A prenatal coparenting intervention with unmarried father-mother dyads: Fidelity of intervention delivery by male-female community mentor teams

Background: Most prenatal preventive interventions for unmarried mothers do not integrate fathers or help the parents plan for the development of a functional coparenting alliance after the baby's arrival. Furthermore, properly trained professionals have only rarely examined the fidelity of these interventions. Purpose: This report examines whether experienced community interventionists (home visitors, health educators, fatherhood service personnel) with no formal couples' therapy training are capable of pairing together to deliver with adequate fidelity a manualized dyadic intervention designed for expectant unmarried mothers and fathers. Methods: Three male and four female mentors (home visitors, health educators, fatherhood personnel) working in paired maleY female co-mentor teams delivered a seven-session BFiguring It Out for the Child[curriculum (six prenatal sessions, one booster) to 14 multirisk, unmarried African American families (parent age ranging from 14 to 40). Parental well-being and views of fatherhood were assessed before the intervention and again 3 months after the baby's birth. Quality assurance analysts evaluated mentor fidelity (adherence to the curriculum, competence in engaging couples with specified curricular content) through a review of the transcripts and audiotapes from the sessions. Mentors also rated their own adherence. Results: Although the mentors overestimated adherence, quality assurance analyst ratings found acceptable levels of adherence and competence, with no significant maleYfemale differences in fidelity. Adherence and competence were marginally higher in sessions that required fewer direct couples' interventions. Parents reported satisfaction with the interventions and showed statistically significant improvement in the family dimensions of interest at 3-4 months posttreatment. Conclusions/Implications for Practice: Findings support the wisdom of engaging men both as interventionists and as recipients of prenatal coparenting interventionsVeven in families where the parents are uncoupled and non-co-residential. © 2017 Taiwan Nurses Association

Coparenting in the context of Mother–Father–Infant versus Mother–Grandmother–Infant triangular interactions in Turkey.

In this report, coparenting behaviors during triangular interactions among families raising a 3-month-old infant in Turkey are examined. Given the significant role played by extended family members in Turkish culture, coparenting dynamics were examined as mothers and babies played together with grandmothers, as well as together with fathers. Forty-five families took part, and 42 father–mother–baby and 33 grandmother–mother–baby triangular interactions of approximately 10 min in length were filmed during the Lausanne Trilogue Play. From videotapes of the interactions, individual and mutual coparenting behaviors were evaluated using the Coparenting and Family Rating System: 3 Month Adaptation (CFRS3M). Results indicated that while mothers’ own parenting behavior when in the LTP role of Active Parent (AP) was comparable whether with fathers or grandmothers, their behavior when in the LTP role of third party parent (TPP) was comparatively more engaged while with fathers than while with grandmothers. Fathers were comparatively less engaged when occupying the TPP role than were mothers in the TPP role, while grandmothers showed more flirting and distracting behavior in the TPP role than did either fathers or mothers. These findings are significant in documenting meaningful distinctions in Turkish grandmothers’ as well as in Turkish fathers’ and mothers’ coparenting propensities when engaging in triangular interactions with babies during the LTP

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro-and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity. (c) 2019 The Author(s) Published by S. Karger AG, Base

Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)

Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors