Exclusive Rates Research Articles

THE MAIN CHALLENGES OF THE SOCIAL PROTECTION SYSTEM IN POST-PANDEMIC GEORGIA

In the post-pandemic period in Georgia, despite the high rate of economic growth, poverty and social exclusion remain an acute challenge. The social protection mechanisms operating in the country, such as one-time cash assistance, targeted social assistance, and other support services, such as housing and shelter, services for disabled persons, etc., still cannot provide the desired living conditions for citizens. Establishing and further improving a sustainable, fair, and effective social protection system is one of the country's priorities. Ensuring the effectiveness of the targeted social assistance system is a significant task of both the central and municipal governments. The targeted social assistance program operating in Georgia, which assesses the socio-economic status of families according to the updated methodology, tries to realistically evaluate the needs of the socially vulnerable part of the population, children and families with children, and accordingly determine the main directions of social policy. It is also significant to promote the integration of individuals with disabilities, to improve the socio-economic status and living conditions of internally displaced individuals and eco-migrants, and others. The paper analyzes the primary mechanisms, achievements, and challenges of the social protection system in Georgia. Recommendations are presented in the direction of overcoming poverty and raising the population's standard of living.

Do children receiving care and support have higher rates of school exclusion than their peers?

The Children, Young People and Education Committee recently held an inquiry to scrutinise the Welsh Government’s progress in delivering its Programme for Government Commitment to ‘explore radical reform of current services for children looked after and care leavers’. A key observation highlighted in their report was that there was a lack of robust data collected about various aspects of the care system. Notably it was highlighted that there is a lack of data collected about permanent exclusions and suspensions from school amongst children looked after in out of home care (CLA). This study was therefore designed to fill this evidence gap. Using anonymised linked administrative data held in SAIL Databank to identify those receiving care and support (CRCS) from their local authority, rates of permanent exclusion and suspension have been determined for the different groups within the CRCS cohort (CLA, those on the child protection register (CPR) and those receiving support who are neither CLA nor CPR) which have then been compared to their peers without this experience. Factors such as phase of education, setting, free school meal entitlement, having additional learning needs, age and gender have also been considered along with the reason for the suspension or exclusion. In drawing comparisons with peers, an intersectional approach was adopted to identify disparity. It is hoped that findings from this student study will stimulate debate and contribute towards the development of changes in Welsh policy.

Development of a breastfeeding co-parenting intervention program for couples with primiparas: a program development process study

BackgroundThe exclusive breastfeeding rates is low in some countries. Low breastfeeding rates results in higher healthcare expenses and adverse health outcomes for individuals and society. Co-parenting is effective in promoting breastfeeding as it involves shared responsibility and collaboration between parents in raising children. However, the current breastfeeding co-parenting intervention programs exhibits significant variations in components, timing, and duration across studies. An evidence-based breastfeeding co-parenting intervention program is essential for enhancing breastfeeding-related outcomes.ObjectiveTo develop an evidence-based breastfeeding co-parenting intervention program for healthcare providers to guide parents with primiparas on breastfeeding.MethodTo form an initial version of the intervention program, a systematic literature review was conducted to consolidate information on current intervention programs. Two rounds of Delphi method were followed to gather expert comments for the program modification to establish the formal version.ResultsFourteen articles published between 1995 and 2022 were screened. Details of these researches, including starting and ending time, duration and specific contents, were integrated to developed the initial program. Then, six experts completed the two rounds consultation with a positive coefficient of 85.71%, coefficient judgment basis of 0.93, familiarity coefficient of 0.87, authority coefficient of 0.90 and the Kendall’s W of 0.62. Finally, an evidence-based breastfeeding co-parenting intervention program was constructed in this study, consisting of breastfeeding co-parenting courses, individual counselling and a father’s support group.ConclusionThis research developed a breastfeeding co-parenting intervention program for healthcare providers to guide primiparous parents to improve breastfeeding rates. Through a systematic literature review and Delphi method with good reliability, the program integrates breastfeeding courses, individual counseling, and a father’s support group. Future research will focus on evaluating its impact and scalability to benefit maternal and infant health globally.Trial registrationChiCTR.org.cn (ChiCTR2300069648). Registration date: 2023-03-22.

Association between breastfeeding duration and BMI, 2009-2018: a population-based study.

In the 21st century, childhood overweight and obesity have become major public health issues worldwide. Previous studies have shown that breastfeeding helps prevent overweight or obesity in children. Despite the significant advantages of breastfeeding, the global exclusive breastfeeding rate for infants under 6 months old is only 40%, while in the United States, the rate is only 25%. The aim of this study is to explore the relationship between breastfeeding duration and BMI in children aged 2 to 6 in the United States, and to raise awareness of breastfeeding. A cross-sectional study included 2,769 participants between the ages of 2 and 6 from a sample that represented the entire NHANES 2009-2018. Data was analyzed using EmpowerStats, (www.empowerstats.com) linear regression as well as Chi-square test, t-tests, multivariate regression analysis and smooth cure fitting were done. Breastfeeding duration long-term group exhibited a statistically significant negative association with BMI, with a regression coefficient of -0.21 (P < 0.05). The continuous analysis of breastfeeding duration by tertile also demonstrate a statistically significant negative association with BMI. Subgroup analysis revealed that the potential benefits of breastfeeding on BMI were more obvious in low-income environments and maternal age 18 to 35 years, with a regression coefficient of -0.57 and -0.24, respectively (all P < 0.05). The findings emphasize the importance of breastfeeding in reducing childhood overweight/obesity and preventing associated diseases, both in clinical and public health settings.

Exclusive Breastfeeding Rates Upon Hospital Discharge at a Tertiary Centre Prior to and During the COVID-19 Pandemic

This study aimed to describe exclusive breastfeeding (EBF) rates at discharge at Sunnybrook Health Sciences Centre and explore factors that contributed to changes in breastfeeding rates during the COVID-19 pandemic. Overall, 4762 patient charts were reviewed, 2000 from the pre-pandemic period, and 2762 from the lockdown period. Data was collected on EBF status at discharge, on maternal health history, and on infant characteristics. EBF rates fell from 75.8% to 73.85% from the pre-COVID-19 to COVID-19 period. During the pandemic, EBF was positively associated with BMI <30, spontaneous conception, and infants at risk of low blood sugar. Non-spontaneous conception was associated with lower EBF.

Knowledge, Attitude, and Practice of Breastfeeding among South Indians: A Cross-sectional Study

Introduction: Research shows that exclusively breastfed infants have a 13% lower mortality risk. However, only 37% of infants in Low and middle income country (LMIC) are exclusively breastfed. Materials and Methods: This cross-sectional study was conducted in a Chennai hospital’s outpatient department, focusing on pediatrics. The study commenced after obtaining ethical clearance (99/IEC-SMMCHRI). Breastfeeding knowledge, attitude, and practice (KAP) scales were developed by modifying existing KAP tools. The KAP questionnaire was based on the World Health Organization. The same was applied to 250 consenting mothers. Results: Participants had a mean age of 27 years, with the youngest mother at 19 and the oldest at 40. Forty-one percent had finished high school, and 37% had completed undergraduate studies. Eighty-eight percent had strong breastfeeding comprehension, and 96% had a favorable attitude. However, only 32% exclusively breastfed. The study found significant correlations between knowledge and behavior (χ2 = 4.27, P = 0.04) and between attitude and behavior (χ2 = 5.69, P = 0.017). Mothers with adequate knowledge tended to follow recommended feeding practices, and those with a positive attitude displayed good practices. Conclusion: Despite positive attitudes toward breastfeeding, the cultural practice of introducing prelacteal food hinders exclusive breastfeeding, leading to negative outcomes. While there have been some improvements in exclusive breastfeeding rates, addressing this disparity could reduce child mortality rates. The outcomes of the research will be highly beneficial for primary care physicians in their efforts to promote exclusive breastfeeding among expectant mothers.

An economic evaluation on sub-optimal breastfeeding in Hong Kong: Infant health outcomes and costs.

This study estimated the healthcare cost savings for the government due to the prevention of gastroenteritis (GE) infections and lower respiratory tract infections (LRTI) in the first year of life, attributed to an increase in the exclusive breastfeeding rate at 4 months in Hong Kong. The model used the best available data inputs, with uncertainty considered using probabilistic sensitivity analysis. We additionally assessed the impact of neonatal jaundice (NNJ) on the economic benefits of increasing exclusive breastfeeding rates. During 2010-2019, five admissions for GE and three admissions for LRTI per 1000 births would have been prevented in the first year of life if the exclusive breastfeeding rate at 4 months increased from the actual levels (~15-30%) to 50%, resulting in annual healthcare cost savings of USD1.05 (95% CI 1.03-1.07) million/year. The cost saving would reach USD1.89 (95% CI 1.86-1.92) million/year if the exclusive breastfeeding rate at 4 months increase to 70%. However, if higher NNJ admissions during 7-90 days related to more exclusive breastfeeding are considered, the cost saving would reduce by 60%. Our findings can guide policymakers in allocating budget and resources for breastfeeding promotion in Hong Kong. The prevention of unnecessary NNJ admissions would maximise the economic benefits of exclusive breastfeeding at 4 months.

Adaptive Top-K Algorithm for Medical Conversational Diagnostic Model.

With advancements in computing technology and the rapid progress of data science, machine learning has been widely applied in various fields, showing great potential, especially in digital healthcare. In recent years, conversational diagnostic systems have been used to predict diseases through symptom checking. Early systems predicted the likelihood of a single disease by minimizing the number of questions asked. However, doctors typically perform differential diagnoses in real medical practice, considering multiple possible diseases to address diagnostic uncertainty. This requires systems to ask more critical questions to improve diagnostic accuracy. Nevertheless, such systems in acute medical situations need to process information quickly and accurately, but the complexity of differential diagnosis increases the system's computational cost. To improve the efficiency and accuracy of telemedicine diagnostic systems, this study developed an optimized algorithm for the Top-K algorithm. This algorithm dynamically adjusts the number of the most likely diseases and symptoms by real-time monitoring of case progress, optimizing the diagnostic process, enhancing accuracy (99.81%), and increasing the exclusion rate of severe pathologies. Additionally, the Top-K algorithm optimizes the diagnostic model through a policy network loss function, effectively reducing the number of symptoms and diseases processed and improving the system's response speed by 1.3-1.9 times compared to the state-of-the-art differential diagnosis systems.

A study of the teenage population in the Portibi subdistrict of the North Padang Lawas Regency

The percentage of teenage pregnancies in Indonesia is 0.02% at the age of &lt;15 years and 1.97% at the age of 15-19 years in Portibi sub-district, North Padang Lawas District. Adolescent mothers are known to have low exclusive breastfeeding coverage rates. The purpose of this study was to determine the factors that influence exclusive breastfeeding in adolescent mothers in Portibi sub-district, North Padang Lawas Regency. This study used a survey method with a cross-sectional design. The study population was teenage mothers who had babies aged 6-24 months in Portibi sub-district, North Padang Lawas Regency. Data collection using questionnaires. Bivariate analysis used chi square and fisher's exact test while multivariate analysis used logistic regression. The results showed 46.7% of teenage mothers provided exclusive breastfeeding. Bivariate analysis showed that pregnancy status (p=0.029), perceived birth experience (p=0.045), perceived breastfeeding (p=0.005), husband support (p=0.009), family support (p=0.000) were associated with exclusive breastfeeding, education level (p=0.143) and employment status (p=0.352) were not associated with exclusive breastfeeding. Multivariate analysis showed that family support (p=0.014; RP=7.637) and breastfeeding perception (p=0.015; RP=9.746) were associated with exclusive breastfeeding. Family support was the most dominant factor in exclusive breastfeeding among adolescent mothers. Adolescent mothers who received support from their family and had a positive perception of breastfeeding had a 72.7% probability of exclusive breastfeeding.

Interactive Nursing Education to Promote Exclusive Breastfeeding.

Background: Although breast milk provides the most robust human nutrition and offers extensive immunological protection, many mothers are still hesitant to breastfeed exclusively, and the rate of exclusive breastfeeding declines significantly over time in the postpartum period. Objective: The objective is to educate nurses on the practice of exclusive breastfeeding. Methods: Breastfeeding education was provided to nurses (n = 11) at an urban academic medical center. The education included hands-on skills training, case scenarios, and interactive games. Knowledge was measured using an eight-item multiple choice pre- and posttest. Exclusive breastfeeding rates were measured before and after the 10-week intervention period using a report on infant feeding practices. Results: Comparison of pre- and posttest scores revealed nurses' knowledge increased by 25%; however, exclusive breastfeeding rates were not impacted. Conclusion: Several limitations may have impacted the rates of exclusive breastfeeding. Other strategies may be needed to provide a holistic and effective approach. Barriers related to the lack of exclusive breastfeeding should be explored further. Implications for Nursing: Ongoing education is an effective method to increase nurses' knowledge. Advanced practice nurses, in a unique position to impact nursing practice and influence health, are encouraged to continue to identify and evaluate methods to increase rates of exclusive breastfeeding.

Family-centered care for newborns: a global perspective and review.

Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother-child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal-infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.

ANÁLISE DAS PRÁTICAS DE ALIMENTAÇÃO EM RECÉM-NASCIDOS ADMITIDOS EM UNIDADE DE TERAPIA INTENSIVA NEONATAL DE UMA MATERNIDADE DE REFERÊNCIA

Introduction: The nutritional need is high in the newborn (NB), especially in premature infants, and the supply of nutrients is an important factor for survival, as a result of the growth rate. The nutritional therapy used (parenteral and/or enteral) varies according to the gestational age and the follow-up becomes fundamental in the evolution, because the early detection of nutritional insufficiencies allows an adequate intervention. Objective: to analyze feeding practices in newborns admitted to a neonatal intensive care unit, based on the identification of the day of life on which the enteral diet was started, the beginning and the time of use of parenteral nutrition, in addition to describing the exclusive breastfeeding rate at hospital discharge and nutritional status at admission and discharge. Methodology: This is a descriptive, retrospective study, carried out in a Reference Maternity Hospital in the State of Piauí through the analysis of medical records and Quali-Neo records of newborns admitted to the neonatal intensive care unit of the aforementioned maternity hospital during the period from January to December 2020. Results: 161 forms were evaluated, with a predominance of male newborns (60.87%), mean birth weight at admission of 1,711g and at discharge of 2,213g, mean Gestational Age of 32 weeks. Enteral diet was started, on average, on the fifth day of life, the most common was Breast Milk and/or Colostrum. Conclusion: The newborns received an early and adequate enteral diet, presenting weight gain during the period of hospitalization comparable to others hospitals, with human milk being the main caloric supply.

Capturing anatomy in computed tomography scans for genital pathology.

In this cross-sectional study,we aimed to characterize how frequently the anatomy of interest (AOI) was excluded when evaluating genital pathology using the current CT pelvis protocol recommended by the American College of Radiology and evaluate how AOI exclusion affects patient management. We retrospectively reviewed medical records, using diagnosis and CPT codes, of patients admitted with genital pathology who obtained a CT scan at our institution from July 1, 2020-April 30, 2023. Baseline patient demographics were included. Data about each index CT scan (scan obtained at our institution) were recorded and assessed for exclusion of the AOI. Statistical analysis was performed to determine the rate of AOI exclusion and to compare patient management between patients with AOI excluded versus those without AOI exclusion. 113 presentations for genital pathology included an index CT scan and were included for analysis. Patients were primarily men (98%) with a mean age of 53.1 years (SD 13.9). The most common diagnoses were Fournier's gangrene (35%), scrotal abscess (22%) and unspecified infection (19%). 26/113 scans (23%) did not capture the entire AOI. When the AOI was missed during the index scan, there was a higher rate of obtaining additional scans (38% vs. 21%), but a similar rate of intervention (77% vs. 63%) when compared to index scans that captured the entire AOI.35 scans (31%) had protocol-extending instructions;index scans that captured the entire AOI were more likely to have specific protocol-extending instructions(38% vs. 8% p < 0.01). Creating a specific CT protocol for genital pathology could decrease the amount of inappropriate irradiation and improve AOI capture rates without relying on specific request for protocol deviation.

Unintended consequence of high bid price exclusion in IPO auctions: Evidence from China

Using a reform to relax the exclusion rate of highest bids in the book-building process as an exogenous shock, we find that IPO underpricing decreases, which indicates that excluding a certain percentage of the highest bids impairs IPO pricing efficiency. Further tests reveal that relaxing the mandate increases investors’ valuation of an IPO, thereby decreasing IPO underpricing. Our results also suggest that the relaxation of the stipulation motivates investors to provide more information, as revealed by fewer anchoring bids and reduced herding behavior, as well as higher opinion divergence and better predictive power for investor bids on post-IPO prices.

Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation

BackgroundExtremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications.MethodsWe performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding.ResultsThe KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants.ConclusionKangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.

Infant feeding knowledge, attitudes and practices of HIV-positive breastfeeding mothers.

Assessment of infant feeding knowledge, attitudes and practices of human immunodeficiency virus (HIV)-positive breastfeeding mothers may determine compliance with the chosen feeding method. The study assessed knowledge, attitudes and practices on infant feeding among HIV-positive breastfeeding mothers. The study was conducted at five clinics in the Chief Albert Luthuli sub-district of Mpumalanga, South Africa. A descriptive cross-sectional study with a convenient sample of 155 HIV-positive breastfeeding mothers. More than half of the participants (54.8%) were knowledgeable of exclusive breastfeeding in general. However, less than half were knowledgeable of exclusive breastfeeding in the context of HIV (46.5%), mixed feeding (28.4%) and replacement feeding (49.0%). Most participants (85.8%) reported that they were advised to exclusively breastfeed for 6 months, 61.3% intended to exclusively breastfeed for 6 months, and 29% intended to stop breastfeeding at 6 months. Most participants (64.5%) intended to introduce solids at 6 months, and for participants who intended to introduce solids before 6 months, 37.7% did not believe that exclusive breastfeeding was sufficient for the baby. Although most participants were knowledgeable about exclusive breastfeeding, there were misconceptions that required attention such as the lack of knowledge on exclusive breastfeeding in the context of HIV, mixed feeding and replacement feeding. Exclusive breastfeeding for 6 months was the most emphasised infant feeding practice. This study builds on existing literature on infant feeding knowledge, attitudes and practices and provides a basis for interventions for improved exclusive breastfeeding rates.

Gender and child feeding practices in Belize- a trend analysis

The study aimed to determine the trend and gender differences in child feeding practices in Belize based on consecutive multiple indicator cluster surveys (MICS) using a retrospective quantitative study. The secondary analysis of the last consecutive MICS data from 2006, 2011 and 2015-16 was done using SPSS software version 23. Association between gender and feeding practices was determined by bivariate analysis using chi-square test and p value &lt; 0.05 was considered statistically significant. There was increased gender differentials in optimal feeding practices in children over the study period. The inequalities between male and female increased over the study period for most of the feeding practices except for exclusive breastfeeding where the gender inequality diminished. The exclusive breastfeeding rate among female children was higher than among male children in the three surveys but significant only in 2006 and 2011 surveys, p&lt;0.05. More female children were timely initiated on complementary feeding compared to male children in the three surveys and was found to be significant in 2006 and 2015 surveys, p&lt;0.05. Minimal meal frequency and minimal dietary diversity was higher among female than among male but there was no significant difference(p&gt;0.05). The study shows evidence of gender differential in feeding practices. There is need to improve gender sensitization in terms of feeding practices within the households; develop and implement culturally appropriate gender sensitive guidance and approaches on optimum infant and young child feeding practices in the country.

Breastfeeding support among healthcare workers in Nigeria

BackgroundThe exclusive breastfeeding rate in Sub-Saharan Africa is abysmally low, and based on current trends, achieving the World Health Organization's (WHO) global nutrition goal of a 50% exclusive breastfeeding rate by 2025 will require an additional three decades.MethodsThis is a cross-sectional study involving healthcare workers (HCWs) providing direct care to breastfeeding mothers in six geopolitical zones in Nigeria. HCWs were recruited using a stratified random sampling method, with a minimum sample size of 1537. Data was collected through validated-interviewer-administered-questionnaires.ResultsThe mean age of the 1294 respondents was 35.2 ± 10.0 years, with a male-to-female ratio of 1:3. Overall, breastfeeding knowledge was subsufficient (41.2% across three domains), with specific knowledge gaps observed in breastfeeding for mothers with breast cancer (13.4%) and hepatitis B (59.4%). Only 18.9% correctly identified laid-back and cross-cradle breastfeeding positions. High school and tertiary education were significantly associated with sufficient breastfeeding knowledge (AOR: 2.2, 95% CI 1.299–3.738; AOR: 2.0, 95% CI 1.234–3.205). Negative attitudes toward breastfeeding support were associated with being female (AOR: 1.5, 95% CI 1.094–1.957), while being a doctor was linked to the lowest instructional support (AOR: 0.3, 95% CI 0.118–0.661). Positive attitudes toward breastfeeding support were significantly associated with sufficient knowledge (AOR: 2.4, 95% CI 1.833–3.161; p < 0.001), but not with technical knowledge (AOR: 0.8, 95% CI 0.629–0.993).ConclusionHealthcare workers showed subsufficient overall breastfeeding knowledge, especially regarding breastfeeding in maternal illnesses and positioning. Targeted programs are needed to improve breastfeeding support knowledge, instructional support and attitudes, especially among female HCWs and physicians.

O-188 Conventional in vitro fertilisation versus intracytoplasmic sperm injection in first cycle patients without severe male factor infertility (INVICSI): a randomised, controlled, open-label, multicentre trial

Abstract Study question Is the cumulative live birth rate (CLBR) after ICSI superior to conventional IVF (c-IVF) in first cycle fertility patients without severe male factor infertility? Summary answer In couples without severe male factor infertility, ICSI does not improve the CLBR compared to c-IVF after transfer of embryos from the first oocyte collection What is known already The ICSI procedure, originally developed for addressing severe male factor infertility, has seen expanded utilisation across various causes of infertility. Large retrospective studies and a recent randomised controlled trial (RCT) demonstrated comparable reproductive outcomes between ICSI and c-IVF in couples without male factor infertility. In approximately half of infertility cases, a male factor is involved, with about one-third attributed to male factor alone. Despite this, ICSI currently constitutes two-thirds of all assisted reproductive technology treatments worldwide Study design, size, duration Open-label, two-armed, multicentre RCT. A sample size of 784 women was required to detect a clinically relevant change of 10 percentage points with 80% power. Accounting for an expected 5% exclusion rate (dropouts and unexpected severely decreased quality sperm samples on the day of oocyte retrieval), 824 women were recruited from six public fertility clinics in Denmark between Nov 29, 2019, and Dec 14, 2022 Participants/materials, setting, methods Eligible participants were women aged 18-42 years and in their first treatment cycle with a partner/donor with normal or lightly to moderately decreased sperm quality. Randomisation was performed in a 1:1ratio between ICSI and c-IVF. The primary outcome was CLBR. Follow-up continued until the primary outcome was achieved or for a minimum of one year after the last participant’s inclusion.The primary outcome was assessed in an intention to treat (ITT) and a per protocol analysis Main results and the role of chance In total, 414 and 410 women were randomised to ICSI and c-IVF, respectively. Results include fresh as well as frozen-thawed embryo transfers from the first oocyte collection and are displayed as ITT. All transfers were elective single embryo transfers or single embryo transfers. The cumulative probability of achieving a live birth for couples/women undergoing ICSI was not different compared to those undergoing c-IVF (CLBR: ICSI 42.0% vs. c-IVF 46.6%, Risk ratio: 0.90, 95% CI: 0.77-1.05). The median time from inclusion to live birth did not differ between ICSI and c-IVF (309 days (IQR 268-378) vs 308 days (IQR 269-356); p = 0.12). Total fertilisation failure was seen in 4.9% of the ICSI group compared to 3.8% in the c-IVF group (Risk ratio: 1.29, 95% CI: 0.68-2.54) Limitations, reasons for caution This study was designed with 80% power to identify a 10% percentage point difference in CLBR between ICSI and c-IVF. We cannot dismiss the possibility of a smaller difference between the two methods Wider implications of the findings Our study, supported by prior research, shows that c-IVF rather than ICSI should be the first choice in initial cycles for patients without severe male factor infertility. Fertility staff should inform first cycle patients that ICSI does not increase the live birth rate for couples without severely decreased sperm quality Trial registration number NCT04128904

Effectiveness of Husbands' Support Exclusive Breastfeeding Facebook Programme During the COVID-19 Pandemic.

The exclusive breastfeeding rate for six months in the Northeast region of Thailand has recently significantly decreased, in contrast to all other regions in Thailand. Facebook is widely used worldwide to enhance knowledge, attitudes, and behaviours that support breastfeeding. This study aims to assess the effectiveness of a Facebook programme for husbands' support of exclusive breastfeeding during the COVID-19 pandemic. We employed a quasi-experimental study design conducted from September 2020 to November 2021. Data were collected from two tertiary hospitals in Thailand, involving a total of 72 participants-36 in the experimental group and 36 in the control group. These participants were husbands of postpartum women admitted to the postpartum wards. Four research instrument were the demographic questionnaire, the Husband's EBF Knowledge, Husband's EBF Attitude, and Husband's EBF Behavior Questionnaires. Demographic data were analysed using frequency distribution, percentages, and the Chi-square test. The mean difference in husbands' exclusive breastfeeding (EBF) knowledge scores was analysed using an independent samples t-test. At baseline, there was no significant difference in husbands' exclusive breastfeeding (EBF) knowledge scores between the experimental and control groups (p = 0.82). By the 1st month, there was a significant difference in the mean scores of husbands' EBF knowledge between the two groups (p < 0.01). However, the mean score of attitude at 6-month (mean=108.03, SD=19.89) was higher than the mean score of behaviour at baseline (mean=101.81, SD=17.99), but it was not significant (p=0.40). In addition, the different score of behaviour among baseline (mean=65.86, SD=7.02) and 6-month (mean=68.58, SD=10.42) was not significant (p=0.24). The findings suggest that the Facebook programme is an effective platform for conveying exclusive breastfeeding (EBF) knowledge to husbands in Northeast Thailand during the COVID-19 pandemic.