Unsupportive Partner Research Articles

Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy-A Narrative Review.

Sleep apnea-hypopnea syndrome (SAHS) is a respiratory disorder characterized by cessation of breathing during sleep, resulting in daytime somnolence and various comorbidities. SAHS encompasses obstructive sleep apnea (OSA), caused by upper airway obstruction, and central sleep apnea (CSA), resulting from lack of brainstem signaling for respiration. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for SAHS, reducing apnea and hypopnea episodes by providing continuous airflow. CPAP enhances sleep quality and improves overall health by reducing the risk of comorbidities such as hypertension, type 2 diabetes mellitus, cardiovascular disease and stroke. CPAP nonadherence leads to health deterioration and occurs due to mask discomfort, unsupportive partners, upper respiratory dryness, and claustrophobia. Technological advancements such as auto-titrating positive airway pressure (APAP) systems, smart fit mask interface systems, and telemonitoring devices offer patients greater comfort and enhance adherence. Future research should focus on new technological developments, such as artificial intelligence, which may detect treatment failure and alert providers to intervene accordingly.

“Killing two birds with one stone” – a qualitative study on women’s perspectives on the dual prevention pill in Johannesburg, South Africa

Background HIV incidence remains high in South Africa, with ~ 60% of all new HIV infections among adolescent girls and women (Country factsheets HIV and AIDS Estimates, 2022). Oral pre-exposure prophylaxis (PrEP), approved for HIV prevention in South Africa since 2015, is hampered by low uptake and adherence, particularly among adolescent girls and young women (AGYW). Combining oral PrEP with oral contraceptives could increase PrEP uptake, persistence and address unmet needs for contraception. We investigated the acceptability of a dual prevention pill (DPP), combining oral PrEP and a combined oral contraceptive (COC) for HIV and pregnancy prevention among women in Johannesburg, South Africa.MethodsBetween March-July 2021, we conducted 12 focus group discussions (FGDs) with adolescent girls and women (n = 74) aged 16–40 stratified by ages (16–17, 18–24, 25–40), half of whom were COC users. We explored adolescent girls and women’s opinions about the DPP concept, existing HIV and pregnancy prevention options, and input on perceived facilitators and barriers to DPP use. FGDs were conducted in English or isiZulu, using a standardized interview guide. FGDs were audio-recorded, transcribed to English and analyzed using ethnographic content analysis.ResultsThe majority viewed the DPP favorably as a multipurpose option preventing unplanned pregnancy and HIV. Most saw it as a convenient “two-in-one” solution, requiring one clinic visit for both PrEP and COCs. AGYW were viewed as the most likely to benefit from the DPP due to the likelihood of multiple partners and unplanned sex, possibly preventing school dropout from unplanned pregnancy or HIV acquisition. The DPP was perceived to be more reliable than condoms, especially when condom negotiation is limited. Benefits were also seen by participants in rape cases, protecting against pregnancy and HIV. DPP use barriers included side effect concerns, unsupportive partners and judgmental healthcare providers.Conclusions/significanceThe DPP was perceived as acceptable for HIV and pregnancy prevention to AGYW in Johannesburg and its dual indications helpful in supporting improved PrEP uptake and persistence. DPP implementation programs need to consider solutions to potential barriers, like education on DPP benefits, coupled with reliable side effect support and healthcare provider sensitization as part of routine sexual health services to encourage uptake and adherence.

Persevering through communication challenges: a qualitative descriptive exploration of communication experiences in aphasia

ABSTRACT Background People with aphasia often experience activity limitations and participation restrictions despite wanting to engage in communication activities that are satisfying and meaningful. Communication partner support, the complexity of the communication environment, and the thoughts and feelings of people with aphasia have important implications for both language processing and communicative participation. The perspectives of PWA about the role that environmental and personal factors (e.g. thoughts and feelings) play in their communication experiences could inform clinical practice. Aims To qualitatively explore the communication experiences of people with aphasia and how environmental demands and personal factors (especially emotional responses) affect these experiences. Methods & Procedures Fourteen participants with aphasia completed semi-structured interviews immediately following testing sessions for a larger mixed-methods project investigating the relationship between mood, attention, and language function. Interview questions related to their everyday communication experiences and how their communication environment affected their communication and concentration as well as how their emotions affected their communication. Interviews were recorded, transcribed orthographically, then analyzed using a generic qualitative descriptive approach. Coding was completed in two rounds, which included inductive and deductive coding. Codes were synthesized by reflexively analyzing code co-occurrence. Outcomes & Results Key antecedent variables included language deficits associated with aphasia and environmental demands, often leading to communication challenges. Participation was highlighted as the principal outcome, ranging from proactive engagement to withdrawal. Mental rehearsal, feelings, and attitudes mediated participation, but feelings and attitudes were also described as outcomes. Communication partners played a pivotal mediating role, often determining positive or negative outcomes. Supportive partners facilitated engagement, optimism, and contentment, while unsupportive partners led to frustration. Conclusions The results of this study highlight the role of various factors in influencing the communication experience of people with aphasia and indicate that, within the context of communication challenges, communication partners, attitudes, feelings, and participation play critical and interacting roles. Preparatory strategies such as mental rehearsal can also facilitate participation. These findings imply that targeting communication partner support, mental rehearsal focused on social scripts, or psychosocial adjustment could have important effects on participation.

Partner support behaviors and relationship quality in interracial and intraracial Black romantic relationships

AbstractA convergent, mixed‐methods design was used to understand associations between partner behaviors and relationship quality among people in interracial and intraracial romantic relationships. Across two samples, 224 individuals (including 55 couples) who were in a relationship in which they and/or their partner identified as Black completed measures of perceived partner responsiveness, partner responses to stress, and relationship quality. Participants in the first sample also provided open‐ended responses about the role of race in their relationship. Participants who reported higher partner responsiveness, more supportive partner responses to their stress, better overall dyadic coping, and fewer unsupportive partner responses to their stress reported higher relationship quality. The strength of the associations for perceived partner responsiveness and partner responses to stress with relationship quality did not differ based on the racial composition of the relationship. Qualitative responses revealed additional support processes and barriers to support that may be unique to different relationship compositions. These findings expand understanding of the most effective support behaviors that Black individuals and their romantic partners use in their relationships and illuminate how support processes might differ depending on an individual's race and the race of their partner.

"I Need Help With the Abortion, so I Won't Have to Ever See or Hear From Him Again": Relationship Barriers Faced by Abortion Fund Applicants in the Rocky Mountain West.

To explore the factors impacting abortion access for abortion fund clients, data from 816 applicants was analyzed using a summative content analysis approach. Nine relationship themes emerged for applicants who cited their partner as a significant factor in their abortion decision-making, including (a) power and control, (b) fear and safety concerns, (c) leaving the relationship, (d) barriers to accessing care, (e) sexual violence, (f) perpetration and victimization, (g) having an unsupportive partner, (h) being partnerless, and (i) having a supportive partner. Abortion funds are a potential resource for those experiencing intimate partner violence and can support survivors through confidential care and referrals.

Partner and social support in childbearing and rearing in a Gulf Coast Native American community.

This study sought to understand the roles of partners in pregnancy, childbirth, and childrearing in Indigenous communities. It explores supportive and unsupportive attitudes in the relationships mothers experienced, and how these relationships affected their lives. Settler colonialism has negatively impacted Indigenous communities. However, little research has explored how it has influenced partner and social support during the perinatal time period. Through 31 semistructured interviews with women from a tribe in the southeastern United States, participants described their experiences with supportive and unsupportive partners and how that shaped their experiences during pregnancy, childbirth, and childrearing. Participants described themes of (a) supportive and unsupportive partner relationships, (b) importance of partner support in childbirth, and (c) mothers as primary caregivers. Results suggest that women experienced a wide range of partner relationships, and they relied more on their female family members to provide support during this time, rather than counting on their male counterparts. Health care providers may want to take these findings into consideration when approaching their patient's care. These findings indicate that the impacts of settler colonialism continue to impact family relationships for the participants in this study.

Prevalence, characteristics, and associated determinants of postpartum depression among adolescent mothers in Kenyatta National Hospital and Pumwani Maternity Hospital from March to July 2023: A prospective, cross-sectional study

Background: Postpartum depression (PPD) is a depressive episode that occurs in women within 6 weeks of parturition. It has a global prevalence of 13-19%. Long-term consequences include a high likelihood of experiencing depression in mothers, suicide, and infanticide. There is currently no routine screening for postpartum depression at the postnatal clinic. Objectives: To determine the prevalence of postpartum depression among adolescent mothers, characteristics, and associated determinants in Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH). Methods: This was a cross-sectional study, involving 162 consenting postnatal adolescent mothers (14-19 years) at Kenyatta National and Pumwani Maternity hospitals. Consecutive sampling was employed. Data were collected using a structured sociodemographic questionnaire and the Edinburg Postpartum Depression Scale (EPDS). Data were analyzed using SPSS version 25. Results: Of all participants, 77.2% were from PMH and 22.8% were from KNH. Most participants were 18–19 years old, had primary education as the highest entry level, were single, depended on their parents for financial support, and were Christians. For obstetric characteristics, the majority had no history of miscarriage, were primipara, had unintended pregnancy, had amenorrhea as the first symptom, had an initial antenatal clinic (ANC) visit during the first trimester, had at least four ANC visits, and delivered via spontaneous vaginal birth. The prevalence of postpartum depression was 22.2%. The most prominent characteristics of PPD were feeling overwhelmed, sadness, anxiety, and crying episodes. Associated determinants of PPD in adolescent mothers were age <18 years, starting ANC visits after the second trimester, less than four ANC visits, being HIV-positive, unsupportive partner, and having a post-delivery illness for the mother. Conclusion: This study established that approximately one in four adolescent mothers are likely to suffer from postpartum depression.

Exploratory validation of relationship functioning and non-pregnant partner behavior scales in pregnant people living with HIV in Mpumalanga Province, South Africa

ABSTRACT Partner engagement in antenatal care can improve care for pregnant people living with HIV. However, concerns about engaging unsupportive non-pregnant partners warrant further study to avoid engaging partners who pressure their pregnant partner to refuse testing or treatment and/or perpetuate intimate partner violence. We adapted established relationship functioning and partner behaviour questionnaires among pregnant people living with HIV initiating antenatal care in rural South Africa. We identified 13 previously validated psychometric scales with 255 items that assess relationship functioning and partner behaviour, but, to our knowledge, had not been used in Southern Africa. After item translation and cognitive interviewing with 30 pregnant people, we recruited an additional 208 pregnant people living with HIV receiving antenatal care. We conducted an exploratory factor analysis with maximum-likelihood extraction and oblique promax rotation with the 58 items and 10 scales that remained after translation and cognitive interviewing. We used parallel analysis, scree plots, and the Kaiser criterion to guide factor retention and assessed internal factor consistency via Cronbach’s alpha. Of the 208 participants recruited, 197 (95%) answered each question and were included in the analysis. Exploratory factor analysis revealed 7 factors that assessed partner social support, sexual relationship power, emotional intimacy, threatened or enacted violence, sexual intimacy, violence in relationships, and partner engagement in pregnancy care via 37 items. Factor absolute Spearman correlations ranged from 0.012 to 0.518 and Cronbach’s alpha ranged from 0.84 to 0.92. This preliminary analysis will guide further scale development. Future developments will also include relevant clinical outcomes to assess the predictive validity of the resulting measures. These steps will further refine these questions into a succinct screening tool to assess relationship functioning and partner behaviour. This screening tool may eventually guide the selection of partner-based interventions during pregnancy to improve outcomes for pregnant people and their partners.

The Predictive Accuracy of the LSI-R in Female Forensic Inpatients-Assessing the Utility of Gender-Responsive Risk Factors.

Female reoffending has long been a neglected research interest. Accordingly, risk assessment instruments were developed based on the criminological knowledge of male recidivism. While feminist researchers have repeatedly criticized the failure to incorporate gender-responsive risk (GR) factors, opinions on the gender neutrality of existing instruments remain inconsistent. In order to substitute the existing literature, while extending the scope to mentally disordered offenders, the aim of the given study was the prediction of general recidivism in a sample of 525 female forensic inpatients who had been discharged from forensic psychiatric care in Germany between 2001 and 2018. Primarily, ROC analysis was conducted to assess the predictive accuracy of the LSI-R. Subsequently, separate binary logistic regression analyses were performed to determine the predictive utility of GR factors on recidivism. Lastly, multiple binary logistic regression was used to assess the incremental validity of the GR factors. The results showed that the GR factors (i.e., intimate relationship dysfunction, mental health issues, parental stress, adult physical abuse, and poverty) significantly contributed to the prediction of recidivism, while a mixed personality disorder, a dissocial personality, an unsupportive partner, and poverty added incremental validity to the predictive accuracy of the LSI-R. However, given that the added variables could only improve classification accuracy by 2.2%, the inclusion of gender-specific factors should be cautiously evaluated.

Women’s experiences of living with involuntary childlessness in Uganda: a qualitative phenomenological study

BackgroundInvoluntary childlessness is a global phenomenon that negatively impacts the couple, or the family involved. The experiences of women living with involuntary childlessness have not been well documented in the literature, specifically in the Ugandan context. The purpose of the study was to explore the experiences of women living with involuntary childlessness in Uganda.MethodsA qualitative phenomenological approach was used. Fifteen in-depth interviews were conducted among women experiencing involuntary childlessness attending a National Referral Hospital. Purposive sampling was, and data saturation determined the actual sample size. Thematic analysis was used for data analysis. The results are presented in the form of text and narrative quotes from participants.ResultsSix themes emerged (i) Inadequate social support (ii) psychological torture (iii) continued grief (iv) marital instability (v) failure attributed to childlessness and (vi) financial constraints. Inadequate social support was in the form of having an unsupportive partner, altered social relation, and altered social status, while women experienced name-calling, emotional abuse, stigma, and blame under the psychological torture theme. Women experienced feelings of distress and grief, including anger, irritability, sadness, stress, and feelings of despair. Women with involuntary childlessness recounted experiencing unstable marriages characterized by infidelity, divorce, abandonment, and polygamous marriages. Some women coped positively, while others employed negative coping strategies such as social withdrawal and isolation. Women who their partners and families well supported coped positively. In contrast, those who did not receive as much support were stressed, sad, angry, and had lost hope of pregnancy.ConclusionsIn this study, women with involuntary childlessness lacked social support amidst experiences of marital turmoil, psychological torture, feelings of distress and grief, unfulfilled motherhood expectations, and financial constraints while seeking treatment, therefore, there is a need to screen the women for psychological / mental illness symptoms and provide empathetic care and counseling. The prevalence of involuntary childlessness is not well documented in Uganda and a study can be done to determine its extent.

Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review

ObjectivesLow-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions.DesignThis was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model.SettingWe included studies conducted in LMICs published in English between 2010 and 2020.ParticipantsWe included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening.ResultsSeventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women.ConclusionA wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women’s health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

Adherence to Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea.

Adherence to either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) therapy in patients with obstructive sleep apnea syndrome (OSAS) represents a real challenge to sleep medicine physicians. Many risk factors/predictors for nonadherence exist, and usually, it is multifactorial. Long-term nonadherence with CPAP therapy has been associated with the use of CPAP for <4 hours/night during early treatment, moderate to severe obstructive sleep apnea (OSA), poor self-efficacy, and unsupportive bed partner. The American Academy of Sleep Medicine (AASM) recommends follow-up of patients with OSA within the first two weeks of CPAP use to optimize adherence. Measures to improve adherence to positive airway pressure (PAP) therapy go through an integrated approach that involves behavioral therapy and prompt management of side effects. Pharmacologic therapy in the form of a sedative-hypnotic sleep aid has a minor role in managing nonadherence to CPAP based on the greater risk of side effects. This article will briefly discuss the risk factors and management of nonadherence to PAP therapy in patients with OSAS.

Antenatal depressive symptoms in rwanda: rates, risk factors, and social support

BackgroundPrevalence of perinatal depression is high in Rwanda and has been found to be associated with the quality of relationship with partner. This study extends this work to examine the relationship between antenatal depressive symptoms and social support across several relationships among women attending antenatal care services.MethodsStructured survey interviews were conducted with 396 women attending antenatal care services in 4 health centres in the Southern Province of Rwanda. The Edinburgh Postnatal Depression Scale (EPDS) and Maternity Social Support Scale (MSSS) were used to assess antenatal depressive symptoms and the level of support respectively. Socio-demographic and gestational information, pregnancy intentions, perceived general health status, and experience of violence were also collected. Univariate, bivariate analyses and a multivariate logistic regression model were performed to determine the relationship between social support and risk factors for antenatal depressive symptoms.ResultsMore than half of respondents were married (55.1%) or living with a partner in a common-law relationship (28.5%). About a third (35.9%) were in their 6th month of pregnancy; the rest were in their third term. The prevalence of antenatal depressive symptoms was 26.6% (EPDS ≥ 12). Bivariate analyses suggested that partner and friend support negatively predict depression level symptoms. Adjusting for confounding variables such as unwanted pregnancy (AOR: 0.415, CI: 0.221- 0.778), parity (AOR: 0.336, CI: 0.113–1.000) and exposure to extremely stressful life events (AOR: 2.300, CI: 1.263- 4.189), partner support (AOR: 4.458, CI: 1.833- 10.842) was strongly significantly associated with antenatal depressive symptoms; women reporting good support were less likely to report depressive symptoms than those reporting poor support or those with no partner. Friend support was no longer significant.ConclusionThe study revealed that social support may be a strong protector against antenatal depressive symptoms but only support from the partner. This suggests that strengthening support to pregnant women may be a successful strategy for reducing the incidence or severity of maternal mental health problems, but more work is required to assess whether support from the broader social network can compensate for absent or unsupportive partners.

Health providers’ perspectives on contraceptive use in rural Northwest Tanzania: A qualitative study

ObjectivesIn Tanzania, contraceptive use is limited, particularly in rural communities and even among women who would like to delay childbearing. This paper aims to present health providers’ perspectives on populations seeking contraception and barriers that could be addressed to increase access to and uptake of contraception, given their interface with large portions of their communities. Study DesignWe conducted 18 in-depth interviews with providers stationed at health dispensaries in six rural villages in northwest Tanzania. Two investigators independently coded interviews using a stepwise process to achieve consensus on prevalent topics. ResultsThree topics emerged from our analysis: (1) nature of clients seeking contraception; (2) barriers to uptake of contraception; and (3) the role of secrecy in obtaining and using contraception. Health providers reported that married women with children were the most frequent users of contraception, alongside some single women, men, sex workers, and students. Barriers to contraception included lack of supplies and trained staff, misconceptions and fears, stigma, and unsupportive partners. Providers observed that contraception was often used secretly. They reported surreptitious visits and described clients’ preferential use of discreet methods. Providers respected and supported clients’ desires to keep visits confidential. ConclusionOur data suggest maintaining high stocks of discreet contraceptive methods and deploying more trained staff to dispensaries could increase availability and access to contraceptives. At the community level, more education campaigns are warranted to address barriers, especially those related to stigma. ImplicationsOur work highlights the need for additional contraceptive methods that are easy to administer and discreet for women who must maintain secrecy. Future studies of the effectiveness of interventions and new contraceptives should obtain healthcare providers’ perspectives, as they can provide important insights to service provision.

Unsupportive romantic partner behaviors increase neural reactivity to mistakes

Romantic relationships involve a range of positive and negative experiences, from supportive and security-enhancing behaviors to unsupportive interactions involving criticism and dismissiveness. The present study aimed to examine the functional impact of these experiences on reactivity to mistakes, as error salience has key implications for adaptive functioning in areas such as goal-striving and appropriate risk-taking. To this end, a study was conducted in which participants completed the Eriksen Flanker Task (EFT) alone and under romantic partner observation while electrophysiological brain activity related to error salience (the error-related negativity (ERN)) was recorded. Findings indicated that unsupportive, but not supportive, partner behaviors were associated with changes in error salience, furthering the notion that negative relationship experiences have a stronger effect on functioning than do positive ones and highlighting the impact of relationship context on reactivity to mistakes.

Prevalence and predictors of postpartum depression among postnatal women in Lagos, Nigeria.

Globally, postpartum depression is one of the most common but often unrecognized complications of childbirth, yearly affecting about 10-15% of postnatal women. This study aimed to determine the prevalence of postpartum depression and its predictors among postnatal women in Lagos. A descriptive cross-sectional study was conducted among 250 mothers in Eti-Osa Local Government Area of Lagos State, Nigeria, attending six Primary Health Care centers for infant immunization at six weeks post-delivery. Data was collected using a pretested semi-structured interviewer administered questionnaire which included the Edinburgh Postnatal Depression Scale. Analysis was carried out using SPSS version 23TM. Chi-square and logistic regression analyses were used to determine associations and predictive relationships between various factors and the presence of postpartum depression. The level of significance was set at <0.05. The prevalence of postpartum depression was 35.6%. Multiparity, delivery by cesarean section, mother being unwell after delivery, and not exclusively breastfeeding the baby were the factors linked with postpartum depression. Following multiple logistic regression, having postpartum blues (p=0.000; OR=32.77; 95%CI=7.23-148.58)., not getting help with caring for the baby (p=0.008; OR=2.64; 95%CI=1.29-5.42), experiencing intimate partner violence (p=0.000; OR=5.2; 95%CI=2.23-11.91) and having an unsupportive partner (p=0.018; OR=2.6; 95%CI=1.17-5.78) were identified as predictors of postpartum depression. This study revealed a high prevalence of postpartum depression, identifying both the obstetric and psychosocial predictors. Social support for women both in the pre- and postnatal periods and routine screening of women for postpartum depression should be encouraged for early detection and immediate intervention.

Barriers and facilitators to weight management in overweight and obese women living in Australia with PCOS: a qualitative study

BackgroundLifestyle modification targeting weight management is the first-line treatment for women with Polycystic Ovary Syndrome (PCOS) regardless of presenting symptoms. Women with PCOS are more likely to gain more weight compared with women without PCOS, which may be related to barriers in engaging in lifestyle modification. The aim of this study is to explore the experience of women with PCOS in weight management and to determine the facilitators and barriers to lifestyle modifications in women with PCOS.MethodsTen women with PCOS participated in focus groups and semi-structured telephone interviews on lifestyle and weight management in PCOS. Discussions were audio-recorded and transcribed verbatim. Thematic analysis of the transcripts was conducted. Thematic analysis of the transcripts were conducted using the method of constant comparison.ResultsWomen in the current study attempted a wide range of weight loss interventions, but had difficulties losing weight and preventing weight regain. Women felt that having PCOS affected their ability to lose weight and to keep it off. Facilitators to lifestyle modification for weight management were reported as structured approaches such as having balanced meals and support by health professionals, peers, friends or family. Barriers to lifestyle changes in women with PCOS included logistical barriers such as time and cost, motivational barriers including tiredness or feeling unrewarded, environmental barriers such as not having access to safe places to exercise, emotional barriers such as having depressive and defeating thoughts, and relational barriers such as having unsupportive partner or prioritising children’s meal preferences.ConclusionsWomen with PCOS face a number of personal, environmental and social facilitators and barriers to lifestyle modification for weight loss. While many of these are also experienced by women without PCOS, women with PCOS face additional barriers in having low sense of self-confidence and high prevalence of negative thoughts which may impair their ability to maintain efforts in lifestyle modification over the long term. Future research should further explore the impact of the emotional and mental burden of PCOS on the management of weight and other aspects of PCOS. Future lifestyle intervention should also address the psychosocial aspect of PCOS.

Smoking cessation in pregnancy: An update for maternity care practitioners.

INTRODUCTIONThis paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings.METHODSWe conducted a qualitative review of published peer reviewed and grey literature.RESULTSThere is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high.CONCLUSIONSThere have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.

Correlates of Light Physical Activity Among Cancer Survivors

Emerging evidence demonstrates positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Furthermore, studies are often underpowered for conducting sub-group analyses. PURPOSE: To explore modifiable correlates of LPA among cancer survivors using a social cognitive framework, and how these correlates may differ among those engaging/not engaging in moderate-to-vigorous physical activity (MVPA). METHODS: Self-report data from the third survey of the American Cancer Society’s Studies of Cancer Survivors I (N = 1720) were analyzed. Social cognitive variables of interest reflect cognitive determinants (i.e. perceived health competence and perceived susceptibility to cancer recurrence) and environmental determinants (i.e. healthcare provider support, perceived social support, and unsupportive partner behaviors). The Leisure Time Exercise Questionnaire was used to create four LPA categories (0, 1-59, 60-119, and 120+ minutes/week). Ordinal regressions using forced entry were conducted, stratified by MVPA status (0 minutes of MVPA, ≥ 1 min MVPA). Models were adjusted for relevant covariates (i.e., demographic, cancer-related, health-related variables), missing data bias was examined, and sensitivity analyses were conducted to examine the robustness of the results. RESULTS: Among cancer survivors reporting no MVPA (n = 747), greater provider support for PA (adjusted OR [aOR] = 1.49, p = .03), greater perceived health competence (aOR = 1.44, p = .01), and greater unsupportive partner behaviors (aOR = 1.06, p = .03) were significantly correlated with higher LPA. No constructs were correlated with LPA among cancer survivors already engaging in MVPA (n = 973). Missing data bias was small (Cramer’s V/Phi < 0.1). Results were similar in unadjusted analyses, and when stratifying by insufficient and meeting MVPA recommendations. CONCLUSIONS: The utility of a social cognitive framework in explaining LPA among cancer survivors who do not engage in any MVPA was supported. Interventions may be more efficacious by incorporating healthcare provider support, improving health competence, and improving interpersonal skills that address unsupportive partners.

Correlates of light physical activity among cancer survivors.

Emerging evidence demonstrates the positive health benefits of light physical activity (LPA) for cancer survivors. Yet, little research has explored modifiable factors that facilitate or hinder LPA behavior in this population. Correlates of LPA among cancer survivors were examined, and stratified by moderate-to-vigorous physical activity (MVPA) status. A cross-sectional analysis using the American Cancer Society's Studies of Cancer Survivors-I (N=1751) was conducted. Correlates of interest were health-care provider support for physical activity, perceived health competence, perceived social support, unsupportive partner behaviors, and perceived susceptibility to cancer recurrence. The primary outcome was self-reported LPA categorized at 0, 1-59, 60-119, and 120+minutes per week. Multivariable ordinal regressions using forced entry were conducted, stratified by MVPA status. Adjusted multivariable models revealed that, among those reporting no MVPA (n=757), greater provider support for physical activity (adjusted odds ratio [aOR]=1.51; 95% CI, 1.05-2.17; P=0.03), greater perceived health competence (aOR=1.44; 95% CI, 1.10-1.88; P=0.01), and greater unsupportive partner behaviors (aOR=1.06; 95% CI, 1.01-1.12; P=0.03) were significantly correlated with higher LPA. No social cognitive constructs were correlated with LPA among those already engaging in MVPA (n=994). LPA interventions targeting cancer survivors not engaging in any MVPA are warranted and may optimize limited intervention resources. Furthermore, interventions may be more efficacious by applying behavior change techniques that incorporate health-care provider support and improves health competence and positive interpersonal skills.