The risk of cardiovascular diseases after miscarriage, stillbirth, and induced abortion: a systematic review and meta-analysis.

Aims: Miscarriage and stillbirth have been included in cardiovascular disease (CVD) risk guidelines, however heterogeneity in exposures and outcomes and the absence of reviews assessing induced abortion, prevented comprehensive assessment. We aimed to perform a systematic review and meta-analysis of the risk of cardiovascular diseases for women with prior pregnancy loss (miscarriage, stillbirth, and induced abortion). Methods and results: Observational studies reporting risk of CVD, coronary heart disease (CHD), and stroke in women with pregnancy loss were selected after searching MEDLINE, Scopus, CINAHL, Web of Knowledge, and Cochrane Library (to January 2020). Data were extracted, and study quality were assessed using the Newcastle-Ottawa Scale. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated using inverse variance weighted random-effects meta-analysis.Twenty-two studies involving 4 337 683 women were identified. Seven studies were good quality, seven were fair and eight were poor. Recurrent miscarriage was associated with a higher CHD risk (RR = 1.37, 95% CI: 1.12-1.66). One or more stillbirths was associated with a higher CVD (RR = 1.41, 95% CI: 1.09-1.82), CHD (RR = 1.51, 95% CI: 1.04-1.29), and stroke risk (RR = 1.33, 95% CI: 1.03-1.71). Recurrent stillbirth was associated with a higher CHD risk (RR = 1.28, 95% CI: 1.18-1.39). One or more abortions was associated with a higher CVD (RR = 1.04, 95% CI: 1.02-1.07), as was recurrent abortion (RR = 1.09, 95% CI: 1.05-1.13). Conclusion: Women with previous pregnancy loss are at a higher CVD, CHD, and stroke risk. Early identification and risk factor management is recommended. Further research is needed to understand CVD risk after abortion.

Use of Personal Health Records to Support Diabetes Self-management: An Integrative Review.

More than 30 million persons in the United States have diagnosed or undiagnosed diabetes. Persons with chronic types of diabetes must learn self-management principles and techniques and perform self-care behaviors to reduce the risk of diabetes-related complications. An electronic personal health record is one type of technology commonly used to support diabetes self-management. This integrative review examines research on how personal health records incorporate or address the American Association of Diabetes Educators self-care behaviors, diabetes-related psychosocial concerns, and the diabetes-related clinical quality-of-care measures of hemoglobin A1c, low-density lipoprotein cholesterol, and blood pressure. In the majority of studies reviewed, participants showed improvement in the self-care behavior or physiological outcome examined. Findings were inconclusive about the impact of personal health record use on diabetes distress. Results also revealed a lack evidence of patient specific factors influencing intention to use a personal health record for management of type 2 diabetes mellitus. Despite evidence that personal health record use improves diabetes self-management, they are underutilized. Implications for practice include understanding what influences intention to use a personal health record. Further research is also needed to determine the impact of personal health record use on diabetes distress.

Future Cardiovascular Disease Risk for Women With Gestational Hypertension: A Systematic Review and Meta-Analysis.

Background Inconsistent findings have been found among studies evaluating the risk of cardiovascular disease for women who have had pregnancies complicated by gestational hypertension (the new onset of high blood pressure without proteinuria during pregnancy). We provide a comprehensive review of studies to quantify the association between gestational hypertension and cardiovascular events in women. Methods and Results We conducted a systematic search of PubMed, Embase, and Web of Science in March 2019 for studies examining the association between gestational hypertension and any cardiovascular event. Two reviewers independently assessed the abstracts and full-text articles. Study characteristics and the relative risk (RR) of cardiovascular events associated with gestational hypertension were extracted from the eligible studies. Where appropriate, the estimates were pooled with inverse variance weighted random-effects meta-analysis. A total of 21 studies involving 3 60 1192 women (127 913 with gestational hypertension) were identified. Gestational hypertension in the first pregnancy was associated with a greater risk of overall cardiovascular disease (RR, 1.45; 95% CI, 1.17-1.80) and coronary heart disease (RR, 1.46; 95% CI, 1.23-1.73), but not stroke (RR, 1.26; 95% CI, 0.96-1.65) or thromboembolic events (RR, 0.88; 95% CI, 0.73-1.07). Women with 1 or more pregnancies affected by gestational hypertension were at greater risk of cardiovascular disease (RR, 1.81; 95% CI, 1.42-2.31), coronary heart disease (RR, 1.83; 95% CI, 1.33-2.51), and heart failure (RR, 1.77; 95% CI, 1.47-2.13), but not stroke (RR, 1.50; 95% CI, 0.75-2.99). Conclusions Gestational hypertension is associated with a greater risk of overall cardiovascular disease, coronary heart disease, and heart failure. More research is needed to assess the presence of a dose-response relationship between gestational hypertension and subsequent cardiovascular disease. Registration URL: https://www.crd.york.ac.uk/prosp​ero/; Unique identifier: CRD42018119031.

PlexinA2 Forward Signaling through Rap1 GTPases Regulates Dentate Gyrus Development and Schizophrenia-like Behaviors.

Dentate gyrus (DG) development requires specification of granule cell (GC) progenitors in the hippocampal neuroepithelium, as well as their proliferation and migration into the primordial DG. We identify the Plexin family members Plxna2 and Plxna4 as important regulators of DG development. Distribution of immature GCs is regulated by Sema5A signaling through PlxnA2 and requires a functional PlxnA2 GTPase-activating protein (GAP) domain and Rap1 small GTPases. In adult Plxna2-/- but not Plxna2-GAP-deficient mice, the dentate GC layer is severely malformed, neurogenesis is compromised, and mossy fibers form aberrant synaptic boutons within CA3. Behavioral studies with Plxna2-/- mice revealed deficits in associative learning, sociability, and sensorimotor gating-traits commonly observed in neuropsychiatric disorder. Remarkably, while morphological defects are minimal in Plxna2-GAP-deficient brains, defects in fear memory and sensorimotor gating persist. Since allelic variants of human PLXNA2 and RAP1 associate with schizophrenia, our studies identify a biochemical pathway important for brain development and mental health.

Deletion of the Mouse Homolog of CACNA1C Disrupts Discrete Forms of Hippocampal-Dependent Memory and Neurogenesis within the Dentate Gyrus.

L-type voltage-gated calcium channels (LVGCCs) have been implicated in various forms of learning, memory, and synaptic plasticity. Within the hippocampus, the LVGCC subtype, CaV1.2 is prominently expressed throughout the dentate gyrus. Despite the apparent high levels of CaV1.2 expression in the dentate gyrus, the role of CaV1.2 in hippocampal- and dentate gyrus-associated forms of learning remain unknown. To address this question, we examined alternate forms of hippocampal-dependent associative and spatial memory in mice lacking the mouse ortholog of CACNA1C (Cacna1c), which encodes CaV1.2, with dentate gyrus function implicated in difficult forms of each task. We found that while the deletion of CaV1.2 did not impair the acquisition of fear of a conditioned context, mice lacking CaV1.2 exhibited deficits in the ability to discriminate between two contexts, one in which the mice were conditioned and one in which they were not. Similarly, CaV1.2 knock-out mice exhibited normal acquisition and recall of the location of the hidden platform in a standard Morris water maze, but were unable to form a memory of the platform location when the task was made more difficult by restricting the number of available spatial cues. Within the dentate gyrus, pan-neuronal deletion of CaV1.2 resulted in decreased cell proliferation and the numbers of doublecortin-positive adult-born neurons, implicating CaV1.2 in adult neurogenesis. These results suggest that CaV1.2 is important for dentate gyrus-associated tasks and may mediate these forms of learning via a role in adult neurogenesis and cell proliferation within the dentate gyrus.

Occupational therapy - meeting the needs of older adult workers?

OBJECTIVE: The purpose of this phenomenological study was to explore and better understand (a) why aging workers continue to work past retirement age, (b) how aware occupational therapists are of the needs of the growing demographic of the aging worker, and (c) potential occupational therapy interventions that could better help this population. METHOD: This study was conducted with a mixed method design approach, specifically the parallel/simultaneous design, which consisted of both qualitative and quantitative investigation. The quantitative portion of the study focused on data obtained from the surveys and the qualitative portion was based on phenomenological interviews of aging workers. RESULTS: Themes emerging from the interviews demonstrate the importance of health promoting habits and family support in providing the critical foundation to maintain employment past age 55. Financial stability was a key motivator which compelled the interviewees to continue working. The older workers had no planned date for retirement and felt confident that the knowledge and life experience they offered were important qualities they brought to the workplace. The survey showed a need for occupational therapists to become more responsive to the growing demographic of older adult workers as they reported limited service enhancement and expansion for this group. CONCLUSION: Aging workers are prime candidates for occupational therapy. However, the profession appears to be overlooking opportunities to meet the needs of these productive community members. Occupational therapists need to better respond to the physical, social, psychological, cognitive, and environmental challenges faced by this well population. The authors challenge occupational therapists to alter services, seek funding and obtain continuing education so they are better equipped to establish and enhance effective programs for this growing population.

A model of occupational empowerment for marginalized populations in community environments.

Globally there are individuals who are marginalized from mainstream society due to problems such as physical or psychological impairment, poor socio-economic circumstances, and occupational deprivation. Many develop learned helplessness syndrome, rendering them unable to control their lives and their destinies. This paper proposes a Model of Occupational Empowerment for providing services to these community populations. The model, a grounded theory, emerged from our work at a homeless shelter for women and children. Disempowering environments in the past had caused learned helplessness in the women at the shelter. Occupational engagement was used to empower them. We contend that the model may be used to guide occupational therapy practice with marginalized individuals and families in a number of community environments.

Chronic pain and occupation: an exploration of the lived experience.

OBJECTIVE: There is limited research on the relationship between chronic pain and occupation. This phenomenological research study explored the lived occupational experiences of people who have chronic pain. METHOD: Via demographic questionnaires, semistructured interviews, and field notes, data were collected on 13 participants with various types of pain. RESULTS: Thematic analysis yielded one main theme: "Chronic Pain Is Life Changing." The following subthemes also emerged: "Chronic Pain Triggers Emotional Distress"; "Chronic Pain Reveals the Strength of Relationships"; "Chronic Pain and Occupation Are Reciprocally Related Forces"; and "Chronic Pain Elicits Innovative Adaptive Responses." Study participants reported experiencing myriad troubling emotions; however, they resourcefully modified their routines and tasks and found enhanced meaning in favored occupations. CONCLUSIONS: This study illuminates the importance of therapeutic listening, the innovativeness of people who have chronic pain, and the possible therapeutic potential of occupation.

A pilot study of the delivery of occupational therapy in long term care settings under the medicare prospective payment system.

OBJECTIVE: The purpose of this pilot study was to examine occupational therapists' perceptions of practice in skilled nursing facilities since the implementation of the Medicare Prospective Payment System (PPS). METHOD: A survey was sent to 250 randomly selected occupational therapists who had worked or were currently working in skilled nursing facilities for a minimum of two years. RESULTS: A majority of therapists reported an increase in caseload size since the implementation of the new prospective payment system. Most also noted increasing expectations to maintain patients on their caseloads for longer periods of time. Many reported that their facilities were decreasing the number of level II fieldwork students they were accepting. An even greater number reported that their facilities were decreasing the amounts of their continuing education budgets. A significant number also reported that they felt the quality of life for their residents had decreased since the implementation of prospective payment. CONCLUSION: This pilot survey may indicate some problematic trends in occupational therapists' perceptions of practice in skilled nursing facilities. There may be a relationship between these trends and the implementation of prospective payment in these settings. Further studies are recommended to more deeply assess occupational therapists' practice perceptions, as well as the quality of life of patients in skilled nursing facilities. Research is also needed to determine if occupational therapists' perceptions of practice in skilled nursing facilities changes or stabilizes under the prospective payment system.