Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis.

BACKGROUND: Moving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams' approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science. METHODS: We conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014-2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step. RESULTS: Participants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3-7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools. CONCLUSIONS: We identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.

Two-month administration of methylphenidate improves olfactory sensitivity and suppresses appetite in individuals with obesity.

Olfaction contributes to feeding behaviour and is modulated by changes in dopamine levels. Methylphenidate (MPH) increases brain dopamine levels and has been shown to reduce appetite and promote weight loss in patients with attention deficit hyperactivity disorder. The objectives of this study were to test the effect of MPH on olfaction, appetite, energy intake, and body weight (BW) on individuals with obesity. In a randomized, double-blind study, 12 participants (age 28.9 ± 6.7 years) with a body mass index (BMI) of 36.1 ± 4.5 kg/m2 were assigned to MPH (0.5 mg/kg) (n = 5) or placebo (n = 7) twice daily for 2 months. Appetite (visual analog scale), odour threshold (Sniffin' Sticks®), energy intake (food menu), and BW (DEXA scan) were measured at day 1 and day 60. MPH intake significantly increased odour threshold scores (6.3 ± 1.4 vs. 9.4 ± 2.1 and 7.9 ± 2.3 vs. 7.8 ± 1.9, respectively; p = 0.029) versus placebo. There was a significantly greater suppression of appetite sensations (desire to eat (p = 0.001), hunger (p = 0.008), prospective food consumption (p = 0.003)) and an increase in fullness (p = 0.028) over time in the MPH versus placebo. MPH suppressed appetite and improved olfactory sensitivity in individuals with obesity. These data provide novel findings on the favourable effects of MPH on appetite and weight regulation in individuals living with obesity.

Effects of 2 months of methylphenidate on energy expenditure in individuals with obesity: A randomized, double-blind, placebo-controlled pilot study.

Methylphenidate (MPH) has been previously shown to increase resting energy expenditure (REE) in individuals of normal weight; however, the effects on individuals living with obesity are currently unknown. Ten individuals living with obesity were randomly assigned to undergo 60 days of MPH administration with a daily dose of 0.5 mg/kg body weight or a placebo control. REE was measured before and after the 60-day intervention. There was a trend toward significance for group × time interaction on REE (p = 0.082) with a large effect size (η2 = 0.331), with MPH administration increasing REE compared to a decrease in placebo control. Preliminary findings from this pilot study show that MPH has the potential to counter the adaptive thermogenic process commonly seen in weight loss. This is a unique finding among pharmacotherapies, as no approved obesity drugs measurably impact REE.

Association of maternal socioeconomic status and race with risk of congenital heart disease: a population-based retrospective cohort study in Ontario, Canada.

OBJECTIVE: To investigate the interrelationships between maternal socioeconomic status (SES), race and congenital heart diseases (CHD) among infants. DESIGN: Retrospective cohort study. STUDY SETTING: Ontario, Canada. STUDY POPULATION: All singleton stillbirths and live births born in hospitals between 1 April 2012 and 31 March 2018 in Ontario, Canada (n=804 292). OUTCOME: CHD. ANALYSIS: Multivariable logistic regression models were performed to assess associations between maternal neighbourhood household income, education level, race and CHD while adjusting for maternal age at birth, assisted reproductive technology, obesity, pre-existing health conditions, substance use during pregnancy, maternal rural residence and infant's sex. RESULTS: Compared with infants whose mothers lived in the highest median household income neighbourhoods, infants whose mothers lived in the lowest median income neighbourhoods had a higher likelihood of having CHD (adjusted OR 1.15, 95% CI 1.06 to 1.24). Compared with infants whose mothers lived in neighbourhoods with more people with a university or higher degree, those infants whose mothers lived in neighbourhoods with less people with a university or higher degree had a higher chance of developing CHD (adjusted OR 1.26, 95% CI 1.16 to 1.36). Compared with white mothers, black mothers had a higher odds of giving birth to a child with CHD (adjusted OR 1.40, 95% CI 1.27 to 1.54). No association was detected between White and Asian mothers and CHD among infants. CONCLUSIONS: Our study indicates that there are inequities in CHD burden by maternal SES and race in Ontario, Canada. Further investigation is needed to examine racial variation in CHD using more detailed ethnic data.

Effects of prenatal exposure to cigarettes on anthropometrics, energy intake, energy expenditure, and screen time in children.

BACKGROUND: Maternal prenatal smoking is associated with downstream childhood obesity. Although animal research suggests reduced resting energy expenditure (REE), decreased physical activity (PA), and increased energy intake as mechanisms, these relationships are unclear in humans. The objectives were to examine the association of prenatal maternal smoking with non-volitional energy expenditure (REE and the thermic effect of feeding [TEF]), child adiposity, energy intake, free-living PA (daily light PA (LPA), daily moderate-to-vigorous PA (MVPA), daily sedentary behavior (SB)), and screen time (television and computer/video game) in children. METHODS: As part of a longitudinal study, 46 children (n = 27 controls and n = 19 smoking exposed) with mean age 7.6 ±â€¯2 years were recruited. Body weight and composition (Bioelectrical Impedance), height (Stadiometer), waist circumference (cm; tape), BMI (kg/m2), REE (kcal/day; indirect calorimetry), PA (minutes; Accelerometry), screen time (hours; self-report) and ad libitum energy intake (lunch buffet; 7-day food log) were measured. Effects sizes were evaluated using Cohen's d. RESULTS: Relative to controls, after controlling for age and family income, children who were exposed to cigarette smoke in utero exhibited greater waist circumference (p = 0.04, Cohen's d = 1.03), percent body fat (%BF; p = 0.02, Cohen's d = 0.97), and a trend for BMI (p = 0.05, Cohen's d = 0.86). Exposed children did not differ in REE (trend for lower: p = 0.1, Cohen's d = 0.42) or TEF but were shown to have significantly higher ad libitum energy intake (p = 0.02, Cohen's D = 0.70) from the palatable lunch buffet, but not from the out of laboratory 7-day energy intake (p = 0.8). Examining screen time behaviors, exposed children spent more time watching television during the week (p = 0.03, Cohen's D = 0.82), and overall television watching (p = 0.02, Cohen's D = 0.80); there were no group differences in any other screen time behaviors. CONCLUSIONS: Children exposed to cigarette smoke in utero exhibit greater adiposity, and this exposure may have as contributing factors higher screen time, ad libitum energy intake, and a trend for reduced REE. The data suggest that lifestyle factors such as diet and screen time represent targets for obesity prevention in a high-risk population of young children exposed to prenatal cigarette smoke. Findings also highlight the need for smoking cessation programs to reduce downstream obesity in offspring.