Content Analysis of Public Instagram Posts about Pelvic Floor Disorders and Pelvic Floor Muscle Training in Pregnancy

Objective: To analyze the content of public Instagram posts and describe the discussion of pelvic floor disorders (PFDs) and pelvic floor muscle training (PFMT)/pelvic floor physical therapy (PFPT) in pregnancy. Methods: Public Instagram accounts based in the U.S. with posts within the past 7 days focused on pregnancy were included. We analyzed English posts related to pelvic floor health, PFDs or PFMT. We categorized accounts by user type, health-related expertise, business endorsement, and influencer status. We categorized posts by content (informative, recommendation, sharing experience, meme, advertisement), context (informative, preventive, interventive), and terminology (scientific, lay). We used chi-squared tests to compare scientific terminology use and PFMT/PFPT recommendation presence by user type and health-related expertise. Results: 156 posts from 21 Instagram accounts were included. Most users presented as companies (43%), provided a link to a business (95%), claimed licensed health-related expertise (43%), and were meso-influencers (72%). Most posts were in an informative (45%) or interventive (41%) context, and included information (81%), an advertisement (48%) and/or a recommendation (47%). Fifty-two percent of posts with a recommendation endorsed PFMT/PFPT. Most posts used lay terminology (40%) or scientific and lay terminology (36%). Use of scientific terminology differed by health-related expertise (p=0.0014) but not user type (p=0.1489). Recommendations for PFMT/PFPT did not differ by user type (p=0.0654) or health-related expertise (p=0.1277). Conclusions: Public health policy should target preventive information and resources for PFMT towards pregnant persons on social media. Future research is needed to evaluate quality of pelvic floor health information and recommendations during pregnancy

e-Prescribing and Patient Safety: Results From a Mixed Method Study

Objective: To describe the perspectives of ambulatory care clinicians on the effect of electronic prescribing (e-prescribing) systems on patient safety outcomes. Study Design: Mixed method study of clinicians and staff in 64 practices using 1 of 6 e-prescribing technologies in 6 US states. Methods: We used clinician surveys (Web-based and paper) and focus groups to obtain the perspectives of clinicians on e-prescribing and patient safety. Results: Providers highly valued having medications prescribed by other providers on the medication list and the ability to access patient medication lists remotely. Providers thought that there will always be prescription or medication errors and that the implementation of e-prescribing software changes rather than eliminates prescription or medication errors. New errors related to the dosing or scheduling of a medication, accidentally prescribing the wrong drug, or duplicate prescriptions. Conclusions: Lessons from the ambulatory care trenches must be considered as technology moves forward so that the hypothesized patient safety gains will be realized

Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study

BACKGROUND: Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps. OBJECTIVE: This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss. METHODS: Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks. RESULTS: Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight (P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed (P=.62 and P=.27, respectively). CONCLUSIONS: Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2). Danielle E Jake-Schoffman. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.06.2018

Exploring Perceptions of Sugar Sweetened Beverages Among Early Adolescents in Worcester, MA: a Qualitative Study

Background: Among adolescents, sugar-sweetened beverages (SSBs) are the primary source of added dietary sugar and constitute 10-15% of their total caloric intake. A range of factors influence adolescent dietary behaviors and food choices. This study aimed to explore adolescents\u27 attitudes and knowledge about SSBs, how they receive messages about SSBs, and motivations for SSB consumption. Methods: We conducted 5 focus groups with youth aged 12-14 years that attend one of the eight Youth Connect programs in Worcester, MA in 2016-2017. Groups were sex-specific because of changes during adolescence and experiences with body image and health behaviors between the groups. A semi-structured guide was used to facilitate a discussion with adolescents\u27 around SSBs. The audio recorded data were transcribed and all transcripts were double coded. The data were analyzed using thematic analysis. Results: Discussions included 16 boys in three focus groups and 17 girls in two groups. Participants were 12-14 years old, 27% identified as Hispanic, 24% black and 33% white. One third speaks more than one language at home and the majority consume SSBs daily. Qualitative analysis led to the identification and classification of various subdimensions under the following analytic categories: Attitudes, Motivations, Knowledge, and SSB Messaging. Common themes that emerge under each category will be reported. Analyses are in progress. Conclusions: This research will present a deeper understanding of factors that influence Worcester adolescents\u27 beverage choices from their own perspective. The information can be used in public health messaging in Worcester around obesogenic behaviors such as excess caloric intake from SSBs

Diet quality and history of gestational diabetes mellitus among childbearing women, United States, 2007-2010

INTRODUCTION: Women with a history of gestational diabetes mellitus (GDM) have elevated risk of developing type 2 diabetes. Diet quality plays an important role in the prevention of type 2 diabetes. We compared diet quality among childbearing women with a history of GDM with the diet quality of childbearing women without a history of GDM. METHODS: We used data from the National Health and Nutrition Examination Survey for 2007 through 2010. We included women without diabetes aged 20 to 44 years whose most recent live infant was born within the previous 10 years and who completed two 24-hour dietary recalls. The Healthy Eating Index (HEI)-2010 estimated overall and component diet quality. Multivariable linear regression models estimated the association between a history of GDM and current diet quality, adjusting for age, education, smoking status, and health risk for diabetes. RESULTS: A history of GDM was reported by 7.7% of women. Compared with women without a history of GDM, women with a history of GDM had, on average, 3.4 points lower overall diet quality (95% confidence interval [CI], -6.6 to -0.2) and 0.9 points lower score for consumption of green vegetables and beans (95% CI, -1.4 to -0.4). Other dietary component scores did not differ by history of GDM. CONCLUSION: In the United States, women with a history of GDM have lower diet quality compared with women who bore a child and do not have a history of GDM. Improving diet quality may be a strategy for preventing type 2 diabetes among childbearing women

Association between First Trimester Pregnancy Associated Plasma Protein–A and the Development of Gestational Diabetes Mellitus

Background: Gestational diabetes (GDM) is a common pregnancy complication with significant cardiometabolic consequences for mothers and offspring. Previous research from our group suggests that adipose tissue IGFBP-5 and its unique metalloprotease PAPP-A (Pregnancy Associated Plasma Protein-A) may play mechanistic roles in GDM development by regulating functional IGF-1 levels and lipid storage and metabolism. Aim: To examine the relationship between circulating PAPP-A levels and GDM development. We hypothesized that high first trimester PAPP-A levels would be associated with decreased GDM risk. Methods: A retrospective cohort of women delivering singleton gestations at UMass Memorial Healthcare (2009, 2010, 2014, 2015) was assembled by abstracting electronic medical records. PAPP-A was measured in first trimester (11-14 weeks), and reported as quartiles of multiples of the mean (MoM) based on gestational age and adjusted for maternal weight and race/ethnicity. GDM diagnosis based on standard 2-step protocol (~24-28 weeks; failed 50g 1hr glucola screen then ≥2 abnormal values per Carpenter-Coustan criteria on 100g 3hr glucose tolerance test). Crude and multivariable-adjusted logistic regression models estimated the association between PAPP-A MoM quartiles and GDM. Results: Women (N=1,251) were 29.7 (SD:5.7) years old and 12.5 (SD:0.6) weeks gestation at PAPP-A measurement. 7.6% (n=95) developed GDM. Median PAPP-A MoM were 0.7 (inter-quartile range [IQR]=0.5-1.0) among women with GDM and 0.9 (IQR=0.6-1.3) among controls; 39% versus 23% were in the 1st quartile, respectively. After adjusting for pre-pregnancy body mass index, nuchal translucency, crown rump length, smoking status, and parity, women with PAPP-A MoM in 2nd, 3rd, and 4th quartiles had 52% (OR=0.48, 95%CI=0.26-0.88), 45% (OR=0.55, 95%CI=0.30-0.99) and 73% (OR=0.27, 95%CI=0.13-0.53) lower odds of GDM compared to women in the 1st quartile. Conclusion: Higher PAPP-A MoM levels were associated with lower GDM risk. Future studies will assess whether higher PAPP-A levels are associated with enhanced IGF-1 signaling and improved pregnancy metabolic homeostasis

Association between First Trimester Pregnancy Associated Plasma Protein–A (PAPP-A) and Gestational Diabetes Mellitus Development

Background: Gestational diabetes (GDM) is a common pregnancy complication with significant cardiometabolic consequences for mothers and offspring. Previous research from our group suggests that adipose tissue IGFBP-5 and its unique metalloprotease PAPP-A (Pregnancy Associated Plasma Protein-A) may play mechanistic roles in GDM development by regulating functional IGF-1 levels and lipid storage and metabolism. Aim: To examine the relationship between circulating PAPP-A levels and GDM development. We hypothesized that high first trimester PAPP-A levels would be associated with decreased GDM risk. Methods: A retrospective cohort of women delivering singleton gestations at UMass Memorial Healthcare (2009, 2010, 2014, 2015) was assembled by abstracting electronic medical records. PAPP-A was measured in first trimester (11-14 weeks), and reported as quartiles of multiples of the mean (MoM) based on gestational age and adjusted for maternal weight and race/ethnicity. GDM diagnosis based on standard 2-step protocol (~24-28 weeks; failed 50g 1hr glucola screen then ≥2 abnormal values per Carpenter-Coustan criteria on 100g 3hr glucose tolerance test). Crude and multivariable-adjusted logistic regression models estimated the association between PAPP-A MoM quartiles and GDM. Results: Women (N=1,251) were 29.7 (SD:5.7) years old and 12.5 (SD:0.6) weeks gestation at PAPP-A measurement. 7.6% (n=95) developed GDM. Median PAPP-A MoM were 0.7 (inter-quartile range [IQR]=0.5-1.0) among women with GDM and 0.9 (IQR=0.6-1.3) among controls; 39% versus 23% were in the 1st quartile, respectively. After adjusting for pre-pregnancy body mass index, nuchal translucency, crown rump length, smoking status, and parity, women with PAPP-A MoM in 2nd, 3rd, and 4th quartiles had 52% (OR=0.48, 95%CI=0.26-0.88), 45% (OR=0.55, 95%CI=0.30-0.99) and 73% (OR=0.27, 95%CI=0.13-0.53) lower odds of GDM compared to women in the 1st quartile. Conclusion: Higher PAPP-A MoM levels were associated with lower GDM risk. Future studies will assess whether higher PAPP-A levels are associated with enhanced IGF-1 signaling and improved pregnancy metabolic homeostasis

Home Matters: Adolescents Drink More Sugar Sweetened Beverages When They Are Available at Home

Objective: Sugar sweetened beverage (SSB) consumption has increased by 300% in the past three decades and the largest source of both added sugar and calories in the diets of US adolescents. It has been argued that the increased intake of SSBs has contributed to the rising prevalence of obesity. The availability and accessibility of foods/drinks in multiple levels of an adolescent’s environment can influence one’s choices and impact consumption. The aim of this study is to examine the association between adolescent self-report of the availability of SSBs in their home and SSB consumption and whether neighborhood and school SSB availability modifies the association between availability of SSBs in the home and adolescent SSB consumption. Methods: The Family Life, Activity, Sun, Health and Eating (FLASHE) was used to conduct a cross sectional analysis of 1,484 parent-adolescent dyads. Each dyad completed four online surveys about dietary and activity health behaviors. Ordinal logistic regression analyses were conducted to determine the association between the measures of SSB availability in the home and teen SSB consumption behaviors. The potential moderators, school SSB availability and neighborhood SSB availability, were tested separately using stratified ordinal logistic regression analyses. Results: The greater frequency of availability of SSB’s in the home had a positive association with teen SSB consumption. This association remained present despite the availability of SSB’s in other locations. There was no moderation effect present in either school SSB availability and neighborhood SSB availability. Conclusion: Understanding the impact of the availability of SSB’s in multiple environments on consumption is important for obesity prevention efforts. This study found that parents can be important factors in reducing adolescent SSB consumption by influencing the home environment. Despite the availability of SSB’s in other environments, the home remains important for impacting consumption. Also Presented at the 2018 Society of Behavioral Medicine Annual Meeting

Frailty, cognitive impairment and anticoagulation among older adults with non-valvular atrial fibrillation

BACKGROUND/OBJECTIVES Oral anticoagulation (OAC) is challenging in older patients with nonvalvular atrial fibrillation (NVAF) who are often frail and have cognitive impairment. We examined the characteristics of older NVAF patients associated with higher odds of physical and cognitive impairments. We also examined if these high-risk patients have different OAC prescribing patterns and their satisfaction with treatment because it may impact optimal management of their NVAF. METHODS The patients in the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF study cohort 2016–2018) had NVAF, were aged 65 and older, and eligible for the receipt of OAC. Measures included frailty (Fried Frailty scale), cognitive impairment (Montreal Cognitive Assessment Battery), OAC prescribing and type (direct oral anticoagulant [DOAC] or vitamin K antagonist [VKA]), depressive symptoms (Patient Health Questionnaire-9), bleeding, stroke risk, and treatment benefit (Anti-Clot Treatment Scale). RESULTS Patients (n = 1,244) were 49% female, aged 76 (standard deviation = 7) years. A total of 14% were frail, and 42% had cognitive impairment. Frailty and cognitive impairment co-occurred in 9%. Odds of having both impairments versus none were higher with depression (odds ratio [OR] = 4.62; 95% confidence interval [CI] = 2.59–8.26), older age (OR = 1.56; 95% CI = 1.29–1.88), lower education (OR = 3.81; 95%CI = 2.13–6.81), race/ethnicity other than non-Hispanic White (OR = 7.94; 95% CI = 4.34–14.55), bleeding risk (OR = 1.43; 95% CI = 1.12–1.81), and stroke risk (OR = 1.35; 95% CI = 1.13–1.62). OAC prescribing was not associated with CI and frailty status. Among patients taking OACs (85%), those with both impairments were more likely to take DOAC than VKA (OR = 1.69; 95% CI = 1.01–2.80). Having both impairments (OR = 1.87; 95% CI = 1.08–3.27) or cognitive impairment (OR = 1.56; 95% CI = 1.09–2.24) was associated with higher odds of reporting lower treatment benefit. CONCLUSION In a large cohort of older NVAF patients, half were frail or cognitively impaired, and 9% had both impairments. We highlight the characteristics of patients who may benefit from cognitive and physical function screenings to maximize treatment and enhance prognosis. Finally, the co-occurrence of impairment was associated with low perceived benefit of treatment that may impede optimal management