PubMed Baby Friendly

Knowledge of, and attitudes to giving expressed breastmilk to infants in rural coastal Kenya; focus group discussions of first time mothers and their advisers.

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Knowledge of, and attitudes to giving expressed breastmilk to infants in rural coastal Kenya; focus group discussions of first time mothers and their advisers.

Int Breastfeed J. 2018;13:16

Authors: Talbert AW, Tsofa B, Mumbo E, Berkley JA, Mwangome M

Abstract
Background: The World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative step number five of the "Ten steps to successful breastfeeding" states "Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants." Urban mothers in Nairobi have low rates of exclusive breastfeeding after returning to work but there are no published data on rural Kenya mothers' infant feeding practices when working or schooling away from home.
Methods: We explored knowledge of, and attitudes to, the practice of giving expressed breastmilk in a mixed methods observational study of breastfeeding in rural Kenyan mothers. Fifty mothers with newborns, identified by nurses and community health workers, were asked questions about their experiences of breastfeeding and who they had sought or received advice from on breastfeeding. Focus group discussions, one with community health workers, and four each with mothers and their named advisers were held. Recordings were analyzed using a thematic framework approach.
Results: The main themes were: the baby's right to feed from the breast, lack of knowledge about expressing and giving breastmilk, negative attitudes towards expressed breastmilk, and traditional customs for disposing of expressed breast milk. Most participants did not have any experience of giving expressed breastmilk to infants. They described practices of expressing and discarding milk when the mother or baby was ill, to relieve discomfort from engorgement or after the baby had died.
Conclusions: Feeding expressed breastmilk to infants is a new concept in this context. Promotion of, and training in this practice would help mothers to maintain their milk supply when away from their babies and benefit the infants of working and schoolgirl mothers.

PMID: 29719563 [PubMed]

Molecular diagnostics for Chagas disease: up to date and novel methodologies.

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Molecular diagnostics for Chagas disease: up to date and novel methodologies.

Expert Rev Mol Diagn. 2017 Jul;17(7):699-710

Authors: Alonso-Padilla J, Gallego M, Schijman AG, Gascon J

Abstract
INTRODUCTION: Chagas disease is caused by the parasite Trypanosoma cruzi. It affects 7 million people, mainly in Latin America. Diagnosis is usually made serologically, but at some clinical scenarios serology cannot be used. Then, molecular detection is required for early detection of congenital transmission, treatment response follow up, and diagnosis of immune-suppression reactivation. However, present tests are technically demanding and require well-equipped laboratories which make them unfeasible in low-resources endemic regions. Areas covered: Available molecular tools for detection of T. cruzi DNA, paying particular attention to quantitative PCR protocols, and to the latest developments of user-friendly molecular diagnostic methodologies. Expert commentary: In the absence of appropriate biomarkers, molecular diagnosis is the only option for the assessment of treatment response. Besides, it is very useful for the early detection of acute infections, like congenital cases. Since current Chagas disease molecular tests are restricted to referential labs, research efforts must focus in the implementation of easy-to-use diagnostic tools in order to overcome the access to diagnosis gap.

PMID: 28582629 [PubMed - indexed for MEDLINE]

Analyzing Factors That Impact Breastfeeding Duration in the Postpartum Period: A Secondary Analysis of PRAMS Data.

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Analyzing Factors That Impact Breastfeeding Duration in the Postpartum Period: A Secondary Analysis of PRAMS Data.

Breastfeed Med. 2018 Apr 30;:

Authors: Pounds L, Shostrom V

Abstract
BACKGROUND: Benefits of breastfeeding are well established. What is more, breastfeeding is associated with lower healthcare costs. More U.S. hospitals are adopting the World Health Organization's Ten Steps to Successful Breastfeeding; however, most hospitals fall short on key factors.
OBJECTIVE: To our knowledge, this project is the first of its kind to use national-level data and a complex statistical modeling approach to identify a more complete picture of the variables related to breastfeeding duration within the postpartum period.
METHODS: This secondary data analysis project used the Phase 7 Core PRAMS Research File (2012-2013) and the Standard Questions B1, B2, B3, and B4 variables in the statistical analysis. The outcome variable of interest was length of breastfeeding during the postpartum period. The postpartum period was defined as 8 weeks after delivery rather than the usual definition of 6 weeks to accommodate the way quit time is reported in the Pregnancy Risk Assessment Monitoring System (PRAMS) data. Univariate and multivariate analyses were conducted using PC SAS version 9.4.
RESULTS: The multivariate analysis indicates that many of the modifiable factors associated with quitting breastfeeding within the postpartum period are hospital related. This pilot study reinforces the importance of 7 of the 10 Steps.
CONCLUSIONS: These results underscore the importance of hospitals adopting evidence-based best practices for breastfeeding. The relationship found between Women, Infants, and Children receiving supplemental nutrition benefits and breastfeeding quit times requires further exploration. The study results also highlight the need to address modifiable factors that may be overlooked in traditional breastfeeding promotion efforts, such as depression and alcohol use.

PMID: 29708765 [PubMed - as supplied by publisher]

'We knew it was a totally at random thing': parents' experiences of being part of a neonatal trial.

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'We knew it was a totally at random thing': parents' experiences of being part of a neonatal trial.

Trials. 2017 Aug 01;18(1):361

Authors: Harvey M, Nongena P, Edwards D, Redshaw M

Abstract
BACKGROUND: Studies exploring parents' trial experiences generally relate to their understanding of the consent process and the development of researcher strategies to facilitate recruitment and retention. The aim was to better understand parents' experience of being part of a trial at the time and their perceptions of trial participation in retrospect.
METHODS: Data were collected in a number of ways: from recorded discussions between parents and clinicians about the MRI or ultrasound, in open-text responses to questionnaires and in qualitative interviews at 1 and 2 years after participation. Thematic analysis was undertaken using NVivo10.
RESULTS: Key themes identified were 'deciding to take part', with subthemes associated with 'benefitting self', 'benefitting others' and 'being prepared'; 'the randomisation process' with subthemes relating to 'acceptance' and 'understanding' and 'actual engagement' with subthemes of 'practicalities' and 'care from responsive staff'.
CONCLUSION: Parents' perspectives on the trial and the processes and information received reflect their understanding and experience of the trial and the value of parent-friendly information-giving about participation, randomisation and follow-up. The practical and logistical points raised confirm the key issues and parents' need for sensitive care and support in the course of a trial. Looking back, almost all parents were positive about their experience and felt that the family had benefitted from participation in the trial and follow-up studies, even when the developmental outcomes were poor.
TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT01049594. https://clinicaltrials.gov/ct2/show/NCT01049594 . Registered on 13 January 2010. EudraCT: EudraCT: 2009-011602-42. https://www.clinicaltrialsregister.eu/ .

PMID: 28764800 [PubMed - indexed for MEDLINE]

Characteristics and respiratory risk profile of children aged less than 5 years presenting to an urban, Aboriginal-friendly, comprehensive primary health practice in Australia.

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Characteristics and respiratory risk profile of children aged less than 5 years presenting to an urban, Aboriginal-friendly, comprehensive primary health practice in Australia.

J Paediatr Child Health. 2017 Jul;53(7):636-643

Authors: Hall KK, Chang AB, Anderson J, Dunbar M, Arnold D, O'Grady KF

Abstract
AIM: There are no published data on factors impacting on acute respiratory illness (ARI) among urban Indigenous children. We describe the characteristics and respiratory risk profile of young urban Indigenous children attending an Aboriginal-friendly primary health-care practice.
METHODS: We conducted a cross-sectional analysis of data collected at baseline in a cohort study investigating ARI in urban Indigenous children aged less than 5 years registered with an Aboriginal primary health-care service. Descriptive analyses of epidemiological, clinical, environmental and cultural factors were performed. Logistic regression was undertaken to examine associations between child characteristics and the presence of ARI at baseline.
RESULTS: Between February 2013 and October 2015, 180 Indigenous children were enrolled; the median age was 18.4 months (7.7-35), 51% were male. A total of 40 (22%) children presented for a cough-related illness; however, ARI was identified in 33% of all children at the time of enrolment. A total of 72% of children were exposed to environmental tobacco smoke. ARI at baseline was associated with low birthweight (adjusted odds ratio (aOR) 2.54, 95% confidence interval (CI) 1.08-5.94), a history of eczema (aOR 2.67, 95% CI 1.00-7.15) and either having a family member from the Stolen Generation (aOR 3.47, 95% CI 1.33-9.03) or not knowing this family history (aOR 3.35, 95% CI 1.21-9.26).
CONCLUSIONS: We identified an urban community of children of high socio-economic disadvantage and who have excessive exposure to environmental tobacco smoke. Connection to the Stolen Generation or not knowing the family history may be directly impacting on child health in this community. Further research is needed to understand the relationship between cultural factors and ARI.

PMID: 28436124 [PubMed - indexed for MEDLINE]

Beyond BFHI: The Spatz 10-Step and Breastfeeding Resource Nurse Model to Improve Human Milk and Breastfeeding Outcomes.

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Beyond BFHI: The Spatz 10-Step and Breastfeeding Resource Nurse Model to Improve Human Milk and Breastfeeding Outcomes.

J Perinat Neonatal Nurs. 2018 Apr/Jun;32(2):164-174

Authors: Spatz DL

Abstract
A report released by the World Health Organization states that worldwide less than 10% of birth occur in hospitals certified through the Baby-Friendly Hospital Initiative. Furthermore, the Baby-Friendly Hospital Initiative's primary focus is on breastfeeding for healthy, mother-infant dyads. This article provides alternative models for implementing evidence-based care during maternal-infant separation so that mothers can achieve their personal breastfeeding goals. These include the Spatz 10-step model for human milk and breastfeeding in vulnerable infants and the Breastfeeding Resource Nurse model. Clinical outcome data are provided to demonstrate the effectiveness of the models as well as a road map of strategies to implement the models and measure outcomes.

PMID: 29689018 [PubMed - in process]

Baby-Friendly as a Regional Collaborative Quality Improvement Project in an Academic Medical Center Environment.

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Baby-Friendly as a Regional Collaborative Quality Improvement Project in an Academic Medical Center Environment.

J Perinat Neonatal Nurs. 2018 Apr/Jun;32(2):136-143

Authors: Krauss MJ, Sharp M

Abstract
In 2012, the state of South Carolina lacked any Baby-Friendly designated hospitals. The Medical University of South Carolina had a strong lactation service since 2002 but continued to struggle with improving breastfeeding rates. The Baby-Friendly Hospital Initiative was the catalyst to increase breastfeeding rates at this academic medical center. In 2012, membership in the Best Fed Beginnings Learning Collaborative heightened awareness of the importance of interdisciplinary collaboration. Participation in the regional collaborative provided evidence-based breastfeeding education and best clinical practices that supported the maternal-infant dyad. These improved practices are achieved by implementation of the Ten Steps to Successful Breastfeeding. The collaborative model accelerated change, and the goals to reach 80% of each metric were met. The exclusive breastfeeding rate increased by 30%. As a result of swiftly achieving designation, the institution was then able to focus on sustainability issues and efforts to expand breastfeeding support into the community. The purpose of this article is to review one hospital's journey while providing guidance to other organizations undergoing the process of becoming Baby-Friendly. The invaluable membership in the Best Fed Beginnings Learning Collaborative quality improvement initiative proved to be a major incentive and source of support in efficiently achieving Baby-Friendly status.

PMID: 29689014 [PubMed - in process]

Incorporating "Father-Friendly" Breastfeeding Language in Maternity Settings.

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Incorporating "Father-Friendly" Breastfeeding Language in Maternity Settings.

J Perinat Neonatal Nurs. 2018 Apr/Jun;32(2):112-115

Authors: Johnston JT

Abstract
The purpose of this commentary is to provide perinatal providers with the tools they need to incorporate fathers into the breastfeeding relationship. Research shows that engaged fathers increase initiation rates, decrease the rate of breastfeeding complications that lead to premature cessation, and increase the duration and exclusivity of a mother's breastfeeding efforts. Despite this evidence, studies frequently show that fathers report being ignored or excluded from breastfeeding education. This is likely an oversight on the behalf of perinatal providers rather than a conscious effort. Ultimately, however, perinatal providers need to be prepared to address the concerns of all parents who will provide care to the infant and not the mother alone. This commentary discusses the value of fathers as breastfeeding supporters and offers evidence-based teaching strategies requested by fathers. This commentary also identifies and describes 4 father-friendly breastfeeding promotion resources and highlights the techniques used to draw fathers into the mother's breastfeeding efforts.

PMID: 29689012 [PubMed - in process]

Live Birth after Rescue In vitro Maturation-intracytoplasmic Sperm Injection in Type 1 Diabetes, Polycystic Ovary Syndrome Patient Using Clomiphene-antagonist Protocol.

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Live Birth after Rescue In vitro Maturation-intracytoplasmic Sperm Injection in Type 1 Diabetes, Polycystic Ovary Syndrome Patient Using Clomiphene-antagonist Protocol.

J Hum Reprod Sci. 2018 Jan-Mar;11(1):75-78

Authors: Sankari S, Elanchezhian M, Selvamani D, Nagarajan M, Gopikrishnan D

Abstract
Infertility in patients with polycystic ovary syndrome (PCOS) associated with diabetes leads to challenging situations seeking alternative treatments. In vitro maturation (IVM) followed by intracytoplasmic sperm injection (ICSI) could overcome the challenges with promising pregnancies in such patients. In the treatment of a 32-year-old diabetic woman who also had PCOS, single immature oocyte was retrieved. Rescue IVM followed by ICSI yielded a grade 1 day 3 embryo which on transferring resulted in pregnancy and a healthy infant was delivered. Rescue IVM-ICSI could help in achieving pregnancy and live birth. Stimulation involving clomiphene and gonadotropin-releasing hormone antagonist is an effective and patient-friendly protocol for women with PCOS and diabetes and also for poor responders.

PMID: 29681720 [PubMed]

Retrieval and clinical analysis of distraction-based dual growing rod constructs for early-onset scoliosis.

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Retrieval and clinical analysis of distraction-based dual growing rod constructs for early-onset scoliosis.

Spine J. 2017 Oct;17(10):1506-1518

Authors: Hill G, Nagaraja S, Akbarnia BA, Pawelek J, Sponseller P, Sturm P, Emans J, Growing Spine Study Group, Bonangelino P, Cockrum J, Kane W, Dreher M

Abstract
BACKGROUND CONTEXT: Growing rod constructs are an important contribution for treating patients with early-onset scoliosis. These devices experience high failure rates, including rod fractures.
PURPOSE: The objective of this study was to identify the failure mechanism of retrieved growing rods, and to identify differences between patients with failed and intact constructs.
STUDY DESIGN/SETTING: Growing rod patients who had implant removal and were previously enrolled in a multicenter registry were eligible for this study.
PATIENT SAMPLE: Forty dual-rod constructs were retrieved from 36 patients across four centers, and 34 of those constructs met the inclusion criteria. Eighteen constructs failed due to rod fracture. Sixteen intact constructs were removed due to final fusion (n=7), implant exchange (n=5), infection (n=2), or implant prominence (n=2).
OUTCOME MEASURES: Analyses of clinical registry data, radiographs, and retrievals were the outcome measures.
METHODS: Retrievals were analyzed with microscopic imaging (optical and scanning electron microscopy) for areas of mechanical failure, damage, and corrosion. Failure analyses were conducted on the fracture surfaces to identify failure mechanism(s). Statistical analyses were performed to determine significant differences between the failed and intact groups.
RESULTS: The failed rods fractured due to bending fatigue under flexion motion. Construct configuration and loading dictate high bending stresses at three distinct locations along the construct: (1) mid-construct, (2) adjacent to the tandem connector, or (3) adjacent to the distal anchor foundation. In addition, high torques used to insert set screws may create an initiation point for fatigue. Syndromic scoliosis, prior rod fractures, increase in patient weight, and rigid constructs consisting of tandem connectors and multiple crosslinks were associated with failure.
CONCLUSION: This is the first study to examine retrieved, failed growing rod implants across multiple centers. Our analysis found that rod fractures are due to bending fatigue, and that stress concentrations play an important role in rod fractures. Recommendations are made on surgical techniques, such as the use of torque-limiting wrenches or not exceeding the prescribed torques. Additional recommendations include frequent rod replacement in select patients during scheduled surgeries.

PMID: 28456673 [PubMed - indexed for MEDLINE]

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