Exclusive Rates Research Articles

Effectiveness of a home-based peer support programme for Chinese mothers with low breastfeeding self-efficacy to increase the exclusivity and duration of breastfeeding: study protocol of a randomised control trial

IntroductionBreastfeeding is associated with many health benefits for both women and their newborns. Exclusive breastfeeding has been recommended for at least 6 months to optimise infant growth, development and health....

Midwifery continuity of care, breastfeeding and neonatal hyperbilirubinemia: A retrospective cohort study

AimTo examine the association between Midwifery Continuity of Care (MCoC) and exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia. MethodsA matched cohort design was employed using data from the Swedish Pregnancy Register. The study included 12,096 women who gave birth at a university hospital in Stockholm, Sweden from January 2019 to August 2021. Women and newborns cared for in a MCoC model were compared with a propensity-score matched set receiving standard care. Risk ratios (RR) were determined with 95 % confidence intervals (CI) based on the matched cohort through modified Poisson regressions with robust standard error. A mediation analysis assessed the direct and indirect effects of MCoC on exclusive breastfeeding at hospital discharge and neonatal hyperbilirubinemia and to what extent the association was mediated by preterm birth. FindingFindings showed that MCoC was associated with a higher chance of exclusive breastfeeding rate (RR: 1.06, 95 % CI: 1.01–1.12) and lower risk of neonatal hyperbilirubinemia (RR: 0.51, 95 % CI: 0.32–0.82) compared with standard care. Mediation analysis demonstrated that lower preterm birth accounted for approximately 28 % of total effect on the reduced risk of neonatal hyperbilirubinemia. Discussion/ConclusionThis matched cohort study provided preliminary evidence that MCoC models could be an intervention for improving exclusive breastfeeding rates at hospital discharge and reducing the risk of neonatal hyperbilirubinemia.

Childhood Opportunity and Acute Interstage Outcomes: A National Pediatric Cardiology Quality Improvement Collaborative Analysis.

The interstage period after discharge from stage 1 palliation carries high morbidity and mortality. The impact of social determinants of health on interstage outcomes is not well characterized. We assessed the relationship between childhood opportunity and acute interstage outcomes. Infants discharged home after stage 1 palliation in the National Pediatric Quality Improvement Collaborative Phase II registry (2016-2022) were retrospectively reviewed. Zip code-level Childhood Opportunity Index (COI), a composite metric of 29 indicators across education, health and environment, and socioeconomic domains, was used to classify patients into 5 COI levels. Acute interstage outcomes included death or transplant listing, unplanned readmission, intensive care unit admission, unplanned catheterization, and reoperation. The association between COI level and acute interstage outcomes was assessed using logistic regression with sequential adjustment for potential confounders. The analysis cohort included 1837 patients from 69 centers. Birth weight (P<0.001) and proximity to a surgical center at birth (P=0.02) increased with COI level. Stage 1 length of stay decreased (P=0.001), and exclusive oral feeding rate at discharge increased (P<0.001), with higher COI level. More than 98% of patients in all COI levels were enrolled in home monitoring. Death or transplant listing occurred in 101 (5%) patients with unplanned readmission in 987 (53%), intensive care unit admission in 448 (24%), catheterization in 345 (19%), and reoperation in 83 (5%). There was no difference in the incidence or time to occurrence of any acute interstage outcome among COI levels in unadjusted or adjusted analysis. There was no interaction between race and ethnicity and childhood opportunity in acute interstage outcomes. Zip code COI level is associated with differences in preoperative risk factors and stage 1 palliation hospitalization characteristics. Acute interstage outcomes, although common across the spectrum of childhood opportunity, are not associated with COI level in an era of highly prevalent home monitoring programs. The role of home monitoring in mitigating disparities during the interstage period merits further investigation.

The role of antibiotic exposure and the effects of breastmilk and human milk feeding on the developing infant gut microbiome.

The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life followed by complementary foods and sustained breastfeeding for at least 2 years, underscoring its pivotal role in reducing infant mortality and preventing various illnesses. This perspective delves into the intricate relationship between breastfeeding practices, early life antibiotic exposure, and infant gut microbiome development, highlighting their profound influence on child health outcomes. Antibiotics are extensively prescribed during pregnancy and childhood, disrupting the microbiome, and are related to increased risks of allergies, obesity, and neurodevelopmental disorders. Breastfeeding is a significant determinant of a healthier gut microbiome, characterized by higher levels of beneficial bacteria such as Bifidobacterium and lower levels of potential pathogens. Despite widespread recognition of the benefits of breastfeeding, gaps persist in healthcare practices and support mechanisms, exacerbating challenges faced by breastfeeding families. This highlights the pressing need for comprehensive research encompassing breastfeeding behaviors, human milk intake, and their impact on infant health outcomes. Additionally, promoting awareness among healthcare providers and families regarding the detrimental effects of unnecessary formula supplementation could facilitate informed decision-making and bolster exclusive breastfeeding rates. Moreover, donor human milk (DHM) is a promising alternative to formula, potentially mitigating disruptions to the infant gut microbiome after antibiotic exposure. Overall, prioritizing breastfeeding support interventions and bridging research gaps are essential steps towards improving child health outcomes on a global scale.

A survey of breastfeeding among women with previous surgery for benign breast disease: a descriptive exploratory study

BackgroundSurgery is the primary treatment for benign breast disease and causes some disruption to the normal physiology of the breast, even when this disruption is localised, it remains unclear whether it affects women’s ability to breastfeed. There are only a few studies describing the experience of breastfeeding in women who have undergone benign breast disease (BBD) surgery.MethodsWe retrospectively analysed data from patients aged 20–40 years in Guangdong, China, who underwent breast lumpectomy for BBD in our department between 01 January 2013 and 30 June 2019, with a follow-up date of 01 February 2022. Patients were included who had a history of childbirth between the time of surgery and the follow-up date. By collecting general information about this group of patients and information about breastfeeding after surgery, we described the breastfeeding outcomes of women of a fertile age who had previously undergone surgery for benign breast disease.ResultsWith a median follow-up of 5.9 years, a total of 333 patients met the inclusion criteria. From the breastfeeding data of the first child born postoperatively, the mean duration of ‘exclusive breastfeeding’ was 5.1 months, and the mean duration of ‘any breastfeeding’ was 8.8 months. The rate of ‘ever breastfeeding’ is 91.0%, which is lower than the national average of 93.7%, while the exclusive breastfeeding rate at six months was 40.8%, was higher than the 29.2% national average. The any breastfeeding rate at 12 months was 30.0%, which was well below the 66.5% national average. The common reason for early breastfeeding cessation was insufficient breast milk. A total of 29.0% of patients who had ever breastfed after surgery voluntarily reduced the frequency and duration of breastfeeding on the operated breast because of the surgery.ConclusionsThere are some impacts of BBD surgery on breastfeeding and some may be psychological. Institutions should provide more facilities for mothers who have undergone breast surgery to help them breastfeed, such as conducting community education on breastfeeding after breast surgery, training professional postoperative lactation consultants in hospitals, and extending maternity leave. Families should encourage mothers to breastfeed with both breasts instead of only the non-operated breast.

Impact of baby-friendly hospital initiative on exclusive breastfeeding rates and mother satisfaction

BackgroundBreastfeeding offers numerous benefits for both babies and mothers. Exclusive Breastfeeding for at least the first 6 months of life was encouraged by the World Health Organisation through employing the Baby-Friendly Hospital Initiative. AimsThe study aimed to investigate the impact of this Initiative on maternal satisfaction and exclusive breastfeeding rates. Methodsin this retrospective study 160 participants were divided into group one who experienced the Initiative and group two who did not. Exclusive breastfeeding was measured using the Index of Breastfeeding Status. Maternal satisfaction was measured using the Maternal Breastfeeding Evaluation Scale. ResultsThe results revealed a significant difference in maternal satisfaction between the two groups (p < 0.05). Fisher's exact test indicated a significant association between experiencing the Baby-Friendly Hospital Initiative and exclusive breastfeeding rates (p < 0.001). ConclusionThe findings underscored the role of the Baby-Friendly Hospital Initiative in promoting exclusive breastfeeding and enhancing maternal satisfaction.

Does the 3C (Counselling, Checking and Certification) Initiative Prevent Hypoglycemia Among At-Risk Stable Late Preterm and Term Neonates? - A Randomized Controlled Trial.

To evaluate whether the 3C (Counselling, Checking, Certification) initiative helps in preventing hypoglycemia among at-risk neonates compared to standard care. This randomised controlled trial included 222 mother-newborn dyads with risk factors for neonatal hypoglycemia-Small for gestational age (SGA) babies, infants of diabetic mothers (IDM), large for gestational age (LGA) babies and late preterm infants (LPI). They were randomized to two groups. Group A received standard care while mothers in group B were administered 3C intervention. Early initiation of breastfeeding, incidence of neonatal hypoglycemia within 24h, and exclusive breastfeeding rate at 6 mo were evaluated. Early initiation of breastfeeding was higher in the 3C group compared to standard care group (94.6% vs. 55.9% p <0.001). The incidence of hypoglycemia within 24h was lower in the intervention group compared to standard care (3.6% vs. 15.3%, p <0.05). However, there was no significant difference in exclusive breastfeeding rates at 6 mo between the two groups (61% and 66% in group A and B respectively). The 3C intervention decreases the incidence of hypoglycemia among at-risk neonates. Early initiation of breast-feeding is higher among mothers who receive the 3C intervention.

Education and economic growth in Sub-Saharan African Countries: Does governance quality Matter?

This paper examines the dynamic relationship between education, governance and economic growth in 28 sub-Saharan African (SSA) countries from 2002 to 2018 using the generalized method of moments (GMM) approach. The study first examines the effect of education on economic growth and, thereafter, examines the modulating effect of governance quality on the nexus between education and economic growth. Two proxies of education, namely primary and secondary education, and five proxies of governance quality, namely a) corruption control, b) government effectiveness, c) regulations, d) rule of law, and e) voice and accountability, have been used to examine this linkage. Overall, the study found that the impact of education on economic growth is largely insignificant in all the specifications, with the exception of secondary education, which has an unconditional positive effect on economic growth in one of the five specifications of governance quality (i.e., regulatory quality). The study also found that, although governance quality spurs economic growth in seven of the ten specifications, it interacts with education to foster growth in only one specification (i.e., regulatory quality in the case of secondary education). When primary education specifications are considered, governance does not interact with education to spur economic growth in any of the specifications. These findings, though contrary to some of the previous studies, are not surprising given the primary and secondary education landscape in some SSA countries. According to UNESCO, SSA has the highest rates of education exclusion in the world.

The disparity in pediatric spinal cord tumor clinical trials: A scoping review of registered clinical trials from 1989 to 2023.

Spinal cord tumors (SCTs) comprise 10% of all central nervous system (CNS) tumors. Pediatric SCTs are often excluded and underrepresented in clinical trials though exclusion rates haven't been reported. We reviewed all interventional clinical trials recruiting patients <21 years with SCTs on ClinicalTrials.gov between 1989 and 2023. Five hundred and two CNS tumor trials were identified, of which 255 included SCTs and/or spincal metastases. Among these, 96.5% were open to all CNS tumors (brain or spine); however, only 3.5% were exclusive to spine tumors. One trial was specific to pediatric spine tumors (inclusive of bone, soft tissue, and neural tumors); no trial was specific to primary pediatric SCTs. Most trials were located in North America, with multisite investigations being more common than single-institution designs. Trials frequently evaluated interventions/treatments (89%), supportive care/quality of life measures (7.1%), or diagnostic protocols (3.1%). Among included treatment paradigms, systemic therapies using cytotoxic chemotherapies, targeted therapies, and/or immunotherapies were more common among brain/spine trials, while radiotherapy, surgical adjuncts, and/or local drug delivery more frequently occurred in spinal tumor trials. Though SCTs comprise 10% of pediatric CNS tumors, they remain underrepresented in clinical trials. This lack of trials specific to advancing pediatric SCTs management highlights an area of clinical and research need.

Effect of exclusive breastfeeding and other infant and young child feeding practices on childhood morbidity outcomes: associations for infants 0–6 months in 5 South Asian countries using Demographic and Health Survey data

BackgroundDespite growing evidence of the impacts of exclusively breastfeeding infants during the first 6 months of life on preventing childhood infections and ensuring optimal health, only a small number of studies have quantified this association in South Asia.MethodsWe analyzed data from the Demographic and Health Surveys in Afghanistan (2015; n = 3462), Bangladesh (2017–2018; n = 1084), India (2019–2021; n = 26,101), Nepal (2022; n = 581), and Pakistan (2017–2018; n = 1,306), including babies aged 0–6 months. Multivariate logistic regression models were used to determine the association between exclusive breastfeeding in the last 24 h and diarrhoea, acute respiratory infections, and fever in the two weeks before the survey. We also examined the association between other infant and young feeding indicators and these outcomes.ResultsInfants who were exclusive breastfed had decreased odds of diarrhoea in Afghanistan (AOR: 0.49, 95% CI 0.35, 0.70), India (AOR: 0.80, 95% CI 0.70, 0.91), and Nepal (AOR: 0.42, 95% CI 0.20, 0.89). Compared with infants who were not exclusive breastfed, infants who were exclusively breastfed were less likely to have fever in Afghanistan (AOR: 0.36, 95% CI 0.26, 0.50) and India (AOR: 0.75, 95% CI 0.67, 0.84). Exclusive breastfeeding was associated with lower odds of acute respiratory infections in Afghanistan (AOR: 0.57, 95% CI 0.39, 0.83). Early initiation of breastfeeding was protective against diarrhoea in India. Bottle feeding was a risk factor for diarrhoea in India and for fever in Afghanistan and India. Bottle feeding was also a risk factor for acute respiratory infection in Afghanistan and India.ConclusionsNot exclusive breastfeeding is a risk factor for diarrhoea, acute respiratory infections, and fever in some South Asian countries. These findings could have substantial implications for global and national efforts to increase exclusive breastfeeding rates. More support, advocacy, and action are required to boost breastfeeding rates as a crucial public health measure.

Evolution of Exclusive Breastfeeding Practices According to Continuous Demographic and Health Surveys (DHS-C) from 2010-2011 to 2019 and Associated Factors in Senegal

Introduction: The first two years of a child&amp;apos;s life are particularly important. Inadequate breastfeeding practices during this period considerably compromise the health, development and survival of infants, children and mothers. Several studies have assessed the impact of breastfeeding on infant mortality. The objectives of our study were to investigate changes in exclusive breastfeeding practices during the first six months of life according to DHS data from 2010-2011 to 2019 and to identify the various associated factors. Methodology: This is a quantitative analysis of secondary data based on cross-sectional data from the DHS from 2010-2011 to 2019 on changes in exclusive breastfeeding practices for infants under six months of age. Our study focused on women aged 15 to 49 years interviewed during the DHS and residing in Senegal at the time of the various surveys who had children under two years of age. Data were collected on exclusive breastfeeding rates in different years, the socio-demographic and gyneco-obstetric characteristics of mothers, and the characteristics of newborn children. A multivariate analysis was performed to identify factors associated with exclusive breastfeeding. Results: showed that exclusive breastfeeding rates remained below 50% from 2010-11 to 2019. Analysis by region showed a disparity between the different regions. The associated factors were: ethnic group: Wolof are less likely to practice EBF with an adjusted AOR of 0.59 with a CI&amp;lt;sub&amp;gt;95&amp;lt;/sub&amp;gt;: [0.38, 0. 90], maternal literacy: mothers who could not read were less likely to perform EBF with an adjusted AOR of 0.71 and a CI&amp;lt;sub&amp;gt;95&amp;lt;/sub&amp;gt;: [0.53-095], birth order: mothers with 6 or more children were more likely to perform EBF, with an AOR of 3.20 and a CI&amp;lt;sub&amp;gt;95&amp;lt;/sub&amp;gt;: [1.68-6.17], maternal occupation: Working mothers were less likely to practice EBF than non-working mothers, with an AOR of 0.60 and a CI&amp;lt;sub&amp;gt;95&amp;lt;/sub&amp;gt; [0.46-0.79], access to the media: Mothers with access to the media were less likely to practice assisted fertilization, with an AOR of 0.57 and a CI&amp;lt;sub&amp;gt;95&amp;lt;/sub&amp;gt;: [0.37-0.90] and use of modern contraception: Mothers using modern contraception were less likely to practice exclusive breastfeeding, with an AOR of 0.53 and a CI&amp;lt;sub&amp;gt;95&amp;lt;/sub&amp;gt;: [0.38-0.72]. Conclusion: Despite all the efforts made by the Senegalese government and its technical and financial partners, rates are still low. To strengthen the practice of exclusive breastfeeding, it is important and urgent to design and implement innovative evidence-based interventions covering the different levels of the socio-ecological model (individuals, families, communities and public policies).

Client-centered flexible planning of home-based postpartum care: A randomized controlled trial on the quality of care.

Standardization of health systems often hinders client-centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home-based postpartum care service improves its quality of care, as innovative approach to client-centered care. A randomized controlled trial was conducted (2017-2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th-day postpartum, instead of the first 8-10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so-called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self-care experience, overall care experience, and exclusive breastfeeding duration rate. Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98-1.07). Both groups showed similar self-care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. This study found no effect on the quality of care when allowing more flexibility in the planning range of home-based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home-based postpartum care.

HUBUNGAN POLA ASUH DAN PEMBERIAN ASI EKSKLUSIF DENGAN STATUS GIZI BAYI DI KLINIK SARGIATI Amd.Keb TAHUN 2023

The focus on improving public nutrition in Indonesia remains centered on addressing the nutritional status of Indonesian children. According to the 2014 Global Nutrition Report (GNR), Indonesia is one of 17 out of 117 countries facing the triple burden of stunting, wasting, and overweight among infants or toddlers within the first days of life. Despite efforts, exclusive breastfeeding rates in Indonesia have not met the targeted 80%. In 2016, exclusive breastfeeding rates for infants aged 0-5 months were at 54.0%, while only 29.5% were exclusively breastfed up to 6 months. Although South Sumatra province has surpassed the national average with a rate of 60.4%, it still falls short of the desired 80%. Researchers focused on the Sargiati Amd clinic, particularly exploring the correlation between parenting styles, exclusive breastfeeding, and infant nutritional status. Among the 19 respondents, the majority exhibited a certain parenting style. Among them, 11 individuals had good nutritional status (36.7%), while 8 had poor nutritional status (36.7%). Only a minority (6.7%) had poor nutritional status. Surprisingly, among those with good parenting habits, the majority had poor nutritional status (23.3%), while the minority had good nutritional status (13.3%). Statistical analysis using a chi-square test with a significance level of 0.05 yielded a p-value of 0.256 (P &gt; 0.05), indicating acceptance of the null hypothesis (Ho) and rejection of the alternative hypothesis (Ha). Thus, no significant relationship was found between parenting style and nutritional status. However, there was a significant relationship between parents' eating habits and healthy habits with nutritional status (p = 0.014; p = 0.006).

Implementation of early essential neonatal care for newborns delivered by cesarean section in Jiaxing: a single-center prospective randomized controlled trial

BackgroundAs an essential part of Early Essential Newborn Care, 90 minutes of mother-infant skin-to-skin contact is significant in improving maternal and infant outcomes. However, due to human resource constraints and the consideration of maternal and infant safety, it is difficult to achieve continuous uninterrupted skin-to-skin contact for at least 90 minutes during and after cesarean delivery. The aim of this study was to investigate the efficacy and safety of the continuous uninterrupted skin-to-skin contact for at least 90 minutes during and after cesarean section for exclusive breastfeeding rate during hospitalization and maternal and infant health indicators during and after cesarean delivery.MethodsThis is a single-center, prospective randomized controlled trial conducted in one tertiary care hospital in China. We selected 280 cases of elective cesarean delivery in a tertiary maternal and child specialty hospital in Zhejiang Province from September 2018 to August 2022, which were randomly divided into two groups: in the conventional group, doulas performed at least 30 minutes for early continuous SSC within 10–30 minutes during and after cesarean delivery. In the EENC group, with immediate continuous SSC within 5–10 minutes of neonatal delivery until surgery is completed and continued SSC after returning to the ward. Exclusive breastfeeding rate during hospitalization and maternal and infant health indicators were compared between the groups.ResultsA total of 258 cases were analyzed. Compared with the control group, the EENC group had earlier first breastfeeding initiation (13.7 ± 3.6 vs 62.8 ± 6.5 minutes, P < 0.001), longer duration of first breastfeeding (42.6 ± 9.0 vs 17.9 ± 7.5 minutes, P < 0.001), earlier onset of lactogenesis II (73.7 ± 3.6 vs 82.5 ± 7.4 hours, P < 0.001), higher breastfeeding self-efficacy score (128.6 ± 8.9 vs 104.4 ± 8.5, P < 0.001), higher Exclusive breastfeeding rate during hospitalization (88% vs 81%, P = 0.018), higher maternal satisfaction scores (18.9 ± 1.1 vs 14.0 ± 2.7, P < 0.001). Meanwhile the EENC group showed lower incidence of neonatal hypothermia (0% vs 4.6%, P = 0.014), lower neonatal hypoglycemia (0% vs 5.4%, P = 0.007) and less cumulative blood loss within 24 hours postpartum (254.2 ± 43.6 vs 282.8 ± 63.8 ml, P < 0.001).ConclusionThe implementation of EENC up to 90 minutes by caesarean doula company nurses is feasible and beneficial to maternal and infant health.Trial RegistrationChiCTR1800018195(2018-09-04).

How Did the Recent Infant Formula Shortage Affect Breastfeeding Rates in Northeast New York [ID 2683397

INTRODUCTION: To determine the effect of the recent infant formula shortage on breastfeeding rates in the northeast New York area. METHODS: This was a retrospective analysis of the Northeast New York (NENY) Regional Birth Registry database from January 2021 to June 2022. Breastfeeding rates of patients in the first 6 months of 2022 were compared to those from 2021. Maternal demographics, obstetrical history, breastfeeding, and delivery information were collected. We wanted to determine whether the recent infant formula shortage in the United States affected the breastfeeding rates. Statistical analyses were performed using STATA software (Stata/SE 12.1). A P value of &lt;.05 was considered statistically significant. This study was approved by the IRB at Albany Medical Center. We controlled for maternal marital status, education level, ethnicity, and employment status during pregnancy in our statistical analysis. RESULTS: We identified 19,610 patients in the NENY database from January 2021 to June 2022. 170 (0.87%) were excluded from our study due to breastfeeding data not being available. The exclusive breastfeeding rate increased from 55.97% to 57.25%. However, this was not statistically significant (P&lt;.104). The formula-only rates essentially stayed the same, 17.94% versus 17.54%. The rates of the infants who were supplemented with formula had a nonsignificant decrease from 25.23% to 24.33% (P&lt;.185). We did a secondary analysis in which the data were excluded for those infants who were admitted to the neonatal intensive care unit and the differences were even smaller with an overall P value of 0.949. CONCLUSION: Although the recent infant formula shortage in the United States led to a slight increase in exclusive breastfeeding rates and decrease in formula feeding in a first 6 months of 2022, none of these were statistically significant. These differences were not statistically significant even after controlling for demographic factors such as marital status, race, and education level and BMI.

Factors Influencing Delayed Onset of Lactogenesis: A Scoping Review.

Delayed onset of lactogenesis is a significant barrier to achieving the WHO-recommended 50% exclusive breastfeeding rate in the first six months. This study maps the main factors influencing this condition, addressing gaps in the current research landscape. Following Arksey and O'Malley's scoping review framework, databases such as PubMed, Web of Science (WOS), Embase, Cochrane Library, CINAHL plus with full text, China National Knowledge Infrastructure (CNIK), Weipu Chinese Journal Service Platform (VIP), Wanfang Data Knowledge Service Platform, and China Biomedical Literature Database (CBM) were searched on February 1, 2023. Studies in Chinese and English involving pregnant and postpartum women, focusing on delayed onset of lactogenesis, were included without restrictions on publication date or geography. Forty-six studies published between 2002 and 2022 met the inclusion criteria, revealing variable incidences of delayed lactogenesis among different groups. Thirty-four influencing factors were identified and organized into five themes: maternal-infant characteristics, perinatal mental state, physical activity participation during pregnancy, breastfeeding behaviors, and medical staff interventions. Within eighteen major factors highlighted, factors such as age, pre-pregnancy BMI, gestational weight gain, average LATCH score within 24 hours postpartum, labor analgesia, sleep, frequency of postpartum breastfeeding, and timing of initial breast suckling/pumping showed inconsistent or conflicting conclusions. High and variable incidences of delayed lactogenesis underline its multifactorial nature. Effective interventions require strong advocacy from healthcare professionals and adherence by pregnant women. Further research using standardized methods is essential to clarify inconsistent or conflicting findings on the influencing factors.

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

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

Examining the predictors of school exclusion for Māori and Pākehā Learners

The sample used for this study followed an entire cohort of over 40,000 students through their compulsory education in New Zealand. A previously developed econometric model explaining higher rates of school exclusions for Pacific learners (an ethnic group over-represented in lower SES, higher rates of SEN, and greater rates of school exclusion) is applied to a large cohort of indigenous Māori and Pākehā learners in this study. Significant variables in the model that predict Pākehā learner school exclusion are very similar to those predicting Māori learner school exclusion. However, after accounting for variables identified in the literature as correlated with school exclusion, Māori learners are still more likely to be excluded, are more likely to be excluded more often, and are more likely to be excluded earlier than their Pākehā peers. One possible explanation of this result is that the Pygmalion Effect of teachers having lower expectations of Māori students may also contribute to higher rates of school exclusion. Māori students have previously reported lower rates of belonging at school. One implication of this may be the need for a cheaper, faster way for families or advocates to appeal the decision made to exclude a learner by local principals or Boards of Trustees. This is in contrast to the current system of recourse through the court system, which can be an expensive and time-consuming process.

Personal identification using frontal sinus coding methods: The effect of mixed image modality comparisons.

Several code-based methods have been created for comparing the frontal sinus in skeletal identification scenarios. However, little is known regarding matched-pair accuracy rates of these methods or how varying image modalities may affect these rates. The goals of this study were to validate the exclusion rates and to establish matched-pair accuracy rates of two well-cited coding methods, Cameriere etal. [23] and Tatlisumak etal. [24]. Additionally, individual variables were assessed for consistency in scoring between image modalities. Using a sample of U.S. African American, Native American, and European American females and males (n = 225), we examined individual variable scoring and string codes between two different image modalities (radiographs and CT-based 3D models). Arcades showed poor scoring consistency between modalities (p < 0.001). Although exclusion rates were similar to those reported in the original studies (93%-96%), matched-pair accuracy rates were low (13%-18%). None of the demographics (collection, sex, age, ancestry, and orientation) had an effect on the odds of a match. Interobserver and intraobserver analyses showed moderate to near-perfect agreement for all variables except supraorbital cells, which had minimal to no agreement. Currently, we do not recommend the application of these frontal sinus coding methods independent of other supporting identification methods given low variable consistency and accuracy rates. Visual identification should still be used to include or exclude an identification when using the frontal sinus.

Investigating midwives and nurses reporting of ‘infant feeding at hospital discharge’: an online survey across NSW Australia

BackgroundThe collection of data on ‘infant feeding at hospital discharge’ is used to monitor breastfeeding outcomes, health service benchmarking, and research. While some Australian states have clear definitions of this data collection point, there is no operational definition of ‘infant feeding at hospital discharge’ in the Australian state of New South Wales. Little is known about how midwives interpret the term ‘infant feeding at hospital discharge’, in particular, the timeframe used to calculate these important indicators. The purpose of this study was to explore midwives’ and nurses’ practices of reporting ‘infant feeding at hospital discharge’ in the Australian state of New South Wales.MethodsAn online survey was distributed across public and private maternity hospitals in New South Wales, Australia. The survey asked midwives and nurses their practice of reporting ‘infant feeding at discharge’ from categories offered by the state Mothers and Babies report of either “full breastfeeding”, “any breastfeeding”, and “infant formula only”. The Qualtrics survey was available from December 2021 to May 2022.ResultsThere were 319 completed surveys for analysis and all 15 NSW Health Districts were represented. Some participants reported using the timeframe ‘since birth’ as a reference (39%), however, the majority (54%, n = 173) referenced one of the feeding timeframes within the previous 24 h. Most midwives and nurses (83%, n = 265) recommended 24 h before discharge as the most relevant reference timeframe, and 65% (n = 207) were in favour of recording data on ‘exclusive breastfeeding’ since birth.ConclusionThis study identified multiple practice inconsistencies within New South Wales reporting of ‘infant feeding at hospital discharge’. This has ramifications for key health statistics, state reporting, and national benchmarking. While the Baby Friendly Hospital Initiative accreditation requires hospitals to demonstrate and continuously monitor at least a 75% exclusive breastfeeding rate on discharge, only 11 New South Wales facilities have achieved this accreditation. We recommend introducing an option to collect ‘exclusive breastfeeding’ on discharge’ which is in line with participant recommendations and the Baby Friendly Hospital accreditation. Other important considerations are the updated World Health Organization indicators such as, “Ever breastfed”; “Early initiation of breastfeeding” (first hour); “Exclusively breastfed for the first two days after birth”.