Lactating Women Research Articles

Impact of clinical pharmacist on medication adherence among psoriasis patients: A randomized controlled study

BackgroundPsoriasis is a chronic inflammatory disease and requires long term management due to which patients become non-adherent to the therapy. Hence this study aims to assess the impact of clinical pharmacists to improve medication adherence in patients with psoriasis. Materials and methodsThis is a randomized controlled study conducted at a tertiary care teaching hospital in the dermatology department, among 68 patients. Aged 18–65 years from the outpatient department diagnosed with psoriasis disease and on treatment were enrolled in the study. Patients with multiple co-morbidities like HIV, hepatitis B/C, and vulnerable populations like lactating and pregnant women are excluded from the study. Enrolled patients are then randomized after taking the Informed consent form. The interventional groups of patients were provided with a patient information leaflet and pharmacist education and counselling along with standard care. Medication adherence of the patients was evaluated at the baseline level to the follow-up after 1 month. ResultsTotal of 68 were enrolled in the study, out of which 63 completed the study. There was no difference observed at the pre-test in both the groups. After the intervention, there was a significant difference in the experimental group after post-test (U = 200.00, p = 0.0001). Adherence was improved in the experimental group. ConclusionThere is a need for clinical pharmacists in providing the patients with knowledge about long term disease management like psoriasis. The implement of specialty pharmacists in dermatological disorders is an excellent choice to address the unattended needs of the patient.

Climate change worsens global inequity in maternal nutrition

Climate change worsens global inequity in maternal nutrition

A mixed-methods study of pesticide exposures in Breastmilk and Community & Lactating Women\u2019s perspectives from Haryana, India

BackgroundPopulation growth which has resulted in a need for increased crop yields to sustain food security, in addition to the effects of climate change, have led to the widespread use of chemical pesticides. The indiscriminate use of pesticides has in turn led to contamination of the environment, food commodities and bioaccumulation in human tissues, particularly in agrarian regions of India including the northern state of Haryana.MethodsWe conducted a pilot screening study to investigate the presence of organochlorine, organophosphate, and pyrethroid pesticides in breastmilk samples (n = 75) from Haryana, India. Pesticide analyses were conducted using gas chromatography mass spectrometry (GC-MS) for OC and OP pesticides and GC-electron capture detector for pyrethroids. The study was complemented by a qualitative evaluation of maternal and community perceptions, knowledge, attitudes and practices associated with pesticide use and risk of exposure (n = 30 in-depth interviews; n = 9 focus group discussions).ResultsAnalysis of breastmilk showed the presence of p,p’-dichlorodiphenyltrichloroethane (DDT) and p,p’-dichlorodiphenyldichloroethylene (DDE) in 4% (range: <LOQ - 28 μg/L) and 5% (range: < LOQ – 107 μg/L) of samples, respectively. No other pesticides were detected.Our qualitative findings showed that community members commonly held perceptions of pesticides as medicines and poison but acknowledged their widespread use to ensure crop yields. Given the gendered engagement in farming in this setting, lactating women in study communities do not directly handle chemical pesticides, thus lowering risk of inhalation and dermal exposure.ConclusionsIn our small sample, breastmilk pesticide concentrations were low and did not pose a risk to infants. Based on the persistent nature of many organic pollutants and reported widespread use, we recommend more comprehensive and longitudinal investigation of upstream pesticide contamination in the food supply and exposures among mothers and children.Trial registrationCTRI/2017/01/007636, Date Registered: 06/01/2017.CTRI website: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=17249&EncHid=&modid=&compid=%27,%2717249det%27

Perspectives on Continuing Education Programs for Foundation-Level Drugstore Pharmacists in Japan.

Background: Continuing education (CE) is important for developing and updating pharmacists’ knowledge, skills, and attitudes. CE programs should be developed according to social requirements but also based on personal requirements depending on the sectors the pharmacists work in. This research aims to explore perspectives on CE programs for foundation-level drugstore pharmacists in Japan. Method: Foundation-level drugstore pharmacists were asked what CE programs or training they needed to develop patient care or customer satisfaction. Results: We obtained 417 opinions (multiple answers were allowed) in 280 responses from 460 pharmacists (male: 245 and female: 215). The products and goods about which drugstore pharmacists wanted to learn covered a wide range. They wanted to learn about taping skills, tests, and products and devices related to care of the elderly. Taping skill would be quite unique for drugstore pharmacists. For special populations, they wanted knowledge and skills related to pregnancy tests and the safe use of medication by pregnant or lactating women. Conclusion: Drugstore pharmacists in Japan have different CE and continuing professional development (CPD) requirements from community pharmacists. The benefits of CE programs meeting pharmacists’ requirements should be evaluated in future research.

New emergent therapies for atopic dermatitis: A review of safety profile with respect to female fertility, pregnancy, and breastfeeding.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Systemic treatment is usually mandatory in moderate-to-severe AD of the adult; these patients need to be informed about safe and effective management of AD also regarding the reproduction. Treating a pregnant woman with AD with systemic drugs may affect the unborn child. While effects of traditional systemic treatments for AD on female fertility, pregnancy, and breastfeeding are largely known, data about new emergent therapies for AD are still poor. Treating pregnant or lactating women with AD can be a challenge since no large clinical studies on its possible effects and side-effects on conception, pregnancy, the unborn child and lactation are currently available for new AD treatments.

The Safety and Efficacy of Intermittent Fasting for Weight Loss

Intermittent fasting (IF) diets have recently gained popularity as a weight loss and antiaging method that attracts celebrity endorsements and public interest. Despite the growing use of IF, the debate over its safety and efficacy is still ongoing. Defined IF regimens include 5 different types: alternate-day fasting, periodic fasting, time-restricted feeding, less clearly defined IF (fast mimicking diet, juice fasting), and religious fasts. Our literature review highlights the effect of IF essentially on body weight and cardiometabolic risk factors. Intermittent fasting may be effective for weight loss and may improve cardiovascular and metabolic health, although the long-term sustainability of these effects has not been studied. While data on the safety of IF are sparse, the most frequent adverse effects (hunger, irritability, and impaired cognition) may dissipate within a month of the fasting period. Intermittent fasting is not recommended for pregnant or lactating women, children or adolescents during maturation, the elderly or underweight people, and individuals vulnerable to eating disorders.

Características da gravidez e lactação de mulheres atendidas em um banco de leite humano

Objetivo: identificar as características da gravidez e da lactação de mulheres que procuraram um banco de leite humano e as razões que motivaram essas mães a recorrerem ao serviço. Métodos: Trata-se de um estudo realizado no Banco de Leite Humano (BLH) da Fundação Santa Casa da Misericórdia de Franca. Foram recrutadas 60 mulheres que responderam a um questionário para a obtenção de informações a respeito da gestação, da amamentação e dos motivos que as levaram ao banco de leite. Resultados: As participantes realizaram o pré-natal em número adequado de consultas e tinham em média 25(6,1) anos. Os sintomas gestacionais mais relatados foram náuseas/vômitos (71,7%) e picamalácia (60%). A maior aversão alimentar referida foi à ingestão de carnes (42,3%). Dentre os fatores que levaram as mulheres a buscarem o BLH, destacaram-se o auxílio para estimular a produção do leite ou para doação do mesmo. 58% das mulheres estavam em aleitamento materno exclusivo e as demais referiram estar aguardando a descida do leite ou estarem distantes dos bebês, que se encontravam no centro de terapia intensiva. Alguns bebês menores de 2 meses receberam água, chás e papas precocemente. Conclusão: As nutrizes recorreram ao BLH por problemas na amamentação, apesar das orientações no pré-natal. Algumas necessitaram de apoio para o estímulo da produção de leite. A importância do BLH vai além de possibilitar o leite às crianças que não puderam ser amamentadas por suas mães, mas também por proporcionar instrução e apoio às lactantes, além do incentivo ao aleitamento materno.

National guidelines on nutrient reference values for the healthy adult population and for pregnant or lactating women are based on heterogeneous sources of evidence: review of guidelines.

Many countries provide dietary guidelines for health practitioners and/or the general population. However, there is no general, international guideline serving as a template for national dietary guidelines, and there is little to no consensus regarding reference values for different nutrients. The present review compared 27 national dietary guidelines for healthy adults as well as for pregnant and/or breastfeeding women, and analysed their quality and the evidence behind their recommendations. The guidelines were evaluated for their quality using the instrument Agree II, and found to be heterogeneous (overall quality score 14%-100%) and often insufficient (quality score < 50%) due to missing information about their methodology and sources of evidence. We analysed the evidence (number of studies, study types and publication years) of reference values of a number of nutrients using the five guidelines that provided the highest scores in the Agree II assessment. The reference values varied among guidelines, were rarely based on up-to-date meta-analyses, and were often based on insufficiently reported evidence (22/27 guidelines with quality score < 50%). We recommend systematic reviews of high quality studies to formulate future guidelines, and to use guidelines on how to write guidelines.

Assessing statistical similarity in dietary intakes of women of reproductive age in Bangladesh.

Women of reproductive age (WRA) need adequate nutrient intakes to sustain a healthy pregnancy, support fetal growth, and breastfeed after childbirth. However, data on women's dietary intake in low‐ and middle‐income countries (LMICs) are limited, and assessment of differences between dietary intakes of pregnant or lactating women compared with that of nonpregnant, nonlactating (NPNL) women is untested. Using single, multiple‐pass 24‐h dietary recall data from a sample of WRA residing in rural Bangladesh, we examined women's dietary intakes for energy, protein, calcium, iron, vitamin A, and dietary diversity for three groups: NPNL (n = 2,903), pregnant (n = 197), and lactating women (n = 944). We used equivalence testing to examine similarity in adjusted intakes for pregnant versus NPNL women and lactating versus NPNL women with a predetermined equivalence threshold based on recommendations specific for each reproductive stage. On average, both pregnant and lactating women had insufficient intakes for all dietary measures. Although statistically significant differences were observed between pregnant and NPNL women for energy intake and dietary diversity and between lactating and NPNL women for energy and protein intake, the magnitudes of these differences were too small to reject equivalence. Statistical similarity was also evident in all micronutrients and dietary diversity for both two‐group comparisons. Understanding statistical differences and similarities between dietary measures of women in distinct reproductive stages has important implications for the relevance, appropriateness, and evaluation of maternal diet‐enhancing interventions in LMICs, especially during pregnancy and lactation, when demand for macronutrients and micronutrients is elevated.

Hyperthyroidism associated with intraocular pressure and dry eye

Graves’ orbitopathy/ophthalmopathy (GO) also known as thyroid eye disease (TED),dysthyroid/thyroid-associated ophthalmopathy (TAO), is an autoimmune disorder representing thecommonest and most important extrathyroidal manifestation of Graves’ disease. Materials andMethods: This is a prospective study conducted for 2 years. A total of 60 established cases ofHyperthyroidism of all Age groups with either gender subjects who were diagnosed with Thyroidorbitopathy at hospitals were included in this study. History of ocular surgery or medications, thosedemonstrating the recent use of contact lenses, pregnant or lactating women. All the cases withsimilar presentation not proved to be Thyroid Orbitopathy and patients who did not report for thefollow-up were excluded from the study. Result: A total of 60 patients were examined. Of the 60cases analyzed, female preponderance was noted and 41-60 years age group had the highestincidence of thyroid orbitopathy. The most common presentation was found to be unilateral. Inferiorrectus muscle was the commonest muscle involved with 48.3% followed by Medial rectus muscle38.3%, Superior rectus muscle 23.3%, and Lateral rectus muscle involved least with 11.6% indescending order. None of the patients reported a loss of vision. Conclusions: Dry eye andincreased IOP have commonly seen outcomes that should be managed diligently. This potentialsight-threatening condition is seen worldwide and has many functional and cosmetic consequencesthat need to be recognized. Hyperthyroidism was significantly associated with the severity.

Factors affecting successful induced lactation process among Malaysian women: a qualitative study

PurposeThis qualitative study was to understand the factors affecting successful adoptive breastfeeding among women who underwent induced lactation process.Design/methodology/approachThis study conducted in-depth interviews among induced lactation women in five states based on five regions [South (Johor), Central (Selangor), North (Penang), East (Kelantan) and East Malaysia (Sabah)]. The interviews have been consented, audio-recorded then transcribed verbatim, followed by identification of emerging themes.FindingsData saturation was achieved after interviewing a total of 23 induced lactation women. There were six main themes that emerged to describe factors affecting successful induced lactation process: (1) support and encouragement, (2) diet supplementation, (3) breastfeeding devices support, (4) incorporating treatment plan in the daily schedule, (5) high determination and pleasant attitude and (6) being informed on induced lactation process.Research limitations/implicationsThere can be recall bias among the respondents since the information was collected retrospectively, one to two years after the induced lactation practice completed. Due to that, we cannot rule out recall bias in the responses given in the interviews. In this study, induced lactation women barely were ethnic Malay Muslims. Thus, comparisons to other ethnic groups were not possible. This was due to the difficulty to get participation from induced lactation mother of other ethnic groups in the study. Even though the success is demonstrated, a significant limitation is that the ratio between Muslims and non-Muslims cannot be performed for the reason that the respondents only consists of Muslims alone.Originality/valueThe benefits of breastfeeding by an adoptive woman are numerous for both the mother and baby. There are multifactors involved in successful induced lactation process. After experiencing induced lactation, all respondents agreed that it has prepared them to be real mothers and breastfeeding is a pleasurable experience. All respondents corresponded to breastfeeding have a positive influence in the aspect of affection and touch. A mother who feels confident in her ability to lactate and is reassured by those around her will be most likely to feel successful in this great attempt.

Awareness Regarding Lactation Practices Among Lactating Women Attending Sir Ganga Ram Hospital, Lahore

Breast feeding is essential and plays an important role in the growth and development of a child. It is recommended to breast feed child till 6 months exclusively and to start weaning foods slowly to meet the nutritional requirements for the growth and development of child.

The effects of Sambucus nigra berry on acute respiratory viral infections: A rapid review of clinical studies

Brief overviewCollectively the evidence obtained from across five clinical studies involving 936 adults indicate that mono-herbal preparations of Sambucus nigra L. berry (S.nigra), when taken within 48 hours of the onset of acute respiratory viral infection, may reduce the duration and severity of common cold and influenza symptoms in adults. There is currently no evidence to support the use of S.nigra berry for the treatment or prevention of COVID-19. Given the body of evidence from preclinical studies demonstrating the antiviral effects of S.nigra berry, alongside the results from clinical studies involving influenza viral infections included in this review, pre-clinical research exploring the potential effects of S.nigra berry on COVID-19 are encouraged. VerdictThe evidence included in this review is mostly derived from clinical studies involving adult participants and examining short-term use of commercial formulations of S.nigra berry for up to 16 days. Findings from included studies suggest that mono-herbal preparations of S.nigra berry (in extract or lozenge formulation) may reduce influenza-type symptoms, including fever, headache, nasal congestion and nasal mucous discharge in adults, when taken within the first 48 hours of symptom onset. Within 2–4 days of S.nigra treatment, most adult participants experienced significant symptom reduction, by an average of 50%. Evidence regarding the effectiveness of S.nigra berry on the symptom of cough, and need for/use of medicines (including antibiotics) to treat acute respiratory infections, is currently unclear and inconsistent. Adverse events were rare with no serious events reported. Adverse events, reported in two studies, were more common in comparators than in treatments. There is currently no reliable or sufficient scientific evidence to support the use of S.nigra in pregnant or lactating women.

CFTR Modulators: Impact on Fertility, Pregnancy, and Lactation in Women with Cystic Fibrosis.

Cystic fibrosis (CF) is a life-shortening genetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. These mutations lead to abnormal ion transport in mucous membranes throughout the body, including in the respiratory and gastrointestinal and reproductive tracts. Improvements in care and therapy have led to substantial increases in the quantity and quality of life for those with CF. Consequently, women with CF are increasingly interested in having families. Although pregnancy was once discouraged for women with CF, at this point, even women with moderately severe lung disease can successfully navigate pregnancy. With the recent approval of a triple combination CFTR modulator therapy that improves lung function, nutritional status, and quality of life for people with a single copy of the most common CFTR mutation, it is expected that the number of women with CF who choose to become pregnant will continue to increase. Although animal reproduction models show no alarming signals for use during pregnancy at normal human doses, there is a paucity of human safety data in pregnancy and lactation. This review summarizes what is currently known about the impact of use of CFTR modulators on fertility, pregnancy, and lactation in women with CF.

Primaquine alternative dosing schedules for preventing malaria relapse in people with Plasmodium vivax.

Primaquine alternative dosing schedules for preventing malaria relapse in people with Plasmodium vivax.

Knowledge and Awareness among Mothers Regarding Exclusive Breastfeeding in Holy Karbala City / Iraq

Background: World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) “Exclusive breastfeeding (EBF)” is explained as “the infant receives only breast milk, no other liquids or solids. Its recommended for the first 6 months of life, and then complementary feeding should be started. EBF helps to reduce child morbidity and mortality from several diseases such as diarrhea, respiratory and / or ear infections and other infectious diseases, shielding lactation women from breast and ovarian cancer. In addition to offers societal economic and environmental benefits, The objective of this study was to assess the knowledge and awareness of exclusive breast feeding among mothers with a child &lt; 2 years of age. Method: A descriptive cross-sectional study was carried out in Health Directorate of Holy Karbala city. The study consist of (487) mothers how attendant to six Primary Health Care center (PHC). The collected data was done by direct interview with mothers and using a questionnaire form that designed based on the study objectives according to WHO criteria. Data were analyzed by SPSS “ Statistical Package for the Social Sciences”, the descriptive statistics included numbers (N) and percentage (%), and the inferential statistical test was done by using Chi-Square test (?2), P-value (Probability of chance ) was equal or less than 0.05 considered as statistically significant to find for any association between the results variables. Result: A total of 487 participants were included in the study and the rate of response was 92.7%. The highest percentage (66.3%) of study sample were full in the age group (21-30) years, and more than three quarters were lived in urban area. Nearly half of the study sample 47% had primary education and 60% those housewives, and the main source of information being family and friends (84.4%). As an overall assessment, 61.8% of the study sample had good knowledge and awareness about exclusive breastfeeding, with highly significant differences to education level ,occupation residence of the mother. Conclusion: Over half of the subjects had good knowledge and awareness of exclusive Breastfeeding. And, on the other hand, there was a very significant difference between education level, occupation and mother’s residence with a level of knowledge.

Calcium supplementation for improving bone density in lactating women: a systematic review and meta-analysis of randomized controlled trials

Clinical trials evaluating the effect of calcium supplementation on bone loss in lactating women have been small, with inconsistent results. We aimed to determine the effect of calcium supplementation on bone mineral density (BMD) in lactating women. An electronic search of databases was conducted from inception to January 2020. Two authors screened studies, extracted data, and assessed the risk of bias of eligible studies. Percentage change in BMD was pooled using random-effects models and reported as weighted mean differences (WMDs) with 95% CIs. Risk of bias was assessed using the Cochrane risk of bias tool. Five randomized controlled trials including 567 lactating women were included. All had a high risk of bias. Mean baseline calcium intake ranged from 562 to 1333 mg/d. Compared with control groups (placebo/no intervention), calcium supplementation (600/1000 mg/d) had no significant effect on BMD at the lumbar spine (WMD: 0.74%; 95% CI: -0.10%, 1.59%; I2=47%; 95% CI: 0%, 81%; n=527 from 5 trials) or the forearm (WMD: 0.53%; 95% CI: -0.35%, 1.42%; I2=55%; 95% CI: 0%, 85%; n=415 from 4 trials). BMD at other sites was assessed in single trials: calcium supplementation had a small to moderate effect on total-hip BMD (WMD: 3.3%; 95% CI: 1.5%, 5.1%) but no effect on total body or femoral neck BMD. Overall, the meta-analysis indicates that calcium supplementation does not provide clinically important benefits for BMD in lactating women. However, there was adequate dietary intake before supplementation in some studies, and others did not measure baseline calcium intake. Advising lactating women to meet the current recommended calcium intakes (with supplementation if dietary intake is low) is warranted unless new high-certainty evidence to the contrary from robust clinical trials becomes available. More research needs to be done in larger samples of women from diverse ethnic and racial groups.This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42015022092.

Expression of immune cell markers and tumor markers in patients with cervical cancer

ObjectiveCervical cancer is one of the most common cancers worldwide, and immune function may impact disease progression. Serum markers may also be associated with diagnosis and progression. The aim of...

Nutritional Status of Reproductive Ethnic Woman Living in Chittagong Hill Tracts of Bangladesh: Influence of Socio-economic and Nutritional Factors

Aim This cross-sectional study assessed the nutritional status of ethnic reproductive women aged between 15-40 years, comprising 85 lactating women (LW) and 86 non-pregnant-non-lactating women (NPNLW) who lived in various parts of three hilly districts (Bandarban, Khagrachari and Rangamati) of the Chittagong Hill Tracts (CHTs) of Bangladesh. Materials and Method Research tool was pretested semi-structured questionnaire for this observational study. Anthropometric indices like weight, height and mid-upper-arm-circumference (MUAC) were used in assessing the nutritional status. Results Most (44.4%) of the ethnic women were Marma, followed by Chakma (39.8%), Bam (8.2%) and Tripura (5.8%). No significant (P&gt;0.05) differences were observed in socio-economic variables between LW and NPNLW. Overall, mean age of the women was 28 (±7.2) years; mean family income was 18,822.2 (±3091) BDT and majority (86%-87%) were reported to be food secured throughout the year. Mean Dietary calorie (2631±798 kcal) intake of both groups were up to the mark according to the recommended dietary allowances (RDAs) and most (80.3%-86%) of them also possessed good nutritional knowledge. However, no significant (P&gt;0.05) differences were observed in dietary calorie intake and nutritional knowledge score between two groups of women. Overall, most (68.4%) of the women had normal body max index (BMI kg/m2), 11.7% were found to be undernourished or thin and 19.9% were overweight. It was noticed that better nutritional status of LW and NPNLW were significantly associated with literacy (P&lt;0.05), occupancy in household chores (P&lt;0.05), better income (P&lt;0.05), food security (P&lt;0.05), recommended calorie intake level (P&lt;0.05) and better nutritional knowledge score (P&lt;0.05). Conclusion This study showed that vast majority of the ethnic reproductive women of CHTs are in better nutritional status with normal BMI (kg/m2) and daily calorie intake according to RDA. Most of them were food secured and their nutritional knowledge score was also up to the mark. Better socio-economic condition, nutritional knowledge and accurate calorie intake play a vital role in achieving healthy nutritional status of the two women groups of CHTs.

Alcohol use in pregnancy and its impact on the mother and child.

To review the impact of prenatal alcohol exposure on the outcomes of the mother and child. Narrative review. Review of literature. Mothers and infants affected by prenatal alcohol use. Outcomes of mothers and children. Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol-related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol-exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS). The impact of FASD and FAS is enduring and life-long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.