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The objective of this scoping review was to examine and map the literature on defining and assessing nursing informatics competencies for nurses and nursing students.Over the past three decades, nursing informatics competency research has evolved markedly within countries and nursing roles. It is important to examine the available literature on defining and assessing nursing informatics competencies to inform education, clinical practice, policy, and future research.We considered literature that defined or assessed the concept of nursing informatics competency as a combination of knowledge, skills, and attitudes. This included nursing informatics competencies of nurses and nursing students in a variety of health care or academic settings.An extensive search was conducted in Ovid MEDLINE, CINAHL Plus with Full Text via EBSCO, Ovid Embase, Ovid PsycINFO, ProQuest ERIC, Health and Psychosocial Instruments, ProQuest Australian Education Index, ProQuest Education Databases, ProQuest Dissertations and Theses Global, OCLC PapersFirst, Scopus, Web of Science Core Collection, Wiley Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports. The initial search was conducted in May 2017 and updated several times. Nursing informatics websites were searched for gray literature, including unpublished research and organizational documents. Additional papers were identified based on a search of reference lists of all the included papers. Neither language nor date restrictions were applied. Two reviewers assessed each of the included papers independently. Data extraction was undertaken using an extraction tool developed specifically for the scoping review objectives.Fifty-two papers were included. Thirty-four papers identified nursing informatics competencies, grouped into four categories: i) nursing informatics competencies for students, entry-level nurses, or generalist nurses; ii) nursing informatics competencies for a specific nursing role; iii) recommendations for consensus on defining core nursing informatics competencies at the international level; and iv) forecasting future nursing informatics competencies as per evolving nursing roles. Eighteen papers reported on nursing informatics competency assessment tools. Results were discussed in a narrative format supported by tables.This review provided insights to the state of the science on defining and assessing nursing informatics competencies for nurses and nursing students. Several nursing informatics competency lists are available, and despite some variations in domains of nursing informatics competency and indicator statements, they mostly share common themes. This literature demonstrates a heightened awareness of the importance of nursing informatics competency; however, the availability of many lists may be challenging for frontline nursing staff, nursing educators, administrators, researchers, and students to assimilate. Further research is needed to reach a consensus on core domains of nursing informatics competency and associated indicators, preferably per nursing roles, with international involvement and consensus. Additionally, while many nursing informatics competency assessment tools exist, further research is needed to examine psychometric properties of some of these tools.

Caffeine is routinely used in preterm infants for apnea of prematurity. Preterm infants are usually monitored for 5 days after discontinuation of caffeine to assess for possible recurrence of apnea. Our objective was to determine if the serum concentration of caffeine decreases to a subtherapeutic level 5 days after its discontinuation.This is a retrospective analysis of caffeine levels after the drug was discontinued in preterm neonates (birth weight ≤1500 g) born between January 2010 and June 2017. The primary outcome was the proportion of infants with therapeutic levels of caffeine 5 days after the drug was stopped.Caffeine levels were measured in 353 samples from 280 infants (birth weight 1246 ± 390 g and gestational age 29.2 ± 2.4 weeks) after discontinuation of the drug. Five and more days after discontinuation of caffeine, 29.3% (82/280) of the infants had caffeine levels ≥5 mg/L. Approximately 41% (75/181) of the caffeine levels measured between 5 and 7 days and 18% (17/95) between 8 and 10 days were ≥5 mg/L. A caffeine dose of5 mg/kg/day when discontinued was associated with the caffeine level of ≥5 mg/L (OR 2.3, 95% CI 1.28-4.13,Preterm infants treated with caffeine frequently had therapeutic levels of caffeine 5-10 days after discontinuation of the drug. The infants receiving higher doses were more likely to have a therapeutic level of caffeine 5 days after stopping the medication. Preterm infants should be monitored for recurrence of apnea for more than 5 days after stopping caffeine or levels should be monitored prior to discharge.

Review question:How are nursing informatics competencies defined or assessed in the literature?

Immunocompromised children are at increased risk of severe illness from vaccine-preventable infections. However, inadequate vaccine coverage remains a concern. This scoping review sought to determine the current state of knowledge regarding vaccine coverage of immunocompromised children. Bibliographic databases were searched for primary research from any year. Data were analyzed quantitatively and narratively. Ninety-seven studies met inclusion criteria. The most commonly studied vaccines were pneumococcal (n = 46), influenza (n = 44), diphtheria/tetanus/pertussis/poliomyelitis/Haemophilus influenzae type B/hepatitis B-containing (n = 36), and measles- and/or mumps- and/or rubella-containing (n = 29). Immunocompromising conditions studied included cancer/stem cell transplants (n = 24), solid organ transplants (n = 23), sickle cell disease (n = 21), immunosuppressive therapy (n = 14), human immunodeficiency virus (n = 12), splenectomy (n = 4), and primary immunodeficiency (n = 2). As more children are treated with immunosuppressive therapies, it is critical to identify whether they are being appropriately vaccinated for age and condition. We identified gaps in the current state of knowledge for specific vaccine types in specific immunocompromised populations.

Background Bed rest is prescribed by most maternity health care professionals for high-risk pregnancy complications, but the impact of bed rest at home and in hospital has not been explored. Our aim was to quantify the influence of bed rest on maternal/fetal health outcomes in developed and developing regions. Methods We conducted a systematic review and meta-analysis of randomized controlled trials. We conducted a structured search through MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Library through Mar. 7, 2019. Trials comparing standard care to standard care plus bed rest after 20 weeks' gestation were assessed. Outcomes included infant birth weight, being small for gestational age, gestational age, premature or very premature birth, perinatal death, admission to the neonatal intensive care unit, preterm rupture of membranes, hypertensive disorders of pregnancy, preeclampsia and gestational diabetes mellitus. Results We identified 1191 publications, of which 43 were assessed for eligibility. Sixteen publications reporting on 14 unique studies (2608 women, 3328 infants) were included in the analysis. Overall, maternal/newborn outcomes were similar between women on bed rest and those not on bed rest. In subgroup analyses of developed and developing regions, length of gestation was shorter with bed rest (weighted mean difference -0.77 wk, 95% confidence interval [CI] -1.26 to -0.27, I 2 = 0%), and the risk of a very premature birth was increased (risk ratio 2.07, 95% CI 1.15 to 3.73, I 2 = 0%) in developed countries. Interpretation In developed regions, treatment of complicated pregnancies with more than 1 week of bed rest results in worse newborn outcomes. Additional studies are required to determine whether bed rest or hospital admission improves outcomes in developing regions. PROSPERO Trial registration number: CRD42018099237.

Objective The objective is to provide guidance for pregnant women, and obstetric care and exercise professionals, on prenatal physical activity. Outcomes The outcomes evaluated were maternal, fetal, or neonatal morbidity or fetal mortality during and following pregnancy. Evidence Literature was retrieved through searches of Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full-text, Child Development & Adolescent Studies, ERIC, Sport Discus, ClinicalTrials.gov, and the Trip Database from database inception up to January 6, 2017. Primary studies of any design were eligible, except case studies. Results were limited to English, Spanish, or French language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal, or neonatal morbidity or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Values The Guidelines Consensus Panel solicited feedback from end-users (obstetric care providers, exercise professionals, researchers, policy organizations, and pregnant and postpartum women). The development of this guideline followed the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument. Benefits, harms, and costs The benefits of prenatal physical activity are moderate, and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end-users indicated that following these recommendations would be feasible, acceptable, and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives. Preamble This guideline provide evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal, and neonatal health. In the absence of contraindications (see later for a detailed list), following this guideline is associated with: (1) fewer newborn complications (i.e., large for gestational age); and (2) maternal health benefits (i.e., decreased risk of preeclampsia, gestational hypertension, gestational diabetes, Caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression; improved blood glucose; decreased total gestational weight gain; and decreased severity of depressive symptoms and lumbopelvic pain). Physical activity is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycemia, low birth weight, birth defects, induction of labour, or birth complications. In general, more physical activity (frequency, duration, and/or volume) is associated with greater benefits. However, evidence was not identified regarding the safety or additional benefit of exercising at levels significantly above the recommendations. Prenatal physical activity should be considered a front-line therapy for reducing the risk of pregnancy complications and enhancing maternal physical and mental health. For pregnant women not currently meeting this guideline, a progressive adjustment toward them is recommended. Previously active women may continue physical activity throughout pregnancy. Women may need to modify physical activity as pregnancy progresses. There may be periods when following the guideline is not possible due to fatigue and/or discomforts of pregnancy; women are encouraged to do what they can and to return to following the recommendations when they are able. This guideline were informed by an extensive systematic review of the literature, expert opinion, end-user consultation and considerations of feasibility, acceptability, costs, and equity. Recommendations The specific recommendations in this 2019 Canadian Guideline for Physical Activity Throughout Pregnancy are provided below with corresponding statements indicating the quality of the evidence informing the recommendations and the strength of the recommendations (explanations follow). Contraindications All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation. Absolute contraindications to exercise are the following: Relative contraindications to exercise are the following: STRENGTH OF THE RECOMMENDATIONS: The GRADE system was utilized to grade the strength of the recommendations. Recommendations are rated as strong or weak based on the: (1) balance between benefits and harms; (2) overall quality of the evidence; (3) importance of outcomes (i.e., values and preferences of pregnant women); (4) use of resources (i.e., cost); (5) impact on health equity; (6) feasibility, and (7) acceptability. Strong recommendation: Most or all pregnant women will be best served by the recommended course of action. Weak recommendation: Not all pregnant women will be best served by the recommended course of action; there is a need to consider other factors such as the individual's circumstances, preferences, values, resources available, or setting. Consultation with an obstetric care provider may assist in decision-making. Quality of the evidence The quality of the evidence refers to the level of confidence in the evidence and ranges from very low to high. High quality: The Guideline Consensus Panel is very confident that the estimated effect of physical activity on the health outcome is close to the true effect. Moderate quality: The Guideline Consensus Panel is moderately confident in the estimated effect of physical activity on the health outcome; the estimate of the effect is likely to be close to the true effect, but there is a possibility that it is substantially different. Low quality: The Guideline Consensus Panel's confidence in the estimated effect of physical activity on the health outcome is limited; the estimate of the effect may be substantially different from the true effect. Very low quality: The Guideline Consensus Panel has very little confidence in the estimated effect of physical activity on the health outcome; the estimate of the effect is likely to be substantially different from the true effect. aThis was a weak recommendation because the quality of evidence was low, and the net benefit between women who were physically active and those who were not was small. bThis was a strong recommendation because, despite low quality evidence supporting physical activity during pregnancy for women categorized as overweight or obese, there was evidence from randomized controlled trials demonstrating an improvement in gestational weight gain and blood glucose. cModerate-intensity physical activity is intense enough to noticeably increase heart rate; a person can talk but not sing during activities of this intensity. Examples of moderate-intensity physical activity include brisk walking, water aerobics, stationary cycling (moderate effort), resistance training, carrying moderate loads, and household chores (e.g., gardening, washing windows). dThis was a weak recommendation because urinary incontinence was was not rated as a "critical" outcome and the evidence was low quality. eThis was a weak recommendation because: (1) the quality of evidence was very low; and (2) although harms were investigated there was limited available information to inform the balance of benefits and harms. This recommendation was primarily based on expert opinion.

Objectif L'objectif est de guider les femmes enceintes et les professionnels de l'obstetrique et de l'exercice en ce qui concerne l'activite physique prenatale. ReSULTATS: Les issues evaluees etaient la morbidite maternelle, fœtale ou neonatale et la mortalite fœtale pendant et apres la grossesse. DONNeES: Nous avons interroge MEDLINE, Embase, PsycINFO, la Cochrane Database of Systematic Reviews, le Cochrane Central Register of Controlled Trials, Scopus et la Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, ERIC, SPORTDiscus, ClinicalTrials.gov de leur creation jusqu'au 6 janvier 2017. Les etudes primaires de tous types etaient admissibles, a l'exception des etudes de cas. Seules les publications en anglais, en espagnol et en francais ont ete retenues. Les articles lies a l'activite physique durant la grossesse qui abordaient la morbidite maternelle, fœtale ou neonatale ou la mortalite fœtale etaient admissibles. La qualite des donnees probantes a ete evaluee au moyen de l'approche GRADE (Grading of Recommendations Assessment, Development and Evaluation). Valeurs Le groupe d'experts responsable des lignes directrices a recueilli les commentaires d'utilisateurs finaux (fournisseurs de soins obstetricaux, professionnels de l'exercice, chercheurs, organismes responsables de politiques, et femmes enceintes et en periode postpartum). La directive clinique a ete elaboree au moyen de l'outil Appraisal of Guidelines for Research Evaluation (AGREE) II. AVANTAGES, INCONVeNIENTS, ET COuTS: Les avantages de l'activite physique prenatale sont moderes, et aucun inconvenient n'a ete releve; la difference entre les consequences desirables et indesirables (avantage net) devrait donc etre moderee. La majorite des intervenants et des utilisateurs finaux ont indique qu'il serait faisable, acceptable et equitable de suivre ces recommandations, qui necessitent generalement des ressources minimes de la part des personnes et des systemes de sante. PREAMBULE: Les presentes lignes directrices contiennent des recommandations fondees sur des donnees probantes au sujet de l'activite physique durant la grossesse visant a favoriser la sante maternelle, fœtale et neonatale. En l'absence de contre-indications (voir la liste detaillee plus loin), le fait de suivre ces lignes directrices est associe a : 1) moins de complications pour le nouveau-ne (p. ex., gros par rapport a l'âge gestationnel); et 2) des bienfaits pour la sante maternelle (p. ex., diminution du risque de preeclampsie, d'hypertension gravidique, de diabete gestationnel, de cesarienne, d'accouchement operatoire, d'incontinence urinaire, de gain de poids excessif durant la grossesse et de depression; amelioration de la glycemie; diminution du gain de poids total durant la grossesse; et diminution de la gravite des symptomes depressifs et de la douleur lombo-pelvienne). L'activite physique n'est pas associee a la fausse couche, a la mortinaissance, au deces neonatal, a l'accouchement premature, a la rupture prematuree preterme des membranes, a l'hypoglycemie neonatale, au poids insuffisant a la naissance, aux anomalies congenitales, au declenchement du travail, ou aux complications a la naissance. En general, une augmentation de l'activite physique (frequence, duree ou volume) est liee a une augmentation des bienfaits. Cependant, nous n'avons pas trouve de donnees probantes concernant l'innocuite ou l'avantage accru de l'exercice a des niveaux considerablement superieurs aux recommandations. L'activite physique prenatale devrait etre vue comme un traitement de premiere ligne pour reduire le risque de complications de la grossesse et ameliorer la sante physique et mentale de la mere. Pour les femmes enceintes qui n'atteignent actuellement pas le niveau recommande, nous recommandons une augmentation progressive pour l'atteindre. Les femmes deja actives peuvent continuer de l'etre tout au long de la grossesse. Elles pourraient devoir modifier le type d'activite a mesure que leur grossesse avance. Il peut devenir impossible de suivre les lignes directrices pendant certaines periodes en raison de la fatigue ou des inconforts de la grossesse; nous encourageons les femmes a faire ce qu'elles peuvent et a revenir aux recommandations lorsqu'elles en sont capables. Les recommandations qui suivent reposent sur une revue systematique approfondie de la litterature, l'opinion d'experts, la consultation d'utilisateurs finaux et des considerations de faisabilite, d'acceptabilite, de cout et d'equite. Recommandations Les recommandations des Lignes directrices canadiennes sur l'activite physique durant la grossesse 2019 sont fournies ci-dessous avec des enonces indiquant la qualite des donnees probantes utilisees et la force des recommandations (des explications suivent). Contre-indications Toutes les femmes enceintes peuvent faire de l'activite physique durant la grossesse, sauf celles qui presentent des contre-indications (voir ci-dessous). Celles presentant des contre-indications absolues peuvent poursuivre leurs activites quotidiennes habituelles, mais ne devraient pas faire d'activites plus vigoureuses. Celles presentant des contre-indications relatives devraient discuter des avantages et des inconvenients de l'activite physique d'intensite moderee a vigoureuse avec leur fournisseur de soins obstetricaux avant d'y prendre part. Contre-indications absolues Contre-indications relatives FORCE DES RECOMMANDATIONS: Nous avons utilise le systeme GRADE pour evaluer la force des recommandations. Les recommandations sont jugees fortes ou faibles en fonction de : 1) l'equilibre entre les avantages et les inconvenients; 2) la qualite globale des donnees probantes; 3) l'importance des issues (valeurs et preferences des femmes enceintes); 4) l'utilisation de ressources (cout); 5) l'incidence sur l'equite en matiere de sante; 6) la faisabilite et 7) l'acceptabilite. Recommandation forte : La majorite ou la totalite des femmes enceintes auraient avantage a suivre la recommandation. Recommandation faible : Les femmes enceintes n'auraient pas toutes avantage a suivre la recommandation; il faut tenir compte d'autres facteurs comme la situation, les preferences, les valeurs, les ressources et le milieu de chaque personne. La consultation d'un fournisseur de soins obstetricaux peut faciliter la prise de decisions. QUALITe DES DONNeES PROBANTES: La qualite des donnees probantes fait reference au degre de confiance dans les donnees et va de tres faible a elevee. Qualite elevee : Le groupe d'experts responsable des lignes directrices est tres convaincu que l'effet estime de l'activite physique sur l'issue de sante est pres de l'effet reel. Qualite moyenne : Le groupe d'experts responsable des lignes directrices a moyennement confiance en l'effet estime de l'activite physique sur l'issue de sante; l'effet estime est probablement pres de l'effet reel, mais il est possible qu'il soit tres different. Qualite faible : Le groupe d'experts responsable des lignes directrices a peu confiance en l'effet estime de l'activite physique sur l'issue de sante; l'effet estime pourrait etre tres different de l'effet reel. Qualite tres faible : Le groupe d'experts responsable des lignes directrices a tres peu confiance en l'effet estime de l'activite physique sur l'issue de sante; l'effet estime est probablement tres different de l'effet reel. a Il s'agit d'une recommandation faible parce que la qualite des donnees probantes etait faible et que l'avantage net entre les femmes qui etaient physiquement actives et celles qui ne l'etaient pas etait petit. b Il s'agit d'une recommandation forte parce que, malgre le fait que les donnees probantes appuyant l'activite physique durant la grossesse pour les femmes en surpoids ou obeses etaient de qualite faible, des donnees tirees d'essais cliniques randomises demontraient une diminution du gain de poids durant la grossesse et une amelioration de la glycemie. c On parle d'intensite moderee lorsque l'activite est assez intense pour augmenter la frequence cardiaque de facon perceptible; une personne peut parler, mais pas chanter durant les activites de cette intensite. Pensons par exemple a la marche rapide, a la gymnastique aquatique, au velo stationnaire (effort modere), a l'entrainement musculaire, au port de charges moderees et aux travaux menagers (p. ex., jardinage, lavage de fenetres). d Il s'agit d'une recommandation faible parce que l'incontinence urinaire n'etait pas jugee comme etant une issue « critique » et que les donnees etaient de qualite faible. e Il s'agit d'une recommandation faible parce que : 1) la qualite des donnees probantes etait tres faible; et 2) bien que nous ayons etudie les inconvenients, il y avait peu de renseignements disponibles sur l'equilibre entre les avantages et les inconvenients. Cette recommandation etait principalement fondee sur l'opinion d'experts.

In the last decade, an abundance of new research from Canada and internationally has provided substantial evidence for the efficacy of exercise in preventing pregnancy complications and improving long-term maternal and fetal outcomes. Indeed, guidelines for exercise during pregnancy are available from several countries. This includes the expert consensus-based 2003 Joint SOGC and Canadian Society for Exercise Physiology Clinical Practice Guidelines: Exercise in Pregnancy and the Postpartum Period. With the plethora of new scientific evidence, it was vital to re-examine the literature by using the rigorous process followed by previous Canadian health behaviour guidelines.The purpose of this document is to outline the process and outcomes for the re-development of the 2019 Canadian Guideline for Physical Activity Throughout Pregnancy, herein referred to as the Guidelines. The target users for these Guidelines are obstetric care providers, policymakers, and exercise professionals who provide guidance for pregnant women regarding prenatal physical activity.

ObjectiveTo examine the relationships between prenatal physical activity and prenatal and postnatal urinary incontinence (UI).DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal UI).Results24 studies (n=15 982 women) were included. ‘Low’ to ‘moderate’ quality evidence revealed prenatal pelvic floor muscle training (PFMT) with or without aerobic exercise decreased the odds of UI in pregnancy (15 randomised controlled trials (RCTs), n=2764 women; OR 0.50, 95% CI 0.37 to 0.68, I2=60%) and in the postpartum period (10 RCTs, n=1682 women; OR 0.63, 95% CI 0.51, 0.79, I2=0%). When we analysed the data by whether women were continent or incontinent prior to the intervention, exercise was beneficial at preventing the development of UI in women with continence, but not effective in treating UI in women with incontinence. There was ‘low’ quality evidence that prenatal exercise had a moderate effect in the reduction of UI symptom severity during (five RCTs, standard mean difference (SMD) −0.54, 95% CI −0.88 to –0.20, I2=64%) and following pregnancy (three RCTs, ‘moderate’ quality evidence; SMD −0.54, 95% CI −0.87 to –0.22, I2=24%).ConclusionPrenatal exercise including PFMT reduced the odds and symptom severity of prenatal and postnatal UI. This was the case for women who were continent before the intervention. Among women who were incontinent during pregnancy, exercise training was not therapeutic.

ObjectiveThe purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (prevalence and symptom severity of LBP, PGP and LBPP).ResultsThe analyses included data from 32 studies (n=52 297 pregnant women). ‘Very low’ to ‘moderate’ quality evidence from 13 randomised controlled trials (RCTs) showed prenatal exercise did not reduce the odds of suffering from LBP, PGP and LBPP either in pregnancy or the postpartum period. However, ‘very low’ to ‘moderate’ quality evidence from 15 RCTs identified lower pain severity during pregnancy and the early postpartum period in women who exercised during pregnancy (standardised mean difference −1.03, 95% CI −1.58, –0.48) compared with those who did not exercise. These findings were supported by ‘very low’ quality evidence from other study designs.ConclusionCompared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point.

ObjectiveGestational weight gain (GWG) has been identified as a critical modifier of maternal and fetal health. This systematic review and meta-analysis aimed to examine the relationship between prenatal exercise, GWG and postpartum weight retention (PPWR).DesignSystematic review with random effects meta-analysis and meta-regression. Online databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs in English, Spanish or French were eligible (except case studies and reviews) if they contained information on the population (pregnant women without contraindication to exercise), intervention (frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume or type of exercise) and outcomes (GWG, excessive GWG (EGWG), inadequate GWG (IGWG) or PPWR).ResultsEighty-four unique studies (n=21 530) were included. ‘Low’ to ‘moderate’ quality evidence from randomised controlled trials (RCTs) showed that exercise-only interventions decreased total GWG (n=5819; −0.9 kg, 95% CI −1.23 to –0.57 kg, I2=52%) and PPWR (n=420; −0.92 kg, 95% CI −1.84 to 0.00 kg, I2=0%) and reduced the odds of EGWG (n=3519; OR 0.68, 95% CI 0.57 to 0.80, I2=12%) compared with no exercise. ‘High’ quality evidence indicated higher odds of IGWG with prenatal exercise-only (n=1628; OR 1.32, 95% CI 1.04 to 1.67, I2=0%) compared with no exercise.ConclusionsPrenatal exercise reduced the odds of EGWG and PPWR but increased the risk of IGWG. However, the latter result should be interpreted with caution because it was based on a limited number of studies (five RCTs).

ObjectiveTo investigate the relationships between exercise and incidence of congenital anomalies and hyperthermia.DesignSystematic review with random-effects meta-analysis .Data sourcesOnline databases were searched from inception up to 6 January 2017.Study eligibility criteriaStudies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume or type of exercise) and outcome (maternal temperature and fetal anomalies).ResultsThis systematic review and meta-analysis included ‘very low’ quality evidence from 14 studies (n=78 735) reporting on prenatal exercise and the odds of congenital anomalies, and ‘very low’ to ‘low’ quality evidence from 15 studies (n=447) reporting on maternal temperature response to prenatal exercise. Prenatal exercise did not increase the odds of congenital anomalies (OR 1.23, 95% CI 0.77 to 1.95, I2=0%). A small but significant increase in maternal temperature was observed from pre-exercise to both during and immediately after exercise (during: 0.26°C, 95% CI 0.12 to 0.40, I2=70%; following: 0.24°C, 95% CI 0.17 to 0.31, I2=47%).Summary/ConclusionsThese data suggest that moderate-to-vigorous prenatal exercise does not induce hyperthermia or increase the odds of congenital anomalies. However, exercise responses were investigated in most studies after 12 weeks’ gestation when the risk of de novo congenital anomalies is negligible.

A high quality systematic review search has three core attributes; it is systematic, comprehensive, and transparent. The current over-emphasis on the primacy of systematic reviews over other forms of literature review in health research, however, runs the risk of encouraging publication of reviews whose searches do not meet these three criteria under the guise of being systematic reviews. This correspondence comes in response to Perman S, Turner S, Ramsay AIG, Baim-Lance A, Utley M, Fulop NJ. School-based vaccination programmes: a systematic review of the evidence on organization and delivery in high income countries. 2017; BMC Public Health 17:252, which we assert did not meet these three important quality criteria for systematic reviews, thereby leading to potentially unreliable conclusions. Our aims herein are to emphasize the importance of maintaining a high degree of rigour in the conduct and publication of systematic reviews that may be used by clinicians and policy-makers to guide or alter practice or policy, and to highlight and discuss key evidence omitted in the published review in order to contextualize the findings for readers. By consulting a research librarian, we identified limitations in the search terms, the number and type of databases, and the screening methods used by Perman et al. Using a revised Ovid MEDLINE search strategy, we identified an additional 1016 records in that source alone, and highlighted relevant literature on the organization and delivery of school-based immunization program that was omitted as a result. We argue that a number of the literature gaps noted by Perman et al. may well be addressed by existing literature found through a more systematic and comprehensive search and screening strategy. We commend both the journal and the authors, however, for their transparency in supplying information about the search strategy and providing open access to peer reviewer and editor’s comments, which enabled us to understand the reasons for the limitations of that review.

The overall purpose of this study was to create a model of positive youth development (PYD) through sport grounded in the extant qualitative literature. More specifically, the first objective was to review and evaluate qualitative studies of PYD in sport. The second objective was to analyze and synthesize findings from these studies. Following record identification and screening, 63 articles were retained for analysis. Meta-method analysis revealed strengths of studies were the use of multiple data collection and validity techniques, which produced high-quality data. Weaknesses were limited use of ‘named’ methodologies and inadequate reporting of sampling procedures. Philosophical perspectives were rarely reported, and theory was used sparingly. Results of an inductive meta-data analysis produced three categories: PYD climate (adult relationships, peer relationships, and parental involvement), life skills program focus (life skill building activities and transfer activities), and PYD outcomes (in personal, social, and physical domains). A model that distinguishes between implicit and explicit processes to PYD is presented.

To comprehensively review all observational and experimental studies examining the relationship between physical activity and cognitive development during early childhood (birth to 5 years).Systematic review.Electronic databases were searched in July, 2014. No study design, date, or language limits were imposed on the search. Included studies had to be published, peer reviewed articles that satisfied the a priori determined population (apparently healthy children aged birth to 5 years), intervention (duration, intensity, frequency, or patterns of physical activity), comparator (various durations, intensity, or patterns of physical activity), and outcome (cognitive development) study criteria. Study quality and risk of bias were assessed in December 2014.A total of seven studies, representing 414 participants from five different countries met the inclusion criteria, including two observational and five experimental studies. Six studies found increased or higher duration/frequency of physical activity had statistically significant (p0.05) beneficial effects on at least one cognitive development outcome, including 67% of the outcomes assessed in the executive function domain and 60% in the language domain. No study found that increased or higher duration/frequency of physical activity had statistically significant detrimental effects on cognitive development. Six of the seven studies were rated weak quality with a high risk of bias.This review provides some preliminary evidence that physical activity may have beneficial effects on cognitive development during early childhood. Given the shortage of the information and the weak quality of available evidence, future research is needed to strengthen the evidence base in this area.

ObjectiveTo perform a systematic review and meta-analysis examining the influence of acute and chronic prenatal exercise on fetal heart rate (FHR) and umbilical and uterine blood flow metrics.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcomes (FHR, beats per minute (bpm); uterine and umbilical blood flow metrics (systolic:diastolic (S/D) ratio; Pulsatility Index (PI); Resistance Index (RI); blood flow, mL/min; and blood velocity, cm/s)).Results‘Very low’ to ‘moderate’ quality evidence from 91 unique studies (n=4641 women) were included. Overall, FHR increased during (mean difference (MD)=6.35bpm; 95% CI 2.30 to 10.41, I2=95%, p=0.002) and following acute exercise (MD=4.05; 95% CI 2.98 to 5.12, I2=83%, pConclusionAcute and chronic prenatal exercise do not adversely impact FHR or uteroplacental blood flow metrics.

Problem Strategies assisting healthcare professionals to make evidence-based decisions are crucial for quality patient care and outcomes. To date, there is one systematic review (Albrecht et al., 2016) examining knowledge translation (KT) efforts in child health settings. This systematic review aims to provide an update on current evidence identifying KT interventions implementing research into child health settings. Eligibility criteria Nine electronic databases were searched, restricted by date (2011–2018) and language (English). Eligibility included: 1) randomized controlled trials (RCT), controlled clinical trials (CCT), or controlled before-and-after (CBA) studies; 2) interventions implementing research into child health practice; and 3) outcomes were measured at the healthcare professional/process, patient, or economic level. Sample Health care professionals working in child health settings. Results 48 studies (38 RCT, 7 CBA, 3 CCT) were included. Studies employed single (n = 34) and multiple (n = 14) interventions. The methodological quality of studies was moderate (n = 18), strong (n = 16) and weak (n = 14). Studies showing significant, positive effects included (n = 9) RCTs, (n = 3) CBAs and (n = 2) CCTs. These studies employed (n = 11) single KT interventions and (n = 3) multiple KT interventions. Interventions included educational (n = 6), reminders (n = 3), computerized decision supports (n = 2), multidisciplinary teams (n = 2) and financial and educational interventions combined (n = 1). Conclusions Effective KT strategies used by health care professionals in child health settings were found to be online education curriculums and computerized decision supports or reminders. Implications This review update serves as an up-to-date ‘state of the science’ on KT strategies used in pediatric health professionals' clinical practice, assessed by the most rigorous research designs.

ObjectiveTheoretical concerns regarding the supine position at rest due to the gravid uterus obstructing aorta and vena caval flow may impinge uterine blood flow (UBF) to the fetus and maternal venous return.DesignSystematic review.Data sourcesOnline databases up to 11 December 2017.Study criteriaEligible population (pregnant without contraindication to exercise), intervention (frequency, intensity, duration, volume or type of supine exercise), comparator (no exercise or exercise in left lateral rest position, upright posture or other supine exercise), outcomes (potentially adverse effects on maternal blood pressure, cardiac output, heart rate, oxygen saturation, fetal movements, UBF, fetal heart rate (FHR) patterns; adverse events such as bradycardia, low birth weight, intrauterine growth restriction, perinatal mortality and other adverse events as documented by study authors), and study design (except case studies and reviews) published in English, Spanish, French or Portuguese.ResultsSeven studies (n=1759) were included. ‘Very low’ to ‘low’ quality evidence from three randomised controlled trials indicated no association between supervised exercise interventions that included supine exercise and low birth weight compared with no exercise. There was ‘very low’ to ‘low’ quality evidence from four observational studies that showed no adverse events in the mother; however, there were abnormal FHR patterns (as defined by study authors) in 20 of 65 (31%) fetuses during an acute bout of supine exercise. UBF decreased (13%) when women moved from left lateral rest to acute dynamic supine exercise.ConclusionThere was insufficient evidence to ascertain whether maternal exercise in the supine position is safe or should be avoided during pregnancy.

The objective is to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity. The outcomes evaluated were maternal, fetal or neonatal morbidity, or fetal mortality during and following pregnancy. Literature was retrieved through searches of MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, Education Resources Information Center, SPORTDiscus, ClinicalTrials.gov and the Trip Database from inception up to 6 January 2017. Primary studies of any design were eligible, except case studies. Results were limited to English-language, Spanish-language or French-language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal or neonatal morbidity, or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation methodology. The Guidelines Consensus Panel solicited feedback from end users (obstetric care providers, exercise professionals, researchers, policy organisations, and pregnant and postpartum women). The development of these guidelines followed the Appraisal of Guidelines for Research and Evaluation II instrument. The benefits of prenatal physical activity are moderate and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end users indicated that following these recommendations would be feasible, acceptable and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives.

ObjectiveTo perform a systematic review and meta-analysis to explore the relationship between prenatal exercise and glycaemic control.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of acute or chronic exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’) at any stage of pregnancy), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (glycaemic control).ResultsA total of 58 studies (n=8699) were included. There was ‘very low’ quality evidence showing that an acute bout of exercise was associated with a decrease in maternal blood glucose from before to during exercise (6 studies, n=123; mean difference (MD) −0.94 mmol/L, 95% CI −1.18 to −0.70, I2=41%) and following exercise (n=333; MD −0.57 mmol/L, 95% CI −0.72 to −0.41, I2=72%). Subgroup analysis showed that there were larger decreases in blood glucose following acute exercise in women with diabetes (n=26; MD −1.42, 95% CI −1.69 to −1.16, I2=8%) compared with those without diabetes (n=285; MD −0.46, 95% CI −0.60 to −0.32, I2=62%). Finally, chronic exercise-only interventions reduced fasting blood glucose compared with no exercise postintervention in women with diabetes (2 studies, n=70; MD −2.76, 95% CI −3.18 to −2.34, I2=52%; ‘low’ quality of evidence), but not in those without diabetes (9 studies, n=2174; MD −0.05, 95% CI −0.16 to 0.05, I2=79%).ConclusionAcute and chronic prenatal exercise reduced maternal circulating blood glucose concentrations, with a larger effect in women with diabetes.

ObjectiveWe aimed to identify the relationship between maternal prenatal exercise and birth complications, and neonatal and childhood morphometric, metabolic and developmental outcomes.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were eligible (except case studies and reviews) if published in English, Spanish or French, and contained information on the relevant population (pregnant women without contraindication to exercise), intervention (subjective/objective measures of frequency, intensity, duration, volume or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’)), comparator (no exercise or different frequency, intensity, duration, volume, type or trimester of exercise) and outcomes (preterm birth, gestational age at delivery, birth weight, low birth weight (4000 g), small for gestational age, large for gestational age, intrauterine growth restriction, neonatal hypoglycaemia, metabolic acidosis (cord blood pH, base excess), hyperbilirubinaemia, Apgar scores, neonatal intensive care unit admittance, shoulder dystocia, brachial plexus injury, neonatal body composition (per cent body fat, body weight, body mass index (BMI), ponderal index), childhood obesity (per cent body fat, body weight, BMI) and developmental milestones (including cognitive, psychosocial, motor skills)).ResultsA total of 135 studies (n=166 094) were included. There was ‘high’ quality evidence from exercise-only randomised controlled trials (RCTs) showing a 39% reduction in the odds of having a baby >4000 g (macrosomia: 15 RCTs, n=3670; OR 0.61, 95% CI 0.41 to 0.92) in women who exercised compared with women who did not exercise, without affecting the odds of growth-restricted, preterm or low birth weight babies. Prenatal exercise was not associated with the other neonatal or infant outcomes that were examined.ConclusionsPrenatal exercise is safe and beneficial for the fetus. Maternal exercise was associated with reduced odds of macrosomia (abnormally large babies) and was not associated with neonatal complications or adverse childhood outcomes.

ObjectiveTo perform a systematic review of the relationship between prenatal exercise and fetal or newborn death.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (miscarriage or perinatal mortality).ResultsForty-six studies (n=2 66 778) were included. There was ‘very low’ quality evidence suggesting no increased odds of miscarriage (23 studies, n=7125 women; OR 0.88, 95% CI 0.63 to 1.21, I2=0%) or perinatal mortality (13 studies, n=6837 women, OR 0.86, 95% CI 0.49 to 1.52, I2=0%) in pregnant women who exercised compared with those who did not. Stratification by subgroups did not affect odds of miscarriage or perinatal mortality. The meta-regressions identified no associations between volume, intensity or frequency of exercise and fetal or newborn death. As the majority of included studies examined the impact of moderate intensity exercise to a maximum duration of 60 min, we cannot comment on the effect of longer periods of exercise.Summary/conclusionsAlthough the evidence in this field is of ‘very low’ quality, it suggests that prenatal exercise is not associated with increased odds of miscarriage or perinatal mortality. In plain terms, this suggests that generally speaking exercise is ‘safe’ with respect to miscarriage and perinatal mortality.

ObjectiveTo perform a systematic review of the relationships between prenatal exercise and maternal harms including labour/delivery outcomes.DesignSystematic review with random effects meta-analysis and meta-regression.DatasourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]) and outcome (preterm/prelabour rupture of membranes, caesarean section, instrumental delivery, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms (author defined) and diastasis recti).Results113 studies (n=52 858 women) were included. ‘Moderate’ quality evidence from exercise-only randomised controlled trials (RCTs) indicated a 24% reduction in the odds of instrumental delivery in women who exercised compared with women who did not (20 RCTs, n=3819; OR 0.76, 95% CI 0.63 to 0.92, I 2= 0 %). The remaining outcomes were not associated with exercise. Results from meta-regression did not identify a dose–response relationship between frequency, intensity, duration or volume of exercise and labour and delivery outcomes.Summary/conclusionsPrenatal exercise reduced the odds of instrumental delivery in the general obstetrical population. There was no relationship between prenatal exercise and preterm/prelabour rupture of membranes, caesarean section, induction of labour, length of labour, vaginal tears, fatigue, injury, musculoskeletal trauma, maternal harms and diastasis recti.

ObjectiveTo examine the influence of prenatal exercise on depression and anxiety during pregnancy and the postpartum period.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal depression or anxiety).ResultsA total of 52 studies (n=131 406) were included. ‘Moderate’ quality evidence from randomised controlled trials (RCTs) revealed that exercise-only interventions, but not exercise+cointerventions, reduced the severity of prenatal depressive symptoms (13 RCTs, n=1076; standardised mean difference: −0.38, 95% CI −0.51 to –0.25, I2=10%) and the odds of prenatal depression by 67% (5 RCTs, n=683; OR: 0.33, 95% CI 0.21 to 0.53, I2=0%) compared with no exercise. Prenatal exercise did not alter the odds of postpartum depression or the severity of depressive symptoms, nor anxiety or anxiety symptoms during or following pregnancy. To achieve at least a moderate effect size in the reduction of the severity of prenatal depressive symptoms, pregnant women needed to accumulate at least 644 MET-min/week of exercise (eg, 150 min of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, resistance training).Summary/ConclusionsPrenatal exercise reduced the odds and severity of prenatal depression.

ObjectiveGestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).ResultsA total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).Summary/conclusionsIn conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.

Background Evidence relating maternal history of abuse before pregnancy with pregnancy outcomes is controversial. This study aims to examine the association between maternal histories of abuse before pregnancy and the risk of preterm delivery and low birth weight. Methods We searched Subject Headings and keywords for exposure and the outcomes through MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Psycinfo, CINAHL, Scopus, PILOTS, ProQuest Dissertations & Theses Global and Web of Science Core Collection in April 2017. We selected original studies that reported associations between maternal histories of abuse of any type and either preterm delivery or low birth weight. Studies that included interventions during pregnancy to lower maternal stress but reported no control data were excluded. We utilized the Newcastle-Ottawa Quality Assessment Scales for observational studies to assess the risk of bias in the primary studies. Two independent reviewers performed the selection of pertinent studies, assessment of risk of bias, and data extraction. Unadjusted pooled odds ratios (OR) with 95% Confidence Interval (CI) were calculated for the two outcomes of preterm delivery and low birth weight in 16 included studies. Results Maternal history of abuse before pregnancy was significantly associated with preterm delivery (OR 1.28, 95% CI: 1.12–1.47) and low birth weight (OR 1.35, 95% CI: 1.14–1.59). A substantial level of heterogeneity was detected within the two groups of studies reporting preterm birth and low birth weight (I2 = 75% and 69% respectively). Subgroup analysis based on the specific time of abuse before pregnancy indicated that childhood abuse increases the risk of low birth weight by 57% (95% CI: 0.99–2.49). When the included studies were categorized based on study design, cohort studies showed the highest effect estimates on preterm delivery and low birth weight (OR: 1.69, 95%CI: 1.19–2.40, OR: 1.56, 95% CI: 1.06–2.3, respectively). Conclusions We recommend that more high quality research studies on this topic are necessary to strengthen the inference. At the practice level, we suggest more attention in detecting maternal history of abuse before pregnancy during antenatal visits and using this information to inform risk assessment for adverse pregnancy outcomes. Trial registration Registration number: PROSPERO (CRD42016033231). Electronic supplementary material The online version of this article (10.1186/s12884-018-2030-8) contains supplementary material, which is available to authorized users.

Background The aim of this study was to systematically summarize knowledge on the association between exposure to interpersonal trauma and addictive behaviors. Extant reviews on this association focused on a restricted range of substance-related addictions, and/or used a narrative instead of a systematic approach. Methods Systematic searches of 8 databases yielded 29,841 studies, of which 3054 studies were included and subsequently classified in relation to study design (scoping review). A subset of observational studies (N = 181) prospectively investigating the relationship between exposure to interpersonal traumata and subsequent behavioral or substance-related addiction problems were characterized. Heterogeneity in study methodologies and types of addictive behaviors and traumatic experiences assessed precluded meta-analysis. Instead, the proportions of associations tested in this literature that revealed positive, negative, or null relationships between trauma exposure and subsequent addictive behaviors were recorded, along with other methodological features. Results Of 3054 included studies, 70.7% (n = 2160) used a cross-sectional design. In the 181 prospective observational studies (407,041 participants, 98.8% recruited from developed countries), 35.1% of the tested associations between trauma exposure and later addictive behaviors was positive, 1.3% was negative, and 63.6% was non-significant. These results were primarily obtained among non-treatment seeking samples (80.7% of studies; n = 146), using single and multi-item measures of addictive behaviors of unknown psychometric quality (46.4% of studies). Positive associations were more frequently observed in studies examining childhood versus adult traumatization (39.7% vs. 29.7%). Conclusions Longitudinal research in this area emphasizes alcohol abuse, and almost no research has examined behavioral addictions. Results provide some support for a positive association between exposure to interpersonal trauma and subsequent addictive behaviors but this relationship was not consistently reported. Longitudinal studies typically assessed trauma exposure retrospectively, often after addictive behavior onset, thus precluding robust inferences about whether traumatization affects initial onset of addictive behaviors. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1323-1) contains supplementary material, which is available to authorized users.

parke b., beaith a., slater l. & clarke a.m. (2011) Contextual factors influencing success or failure of emergency department interventions for cognitively impaired older people: a scoping and integrative review. Journal of Advanced Nursing67(7), 1426–1448. Abstract Aim. This paper is a report of a scoping review of research on cognitive impairment in older adults who visit Emergency Departments of acute care hospitals, followed by an integrative review that included a quality assessment to determine the effectiveness of interventions for this population. Background. Being old and cognitively impaired in the Emergency Department – a fast-paced intervention system – is a complex phenomenon that challenges many healthcare professionals. The rise in the incidence and prevalence of dementia will have a large impact on healthcare systems. Data sources. MEDLINE, EMBASE, CINAHL, PsycInfo, AgeLine, Abstracts in Social Gerontology, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Google Scholar between 1990 and 2008, for qualitative or quantitative studies reporting extractable data on delirium or dementia in non-institutionalized older people (65+ years) in the Emergency Department. Review methods. Titles screened by a project researcher and checked against inclusion criteria by another researcher. Two reviewers completed independent data extraction and synthesis of included studies. Quality assessment occurred using the Critical Appraisal Skills Programme Tools. Results. Fifteen studies met the inclusion criteria for integrative review. Analysis of these studies indicates that the prevalence of cognitive impairment is high and improvements are needed. Contextual details and relevant features of an appropriate intervention are poorly explained. Conclusion. Although the prevalence and incidence of cognitive impairment is recognized, appropriate interventions and programmatic responses remain elusive. Quality improvements require more thorough examination of emergency department context to identify modifiable influencing factors that are transferable across settings.

Background Bed rest is prescribed by many obstetric care providers for high-risk pregnancy complications. There is strong evidence that prolonged bed rest negatively impacts maternal health, but is justified in order to try and improve fetal health outcomes. Objective To quantify the influence of maternal bed rest on fetal health outcomes in developed and undeveloped countries. Search strategy A structured search was conducted through MEDLINE, EMBASE, CINAHL, Web of Science, Ovid’s Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and ClinicalTrials.gov up to December 16, 2016. The search combined keywords and MeSH-like terms such as “bed rest,” “pregnancy” and “randomized controlled trial (RCT)”. Selection criteria RCTs comparing standard care to standard care plus bed rest after 20 weeks gestation were assessed. Data collection and analysis Our search identified 694 publications of which 61 were assessed for eligibility. Sixteen publications reporting on fourteen unique studies (2608 women, 3328 fetuses’) were included in the analysis. Main results Overall newborn outcomes were similar between groups; however, there was a 50 g greater birth weight with bedrest (Weighted Mean Difference [WMD]: 50 g, 95% confidence interval [CI]:0 g, 100 g, I2 = 31%). Studies conducted in undeveloped countries took place solely in Zimbabwe. In subgroup analyses between developed and undeveloped countries, divergent effects were observed. Gestational length was shorter with bedrest in developed countries (WMD: −0.77 weeks, 95% CI: −1.26, −0.27, I2 = 0%). The odds of a very premature birth (Odds Ratio [OR]: 2.72, 95%CI: 1.22, 6.07, I2 = 0%) and having a newborn weighing less than 1500 g (OR: 1.96, 95% CI: 1.04, 3.67, I2 = 0%) were also increased in developed countries. Conclusions In developed countries, treatment of complicated pregnancies with prolonged bedrest results in worse newborn outcomes.

Objective To comprehensively review observational and experimental studies examining the relationship between sedentary behavior and cognitive development during early childhood (birth to 5 years). Method Electronic databases were searched in July, 2014 and no limits were imposed on the search. Included studies had to be peer-reviewed, published, and meet the a priori determined population (apparently healthy children aged birth to 5 years), intervention (duration, types, and patterns of sedentary behavior), comparator (various durations, types, or patterns of sedentary behavior), and outcome (cognitive development) study criteria. Data extraction occurred in October and November 2014 and study quality and risk of bias were assessed in December 2014. Results A total of 37 studies, representing 14,487 participants from nine different countries were included. Thirty-one studies used observational study designs and six studies used experimental study designs. Across study designs, increased or higher screen time (most commonly assessed as television viewing (TV)), reading, child-specific TV content, and adult-specific TV content had detrimental (negative) associations with cognitive development outcomes for 38%, 0%, 8%, and 25% of associations reported, respectively, and beneficial (positive) associations with cognitive development outcomes for 6%, 60%, 13%, and 3% of associations reported, respectively. Ten studies were moderate quality and 27 studies were weak quality. Conclusions The type of sedentary behavior, such as TV versus reading, may have different impacts on cognitive development in early childhood. Future research with reliable and valid tools and adequate sample sizes that examine multiple cognitive domains (e.g., language, spatial cognition, executive function, memory) are needed. Registration no. CRD42014010004.

Objective: To conduct a content analysis of library and information studies (LIS) literature published in 2001 and test the domains developed by Crumley and Koufogiannakis. Methods: A comprehensive list of refereed library and information studies journals was compiled and reviewed independently by two researchers to derive a list of included journals. Articles published in 2001 from included journals were independently assessed for relevancy by two researchers. Researchers separately extracted and checked data from included articles. Results: 217 LIS journals were reviewed and 107 were included; 91 journals provided data. 2664 journal articles were examined, with 807 (30.3%) classified as research. The Top 10 journals for research published in 2001 were: 1) JASIST, 2) Scientometrics, 3) Info Proc & Man; 4) Coll & Res Lib, 5) Tie: J Lib Adm/Bull Med Lib Assn, 7) Libs & Culture, 8) J Doc, 9) Tie: J Info Sci/J Acad Libr. For the period studied, descriptive research (329 out of 807 articles) was published far more frequently than any other type. The domain Information Access & Retrieval had the highest number of research articles (314/807), followed by Collections (193/807), Management (135/807), Education (95/807) and Reference (77/807). Two new possible domains were identified: Library History and Professional Issues. Conclusions: Because 36 articles fell into the domain of Professional Issues, a case can be made to add this domain to Crumley and Koufogiannakis’ taxonomy. Library History was not added as a domain because historical research is not used for evidence-based decision-making. There was no evidence to support keeping the Marketing & Promotion domain. LISA provides the best coverage of the top 10 LIS research journals identified in this study.

The generation of a blood glucose curve is important for assessing the response to insulin therapy in diabetic dogs. Disadvantages of this technique include patient discomfort and the potential for missing transient hypo- or hyperglycaemic episodes. The aim of the current study was to evaluate a continuous glucose monitoring system (CGMS) for use in diabetic dogs. Interstitial fluid glucose concentrations were recorded in 10 diabetic dogs, every five minutes for up to 48 hours, using a subcutaneous sensor attached to the CGMS device. Blood glucose concentrations were measured simultaneously using a glucometer. The correlation between interstitial fluid and blood glucose values was 0.81 (P < 0.01). The largest discrepancies between the two sets of data were seen during the one- to three-hour period following feeding, suggesting that postprandial hyperglycaemia might not be reflected in the interstitial fluid. The authors conclude that the CGMS is a potentially valuable tool in the management of canine diabetic patients.

Purpose To produce a meta-study by completing a systematic review of qualitative research examining determinants of independent active free play in children. Method Following systematic electronic and manual searches and application of inclusion/exclusion criteria, 46 studies were retained and subjected to meta-method, meta-theory, and meta-data analyses, followed by a final meta-synthesis. Results Identified determinants of independent active free play were child characteristics (age, competence, and gender), parental restrictions (safety concerns and surveillance), neighborhood and physical environment (fewer children to play with, differences in preferences for play spaces between parents and children, accessibility and proximity, and maintenance), societal changes (reduced sense of community, good parenting ideal, changing roles of parents, privatization of playtime and play spaces), and policy issues (need to give children voice). An ecological model depicting these factors, and the relationships therein, was created. Conclusions This comprehensive meta-study helps establish a knowledge base for children’s independent active free play research by synthesizing a previously fragmented set of studies. Parents’ perceived safety concerns are the primary barrier to children’s active free play. These safety concerns are moderated by child-level factors (age, competence, gender) and broader social issues. Interventions should focus on community-level solutions that include children’s perspectives. From a methods perspective, the reviewed studies used a range of data collection techniques, but methodological details were often inadequately reported. The theoretical sophistication of research in this area could be improved. To this end, the synthesis reported in this study provides a framework for guiding future research. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0165-9) contains supplementary material, which is available to authorized users.

Study Objective: The objective of this study was to examine the scientific quality of systematic reviews published in 5 leading emergency medicine journals. Methods: MEDLINE and EMBASE databases were electronically searched to identify published systematic reviews. Searches were only conducted in emergency medicine journals during the past 10 years; 4 of the journals were also hand searched. Potential reviews were assessed independently by 2 reviewers for inclusion. Data regarding methods were extracted from each review independently by 2 reviewers. All systematic reviews were retrieved and rated for quality by using the 10 questions from the overview quality assessment questionnaire. Results: Twenty-nine reviews were identified from more than 100 citations. The overall scientific quality of the systematic reviews was low (mean score, 2.7; 95% confidence interval 2.1 to 3.2; maximum possible score, 7.0). Selection and publication biases were rarely addressed in this collection of reviews. For example, the search strategies were only identified in 9 (31%) reviews, whereas independent study selection (6 [21%]) and quality assessment of included studies (9 [31%]) were infrequently performed. Overall, the majority of reviews had extensive flaws, and only 3 (10%) had minimal flaws. Conclusion: The results of the study indicate that many of the systematic reviews published in the emergency medicine literature contain major flaws; reviews with poor methodology may limit the validity of reported results. Further efforts should be made to improve the design, reporting, and publication of systematic reviews in emergency medicine. [Kelly KD, Travers A, Dorgan M, Slater L, Rowe BH. Evaluating the quality of systematic reviews in the emergency medicine literature. Ann Emerg Med. November 2001;38:518-526.]

This analysis compares the gold mining industry investment climate in the USA to the investment climate in Austrulia. These two major gold producing nation's industries share many similarities ; in both the USA and Australia, there is evidence of a maturing gold mining industry. Each country has experienced a dramatic increase in gold production and, more recently, greater mining of refractory ore and development of more underground operations. In the 1980s both nations experienced a pronounced rationalization trend that consolidated some gold producing operations and eliminated others. Each country commands a disproportionately large share of exploration expenditures. Land access, a major concern in the USA, has also become a critical issue in Australia as well. For all their similarities, however, the two countries have differences that are significant enough to influence mining company investment decisions. This paper explores those differences and how they may affect the future course of these nations' gold mining industries. Both effective government policy making and corporate strategic planning will occupy a major role in the future course of the two nations' gold mining industries.

Importance The incidence of depression in patients with head and neck cancer (HNC) is estimated to be as high as 40%. Previous studies have demonstrated an effect of depression on rehabilitation and survival in the posttreatment period. Objective To systematically review the relationship between depression and survival in patients with HNC undergoing curative treatment. Evidence Review A search of electronic databases as well as gray literature was undertaken from January 1, 1974, to August 20, 2014, including MEDLINE (via Ovid), EMBASE (via Ovid), CINAHL, EBSCO, PsycINFO (via Ovid), Elsevier Scopus, and Institute for Scientific Information Web of Science Core Collection, using controlled vocabulary and medical subject headings representing HNC, depression, and survival. Articles in these databases were reviewed for inclusion by 2 independent reviewers according to predetermined eligibility criteria and were adjudicated by a third reviewer. The articles were then quantitatively scored using the GRACE (Good Research for Comparative Effectiveness) tool, a validated instrument for assessing the quality of observational studies. Qualitative assessment of each article was then undertaken. Findings A total of 654 references were retrieved across all databases. A review of the abstracts and full texts identified 3 articles, each describing a distinct, single study, including a total of 431 patients, that were eligible for analysis. Scores for the articles as assessed with the GRACE tool ranged from 9 to 11. In each of the 3 studies used in the analysis, the comparison groups were depressed and nondepressed patients as established by a standardized psychiatric assessment tool. Two of the 3 studies demonstrated a statistically significant difference in survival for patients with HNC and depression; however, a sensitivity analysis was not possible due to the incompatible statistical analyses performed in each study. Conclusions and Relevance An association between depression and survival in patients with HNC is apparent; however, the strength and etiology of this association is not yet clear. Further directed and multi-institutional study is required to investigate this association and determine appropriate screening and management strategies.

This paper is a report of a scoping review of research on cognitive impairment in older adults who visit Emergency Departments of acute care hospitals, followed by an integrative review that included a quality assessment to determine the effectiveness of interventions for this population.Being old and cognitively impaired in the Emergency Department--a fast-paced intervention system--is a complex phenomenon that challenges many healthcare professionals. The rise in the incidence and prevalence of dementia will have a large impact on healthcare systems.MEDLINE, EMBASE, CINAHL, PsycInfo, AgeLine, Abstracts in Social Gerontology, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Google Scholar between 1990 and 2008, for qualitative or quantitative studies reporting extractable data on delirium or dementia in non-institutionalized older people (65+ years) in the Emergency Department.Titles screened by a project researcher and checked against inclusion criteria by another researcher. Two reviewers completed independent data extraction and synthesis of included studies. Quality assessment occurred using the Critical Appraisal Skills Programme Tools.Fifteen studies met the inclusion criteria for integrative review. Analysis of these studies indicates that the prevalence of cognitive impairment is high and improvements are needed. Contextual details and relevant features of an appropriate intervention are poorly explained.Although the prevalence and incidence of cognitive impairment is recognized, appropriate interventions and programmatic responses remain elusive. Quality improvements require more thorough examination of emergency department context to identify modifiable influencing factors that are transferable across settings.

The recently published findings of the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR)1 trial have dramatically changed clinician attitudes toward the achievement of euglycemia in intensive care unit (ICU) patients (1). In defending the proof-of-concept studies that validated the efficacy of normalizing blood glucose in the ICU, Van den Berghe et al. pointed out numerous variances between their original studies and those of the NICE-SUGAR trial(2). They included differences in blood glucose targets, insulin administration, blood sampling, nutritional strategies, clinician expertise, and the relative accuracy of the glucose measurement devices. Recently, Clinical Chemistry presented a very interesting Q&A on the use of blood glucose meters to achieve tight glucose control in patients in the ICU(3). Because one of our ICUs participated in the NICE-SUGAR trial, we report here some interesting and relevant data that shed more light on the NICE-SUGAR trial, data that yield more questions than answers. In our 30-bed general systems ICU at the University of Alberta Hospital, point-of-care glucose concentrations can be measured in 2 different ways: respiratory therapists measure arterial blood gases, hemoglobin, electrolytes, and glucose values with the Radiometer 800 blood gas system (BGA) and nurses measure arterial blood and …

Background Nurses are the primary activators of the medical emergency team (MET). Although the MET system can empower nurses to seek help in managing acutely ill patients, few data on nurses' beliefs about the system are available. Objective To evaluate nurses' beliefs and behaviors about the MET system. Methods Nurses from a large academic hospital in Canada were surveyed (2 demography-related questions and 17 Likert-scale questions). Results Of 614 nurses employed on units participating in the MET system, 293 (47.7%) were approached and 275 completed the survey (response rate, 93.9%). Most respondents (84.2%) believed that the MET could prevent cardiopulmonary arrest in acutely ill patients, and 94% believed that the MET allowed them to seek help for patients they were worried about. Most nurses (75.9%) would call the responsible physician before activating the MET. Fifteen percent indicated reluctance to activate the MET because of fear of criticism, but only 2.2% considered the MET overused. Most (81.3%) believed that the MET did not increase their workload, and 91.3% did not believe that the MET reduced their skills. Forty-eight percent of nurses indicated that they would activate the MET for a patient they were worried about, even if the patient had normal vital signs. Conclusion Nurses value the MET system. Nurses believe that the MET can help them care for acutely ill patients and improve outcomes. However, barriers to MET activation exist, including a fear of criticism and an adherence to a more traditional model of first contacting the responsible physician before activating the MET.

Importance Metformin hydrochloride use is increasing in children and adolescents. Previous meta-analyses have identified a large variability in the effects of metformin use on body mass index changes but have not considered height changes as a confounder, to our knowledge. Objective To conduct a systematic review and meta-analysis of the effects of metformin use on height in children and adolescents. Data Sources Computerized databases, including MEDLINE and EMBASE, were searched up to September 9, 2014, for terms related to metformin and childhood or adolescence. Study Selection Randomized clinical trials examining the effects of metformin use on height of participants younger than 19 years were considered eligible. Trials with cointerventions other than lifestyle changes were excluded. Data Extraction and Synthesis Height, weight, body mass index, age, sex, metformin dosage, and study duration were independently extracted by 2 reviewers. The weighted mean differences for changes in height, weight, and body mass index were compared between the metformin and control groups using random-effects models. Main Outcome and Measure Height changes. Results Ten studies were included, with a total of 562 participants, 330 (58.7%) of whom were female. The mean age within the studies ranged from 7.9 to 16.1 years, with a high variability in most studies. The duration of metformin interventions lasted from 3 to 48 months. Overall, height changes were not significantly different between the metformin and control groups. However, stratified analyses according to the cumulative metformin dose (in milligrams per day times the number of days of treatment) showed a greater increase in height with metformin use in the 5 studies providing the largest cumulative metformin doses (weighted mean difference, 1.0; 95% CI, 0.0 to 2.0 cm) but not in the 5 studies providing the lowest doses (weighted mean difference, −0.1; 95% CI, −0.7 to 1.0 cm) compared with the control group. Conclusions and Relevance Preliminary evidence suggests a dose-response relationship between metformin use and increases in height in children and adolescents compared with a control group. While an approximate 1-cm increase in height may appear small, it is likely underestimated given that many studies were of short duration and included older adolescents, potentially after epiphyseal growth plate closure.

Aim. This paper reports a systematic review of the effectiveness of interventions for fathers with infants or toddlers. Background. Nurses and other healthcare professionals work closely with families of infants and young children. This contact provides an opportunity to promote positive parent–child interactions and optimal child development. Previous research has demonstrated that interventions with mothers of infants can be effective in promoting sensitive, responsive parent–child interactions and positive child development. Recent research has indicated that fathers also contribute to child development, but little is known about what types of interventions with fathers are effective in promoting sensitive, responsive father–child interactions. Methods. Literature from 1983 to 2003 in the Medline, CINAHL, and PsycINFO databases was searched to locate intervention studies published in English that included a control group or used a pretest and post-test design; measured an aspect of father–child interaction; analysed father outcomes separately from mother outcomes; had a sample greater than one; and included infants or toddlers. Additional studies were located by cross-checking reference lists. Results. Fourteen papers describing 12 interventions met the inclusion criteria. The interventions included infant massage, observation and modelling of behaviour with infant, kangaroo care, participation with child in a preschool programme, discussion groups, and parent training programmes. Conclusion. Although the number of intervention studies is limited, there is evidence that, if interventions involve active participation with or observation of the father's own child, the intervention may be effective in enhancing the father's interactions with the child and a positive perception of the child. There is less information on how interventions influence child development. More research is needed to determine the influence of interventions over time, the differential influence on mothers and fathers, and the optimal dose of intervention required.

Purpose: To describe nursing education research literature in terms of quality, content areas under investigation, geographic location of the research, research designs utilized, sample sizes, instruments used to collect data, and funding sources.Design and Methods: Quantitative and qualitative research literature published between January 1991 and December 2000 were identified and classified using an author-generated Relevance Tool.Findings: 1286 articles were accepted and entered into the inventory, and an additional 22 were retained as references as they were either literature reviews or meta-analyses. Not surprisingly, 90% of nursing education research was generated in North America and Europe, the industrialised parts of the world. Of the total number of articles accepted into the inventory, 61% were quantitative research based. The bulk of the research was conducted within the confines of a course or within a program, with more than half based in educational settings. Sample sizes of the research conducted were diverse, with a bare majority using a sample between 50 and 99 participants. More than half of the studies used questionnaires to obtain data. Surprising, 80% of the research represented in these articles was not funded. The number of publications of nursing education research generated yearly stabilised at approximately 120 per year.Conclusion: Research programs on teaching and learning environments and practice in nursing education need to be developed. Lobbying is needed to increase funding for this type of research at national and international levels.

In many critical care units, extended orientation or education programs have been offered to prepare the registered nurse to work in this specialty area. Current shortages of nurses and less experienced nurses applying for critical care positions have augmented the need for educational programs. In the Edmonton region, a partnership between two public institutions led to the development and implementation of an innovative educational program. In this article, we describe challenges and strategies to prepare critical care nurses to integrate knowledge, and meet the standards and expectations of both partners. In particular, methods are described to achieve theoretical and clinical outcomes. This article contributes to the discussion and implementation to offer knowledge and skill acquisition for a novice critical care nurse.

1. Tell us about your current position. As Public Services Manager at the John W. Scott Health Sciences Library, University of Alberta (U of A), I am responsible for ensuring that the circulation and reference services provided at our integrated Service Desk and the reference service provided at our satellite location in the Edmonton Clinic Health Academy meet the needs of our users and are in line with system-wide policies and procedures. In this role, I supervise five Public Service Assistants and coordinate the public service activities of nine librarians and two other nonprofessional staff. I participate in the U of A Libraries’ Public Service Council, which is comprised of the Public Services Managers from each unit library as well as other key personnel with duties essential to Public Service. We meet bi-weekly to discuss public service policies and issues and to coordinate upcoming changes to public service policies and procedures. In addition to my duties as Public Services Manager, I have liaison responsibility for the Faculty of Nursing and interim responsibility for the Faculty of Physical Education and Recreation. As liaison, I am responsible for collection management as well as coordinating information literacy sessions for these faculties. I also consult with students and faculty on a regular basis when they need assistance with literature searches or other library-related matters. As is the case with many health sciences libraries, I am frequently called upon to work with systematic review teams. In some cases, this involves one or two consultations to assist in developing a search strategy, but in other cases, it involves full membership on the systematic review team. In these cases, I am responsible for developing and executing the search, advising on citation management, and providing the details of the search methodology for the final publication.