Outcomes From a Hybrid Implementation-effectiveness Study of the Living Well During Pregnancy Tele-coaching Program for Women at High Risk of Excessive Gestational Weight Gain

BackgroundExcess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework reports on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. MethodsThe LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity. ResultsThe LWdP intervention group (n=142) were compared with women in the historical comparison group (n=49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9 – 3.8) appointments compared with 1.9 (95% CI, 1.6 – 2.2). GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p=0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in the LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p<0.05). ConclusionThe LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.

What is a “Good Life”: Protocol for a qualitative study to explore the viewpoint of older persons

Introduction Over the last fifteen years, Living Labs have been on the rise in Europe to bridge the gap between service providers, and the needs of end-users, and to speed up innovation, particularly in the field of healthcare and ageing. Ageing tends to be considered by institutions as a set of risks to be managed for older persons, illustrated in particular via the concepts of “ageing well” or “successful ageing”. In this context, this project aims to define the meaning and the conditions for a good life from the point of view of older persons themselves, thereby improving institutions’ recognition and support of older persons’ ways of living well, rather than imposing a general definition of “successful ageing” based on functional capacity. Methods and analysis This qualitative study is designed as an action research underpinned by a Living-Lab approach to co-creation. The aims are to: define the conditions for a good life as accurately as possible with older persons (Step 1); share these findings with different healthcare and service providers to adjust existing services or create new ones (Step 2); and disseminate them more broadly within the regions under study and across the scientific community (Step 3). During Step 1, the features of a “good life” will be analysed in a socio-anthropological study based on semi-directed interviews and observations made in the homes of 70 elderly people living in a wide range of accommodation types and regions. In accordance with French legislation, and as confirmed by our formal Ethics Committee, this study does not require approval. The dissemination stage is integrated into the design of this action research, and notably will provide for the appropriation of research findings by the partners of this study, by setting up creativity sessions (Step 2) and by sharing the general findings through panel discussions bringing together regional and national stakeholders (Step 3).

BEM VIVER E FELICIDADE NO TRABALHO: A PERCEPÇÃO DE PROFESSORES UNIVERSITÁRIOS DE UMA INSTITUIÇÃO PRIVADA

O presente estudo tem como proposta através do instrumento de pesquisa saber qual a forma sentida pelos docentes universitários de uma instituição privada de ensino superior, situada na cidade de Santa Maria/RS como eles percebem a felicidade e qualidade de vida no trabalho (QVT) ou bem viver nas instituições em que trabalham. A busca de conciliar o bem viver no ambiente de trabalho, tornou-se uma estratégia imprescindível para as instituições de maneira geral, pois os colaboradores passam maior parte do seu tempo dentro das organizações, e essas precisam buscar estratégias que acompanhem constantemente os indicadores de qualidade e felicidade no ambiente organizacional. Os temas felicidade e bem viver fazem parte da rotina nas organizações, sempre buscando o bem-estar e auxiliando a saúde dos colaboradores, e com isso melhorar o desempenho da organização. A importância do estudo justifica-se perante o impacto que a falta de felicidade no trabalho e a incidência de fontes de pressão e a cobrança são mais elevadas. Com os resultados obtidos através da pesquisa é possível identificar ações que possam melhorar esses quesitos, visando manter um clima harmônico que contribua para o alcance dos resultados institucionais. Palavras-Chave: Bem Viver. Felicidade no Trabalho. Professores Universitários. Abstract: The present study proposes, through the research instrument, to know how university professors of a private higher education institution, located in the city of Santa Maria/RS, feel how they perceive happiness and quality of life at work (QWL) or living well in the institutions where they work. The quest to reconcile well-being in the work environment has become an essential strategy for institutions in general, as employees spend most of their time within organizations, and these need to seek strategies that constantly monitor the indicators of quality and happiness in the organizational environment. The themes of happiness and well being are part of the routine in organizations, always seeking the well-being and helping the health of employees, and thus improving the organization's performance. The importance of the study is justified by the impact that the lack of happiness at work and the incidence of pressure and demand sources are higher. With the results obtained through the research, it is possible to identify actions that can improve these requirements, aiming to maintain a harmonious climate that contributes to achieving institutional results. Keywords: Live Well. Happiness at Work. University Teachers.

The Experiences of Family Caregivers in Response to a Dementia Diagnosis Disclosure

Background: Dementia is a serious disease that can lead to disability because it impacts the individual’s memory, cognition, behavior, and capacity to perform activities of daily living. While most people prefer to receive a full diagnostic disclosure, the actual care requirements of family caregivers, based on their perspectives, are often unknown. The primary aim of this study was to explore the experiences of family caregivers in response to a dementia diagnosis disclosure and analyze the care needs of caregivers.Methods: A qualitative study conducted in accordance with COREQ guidelines. The grounded theory approach was undertaken in 20 family caregivers of patients with dementia, who were selected using purposive sampling. Data were analysed using the constant comparative method.Results: Diagnostic disclosure: Start the long road of care challenges was identified as the core category of this study, which was defined as describing the experiences of family caregivers of patients with dementia after first being informed of the patients’ diagnosis, which activates their willpower to progress against the disease. Five major categories describing the experiences of family caregivers following a dementia diagnosis was developed: ‘deciding to seek medical attention,’ ‘the moment of disclosure,’ ‘conveying information,’ ‘maintaining the patients’ functioning,’ and ‘receiving support and living well with dementia.’ Subcategories within each major category also emerged.Conclusions: Clear diagnostic disclosure is important for ensuring that positive developments can occur in response to disclosure. Healthcare professionals must develop strategies to prevent disclosure from triggering overreactive emotions from patients with cognitive impairments, assist them in understanding their illness in a tactful manner, and ensure that they understand how to cooperate in any subsequent care plans.

Dissonant dementia: neuropsychiatry, awareness, and contradictions in cognitive decline

This paper presents an analysis of contemporary neuropsychiatric meaning-making regarding dementia, encompassing distinct beliefs, practices and objects, and the peculiarities of its fragmented public manifestations. First, some core neuropsychiatric beliefs are discussed, arguing that the designation of those beliefs as exceptional truths engenders an imperialist ethic whereby the beliefs must be spread into other populations. Second, the enactment of this spread through dementia awareness is considered, whereby people are presented as having wrong beliefs to justify the promotion of alternative correct knowledge. Third, some emerging contradictions within neuropsychiatric dementia are outlined, as moves toward early diagnosis and “living well” sit uneasily beside notions of dementia as a frightening epidemic. The paper concludes that this produces dissonant dementia wherein contradictory meanings are held together. Finally, it is suggested that this dissonance will likely continue, underpinned by specific interests.