This study evaluated the efficacy of breastfeeding support provided by trained clinicians during an early routine preventive visit. The study involved 226 mother-infant pairs who were randomized to an intervention group that received an additional preventive visit within 2 weeks postpartum or a control group that received usual care. The intervention group had higher rates of exclusive breastfeeding at 4 weeks and longer breastfeeding duration. The intervention group also reported fewer breastfeeding difficulties. The study provides preliminary evidence that breastfeeding support during an early routine preventive visit can improve breastfeeding outcomes.
The Effects Of Early Pacifier Use On Breastfeeding DurationBiblioteca Virtual
This study examined the effects of pacifier use on breastfeeding duration in a cohort of 265 breastfeeding mother-infant dyads in the United States. The researchers found that:
1) Pacifier introduction by 6 weeks was associated with a 53% increased risk of shortened duration of full breastfeeding and a 61% increased risk of shortened overall breastfeeding duration.
2) Mothers who introduced pacifiers tended to breastfeed less frequently, with statistically significant differences at 2 and 12 weeks.
3) At 12 weeks, mothers using pacifiers were more likely to report breastfeeding being inconvenient and having insufficient milk supply.
4) Pacifier use begun before 2 weeks or 6 weeks was not significantly associated
Health System Factors Contributing To Breastfeeding SuccessBiblioteca Virtual
This study examined factors contributing to breastfeeding success in 522 women at five hospitals. The researchers found that 76% of mothers breastfed successfully for as long as planned. Higher education, positive ratings of hospital support, and home nurse support were associated with breastfeeding success. Mothers most often contacted family/friends for breastfeeding concerns rather than medical providers after discharge. The study suggests health system support during and after hospitalization impacts breastfeeding outcomes.
The Timing And Predictors Of The Early Termination Of BreastfeedingBiblioteca Virtual
This study examined the early termination of breastfeeding among low-income mothers enrolled in the Women, Infants, and Children (WIC) program. The researchers found that over 70% of mothers stopped breastfeeding within the first 2 months. Through interviews, the researchers identified a lack of confidence in continuing to breastfeed at 2 months and a belief that the baby prefers formula as predictors of stopping breastfeeding within the first 2 weeks. The results suggest interventions should focus on boosting mothers' confidence in breastfeeding rather than only providing information.
Randomized, Controlled Trial Of A Prenatal And Postnatal Lactation ConsultantBiblioteca Virtual
This randomized controlled trial evaluated the effectiveness of a prenatal and postnatal lactation consultant intervention on the duration and intensity of breastfeeding up to 12 months. Over 300 low-income women receiving prenatal care at two community health centers were randomly assigned to an intervention or control group. The intervention group received individualized support from lactation consultants including prenatal meetings, a postpartum hospital visit, and home visits/phone calls. The trial found the intervention group was more likely to breastfeed through 20 weeks and had higher breastfeeding intensity scores at 13 and 52 weeks compared to the control group. US-born women in the control group had the lowest breastfeeding intensity. The study concluded the "best-practices" lactation
Do Baby Friendly Hospitals Influence Breastfeeding Duration On ABiblioteca Virtual
This study examined the influence of Baby-Friendly Hospital Initiative (BFHI) compliance on breastfeeding rates and duration in Switzerland. The authors conducted a national survey in 2003 of over 2800 mothers who had given birth in the previous 9 months. They collected data on breastfeeding practices and the hospital of delivery. They found that infants born in hospitals with high BFHI compliance had significantly longer durations of exclusive, full, and any breastfeeding compared to other hospitals, even after controlling for other factors. This supports the hypothesis that increased BFHI implementation in Switzerland has contributed to improved national breastfeeding outcomes since 1994. However, the authors note mothers choosing BFHI hospitals may also breastfeed longer regardless of the hospital practices.
This document summarizes a research study that evaluated the effectiveness and cost-effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding mothers in primary care settings in Scotland. The study was a cluster randomized controlled trial that compared breastfeeding outcomes in localities that established new breastfeeding groups to those that did not change existing group activities. The primary outcome was the percentage of infants receiving any breastfeeding at 6-8 weeks. Secondary outcomes included breastfeeding rates at birth, 5-7 days, and 8-9 months as well as maternal satisfaction. The results found no significant differences in breastfeeding rates between the intervention and control localities at 6-8 weeks.
Hospital Practices And Womens Likelihood Of Fulfilling Their Intention To Exc...Biblioteca Virtual
This study examined the relationship between hospital practices and mothers' ability to exclusively breastfeed according to their intentions. The researchers analyzed data from a national survey of over 1500 mothers who gave birth in 2005. They found that primiparas (first time mothers) reported a substantial gap between their intention to exclusively breastfeed (70%) and actually doing so at 1 week postpartum (50%). Primiparas reported hospital practices like supplementation (49%) and pacifier use (45%) that conflict with the Baby-Friendly Hospital Initiative's Ten Steps. Primiparas who delivered at hospitals implementing 6-7 of the Ten Steps were 6 times more likely to achieve their exclusive breastfeeding intention compared to those at hospitals implementing 0-
The Effects Of Early Pacifier Use On Breastfeeding DurationBiblioteca Virtual
This study examined the effects of pacifier use on breastfeeding duration in a cohort of 265 breastfeeding mother-infant dyads in the United States. The researchers found that:
1) Pacifier introduction by 6 weeks was associated with a 53% increased risk of shortened duration of full breastfeeding and a 61% increased risk of shortened overall breastfeeding duration.
2) Mothers who introduced pacifiers tended to breastfeed less frequently, with statistically significant differences at 2 and 12 weeks.
3) At 12 weeks, mothers using pacifiers were more likely to report breastfeeding being inconvenient and having insufficient milk supply.
4) Pacifier use begun before 2 weeks or 6 weeks was not significantly associated
Health System Factors Contributing To Breastfeeding SuccessBiblioteca Virtual
This study examined factors contributing to breastfeeding success in 522 women at five hospitals. The researchers found that 76% of mothers breastfed successfully for as long as planned. Higher education, positive ratings of hospital support, and home nurse support were associated with breastfeeding success. Mothers most often contacted family/friends for breastfeeding concerns rather than medical providers after discharge. The study suggests health system support during and after hospitalization impacts breastfeeding outcomes.
The Timing And Predictors Of The Early Termination Of BreastfeedingBiblioteca Virtual
This study examined the early termination of breastfeeding among low-income mothers enrolled in the Women, Infants, and Children (WIC) program. The researchers found that over 70% of mothers stopped breastfeeding within the first 2 months. Through interviews, the researchers identified a lack of confidence in continuing to breastfeed at 2 months and a belief that the baby prefers formula as predictors of stopping breastfeeding within the first 2 weeks. The results suggest interventions should focus on boosting mothers' confidence in breastfeeding rather than only providing information.
Randomized, Controlled Trial Of A Prenatal And Postnatal Lactation ConsultantBiblioteca Virtual
This randomized controlled trial evaluated the effectiveness of a prenatal and postnatal lactation consultant intervention on the duration and intensity of breastfeeding up to 12 months. Over 300 low-income women receiving prenatal care at two community health centers were randomly assigned to an intervention or control group. The intervention group received individualized support from lactation consultants including prenatal meetings, a postpartum hospital visit, and home visits/phone calls. The trial found the intervention group was more likely to breastfeed through 20 weeks and had higher breastfeeding intensity scores at 13 and 52 weeks compared to the control group. US-born women in the control group had the lowest breastfeeding intensity. The study concluded the "best-practices" lactation
Do Baby Friendly Hospitals Influence Breastfeeding Duration On ABiblioteca Virtual
This study examined the influence of Baby-Friendly Hospital Initiative (BFHI) compliance on breastfeeding rates and duration in Switzerland. The authors conducted a national survey in 2003 of over 2800 mothers who had given birth in the previous 9 months. They collected data on breastfeeding practices and the hospital of delivery. They found that infants born in hospitals with high BFHI compliance had significantly longer durations of exclusive, full, and any breastfeeding compared to other hospitals, even after controlling for other factors. This supports the hypothesis that increased BFHI implementation in Switzerland has contributed to improved national breastfeeding outcomes since 1994. However, the authors note mothers choosing BFHI hospitals may also breastfeed longer regardless of the hospital practices.
This document summarizes a research study that evaluated the effectiveness and cost-effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding mothers in primary care settings in Scotland. The study was a cluster randomized controlled trial that compared breastfeeding outcomes in localities that established new breastfeeding groups to those that did not change existing group activities. The primary outcome was the percentage of infants receiving any breastfeeding at 6-8 weeks. Secondary outcomes included breastfeeding rates at birth, 5-7 days, and 8-9 months as well as maternal satisfaction. The results found no significant differences in breastfeeding rates between the intervention and control localities at 6-8 weeks.
Hospital Practices And Womens Likelihood Of Fulfilling Their Intention To Exc...Biblioteca Virtual
This study examined the relationship between hospital practices and mothers' ability to exclusively breastfeed according to their intentions. The researchers analyzed data from a national survey of over 1500 mothers who gave birth in 2005. They found that primiparas (first time mothers) reported a substantial gap between their intention to exclusively breastfeed (70%) and actually doing so at 1 week postpartum (50%). Primiparas reported hospital practices like supplementation (49%) and pacifier use (45%) that conflict with the Baby-Friendly Hospital Initiative's Ten Steps. Primiparas who delivered at hospitals implementing 6-7 of the Ten Steps were 6 times more likely to achieve their exclusive breastfeeding intention compared to those at hospitals implementing 0-
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
Mothers And Clinicians Perspectives On Breastfeeding Counseling During Routin...Biblioteca Virtual
This document summarizes a study examining breastfeeding counseling provided during routine preventive visits from the perspectives of both mothers and their clinicians. The study involved surveying 429 mother-newborn pairs and their 121 obstetric and pediatric clinicians. The results identified several areas of disagreement between what mothers reported discussing with clinicians regarding breastfeeding duration, continuation after returning to work, and specific advice provided, highlighting potential unintentional gaps in communication around breastfeeding counseling during routine visits.
Breastfeeding Practices of Postnatal Mothers: Exclusivity, Frequency and Dura...IJEAB
This study examined breastfeeding practices of 299 postnatal mothers in southeast Nigeria in terms of exclusivity, frequency, and duration. The results showed that most mothers exclusively breastfed for a short period, with 22.3% exclusively breastfeeding for 1 month and 31.5% for 4-6 months. The majority (80.7%) breastfed infants on demand day and night, while 40.5% reported infants suckling for over 20 minutes. Breastfeeding patterns were found to differ across primary, secondary, and tertiary health institutions, though not significantly. The study concluded that efforts are needed to motivate mothers to exclusively breastfeed for the recommended 6 months.
The document discusses best practices and medical options for labor and delivery, including facilities like hospitals, birthing centers, and home births; care providers such as doctors, midwives, and doulas; pain management options involving natural techniques or drug-induced methods; birthing positions on hands and knees, squatting, or using an exercise ball; and monitoring and interventions during each stage of labor.
Antenatal Peer Support Workers And Initiation Of Breast Feeding Cluster Rando...Biblioteca Virtual
This study assessed the effectiveness of an antenatal peer support worker service on the initiation of breastfeeding. The study involved a cluster randomized controlled trial of 66 antenatal clinics and 2511 pregnant women in a deprived, multiethnic population in Birmingham, UK. Clinics were randomly assigned to receive the peer support worker intervention (n=1140) or standard antenatal care (n=1371). The primary outcome of breastfeeding initiation did not differ significantly between the intervention (69.0%) and control (68.1%) groups after adjusting for clustering. Ethnicity, parity and mode of delivery predicted initiation, but the peer support worker intervention did not increase initiation rates.
Effect Of An Educational Intervention About Breastfeeding On The Knowledge,Biblioteca Virtual
This study evaluated the impact of an educational intervention on pediatric residents' knowledge, confidence, and clinical behaviors regarding breastfeeding. The residents completed pre- and post-intervention questionnaires to assess knowledge and confidence. Telephone interviews with breastfeeding mothers after clinic visits evaluated residents' clinical behaviors. The results showed that residents' knowledge scores increased significantly after the intervention. Their clinical behaviors when interacting with breastfeeding mothers also improved substantially. The educational intervention was effective in enhancing residents' support of breastfeeding patients.
This document summarizes a national survey of breastfeeding rates in US hospitals designated as "Baby-Friendly" in 2001. The survey found that Baby-Friendly hospitals had higher rates of breastfeeding initiation (83.8% vs national rate of 69.5%) and exclusive breastfeeding during hospital stay (78.4% vs national rate of 46.3%) compared to national averages. The 3 Steps to Successful Breastfeeding that were most difficult for hospitals to meet were paying for infant formula (Step 6), training staff (Step 2), and limiting formula marketing (Step 7). Overall, the results suggest that Baby-Friendly designation is associated with higher breastfeeding rates, regardless of hospital demographic factors.
Professor Soo Downe presenting at the Doctoral Midwifery Research Society Alcohol & Medication in Pregnancy Conferene about 'Which horse for which courses? The EBM Problem in studies of pharmacological substances in maternity care'.
Childbirth Connection works to improve maternity care quality through research and policy change. Their research shows significant variation and overuse of interventions in maternity care across regions and facilities. Their Transforming Maternity Care project identified reducing non-medically indicated deliveries before 39 weeks as a key priority. Quality improvement programs that strictly limited early elective deliveries improved outcomes and lowered costs without increasing risks.
This study examined predictors of breastfeeding duration in Australia by following 587 women from hospital discharge through 52 weeks postpartum. The researchers found that less than half of infants were receiving any breast milk at 6 months, and only 12% were exclusively breastfed. By 12 months, only 19.2% received any breast milk. Factors positively associated with longer breastfeeding duration included higher maternal infant feeding attitudes and negatively associated factors included breastfeeding difficulties in the first 4 weeks, maternal smoking, early pacifier introduction, and early return to work. Relatively few women achieved international breastfeeding recommendations.
Current point of view in preterm labor management in albania (2)Alexander Decker
This study examined the use of maintenance tocolysis therapy to prevent preterm labor in Albania. The study included 325 pregnant women between 28-32 weeks gestation hospitalized for preterm labor. Women received tocolysis therapy for over one month. Those between 28-30 weeks (n=200) had greater benefits, with pregnancy prolonged by 6-8 weeks on average. The authors conclude maintenance tocolysis therapy can considerably prolong pregnancy for women diagnosed with preterm labor between 28-32 weeks gestation, though larger studies are still needed.
Effect of instructional sessions on nurses' and doctors' knowledge and practi...Alexander Decker
This document summarizes a study that evaluated the effect of instructional sessions on nurses' and doctors' knowledge and practice of developmental care in the neonatal intensive care unit (NICU) in Abha City, Saudi Arabia. The study involved providing instructional sessions to 54 nurses and 12 doctors on developmental care approaches. Developmental care aims to optimize the NICU environment for preterm infants by reducing stress and supporting development. Assessments before and after the sessions found they improved both nurses' and doctors' knowledge of developmental care, and nurses' practice of developmental care approaches. The study concluded the instructional sessions were effective in enhancing knowledge and applying developmental care practices in the NICU. It recommended NICU design support developmental
This document summarizes a conference on maternal nutrition and infant feeding practices. The conference was organized to address gaps in understanding how maternal nutrition affects fetal growth, birth outcomes, and infant feeding practices. It covered 3 topics: 1) the effect of maternal nutrition and the placenta on fetal development and birth outcomes, 2) feeding preterm infants, and 3) feeding full-term infants. For topic 1, presentations showed the placenta's role in nutrient transport affects fetal growth and discussed the importance of nutrients like folate and calcium. Research priorities identified included studying nutrient interactions and their effects on different populations. Topic 2 noted a lack of evidence on best practices for preterm infant nutrition. Topic 3 discussed ensuring evidence on human milk
Association Of Breastfeeding Intensity And Bottle Emptying Behaviors At Early...Biblioteca Virtual
This study examined the relationship between breastfeeding intensity, bottle emptying behaviors, and risk of excess weight in infants. The study found:
1) Infants who were breastfed at low (20% of milk feeds) or medium (20-80% of milk feeds) intensities in early infancy were over twice as likely to have excess weight in late infancy compared to infants breastfed at high (80% of milk feeds) intensities.
2) Infants who often emptied bottles in early infancy were 69% more likely to have excess weight in late infancy than infants who rarely emptied bottles.
3) Mothers' encouragement of bottle emptying was negatively associated with infants' risk of
The Infant Feeding Practices Study II (IFPS II) was a longitudinal study that collected data from over 4,900 pregnant women from 2005 to 2007 regarding infant feeding practices, health, and related issues during the first year of the infant's life. Questionnaires were administered prenatally and monthly during the first year. The study aimed to understand infant feeding in the context of changes since the previous IFPS study in the 1990s. It provided detailed information on breastfeeding, formula feeding, complementary foods, and other factors to help evaluate infant feeding recommendations and policies.
This study assessed how mothers learn about proper handling of infant formula and whether they follow safe practices. The study found that most mothers did not receive instruction from health professionals on formula preparation or storage. Many mothers did not fully read or understand package label instructions. While most believed following safety directions was important, many mothers engaged in unsafe practices like not always washing hands before preparing formula or heating bottles in microwaves. No consistent maternal traits predicted unsafe practices. More education is needed to promote proper formula handling and reduce risks of illness.
This study compared neonatal and maternal outcomes following administration of fentanyl and midazolam or placebo to 60 pregnant women prior to Cesarean section under spinal anesthesia. The study found:
1) No significant differences between groups in neonatal Apgar scores, neurobehavioral scores, or continuous pulse oximetry measurements over three hours.
2) Mothers who received fentanyl and midazolam were more likely to report finding the study medication helpful, but both groups showed no difference in recall of the birth.
3) Maternal catecholamine levels and neonatal cord blood gas values were similar between groups.
The study concluded that a single dose of fentanyl and mid
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
1) Cesarean delivery rates in the US have risen to over 33% of all births, and preventing unnecessary first cesarean deliveries could help reduce overall cesarean rates and risks.
2) Many factors can influence first cesarean rates, including how labor is managed, definitions of issues like failed induction and labor arrest, and non-medical factors.
3) Careful examination of indications for cesarean deliveries, adherence to evidence-based practices for issues like labor induction and operative vaginal delivery, and addressing modifiable factors could help lower first cesarean rates.
The document provides summaries of popular children's television shows from the late 1990s to mid 2000s. It describes what each show is about and what lessons they aim to teach young viewers. Many shows emphasize problem solving, teamwork, learning basic concepts like math and spelling, encouraging imagination and physical activity.
InfluêNcia Do Apoio à AmamentaçãO Sobre O Aleitamento Materno Exclusivo Dos B...Biblioteca Virtual
1) O estudo avaliou os índices de aleitamento exclusivo no primeiro mês de vida de bebês nascidos em hospitais com e sem a Iniciativa Hospital Amigo da Criança (IHAC) em Pelotas, Brasil.
2) Os resultados mostraram que bebês nascidos em hospitais sem a IHAC tiveram maior risco de não receber apoio ao aleitamento, de não mamar na primeira hora e de receber chupeta e chá no hospital.
3) A prevalência de aleitamento exclusivo com um mês foi
Clinician Support And Psychosocial Risk Factors Associated With BreastfeedingBiblioteca Virtual
This study examined factors associated with breastfeeding discontinuation at 2 and 12 weeks postpartum in a cohort of 1007 low-risk mothers who initiated breastfeeding. The study found that breastfeeding rates declined over time, with 13% discontinuing by 2 weeks and 45% discontinuing by 12 weeks. Factors associated with earlier discontinuation included lack of breastfeeding confidence, early breastfeeding problems, Asian race, lower education, and depressive symptoms. Receiving encouragement from clinicians was associated with lower risk of discontinuing by 12 weeks, as was not returning to work or school by 12 weeks. The results suggest clinician support and addressing maternal mental health could help promote longer breastfeeding duration.
Mothers And Clinicians Perspectives On Breastfeeding Counseling During Routin...Biblioteca Virtual
This document summarizes a study examining breastfeeding counseling provided during routine preventive visits from the perspectives of both mothers and their clinicians. The study involved surveying 429 mother-newborn pairs and their 121 obstetric and pediatric clinicians. The results identified several areas of disagreement between what mothers reported discussing with clinicians regarding breastfeeding duration, continuation after returning to work, and specific advice provided, highlighting potential unintentional gaps in communication around breastfeeding counseling during routine visits.
Breastfeeding Practices of Postnatal Mothers: Exclusivity, Frequency and Dura...IJEAB
This study examined breastfeeding practices of 299 postnatal mothers in southeast Nigeria in terms of exclusivity, frequency, and duration. The results showed that most mothers exclusively breastfed for a short period, with 22.3% exclusively breastfeeding for 1 month and 31.5% for 4-6 months. The majority (80.7%) breastfed infants on demand day and night, while 40.5% reported infants suckling for over 20 minutes. Breastfeeding patterns were found to differ across primary, secondary, and tertiary health institutions, though not significantly. The study concluded that efforts are needed to motivate mothers to exclusively breastfeed for the recommended 6 months.
The document discusses best practices and medical options for labor and delivery, including facilities like hospitals, birthing centers, and home births; care providers such as doctors, midwives, and doulas; pain management options involving natural techniques or drug-induced methods; birthing positions on hands and knees, squatting, or using an exercise ball; and monitoring and interventions during each stage of labor.
Antenatal Peer Support Workers And Initiation Of Breast Feeding Cluster Rando...Biblioteca Virtual
This study assessed the effectiveness of an antenatal peer support worker service on the initiation of breastfeeding. The study involved a cluster randomized controlled trial of 66 antenatal clinics and 2511 pregnant women in a deprived, multiethnic population in Birmingham, UK. Clinics were randomly assigned to receive the peer support worker intervention (n=1140) or standard antenatal care (n=1371). The primary outcome of breastfeeding initiation did not differ significantly between the intervention (69.0%) and control (68.1%) groups after adjusting for clustering. Ethnicity, parity and mode of delivery predicted initiation, but the peer support worker intervention did not increase initiation rates.
Effect Of An Educational Intervention About Breastfeeding On The Knowledge,Biblioteca Virtual
This study evaluated the impact of an educational intervention on pediatric residents' knowledge, confidence, and clinical behaviors regarding breastfeeding. The residents completed pre- and post-intervention questionnaires to assess knowledge and confidence. Telephone interviews with breastfeeding mothers after clinic visits evaluated residents' clinical behaviors. The results showed that residents' knowledge scores increased significantly after the intervention. Their clinical behaviors when interacting with breastfeeding mothers also improved substantially. The educational intervention was effective in enhancing residents' support of breastfeeding patients.
This document summarizes a national survey of breastfeeding rates in US hospitals designated as "Baby-Friendly" in 2001. The survey found that Baby-Friendly hospitals had higher rates of breastfeeding initiation (83.8% vs national rate of 69.5%) and exclusive breastfeeding during hospital stay (78.4% vs national rate of 46.3%) compared to national averages. The 3 Steps to Successful Breastfeeding that were most difficult for hospitals to meet were paying for infant formula (Step 6), training staff (Step 2), and limiting formula marketing (Step 7). Overall, the results suggest that Baby-Friendly designation is associated with higher breastfeeding rates, regardless of hospital demographic factors.
Professor Soo Downe presenting at the Doctoral Midwifery Research Society Alcohol & Medication in Pregnancy Conferene about 'Which horse for which courses? The EBM Problem in studies of pharmacological substances in maternity care'.
Childbirth Connection works to improve maternity care quality through research and policy change. Their research shows significant variation and overuse of interventions in maternity care across regions and facilities. Their Transforming Maternity Care project identified reducing non-medically indicated deliveries before 39 weeks as a key priority. Quality improvement programs that strictly limited early elective deliveries improved outcomes and lowered costs without increasing risks.
This study examined predictors of breastfeeding duration in Australia by following 587 women from hospital discharge through 52 weeks postpartum. The researchers found that less than half of infants were receiving any breast milk at 6 months, and only 12% were exclusively breastfed. By 12 months, only 19.2% received any breast milk. Factors positively associated with longer breastfeeding duration included higher maternal infant feeding attitudes and negatively associated factors included breastfeeding difficulties in the first 4 weeks, maternal smoking, early pacifier introduction, and early return to work. Relatively few women achieved international breastfeeding recommendations.
Current point of view in preterm labor management in albania (2)Alexander Decker
This study examined the use of maintenance tocolysis therapy to prevent preterm labor in Albania. The study included 325 pregnant women between 28-32 weeks gestation hospitalized for preterm labor. Women received tocolysis therapy for over one month. Those between 28-30 weeks (n=200) had greater benefits, with pregnancy prolonged by 6-8 weeks on average. The authors conclude maintenance tocolysis therapy can considerably prolong pregnancy for women diagnosed with preterm labor between 28-32 weeks gestation, though larger studies are still needed.
Effect of instructional sessions on nurses' and doctors' knowledge and practi...Alexander Decker
This document summarizes a study that evaluated the effect of instructional sessions on nurses' and doctors' knowledge and practice of developmental care in the neonatal intensive care unit (NICU) in Abha City, Saudi Arabia. The study involved providing instructional sessions to 54 nurses and 12 doctors on developmental care approaches. Developmental care aims to optimize the NICU environment for preterm infants by reducing stress and supporting development. Assessments before and after the sessions found they improved both nurses' and doctors' knowledge of developmental care, and nurses' practice of developmental care approaches. The study concluded the instructional sessions were effective in enhancing knowledge and applying developmental care practices in the NICU. It recommended NICU design support developmental
This document summarizes a conference on maternal nutrition and infant feeding practices. The conference was organized to address gaps in understanding how maternal nutrition affects fetal growth, birth outcomes, and infant feeding practices. It covered 3 topics: 1) the effect of maternal nutrition and the placenta on fetal development and birth outcomes, 2) feeding preterm infants, and 3) feeding full-term infants. For topic 1, presentations showed the placenta's role in nutrient transport affects fetal growth and discussed the importance of nutrients like folate and calcium. Research priorities identified included studying nutrient interactions and their effects on different populations. Topic 2 noted a lack of evidence on best practices for preterm infant nutrition. Topic 3 discussed ensuring evidence on human milk
Association Of Breastfeeding Intensity And Bottle Emptying Behaviors At Early...Biblioteca Virtual
This study examined the relationship between breastfeeding intensity, bottle emptying behaviors, and risk of excess weight in infants. The study found:
1) Infants who were breastfed at low (20% of milk feeds) or medium (20-80% of milk feeds) intensities in early infancy were over twice as likely to have excess weight in late infancy compared to infants breastfed at high (80% of milk feeds) intensities.
2) Infants who often emptied bottles in early infancy were 69% more likely to have excess weight in late infancy than infants who rarely emptied bottles.
3) Mothers' encouragement of bottle emptying was negatively associated with infants' risk of
The Infant Feeding Practices Study II (IFPS II) was a longitudinal study that collected data from over 4,900 pregnant women from 2005 to 2007 regarding infant feeding practices, health, and related issues during the first year of the infant's life. Questionnaires were administered prenatally and monthly during the first year. The study aimed to understand infant feeding in the context of changes since the previous IFPS study in the 1990s. It provided detailed information on breastfeeding, formula feeding, complementary foods, and other factors to help evaluate infant feeding recommendations and policies.
This study assessed how mothers learn about proper handling of infant formula and whether they follow safe practices. The study found that most mothers did not receive instruction from health professionals on formula preparation or storage. Many mothers did not fully read or understand package label instructions. While most believed following safety directions was important, many mothers engaged in unsafe practices like not always washing hands before preparing formula or heating bottles in microwaves. No consistent maternal traits predicted unsafe practices. More education is needed to promote proper formula handling and reduce risks of illness.
This study compared neonatal and maternal outcomes following administration of fentanyl and midazolam or placebo to 60 pregnant women prior to Cesarean section under spinal anesthesia. The study found:
1) No significant differences between groups in neonatal Apgar scores, neurobehavioral scores, or continuous pulse oximetry measurements over three hours.
2) Mothers who received fentanyl and midazolam were more likely to report finding the study medication helpful, but both groups showed no difference in recall of the birth.
3) Maternal catecholamine levels and neonatal cord blood gas values were similar between groups.
The study concluded that a single dose of fentanyl and mid
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
1) Cesarean delivery rates in the US have risen to over 33% of all births, and preventing unnecessary first cesarean deliveries could help reduce overall cesarean rates and risks.
2) Many factors can influence first cesarean rates, including how labor is managed, definitions of issues like failed induction and labor arrest, and non-medical factors.
3) Careful examination of indications for cesarean deliveries, adherence to evidence-based practices for issues like labor induction and operative vaginal delivery, and addressing modifiable factors could help lower first cesarean rates.
The document provides summaries of popular children's television shows from the late 1990s to mid 2000s. It describes what each show is about and what lessons they aim to teach young viewers. Many shows emphasize problem solving, teamwork, learning basic concepts like math and spelling, encouraging imagination and physical activity.
InfluêNcia Do Apoio à AmamentaçãO Sobre O Aleitamento Materno Exclusivo Dos B...Biblioteca Virtual
1) O estudo avaliou os índices de aleitamento exclusivo no primeiro mês de vida de bebês nascidos em hospitais com e sem a Iniciativa Hospital Amigo da Criança (IHAC) em Pelotas, Brasil.
2) Os resultados mostraram que bebês nascidos em hospitais sem a IHAC tiveram maior risco de não receber apoio ao aleitamento, de não mamar na primeira hora e de receber chupeta e chá no hospital.
3) A prevalência de aleitamento exclusivo com um mês foi
In Search of Diablotín: One of the world's rarest birds and its unlikely stro...Julie Hart
Background on the biology of and threats to Diablotín/Black-capped Petrel and a presentation on my participation in searching for this rare species in Haiti in 2010.
The document introduces PowerPoint toolbars and other essential concepts. It discusses the four main toolbars - Standard, Formatting, Drawing, and Common Tasks. It describes how to move, dock, add, and remove toolbars. Key terms like slide, presentation, object, and transition are defined. The document recommends teaching PowerPoint basics like toolbars and vocabulary to students in a systematic way before introducing more advanced features.
Biography
About Tammy Bality
As an only child growing up on the Colorado farm her family originally homesteaded in
1875, Tammy Bality shared a special connection with animals: The horses, calves, dogs, cats,
and birds were her friends.
Ever since she could hold a crayon, art has been Tammy’s form of expression. Tammy now
creates sculptures that capture animals’ life force and honor their spirits.
Compelled to create
Tammy has always felt a bond with animals and aimed to recreate that feeling in art, but it
wasn’t until the 1988 Loveland Sculpture Show that she felt compelled to try her hand at
sculpting bronze.
Drawing on a variety of life experiences and technical workshops, Tammy developed her
own signature style utilizing different techniques and media to create unique pieces representing
our interconnectedness with animals.
Mixing media and melding heritages
People have always had a spiritual connection to animals through the millennia, whether it’s through Native American folklore
or Celtic mythology, and Tammy aims to honor that through her artwork.
Growing up in Colorado, Tammy loved the tributes to animals incorporating antlers, fur, feather and stone seen in Native
American artwork. These tributes lead the artist to delve into her own heritage, exploring Swedish, Irish and Scottish history
for inspiration and she was thrilled to discover that her Druid and Viking ancestors also had animal totems and tributes.
Tammy combines traditional influences with a variety of media and sculpting techniques to create innovative art that gives
voice to nature’s spirit.
She sculpts horses, dogs, birds of prey, bulls and bears from clay, bronze and crystal, incorporating silver and stone as well.
Tammy enjoys exploring the strengths of each medium – the freedom and spontaneity of ceramic, the strength and precision of
bronze, the luminosity and intrigue of crystal – and complementing their weaknesses with the strengths of the others.
Art on a Grand Scale
In the scope of Tammy’s body of work, you will find delicate Raku horses and Journey Ponies, life-like bronze representational
pieces ranging from miniature to monumental, spiritual Celtic-inspired totems and tributes, and breathtaking birds of
prey.
Tammy’s work is available in collections nationwide and at Chisholm Gallery in Millbrook, New York.
Toxic Inheritance – More Than 300 Pollutants In Breast Milk – Time For A New ...Biblioteca Virtual
The document summarizes a study that analyzed scientific literature on chemical pollutants detected in breast milk. Over 300 pollutants have been found in more than 40,000 breast milk samples tested in Germany since 1980. This includes substances that were banned decades ago but persist in the environment and accumulate in fatty tissues. Exposure occurs not just through breastfeeding but also prenatally, as chemicals can transfer from a mother's blood to her unborn baby. The contamination of breast milk is concerning given its importance for infant health and development. However, breastfeeding should not be discouraged. The findings emphasize the need to reform chemical policy like the proposed EU REACH legislation to better regulate the testing and use of chemicals.
14. Groupings activities EXTRA BITS - Bus Man CFE HigherNBHS
The document discusses some issues with functional departments like duplication of tasks, lack of promotion opportunities, and poor staff motivation. It then notes that organizing staff into divisions focused on specific products, customers, or geographic areas can help them become experts, improve customer loyalty, quality, and sales. Separating groups also makes performance easier to identify and allows concentrating on profitable areas. However, competition between departments may become unproductive and prevent collaboration, and duplicating resources for each group can be expensive.
The document describes the students, subjects, places, people, rules, timetables, punishments, and facilities at a school. It lists 4 students and 10 subjects including break dance, technology, philosophy, and cooking. It details the various rooms and buildings at the school like the computer room, gym, and library. The document outlines the rules around homework, exams, uniforms, and rubbish disposal. It provides the daily schedule with class times and breaks. Punishments are described as cleaning if you write on furniture or paying for broken items. Facilities such as air conditioning, heating, benches, and a garden area are also listed.
The document lists various industries and the percentage of customers in those industries that report having positive customer experiences. Industries like technology, consumer electronics manufacturing, and automotive reported the highest percentages of customers having positive experiences, between 73-66%. Other industries like media, banks, and chemicals reported lower percentages, between 50-51%. The document emphasizes that positive customer experiences correlate strongly with customer loyalty, willingness to purchase again, recommend to others, and not switch to competitors.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
Ten students from Studio Picasso Enrichment at Waikato Intermediate Schools attended the Visual Arts Day on Friday 4 April 2014 at Fairfield Intermediate School. The students participated in activities like decorating wooden blocks, graffiti painting, urban landscape painting, book making, mixed media art, and creating 3D words out of wooden blocks. The students made new friends and produced great artworks to take back to their school. A slideshow was later created by the visual arts teacher at Fairfield Intermediate School to showcase the day's activities and artworks for an assembly presentation.
The document is a student paper on global warming written by Awadh Jumaan Awadh. It discusses the causes of global warming such as the industrial revolution and greenhouse gas emissions. It also examines the effects of global warming like rising sea levels and threats to human health and plant life. Finally, it proposes solutions such as using alternative energy sources, reducing car usage, and recycling to address the impacts of climate change.
The speaker feels they have not heard from the person they love in a long time. They worry they have done something wrong. The speaker wishes to be the angel or prince from the fairytale stories that the person loves. They want to protect the person with wings and have a happy ending like in the stories. The speaker hopes the person will believe they can have a relationship like in the fairytales.
The IEEE has approved the development of a 40-Gigabit Ethernet standard alongside the 100-Gigabit Ethernet specification. Additionally, the INCITS is close to approving specifications for transmitting Fibre Channel signals over copper cabling, and the TIA is revising the TIA-606 telecommunications infrastructure administration standard rather than just affirming the current version. These standards activities aim to address the growing need for higher speed networking and more flexible cabling options in data centers.
The document outlines The Ochendo Agenda 2011, which aims to transform Abia State, Nigeria through socio-economic development and securing Governor Ochendo's reelection. It analyzes opportunities and challenges facing Abia State and sets goals of creating a shared vision, reconnecting people with leadership, and fulfilling promises of a secure, prosperous state. The agenda focuses on infrastructure, security, agriculture, manufacturing and branding to make Abia a model economy and leave a legacy for Ochendo.
The document describes an art exhibition by Leslie Shiels titled "Canine Culture" showing at the Chisholm Gallery. It features 16 oil paintings on drawing panels measuring 36" x 36" each depicting dogs interacting. The paintings explore behavioral similarities between dogs and humans such as leadership, cooperation and conflict resolution. Contact information is provided for the gallery.
Opinions And Practices Of Clinicians Associated With Continuation Of Exclusiv...Biblioteca Virtual
This study examined how clinician opinions and practices are associated with continuation of exclusive breastfeeding. The study prospectively followed 288 low-risk mother-newborn pairs who were breastfeeding at 4 weeks. Mothers completed interviews at 4 and 12 weeks, and their obstetric and pediatric clinicians completed surveys. The primary outcome was exclusive breastfeeding at 12 weeks. The study found that clinicians who recommended formula supplementation if an infant was not gaining weight or who felt their breastfeeding advice was not important were associated with early discontinuation of exclusive breastfeeding. Continued exclusive breastfeeding support from clinicians may help improve breastfeeding rates at 6 months.
The document discusses the revised training package for the Baby Friendly Hospital Initiative (BFHI). Some key points:
- The BFHI was launched in 1991 to promote breastfeeding. Over 15,000 facilities in 134 countries have achieved Baby-Friendly status.
- However, progress in designating new hospitals has slowed since 1996. On average, less than seven hospitals per country are designated each year.
- WHO and UNICEF have developed a revised 20-hour training course package to revitalize the BFHI both quantitatively and qualitatively.
- The package includes updates to certain steps and new/optional criteria on areas like HIV/AIDS, labor/childbirth care, and compliance with
A Home Visit Program For Breastfeeding Education And SupportRachel Doty
A home visit program was developed to provide breastfeeding education and support to mothers at risk of breastfeeding failure. The program aimed to increase breastfeeding rates and support mothers discharged within 24 hours after delivery. Nurses conducted home visits and assessments to help mothers breastfeed successfully. Evaluation found lower readmission rates for infants receiving home visits compared to those who did not. Patient satisfaction with the program was positive.
Peripartum Breastfeeding Management For The Healthy Mother And Infant At Term...Biblioteca Virtual
This document provides guidelines for peripartum breastfeeding management for healthy mothers and infants. It recommends:
1) Prenatal breastfeeding education and support.
2) Skin-to-skin contact immediately after birth and rooming-in to facilitate breastfeeding.
3) Assessment and support for breastfeeding mothers to ensure effective latching and milk transfer.
4) Avoidance of supplemental feedings unless medically necessary to avoid breastfeeding difficulties.
Why Do Women Stop Breastfeeding Findings From The Pregnancy RiskBiblioteca Virtual
This study examined breastfeeding behaviors using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2000-2001. The authors found that 32% of women did not initiate breastfeeding, 4% stopped within the first week, 13% stopped within the first month, and 51% continued for over 4 weeks. Younger women and those with limited socioeconomic resources were more likely to stop breastfeeding early. Common reasons for stopping included sore nipples, perceived inadequate milk supply, and difficulties with breastfeeding. Women's predelivery intentions impacted their likelihood of initiating and continuing breastfeeding.
This document provides an introduction and background for a study examining the effectiveness of a Breastfeeding Empowerment Programme (BEP) on knowledge, skills, self-confidence, and breastfeeding outcomes among first-time mothers in India. The study aims to evaluate the impact of the BEP, correlate outcomes with domains, and associate outcomes with background variables. It outlines the objectives, hypotheses, variables, sample size, population, sampling technique, data collection tools, and data analysis methods for the randomized controlled study.
This study examined the association between phototherapy treatment for neonatal jaundice and breastfeeding duration and exclusivity. The study analyzed data from a national survey of over 4,000 mothers who initiated breastfeeding. Around 5% of infants received phototherapy for jaundice. The study found phototherapy was associated with decreased exclusive breastfeeding at 1-4 months but did not find significant decreases in any breastfeeding until 12 months. The results suggest greater breastfeeding support may help mothers maintain confidence in exclusive breastfeeding during and after phototherapy treatment.
1) The study examined the effects of a digital prenatal program called the Baby Care Program (BCP) on 512 first-time mothers. The BCP included mindfulness activities like meditation, yoga, music, and baby bonding exercises.
2) Results showed statistically significant benefits for mothers who used the BCP, including lower stress, better sleep, fewer preterm births and higher birth weights, compared to mothers who did not participate.
3) The BCP was found to help mothers develop a stronger bond with their babies, better manage nutrition and pregnancy symptoms, and have an overall healthier pregnancy experience.
1. The document presents a study on the effectiveness of early ambulation on uterine involution among postnatal mothers.
2. The study aims to assess uterine involution levels before and after early ambulation in an experimental group, and compare this to a control group without early ambulation.
3. A quasi-experimental design is used with 60 postnatal mothers divided into experimental and control groups, with uterine involution measured on a scale before and after the intervention of early ambulation for the experimental group.
Antenatal care aims to ensure a healthy pregnancy and delivery for both mother and baby. It involves regular checkups including medical history, examinations, tests and education. The document outlines the definition, goals, models and process of antenatal care. It discusses the traditional model involving monthly visits and a newer WHO model with a minimum of eight contacts. Key aspects of antenatal care covered include comprehensive maternity services, risk assessment, monitoring of mother and baby, and addressing issues that could impact pregnancy outcomes.
Breastfeeding And Early Weaning Practices In Northeast BrazilBiblioteca Virtual
This study examined breastfeeding practices in 4 towns in northeast Brazil by interviewing 364 mothers. The researchers found:
1) While mothers were positive about breastfeeding, exclusive breastfeeding was rare and the median duration of exclusive breastfeeding was 0 days.
2) The median age for introducing other milk was 24 days, and the median duration of breastfeeding was 65 days for mothers who introduced other milk within the first month compared to 165 days for other mothers.
3) Pacifier use in the first week, intention to introduce other milk in the first month, giving water/tea in the first week, and leaving the maternity ward before breastfeeding was established were associated with introducing other milk within the first month
Moringa is a plantfood of high nutritional value, ecologically and economically beneficial and readily available in the countries hardest hit by the food crisis. http://miracletrees.org/ http://moringatrees.org/
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
This study evaluated the effectiveness of applying breast milk to treat sore nipples among postnatal mothers. It found that applying breast milk significantly reduced nipple soreness in the experimental group compared to the control group. Specifically, the mean nipple soreness score decreased from 13.53 to 5.27 in the experimental group after applying breast milk for one week, while it only decreased from 9.43 to 6.53 in the control group. This provides evidence that applying breast milk is an effective treatment for sore nipples among postnatal mothers.
CLINICAL BRIEF
A Quality Improvement Initiative: Improving Exclusive
Breastfeeding Rates of Preterm Neonates
Amanpreet Sethi1 & Meena Joshi1 & Anu Thukral1 & Jagjit Singh Dalal1 &
Ashok Kumar Deorari1
Received: 7 October 2016 /Accepted: 31 January 2017 /Published online: 24 February 2017
# Dr. K C Chaudhuri Foundation 2017
Abstract This study is a single center quality improve-
ment (QI) initiative in a tertiary care neonatal intensive
care unit which was done with an objective to increase
the proportion of neonates receiving mother’s own milk
(at postnatal age of 7 d) from the current rate of 12.5%
to 30% over a period of six weeks. Additional objec-
tives were to evaluate the proportion of mothers’ ex-
pressing breast milk within 3 h of birth, on day one
and three and the amount of expressed breast milk
(EBM) on day one and day seven. A team was formu-
lated to evaluate the reasons for inadequate breast milk
expression and to plan the steps for promoting the
same. Comprehensive postnatal breast feeding counsel-
ing (CPNC) to promote early breast milk expression
was initiated soon after the birth of a preterm neonate.
CPNC was done for next fifteen mothers and their
breast feeding support was streamlined. The effect of
CPNC and teamwork was discussed amongst the team
members every day and adjustments incorporated (Plan-
Do-Study-Act cycle). The proportion of neonates receiv-
ing mother’s only milk (MOM) on day 7 increased to
80% (12/15) after 4 wk of QI. Thus, a simple and
feasible CPNC package lead to improved breast milk
output in mothers.
Keywords Breast milk . Neonate . Quality improvement
Introduction
Exclusive breastfeeding for six months is the most effective
preventive strategy for under-five mortality [1]. Host resis-
tance factors are abundant in fresh breast milk and when prop-
erly collected and stored, it provides the highest quality of
anti-infective properties. [2, 3] However, for various reasons,
mothers of these neonates face multiple challenges in estab-
lishing and maintaining an adequate supply of milk, this phe-
nomenon being more common in preterm neonates [4, 5]. The
gap in current evidence based implementation is the strategy
to reduce the time to first milk expression and to increase
frequency of expression and night time expression of milk in
these mothers. It is also known that mothers of extremely
preterm neonates should be taught early and effective milk
expression techniques [6].
The authors identified problem of delayed breast milk ex-
pression by mothers of preterm neonates whose babies were
admitted in the neonatal intensive care unit (NICU). The fre-
quency of milk expression in these mothers was limited to two
to three times in the entire day leading to most neonates re-
ceiving predominant formula feed for the first one week.
In view of the existing evidence and the identified problem,
the authors formulated an aim to increase the proportion of
breast milk intake in the admitted preterm neonates o.
This quality improvement study conducted in a neonatal intensive care unit aimed to increase exclusive breastfeeding rates of preterm neonates from 12.5% to 30% over 6 weeks. The team implemented comprehensive postnatal breastfeeding counseling for mothers, which focused on early and frequent milk expression. This led to improved breast milk output, with the proportion of neonates receiving mother's own milk increasing from 12.5% to 80%. Sustaining efforts like allocating breast pumps and celebrating successes helped maintain high exclusive breastfeeding rates of over 80% in follow up periods. The simple counseling approach improved breastfeeding outcomes without external funding or additional staffing.
This document from the American Academy of Pediatrics outlines their policy statement on breastfeeding and the use of human milk. The key points are:
1) Extensive research has demonstrated significant health benefits for infants and mothers from breastfeeding, including reduced risk of infectious diseases, sudden infant death syndrome, diabetes, obesity, and improved cognitive development.
2) The policy statement provides recommendations for pediatricians and healthcare professionals to promote, protect, and support breastfeeding through individual practice, hospitals, medical schools, and communities.
3) Certain infectious diseases like HIV may preclude breastfeeding in some situations, but exclusive breastfeeding for the first 6 months does not increase HIV transmission risk according to some studies in developing countries.
LESSON 12 Paying for Care and Health Information LEA.docxSHIVA101531
LESSON 12
Paying for Care and Health Information
LEARNING OUTCOMES
______________________________________________________________________________
In this lesson, you will do the following:
Describe how coding, reimbursement, and billing are impacted by health information systems.
READINGS
The following reading assignments are for Lessons 9 through 12:
Gartee Text:
Chapter 4, pp. 74 - 95
Chapter 5, pp. 98 - 126
Chapter 6, pp. 127 - 151
Chapter 9, pp. 208 - 236
Chapter 10, pp. 237 - 259
ACTIVITIES / ASSESSMENTS
The following activities/assessments are for Lessons 9 through 12:
1. Read the assigned pages from the Gartee text.
2. Review the Lecture Notes, Unit 3 PowerPoint, and Voice Pod.
3. Participate in the weekly discussion question.
4. Complete the written assignment.
WRITTEN ASSIGNMENTS
Hospital Medicare Payment System - DRGs:
Research how large hospitals are paid by a Medicare fee for service reimbursements (DRG’s).
Include a brief history and relate how health information supports the request for a payment.
PLEASE NOTE: All graded assignments for the lessons in this unit should be grouped together
and submitted as ONE document using the Assignment Submission form accessed from your
course homepage or http://www.sjcme.edu/gps/assignments.
All activities/assignments for this unit should be as follows:
1. Should include a cover sheet for each assignment stating the following:
Course (HA 214)
Your Name
Unit and Lesson Number
Date Submitted
2. Each individual assignment number and copy of the assignment directions should be
included in the submission as the starting header of each lesson.
3. Carefully check grammar and spelling.
4. Use APA format for any research or sources that are being used or quoted.
5. Email the instructor if you have questions regarding the assignments.
http://www.sjcme.edu/gps/assignments
g
Research www.AJOG.org
O B S T E T R I C S
Preterm premature rupture of membranes >32 weeks’
estation: impact of revised practice guidelines
Arij Faksh, DO; Joseph R. Wax, MD; F. Lee Lucas, PhD; Angelina Cartin; Michael G. Pinette, MD
OBJECTIVE: The purpose of this study was to determine the perinatal
impact of the 2007 American College of Obstetricians and Gynecolo-
gists Practice Bulletin on preterm premature membrane rupture.
STUDY DESIGN: Perinatal outcomes were compared in women who
had experienced preterm membrane rupture in the 3 years before the
2007 Practice Bulletin to similar women who experienced preterm pre-
mature rupture of membranes in the 3 years after the issue and imple-
mentation of the guideline.
RESULTS: After adjustment for gestational age at membrane rupture
and steroids, composite severe morbidity (death, respiratory distress
Obstet Gynecol 2011;205:340.e1-5.
p
remained uncertain, p
doi: 10.1016/j.ajog.2011.05.036
340.e1 American Journal of Obstetrics & Gynecology OCTOB ...
This document discusses models of midwifery care in Central New York and summarizes a presentation given by two midwives. The presentation covered three main points: 1) It discussed models of care that use midwifery for healthy women during pregnancy and well woman care. 2) It discussed research findings that support safe and healthy outcomes for physiologic labor and birth. 3) It facilitated collaboration of a healthcare team to provide comprehensive safe maternity care for women in Central New York.
Similar to Efficacy Of Breastfeeding Support Provided By Trained Clinicians During (20)
Este documento fornece informações sobre a anatomia e fisiologia da glândula mamária. Resume que a mama é composta de tecido glandular, gordura e tecido conjuntivo, e descreve o desenvolvimento da mama desde a embriogênese até a puberdade. Também aborda a anatomia da mama adulta e a fisiologia da produção de leite, incluindo os hormônios envolvidos.
The 2008 IBLCE examination saw the largest candidate population in its history with 3,323 candidates taking the exam across 37 countries and territories. The exam was administered in 13 languages and saw continued growth in candidates from outside the United States, Canada, and Australia. Analysis of exam results found a pass rate of 93.56% with a mean score of 77.87% and standard deviation of 8.21%.
This document provides an overview of the Third Edition (Revised) of the Wellstart International Lactation Management Self-Study Modules, Level I. It was developed by Wellstart International, a nonprofit organization focused on educating healthcare providers about optimal infant and young child feeding. The Third Edition was reviewed by 30 volunteer experts from around the world and updated to ensure the information is current and internationally relevant. It is intended to be available at low or no cost globally to support breastfeeding education.
AvaliaçãO Do Impacto De Um Programa De Puericultura Na PromoçãO Da Amamentaçã...Biblioteca Virtual
1) O estudo avaliou o impacto de um programa de puericultura na promoção da amamentação exclusiva em uma coorte de 112 crianças no Sul do Brasil.
2) A prevalência de amamentação exclusiva no primeiro mês foi de 95%, caindo progressivamente para 81%, 64%, 53%, 39% e 35% nos meses seguintes.
3) A mediana da duração da amamentação exclusiva foi de 4 meses, maior do que as taxas nacionais brasileiras, indicando a eficácia do programa.
AnáLise Da Efetividade De Um Programa De Incentivo Ao Aleitamento Materno Exc...Biblioteca Virtual
O documento analisa a efetividade de um programa de incentivo ao aleitamento materno exclusivo em uma comunidade carente de São Paulo. Os principais resultados são: 100% das mulheres eram desempregadas, 51,8% aderiram ao programa mas 48,2% abandonaram por motivos desconhecidos, e no momento da alta apenas 17,3% relataram aleitamento exclusivo até os seis meses.
The 2008 IBLCE examination saw the largest candidate population in its history with 3,323 candidates taking the exam across 37 countries and territories. The exam was administered in 13 languages and saw continued growth in candidates from outside the United States, Canada, and Australia. Analysis of exam results found a pass rate of 93.56% with a mean score of 77.87% and standard deviation of 8.21%.
The document summarizes monitoring results from the Baby Feeding Law Group (BFLG) project on marketing practices of baby formula companies in the UK. It finds that Danone, maker of Aptamil and Cow & Gate formulas, continues advertising claims promoting follow-on formulas and undermining breastfeeding, despite rulings against such claims from the Advertising Standards Authority. The report provides examples of non-compliant magazine and television ads, and calls on Trading Standards offices to take action against illegal marketing practices.
The document summarizes statistics from the 2008 IBLCE lactation consultant examination. It reported that:
- 3,323 candidates took the exam across 37 countries, representing the largest candidate population in the exam's history.
- Less than half of candidates were from the US, with over 30% from other countries, indicating the credential has become a global standard.
- The exam was administered in 13 languages across 5 continents, and was taken online or on paper.
- 771 candidates took the exam for recertification purposes after 5 years of practice.
PromoçãO, ProtecçãO E Apoio. Apoio RepresentaçõEs Sociais Em Aleitamento MaternoBiblioteca Virtual
Este documento resume uma dissertação de mestrado sobre representações sociais em aleitamento materno. O trabalho analisou as percepções de profissionais de saúde e puérperas de dois hospitais sobre o aleitamento materno, comparando um hospital credenciado pela Iniciativa Hospital Amigo da Criança e outro não credenciado. Entre os principais achados, destacam-se a culpabilização da mulher no desmame, os efeitos das rotinas médicas no aleitamento e diferenças nas percepções entre os profissionais dos dois hosp
O Ensino De Aleitamento Materno Na GraduaçãO Em Medicina Um Estudo De CasoBiblioteca Virtual
Este documento descreve uma dissertação de mestrado sobre o ensino de aleitamento materno na graduação em medicina da Universidade Federal de Juiz de Fora. O estudo avaliou o nível de formação teórica e prática dos alunos, sua confiança em lidar com o tema e em transmitir informações às futuras mães. Os resultados sugerem que é necessária uma reavaliação do ensino teórico com foco prático para preparar melhor os médicos.
No Seio Da FamíLia AmamentaçãO E PromoçãO Da SaúDe No Programa De SaúDe Da ...Biblioteca Virtual
Este documento apresenta os resultados de uma pesquisa sobre a implementação da promoção da saúde no Programa de Saúde da Família em cinco municípios brasileiros. A pesquisa avaliou os conhecimentos e atividades de profissionais de saúde em relação à promoção do aleitamento materno, e entrevistou mães sobre sua experiência com o programa. Os resultados mostraram que os programas capacitaram bem suas equipes, que demonstraram conhecimentos acima da média sobre aleitamento materno. No entanto, as at
This document is the third edition of Wellstart International's self-study modules on lactation management at level 1. It contains pre-tests and post-tests, 3 modules that cover the basics of breastfeeding and common problems, and annexes with additional resources. The modules are designed to teach health care providers about promoting and supporting breastfeeding.
AnáLise Da Efetividade De Um Programa De Incentivo Ao Aleitamento Materno Exc...Biblioteca Virtual
O documento analisa a efetividade de um programa de incentivo ao aleitamento materno exclusivo em uma comunidade carente de São Paulo. Os principais resultados foram: 100% das mulheres eram desempregadas, 51,8% aderiram ao programa mas 48,2% abandonaram por motivos desconhecidos, e no momento da alta apenas 17,3% relataram aleitamento exclusivo até os seis meses.
AvaliaçãO Do Impacto De Um Programa De Puericultura Na PromoçãO Da Amamentaçã...Biblioteca Virtual
1) O estudo avaliou o impacto de um programa de puericultura na promoção da amamentação exclusiva em uma coorte de 112 crianças acompanhadas desde o nascimento.
2) A prevalência de amamentação exclusiva no primeiro mês foi de 95%, caindo progressivamente para 81%, 64%, 53%, 39% e 35% nos meses seguintes.
3) A mediana da duração da amamentação exclusiva foi de 4 meses, maior do que as taxas nacionais brasileiras, indicando a eficácia do programa.
Iblce Regional Office In Europe Candidate Information GuideBiblioteca Virtual
This document provides information for candidates applying to take the International Board Certified Lactation Consultant (IBCLC) certification exam. It outlines the eligibility requirements including the necessary educational background, clinical experience providing breastfeeding counseling, and professional lactation education. Candidates must meet the eligibility criteria for one of several pathways that differ in their required hours of clinical experience depending on a candidate's educational background and profession. The document reviews the application process and provides sample exam questions to help candidates prepare for the rigorous international certification exam.
A ImportâNcia Da AmamentaçãO Para A SaúDe Da Mulher Que AmamentaBiblioteca Virtual
O documento discute os benefícios da amamentação para a saúde da mulher, incluindo proteção contra câncer de mama e ovário, recuperação pós-parto mais rápida, e prevenção de osteoporose. A amamentação também ajuda no controle de natalidade através da produção de hormônios que inibem a ovulação.
AmamentaçãO E Uso De AntiinflamatóRios NãO EsteróIdes Pela Nutriz InformaçõEs...Biblioteca Virtual
1) O documento analisa as informações contidas nas bulas de medicamentos antiinflamatórios não esteróides em comparação com as evidências científicas sobre seu uso durante a amamentação.
2) Foi encontrada referência à segurança de uso durante a amamentação em apenas 14 de 27 medicamentos, e 9 de 10 medicamentos considerados seguros aconselhavam evitar o uso ou suspender a amamentação.
3) As bulas são discordantes das evidências científicas sobre a compatibilidade desses medicamentos com a amamentação, sendo necess
Este documento descreve a anatomia e fisiologia da amamentação. Resume a estrutura da mama, incluindo lobos, alvéolos e ductos, e explica os processos de mamogénese, mastogénese e lactogénese, que envolvem o desenvolvimento da mama durante a puberdade, gravidez e após o parto.
Contribution Of Environmental Factors To The Risk Of Male InfertilityBiblioteca Virtual
This study investigated the relationship between environmental exposures and male infertility in 225 men seeking infertility treatment in Argentina. The men were grouped based on reported exposures to pesticides, solvents, heat, or a mixture. Semen analysis and hormone levels were compared between exposure groups. Results showed that exposure to pesticides was associated with lower sperm counts and higher estrogen levels, while solvent exposure was linked to lower LH levels, with effects being more pronounced in men with primary infertility. The study suggests environmental factors contribute to male infertility severity and may worsen genetic or medical risk factors.
This document provides information on contraindications and conditions where breastfeeding may or may not be advised. It lists situations where breastfeeding is not recommended, such as if the baby has galactosemia or the mother has active untreated tuberculosis. It also outlines conditions where the benefits of breastfeeding outweigh the risks, such as if the mother is a hepatitis B carrier or smokes, as long as she takes certain precautions. The document is intended as a factsheet for GPs and pharmacists on breastfeeding recommendations.
3. peds.2004-1362; breastfeeding, counseling, primary care was 4.8 days in France. Newborns benefit from rou-
physicians, randomized, controlled trial. tine, preventive, outpatient visits delivered by a pe-
diatrician or a family physician in an office setting
ABBREVIATION. CI, confidence interval. during the first 6 months of life (ie, at 8 days, and 1,
2, 3, 4, 5, and 6 months of infant age). The period of
paid maternity leave is 10 weeks after the birth,
T
he benefits of prolonged breastfeeding for extended to 18 weeks after the birth of the third
mother and infant health are documented in a child. Despite these legal conditions, the prevalence
vast scientific literature.1 The American Acad- of breastfeeding was 70.8% in our hospital and 58.1%
emy of Pediatrics recommends exclusive breastfeed- at 1 month of infant age.16 The decrease in breast-
ing for the first 6 months of life, continuing to 1 feeding rates during the first 1 month of life is likely
year with the addition of complementary foods at 6 to be related to a lack of early adequate breastfeeding
months of age.2 In its Healthy People 2010 recom- support after discharge. Most mothers do not attend
mendations, the US Department of Health and Hu- the mandatory preventive outpatient visit at 8 days
man Services sets goals of 75% of mothers breast- of infant age, because it is usually anticipated in the
feeding exclusively in the early postpartum period maternity ward before discharge, for various practi-
and 50% continuing to breastfeed for at least 6 cal reasons.
months.3 The objective of this prospective, randomized, par-
The hospital has been a particular focus of efforts allel-group, open trial was to determine whether at-
to promote initiation of breastfeeding in the past tending a routine, preventive, outpatient visit deliv-
decade.4 As a result, large-scale national surveys ered in a primary care physician’s office within 2
indicated that the in-hospital breastfeeding rate weeks after the infant’s birth would improve breast-
reached the highest level recorded to date in the feeding outcomes. Our primary hypothesis was that
United States (69.5% in 2001) and would meet or the exclusive breastfeeding rate at 4 weeks would be
exceed the Healthy People 2010 goal of 75% for the increased among mother-infant pairs attending the
early postpartum period if increases in breastfeeding routine, preventive, outpatient visit (ie, the interven-
continued at the current rate ( 2% per year).5 How- tion group), in comparison with those receiving the
ever, the estimates of any breastfeeding at 6 months usual postnatal support (ie, the control group). Our
of age (from 27.0% to 32.5% in 2001) still fall signif- secondary hypotheses were that the rate of any
icantly short of the Healthy People 2010 goal.5,6 The breastfeeding at 4 weeks, breastfeeding duration, the
largest decreases in breastfeeding rates occur during proportion of mothers who experienced no breast-
the first 4 postpartum weeks among different sub- feeding difficulty, and the rate of satisfaction with
groups of mother-infant pairs.7,8 Reasons for early the breastfeeding experience would be increased
breastfeeding discontinuation are complicated. among mother-infant pairs in the intervention
Mothers who discontinue breastfeeding early are group, in comparison with those in the control
more likely to report a lack of confidence in their group.
ability to breastfeed,7,8 problems with the infant
latching or suckling,8,9 breast pain or soreness,8,9 per-
ceptions of insufficient milk supply,8,9 or a lack of METHODS
individualized encouragement from their clinicians8 Setting
in the early postdischarge period. Mother-infant pairs were recruited in the maternity section of
Many interventions directed at early preventable the department of obstetrics and gynecology of the Chambery
breastfeeding problems and relying on peer coun- Teaching Hospital (Chambery, France), a level 3 maternity facility
where an average of 2000 deliveries per year have taken place in
selor or nurse follow-up visits at home or in the clinic
the past 5 years.
have attempted to increase breastfeeding rates. These
interventions occur as an adjunct to routine preven-
tive visits, rather than within them, and have had Participants
generally limited success.10–13 In contrast, the results The study population consisted of mothers who had delivered
of observational studies suggest that support with a healthy singleton infant (gestational age: 37 completed weeks)
breastfeeding problems and promotion of breast- and were breastfeeding on the day of discharge. Mother-infant
pairs were considered ineligible and were not enrolled in the
feeding provided by clinicians during routine pre- study if the infant was admitted to a neonatal unit or if the mother
ventive visits in office settings are associated with was transferred to an intensive care unit, was 18 years of age,
higher rates of exclusive breastfeeding.14 However, was living outside Chambery and its suburbs, refused or was
randomized trials testing the efficacy of interven- unable to give consent, was unable to speak French, or was un-
likely to complete follow-up monitoring because of psychosocial
tions delivered through existing primary health care problems such as homelessness.
services are currently lacking.8 Such trials are chal-
lenging to conduct in the United States because
mothers, health care providers, managed care orga- Enrollment and Interventions
nizations, and insurance companies have vested in- Consecutive mother-infant pairs were screened for eligibility
terests in early discharge, home or clinic postpartum by 2 residents 7 days per week. Eligible mother-infant pairs were
follow-up visits, and specific breastfeeding support. recruited on the day of discharge. They were randomly assigned
either to receive the usual postdischarge support (control group)
The French health care system differs to some or to attend a routine, preventive, outpatient visit in a primary
extent from the US health care system.15 In 2001, the care physician’s office within 2 weeks after the birth (intervention
mean length of stay after normal vaginal delivery group).
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4. Fig 1. Flow diagram of mother-infant pair progress through the trial.
Control Group cles.17–19 It was intended to improve the physicians’ breastfeeding-
The mothers in the control group received the usual verbal related knowledge and counseling skills. The topics covered were
encouragement to maintain breastfeeding, provided by the mater- general health assessment, lactation physiology, feeding position
nity ward staff. On the day of discharge, the infant was examined and latch-on assessment, management of common lactation prob-
by the pediatrician working in the department, for a general lems (nipple pain, nipple cracks, sore nipples, mastitis, and ma-
health assessment and an evaluation for evidence of successful ternal concern regarding low milk supply), management of infant
breastfeeding behavior. The mothers were also provided with the problems (insufficient weight gain, breastfeeding jaundice, diar-
telephone number of a peer support group that they could call to rhea, and dehydration), maternal medication use while breast-
ask questions and request help. They were not required to attend feeding, and sources of support. The training program was deliv-
the mandatory, preventive, outpatient visit at 8 days of infant age, ered through lectures, panel discussions, role-playing exercises,
because it was anticipated in the maternity ward before discharge. and printed educational materials. It was delivered as a stand-
The postdischarge follow-up monitoring consisted of routine, pre- alone intervention and did not contain any postcourse measures to
ventive, outpatient visits in a primary care physician’s office at 1, change health professionals’ performance.
2, 3, 4, 5, and 6 months of infant age.
Randomization
Intervention Group The allocation sequence was generated by the statistical adviser
of the study with random permuted blocks with a block size of 8.
In addition to the usual predischarge and postdischarge sup-
The randomization assignments were unknown to any of the
port, the mothers in the intervention group were invited to attend
investigators and were concealed in consecutively numbered,
an individual, routine, preventive, outpatient visit in the office of
sealed, opaque envelopes. The 2 residents opened the envelopes
1 of the 17 participating primary care physicians, within 2 weeks
sequentially after the mothers signed the consent forms.
after the birth. The participating physicians were pediatricians or
family physicians practicing in Chambery and its suburbs. They
had attended a 5-hour training program delivered in 2 parts in 1 Data Collection
month before the beginning of the study. We had developed the Baseline data on demographic characteristics, clinical variables,
training program on the basis of guidelines and review arti- and in-hospital breastfeeding experiences were collected by the 2
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5. residents through chart review and enrollment interviews. The where appropriate, for categorical variables. In the multivariate
participating physicians were asked to complete and return a analysis, we used a logistic regression model to estimate the odds
questionnaire after each routine, preventive, outpatient visit ratio of exclusive breastfeeding at 4 weeks associated with the
within 2 weeks after the birth. The data included breastfeeding- intervention, after adjustment for maternal age, white-collar em-
related problems and management of those problems (counseling, ployment status, education status, smoking history, parity, prena-
prescribed medications, or additional visits). Mothers in the con- tal class attendance, epidural anesthesia, gestational age at deliv-
trol and intervention groups were sent a postal questionnaire ery, infant birth weight, breastfeeding within 1 hour after birth
when the infants reached 4 and 26 weeks of age, respectively. As status, postpartum length of stay, and expected breastfeeding
described previously,20,21 we used a postal questionnaire to assess duration. The risks of breastfeeding continuation over time were
breastfeeding outcomes and satisfaction with breastfeeding expe- estimated according to the Kaplan-Meier method and were com-
riences, to limit the risk of observer bias. A stamped addressed pared between the 2 groups with the Cox proportional-hazards
envelope was enclosed with a cover letter encouraging the mother model. A 2-tailed P value of .05 was considered to indicate
to complete and return the questionnaire. A second questionnaire statistical significance. Hazard ratios were reported with 95%
was sent to nonrespondents 10 days later. Nonrespondents to the confidence intervals (CIs). All statistical analyses were performed
second questionnaire were interviewed by telephone by 1 of the with Stata 6.0 (Stata Corp, College Station, TX).
authors. The study protocol was approved by the Grenoble University
Hospital Institutional Review Board for the Protection of Human
Outcome Measures Subjects (Comite Consultatif de Protection des Personnes pour la
The primary outcome was the prevalence of exclusive breast- Recherche Biomedicale), the French Data Protection Agency
feeding reported at 4 weeks. Exclusive breastfeeding was defined (Commission Nationale de l’Informatique et des Libertes), and the
as giving maternal milk as the only food source, with no other Medical Board of Savoie County (Conseil de l’Ordre des Medecins
liquids (other than vitamins or medications) or foods being giv- de Savoie). Written informed consent was obtained from all en-
en.22 The secondary study outcomes were prevalence of any rolled mothers.
breastfeeding reported at 4 weeks, median duration of breastfeed-
ing, breastfeeding difficulties, and maternal satisfaction with the RESULTS
infant feeding experience, rated on a 4-point, single-item scale. Study Patients
Breastfeeding was defined as receipt by the infant of any breast
milk. Classification into breastfeeding categories, as reported at 4 Between October 1, 2001, and May 31, 2002, a total
weeks, was based on 24-hour dietary recall. Breastfeeding dura- of 1080 mother-infant pairs were assessed for eligi-
tion was equal to the infant age when the mother completely bility; 231 were eligible, were approached, provided
stopped breastfeeding and was censored at the time of 26 weeks informed consent, and were randomized (Fig 1). Of
for mothers who reported that they were still breastfeeding at that
time.
these, 116 were assigned to the intervention group
and 115 to the control group. The baseline character-
Sample Size istics of the 2 groups were similar (Table 1).
On the basis of the results of a previous study,16 we expected an
exclusive breastfeeding rate of 70% at 4 weeks among mother- Attendance at the Routine, Preventive, Outpatient Visit
infant pairs in the control group. We estimated that a sample of Ninety-two mothers (79.3%) assigned to the inter-
108 mother-infant pairs in each group would have 85% power vention group and 8 mothers (7.0%) assigned to the
with a 2-tailed error of .05 to detect a 25% relative increase in
the rate of exclusive breastfeeding at 4 weeks (corresponding to a control group reported that they had attended the
17.5% absolute increase from 70% to 87.5%). We assumed that routine, preventive, outpatient visit in the office of 1
5% of mothers would be lost to follow-up monitoring; therefore, of the 17 primary care physicians participating in the
we planned to include 115 eligible mother-infant pairs in each study (Fig 1). Eighty-seven questionnaires were com-
group.
pleted and returned by 13 physicians (range: 1–26
Statistical Analyses questionnaires per physician). The questionnaires in-
Analyses were conducted according to the intention-to-treat
volved 86 mothers in the intervention group and 1
principle. Comparisons were performed by using the Student’s t mother in the control group. The mothers attended
test for continuous variables and the 2 test or Fisher’s exact test, the physician’s office visit at 15.2 days of infant age,
TABLE 1. Baseline Characteristics of the Mother-Infant Pairs
Characteristics No. of Patients (%)
Intervention Group Control Group
(n 116) (n 115)
Age, y, mean (SD) 29.3 (4.1) 29.7 (4.8)
Education more than high school graduate 87 (75.0) 84 (73.0)
White-collar worker 92 (79.3) 87 (75.6)
Living with spouse/partner 114 (98.3) 112 (97.4)
Smoking history 27 (23.3) 22 (19.1)
Prenatal class attendance 84 (72.4) 88 (76.5)
Primiparity 58 (50.0) 63 (54.8)
Epidural anesthesia 69 (59.5) 73 (63.5)
Delivery through cesarean section 10 (8.6) 10 (8.7)
Female infant 56 (48.3) 53 (46.1)
Gestational age at delivery, wk, mean (SD) 39.7 (1.3) 39.8 (1.2)
Infant birth weight, g, mean (SD) 3314 (441) 3325 (396)
Apgar score of 7 at 1 min 1 (0.9) 0
Breastfed within 1 h after birth 48 (41.4) 53 (46.1)
Expected duration of breastfeeding, mo, 4 (3–6) 4 (3–6)
median (interquartile range)
Postpartum length of stay of 4 d 57 (49.1) 59 (51.3)
Return to work or school at 18 wk 40/112 (35.7) 35/114 (30.7)
e142 BREASTFEEDING SUPPORT BY TRAINED CLINICIANS
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6. on average (SD: 4.2 days). The most frequent breast- breast (4.5% vs 16.7%), mastitis (2.7% vs 2.6%), and
feeding-related problems reported by the physicians other or unspecified difficulties (24.1% vs 38.6%).
were breast pain or soreness (26 cases, 29.9%), jaun- The rates of mothers reporting fair or high satisfac-
dice (15 cases, 17.2%), nipple cracks (14 cases, 16.1%), tion with breastfeeding experiences did not differ
latching difficulties (6 cases, 6.9%), desire to discon- significantly between the 2 groups.
tinue (5 cases, 5.7%), oral thrush (3 cases, 3.4%),
mastitis (1 case, 1.1%), insufficient weight gain (1 DISCUSSION
case, 1.1%), and colic (1 case, 1.1%). The most fre- This prospective randomized trial demonstrates
quent behaviors reported by the physicians were that, compared with usual care, attending a routine,
counseling (25 cases, 28.7%), providing information preventive, outpatient visit in the office of a primary
on a peer support group (15 cases, 17.2%), prescrib- care physician by 2 weeks of infant age is associated
ing medications (10 cases, 11.5%), scheduling a sub- with a significant increase in the rate of exclusive
sequent office visit (8 cases, 9.2%), and prescribing a breastfeeding at 4 weeks (83.9% vs 71.9%) and longer
breast pump (5 cases, 5.7%). No mother-infant pair median breastfeeding duration (18 weeks vs 13
was prescribed laboratory tests. weeks). The benefits of exclusive breastfeeding for
infant health are documented in a vast scientific lit-
Outcomes erature,23 and exclusive breastfeeding is also widely
Outcomes were unknown for 4 mother-infant considered to be a strong predictor of longer breast-
pairs in the intervention group and 1 mother-infant feeding duration. Our findings were robust, because
pair in the control group (Fig 1). Therefore, data for the increase in the rate of exclusive breastfeeding
112 mother-infant pairs in the intervention group persisted after controlling for potential confounding
and 114 in the control group were available for anal- factors in the multivariate analysis (adjusted odds
ysis. ratio: 2.44; 95% CI: 1.18 –5.03). The improvements in
At 4 weeks of infant age, the rate of exclusive breastfeeding outcomes were logically paralleled by
breastfeeding was significantly higher in the inter- a decrease in the rate of mothers reporting any
vention group than in the control group (Table 2). In breastfeeding difficulties in the intervention group
the multivariate analysis, the association between the (55.3% vs 72.8%). This was likely related to the high
intervention and exclusive breastfeeding at 4 weeks level of attendance at the routine, preventive, outpa-
remained significant after adjustment for potential tient visit in the intervention group (79.3%). This
confounding (adjusted odds ratio: 2.44; 95% CI: 1.18 – outpatient visit gave the physicians the opportunity
5.03) (Table 3). No first-order interaction terms for to screen and manage early breastfeeding difficulties
interactions between the intervention group and the and to prevent early discontinuation. One surprising
predictors entered in the model were statistically finding was that the satisfaction rates were equally
significant. With the assumption that missing data high for the 2 groups, despite a significant difference
were negative outcomes in the intervention group in breastfeeding duration (18 weeks vs 13 weeks).
(n 4) and a positive outcome in the control group Satisfaction with breastfeeding experiences is proba-
(n 1) in the sensitivity analysis, the rate of exclu- bly not entirely determined by the discrepancy be-
sive breastfeeding at 4 weeks remained higher, al- tween baseline expectations and final outcomes, and
though not significantly different, in the intervention unmeasured psychologic factors may affect baseline
group, compared with the control group (94 of 116 expectations during breastfeeding experiences, a
cases [81.0%] vs 83 of 115 cases [72.2%]; hazard ratio: phenomenon that is called maturation bias.
1.12; 95% CI: 0.97-1.30). There was no significant Evidence-based data suggest that exclusive breast-
difference between the 2 study groups with respect feeding rates are increased by support for mother-
to the rate of any breastfeeding at 4 weeks. The infant pairs.24 Most interventions aiming to support
median breastfeeding duration was higher in the breastfeeding are time-intensive interventions that
intervention group (18 weeks) than in the control rely on specifically trained nurses or peer counselors
group (13 weeks) (Fig 2). The mothers in the inter- and that occur as adjuncts to routine preventive vis-
vention group were less likely to report any breast- its.8 However, offering support in addition to routine
feeding difficulties (Table 2). The main breastfeeding preventive visits has a limited impact on breastfeed-
difficulties reported were breast pain or soreness ing outcomes in developed countries.12,13,25–27 In
(28.6% in the intervention group vs 31.6% in the contrast, our findings are in accordance with the
control group), not enough milk (23.4% vs 37.7%), results of prior observational studies showing that
lack of motivation (20.5% vs 30.7%), infant refused support provided by clinicians through specific ad-
TABLE 2. Univariate Analyses of Outcome Measures
Outcome No. of Patients (%) Hazard Ratio P Value
(95% CI)
Intervention Group Control Group
Exclusive breastfeeding at 4 wk 94/112 (83.9) 82/114 (71.9) 1.17 (1.01–1.34) .03
Any breastfeeding at 4 wk 100/112 (89.3) 93/114 (81.6) 1.09 (0.98–1.22) .10
Duration of any breastfeeding, wk, median 18 13 1.40 (1.03–1.92) .03
Reporting any breastfeeding difficulties 62/112 (55.3) 83/114 (72.8) 0.76 (0.62–0.93) .01
Very or fairly satisfied with experience of 102/112 (91.1) 100/114 (87.7) 1.04 (0.95–1.14) .41
breastfeeding
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7. TABLE 3. Multivariate Analysis of Mother-Infant Pair Characteristics Associated With Exclusive Breastfeeding at 4 Weeks
Characteristics No. of Patients Adjusted P Value
Odds Ratio
Exclusive Lack of Exclusive (95% CI)
Breastfeeding at 4 wk Breastfeeding at 4 wk
(n 176) (n 50)
Intervention group 94 (53.4) 18 (36.0) 2.44 (1.18–5.03) .02
Age
25 y 18 (10.2) 13 (26.0) 0.40 (0.14–1.14) .09
25–29 y 66 (37.5) 18 (36.0) 1.00
30–34 y 69 (39.2) 13 (26.0) 1.22 (0.50–2.98) .66
35 y 23 (13.1) 6 (12.0) 0.75 (0.23–2.51) .65
Education more than high school graduate 132 (75.0) 36 (72.0) 0.90 (0.37–2.17) .80
White-collar worker 139 (79.0) 36 (72.0) 1.51 (0.63–3.66) .36
Smoking history 34 (19.3) 13 (26.0) 0.98 (0.41–2.33) .96
Prenatal class attendance 133 (75.6) 37 (74.0) 1.92 (0.76–4.84) .17
Primiparity 85 (48.3) 34 (68.0) 0.87 (0.32–2.41) .80
Epidural anesthesia 100 (56.8) 39 (78.0) 0.32 (0.13–0.76) .01
Gestational age at delivery
37–38 wk 35 (19.9) 11 (22.0) 0.84 (0.32–2.18) .72
39–40 wk 91 (51.7) 33 (66.0) 1.00
40 wk 50 (28.4) 6 (12.0) 3.44 (1.20–9.82) .02
Infant birth weight
3000 g 30 (17.0) 11 (22.0) 0.94 (0.36–2.48) .90
3000–3499 g 79 (44.9) 26 (52.0) 1.00
3500–3999 g 59 (33.5) 10 (20.0) 1.51 (0.62–3.70) .37
4000 g 8 (4.6) 3 (6.0) 0.87 (0.15–4.85) .87
Breastfed within 1 h after birth 83 (47.2) 18 (36.0) 1.65 (0.75–3.61) .21
Postpartum length of stay of 4 d 81 (46.0) 33 (66.0) 0.66 (0.26–1.69) .39
Expected breastfeeding duration of 4 mo 83 (47.1) 17 (34.0) 2.49 (1.12–5.53) .02
Fig 2. Kaplan-Meier estimates of any breastfeeding, stratified according to study group.
vice and practices during routine preventive visits is that it demonstrates that common barriers to breast-
associated with higher exclusive breastfeeding rates feeding support by primary care physicians during
and increased breastfeeding duration.8,14 routine preventive visits can be resolved. Practicing
This study has broader clinical implications, in physicians have a considerable knowledge deficit
e144 BREASTFEEDING SUPPORT BY TRAINED CLINICIANS
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8. regarding breastfeeding, a lack of confidence in their Some mothers who were exclusively breastfeeding at
counseling skills, difficulties in advising mothers 4 weeks might not have maintained that status since
with lactation problems, and limited time to address birth.31 It is interesting to note that these mothers
breastfeeding issues during preventive visits.14,28 who did not maintain exclusive breastfeeding since
Moreover, substantial gaps in communication be- birth returned to exclusive breastfeeding at 4 weeks,
tween clinicians and mothers regarding breastfeed- which is a positive behavior change. Breastfeeding
ing may occur during preventive visits.29 Therefore, duration was assessed retrospectively, on the basis of
we developed a training program on breastfeeding data obtained at 26 weeks. It has been shown that
for pediatricians and family physicians who partici- reported breastfeeding duration can be considered
pated in the study. The successful implementation of accurate, with a long recall period.32 We did not
our training program depended on many factors, assess exclusive breastfeeding duration, however,
including the clinical content, the use of interactive because 6-month exclusive breastfeeding duration
techniques, and the limited amount of time required recall has been shown to be inaccurate.33
for its delivery within the constraints of busy prac- Third, our study was conducted in a single setting
tices (5 hours, delivered in 2 parts). and focused on a socioeconomically low-risk popu-
Despite the encouraging findings of our study, it lation living in a medium-sized city. Moreover, the
should be noted that the median duration of breast- organization of health services has been recognized
feeding in the intervention group (18 weeks) was still as a major factor contributing to breastfeeding initi-
less than the Healthy People 2010 goal. Breastfeeding ation and continuation.34 These facts may limit the
support provided by the primary care physician dur- applicability of our results to other settings or health
ing routine preventive visits is likely to have limited care systems. In addition, the mean length of stay
impact, compared with the effects of various barriers after normal vaginal delivery is much longer in
that affect breastfeeding duration negatively, such as France than in other Western countries, including the
psychologic factors, cultural factors, and return to United States. However, the mean postpartum
work.30 By 18 weeks, only 33.8% of the mothers in length of stay did not differ between the control
our study had returned to work or school, although group and the intervention group in the current
maternity leave ranges from 10 to 18 weeks in study, and the mothers enrolled in each group were
France. This was in accordance with the results of a still breastfeeding at discharge, a point that supports
prior study conducted in the same area, which sug- the effectiveness of our intervention in improving
gested that some mothers benefit from extended breastfeeding outcomes.
leave.20 Specific counseling regarding methods of
breastfeeding after the return to work has been rec- CONCLUSIONS
ommended,29 although robust evidence of the effects The current study provides preliminary evidence
of such counseling on breastfeeding outcomes is cur- of the efficacy of breastfeeding support through an
rently lacking.20 Other approaches, such as part-time early, routine, preventive visit in the offices of
work, are also thought to help mothers combine trained primary care physicians. These findings sup-
breastfeeding and employment.30 port the American Academy of Pediatrics policy
The findings of the current study need to be inter- statement calling for pediatricians to promote and
preted in the context of its limitations. First, self- support breastfeeding.2 Our findings also suggest
selection of motivated clinicians participating in this that a short training program for practicing physi-
study was likely an important factor contributing to cians may contribute to improving breastfeeding
the improvements in breastfeeding outcomes in the outcomes. We recommend that multifaceted inter-
intervention group. Although this trial demonstrates ventions aiming to support breastfeeding involve
the efficacy of support for breastfeeding delivered by pediatricians and family physicians in developed
the primary care physician through an early, routine, countries with low or intermediate breastfeeding
preventive visit, the effectiveness of this type of sup- prevalences.
port is probably less in daily practice. This issue
deserves additional study, although implementation ACKNOWLEDGMENTS
trials of breastfeeding support during routine pre- This study was supported in part by grants from the Union
ventive visits would be challenging to conduct in Professionnelle des Medecins Liberaux de la Region Rhone Alpes
´ ´
(Lyon, France) and by grants from the Delegation Regionale a la
´ ´ ´
developed countries. Recherche Clinique, Centre Hospitalier Universitaire (Grenoble,
Second, it was not possible to blind observers in France). J.L. was supported by a grant from the Egide Foundation
this randomized, open trial, because of interactions (Program Lavoisier).
with mothers during the outpatient visit and assess- We thank Linda Northrup for editorial assistance.
The following investigators participated in the study: Myriam
ment of breastfeeding outcomes. Therefore, we used Bell, Arnaud Buffin, and Nathalie Gelbert-Baudino (pediatricians);
a postal questionnaire to assess breastfeeding out- Corinne Chabert, Anne Chatriot, Marie-Lise Cressens, Christine
comes, to limit the risk of observer bias. Some moth- Gomez, Frederique Rogeaux, Emmanuel Cussac, and Martine Sut-
ers might have given erroneous information regard- ter (pediatricians, Protection Maternelle et Infantile); and Emman-
ing their breastfeeding status at 4 weeks or the uelle Groult, Bernard Lanier, Christian Perrotte, Francis Ravier,
Jean-Luc Vignoulle, Camille Schelstraete, and Jean-Louis Voyron
duration of breastfeeding. However, it was unlikely (family physicians) (Chambery, France).
that misclassification bias in reporting breastfeeding
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e146 BREASTFEEDING SUPPORT BY TRAINED CLINICIANS
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10. Efficacy of Breastfeeding Support Provided by Trained Clinicians During an
Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226
Mother-Infant Pairs
Jose Labarere, Nathalie Gelbert-Baudino, Anne-Sophie Ayral, Cathy Duc, Martine
Berchotteau, Nathalie Bouchon, Camille Schelstraete, Jean-Philippe Vittoz, Patrice
Francois and Jean-Claude Pons
Pediatrics 2005;115;e139-e146
DOI: 10.1542/peds.2004-1362
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