Identifying maternal needs following childbirth: comparison between pregnant women and recent mothers.

BACKGROUND: The postnatal period is associated with new needs for mothers. Four categories of needs were highlighted in a previous study: for information, for psychological support, for the sharing of experiences and for practical and material support. To ensure that these four needs are inherent to the postpartum period, the aims of this study is to examine these needs by comparing recent mothers' needs with the needs of pregnant women. METHODS: The 4 needs previously identified were cross-sectionally investigated by online self-reported questionnaires completed by women in their last trimester of pregnancy and by mothers who had a child between 0 and 6 months of age. RESULTS: The 4 needs were largely present during the postpartum period. The need for information seemed to be more present during pregnancy (92.4 %) than during the postpartum period (84.6 %, p = 0.03), but women used the Internet significantly more often to search for information after childbirth (54.8 %) than during pregnancy (41.2 %, p < 0.0001). The needs for psychological support and to share experiences seemed to be closely linked. Even if the global satisfaction with psychological support was fairly high, it weakened after childbirth (p < 0.05). Feelings of loneliness (p < 0.0001) and depression scores (p = 0.01) were also higher during the postpartum period than during pregnancy. Finally, the need for practical support was also more pronounced during the postpartum period than during pregnancy (p = 0.01). CONCLUSIONS: All mothers seem to meet the 4 identified needs during the postpartum period but at different levels of intensity. Trying to meet these needs could offer an opportunity to improve mothers' quality of life.

Concordance between muscle mass assessed by bioelectrical impedance analysis and by dual energy X-ray absorptiometry: a cross-sectional study.

BACKGROUND: Besides magnetic resonance imaging, dual energy X-ray absorptiometry (DXA) seems the most reliable tool to evaluate body composition and is often considered as the gold standard in clinical practice. Bioelectrical impedance analysis (BIA) could provide a simpler, portative, and less expensive alternative. Because the body composition assessment by BIA is device-dependent, the aim of this study was to appraise the concordance between the specific bioelectrical impedance device InBody S10 and DXA for the body composition evaluation. METHODS: Body composition, included appendicular lean mass divided by height squared (ALM/ht(2)) was measured by DXA (Hologic QDR Discovery device) and by BIA (InBody S10 Biospace device). Agreement between tools was assessed by means of the Bland Altman method and reliability was determined using the IntraClass Coefficient (ICC). ICC was also computed to assess the reliability of the test-retest performed by the same operator or by two different ones. RESULTS: A total of 219 subjects were enrolled in this study (mean age: 43.7 ± 19.1 years old, 51.6% of women). For the ALM/ht(2), reliability of the test-retest of the BIA was high with an ICC of 0.89 (95%CI: 0.86-0.92) when performed by the same operator and an ICC of 0.77 (95%CI: 0.72-0.82) when performed by two different operators. Agreement between ALM/ht(2) assessed by DXA and BIA was low (ICC = 0.37 (95%CI: 0.25-0.48)). Mean ALM/ht(2) was 9.19 ± 1.39 kg/m(2) with BIA and 7.34 ± 1.34 kg/m(2) with DXA, (p < 0001). A formula developed using a multiple regression analysis, and taking into account muscle mass assessed by BIA, as well as sex and body mass index, explains 89% of the ALM/ht(2) assessed by DXA. CONCLUSIONS: Although our results show that the measure of ALM/ht(2) by BIA is reliable, the agreement between DXA and BIA is low. Indeed, BIA seems to overestimate ALM/ht(2) compared to DXA and, consequently, it is important to use an adapted formula to obtain measurement of the appendicular lean mass by BIA close to that measured by DXA.

Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes.

INTRODUCTION: The postpartum period represents the time of risk for the emergence of maternal postpartum depression. There are no systematic reviews of the overall maternal outcomes of maternal postpartum depression. The aim of this study was to evaluate both the infant and the maternal consequences of untreated maternal postpartum depression. METHODS: We searched for studies published between 1 January 2005 and 17 August 2016, using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane Pregnancy and Childbirth Group trials registry. RESULTS: A total of 122 studies (out of 3712 references retrieved from bibliographic databases) were included in this systematic review. The results of the studies were synthetized into three categories: (a) the maternal consequences of postpartum depression, including physical health, psychological health, relationship, and risky behaviors; (b) the infant consequences of postpartum depression, including anthropometry, physical health, sleep, and motor, cognitive, language, emotional, social, and behavioral development; and (c) mother-child interactions, including bonding, breastfeeding, and the maternal role. DISCUSSION: The results suggest that postpartum depression creates an environment that is not conducive to the personal development of mothers or the optimal development of a child. It therefore seems important to detect and treat depression during the postnatal period as early as possible to avoid harmful consequences.

Exercise and Education Program After Breast Cancer: Benefits on Quality of Life and Symptoms at 3, 6, 12, and 24 Months' Follow-up.

BACKGROUND: Various clinical trials have demonstrated the benefits of physical training offered during and/or after breast cancer treatments. However, given the variety of adverse events that may be encountered, physical training could be combined with psychologic, relational, and social guidance. This kind of multidisciplinary program, as well as its long-term effects, have been little studied so far. Therefore, the objective of our study was to determine the benefits at 3, 6, 12, and 24 months of a 3-month exercise and education program among women after breast cancer treatment. PATIENTS AND METHODS: Two hundred nine outpatients treated for primary breast carcinoma were divided into a control group (n = 106) and an experimental group (n = 103) which underwent a 3-month rehabilitation program including physical training and psychoeducational sessions. The assessments, performed before the program and at 3, 6, 12, and 24 months after inclusion, included validated questionnaires on quality of life and symptoms. RESULTS: The analyses revealed an improvement in quality of life and symptoms after the exercise and education program within the experimental group and a maintenance of these improvements during the 2 years of follow-up. These improvements were significantly better than those in the control group, clearly demonstrating that the program has benefits. CONCLUSION: This trial identified the benefits of a well-detailed 3-month exercise and education program over 24 months' follow-up among women after breast cancer treatment.

Meeting the Needs of Mothers During the Postpartum Period: Using Co-Creation Workshops to Find Technological Solutions.

BACKGROUND: The postnatal period is associated with many new needs for mothers. OBJECTIVE: The aim of this study was to find technological solutions that meet the needs of mothers during the year following childbirth. METHODS: Two co-creation workshops were undertaken with parents and professionals. The aim of the first workshop was to create a list of all the criteria the proposed solution would have to address to meet the needs of mothers after childbirth. The aim of the second workshop was to create solutions in response to the criteria selected during the first workshop. RESULTS: Parents and health professionals want solutions that include empathy (ie, to help fight against the feelings of abnormality and loneliness), that help mothers in daily life, that are personalized and adapted to different situations, that are educational, and that assures some continuity in their contact with health professionals. In practice, we found that parents and professionals think the solution should be accessible to everyone and available at all times. To address these criteria, technology experts proposed different solutions, such as a forum dedicated to the postpartum period that is supervised by professionals, a centralized website, a system of videoconferencing, an online exchange group, a "gift voucher" system, a virtual reality app, or a companion robot. CONCLUSIONS: The human component seems to be very important during the postnatal period. Nevertheless, technology could be a great ally in helping mothers during the postpartum period. Technology can help reliably inform parents and may also give them the right tools to find supportive people. However, these technologies should be tested in clinical trials.

Reliability of muscle strength measures obtained with a hand-held dynamometer in an elderly population.

BACKGROUND: The objective of this study was to assess the reliability of a hand-held dynamometer for isometric strength measurements among nursing home residents. METHODS: The isometric muscle strength of nursing home residents was assessed for eight different muscle groups, using a hand-held dynamometer, the MicroFET2 device. Strength measurements were performed at baseline and after 4 days by the same operator and after 8 days by a second operator. Intraclass coefficients (ICC) were computed to assess the relative reliability, whereas the minimal detectable change (MDC%) was calculated to assess the absolute reliability of the test-retest of the MicroFET2 used by one single operator or by two different ones. RESULTS: Thirty nursing home residents (75·0 ± 11·2 years, 50% of women) were enrolled in this study. ICC of the test-retest with one single operator ranged from 0·60 (0·37-0·83) for the ankle extensors to 0·85 (0·74-0·95) for the elbow flexors. When considering the test-retest with two different operators, the ICC values ranged from 0·62 (0·41-0·84) for the ankle extensors to 0·87 (0·79-0·96) for the elbow extensors. For the absolute reliability, MDC% varies from 27·64 (elbow flexors) to 81·97 (ankle extensors) when performed in intra-observer. In interobserver condition, MDC%, respectively, varies from 24·38 (elbow extensors) 67·59 (ankle extensors). CONCLUSION: Using standardized protocol and standardized instructions to patients, a high relative and moderate absolute reliability was observed for all but ankle muscle groups, making this hand-held dynamometer a potential tool for research in the elderly population.

The effects of vitamin D on skeletal muscle strength, muscle mass, and muscle power: a systematic review and meta-analysis of randomized controlled trials.

CONTEXT: There is growing evidence that vitamin D plays a role on several tissues including skeletal muscle. OBJECTIVE: The aim was to summarize with a meta-analysis, the effects of vitamin D supplementation on muscle function. DATA SOURCES: A systematic research of randomized controlled trials, performed between 1966 and January 2014 has been conducted on Medline, Cochrane Database of Systematics Reviews, Cochrane Central Register of Controlled and completed by a manual review of the literature and congressional abstracts. STUDY SELECTION: All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included. Out of the 225 potentially relevant articles, 30 randomized controlled trials involving 5615 individuals (mean age: 61.1 years) met the inclusion criteria. DATA EXTRACTION: Data were extracted by two independent reviewers. DATA SYNTHESIS: Results revealed a small but significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.17 (P = .02). No significant effect was found on muscle mass (SMD 0.058; P = .52) or muscle power (SMD 0.057; P = .657). Results on muscle strength were significantly more important with people who presented a 25-hydroxyvitamin D level <30 nmol/L. Supplementation seems also more effective on people aged 65 years or older compared to younger subjects (SMD 0.25; 95% CI 0.01 to 0.48 vs SMD 0.03; 95% CI -0.08 to 0.14). CONCLUSIONS: Vitamin D supplementation has a small positive impact on muscle strength, but additional studies are needed to define optimal treatment modalities, including dose, mode of administration, and duration.

Prevalence of vitamin D inadequacy in European women aged over 80 years.

Inadequate vitamin D status is associated with secondary hyperparathyroidism and increased bone turnover and bone loss, which in turn increases fracture risk. The objective of this study is to assess the prevalence of inadequate vitamin D status in European women aged over 80 years. Assessments of serum 25-hydroxyvitamin D levels (25(OH)D) were performed on 8532 European women with osteoporosis or osteopenia of which 1984 were aged over 80 years. European countries included in the study were: France, Belgium, Denmark, Italy, Poland, Hungary, United Kingdom, Spain and Germany. Two cut-offs of 25(OH)D inadequacy were fixed: <75 nmol/L (30 ng/ml) and <50 nmol/L (20 ng/ml). Mean (SD) age of the patients was 83.4 (2.9) years, body mass index was 25.0 (4.0) kg/m(2) and level of 25(OH)D was 53.3 (26.7) nmol/L (21.4 [10.7] ng/ml). There was a highly significant difference of 25(OH)D level across European countries (p<0.0001). In these women aged over 80 years, the prevalence of 25(OH)D inadequacy was 80.9% and 44.5% when considering cut-offs of 75 and 50 nmol/L, respectively. In the 397 (20.0%) patients taking supplemental vitamin D with or without supplemental calcium, the mean serum 25(OH)D level was significantly higher than in the other patients (65.2 (29.2) nmol/L vs. 50.3 (25.2) nmol/L; P<0.001). This study indicates a high prevalence of vitamin D (25(OH)D) inadequacy in old European women. The prevalence could be even higher in some particular countries.

The promise of wearable activity sensors to define patient recovery.

The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.