Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy

OBJECTIVES: Pregnancy may provide a 'teachable moment' for positive health behaviour change, as a time when women are both motivated towards health and in regular contact with health care professionals. This study aimed to investigate whether women's experiences of pregnancy indicate that they would be receptive to behaviour change during this period. DESIGN: Qualitative interview study. METHODS: Using interpretative phenomenological analysis, this study details how seven women made decisions about their physical activity and dietary behaviour during their first pregnancy. RESULTS: Two women had required fertility treatment to conceive. Their behaviour was driven by anxiety and a drive to minimize potential risks to the pregnancy. This included detailed information seeking and strict adherence to diet and physical activity recommendations. However, the majority of women described behaviour change as 'automatic', adopting a new lifestyle immediately upon discovering their pregnancy. Diet and physical activity were influenced by what these women perceived to be normal or acceptable during pregnancy (largely based on observations of others) and internal drivers, including bodily signals and a desire to retain some of their pre-pregnancy self-identity. More reasoned assessments regarding benefits for them and their baby were less prevalent and influential. CONCLUSIONS: Findings suggest that for women who conceived relatively easily, diet and physical activity behaviour during pregnancy is primarily based upon a combination of automatic judgements, physical sensations, and perceptions of what pregnant women are supposed to do. Health professionals and other credible sources appear to exert less influence. As such, pregnancy alone may not create a 'teachable moment'. Statement of contribution What is already known on this subject? Significant life events can be cues to action with relation to health behaviour change. However, much of the empirical research in this area has focused on negative health experiences such as receiving a false-positive screening result and hospitalization, and in relation to unequivocally negative behaviours such as smoking. It is often suggested that pregnancy, as a major life event, is a 'teachable moment' (TM) for lifestyle behaviour change due to an increase in motivation towards health and regular contact with health professionals. However, there is limited evidence for the utility of the TM model in predicting or promoting behaviour change. What does this study add? Two groups of women emerged from our study: the women who had experienced difficulties in conceiving and had received fertility treatment, and those who had conceived without intervention. The former group's experience of pregnancy was characterized by a sense of vulnerability and anxiety over sustaining the pregnancy which influenced every choice they made about their diet and physical activity. For the latter group, decisions about diet and physical activity were made immediately upon discovering their pregnancy, based upon a combination of automatic judgements, physical sensations, and perceptions of what is normal or 'good' for pregnancy. Among women with relatively trouble-free conception and pregnancy experiences, the necessary conditions may not be present to create a 'teachable moment'. This is due to a combination of a reliance on non-reflective decision-making, perception of low risk, and little change in affective response or self-concept

New perspectives on the development of extrahepatic portosystemic shunts

Objective: To develop a hypothesis for the developmental modality of extrahepatic portosystemic shunts. Methods: A retrospective review of a series of dogs and cats managed for congenital portosystemic shunts. Using these data a hypothesis for the role of preferential venous blood flow in the development of common extrahepatic PSSs was postulated. In addition, an online literature search was used to retrieve peer-reviewed data describing the detailed anatomy of shunts in dogs and cats. A systematic review of these data was used as a preliminary test of the hypothesis. Results: In total 50 dogs and 10 cats met the inclusion criteria revealing five common and distinct shunt types. In the dog, these were spleno-caval, left gastro-phrenic, left gastro-azygos and those involving the right gastric vein. The online search confirmed that these were responsible for 94% of extrahepatic shunts described in this species. In the cat, the four shunt types observed were spleno-caval, left gastro-phrenic, left gastro-caval and left gastro-azygos. Excluding the left gastro-azygos, which from the online search was not described in the cat, the spleno-caval, left gastro-phrenic and left gastro-caval were responsible for 92% of extrahepatic shunts in this species. These data were used to develop, propose and provisionally test a hypothesis for the development of extrahepatic portosystemic shunts. Clinical Significance: We hypothesise that it is the presence of preferential blood flow that influences the subsequent formation of one of a number of defined and consistent congenital extrahepatic portosystemic shunts in dogs and cats

Diameters of left gastric vein and its originating vein on magnetic resonance imaging in liver cirrhosis patients with hepatitis B : Association with endoscopic grades of esophageal varices

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108624/1/hepr12246.pd

Chylous ascites following radical nephrectomy: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

When the heart kills the liver: acute liver failure in congestive heart failure

Congestive heart failure as a cause of acute liver failure is rarely documented with only a few cases