Prevalence of Sex-Specific Cardiovascular Disease Risk Factors, Medical Risk, and Engagement in Health-Promoting Behaviours in Premenopausal Females.

Background: Several sex-specific risk factors (SS-RFs) increase a women's risk for cardiovascular disease (CVD) but are often overlooked during risk assessment. The purpose of this study was to identify the prevalence of SS-RFs and assess CVD risk, knowledge, perceptions and behaviours in premenopausal Canadian women. Methods: An online survey was distributed across Canada to premenopausal biological females (19-49 years of age). The survey gathered demographics, medical history, engagement in health-promoting behaviours, and knowledge and perceptions of CVD risk. CVD risk was calculated using medical risk and SS-RFs were tabulated from medical history. Results: A total of 2559 participants (33 ± 8 years) completed the survey. The majority of our sample (82%) was classified as low medical risk. Of those classified as low risk, 35% had at least 1 SS-RF. Of high-risk individuals, 70% underestimated their risk, 21% of whom perceived themselves as low risk. Engagement in health behaviours was suboptimal. Knowledge of traditional CVD risk factors and prevention was relatively high; however, less than one-half were aware of SS-RFs such as early menopause (39.4%). Conclusions: Considering both traditional and SS-RFs, 47% of premenopausal Canadian women may be at risk for developing CVD. Of those deemed low medical risk for developing CVD, more than one-third reported having at least 1 SS-RF. Canadian women have poor knowledge of the risks associated with SS-RFs, lack sufficient awareness of the need for prevention of CVD, and are not engaging in sufficient health-promoting behaviours to mitigate future CVD risk.

Contexte: Plusieurs facteurs de risque liés au sexe (FR-LS) font augmenter le risque de maladies cardiovasculaires (MCV) chez les femmes, mais sont souvent négligés durant l'évaluation des risques. L'objectif de la présente étude était de déterminer la prévalence des FR-LS et d'évaluer le risque de MCV, les connaissances, les perceptions et les comportements au sein des femmes canadiennes préménopausées. Méthodes: Une enquête en ligne a été distribuée aux femmes biologiques préménopausées (19-49 ans) du Canada. L'enquête a permis de recueillir les données démographiques, les antécédents médicaux, les renseignements sur l'adoption de comportements favorisant la santé, les connaissances et les perceptions du risque de MCV. Le risque de MCV a été calculé à partir du risque médical, et les FR-LS, compilés à partir des antécédents médicaux. Résultats: Un total de 2 559 participantes (33 ± 8 ans) ont rempli l'enquête. La majorité de notre échantillon (82 %) a été classifiée dans la catégorie de faible risque médical. Parmi celles classifiées dans la catégorie de faible risque, 35 % avaient au moins 1 FR-LS. Parmi les personnes exposées à un risque élevé, 70 % sous-estimaient leur risque, et 21 % parmi elles se percevaient exposées à un faible risque. L'adoption de comportements liés à la santé était sous-optimale. Les connaissances sur les facteurs de risque de MCV traditionnels et sur la prévention étaient relativement élevées. Toutefois, moins de la moitié connaissaient les FR-LS telle la ménopause précoce (39,4 %). Conclusions: Si l'on tient compte des FR traditionnels et des FR-LS, 47 % des femmes canadiennes préménopausées sont exposées au risque d'avoir une MCV. Parmi celles jugées à faible risque médical de MCV, plus d'un tiers ont déclaré avoir au moins 1 FR-LS. Les femmes canadiennes connaissent peu les risques associés aux FR-LS, ne disposent pas d'informations suffisantes sur la nécessité de la prévention des MCV, et n'adoptent pas suffisamment de comportements favorisant la santé pour atténuer le risque futur de MCV.

Healthcare provider characteristics that influence the implementation of individual-level patient-centered outcome measure (PROM) and patient-reported experience measure (PREM) data across practice settings: a protocol for a mixed methods systematic review with a narrative synthesis.

BACKGROUND: Substantial literature has highlighted the importance of patient-reported outcome and experience measures (PROMs and PREMs, respectively) to collect clinically relevant information to better understand and address what matters to patients. The purpose of this systematic review is to synthesize the evidence about how healthcare providers implement individual-level PROMs and PREMs data into daily practice. METHODS: This mixed methods systematic review protocol describes the design of our synthesis of the peer-reviewed research evidence (i.e., qualitative, quantitative, and mixed methods), systematic reviews, organizational implementation projects, expert opinion, and grey literature. Keyword synonyms for "PROMs," PREMs," and "implementation" will be used to search eight databases (i.e., MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, SPORTDiscus, Evidence-based Medicine Reviews, and ProQuest (Dissertation and Theses)) with limiters of English from 2009 onwards. Study selection criteria include implementation at the point-of-care by healthcare providers in any practice setting. Eligible studies will be critically appraised using validated tools (e.g., Joanna Briggs Institute). Guided by the review questions, data extraction and synthesis will occur simultaneously to identify biographical information and methodological characteristics as well as classify study findings related to implementation processes and strategies. As part of the narrative synthesis approach, two frameworks will be utilized: (a) Consolidated Framework for Implementation Research (CFIR) to identify influential factors of PROMs and PREMs implementation and (b) Expert Recommendations for Implementing Change (ERIC) to illicit strategies. Data management will be undertaken using NVivo 12TM. DISCUSSION: Data from PROMs and PREMs are critical to adopt a person-centered approach to healthcare. Findings from this review will guide subsequent phases of a larger project that includes interviews and a consensus-building forum with end users to create guidelines for implementing PROMs and PREMs at the point of care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020182904 .

Reconciling relationships with physical activity: a qualitative study of women's postnatal physical activity decision-making.

BACKGROUND: Challenges with engaging in postnatal physical activity can negatively affect the health of women and their families. This study investigated women's physical activity decision-making processes and strategies to support their physical activity as part of a healthy postpartum transition. METHODS: Thirty healthy women with infants aged 2.5-12 months completed 3-day activity diaries and an individual interview. Using Glaser and Charmaz's grounded theory methodology, the core category, reconciling relationships with physical activity, was constructed, which explained women's processes of postnatal physical activity decision-making. RESULTS: Through reconciling relationships with physical activity, women discerned the types of physical activity they were comfortable pursuing at various points in the postpartum transition. Based on the meaning physical activity held for participants and their views about risks, supports, and resources, women gauged their capacity and the workability of their physical activity desires. Most women were uncertain of their capacity (physical, emotional) to return to physical activity and viewed the achievement of several or all of their desired physical activities as unworkable. Only a small group of women fully pursued the desirable physical activities they viewed as important for their well-being. Women adjusted the strategies they used to achieve physical activity when their expectations of capacity and workability did not align with their experiences. Some women lacked access to resources or supportive messaging about postpartum physical activity and downgraded their physical activity pursuit after negative personal physical or childcare experiences. CONCLUSIONS: Women can benefit from discussions about physiological birth recovery and navigating community and peer resources to support physical activity access and the safe return to physical activity following birth.

Collaborative peer review process as an informal interprofessional learning tool: Findings from an exploratory study.

Despite numerous studies on formal interprofessional education programes, less attention has been focused on informal interprofessional learning opportunities. To provide such an opportunity, a collaborative peer review process (CPRP) was created as part of a peer-reviewed journal. Replacing the traditional peer review process wherein two or more reviewers review the manuscript separately, the CPRP brings together students from different professions to collaboratively review a manuscript. The aim of this study was to assess whether the CPRP can be used as an informal interprofessional learning tool using an exploratory qualitative approach. Eight students from Counselling Psychology, Occupational and Physical Therapy, Nursing, and Rehabilitation Sciences were invited to participate in interprofessional focus groups. Data were analysed inductively using thematic analysis. Two key themes emerged, revealing that the CPRP created new opportunities for interprofessional learning and gave practice in negotiating feedback. The results reveal that the CPRP has the potential to be a valuable interprofessional learning tool that can also enhance reviewing and constructive feedback skills.

A comparison of actigraphy and sleep diaries for infants' sleep behavior.

Detecting the effectiveness of behavioral interventions to reduce infant night-waking requires valid sleep measures. Although viewed as an objective measure, actigraphy has overestimated night-waking. Sleep diaries are criticized for only documenting night-waking with infant crying. To support potential outcome measure validity, we examined differences between sleep diaries and actigraphy in detecting night-waking and sleep duration. We recruited 5.5 to 8-month-old infants for a behavioral sleep intervention trial conducted from 2009 to 2011. Intervention (sleep education and support) and control groups (safety education and support) collected infant diary and actigraphy data for 5 days. We compared night-time sleep actigraphy with diary data at baseline (194 cases), and 6 weeks (166 cases) and 24 weeks post-education (118 cases). We hypothesized numbers of wakes and wakes of ≥20 min would be higher and longest sleep time and total sleep time shorter by actigraphy compared with diaries. Using paired t-tests, there were significantly more actigraphy night wakes than diary wakes at baseline (t = 29.14, df = 193, p < 0.001), 6 weeks (t = 23.99, df = 165, p < 0.001), and 24 weeks (t = 22.01, df = 117, p < 0.001); and significantly more night wakes of ≥20 min by actigraphy than diary at baseline (t = 5.03, df = 183, p < 0.001), and 24 weeks (t = 2.19, df = 107, p < 0.05), but not 6 weeks (t = 1.37, df = 156, n.s.). Longest sleep duration was significantly higher by diary than actigraphy at baseline (t = 14.71, df = 186, p < 0.001), 6 weeks (t = 7.94, df = 158, p < 0.001), and 24 weeks (t = 17.18, df = 114, p < 0.001). Night sleep duration was significantly higher by diary than actigraphy at baseline (t = 9.46, df = 185, p < 0.001), 6 weeks (t = 13.34, df = 158, p < 0.001), and 24 weeks (t = 13.48, df = 114, p < 0.001). Discrepancies in actigraphy and diary data may indicate accurate actigraphy recording of movement but not sleep given active infant sleep and self-soothing.

Factors associated with differences in Canadian perinatal nurses' attitudes toward birth practices.

OBJECTIVE: To test whether demographic characteristics predict registered nurses' attitudes toward birth practices. DESIGN: A secondary analysis of a cross-sectional survey, the National Maternity Care Attitudes Survey. SETTING: A national survey conducted with health care providers providing maternity care in Canada. PARTICIPANTS: A convenience sample of 545 registered nurses. METHODS: Hierarchical regression analysis was used to examine three hypotheses about nurses' demographic differences in relationship to their attitudes toward birth practices. Attitude scales included acceptability of doulas, effects of routine electronic fetal monitoring, factors decreasing cesarean birth rates, the importance of vaginal birth for women, safety of birth, episiotomy, and epidural analgesia. RESULTS: Tertiary hospital-level of employment was associated with more positive attitudes toward epidural analgesia and less positive attitudes toward the importance of vaginal birth. Nurses working at a tertiary hospital were more likely to select an obstetrician for their own maternity care. Those who worked at a community hospital were more likely to select a family physician. Nurses' selection of an obstetrician was associated with less positive attitudes toward the safety of birth and importance of vaginal birth and more positive attitudes toward electronic fetal monitoring, episiotomy, and epidural analgesia. CONCLUSION: Nurses' attitudes may be influenced by exposure in their workplaces to predominant care providers' birth practices. Research examining the relationships between nurses' workplace exposures, attitudes, and practice behaviors is needed to develop understanding about how nurses contribute to rates of intervention in maternity care.