Sandi Tenfelde

Predictors of Breastfeeding Exclusivity in a WIC Sample

OBJECTIVE To examine predictors of breastfeeding exclusivity in low-income women who received services from a Chicago area clinic of the Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC). DESIGN A secondary data analysis of existing clinical and administrative data. SETTING An urban community health center serving low-income families. PARTICIPANTS Two hundred and thirty-five (235) low-income women who initiated breastfeeding and received WIC services. METHODS Logistic regression models were fit to existing prenatal and postpartum data to determine predictors of breastfeeding exclusivity during the immediate postpartum period. RESULTS Only 23% of the sample breastfed exclusively. Women who received first-trimester prenatal care were more likely to exclusively breastfeed than women who entered prenatal care in later trimesters (OR = 2.02, p ≤ 0.05). Women who declared intentions prenatally to exclusively breastfeed were more likely to exclusively breastfeed than women who did not intend to breastfeed (OR = 3.85, p ≤ 0.001). Overweight/obese women were less likely to exclusively breastfeed than normal/underweight women (OR = 0.50, p ≤ 0.05). CONCLUSION Findings from this study can be used to develop tailored interventions to promote breastfeeding exclusivity among low-income WIC recipients.

Risk of breastfeeding cessation among low-income women, infants, and children: A discrete time survival analysis

Background:Women who receive services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) often stop breastfeeding earlier than recommended. Little is known about maternal background and intrapersonal variables that predict the timing of breastfeeding cessation over the 12-month postpartum period. Objectives:The aim of this study was to identify the maternal background and intrapersonal predictors associated with the timing of breastfeeding cessation in WIC participants over the course of the 12-month postpartum period. Method:Existing longitudinal survey and administrative data from low-income breastfeeding WIC recipients (n = 309) were analyzed using discrete time survival analysis. Risk of breastfeeding cessation was the outcome, and self-reported items were used to derive predictor variables that corresponded to the background and intrapersonal variables of the Interaction Model of Client Health Behavior. Results:Rates of breastfeeding were low (31% at 6 months and 6% at 12 months). In the best fitting discrete time survival analysis model, women who were older and of Mexican ethnicity, who had previous breastfeeding experience, and who had breastfeeding support from family or friends were at lowest risk for breastfeeding cessation at each monthly interval. Discussion:Breastfeeding duration rates were lower than Healthy People 2020 benchmarks of 61% at 6 months and 34% at 12 months. Clinicians and researchers can use the findings from this study to develop interventions that are targeted to periods of greatest risk of premature breastfeeding cessation to prolong breastfeeding duration in this vulnerable population.

Knowledge and perceptions of pelvic floor disorders among african american and latina women.

Objective: The objective of this study was to explore knowledge, barriers to seeking sociocultural perceptions of pelvic floor disorders (PFDs) among African American (AA) and Latina (LA) community-dwelling women. Methods: Thirty-two women participated in 4 focus groups. The sample included AA and LA women aged 24 to 77 years. Focus groups were stratified by age and race/ethnicity. Discussion questions included knowledge of and related health needs and barriers to seeking care with respect to PFDs, urinary incontinence, and pelvic organ prolapse. Demographics and basic knowledge and experience with PFDs were also captured by survey. Results: Several significant themes emerged from the data. AA and LA women had general misconceptions about PFDs and were unaware of PFDs causes, symptoms, and available treatments. Women were eager to receive more information, particularly prevention information that could be shared with their daughters. A major barrier to seeking care was the pattern of placing family demands before their own health needs. Conclusions: Findings suggest that there is a gap in information on PFDs among AA and LA women, yet a demand for information exists. Sociocultural perspectives discerned from focus group with AA and LA women can be used to tailor educational information and materials on PFDs. Findings may increase health provider awareness of the unique sociocultural barriers to seeking care for AA and LA women and improve patient education on PFDs.

Quality of life in women who use pessaries for longer than 12 months.

Objectives Pessaries are an effective treatment for pelvic organ prolapse and urinary incontinence; however, few data exist describing long-term pessary use. Our aim was to describe symptom bother and quality of life (QoL) in women using pessaries for urinary incontinence and/or prolapse for at least 12 months. Methods Consecutive women who met inclusion criteria were approached for this observational cross-sectional study. Wilson and Cleary’s Health-Related Quality of Life Model guided the inclusion of biologic, functional, and individual factors that impact the health-related QoL. Consenting participants completed a generalized QoL index, the Center for Epidemiologic Depression Symptoms, Medical Outcomes Study Social Support Survey, and condition-specific measures; the Pelvic Floor Distress Inventory (PFDI-20-SF) and the Pelvic Floor Impact Questionnaire. Results Fifty-six women, mean age 74.4 years (range, 47–89 years), completed the survey. Mean length of time for pessary use was 4.5 years (1–15 years). Most of the women (n = 31, 55.4%) returned to the clinic for pessary care every 3 months. There was no difference in generalized QoL nor condition-specific total PFDI-20 in women performing self-care versus routine follow-up. Almost one third (29%) of participants reported complications related to pessary use (eg, vaginal erosion), and 41%were considering surgical repair in the near future. Women who were considering surgery had higher PFDI-20 scores relating to more bothersome prolapse symptoms than those not considering surgery (Pelvic Organ Prolapse Distress Inventory 6, 33.91 vs 24.73, P = 0.03). Conclusions Pessaries can be used to control pelvic floor symptoms for extended periods. Complication rates in this study were lower than previously reported, even in women not doing self-care. Not surprisingly, women considering surgical intervention reported greater symptom bother despite pessary use.

Gum chewing and gastrointestinal function following caesarean delivery: a systematic review and meta‐analysis

AIMS AND OBJECTIVES The aims of this systematic review and meta-analysis were to summarise current knowledge regarding gum chewing intervention for activation of the gastrointestinal (GI) system following caesarean delivery. BACKGROUND GI symptoms such as nausea, vomiting and defecatory difficulties are bothersome for women following a caesarean delivery. There is category A recommendation to not withhold oral intake postoperatively. However, current practice guidelines vary widely on time to initiate oral feeding post caesarean delivery, and additional research is needed. Gum chewing has been shown to stimulate the GI system in other postoperative patient populations. DESIGN A systematic review and meta-analysis. METHODS An electronic review was undertaken using the following resources: PubMed (Medline), CINAHL, EMBASE and ClinicalTrials.gov databases. Key words used in various combinations included cesarean section; cesarean delivery; postoperative chewing gum; bowel movement; bowel function and complications. RESULTS A total of 171 articles were found of which 166 were excluded: 157 were duplicates and the remainder did not meet the inclusion criteria. Five randomised control trials were included in the meta-analysis, focusing on gum chewing as an intervention as compared with a nongum chewing intervention, with a total of 846 participants. Compared with the nongum chewing group, gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, gas passage and defecation. CONCLUSIONS This meta-analysis supports the effectiveness of gum chewing post caesarean delivery as a noninvasive/nonpharmacological intervention for reactivation of bowel movement. RELEVANCE TO CLINICAL PRACTICE Gum chewing in the immediate postoperative period following caesarean delivery may provide a socially acceptable, low-cost and safe intervention to reduce postcaesarean delivery GI complications and restore GI function.

Why WIC Women Stop Breastfeeding? Analysis of Maternal Characteristics and Time to Cessation

Women who receive benefits from Women, Infants, and Children (WIC) are not meeting the recommendations for breastfeeding duration. The purpose of this descriptive correlational study was to examine maternal sociodemographic and time factors related to the reason for discontinuing breastfeeding for 238 WIC participants who initiated breastfeeding. This study is a secondary data analysis of existing longitudinal survey and administrative data from a Chicago-area community health center and WIC clinic. The average length of breastfeeding within this sample was 16 weeks. Women in this sample reported a perception of insufficient milk (PIM; 46%), returning to work/school (13%), and other maternal problems (13%) as the main reasons for discontinuing breastfeeding. Within the first 16 weeks, 65% of the women who discontinued breastfeeding cited PIM as the main reason, with 2 distinct time points at 5 weeks and 13 weeks. Women of Hispanic descent were more likely than non-Hispanic women to report this perception ...

Triathlete Risk of Pelvic Floor Disorders, Pelvic Girdle Pain, and Female Athlete Triad.

Objectives Our primary objective was to describe the prevalence of pelvic floor disorders (PFDs), pelvic girdle pain (PGP), and the female athlete triad (disordered eating, menstrual irregularities, and osteoporosis) in a female triathlete population. We also evaluated for an association between these conditions. Methods We administered an online survey to women who self-identified as female triathletes. Using validated questionnaires, Epidemiology of Prolapse and Incontinence Questionnaire and Pelvic Girdle Questionnaire, along with the female athlete triad questionnaire, we identified the prevalence of PFDs, PGP, and female athlete triad in this specific population. Demographic and exercise intensity were also queried to characterize these female triathletes. Results Three hundred eleven female triathletes responded to the Internet survey. There was a significant prevalence of PFDs with stress urinary incontinence and anal incontinence symptoms being most common (37.4% and 28%, respectively). Urgency urinary incontinence and pelvic organ prolapse were less common (16% and 5%, respectively). Stress urinary incontinence and pelvic organ prolapse were more common in parous triathletes (P = 0.001, P = 0.05). Pelvic girdle pain was noted in 18% of these triathletes but was not disabling. Twenty-four percent of participants screened positive for at least 1 arm of the female athlete triad. No association was found between the female athlete triad and PFDs. Conclusions Pelvic floor disorders are common and bothersome in female triathletes. Pelvic girdle pain, while present, does not limit these athletes from their training. These female triathletes may be at risk for the female athlete triad. Female triathletes may be at risk for both metabolic and PFDs and should be screened when identified.

DNP and PhD Collaboration: Bringing Together Practice and Research Expertise as Predegree and Postdegree Scholars.

A deliberate course of predegree intraprofessional DNP and PhD student collaboration can yield relationships that will facilitate postdegree teamwork. Working together, DNP-prepared nurses can use their practice expertise, and PhD-prepared nurses can use their research expertise to improve and change health care. This article presents 3 contexts in which predegree collaboration can occur between DNP and PhD students. Postdegree DNP and PhD collaboration can occur in 2 contexts.

“Maybe black girls do yoga”: A focus group study with predominantly low-income African-American women

OBJECTIVE To explore African American (AA) womens use of mind-body therapies, such as yoga and mindfulness, and factors that impact their experiences, observations and opinions. DESIGN Focus groups were conducted to better understand how AA women perceive mind-body therapies and how to best bring these interventions into their community. Interviews were audiotaped and transcribed. SETTING The urban Midwest. OUTCOME MEASURES In addition to qualitative outcomes, descriptive measures included the Perceived Stressor Scale, Beliefs About Yoga Scale, and Determinants of Meditation Practice Inventory (DOMPI). RESULTS Twenty-two, predominantly low-income (75% reported income <

Sexual Dysfunction and Intimacy for Ostomates

50,000) and single (82%) women participated in three age stratified focus groups (18-34 years, 35-65 years, 66 years and older). Participants acknowledged life stress and shared common coping mechanisms. They recognized that yoga and mindfulness could be beneficial and discussed barriers to practice (including personal and structural). Younger women reported more time constraints as barriers, middle aged women had more experience with yoga, and older women identified the spiritual component to yoga/mindfulness as potentially conflicting with current coping strategies. Participants suggested ways to share mind-body therapies within the AA community along with solutions for engagement. CONCLUSIONS AA women acknowledged stress in their lives and recognized the need for additional coping measures. Although women reported interest in yoga/mindfulness they identified barriers, including limited access to convenient classes, and offered suggestions for bringing yoga and mindfulness to their communities.