Exclusive Rates Research Articles

The Effect of the 2023 Turkey-Syria Earthquakes on the Sixth-Month Breastfeeding Rate of Infants: A Single-Centre Cohort Study

Background: We investigated the effect of earthquakes on the six-month breast milk intake rate in infants. Methods: In this single-centre prospective cohort study, 35 mother-baby dyads who were in the earthquake zone during the February 6, 2023, Turkey-Syria earthquakes were included as the study group, while 29 mother-baby dyads who were not in the earthquake zone were included as the control group. The physical, environmental, and social characteristics of the settlements after the earthquake, along with the nutritional characteristics of the infants, were evaluated through questionnaires during interviews and online assessments. The Breastfeeding Self-Efficacy Form and the Edinburgh Postnatal Depression Scale were administered to the mothers, and their scores were calculated. Results: No significant difference was found between the exclusive breastfeeding rates at six months in the study and control groups [18 (62.9%) vs. 22 (61.9%), n (%), P = 0.95]. The breastfeeding self-efficacy score was significantly higher in the study group [64 (33 - 70) vs. 54 (31 - 70), median (min-max), P = 0.02]. Although the Edinburgh Postpartum Depression Scale (EPDS) score was higher in the control group [10 (0 - 21) vs. 7 (0 - 26), median (min-max)], this difference was not statistically significant. Conclusions: In general, earthquakes do not affect breastfeeding rates in infants at six months. The continuation of breastfeeding, supported by increased resilience in difficult conditions, enhances breastfeeding self-efficacy and provides protection for the mother-baby dyad. Breastfeeding should be continued and supported during natural disasters.

The Effect of Education on Economic Growth in Sub-Saharan African Countries: Do Institutions Matter?

This paper investigates the moderating role of institutional quality on the relationship between education and economic growth in Sub-Saharan Africa (SSA). The study applies the panel ARDL model to data from 18 SSA countries spanning 2000–2020 for its main analysis, along with a battery of diagnostics test to ensure the robustness of the results. The results reveal that the long-term effect of education on economic growth is statistically insignificant, attributing this finding to high rates of education exclusion and low-quality education. Remarkably, the research emphasizes the moderating role of institutional quality, showing the positive effects of education on economic growth when countries demonstrate robust corruption control and political stability. The study contributes to the existing literature by highlighting specific institutional factors influencing the effectiveness of education in driving economic growth, emphasizing the need for a strong institutional framework alongside educational efforts for sustainable development. The findings highlight that robust institutions form a crucial infrastructure that enhances the effectiveness of education in driving productivity and fostering economic growth.

Accuracy and Reproducibility of Bullet Comparison Decisions by Forensic Examiners

Few previous studies have assessed the accuracy and reproducibility of bullet comparison decisions by firearms examiners, and none have evaluated accuracy of examiners’ decisions when comparing damaged bullets, comparisons of questioned bullets, or the effects on decision rates of using jacketed hollow-point vs. full metal jacket bullets. In this study, 49 practicing forensic firearms examiners conducted 3,156 comparisons of bullets, including bullets ranging in quality, bullets from different types of ammunition, and bullets fired from various makes/models of firearms. The study evaluated two scenarios commonly used in casework: questioned-questioned (QQ) comparisons of two bullets from unknown sources, and known-questioned (KQ) comparisons in which a bullet from an unknown source is compared to three known exemplars from a single firearm. Key findings: after controlling for other factors, QQ vs. KQ comparisons had relatively limited effects on decision rates; rates of inconclusive responses were inversely related to bullet quality; bullets fired from polygonally-rifled pistols resulted in more inconclusive or unsuitable responses than conventional rifling; on nonmated comparison sets, the rate of (true) exclusions was particularly high when comparing different caliber bullets, and was higher on comparisons of different makes/models of firearms vs. the same model of firearm; comparisons in which different types of ammunition were fired from the same firearm had a high rate of erroneous exclusions; decision rates differed notably by firearm model; decision rates varied notably among the participants. Because the measured rates vary dramatically due to these various factors, we recommend against using overall decision rates to summarize the results of this study. Significance StatementComparisons of bullets by forensic firearms examiners are a critical part of the criminal justice system, seeking to determine whether recovered bullets from crime scenes can be attributed to specific firearms. This paper reports the results of a research study designed to assess the accuracy and reliability of forensic bullet comparison decisions, which is important to assess scientific validity for admissibility in court. Few studies have been conducted assessing the accuracy of forensic bullet comparison decisions, and no previous studies have evaluated the accuracy and reproducibility of decisions made by practicing forensic firearms examiners when comparing bullets of varying quality or bullets of different types, or when making comparisons of questioned bullets.

Trends in epidemiological characteristics and etiologies of diarrheal disease in children under five: an ecological study based on Global Burden of Disease study 2021

BackgroundDiarrhea remains a significant health threat to children under five years of age. The study aims to systematically elucidate the global burden of diarrhea in children, providing scientific insights for effective prevention and control strategies. MethodsThe data from the Global Burden of Disease (GBD) 2021 study was analyzed to assess the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of diarrhea in children under five years across the globe, 21 geographical region, and 204 countries and territories, stratified by age group, sex, and socio-demographic index (SDI) levels. The trend of the disease burden for childhood diarrhea from 1990 to 2021 was described and estimated using the average annual percentage change (AAPC), and a Bayesian age-period-cohort (BAPC) model was employed to predict the future burden of diarrhea in children. ResultsFrom 1990 to 2021, there was a significant decline in the global burden of diarrhea among children under five years of age. The AAPC for incidence (－4092.18, 95% confidence interval [CI]: －4224.60 – －3959.76), prevalence (－70.98, 95% CI: －72.67 – －69.28), mortality (－6.89, 95% CI: －6.95 – －6.83), and DALYs rate (－621.79, 95% CI: －627.20 – －616.38) of diarrhea in children all showed a marked downward trend. Diarrheal incidence (r = －0.782, P < 0.001), prevalence (r = －0.777, P < 0.001), mortality (r = －0.908, P < 0.001), and DALYs rate (r = －0.904, P < 0.001) were negatively correlated with the SDI. Between 2022 and 2035, the global incidence, prevalence, and mortality rates of diarrhea in children under five years are projected to continue declining. The leading causes of diarrheal mortality in children include wasting, underweight, and non-exclusive breastfeeding. Rotavirus remains the predominant pathogen associated with diarrhea-related mortality rate and DALY rate. ConclusionAlthough the global burden of diarrhea in children under five has steadily declined, it remains a significant health threat. Rotavirus is the leading pathogen, highlighting the importance of expanding rotavirus vaccination. Additionally, improving nutritional status, increasing exclusive breastfeeding rates, and enhancing access to sanitation and clean drinking water are crucial measures that, when widely implemented, can effectively reduce the health risks posed by diarrhea in children.

EXCLUSIVE BREASTFEEDING PRACTICE AND ASSOCIATED FACTORS AMONG FIRST-TIME MOTHER IN LARKANA

Exclusive breastfeeding (EBF) is defined as the practice of feedi: Exclusive breastfeeding (EBF) is defined as the practice of feeding infants solely with breast milk for the first six months of life, without introducing any other liquids or solid foods, except oral rehydration solutions, vitamins, or necessary medications. Objective: The main objective of the study is to find the exclusive breastfeeding practice and associated factors among first-time mothers in Larkana, Pakistan. Methods: This cross-sectional study was conducted at Sheikh Zayed Women's Hospital Larkana from June 2023 to December 2023. Data involve 345 breastfeeding first-time mothers as participants. Data were collected through a random sampling technique. Participants were first-time mothers with infants aged between 0-6 months, willing to provide informed consent were included in the study. Mothers with serious health conditions or those whose infants had medical complications preventing breastfeeding were excluded. Results: Data include 345 participants according to the criteria of the study. The majority of participants in the study were aged between 20-30 years (60.3%), with a smaller proportion under 20 years (9.3%) and over 30 years (30.4%). Most had secondary education or less (68%), while 32% had higher education. Regarding employment status, 59.4% were unemployed, and 40.6% were employed. In terms of socioeconomic status, 40% of participants were from low-income groups, 35% from middle-income, and 25% from high-income. In the study, 58% of participants reported practicing exclusive breastfeeding (EBF), while 42% did not. Conclusion: Exclusive breastfeeding rates among first-time mothers remain suboptimal, with significant factors such as maternal age, education, employment status, mode of delivery, and healthcare support playing key roles in influencing EBF practices.ng infants solely with breast milk for the first six months of life, without introducing any other liquids or solid foods, except oral rehydration solutions, vitamins, or necessary medications. Objective: The main objective of the study is to find the exclusive breast-feeding practice and associated factors among first-time mothers in Larkana, Pakistan. Methodology: This cross-sectional study was conducted at Sheikh Zayed Women Hospital Larkana during June 2023 till December 2023. Data involve 345 breast feeding first-time mothers as participants. Data were collected through a random sampling technique. Participants were first-time mothers with infants aged between 0-6 months, willing to provide informed consent were included in the study. Mothers with serious health conditions or those whose infants had medical complications preventing breastfeeding were excluded. Results: Data include 345 participants according to the criteria of the study. The majority of participants in the study were aged between 20-30 years (60.3%), with a smaller proportion under 20 years (9.3%) and over 30 years (30.4%). Most had secondary education or less (68%), while 32% had higher education. Regarding employment status, 59.4% were unemployed, and 40.6% were employed. In terms of socioeconomic status, 40% of participants were from low-income groups, 35% from middle-income, and 25% from high-income. In the study, 58% of participants reported practicing exclusive breastfeeding (EBF), while 42% did not. Conclusion: Exclusive breastfeeding rates among first-time mothers remain suboptimal, with significant factors such as maternal age, education, employment status, mode of delivery, and healthcare support playing key roles in influencing EBF practices.

Digital Tele-Counseling for Sustainable Maternal Health Services in Indonesia Focus on Telelactation

Breastfeeding is essential for infant health and development, yet Indonesia faces challenges in meeting global breastfeeding targets. This review examines the potential of tele-counseling (telelactation) as a solution to improve breastfeeding support in the digital era, focusing on overcoming geographical and service delivery barriers. A systematic literature search covering PubMed, Scopus, Google Scholar, and local Indonesian journals identified 25 articles from 2019 to 2023, with 14 unique studies meeting inclusion criteria. Findings indicate that telelactation primarily utilizes WhatsApp groups, Androidbased apps, and online counseling sessions, resulting in improved breastfeeding techniques, increased exclusive breastfeeding rates, and enhanced maternal knowledge. However, privacy concerns and technological barriers persist, though these are addressed through specialized training and ongoing support for healthcare providers. Telecounseling demonstrates promise in supporting breastfeeding in Indonesia, though further research is needed to address geographical limitations and assess longterm impacts. Integrating telecounseling into national breastfeeding policies could significantly advance maternal and child health outcomes in Indonesia.

Maternal employment characteristics as a structural social determinant of breastfeeding duration

Abstract Background The European Region exhibits the world’s lowest exclusive breastfeeding rate at 6 months. Addressing work-related breastfeeding challenges is crucial, particularly for women navigating precarious work situations, compounding their adversity. This scoping review surveys research on maternal employment characteristics facilitating breastfeeding continuation post-return to work in the European Region. Methods Studies from 2013 to 2023 were gathered from Scopus, PubMed, and PsycInfo. Inclusion criteria comprised English or French quantitative/qualitative studies exploring links between maternal employment characteristics and breastfeeding status, duration, or experience. Participants were employed mothers of healthy children sustaining breastfeeding post-resumption of work. Key determinants included work-related factors contributing to socially diverse working conditions, encompassing type of employment, working conditions, and work environment. Geographic scope included World Health Organization European Region countries. Results Among 693 hits, 13 studies met criteria. Eight focused on work and breastfeeding, others explored broader breastfeeding determinants. Represented countries: Spain (n = 4), France (n = 4), UK (n = 2), Ireland (n = 2), Netherlands (n = 1). Findings highlighted methodological heterogeneity, indicating a lack of conceptual framework linking work, breastfeeding, and social health inequalities. Nonetheless, self-employment, non-manual professions with time flexibility, workplace breastfeeding facilities, coworker support, and breastfeeding workplace policies emerged as pivotal factors supporting working mothers’ breastfeeding. Conclusions Backing breastfeeding choices for working mothers is crucial amid adversities faced by mothers and children. These results underscore the need for targeted workplace interventions, including time flexibility, breastfeeding facilities, and promotion of breastfeeding-friendly policies. Key messages • Self-employment, non-manual occupations, time flexibility, breastfeeding facilities, support of co-workers and breastfeeding workplace policies promote continuation of breastfeeding. • Policy directives targeting low skilled or precarious jobs are needed to reduce social health inequalities broadly, and in particular, in relation to breastfeeding practices.

Factors Influencing Exclusive Breastfeeding in Rahayu Village, Sanggau, West Kalimantan, Indonesia

Low coverage of exclusive breastfeeding in the community is generally influenced by a lack of maternal knowledge, family support, and cultural influences. This results in a very low exclusive breastfeeding coverage rate, which has the potential to cause various future health problems, such as infections, fevers, and other diseases. This study aims to identify the factors influencing exclusive breastfeeding in Rahayu Village, Sanggau, West Kalimantan. This is an analytic observational study with a case-control design. The population consisted of mothers who had children aged from 6 months and 1 day to 24 months, totaling 90 people. A total of 72 respondents were purposively selected for this study. The analysis used the chi-square statistical test with a 95% confidence level. The results showed that there was a relationship between age (p=0.002; OR=5.3), education level (p=0.031; OR=3.2), IMD (p=0.017; OR=3.6), culture (p=0.000; OR=8.2), knowledge (p=0.000; OR=10), and family support (p=0.000; OR=17.5) and exclusive breastfeeding in the Rahayu Village Study Community in the Working Area of Puskesmas Pusat Damai, Sanggau. The study also found several factors that did not have a relationship with exclusive breastfeeding, including work (p=0.156), parity (p=0.236), income (p=1.000), birth attendants (p=0.107), and place of delivery (p=0.260). It is expected that all sectors of government agencies will collaborate to address issues related to knowledge, family support, and conflicting cultural traditions to better support exclusive breastfeeding programs.

Heart Rate Estimation Considering Reconstructed Signal Features Based on Variational Mode Decomposition via Multiple-Input Multiple-Output Frequency Modulated Continuous Wave Radar

Accurate heart rate estimation using Doppler radar and Frequency Modulated Continuous Wave (FMCW) radar is highly valued for privacy protection and the ability to measure through clothing. Conventional methods struggle to isolate the heartbeat from respiration and body motion. This paper introduces a novel heart rate estimation method using Variational Mode Decomposition (VMD) via Multiple-Input Multiple-Output (MIMO) FMCW radar. The proposed method first estimates human positions within the radar’s coverage, reducing noise by focusing on signals from these positions. The signal is then decomposed into multiple Intrinsic Mode Function (IMF) signals using VMD, and the heartbeat-specific IMF is extracted based on its center frequency. The heart rate signal is reconstructed using weighted addition of IMF signals for each radar cell, with cells defined by specific angles and distances within the coverage area. Peak detection is used to estimate heart rate from these reconstructed signals. To ensure accuracy, the method selects the heart rate estimate with the highest energy and periodicity for the first four time windows. From the fifth time window onward, it selects the estimate closest to the average of the previous four, minimizing extraneous variations. Experiments conducted with one and two subjects showed promising results. In case 1, with one subject, the method achieved a Mean Absolute Error (MAE) of 2.54 BPM and an exclusion rate of 0.94% using MIMO FMCW radar, compared to 4.72% with Doppler radar. In case 2, with two subjects, the method achieved an MAE of 2.28 BPM, confirming accurate simultaneous heart rate estimation.

Knowledge, Attitudes, and Practices Regarding Exclusive Breastfeeding among Lactating Mothers in Rural Bangladesh

Background: Exclusive breastfeeding stands at the forefront of maternal and child health, serving as a fundamental pillar for ensuring the optimal growth and development of infants. It not only acts as a crucial source of nutrition but also plays a pivotal role in fortifying the physical and cognitive well-being of newborns, while simultaneously fostering a profound bond between mothers and their infants.Objective: This research seeks to gauge the level of awareness among lactating mothers regarding the significance and benefits of exclusive breastfeeding. It aims to comprehend their attitudes towards exclusive breastfeeding (EBF) and scrutinize their actual practices in implementing this vital aspect of infant care.Materials and Methods: A cross-sectional study was conducted at the Department of Community Medicine, ASWMC, Jashore, in 2018. Data collection took place in the Outpatient Department (OPD) of 'Ad-din Sakina Medical College Hospital' and 'Mother &amp; Child Welfare Centre, Jashore.Results: The study demonstrates a high awareness and adherence to exclusive breastfeeding, with 94.4% aware, 90.9% knowledgeable about recommended duration, 49.9% recognizing advantages, 14.6% aware of disadvantages, and a substantial majority (92.5%) practicing exclusive breastfeeding, though 7.5% do not.Conclusion: Bridging knowledge gaps, cultivating positive attitudes, and promoting consistent breastfeeding practices emerge as crucial components of a comprehensive strategy to boost exclusive breastfeeding rates. The collaboration between healthcare providers, policymakers, and the community is indispensable for the success of such initiatives, ultimately contributing to the overall health and well-being of both infants and lactating mothers. KYAMC Journal Volume: 15, No: 01, April 2024: 46-49.

Comparative Analysis of Tailored Minicraniotomy versus Standard Pterional Craniotomy in the Treatment of Anterior Circulation Aneurysms: A Single-Center Case–Control Observational Study

Abstract Introduction Multiple minicraniotomies (Mct) have been proposed as alternatives to standard pterional craniotomy (Pct) for intracranial aneurysm treatment. These approaches offer limited surgical corridors and distinct working angles, posing challenges in addressing all aneurysm types with one method. We suggest a tailored Mct technique, comprising three minimally invasive approaches targeting anterior circulation aneurysm sites (middle cerebral artery, internal carotid artery, anterior communicating artery). Methods We conducted a retrospective, case–control study at a single center comparing Pct and Mct outcomes for ruptured and unruptured aneurysms. Parameters evaluated included conversion rates to Pct or decompressive hemicraniectomy (DHC), intraoperative rupture (IOR), surgical complications, complete aneurysm exclusion, 6-month modified Rankin Scale (mRS) scores, and aesthetic outcomes using a visual analog scale. A total of 146 patients were included, with 103 in the Mct group and 43 in the Pct group, comparable in mean age, sex, and aneurysm topography. Hunt–Hess scores and Fisher grades were lower in the Mct group initially. Results No cases required conversion from Mct to Pct or DHC. No significant differences were observed in IOR, surgical complications, and aneurysm exclusion rates between groups. The Mct group demonstrated better 6-month mRS scores and aesthetic outcomes. Conclusion Our study indicates that tailored Mct is as safe and effective as standard Pct for intracranial aneurysms, with significant cosmetic benefits. Thus, tailored Mct can be considered a valuable alternative not only to Pct but also to other minimally invasive surgical methods for these aneurysms.

The Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer (CISTO) study: Lessons learned about management and patient enrollment in a large, pragmatic, patient-centered trial.

The growth of patient and public involvement in clinical research highlights the paucity of literature on operational practices that ensure the success of large, patient-centered outcomes trials. The authors' objective was to identify tools launched by the Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer (CISTO) study team to determine their effectiveness in maximizing patient enrollment in this observational, pragmatic trial. The primary outcomes for this study were patient screening and enrollment across 36 CISTO study sites. The operational strategies included CISTOquestion email correspondence and All Sites Meetings, specifically poll performance data from meetings, and a nonanonymized feedback survey about the CISTO study's management practices. Effectiveness was measured using correlation analysis with patient cohort data, including screenings, enrollments, post-hoc exclusions, and the post-hoc exclusion rate. Average screenings and enrollment rose after the implementation of CISTOquestion in April 2021, with the average number of screenings rising from 7.42 to 26.8 patients per month and enrollment rising from 3.76 to 16 patients per month. Use of CISTOquestion was correlated strongly with increased patient screenings and enrollment across all study sites. Eighty-three percent of sites with above-average post-hoc exclusion rates (≥0.092) sent below the average number of CISTOquestion inquiries. Poll performance and survey data revealed that all survey respondents who used CISTOquestion found that it was a valuable and accessible resource. Of the several operational tools implemented within the CISTO study that aimed to improve patient enrollment, CISTOquestion, a centralized email for addressing eligibility questions, was most beneficial to overall patient accrual.

School exclusion policies across the UK: convergence and divergence

ABSTRACT Previous comparative research has revealed recent high and rising school exclusion rates in England and a contrasting picture of much lower and reducing rates in Northern Ireland, Scotland and Wales. In this paper, we examine findings from new research into school exclusion policies across the four countries of the UK. This interrogates for the first time how the problem of ‘school exclusion’ is framed within these four distinct policy contexts. We take up the question of how policy levers and drivers may shape patterns and trends in permanent exclusion and suspension/temporary exclusion. This analysis reveals that, despite broad agreement in policy on a need to reduce exclusion and increase equity across the UK jurisdictions, there are diverging policy stances on the purposes of exclusion, responsibilities of schools and the role of the state overall in bringing about change. We conclude that deeper critical engagement with policy contexts is a vital element in understanding the persistence of school exclusion itself but also the differential rates of exclusion across the UK.

Father support breastfeeding self-efficacy positively affects exclusive breastfeeding at 6 weeks postpartum and its influencing factors in Southeast China: a multi-centre, cross-sectional study

BackgroundThe exclusive breastfeeding condition in China is not optimism now. Maternal breastfeeding self-efficacy stands as a pivotal factor influencing exclusive breastfeeding. Interestingly, studies have suggested that father support breastfeeding self-efficacy is a pivotal mediator in infant breastfeeding. Thus, the current research aimed to investigate the association between father support breastfeeding self-efficacy and exclusive breastfeeding at six weeks postpartum, and the influencing factors of father support breastfeeding self-efficacy.MethodsThis research was structured as a multi-centre cross-sectional study, involving 328 fathers, whose partners were six weeks postpartum, and recruited from two public hospitals in Southeast China. Self-designed demographic questionnaires, namely, Father Support Breastfeeding Self-Efficacy Scale-Short Form, Breastfeeding Knowledge Questionnaire, Positive Affect Scale and the 14-item Fatigue Scale, were applied. Descriptive statistics, Chi-square test, logistic regression univariate analysis and multiple linear regression were used to analyse data.ResultsResults indicate a significant difference between the infant feeding methods at six weeks postpartum and fathers with different levels of support breastfeeding self-efficacy (p < 0.05). Particularly, father support breastfeeding self-efficacy positively affected exclusive breastfeeding at six weeks postpartum after adjusting all the demographic characteristics of fathers (OR: 2.407; 95% CI: 1.017–4.121). Moreover, results show that the significant influencing factors of father support breastfeeding self-efficacy include breastfeeding knowledge, fatigue, positive affect, successfully experienced helping mothers to breastfeed, spousal relationships and companionship time.ConclusionsHigh-level father support breastfeeding self-efficacy effectively increased exclusive breastfeeding rate at six weeks postpartum. To enhance the exclusive breastfeeding rate, nurses or midwives can endeavour to design educational programmes or take supportive interventions customised for fathers, such as enhancing their breastfeeding knowledge education, reducing fatigue and mobilising positive emotions, thereby bolstering paternal self-efficacy in breastfeeding.

Medicare Part D Protected-Class Policy Is Associated With Lower Drug Rebates.

Medicare Part D does not allow plans to exclude drugs in six protected classes from their formularies, which may limit plans' ability to negotiate rebates and lead to higher spending. We estimated the association between protected-class status, US-level estimated rebates, and formulary coverage during the period 2011-19. We found that protected classes indeed had significantly lower exclusion rates in Medicare Part D during this period relative to nonprotected classes, and this difference was larger than the corresponding difference in commercial plans. US-level average rebates grew 22.5percentage points less in protected than in nonprotected classes during 2011-19, a period when formulary exclusions increased. Relative to nonprotected classes, US-level average rebates in protected classes were especially low among drugs with high Medicare market share. These results suggest that Medicare Part D protected-class policy may reduce rebates.

The Effect of Baby Friendly Neonatal Intensive Care Initiative on Exclusive Breastfeeding Rates following Discharge in Very Preterm Infants.

We aimed to investigate the effect of "Baby Friendly NICU" practice on exclusive breastfeeding rates following discharge in very preterm infants. The Baby-Friendly Hospital Initiative (BFHI) is a global program launched by the World Health Organization (WHO) and UNICEF. The feeding technique, type of nutrition (breastfeeding, formula, mixed) and anthropometric measurements of the very preterm infants (≤32 gestational weeks) were recorded for every month following discharge up to corrected 6months of age. Exclusive breastfeeding rates were compared between 2 periods before "Baby Friendly NICU" practice (group 1) and after (group 2). Data of 252 infants, 135 in group 1 and 117 in group 2 were analyzed. Exclusive formula feeding rates decreased by 6months age in group 2 (46 vs. 32%, P =.02); however, exclusively breastfeeding rates did not changed significantly (20% vs. 29%, P =.14). Baby friendly NICU practices significantly decreased formula feeding rates at 6months; however, it did not have an effect on exclusive breastfeeding rates at any time point during follow-up probably due to small sample size.

Maternal Care of Preterm Infants after Discharge from the Neonatal Intensive Care Unit: A Rapid Review

Abstract The maternal care of infants poses a unique challenge for mothers, especially after discharge from the hospital. This review focused on the literature on maternal care of preterm infants at home after discharge from the hospital’s Neonatal Intensive Care Unit (NICU). A comprehensive literature search was conducted using keywords relevant to the topic. PubMed and EBSCO essential databases were searched for studies published between 2017 and 2023 (six years). Out of the 2903 retrieved studies, 7 were eligible and included in the review. The quality of available evidence was assessed using the Johns Hopkins Nursing Evidence Appraisal Tool (JHNEAT) and the Critical Appraisal Skills Programme (CASP) checklist. This review found that exclusive breastfeeding rates for preterm infants at home varied from 27% to 76% (Pooled prevalence of 48%) in data extracted from the studies conducted in Ethiopia (Africa), Brazil (South America), USA (North America), Denmark, and Italy (Europe). The practice of kangaroo mother care (KMC) for temperature regulation ranged from 41% to 83% (Pooled prevalence of 63%) in data extracted from studies conducted in Ethiopia (Africa) and Denmark (Europe). The review concluded that the care provided by mothers at home after discharge from the NICU was inadequate. Maternal and child health services providers should develop social media platforms to educate and encourage mothers to sustain exclusive breastfeeding and KMC practices after leaving the NICU.

The effect of on-site and on-call nurse on exclusive breastfeeding in two different hospital settings: a prospective observational cohort study

BackgroundExclusive breastfeeding during postpartum hospitalization is very important for ensuring the success of breastfeeding at home. The aim of the study is to determine if the on-site nurse in rooming in improves exclusive breastfeeding ratio.MethodsWe conducted a prospective observational cohort study to evaluate exclusive breastfeeding during the first three months of life in two Neonatology Units in the South of Italy with different hospital settings: Ente Ecclesiastico Miulli of Acquaviva delle Fonti with on-site nurse h24 (on-site group) and Policlinico of Bari with nurse available on call h24 from Neonatology Unit (on-call group).ResultsA total of 564 mother-baby dyads were admitted from 3 January to 31 March 2018 (299 in on-site group and 265 in on-call group). In the overall population, exclusive breastfeeding rate was 76.4% at 90-days, confirming the role of nurse and rooming in, independently of modality of setting. Considering the way of delivery, in infants from cesarean section there were higher rates for exclusive breastfeeding at 30 and 90 days of life in on-site group.ConclusionsWe can assume that the presence of a nurse h24 could better identify breastfeeding problems. Our study suggests the role of on-site nurse during rooming in to encourage exclusive breastfeeding until three months of life in mothers who underwent caesarean section.

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.