Presentation is key in antenatal information, research suggests

The font type of written text and how easy it is to read can be influential when it comes to engaging people with important health information and recruiting them for potentially beneficial programmes, new research by The University of Manchester and Leeds Beckett University has found.Led by Dr Andrew Manley, a Chartered Sport and Exercise Psychologist and Senior Lecturer in Sport and Exercise Psychology at Leeds Beckett, the study – published in the latest issue of Patient Education and Counseling journal – assessed the extent to which the title and font of participant information sheets can influence a person’s perception of written information.Thirty-five pregnant women and 36 trainee midwives took part in the research and were randomly presented with one of four participant information sheets describing an antenatal programme.

Read the rest of the article at http://www.medicalnewstoday.com/releases/290920.php.

Community nurses urged to highlight dangers of female genital mutilation

In their trusted professional capacity, community nurses are well placed to develop effective collaboration with patients and families to tackle the harmful and illegal procedure of female genital mutilation, say academics.Nurses have an important role in preventing female genital mutilation and in providing sensitive care for women and girls who have undergone the procedure, authors writing in Primary Health Care journal warn.King’s College London lecturer in mental health Niall McCrae and lecturer in child health Sheena Bynoe have written about the growing number of girls and women affected by female genital mutilation (FGM).The authors state that although FGM has been illegal in the UK since 1985, healthcare services have lacked a ‘robust response’ until recent years.

Read the rest of the article at  http://www.medicalnewstoday.com/releases/290456.php.

Ten measures to drive quality palliative and hospice care

Patients with serious and life-threatening illnesses may be less likely to experience unnecessary physical and emotional suffering if they receive palliative or hospice care that meets 10 key quality indicators identified by the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurses Association (HPNA). The findings and recommendations of the organizations’ consensus project, Measuring What Matters, were published online in the Journal of Pain and Symptom Management.Measuring What Matters was launched to ensure palliative and hospice care patients receive the highest quality care by identifying the 10 best existing indicators – measures – to gauge that care. The 10 measures range from a complete assessment (including physical, psychological, social, spiritual and functional needs) to a plan for managing pain and shortness of breath to having patients’ treatment preferences followed. They were selected from among 75 indicators largely based on what’s most important to patients and families.Palliative care improves quality of life for patients who are being treated for a serious illness by managing pain and other symptoms. Hospice is a specific type of palliative care for patients in their last year of life.The goal of the project was to select a set of measures that are scientifically rigorous, and that all palliative and hospice care providers should use to ensure they are giving the highest quality care and to eventually enable benchmarking in the field. Currently there is no consistency regarding which measures are required by various groups, from accrediting organizations to payers. As the population ages and the demand for this type of care grows, the ability to assess quality throughout the country and across care settings is increasingly important.

Read the rest of the article http://www.medicalnewstoday.com/releases/289553.php.

Practicing nursing care in a virtual world

Oculus Rift, a gaming headset, can help teach nurses how to communicate better, researchers at the Norwegian University of Science and Technology have found.While Facebook wants to make the world’s best online games using the Oculus Rift headset, researchers at Norwegian University of Science and Technology (NTNU) are using the same set-up to help teach nurses how to communicate better.The Oculus Rift headset gives your body and your mind the powerful experience of being in a virtual world. Your body feels confused, the signals that your brain gets from your eyes don’t quite match with what the rest of your body is experiencing. Your heart rate jumps, and you might even feel nauseated. But many are intrigued – and consumed by the experience.”Forget Google glass. Now it’s Oculus Rift that’s big. Especially if you want to immerse yourself in another reality,” says Ekaterina Prasolova-Førland, an associate professor in NTNU’s Programme for Learning with ICT.

Read the rest of the article http://www.medicalnewstoday.com/releases/288543.php.

Mode of delivery in childbirth associated with pain during or after sexual intercourse

Operative birth is associated with persisting pain during or after sexual intercourse, known as dyspareunia, suggests a new study published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG).

The study aimed to investigate the contribution of obstetric risk factors, including mode of delivery and perineal trauma to postpartum dyspareunia. It also examined the influences of other risk factors, including breastfeeding, maternal fatigue, maternal depression and intimate partner abuse.

A cohort of 1244 first time mothers across six maternity hospitals in Melbourne, Australia was used. Data were taken from baseline and postnatal questionnaires at 3, 6, 12 and 18 months. The mean gestational age of the study participants at the time of enrolment was 15 weeks.

Of the women sampled, 49% had a spontaneous vaginal birth, two thirds of whom sustained a sutured tear and/or episiotomy, 10.8% had an operative vaginal birth assisted by vacuum extraction and 10.7% gave birth assisted by forceps. Additionally, 9.7% were delivered by elective caesarean section and 19.9% were delivered by emergency caesarean section.

Results showed that 78% of the study population had resumed sexual intercourse by 3 months, 94% by 6 months, 97% by 12 months and 98% by 18 months postpartum.

With regards to dyspareunia following childbirth, most of the women (85.7%) who had resumed sex by 12 months postpartum experienced pain during first vaginal sex after childbirth. Dyspareunia was reported by 44.7% of women at 3 months postpartum, 43.4% at 6 months, 28.1% at 12 months and 23.4% at 18 months postpartum. Of the women who reported dyspareunia at 6 months postpartum, a third (32.7%) reported persisting dyspareunia at 18 months postpartum.

Compared to women who had a spontaneous vaginal delivery with intact perineum or unsutured tear, women who had an emergency caesarean section, vacuum extraction or elective caesarean section had double the risk of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other risk factors.

Other factors associated with dyspareunia at 18 months postpartum include pre-pregnancy dyspareunia, intimate partner abuse and maternal fatigue. One in six women (16%) in the study experienced abuse by an intimate partner in the first 12 months postpartum. One third of these women (32.4%) reported dyspareunia at 18 months postpartum, compared with 20.7% of women who did not experience intimate partner abuse. The authors of the study highlight that these results suggest that clinicians should be alert to the possibility that intimate partner abuse is a potential underlying factor in persisting dyspareunia.

The authors conclude that greater recognition and understanding of the role of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities is needed. Additionally, ways to prevent postpartum dyspareunia should be explored.

Ellie McDonald from the Murdoch Childrens Research Institute, Victoria, Australia and co-author of the study said:

“Almost all women experience some pain during first sexual intercourse following childbirth.

“However, our findings show the extent to which women report persisting dyspareunia at 6 and 18 months postpartum is influenced by events during labour and birth, in particular caesarean section and vacuum extraction delivery.

“Not enough is known about the longer term impact of obstetric procedures on maternal health. The fact that dyspareunia is more common among women experiencing operative procedures points to the need for focusing clinical attention on ways to help women experiencing ongoing morbidity, and increased efforts to prevent postpartum morbidity where possible.”

Patrick Chien, BJOG Deputy Editor-in-chief added:

“This is the first study with detailed, frequent and long-term follow-up to assess associations of dyspareunia with obstetric risk factors.

“This study provides us with robust evidence about the extent and persistence of postpartum dyspareunia and associations with mode of delivery and perineal trauma. Future research could look into ways of preventing dyspareunia.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/288323.php

 

Mobility disabilities can contribute to complications during pregnancy

A new study indicates that women with mobility disabilities often experience problems during pregnancy related to their functional impairments.

The study included 8 women with spinal cord injuries, 4 with cerebral palsy, and 10 with other conditions. Impairment-related complications during pregnancy included falls, urinary tract and bladder problems, wheelchair fit and stability problems, significant shortness of breath, increased spasticity, bowel management difficulties, and skin integrity problems.

“Relatively little information is available about the pregnancy experiences of women with physical disabilities, which hampers preconception planning and helping women know what to expect as their pregnancies progress,” said Dr. Lisa Iezzoni, lead author of the Acta Obstetricia et Gynecologica Scandinavica article. “Our findings from 22 interviewees with physical disabilities who described their pregnancies provide insights, albeit preliminary, that could inform both women and their obstetrical practitioners about possible complications so they can plan ahead.”

Adapted by MNT from original media release

http://www.medicalnewstoday.com/releases/287082.php

 

High fitness levels reduce hypertension risk

While being physically fit is beneficial in and of itself, researchers now report that people with high levels of fitness are less likely to develop high blood pressure – also referred to as hypertension – a risk factor for cardiovascular disease.

The study, published in the Journal of the American Heart Association, examined the association of fitness with hypertension among participants undergoing treadmill stress tests to rule out ischemia as a cause of chest pain or shortness of breath.

“If you’re exercising and you’re fit, your chances of developing hypertension are much less than someone else who has the same characteristics but isn’t fit,” says Dr. Mouaz H. Al-Mallah, senior author of the study.

Normal blood pressure is below 120/80 mm Hg – the first number (systolic measurement) represents peak pressure in the arteries and the second number (diastolic measurement) represents minimum pressure in the arteries. Blood pressure is considered to be high when it is greater than 140/90 mm Hg.

There are two types of hypertension. While secondary hypertension appears suddenly and is caused by underlying conditions such as kidney or thyroid problems, primary hypertension has no identifiable cause and develops gradually over the course of many years.

In the US, hypertension affects 1 in 3 adults. According to the American Heart Association (AHA), 78 million people in the country have been diagnosed with the condition.

“Hypertension is associated with a lot of other illnesses and adds significantly to health care costs,” explains Dr. Al-Mallah, “so we need to know how we can reduce it.”

Measuring physical fitness and high blood pressure

The researchers assessed 57,284 participants from the Henry Ford Exercise Testing (FIT) Project, from 1991-2009, taking treadmill stress tests. Of these, 35,175 participants had a history of hypertension.

The team measured the physical fitness of the participants by estimating how much oxygen their bodies used per kg ofbody weight per minute, and thus how much energy they burned in metabolic equivalents (METs).

With 1 MET representing the amount of energy expended by the body at rest, a large number of METs reflects a high-intensity workout.

The researchers observed that participants whose most intense exercise was less than 6 METs had more than a 70% likelihood of having hypertension at the start of the study. Conversely, participants whose maximal exercise output was 12 METs were less than 50% likely to have hypertension.

During the stress test, participants who managed to reach 12 METs or more were 20% less likely to develop hypertension compared with participants who reached less than 6 METs.

A total of 8,053 new cases of hypertension were reported in participants’ medical records and administrative claims during the study’s follow-up period. Of these new cases, 49% were among participants with the lowest fitness (less than 6 METs), and only 21% were among participants with the highest fitness (more than 12 METs).

Fitness: a ‘strong predictor’ of hypertension

Although the study uses a large and diverse population sample, the participants were all originally referred for a stress test, indicating that their initial cardiovascular disease risk would be greater than that of the general population, potentially hindering the generalizability of the findings. The study was also limited by a lack of measuring incidental hypertension in a clinical setting.

Dr. Al-Mallah states that further study is required in order to determine how increasing and decreasing fitness levels affect the risk of hypertension over time. Physical activity was not formally assessed in the study, and this could be addressed in future research as well.

Hypertension is a major risk factor for cardiovascular disease, the number one cause of premature mortality in the developed world. High levels of exercise have been associated with protecting the body from certain health conditions, and now this study suggests adding hypertension to the list.

“Fitness is a strong predictor of who develops hypertension and who does not,” says Dr. Al-Mallah. “This is a clear message to everyone: patients, physicians and lawmakers. It’s very important to be fit.”

Medical News Today also recently reported on a study suggesting that sugars may contribute more to hypertension risk than salt.

Written by James McIntosh

http://www.medicalnewstoday.com/articles/287109.php

 

‘Obesity can reduce life by up to 8 years’

Life expectancy can be reduced by up to 8 years by obesity, which can also cause adults to lose as much as 19 years of healthy life if it leads to type 2 diabetes and cardiovascular disease. A study published in The Lancet Diabetes & Endocrinology examines the issue.

 

The researchers behind the study analyzed data from the US National Health and Nutrition Examination Survey (NHANES), creating a disease-simulation model to estimate the risk of adults of different body weightdeveloping diabetes and cardiovascular disease.

From this, the researchers then calculated the extent to which overweight and obesity may contribute to both years of life lost and years of healthy life lost in American adults aged between 20 and 79 years old, in comparison to people of normal weight.

They found that people who were overweight (BMI 25-30 kg/m2) were estimated to lose up to 3 years of life, depending on age and gender. Individuals classed as obese (BMI 30-35 kg/m2) were calculated to lose up to 6 years, and people classed as very obese (BMI 35 kg/m2 or more) could lose up to 8 years of life.

According to the study, excess weight had the greatest impact on lost years of life among the young and dropped with increasing age.

Obesity can cause the loss of up to 19 ‘healthy life-years’

As well as reducing life expectancy, carrying extra weight was also found to reduce “healthy life-years,” which were defined in the study as years free of obesity-linked cardiovascular disease and diabetes.

Young adults aged between 20 and 29 showed the highest losses of healthy life-years, adding up to around 19 lost years for very obese people. Among people who were overweight or obese, the researchers calculated that two to four times as many healthy life-years were lost than total years of life lost.

Dr. Steven Grover, lead author and professor of medicine at McGill University and a clinical epidemiologist at the Research Institute of the McGill University Health Centre in Canada, explains the findings:

“The pattern is clear. The more an individual weighs and the younger their age, the greater the effect on their health, as they have many years ahead of them during which the increased health risks associated with obesity can negatively impact their lives.

These clinically meaningful calculations should prove useful for obese individuals and health professionals to better appreciate the scale of the problem and the substantial benefits of a healthier lifestyle, including changes to diet and regular physical activity.”

This week on Medical News Today, we also looked at a study published in The BMJ that found obesity during early pregnancy is a risk factor for infant mortality.

The researchers behind that study found that infant mortality was “moderately increased” among overweight and mildly obese mothers (BMI 25-35 kg/m2) compared with mothers of a normal weight; but among more obese mothers (BMI over 35 kg/m2), the risk of infant mortality was more than doubled.

We also reported on a study in the journal Preventing Chronic Disease that found women – particularly black women – are more at risk of increased obesity if they work jobs that involve a lot of sitting down.

Written by David McNamee

http://www.medicalnewstoday.com/articles/286518.php

 

 

80 percent reduction in ‘alarm fatigue’ in hospitals

The sound of monitor alarms in hospitals can save patients’ lives, but the frequency with which the monitors go off can also lead to “alarm fatigue,” in which caregivers become densensitized to the ubiquitous beeping.

Researchers at Cincinnati Children’s Hospital Medical Center have tackled this problem and developed a standardized, team-based approach to reducing cardiac monitor alarms. The process reduced the median number of daily cardiac alarms from 180 to 40, and increased caregiver compliance with the process from 38 percent to 95 percent.

“Cardiac monitors constitute the majority of alarms throughout the hospital,” says Christopher Dandoy, MD, a physician in the Cancer and Blood Diseases Institute at Cincinnati Children’s and lead author of the study. “We think our approach to reducing monitor alarms can serve as a model for other hospitals throughout the country.”

The main accrediting body for healthcare organizations and programs, the Joint Commission, reported 80 alarm-related deaths between January 2009 and June 2012.

Dr. Dandoy’s study of this project was published in the eFirst pages of the journal Pediatrics.

The researchers developed a standardized cardiac monitor care process on the 24-bed, pediatric bone marrow transplant unit at Cincinnati Children’s. The project involved a process for initial ordering of monitor parameters based on age-appropriate standards, daily replacement of electrodes in a manner that was pain-free for patients, individualized daily assessment of cardiac monitor parameters and a reliable method for appropriate discontinuation of the monitors.

“With fewer false alarms, the staff can address significant alarms more promptly,” says Dr. Dandoy. “We believe the roles and responsibilities entailed in this process can be applied to most units with cardiac monitor care.”

Dr. Dandoy designed and conducted the study along with colleagues in the Cancer and Blood Diseases Institute and in the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s.

http://www.medicalnewstoday.com/releases/285215.php

 

 

Tightened guidance for U.S. healthcare workers on personal protective equipment for Ebola

The Centers for Disease Control and Prevention is tightening previous infection control guidance for healthcare workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely.

Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.

The enhanced guidance is centered on three principles:

• All healthcare workers undergo rigorous training and are practiced and competent with PPE, including taking it on and off in a systemic manner
• No skin exposure when PPE is worn
• All workers are supervised by a trained monitor who watches each worker taking PPE on and off.

All patients treated at Emory University Hospital, Nebraska Medical Center and the NIH Clinical Center have followed the three principles. None of the workers at these facilities have contracted the illness.

Principle #1: Rigorous and repeated training

Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step donning and doffing of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.

Principle #2: No skin exposure when PPE is worn

Given the intensive and invasive care that US hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.

CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single use disposable full face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:

• Double gloves
• Boot covers that are waterproof and go to at least mid-calf or leg covers
• Single use fluid resistant or imperable gown that extends to at least mid-calf or coverall without intergraded hood.
• Respirators, including either N95 respirators or powered air purifying respirator (PAPR)
• Single-use, full-face shield that is disposable
• Surgical hoods to ensure complete coverage of the head and neck
• Apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea

http://www.medicalnewstoday.com/releases/284226.php