Pre-eclampsia training needs of midwives in a Ghanaian tertiary hospital: A cross-sectional study

Aim: This study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance. Background: Pre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources. Design: A hospital-based cross-sectional study. Setting: The largest tertiary hospital in Ghana. Methods: An online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives’ training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives’ confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests. Results: Among the 250 midwives who responded, most possessed 1–5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p \u3c 0.001, 95 % confidence interval: 1.08–1.47, Cohen\u27s-D = 1.27; and p \u3c 0.001, 95 % confidence interval: 0.69–1.06, Cohen\u27s-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29–0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency. Conclusion: Midwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care

Midwives’ experiences of providing pre-eclampsia care in a low- and middle-income country – A qualitative study

Problem: Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives\u27 capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives’ experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives\u27 resilience. Background: There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality. Methods: A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis. Findings: There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives’ described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care. Conclusion: To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives’ emotional well-being

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

Background: Preeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed. Aim: This study focuses on the midwife\u27s role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines. Method/design: This study was a qualitative document analysis of national and tertiary hospital policies related to midwives’ scope of practice in Ghana. Altheide\u27s five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents. Results: The findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia. Conclusion: Uniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives’ roles, and optimise maternal and fetal outcomes

Impact of dietary nitrate dose on resistance exercise performance

The purpose of this study was to assess whether various doses of BR supplementation can influence muscle performance during a battery of resistance exercises in healthy, resistance-trained males. In a double-blind, randomized crossover design, 18 males were randomly allocated to consume 4 x 70 ml of BR over four conditions: (1) 4 x 70 ml of nitrate-depleted BR for placebo (PL); (2) 1 x 70 ml of nitrate-rich BR and 3 x 70 ml of PL for a low nitrate dose (BR-LOW); (3) 2 x 70 ml of nitrate-rich BR and 2 x 70 ml of PL for a moderate nitrate dose (BR-MOD); and (4) 4 x 70 ml of nitrate-rich BR for an elevated nitrate dose (BR-HIGH). Participants reported to the laboratory 5 times over 5-wk. Following a 1 repetition max (1RM) and a familiarization to the exercise protocol, participants completed a warm up and then a protocol to assess explosive performance using a linear transducer and force plate during vertical countermovement jumps, and then back squat and bench press, in a randomized order. A resting blood sample was drawn for the determination of plasma nitrate and nitrite concentrations. A two way repeated measures ANOVA was used to determine statistical differences between blood and performance variables, and is currently in progress. These data could provide insight for dietary nitrate as an ergogenic aid and inform both supplementation guidelines and recommendations for enhancing resistance training performance in men

Arterial stiffness index beta and cardio-ankle vascular index inherently depend on blood pressure but can be readily corrected

Objectives: Arterial stiffness index beta and cardio-ankle vascular index (CAVI) are widely accepted to quantify the intrinsic exponent (beta(0)) of the blood pressure (BP)-diameter relationship. CAVI and b assume an exponential relationship between pressure (P) and diameter (d). We aim to demonstrate that, under this assumption, beta and CAVI as currently implemented are inherently BP-dependent and to provide corrected, BP-independent forms of CAVI and beta.Methods and results: In P = P(ref)e(beta 0[(d/dref)-1)], usually reference pressure (P-ref) and reference diameter (d(ref)) are substituted with DBP and diastolic diameter to accommodate measurements. Consequently, the resulting exponent is not equal to the pressure-independent beta(0). CAVI does not only suffer from this 'reference pressure' effect, but also from the linear approximation of (dP=dd). For example, assuming beta(0) = 7, an increase of SBP/DBP from 110/70 to 170/120mmHg increased beta by 8.1% and CAVI by 14.3%. We derived corrected forms of b and of CAVI (CAVI(0)) that indeed did not change with BP and represent the pressure-independent beta(0). To substantiate the BP effect on CAVI in a typical follow-up study, we realistically simulated patients (n = 161) before and following BP-lowering 'treatment' (assuming no follow-up change in intrinsic beta(0) and therefore in actual P-d relationship). Lowering BP from 160 +/- 14/111 +/- 11 to 120 +/- 15/79 +/- 11 mmHg (p &lt;0.001) resulted in a significant CAVI decrease (from 8.1 +/- 2.0 to 7.7 +/- 2.1, p = 0.008); CAVI(0) did not change (9.8 +/- 2.4 and 9.9 +/- 2.6, p = 0.499).Conclusion: beta and CAVI as currently implemented are inherently BP-dependent, potentially leading to erroneous conclusions in arterial stiffness trials. BP-independent forms are presented to readily overcome this problem.</p

Co-Ingestion of Dietary Nitrate and Ascorbic Acid on Nitric Oxide Biomarkers and The Oral Microbiome in Sedentary Hispanic Women

Nitric oxide bioavailability increases following nitrate supplementation wherein oral microbiota facilitate the metabolism and absorption of nitrate. However, few studies have examined if co-ingestion of nitrate with antioxidants can further elevate nitric oxide bioavailability. Moreover, our understanding on how the oral microbiome responds to nitrate supplementation is limited, especially in women. PURPOSE: To examine the effects of ingesting dietary nitrate and ascorbic acid independently and concurrently on markers of nitric oxide bioavailability and oral microbiota species. METHODS: Twelve sedentary women of Hispanic descent (mean ± SD: age 20 ± 1 years; body mass 74 ± 15 kg; height 1.62 ± 0.09 m) consumed nitrate-rich beetroot juice (BR), nitrate-depleted beetroot juice (PL), ascorbic acid (AA), and crystal light (CRY) in four conditions: BR combined with AA (BR+AA); BR only (BR+CRY); AA only (PL+AA); and placebo-control (PL+CRY). Supplements were ingested 2.5 hours prior to a resting blood draw and buccal swab sample. Plasma [nitrate] and [nitrite] were analyzed using gas phase chemiluminescence. Buccal swab samples were used for DNA extraction and isolation. DNA was amplified using polymerase chain reaction (PCR) targeting the V3 - V4 region of the 16S rRNA gene. Following index PCR, amplicons were pooled and sequenced using the iSeq Illumina NGS sequencer. Reads were clustered into amplicon sequence variants and analyzed for alpha and beta diversity and relative abundance. RESULTS: BR increased plasma [nitrate] (BR+AA: 641 ± 252 vs. BR+CRY: 528 ± 307 vs. PL+AA: 35 ± 10 vs. PL+CRY: 35 ± 12 µM, P \u3c 0.001) and plasma [nitrite] (BR+AA: 710 ± 336 vs. BR+CRY: 578 ± 428 vs. PL+AA: 209 ± 88 vs. PL+CRY: 198 ± 82 nM, P \u3c 0.001) with no differences within BR and PL conditions. Alpha and beta diversity, and the relative abundance of higher and lower taxonomic levels were not significantly different between all conditions (P \u3e 0.05) CONCLUSION: Concurrent nitrate and AA supplementation did not elicit additional increases to nitric oxide compared to nitrate ingestion alone. Acute beetroot juice and ascorbic acid were ineffective at modulating oral microbial composition. Further research is required to understand the impact of supplementation regimen and population on the physiological effects of dietary nitrate

Effects of Co-ingesting Dietary Nitrate and Vitamin C on Nitric Oxide Bioavailability, Blood Pressure, and Cardiovascular Reactivity in Hispanic Females

High blood pressure is a hallmark of chronic disease and is disproportionately prevalent in ethnic minorities. Dietary nitrate has been shown to lower blood pressure via increased nitric oxide (NO), but few studies have examined if combining nitrate with vitamin C (VITC) could have beneficial synergistic effects on blood pressure by augmenting NO, and limited data exist in females. PURPOSE: To investigate if combining nitrate-rich beetroot juice (BR) with VITC could further augment NO bioavailability and improve blood pressure in Hispanic females compared to BR and VITC ingested alone. METHODS: Eight sedentary Hispanic females participated in four conditions to ingest: 1) BR and VITC (BR+VITC), 2) BR and crystal light (BR+CRY), 3) nitrate-depleted BR and VITC (PL+VITC), and 4) PL and CRY (PL+CRY). A blood draw and blood pressure were obtained at rest, followed by a cardiovascular reactivity test. RESULTS: Plasma nitrate was increased in BR+VITC and BR+CRY compared to PL+VITC and PL+CRY (P0.05). Plasma nitrite was increased in BR+VITC and BR+CRY compared to PL+VITC and PL+CRY (P0.05). CONCLUSION: Co-ingestion of dietary nitrate and VITC increased plasma nitrite compared to BR alone, which could indicate augmented NO bioavailability following BR+VITC; however, there was no impact of nitrate supplementation on markers of cardiovascular health

The Effects of Acute Beetroot Juice Ingestion on Exercise and Cognitive Performance in Female Athletes

Nitrate-rich beetroot juice can enhance intense exercise performance which is attributed to enhanced skeletal muscle contractility. However, limited data exist in females and it is unknown whether dietary nitrate has an ergogenic effect in this population. PURPOSE: To investigate the potential effects of acute nitrate ingestion on a battery of exercise performance and cognitive tests before and after fatiguing intermittent running exercise. METHODS: Fifteen female team-sport athletes were assigned in a randomized, double-blind, crossover design to consume nitrate-rich beetroot juice (BR; 12 mmol of nitrate) and nitrate-depleted beetroot juice (PL; 0.10 mmol of nitrate) 2.5 h prior to performing the exercise protocol, with a washout period of 7 days between trials. Running 10 m and 20 m sprint split times, sprint reaction time, upper- and lower-body power, handgrip strength, and cognitive flexibility were measured before and after the Yo-Yo intermittent recovery level 1 (Yo-Yo IR1) test, during which performance and rate of perceived exertion were recorded. RESULTS: There were no significant differences in any performance outcome or cognitive flexibility (P \u3e 0.05). CONCLUSION: These findings indicate that acute nitrate ingestion does not influence performance in sprints, intermittent running, power, strength, or cognitive function in young adult female team-sport athletes

The effects of acute beetroot juice ingestion on upper and lower body muscular power during weightlifting exercise in men

Nitrate-rich beetroot juice (BR) supplementation improves movements with high-velocity and high-power muscle contractions which may be due to enhanced blood flow, oxygenation and contractile function in type II muscle fibers. The literature has focused predominantly on the effects of BR supplementation running and cycling performance, but its efficacy in resistance exercise, a modality that relies on type II muscle fibers, has limited data. Furthermore, it is unknown how supplementation strategies impact the physiological and ergogenic effects of BR during exercise. Therefore, the purpose of this study is to assess whether single or multi-day nitrate ingestion will improve performance and muscle oxygenation during resistance exercise. In a double-blind, randomized crossover design, 14 healthy recreationally active men will report to the laboratory for five occasions over a 4-wk period. On the first visit, participants will undergo a 1 repetition-max (1RM) test for back squat and bench press. Subsequently, participants will complete two 4-day experimental trials where they will consume 2 x 70mL doses per day of either nitrate-depleted placebo (PL) or concentrated nitrate-rich BR. On experimental days of each supplementation period (day 1 and 4), subjects will consume 140 mL of their allocated beverage 2.5-h before exercise. On day 2 and 3 of the supplementation period, participants will consume one 70 mL beverage in the morning and one in the evening. On experimental days, participants performed a power protocol, consisting of 2 sets x 2 repetitions of back squats and bench press at 70%1RM followed by repetition-to-failures at 60%1RM. Muscle oxygenation, power and velocity were assessed during exercise using near infrared spectroscopy and a linear transducer, respectively. A subset of data has been collected (n=9) and data collection is ongoing

The effects of acute beetroot juice ingestion on upper and lower body muscular power during weightlifting exercise in men.

Dietary nitrate supplementation, administered per beetroot juice (BR), has been shown to enhance performance while cycling and running. BR has enhanced skeletal muscle contraction and blood flow within type II fibers which are recruited during high-velocity and high-power contractions. However, it is unknown whether BR influences alternative forms of exercise, such as resistance exercise. The purpose of this study is to assess whether BR supplementation influences neuromuscular performance (muscle power and speed), and repetitions-to-failure in healthy, recreationally active men. In a double-blind, randomized crossover design, 14 males will be recruited to complete two 4-day supplementation periods in which they consume 2 x 70mL nitrate-depleted placebo (PL) or nitrate-rich BR per day. Subjects will report to the lab 5 times over a 3-to 4-wk period. Subjects will complete a 1 repetition max (1RM) test and familiarization to the protocol. On experimental days subjects will complete a warm up and then a protocol to assess explosive performance, consisting of 2 sets x 2 repetitions of back squat at 70% 1RM using a cadence that emphasizes an explosive concentric phase. Skeletal muscle oxygenation will be measured using near-infrared spectroscopy and neuromuscular performance will be measured during exercise using a linear transducer. Following a 5-min recovery period, subjects performed 1 set x repetition-to-failure at 60% 1RM to determine muscular endurance. This protocol will be repeated in the bench press exercise. Data was analyzed in a subset of n = 9. There were no significant differences in resistance exercise performance between conditions; however, data collection is ongoing and results are currently underpowered. These data could provide insight for dietary nitrate as an ergogenic aid and inform both supplementation guidelines and recommendations for enhancing resistance training performance in men