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Problem Too much or too little gestational weight gain (GWG) can negatively impact maternal and fetal health, according to Institute of Medicine Guidelines. Background Health care providers are key players in providing reliable evidence-informed prenatal advice related to appropriate GWG. However, there appears to be inconsistent GWG communication among healthcare providers during prenatal care. Aim To determine pregnant women and new mothers’ perceptions of healthcare provider GWG and dietary counselling during the pregnancy period. Methods A reliable and validated cross-sectional electronic survey was administered to currently pregnant women and women who had recently given birth. The web-based questionnaire was self-administered and took 10–25 min. Findings A total of 1507 eligible women participated in the survey. More than half (57%) reported that their healthcare provider talked to them about personal weight gain limits. Of these participants, about a third (34%) of participants were counselled regularly at each or most visits. Among the women that were not counselled on personal GWG limits, over half (56%) reported that healthcare provider guidance would have been helpful to achieve their target weight. Less than half (45%) of participants reported that their healthcare providers discussed dietary requirements or changes in pregnancy. Discussion These findings highlight areas for improvement in prenatal dialogue, which can support better outcomes for both mother and baby. Conclusion A better understanding of pregnant and mothers’ perceptions about weight and diet counselling is needed to understand what may need greater attention and clarification and to improve such dialogue.

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.

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).

Importance Gestational weight gain (GWG) is an independent and modifiable factor for a healthy pregnancy. Gestational weight gain above or below the Institute of Medicine Guidelines has been shown to impact both maternal and fetal health (eg, gestational diabetes, hypertension, downstream obesity). Healthcare providers (HCPs) have the potential to be reliable sources of evidence-based weight information and advice during pregnancy. Objective The aim of this study was to summarize the literature assessing GWG discussions between patients and their HCPs in a clinical setting to better understand the knowledge that is currently being exchanged. Evidence Acquisition A literature review was conducted by searching Ovid Medline, CINAHL, and Embase databases. All relevant primary research articles in English that assessed GWG discussions were included, whereas intervention studies were excluded. Results A total of 54 articles were included in this review. Although the overall prevalence and content of GWG counseling varied between studies, counseling was often infrequent and inaccurate. Healthcare providers tended to focus more on women experiencing obesity and excessive GWG, as opposed to the other body mass index categories or inadequate GWG. Women of higher socioeconomic status, older age, nulliparous, history of dieting, low physical activity, and those categorized as overweight/obese were more likely to receive GWG advice. Patients also reported receiving conflicting facts between different HCP disciplines. Conclusions The evidence regarding GWG counseling in prenatal care remains variable, with discrepancies between geographic regions, patient populations, and HCP disciplines. Relevance Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.

Purpose To discuss general legal considerations for non-US private equity sponsors who seek to market their funds to US institutional investors. Design/methodology/approach Explains relevant aspects of US securities laws, commodity exchange laws, pension and employee benefit plan laws, federal income tax laws, and the Foreign Account Tax Compliance Act (FATCA). Findings The evolving US regulatory regime necessitates careful planning and thorough knowledge of relevant laws and regulations to effect a successful US marketing effort. Originality/value Practical guidance from experienced investment funds and tax lawyers.

Introduction Gestational weight gain (GWG) outside of the 2009 Institute of Medicine guidelines may be harmful to women and their fetuses. Prenatal health care providers (HCPs) are important sources of health information, but not all discuss GWG with their patients. The Canadian Obesity Network's 5As (ask, assess, advise, agree, and assist) of Healthy Pregnancy Weight Gain (5As) is a tool developed to help HCPs counsel their patients on GWG. The main objective of this study was to evaluate the impact of the 5As tool on patient perceptions of GWG discussions with their HCP and to identify suggestions to improve the tool. Methods A quasiexperimental study design was conducted whereby HCPs were trained in using the 5As tool (intervention). Patients were then queried at baseline and postintervention using an electronic questionnaire measuring patient-perceived 5As counseling. Inclusion criteria for pregnant women were (1) currently attending their first appointment with participating HCPs, (2) English-speaking, and (3) over 18 years of age. Results One hundred pregnant women (50 baseline, 50 postintervention) and 15 HCPs (11 midwives, 4 obstetricians) participated. Participants receiving care from 5As-trained HCPs reported scores twice as high (P = .047) in being asked about and were approximately 3 times more likely to be advised an exact amount of target weight gain (P = .03). HCPs suggested improving patient handouts and HCP education on GWG guidelines as well as reducing the content presented in the 5As tool. Discussion The 5As Tool is effective at initiating HCP-mediated GWG counseling; further research is needed to examine the usefulness of the 5As in clinical practice throughout the length of a full pregnancy. Whether the uptake of the 5As tool contributes to prenatal behavior change remains to be established. Future steps include modifying the tool based on HCP feedback, the development of novel knowledge translation tools, and improved HCP and patient education.

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 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.

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 and attitude data gathered as part of a comprehensive study of the Highfields program of treatment of juvenile offenders were used to design a prediction table. The table is used on a sample of boys from Highfields and a matched sample drawn from a typical juvenile institution. The comparison of the samples shows that Highfields has a higher success rate at lower financial cost.

A RE broken homes' a factor in juvenile delinquency? This question the writers attempted to answer in Spokane, Washington, using as a basis of analysis the records of the delinquents who had appeared before the Spokane County Juvenile Court in 1937. It is recognized that broken homes alone do not cause delinquency, as behavior is a product of the total situation. But how close an association is there between delinquency and broken homes when certain other factors are held constant? Clifford R. Shaw and Henry D. McKay attempted to find an answer to this question in Chicago on the basis of data gathered from twenty-nine public schools and from the Cook County Court records.2 To many students of juvenile delinquency the lack of association found in Chicago between delinquency rates and broken home rates came as rather a shock.3 It had been generally accepted by laymen as well as by students in the field that broken homes were a causative factor in juvenile delinquency. Practically every study of delinquents or adult criminals had shown a high percentage of cases from broken homes.4 In addition, many case histories point to the broken home as a v'ery important factor in the child's maladjustment because of his lack of security.5 Specialists in child psychology and psychiatrists have also designated the broken home as an important conditioning factor in delinquent behavior.6 In the face of so much emphasis upon broken homes as a factor in case histories and in statistical studies, it seems surprising that Shaw and McKay should find such a low correlation (.I9, with a probable error of ? t. iL) between broken home rates and rates of juvenile delinquency. Moreover, it was found in Chicago that broken homes were unrelated to geographic location in the city. According to this analysis, the "differences in broken

The data for this study were tabulated from questionnaires submitted to the students attending all the secondary schools in Spokane, Washington. There were on hand from a prior study, 5,811 questionnaires filled in by the students attending the public secondary schools in this city. A test of the coverage of this sample showed that 92.5 percent of the students in average daily attendance at the public high schools had filled in the questionnaire. To this sample of 5,811 were added 737 questionnaires filled in during the fall of 1939 by the students of high school level in the three Spokane parochial schools.2 An attempt was made to eliminate duplications incurred by questionnaires which were marked by two or more members of the same family. This was difficult to do, inasmuch as each questionnaire was filled out anonymously. Some duplication was eliminated, however, by a comparison of street addresses and certain other information.8 After this procedure there were 6,475 u'sable questionnaires for this study. It is believed that these schedules furnish information which is fairly representative of all Spokane families with children old enough to be in the secondary schools. The United States Census shows that a very high proportion of the population of school age in this city (95.6 percent) attends school through the seventeenth year.4 This study deals with the responses to the following three series of questions: (1) Do your own mother and father live together? If not, are they divorced? living apart without divorce? mother dead? father dead? (2) Where does your father work? What does he do? (3) What is your father's religion? What is your mother's religion? The 6,475 questionnaires were first hand-sorted for tabulation of the first series of questions, and then classified by father's occupation. Alba Edwards' classification of social-economic groups was used for this purpose.5 Finally, each of these occupational groups was sorted by the responses to the questions on parents' religious affiliations. These responses were classified broadly into the following categories: non-Catholic, Catholic, Mixed, No Religion, and No Information.6 The following rather arbitrary definitions were used to determine the religious classification: (1) non-Catholic-both parents affiliated with some religious group other than Catholic.7 (2) Catholic -both parents designated as Catholic; (3) Mixed

T HIS IS A report of an attempt to predict juvenile delinquency. It examines the feasibility of setting up prognostic tables to indicate the probabilities of juveniles' becoming delinquent when certain social factors are present in their backgrounds; and suggests uses to which such tables might be put. If it is possible to construct tables which indicate the probabilities of success or failure on parole, or of success or failure in marriage, there seems to be no logical reason why the same procedure cannot be used to indicate the probabilities of delinquency. As the term is used in this study, a delinquent is any male between the ages of seven and eighteen years who has appeared before a juvenile court. A non-delinquent, on the other hand, is any male who has not appeared before a juvenile court.' Source of Data. This study, except for the retest by the second sample, is based on information concerning the 420 males who appeared before the Spokane County Juvenile Court during 1937, and on a comparable group of male non-delinquents picked at random from the public secondary schools of the city of Spokane.

HE broken home generally has been assumed to be associated with juvenile delinquency. Since i9I2, when Breckinridge and Abbott published The Delinquent Child and the Home,' virtually all studies of delinquents or adult criminals have found a high percentage of cases from broken homes.2 Case histories, as well as statistical studies, point to the broken home as an important factor in personality maladjustment.' Psychiatrists have considered abnormal home environments, including the broken home, to be important conditioning factors in delinquent behavior.4 Not only have high percentages of broken homes been found in a delinquent population, but higher percentages of broken homes have been generally shown to exist among the female cases than among the male cases.6 Various attempts have been made to explain this disparity. Such attempts have resulted in devious and complex discussions which have not clarified the question. Inferences have been largely guesses on the basis of assumed differences between the sexes. T. Earl Sullenger, for example, suggests that the reason the broken home rate of girls is higher than that of boys is obvious and is due to the fact that "the girl's life is more closely related to the