bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support
Authors: Casal Corrine S. , Lei Ann , Young Sera L. , Tuthill Emily L. 
Published: January 2017

Background: Breastfeeding provides beneficial health outcomes for infants and their mothers, and increasing its practice is a national priority in many countries. Despite increasing support to exclusively breastfeed, the prevalence at 6 months remains low. Breastfeeding behavior is influenced by a myriad of determinants, including breastfeeding attitudes, knowledge, and social support. Effective measurement of these determinants is critical to provide optimal support for women throughout the breastfeeding period. However, there are a multitude of available instruments measuring these constructs, which makes identification of an appropriate instrument challenging. Research aim: Our aim was to identify and critically examine the existing instruments measuring breastfeeding attitudes, knowledge, and social support. Methods: A total of 16 instruments was identified. Each instrument’s purpose, theoretical underpinnings, and validity were analyzed. Results: An overview, validation and adaptation for use in other settings was assessed for each instrument. Depth of reporting and validation testing differed greatly between instruments. Conclusion: Content, construct, and predictive validity were present for most but not all scales. When selecting and adapting instruments, attention should be paid to domains within the scale, number of items, and adaptation.
Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital
Authors: Leggett Catherine , Costi Lynn , Morrison Janna L. , Clifton Vicki L. , Grzeskowiak Luke E. 
Published: January 2017

Background: Few studies have investigated breastfeeding outcomes among women exposed to antidepressants. Research aim: This study aimed to evaluate the association between antidepressant use in late gestation and maternal psychiatric illness on breastfeeding rates at discharge from hospital. Methods: The authors conducted a retrospective cohort study of 32,662 women delivering live-born singletons between January 2001 and December 2008. Electronic hospital records were used to obtain data on antidepressant exposure during late gestation and whether mothers were breastfeeding at discharge from hospital following delivery. Results: Five hundred seventy-five women received a dispensing for an antidepressant in late gestation (exposed), 1,552 did not receive a dispensing for an antidepressant but had a reported psychiatric illness (disease comparison), and 30,535 served as nonexposed controls. Exposed women were significantly less likely to be breastfeeding their infants at discharge from hospital compared with nonexposed women, adjusted odds ratio ( AOR) = 0.63, 95% confidence interval (CI) [0.50-0.80], but no statistically significant difference was observed when compared with women in the disease comparison group, AOR = 0.83, 95% CI [0.65-1.07]. In stratified analyses, compared with women in the disease comparison group, exposed women were significantly less likely to be breastfeeding their infants at discharge from hospital if their neonate was delivered at term, AOR = 0.73, 95% CI [0.55-0.98], but not preterm, AOR = 1.24, 95% CI [0.66-2.32]. Conclusion: While antidepressant use is associated with a reduction in breastfeeding rates, this association appears to be strongly influenced by factors such as underlying maternal psychiatric illness. Overall, these results highlight that these women may benefit from additional education and support to improve breastfeeding rates.
Human Milk Handling and Storage Practices Among Peer Milk-Sharing Mothers
Authors: Reyes-Foster Beatriz M. , Carter Shannon K. , Hinojosa Melanie Sberna 
Published: January 2017

Background: Peer milk sharing, the noncommercial sharing of human milk from one parent or caretaker directly to another for the purposes of feeding a child, appears to be an increasing infant-feeding practice. Although the U.S. Food and Drug Administration has issued a warning against the practice, little is known about how people who share human milk handle and store milk and whether these practices are consistent with clinical safety protocols. Research aim: This study aimed to learn about the milk-handling practices of expressed human milk by milk-sharing donors and recipient caretakers. In this article, we explore the degree to which donors and recipients adhere to the Academy of Breastfeeding Medicine clinical recommendations for safe handling and storage. Methods: Online surveys were collected from 321 parents engaged in peer milk sharing. Univariate descriptive statistics were used to describe the safe handling and storage procedures for milk donors and recipients. A two-sample t-test was used to compare safety items common to each group. Multivariate ordinary least squares regression analysis was used to examine sociodemographic correlates of milk safety practices within the sample group. Results: Findings indicate that respondents engaged in peer milk sharing report predominantly positive safety practices. Multivariate analysis did not reveal any relationship between safety practices and sociodemographic characteristics. The number of safe practices did not differ between donors and recipients. Conclusion: Parents and caretakers who participate in peer human milk sharing report engaging in practices that should reduce risk of bacterial contamination of expressed peer shared milk. More research on this particular population is recommended.
“I Had One Job and That Was To Make Milk”
Authors: Bower Katherine , Burnette Tara , Lewis Daniel , Wright Courtney , Kavanagh Katie 
Published: January 2017

Background: For very-low-birth-weight (VLBW) infants, breastfeeding may no longer be an immediate option. Mothers often turn to mechanically expressing their milk with a breast pump to provide their infants human milk. Research aim: This study aimed to describe mothers’ experiences expressing milk for their VLBW infants in a level 3 neonatal intensive care unit. Methods: Qualitative, phenomenological methods were used to better understand the milk expression experiences of 17 mothers of VLBW infants. In-depth interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using Colaizzi’s seven-step protocol, and themes were identified to illustrate the lived experience of the mothers. Results: Five global themes emerged from interviews with mothers. However, this article focuses on one global theme, “I had one job and that was to make milk,” and the supporting subthemes: (1) “I was heartbroken,” (2) “Pumping is a full-time thing,” and (3) “I literally sacrificed nights.” Conclusion: This study provides insight into the complex experience that mothers in the southeastern United States undergo when expressing milk for their VLBW infants.
Knowledge, Representations, Attitudes, and Behaviors of Women Faced With Taking Medications While Breastfeeding
Authors: Spiesser-Robelet Laurence , Brunie Vanida , de Andrade Vincent , Gagnayre Rémi 
Published: January 2017

Background: Breastfeeding is a major public health issue in terms of its benefits to both mothers and infants. Despite recommendations, breastfeeding initiation and duration are low in many industrialized countries. Although human milk is viewed as the most appropriate food for infants, when it is perceived as contaminated, doubts about its quality can lead to negative behaviors concerning breastfeeding. This is especially true when mothers are taking medication. Research aim: The aim of this review is to evaluate the data in the literature on the knowledge, representations, attitudes, and behaviors of women with regard to taking medication while breastfeeding. These elements should aid our understanding of how the mothers’ behaviors are constructed in this situation. Methods: The authors conducted a scoping review to map and analyze the available data from literature sources regarding breastfeeding mothers’ knowledge, representations, attitudes, and behaviors about medicines. A staged approach to the scoping review was used. Results: Eighteen studies met the selection criteria. They described safety behaviors like noninitiation, duration reduction, breastfeeding cessation, and refusal to take medication in order to breastfeed. Most showed a conflict between taking medication and breastfeeding. Because the knowledge, representations, and attitudes behind such behaviors have received very little study, it is difficult to explain how these behaviors are constructed. Conclusion: The results of this review confirm the need for a qualitative study to explore the knowledge, representations, and attitudes of breastfeeding women faced with taking medications, so that we can understand their connection with observed behaviors and take appropriate educational action.
Education Attainment and Parity Explain the Relationship Between Maternal Age and Breastfeeding Duration in U.S. Mothers
Authors: Whipps Mackenzie D. M. 
Published: January 2017

Background: Prior research in high-income countries finds that young mothers tend to breastfeed their infants for shorter durations than older mothers; however, there are gaps in our understanding of the processes by which age influences breastfeeding. Research aim: The primary objective of this study was to test the mediating effects of parity and education attainment on the association between maternal age and two breastfeeding outcomes: total duration and duration of exclusive breastfeeding. Methods: This study was a secondary data analysis of the IFPS II, a prospective, longitudinal study of ~ 4,900 American mothers. Robust and bias-corrected regression analyses tested the direct effect of age and the indirect effects of age through parity and education for each outcome of interest. Results: Parity and education attainment together explain nearly all of the association between maternal age and both measures of breastfeeding duration. The mediating role of education is significantly larger than parity for both outcomes. Conclusion: These findings indicate that maternal age primarily indexes parity and education but contributes minimally to breastfeeding duration via a direct effect. The findings have implications for intervention development and targeting strategies.
Workplace Lactation Support in Milwaukee County 5 Years After the Affordable Care Act
Authors: Lennon Tyler , Bakewell Dalvery , Willis Earnestine 
Published: January 2017

Background: Workplace lactation support has become increasingly important because returning to work is associated with discontinuing breastfeeding and women in the workforce are increasing. Research aim: This study examined workplace lactation support among Milwaukee County businesses 5 years after implementation of the Affordable Care Act’s Break Time for Nursing Mothers provision. Methods: A cross-sectional survey of Milwaukee County businesses was conducted in the summer of 2015 that inquired about workplace policies, lactation spaces, and other lactation resources offered. Business supports were stratified based on employer sizes: large (> 500 employees), medium (50-499 employees), and small (20-49 employees). A lactation amenity score was calculated for each business based on lactation resources available. Results: Three hundred surveys were distributed and 71 businesses voluntarily completed the survey. Small employers were excluded from statistical analysis due to fewer responses ( n = 8). Overall, 87.3% ( n = 55) of respondents reported providing access to a multiuser space for lactation and 65.1% ( n = 41) reported providing a designated lactation space. Large employers ( n = 30) were more likely than medium employers ( n = 33) to provide a designated lactation space for breastfeeding or expressing (86.7% vs. 45.5%, p < .001). Large employers’ mean amenity score was significantly higher than that of medium employers (3.37 vs. 2.57, p = .014), and they were also more likely to offer additional supports including access to a lactation consultant, classes, and materials (46.7% vs. 12.1%, p < .01). Conclusion: Large employers provide more lactation support than medium employers in Milwaukee County. All employers, regardless of size, need to increase additional lactation support for women in the workplace.
Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3
Authors: Wouk Kathryn , Tully Kristin P. , Labbok Miriam H. 
Published: January 2017

Background: The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity. Methods: The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies. Results: Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women’s partners or family are involved. However, varying study quality and lack of standardized assessment of participants’ breastfeeding intentions limited the ability to recommend any single intervention as most effective. Conclusion: Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.
Going North on a North-Bound Trail: A Model for Achieving Health Management Goals and Objectives
Authors: Eni Godwin O. , Tan Joseph K. H. 
Published: January 2017

A basic managerial problem in decision making is to synthesise and priorise information relating to the achievement of organisational goals and objectives. This paper discusses the role of critical success factors in health services planning as a means for sorting out and specifying relevant information necessary for achieving organisational goals and managerial objectives. The proposed approach enhances existing planning procedures for health care organisations. Within a conceptual framework of the health care system, managerial insights are provided for the realisation of organisational goals via measurable managerial objectives using critical success factors as pointers to success. More importantly, this paper introduces a planning model which incorporates the CSF concept for developing new health care programmes and for evaluating or restructuring existing programmes.
Clinicians into Management. The Experience in Context
Authors: Burgoyne John , Lorbiecki Anna 
Published: January 2017

This paper interprets the experience of a sample of 60 clinicians becoming involved in formal management, mainly at hospital unit level, in the historical context of changing health service organisation. This includes the introduction of managerialism and the evolution of the NHS into a structured network based around purchaser/provider relationships. The conclusion is that these clinicians are becoming involved in management, and making the personal and social adjustments necessary for this, but in a way that leaves medical culture, and their allegiance to it, at the present largely intact. This is achieved largely through the organisational mechanism of clinical directorates, which promise to function as professional groups from the clinical point of view and as business units from the managerial perspective. An argument is put forward, based on a theoretical view compatible with the data from the clinicians' experience, that this mode of medical involvement in management may operate without undue conflict in the longer term if: (a) clinicians accept the degree of local professional regulation that this model applies; and (b) the conflict between medical need and available resource can be dealt with elsewhere in the system without passing it back to hospitals and clinical directorates. On the other hand it is possible that conflict will increase if the consequences of management control systems and objectives percolate down through the management hierarchy and cross into the medical domain, via clinical directorates.
Evaluation on HIV Serology and Immune-Stimulation on Patients in Tanzania
Authors: Hengster P , Schmutzhard E , Fuchs D , Hofbauer J , Wachter H , Dierich M P 
Published: January 2017

Antibodies against human immunodeficiency virus, other infectious agents and neopterin levels were determined in 253 patients in a rural area of North-West Tanzania. Seroprevalence for HIV was 3.2%. In one case serology was positive for HIV-1 and HIV-2 antibodies and questions whether there was a real double infection or a cross reaction not only concerning core region proteins but also transmembrane protein. The specificity in the diagnosis of HIV-infection is markedly increased with newer serological methods using recombinant peptides but did not improve sensitivity on African sera. Neopterin was determined as a sensitive indirect marker for the activation of T-cells and is therefore correlated with the susceptibility of HIV infection and with progression of disease. High seroprevalence rates for various infectious agents were determined and may explain the high rate of elevated neopterin levels in 80% of the Africans. Neopterin levels were even higher in HIV patients. Viral p24 antigen was found only in two persons, one of whom had no antibodies detectable.
Hepatitis C among Risk Groups for HIV and Hepatitis B
Authors: Vanderschueren S , Van Renterghem L , Plum J , Verhofstede C , Mak R , Vincke J 
Published: January 2017

In order to obtain more information on sexual transmission of hepatitis C (HCV) we compared different high-risk groups for HIV and hepatitis B to see if they were seropositive for HCV. A high seroprevalence (38/81) of hepatitis C (HCV) was found among intravenous drug users. Nursing staff ( n = 35) and patients of a dialysis unit ( n = 57) had a low prevalence of anti-HCV antibodies (0% and 5%, respectively). Serology laboratory technicians also had a very low prevalence (0% out of 29). Among prostitutes ( n = 114), healthy homosexual men ( n = 132) and HIV-infected homosexual men ( n = 31), we found a remarkably low seroprevalence of HCV (3.5%, 0.8% and 0.0% respectively). These data support the view that parenteral exposure to the virus is the most important way of acquiring the infection and that neither heterosexual nor homosexual promiscuity are associated with a high risk of transmission of hepatitis C.
Risk of HIV Infection among Dutch Expatriates in Sub-Saharan Africa
Authors: Houweling Hans , Coutinho Roel A 
Published: January 2017

In order to study the prevalence of human immunodeficiency virus (HIV) infections and related risk factors, Dutch expatriates returning from sub-Saharan Africa were asked to complete a questionnaire on sexual, occupational and other risk factors, and to donate a sample of blood to test for antibodies against HIV. The 1968 participants were workers of various professions and their family members over 16 years of age posted in sub-Saharan African countries by Dutch governmental, non-governmental and commercial organizations for at least 6 months cumulative time between 1 January 1979 and 1 January 1990. Antibodies against HIV-1 were found among 4 of 1122 men (0.4%) and 1 of 846 women (0.1%). The woman and 3 of the men had had sexual contact with African partners and had been treated for sexually transmitted diseases, 2 of these 3 men also had an African life partner. One man reported occupational exposure only. Of the 1968 participants 89 men (7.9%) and 18 women (2.1%) lived with an African partner; 344 men (30.7%) and 111 women (13.1%) had heterosexual contact with other African partners. Only 22.3% (men) and 18.6% (women) of casual sexual contacts with African partners were always protected by a condom. Two hundred and thirty-two of 408 (56.9%) (para)medics reported needlesticks. Groups at risk of HIV infection through sexual exposure were identified using logistic regression models. In conclusion, the observed prevalence of HIV-1 is low. However, unprotected sexual contact with African partners and needlestick accidents were common. This study underscores the continuous need for health education of expatriates on the risks of transmission of HIV in Africa.
Improved Outcome of Pneumocystis Carinii Pneumonia in AIDS Patients: A Multifactorial Treatment Effect
Authors: Beck E J , French P D , Helbert M H , Robinson D S , Moss F M , Harris J R W , Pinching A J , Mitchell D M 
Published: January 2017

Factors determining the outcome of an episode of Pneumocystis carinii pneumonia (PCP) in 149 AIDS patients treated at St Mary's Hospital were identified and their importance on improved survival evaluated between 1984 and 1989. The proportion of fatal episodes of PCP decreased over time. Fatal compared with non-fatal episodes had lower mean alveolar-arterial oxygen gradient (82.5 mmHg vs 53.8 mmHg, P<0.001), mean haemoglobin level (11.2g/dl vs 12.1 g/dl, P=0.01), mean lymphocyte count (0.68 times 109/l vs 0.92 times 109/l, P=0.05) and more coinfections (31% vs 5%, P<0.001). Over time, the most significant change which occurred was a reduction in alveolar-arterial oxygen gradient at time of first presentation with PCP (r=−0.37, P<0.001). Mean alveolar-arterial oxygen gradient declined from 79.9 mmHg in 1984 to 45.3 mmHg in 1989 (r= −0.88, P=0.02), independently of zidovudine therapy or PCP prophylaxis. Patients were being treated at an earlier stage in their disease course as indicated by their reduced alveolar arterial oxygen gradient. This is due either to earlier patient presentation, earlier medical diagnosis or both. The widespread introduction of zidovudine and PCP prophylaxis may further contribute to improve morbidity and mortality patterns in the future.