3 snacks), ‘large meal dominant’ (≤ 2 main eating occasions + \u3c 2 snacks), and ‘snack dominant’ (3 main eating occasions + \u3e 3 snacks and ≤2main + ≥ 2 snacks). A main meal–dominant pattern prevailed at 16 weeks’ (85.3%) and a snack-dominant pattern at 28 weeks’ (68.5%). Dietary glycaemic index was lower among the main meal versus large meal–dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal–dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively). Conclusion Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal–dominant to snack-dominant patterns. Large meal–dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia

Five-Year Follow Up of a Low Glycaemic Index Dietary Randomised Controlled Trial in Pregnancy—No Long-Term Maternal Effects of a Dietary Intervention

Objective: To determine whether a dietary intervention in pregnancy had a lasting effect on maternal outcomes of diet, HbA1c and weight retention 5 years post-intervention; and to establish whether modifiable maternal behaviours were associated with these outcomes. Design: Randomised control trial of low glycaemic index (GI) diet in pregnancy with longitudinal follow up to 5 years post-intervention. Setting: Dublin, Ireland (2007–2016). Population: In all, 403 women of 759 (53.1%) were followed up at 5 years. A total of 370 (intervention n = 188; control n = 182) were included in this analysis. Methods: Fasting glucose was measured at 13 and 28 weeks’ gestation and HbA1c (mmol/mol) at 5-year follow up. Weight retention (kg) from early pregnancy to 5 years post-intervention was calculated. Dietary intakes, anthropometry, and lifestyle factors were measured in pregnancy and 5 years post-intervention. Multiple linear regression models, controlling for confounders, were used for analysis. Outcome: Maternal diet, HbA1c, and weight retention at 5 years post-intervention. Results: There was no difference between the intervention and control at 5 years post-intervention for any long-term maternal outcomes measured. HbA1c at 5 years post-intervention was associated with early-pregnancy fasting glucose (B 1.70, 95% CI 0.36–3.04) and parity ≥3 (B 1.04, 95% CI 0.09–1.99). Weight retention was associated with change in well-being from pregnancy to 5 years (B −0.06, 95% CI −0.11 to −0.02), gestational weight gain (B 0.19, 95% CI 0.00–0.38), and GI (B 0.26, 95% CI 0.06–0.46) at 5 years. Conclusions: The ROLO low-GI dietary intervention in pregnancy had no impact on maternal dietary intakes, HbA1c or body composition 5 years post-intervention. Maternal factors and lifestyle behaviours in pregnancy have long-term effects on glucose metabolism and weight retention up to 5 years later. Tweetable abstract: Pregnancy factors are associated with maternal glucose metabolism and weight retention 5 years later

Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT—An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity

Background: Diet quality and physical activity positively impact pregnancy outcomes among women with obesity, but successful lifestyle interventions require intense clinician time. We aimed to investigate the impact of a behavioral-lifestyle intervention (PEARS) supported by a smartphone app among pregnant women with overweight and obesity, on nutrient intake, behavioral stage-of-change and physical activity. Methods: Pregnant women (BMI 25–39.9 kg/m2, measured, n = 565) were randomized at 15.6 weeks\u27 gestation to the intervention (n = 278), or a control group (n = 287) (ISRCTN29316280). The intervention was grounded in behavior-change theory. Participants received nutrition (low glycaemic index and healthy eating) and exercise advice, a smartphone app and fortnightly emails. The control group received usual care which does not include dietary advice. At baseline and 28 weeks\u27 gestation, dietary data were obtained through 3-day food diaries (n = 290 matched), and stage-of-change and physical activity data were self-reported. App usage data were collected. Results: There were no differences between the groups at baseline. Compared with the control group, the intervention group had improved dietary intakes post-intervention with; lower glycaemic index (MD −1.75); free sugars (%TE) (MD −0.98); fat (%TE) (MD −1.80); and sodium (mg) (MD −183.49). Physical activity (MET-minutes/week) was higher in the intervention group post-intervention (MD 141.4; 95% CI 62.9, 219.9). The proportion of participants at “maintenance” stage-of-change for physical activity was higher in the intervention group (56.3 vs. 31.2%). App use was associated with lower glycaemic index and less energy from free sugars, but not with physical activity. Conclusion: A behavioral-lifestyle intervention in pregnancy supported by a smartphone app improved dietary intakes, physical activity, and motivation to engage in exercise

CV20019

This report provides the main results of the eleventh underwater television survey of the various Nephrops patches in Functional Unit 19. The survey was multi-disciplinary in nature collecting UWTV, multi-beam and other ecosystem data. In 2020 a total 42 UWTV stations were successfully completed. The mean density estimates varied considerably across the different patches. The 2020 raised abundance estimate was a 20% decrease from the 2019 estimate and at 320 million burrows is below the MSY Btrigger reference point (430 million). Using the 2020 estimate of abundance and updated stock data implies catch in 2021 that correspond to the F ranges in the EU multi annual plan for Western Waters are between 531 and 595 tonnes (assuming that discard rates and fishery selection patterns do not change from the average of 2017–2019). Two species of sea pen were observed; Virgularia mirabilis and Pennatula phosphorea which have been observed on previous surveys of FU19. Trawl marks were observed at 26% of the stations surveyed

Subtidal macrozoobenthos communities from northern Chile during and post El Niño 1997–1998

Despite a large amount of climatic and oceanographic information dealing with the recurring climate phenomenon El Niño (EN) and its well known impact on diversity of marine benthic communities, most published data are rather descriptive and consequently our understanding of the underlying mechanisms and processes that drive community structure during EN are still very scarce. In this study, we address two questions on the effects of EN on macrozoobenthic communities: (1) how does EN affect species diversity of the communities in northern Chile? and (2) is EN a phenomenon that restarts community assembling processes by affecting species interactions in northern Chile? To answer these questions, we compared species diversity and co-occurrence patterns of soft-bottoms macrozoobenthos communities from the continental shelf off northern Chile during (March 1998) and after (September 1998) the strong EN event 1997–1998. The methods used varied from species diversity and species co-occurrence analyses to multivariate ordination methods. Our results indicate that EN positively affects diversity of macrozoobenthos communities in the study area, increasing the species richness and diversity and decreasing the species dominance. EN represents a strong disturbance that affects species interactions that rule the species assembling processes in shallow-water, sea-bottom environments

The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study

Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve maternal and neonatal outcomes in the countdown to 2015

Working relationships between obstetric care staff and their managers: a critical incident analysis

Background Malawi continues to experience critical shortages of key health technical cadres that can adequately respond to Malawi’s disease burden. Difficult working conditions contribute to low morale and frustration among health care workers. We aimed to understand how obstetric care staff perceive their working relationships with managers. Methods A qualitative exploratory study was conducted in health facilities in Malawi between October and December 2008. Critical Incident Analysis interviews were done in government district hospitals, faith-based health facilities, and a sample of health centres’ providing emergency obstetric care. A total of 84 service providers were interviewed. Data were analyzed using NVivo 8 software. Results Poor leadership styles affected working relationships between obstetric care staff and their managers. Main concerns were managers’ lack of support for staff welfare and staff performance, lack of mentorship for new staff and junior colleagues, as well as inadequate supportive supervision. All this led to frustrations, diminished motivation, lack of interest in their job and withdrawal from work, including staff seriously considering leaving their post. Conclusions Positive working relationships between obstetric care staff and their managers are essential for promoting staff motivation and positive work performance. However, this study revealed that staff were demotivated and undermined by transactional leadership styles and behavior, evidenced by management by exception and lack of feedback or recognition. A shift to transformational leadership in nurse-manager relationships is essential to establish good working relationships with staff. Improved providers’ job satisfaction and staff retentionare crucial to the provision of high quality care and will also ensure efficiency in health care delivery in Malawi

Attracting and retaining health workers in rural areas: investigating nurses’ views on rural posts and policy interventions

<p>Abstract</p> <p>Background</p> <p>Kenya has bold plans for scaling up priority interventions nationwide, but faces major human resource challenges, with a lack of skilled workers especially in the most disadvantaged rural areas.</p> <p>Methods</p> <p>We investigated reasons for poor recruitment and retention in rural areas and potential policy interventions through quantitative and qualitative data collection with nursing trainees. We interviewed 345 trainees from four purposively selected Medical Training Colleges (MTCs) (166 pre-service and 179 upgrading trainees with prior work experience). Each interviewee completed a self-administered questionnaire including likert scale responses to statements about rural areas and interventions, and focus group discussions (FGDs) were conducted at each MTC.</p> <p>Results</p> <p>Likert scale responses indicated mixed perceptions of both living and working in rural areas, with a range of positive, negative and indifferent views expressed on average across different statements. The analysis showed that attitudes to working in rural areas were significantly positively affected by being older, but negatively affected by being an upgrading student. Attitudes to living in rural areas were significantly positively affected by being a student at the MTC furthest from Nairobi.</p> <p>During FGDs trainees raised both positive and negative aspects of rural life. Positive aspects included lower costs of living and more autonomy at work. Negative issues included poor infrastructure, inadequate education facilities and opportunities, higher workloads, and inadequate supplies and supervision. Particular concern was expressed about working in communities dominated by other tribes, reflecting Kenya’s recent election-related violence.</p> <p>Quantitative and qualitative data indicated that students believed several strategies could improve rural recruitment and retention, with particular emphasis on substantial rural allowances and the ability to choose their rural location. Other interventions highlighted included provision of decent housing, and more rapid career advancement. However, recently introduced short term contracts in named locations were not favoured due to their lack of pension plans and job security.</p> <p>Conclusions</p> <p>This study identified a range of potential interventions to increase rural recruitment and retention, with those most favored by nursing students being additional rural allowances, and allowing choice of rural location. Greater investment is needed in information systems to evaluate the impact of such policies.</p