Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review

Women in the preconception, pregnant, or postpartum period are susceptible to weight stigma, particularly due to the risk of excess weight gain during the reproductive life period and the negative effects of stigma on the health of both the mother and the child. Identifying the drivers and facilitators of weight stigma will help guide focused weight stigma prevention interventions. This systematic review aimed to identify the drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women. In May 2022, Medline, Embase, PsycINFO, and the Maternity and Infant Care Database were searched for peer-reviewed articles published since 2010 using search terms weight AND stigma AND preconception, OR pregnant, OR postpartum. Of the 1724 articles identified, 34 fulfilled the inclusion criteria and were included in a narrative synthesis. Women reported facing insensitive language, misconceptions about obesity across all settings, and inappropriate media representation. The unavailability of appropriate equipment at facilities was reported by both women and health professionals. Our findings indicate that a rigorous effort by all stakeholders is necessary to promote regulatory, legal, and educational initiatives designed to reduce weight stigma and discrimination against women in the reproductive period.

A rapid review of implementation frameworks underpinning Aboriginal and Torres Strait Islander children's health and social care programs

OBJECTIVE

This rapid review aimed to identify (1) key frameworks and components underpinning the effective implementation of Health and Social Care (HSC) programs for Aboriginal and Torres Strait Islander children; and (2) participatory and co-design frameworks guiding the implementation.

METHODS

Four databases were searched for peer-reviewed English-language articles published between 2015 and 2021. The focus was on HSC models, frameworks, projects or services with an implementation focus for Aboriginal and Torres Strait Islander children aged 0-12 years.

RESULTS

Seven studies identifying components supporting effective implementation of Aboriginal and Torres Strait Islander HSC programs were included. Continuous Quality Improvement was the most widely applied approach. Most studies described participatory and co-design approaches to ensure suitability for Aboriginal and Torres Strait Islander children and families.

CONCLUSIONS

There remains a paucity of evidence on the effective implementation of Aboriginal and Torres Strait Islander children's HSC programs. Implementation approaches that foster cultural safety and Aboriginal and Torres Strait Islander leadership, support diverse partnerships and promote localised application may facilitate the effective implementation of HSC programs.

IMPLICATIONS FOR PUBLIC HEALTH

Future research in this area would benefit from greater consideration of appropriate implementation frameworks and co-design approaches, and emphasis on reporting interventions, implementation frameworks and co-design approaches for HSC programs for Aboriginal and Torres Strait Islander children.

Residential Out-of-Home Care Staff Perceptions of Implementing a Trauma-Informed Approach: The Sanctuary Model

The aim of this study was to explore and better understand the enablers and barriers of implementation and how these impact on the organisational successes and challenges of adopting The Sanctuary Model, as perceived by residential care staff. Following ethics approval, three semi-structured interviews and six focus groups were conducted with residential care staff between February and July, 2020. Participants identified a number of enablers, presented in the subthemes: (a) social support systems and resources; (b) shared trauma-informed knowledge and understanding; and (c) leadership and champions. These enablers influenced organisational successes in adopting: (a) the Sanctuary Commitments; (b) the S.E.L.F Framework; (c) Reflective Practice and Supervision; and (d) Trauma Theory. A number of barriers hindering implementation were identified. These were reflected in the subthemes: (a) informal practice; (b) lack of practice-based training; (c) poor introduction to young people; and (d) resources. These barriers impacted on organisational challenges faced in residential out-of-home care including: (a) The Sanctuary Model Toolkit and (b) young people's behaviour and engagement. Comparisons from this study and previous findings identified by executive and upper management staff (decision makers) are discussed. Key findings indicate that when implementing, sustaining and embedding The Sanctuary Model, organisations need to become trauma-informed rather than 'do' trauma-informed care and organisations need to "live and breathe" The Sanctuary Model Commitments, be connected and inclusive of one another, use trauma-informed language and feel safe.

Systematic Review of School-Wide Trauma-Informed Approaches

Extensive research on traumatic life experiences reveals how healthy development can be derailed and brain architecture altered by excessive or prolonged activation of the body's stress response, impacting health, mental health, learning, behavior and relationships. Schools offer a unique environment to prevent and counter the impacts of childhood trauma. This study aimed to investigate empirical evidence for school-wide trauma-informed approaches that met at least two of the three essential elements of trauma-informed systems defined by SAMSHA (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville: Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/shin/content/SMA14-4884.pdf) and consider commonalities in approaches, drivers of change, challenges and learnings related to implementation, sustainability and outcomes for students. A systematic review searching foremost databases was conducted for evidence of trauma-informed school-wide approaches used between 2008 and 2019. Four papers were identified, incorporating four school-wide approaches, The Healthy Environments and Response to Trauma in Schools (HEARTS) Model; The Heart of Teaching and Learning (HTL): Compassion, Resiliency, and Academic Success Model; The New Haven Trauma Coalition (NHTC) and The Trust-Based Relational Intervention. Although heterogeneous, the models shared core elements of trauma-informed staff training, organization-level changes and practice change, with most models utilizing student trauma-screening. Generalizability of the findings was low given the small number of studies, the mix of mainstream and specialist schools and high risk of bias. Given the limitations of research in this emergent but rapidly accelerating field, future research is urgently required to understand the interaction between core elements of a trauma-informed approach, teaching pedagogy and organizational factors that support the embedding, use and transferability of school-wide approaches.

Correction to: Systematic Review of School-Wide Trauma-Informed Approaches

[This corrects the article DOI: 10.1007/s40653-020-00321-1.].

Interventions and practice models for improving health and psychosocial outcomes of children and young people in out-of-home care: protocol for a systematic review

INTRODUCTION

Children and young people placed in out-of-home care (OoHC) are often affected by a history of trauma and adverse childhood experiences. Trauma in early childhood can impact on children's health and psychosocial development, whereas early interventions can improve children's development and placement stability. Although several interventions and practice models have been developed to improve health and psychosocial outcomes for children and young people in OoHC, there remains a lack of rigorous research examining the impact of these interventions in OoHC settings, as there are no systematic reviews examining the impact these interventions and practice models have on the children and young people they serve. We aim to conduct a comprehensive systematic review to examine the effectiveness of interventions and practice models for improving health and psychosocial outcomes in children and young people living in OoHC and to identify relevant knowledge gaps.

METHODS AND ANALYSIS

Major electronic databases including Medline, Medline in-process and other non-indexed citations, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Sociological Abstracts and all Evidence-Based Medicine Reviews incorporating: Cochrane Database of Systematic Reviews, American College of PhysiciansJournal Club, Database of Abstracts of Reviews of Effects,Cochrane Central Register of Controlled Trials, CochraneMethodology Register, Health Technology Assessment and National Health Service Economic Evaluation Database, will be systematically searched for any studies published between 2008 and 2018 of interventions and practice models developed to improve health and psychosocial outcomes for children and young people in OoHC. Two independent reviewers will assess titles and abstracts for eligibility according to prespecified selection criteria and will perform data extraction and quality appraisal. Meta-analyses and/or metaregression will be conducted where appropriate.

ETHICS AND DISSEMINATION

This study will not collect primary data and formal ethical approval is therefore not required. Findings from this systematic review will be disseminated in a peer-reviewed publication and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42019115082.

Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery

INTRODUCTION Recent studies have advocated the use of perioperative fluid restriction in patients undergoing major abdominal surgery as part of an enhanced recovery protocol. Series reported to date include a heterogenous group of high- and low-risk procedures but few studies have focused on rectal cancer surgery alone. The aim of this study was to assess the effects of perioperative fluid volumes on outcomes in patients undergoing elective rectal cancer resection. METHODS A prospectively maintained database of patients with rectal cancer who underwent elective surgery over a 2-year period was reviewed. Total volume of fluid received intraoperatively was calculated, as well as blood products required in the perioperative period. The primary outcome was postoperative morbidity (Clavien-Dindo grade I-IV) and the secondary outcomes were length of stay and major morbidity (Clavien-Dindo grade III-IV). RESULTS Over a 2-year period (2012-2013), 120 patients underwent elective surgery with curative intent for rectal cancer. Median total intraoperative fluid volume received was 3680ml (range 1200-9670ml); 65/120 (54.1%) had any complications, with 20/120 (16.6%) classified as major (Clavien-Dindo grade III-IV). Intraoperative volume >3500ml was an independent risk factor for the development of postoperative all-cause morbidity (P=0.02) and was associated with major morbidity (P=0.09). Intraoperative fluid volumes also correlated with length of hospital stay (Pearson's correlation coefficient 0.33; P<0.01). CONCLUSIONS Intraoperative fluid infusion volumes in excess of 3500ml are associated with increased morbidity and length of stay in patients undergoing elective surgery for rectal cancer.

Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve patient psychomotor skills

BACKGROUND

Early recovery of patients following sedation/analgesia and anesthesia is important in ambulatory practice. The aim of this study was to assess whether modafinil, used for the treatment of narcolepsy, improves recovery following sedation/analgesia.

METHODS

Patients scheduled for extracorporeal shock wave lithotripsy were randomly assigned to one of four groups. Two groups received a combination of fentanyl/midazolam with either modafinil or placebo. The remaining groups received remifentanil/propofol with either modafinil or placebo. Modafinil 200 mg was administered to the treatment group patients 1 h before sedation/analgesia. Groups were compared using the digital symbol substitution test (DSST), trail making test (TMT), observer scale of sedation and analgesia (OAA/S) and Aldrete score. Verbal rating scale (VRS) scores for secondary outcome variables e.g. energy, tiredness and dizziness were also recorded before and after treatment.

RESULTS

Sixty-seven patients successfully completed the study. Groups received similar doses of sedation and analgesic drugs. No statistically significant difference was found for DSST between groups. No significant adverse effects occurred in relation to modafinil. No statistically significant difference between groups was identified for TMT, OAA/S and Aldrete scores. The mean VRS score for tiredness was lesser in the modafinil/fentanyl/midazolam group [1.3 (2.0)] compared with the placebo group [3.8 (2.5)], P=0.02. Such a difference was not found between the remifentanil/propofol groups [placebo 2.6 (2.2) vs. modafinil 3.1(2.7)], p>0.05. Dizziness was greater in the modafinil/remifentanil/propofol group 1.7 (2.0) vs. placebo 0.0 (0.5), p<0.05.

CONCLUSION

Modafinil reduces patient-reported tiredness after sedation/analgesia but does not improve recovery in terms of objective measures of patient psychomotor skills.

Sudden onset fatigue (SOF) in patients with breast cancer: Characteristics and symptomatology

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Background: Cancer-related fatigue is underrecognized and poorly managed. Unpredictability and rapid onset in fatigue is stressed by cancer patients but seldom addressed by health care professionals. Although sudden onset of cancer-related fatigue is anecdotally documented across qualitative studies, the symptom has never been systematically investigated. Our purpose is to describe the symptom and clinical characteristics of SOF in breast cancer patients receiving chemotherapy. Methods: This is a cross-sectional descriptive study enrolling female breast cancer outpatients undergoing chemotherapy in an urban cancer center. A brief questionnaire assessing the symptom characteristics of SOF was completed by subjects. Comprehensive metabolic panel and complete blood counts, were obtained. Descriptive statistics described the symptom characteristics of SOF. Mann-Whitney tests examined the differences between those who did and did not experience SOF. Results: Thirty patients have been enrolled. Median age 53 years (31 to 65; SD=7.7), 60% were Black. 80% (n=24) experienced SOF in the past 7 days with a median of 4 days a week and 2.5 episodes per day. SOF was most likely (75%) to occur in the afternoon while patients were engaging in activities. Levels of fatigue before, during, and after a specific episode of SOF were 5, 9, and 5, respectively, on 0–10 (highest) rating scale. Weakness, sweating, or pain sometimes accompanied SOF. When SOF occurred, individuals immediately needed to stop activities to rest until it went away. Those who experienced SOF had significantly lower levels of calcium (Median=8.9 vs. 9.4), albumin (Median=3.7 vs. 7.1), and hematocrit (Median=32.1 vs. 36) (p<0.05). Those who experienced SOF also had higher levels of GPT (Median=25.5 vs. 17), lower levels of total protein (Median=6.7 vs. 7.1), WBC (Median=4.9 vs. 8.9), RBC (Median=3.4 vs. 3.9), and hemoglobin (Median=10.7 vs. 11.4). Conclusions: Our ongoing study is one of the first to identify the characteristics of patients at high risk of SOF. SOF needs to be recognized and managed when patients undergo chemotherapy. Associated conditions should be identified and addressed. The ultimate goal is to minimize the distress and improve the quality of life of patients receiving chemotherapy.

No significant financial relationships to disclose.

A combination of lidocaine and nitrous oxide in oxygen is more effective in preventing pain on propofol injection than either treatment alone

BACKGROUND AND OBJECTIVE

Propofol is an intravenous (i.v.) anaesthetic agent that possesses many of the qualities of an ideal anaesthetic agent. The most significant side-effect associated with propofol is pain on injection. Despite optimal therapy, the incidence of pain on propofol injection remains a problem. This prospective, randomized, double blinded study evaluated the effect of three different treatment strategies in decreasing pain on propofol injection.

METHODS

We studied 102 adult, ASA I-II patients, scheduled for elective surgical procedures. Combination of i.v. lidocaine and nitrous oxide (N2O) in oxygen (O2) inhalation pre-treatment was compared with either treatment alone in the prevention of pain on propofol injection. A standard propofol injection technique and scoring system, to measure the pain on injection was used.

RESULTS

Demographic variables were similar between the groups. The incidence of no pain on propofol injection was similar in the lidocaine and N2O groups (63.6% vs. 57.5%) (95% confidence interval (CI): 0.17-0.29, P = 0.61). Combination therapy was associated with a greater incidence of no pain on injection (84% vs. 63.6%) (95% CI: 0.06-0.48, P = 0.04).

CONCLUSION

Combination of i.v. lidocaine and N2O in O2 inhalation pre-treatment is more effective than either treatment alone in decreasing pain on propofol injection.

Challenging the precepts of family-centered care: testing a philosophy

Family-centered care (FCC) is a model of patient care delivery that encourages the inclusion of the family in the planning and provision of care. Although this model has been discussed extensively in the literature and adopted by some institutions, it is one that many have difficulty implementing. The purpose of this study was to test the elements of a FCC philosophy developed for maternal/child units at a major medical center. Questionnaires developed for this study and translated into four languages were completed by 193 parent/patient participants. The questionnaire asked participants to rate the importance of FCC interventions and report which interventions had been provided. Most of the participants were Caucasian, married, female, had an annual income of $20,000 or less, had 12 or fewer years of education, and were younger than 40 years of age. Overall, "feeling welcome when I come to the hospital" was the highest rated item by parents of hospitalized neonates and children and perinatal patients. Findings from this study will be used to implement a FCC care philosophy.

Alterations in vertebral growth following prolonged plaster immobilisation

Long-term immobilisation in serial plasters for scoliosis, including the period of the adolescent growth spurt, leads to an increase in height of the vertebral bodies and a decrease of their height to width ratio. These changes are at the expense of the disc which is reduced in thickness. This stimulating effect on the vertebral body growth is probably due to the changes in mechanical factors.