Fiona Bogossian

High-flow nasal cannula oxygen therapy for infants with bronchiolitis: Pilot study

To obtain data on the safety and clinical impact of managing infants with bronchiolitis on the ward with high‐flow nasal cannula (HFNC) treatment.

Cohort Profile: The Nurses and Midwives e-Cohort Study—A Novel Electronic Longitudinal Study

Nurses and midwives comprise the largest professional group in most national health systems, so shortfalls in numbers can have a substantial impact on health care delivery. A scarcity of human resources in health has been internationally recognized and has led the International Council of Nurses to launch the Global Workforce Project in 2004, and the World Health Organization to announce the Health Workforce Decade 2006–15 in 2006.1,2 Efforts to address workforce needs through coherent workforce planning and policy setting are hampered by the complexity of predicting the supply of and demand for nurses and midwives, and the challenges associated with understanding drivers of workforce retention.3 Available workforce descriptors among regulatory authorities vary considerably; and collections are mostly cross-sectional, frequently incomplete and typically limited to administrative databases. In Australia and New Zealand, workforce issues include the migration of staff between states and countries, and critical personnel shortages in rural and . . . [Full Text of this Article]

The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review

BACKGROUND Experiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices. AIM The aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress. METHODS Four electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013. FINDINGS Of 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth. CONCLUSION Complex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants.

Work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians: A systematic review of risk factors and functional consequences

BACKGROUND Given a worldwide shortage of primary health care workers predicted to worsen, it is vital to address sources of attrition among these professionals. One such source may be work-related musculoskeletal disorders. We aimed to identify risk factors for and functional consequences of work-related upper quadrant musculoskeletal disorders in midwives, nurses and physicians. METHODS Eighteen of 87 studies identified from an electronic database search met the inclusion and quality criteria. RESULTS Job demands, demanding work schedules and physical exposures have the strongest associations with work-related upper quadrant musculoskeletal disorders. Functional consequences included widespread use of prescription and over-the-counter medications and major negative impact on activities of daily living. No studies of midwives were located. CONCLUSION High-quality studies of midwives as well as better-designed prospective studies of nurses and physicians are needed. Results of such studies could inform preventive strategies and reduce the contribution of work-related musculoskeletal disorders to attrition.

The association between shift work and unhealthy weight: A cross-sectional analysis from the Nurses and Midwives' e-Cohort Study

Objective: To examine the association between shift work and unhealthy weight among female nurses and midwives. Methods: A cross-sectional study. Measurement outcomes included shift work, unhealthy weight (underweight: body mass index [BMI] < 18.5; overweight: BMI 25.0 to 29.9; obesity: BMI > 30.0), diet quality, physical-activity level, alcohol consumption, and smoking status. Results: Among the 2494 participants (1259 day and 1235 shift workers), only 1% of the participants were underweight, 31.8% were overweight, and 26.9% were obese. After adjusting the selected confounders, shift workers were 1.15 times more likely to be overweight/obese than day workers (P = 0.013, 95% confidence interval, 1.03 to 1.28; P = 0.02, 95% confidence interval, 1.02 to 1.30, respectively). Conclusions: Shift work is associated with higher risk of being overweight/obese. Longitudinal studies are being undertaken to better understand the causal relationship between shift work and unhealthy weight.

A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom

OBJECTIVE The aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives. DESIGN A cross sectional study of self reported survey data. SETTINGS Australia, New Zealand and the United Kingdom. METHODS Measurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mothers age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables. PARTICIPANTS 4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n=3144), New Zealand (n=778) or the United Kingdom (n=1074). RESULTS Amongst the sample 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35-44 yrs aOR 1.71, 95% CI 1.41-2.08; 45-55 yrs aOR 1.90, 95%CI 1.56-2.31; 55-64 aOR 2.22, 95% CI 1.71-2.88), and male gender (aOR 1.46, 95% CI 1.15-1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06-1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11-1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70-0.94 and aOR 0.75, 95% CI 0.59-0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04-1.80). CONCLUSION Nurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their individual health behaviours and risks of occupational injury and chronic disease.

The prevalence of work-related neck, shoulder, and upper back musculoskeletal disorders among midwives, nurses, and physicians: a systematic review.

With the global shortage of health care workers predicted to worsen, attrition from the work force must be minimized. This review examined the incidence or prevalence of neck, shoulder, and upper back musculoskeletal disorders, a possible source of attrition, among midwives, nurses, and physicians. Four electronic databases were systematically searched for publications meeting inclusion criteria. Reference lists of retrieved articles were hand searched for additional articles. After eliminating articles that did not meet inclusion criteria, the remaining articles were assessed for quality and prevalence or incidence data were extracted. Twenty-nine articles published between 1990 and 2012 were included and assessed for quality. Median annual prevalence rates were 45% (neck), 40% (shoulder), and 35% (upper back). Methodological concerns included small sample size, inconsistency of outcome measures, likelihood of non-response bias, and low response rates. Midwives, who have not been well studied, demonstrated prevalence somewhat lower than that of nurses and physicians.

The use of tablet PCs to access an electronic portfolio in the clinical setting: A pilot study using undergraduate nursing students

BACKGROUND In 2006, a digitalised clinical portfolio was introduced into an undergraduate nursing program. The use of a tablet personal computer (PC) with wireless broadband access could overcome issues around computer access in the clinical setting enhancing authenticity and timeliness of assessment. METHODS In July 2007, a Hewlett-Packard TC 4400 tablet PC was issued to three participating students. A focus group utilising a semi-structured interview and a survey collected data from the students at the end of the trial to determine the effectiveness of the strategy. RESULTS Participants used tablet PCs to access their portfolios. However, lack of space, busy wards and concerns about the security of the PCs limited their use in the clinical setting. The majority of their journal entries were made at home and within similar time frames to those prior to access to tablet PCs. Participants also used the PCs to provide education to other students and staff but were reluctant to use them in front of patients. CONCLUSION Barriers limiting the use of tablet PCs in the clinical setting may be overcome with greater proficiency in their utility and increased portability of the technology. Tablet PCs offer advantages related to and beyond portfolio use in the clinical setting.

A Cross-Sectional Analysis of the Association Between Night-Only or Rotating Shift Work and Overweight/Obesity Among Female Nurses and Midwives

Objective: To examine the associations between shift work types and overweight/obesity among female nurses and midwives. Methods: A cross-sectional study. Measurement included exposure variables: rotating shift work and night-only shift work; outcome variables: overweight and obesity; and potential confounding and associated variables: modifiable lifestyle factors, general health status, menopausal status, and work pattern. Results: Among the 2086 participants, almost 60% were overweight/obese (31.7% overweight; 27.1% obese). After we adjusted the selected confounders, we found that rotating shift workers were 1.02 times more likely to be overweight/obese than day workers (P = 0.007; 95% confidence interval [95% CI], 1.004 to 1.03; and P = 0.02; 95% CI: 1.004 to 1.04, respectively). Night-only shift work was found to be significantly associated with obesity only (P = 0.031; relative risk, 1.02; 95% CI, 1.002 to 1.04). Conclusions: Rotating shift work was associated with both overweight and obesity; and night-only shift work was associated with obesity, not overweight.

Autism in toddlers born very preterm

OBJECTIVE: This study aimed to determine the prevalence of autism spectrum disorder (ASD) by using the Autism Diagnostic Observation Schedule-Generic (ADOS-G) classifications in children born very preterm during their toddler years. METHODS: Two birth cohorts of toddlers (2 and 4 years old) each recruited over 12 months and born at <29 weeks’ gestation were administered the Modified Checklist of Autism in Toddlers–Follow-up Interview (M-CHAT-FI) screen, the ADOS-G, and developmental assessments. The ADOS-G was conducted on toddlers with M-CHAT-FI–positive screens. RESULTS: Data were available on 88% (169/192) of children. In total, 22 (13%) toddlers screened positive and 3 (1.8%) were confirmed diagnostically with ASD. These 3 cases reached the highest ADOS-G threshold classification of autism. All but 1 child who scored below the ADOS-G thresholds (11/12) demonstrated some difficulty with social communication. Risk was significantly increased for co-occurring neurodevelopmental problems in 21 of the 22 positive-screen ASD cases. Adaptive behavior (P < .001) was the only co-occurring factor independently predictive of ASD in toddlers. CONCLUSIONS: Children born very preterm are at increased risk of ASD. By using the ADOS-G, we found a lower incidence of ASD in children born at <29 weeks’ gestation compared with previous studies. Children who screened positive for ASD on the M-CHAT-FI had developmental delays consistent with subthreshold communication impairment.