Nutritional status, food choices, barriers and facilitators to healthy nutrition in pregnant women with severe mental illness: a mixed methods approach.

BACKGROUND: Although widely acknowledged that adequate maternal nutrition is important for mother and baby, limited research has focussed on women with severe mental illnesses (SMI) in pregnancy. The present study reports on nutritional factors and food choices and investigates barriers and facilitators to healthy nutritional choices by pregnant women with SMI. METHODS: A prospective mixed method study was undertaken of 38 pregnant women with SMI, including a cross-sectional survey, a food frequency questionnaire and 12 postnatal qualitative interviews, with integrated analysis of all data. RESULTS: Elevated rates of obesity (35%) were found, with 82% of women having above the recommended gestational weight gain. Despite perceived knowledge, 32% of women did not meet any of the Five Food Group serving recommendations for pregnancy and consumed above-recommended levels for processed (19%) and sugar snacks (51%). Thematic analysis identified four main barriers: a discrepancy between knowledge and action, food cravings, mental health, and physical health. During pregnancy, food cravings were reported in 66% of women, psychological distress in 71% and physical distress in 37%. Screening identified 19% with potential eating disordered behaviours. Despite the challenges, several facilitators were identified and covered three themes: access to a dietitian, information delivery and support, and comprehensive care. DISCUSSION: Women with SMI in pregnancy struggle with issues of obesity, gestational weight gain, food cravings and possible eating disorder behaviours. They have additional challenges when pregnant, with management of their mental health and physical health having a direct impact. Interventional strategies in this population should incorporate findings from this research.

Education and devices to prevent blood and body fluid exposures.

BACKGROUND: Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide. AIMS: To assess the impact of an education and SEDs workplace programme on rates of reported exposures. METHODS: A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts. RESULTS: A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7-17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6-4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18-20) incidents per 1000 FTE pre-intervention to 11 (CI 10-12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection. CONCLUSIONS: The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.

Work ability meetings-a survey of Finnish occupational physicians.

BACKGROUND: Work ability meetings (WAMs) are planned discussions between an employee, a manager and an occupational physician (OP) to support work ability and return to work (RTW). During the last decade, WAMs become a popular intervention in Finnish occupational healthcare, although research on their content is lacking. AIMS: To describe the practice of WAMs in Finland. METHODS: We sent an internet survey by e-mail to members of the Finnish Society of Occupational Health Physicians in August 2014. We asked them to describe the last WAM they had attended, the employee the meeting concerned, the reason why it was convened, the content of the meeting and the action plan developed. RESULTS: A total of 303 of 1304 OPs responded (24%) to the survey. The meetings were most often arranged for employees in manual or clerical work (71%). There were several overlapping reasons for convening a WAM, including a worker's reduced work ability (57%), functional ability (42%) or long-term sickness absence (38%). The meetings consisted of RTW planning, clarification of the situation and a dialogue between the three parties. In half of the cases, the action plans dealt with modifications of work tasks. A third of cases were forwarded to vocational rehabilitation, while permanent disability pension was considered in 6% of cases. CONCLUSIONS: The focus of WAMs was on workplace adjustments to support workers to remain at work. The WAMs dealt mostly with early interventions for RTW: work modifications, adjustments and vocational rehabilitation.

The perceptions of a GP's work among fifth-year medical students in Helsinki, Finland.

OBJECTIVE: To explore medical students' potential interest in family medicine in the future and their perceptions of a GP's work. DESIGN: A cross-sectional survey in 2008-2010. SETTING AND SUBJECTS: Fifth-year medical students prior to their main course in General Practice at the University of Helsinki. MAIN OUTCOME MEASURES: The students' opinions regarding the GP's work and their perceptions of the main aims of a GP's work. RESULTS: 309/359 medical students (mean age 25.7 years, 64% females) responded to the survey. Among the students, 76% considered the most attractive feature in the GP's work to be that it is versatile and challenging. The least attractive features included: too hasty, pressing work, too lonely work, and too many non-medical problems. The majority of the students considered the main aim of a GP's work as to identify serious diseases/disorders in order to refer those patients for specialized care (82%). Treatment of chronic diseases is an important responsibility of a GP's work according to 63% of the students. Only 38% considered health promotion to be an important aim. CONCLUSIONS: Medical students may have perceptions of the GP's work that influence their career choices to specialize in other fields.