Mary Ann Faucher

A Community Intervention on Portion Control Aimed at Weight Loss in Low-Income Mexican American Women

A pilot study was conducted to determine if a nutritional intervention aimed at portion control leads to significant weight loss in a community of low-income Mexican American women. Nineteen low-income Mexican American women were randomized to a standard care group or an intervention group in portion control. The trial was 20 weeks in length, and the intervention included four 2-hour classes. Both interventions were administered by a certified nurse-midwife (CNM) and a promotora de salud (i.e., lay health advisor). Women in the intervention group lost more weight than women in the standard care group, though this difference was not statistically significant. The mean weight loss in the intervention group was 6.57 pounds (2.9 kg) compared to a mean weight loss of 2.8 pounds (1.3 kg) in the standard care group (P = .47). Mean weight loss, regardless of group, was significantly greater when participants reported self-weighing (P = .02). This pilot study in portion control for low-income Mexican American women merits further study.

Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

BACKGROUND Obesity and gestational weight gain impact maternal and fetal risks. Gestational weight gain guidelines are not stratified by severity of obesity. AIM Conduct a systematic review of original research with sufficient information about gestational weight gain in obese women stratified by obesity class that could be compared to current Institute of Medicine guidelines. Evaluate variance in risk for selected outcomes of pregnancy with differing gestational weight gain in obese women by class of obesity. METHODS A keyword advanced search was conducted of English-language, peer-reviewed journal articles using 3 electronic databases, article reference lists and table of content notifications through January 2015. Data were synthesized to show changes in risk by prevalence. FINDINGS Ten articles met inclusion criteria. Outcomes assessed were large for gestational age, small for gestational age, and cesarean delivery. Results represent nearly 740,000 obese women from four different countries. Findings consistently demonstrated gestational weight gain varies by obesity class and most obese women gain more than recommended by Institute of Medicine guidelines. Obese women are at low risk for small for gestational age and high risk for large for gestational age and risk varies with class of obesity and gestational weight gain. Research suggests the lowest combined risk of selected outcomes with weight gain of 5-9kg in women with class I obesity, 1 to less than 5kg for class II obesity and no gestational weight gain for women with class III obesity. CONCLUSIONS Gestational weight gain guidelines may need modification for severity of obesity.

Gestational weight gain and preterm birth in obese women: a systematic review and meta‐analysis

Prepregnant obesity is a global concern and gestational weight gain has been found to influence the risks of preterm birth.

Incorporating Breastfeeding Education into Prenatal Care

INTRODUCTION Prenatal breastfeeding education increases breastfeeding initiation, exclusivity, and duration. Current research regarding antenatal breastfeeding education suggests that recurrent, individual, and technology-based education programs are effective in providing women with evidence-based breastfeeding information and guidance. MATERIALS AND METHODS This project was implemented at an obstetrical practice in the northeast United States. Pregnant women between 32 weeks of gestation and birth, receiving care from certified nurse-midwives, were the targeted population. Three breastfeeding modules were created and offered to women at the 32-, 34-, and 36-week prenatal visit via computer tablets. Women answered questionnaires at the end of each module, serving as a measure for participation and content learning. Women also completed a questionnaire at the 6-week postpartum visit to assess summative perceptions. RESULTS Twenty-three women participated, and 21 women completed questionnaires at 6 weeks postpartum. All women answered the content questions at the end of the modules correctly. Sixty-seven percent reported prior breastfeeding experience, 95% initiated breastfeeding, 86% were exclusively breastfeeding at 6 weeks postpartum, and 71% of the women planned to exclusively breastfeed for 6 months. Sixty-seven percent reported the modules promoted or affirmed their decision to breastfeed, whereas 5% would have preferred group-based education. Providers documented breastfeeding education 52% of the time. CONCLUSIONS The results of this project indicate that women successfully learned breastfeeding content via the tablet methodology. The results confirm that prenatal breastfeeding education, in the office setting, is well accepted by women. In order to assess the impact of the program on breastfeeding success, further study is needed.

International Clinical Experience for Midwifery Students

INTRODUCTION The purpose of this survey was to obtain information that would elucidate what types and amounts of international clinical experiences are available to midwifery students in accredited midwifery programs. Furthermore, the survey assessed the need for and interest in an online pre-trip preparation course and the possibility of future collaborative efforts between midwifery programs. METHODS A formal electronic descriptive survey was sent to eligible directors of midwifery education (DOME) from 38 accredited institutions in the United States. RESULTS Twenty-nine of 38 (76%) responded to the survey, and 9 of 29 programs (31%) offer international clinical experiences. Sixteen (80%) of the 20 programs not currently offering international experiences indicated interest in offering these experiences. Of the 9 programs that have international experiences, only 1 reported offering a formal pre-trip course. DISCUSSION The results of this survey suggest that there is interest in collaborative efforts for developing a formal pre-trip preparation course and sharing international experiences that would promote sustainable programs of international experiences for student midwives.

The Gut Microbiome, Obesity, and Weight Control in Women’s Reproductive Health

The microbes residing in the human gut, referred to as the microbiome, are intricately linked to energy homeostasis and subsequently obesity. Integral to the origins of obesity, the microbiome is believed to affect not only health of the human gut but also overall health. This microbiome–obesity association is mediated through the process of energy extraction, metabolism, and cross talk between the brain and the gut microbiome. Host exposures, including diet, that potentially modify genetic predisposition to obesity and affect weight management are reviewed. The higher prevalence of obesity among women and recent evidence linking obesity during pregnancy with offspring health make this topic particularly relevant. Current limitations in microbiome research to address obesity and future advances in this field are described. Applications of this science with respect to applied nursing and overall health care in general are included, with emphasis on the reproductive health of women and their offspring.

A method comparison of photovoice and content analysis: research examining challenges and supports of family caregivers

PURPOSE The purpose of this manuscript is to compare methods and thematic representations of the challenges and supports of family caregivers identified with photovoice methodology contrasted with content analysis, a more traditional qualitative approach. METHODS Results from a photovoice study utilizing a participatory action research framework was compared to an analysis of the audio-transcripts from that study utilizing content analysis methodology. RESULTS Major similarities between the results are identified with some notable differences. Content analysis provides a more in-depth and abstract elucidation of the nature of the challenges and supports of the family caregiver. CONCLUSIONS The comparison provides evidence to support the trustworthiness of photovoice methodology with limitations identified. The enhanced elaboration of theme and categories with content analysis may have some advantages relevant to the utilization of this knowledge by health care professionals.

Nutriceuticals and cardiovascular health in women.

This article examines the evidence on use of nutriceuticals for promotion of cardiovascular health in women. Studies elucidating mechanism of action, physiologic effects of antioxidant vitamins, carotenoids, flavonoids, and garlic are presented. Emerging evidence for the impact of homocysteine on cardiovascular risk factors and events and evidence for the impact of different types of fats on cardiovascular markers are reviewed. The effects of a heart-healthy diet are supported in this review of research on nutriceuticals. Primary prevention of cardiovascular disease in women is clearly efficacious, and this article summarizes information to be shared with women about nutriceuticals and diet to better enable decisions they can adopt to promote cardiovascular health.

Pharmaceutical therapy in midwifery practice: a culturally competent approach

The profession of midwifery can be part of the solution in Americas quest for a culturally sensitive and competent health care system. Midwives who are familiar with a variety of health-related cultural beliefs and practice culturally sensitive inquiry, particularly when using pharmaceutical therapies, can effectively understand and respond to the cultural complexities that impact a clients health. This article describes needed cultural competencies, reviews a variety of health-related cultural beliefs, and relates how these beliefs impact the use and acceptability of pharmaceutical therapies. Specific examples related to culturally sensitive inquiry are discussed along with recommendations.

A model for upscaling global partnerships and building nurse and midwifery capacity

AIM To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. BACKGROUND AND INTRODUCTION Nurses and midwives across nations need skills reaching beyond the bedside and unit level in todays complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. DISCUSSION This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. CONCLUSION AND IMPLICATIONS FOR NURSING Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. IMPLICATION FOR NURSING POLICY Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions.