Breastfeeding woes: a family physician's approach.
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ABSTRACT:
SUBMITTER: Zhou Q
PROVIDER: S-EPMC9251225 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:To evaluate the association between physician's patient-centered communication patterns and parental satisfaction during decision-making family conferences in the PICU.Single-site, cross-sectional study.Forty-four-bed PICUs in a free-standing children's hospital.Sixty-seven English-speaking parents of 39 children who participated in an audiorecorded family conference with 11 critical care attending physicians.Thirty-nine family conferences were audiorecorded. Sixty-seven of 77 (92%) eligible parents were enrolled. The conference recordings were coded using the Roter Interaction Analysis System and a Roter Interaction Analysis System-based patient-centeredness score, which quantitatively evaluates the conversations for physician verbal dominance and discussion of psychosocial elements, such as a family's goals and preferences. Higher patient-centeredness scores reflect higher proportionate dialogue focused on psychosocial, lifestyle, and socioemotional topics relative to medically focused talk. Parents completed satisfaction surveys within 24 hours of the conference. Conferences averaged 45 minutes in length (SD, 19?min), during which the medical team contributed 73% of the dialogue compared with parental contribution of 27%. Physicians dominated the medical team, contributing 89% of the team contribution to the dialogue. The majority of physician speech was medically focused (79%). A patient-centeredness score more than 0.75 predicted parental satisfaction (? = 12.05; p < 0.0001), controlling for the length of conference, child severity of illness, parent race, and socioeconomic status. Parent satisfaction was negatively influenced by severity of illness of the patient (? = -4.34; p = 0.0003), controlling for previously mentioned factors in the model.Parent-physician interactions with more patient-centered elements, such as increased proportions of empathetic statements, question asking, and emotional talk, positively influence parent satisfaction despite the child's severity of illness.
| S-EPMC4893980 | biostudies-literature
Project description:Hotorobo, Woes, and Monty are newly isolated bacteriophages of Gordonia terrae 3612. The three phages are related, and their genomes are similarly sized (76,972 bp, 73,752 bp, and 75,680 bp for Hotorobo, Woes, and Monty, respectively) and organized. They have extremely long tails and among the longest tape measure protein genes described to date.
| S-EPMC4982279 | biostudies-literature
Project description:BackgroundBreastfeeding practice is influenced by the mother's attitude toward and knowledge of breastfeeding. Working mothers face many challenges and need support to maintain breastfeeding. This study aimed to explore working mothers' breastfeeding experiences and challenges that can influenced their practices.MethodsThe qualitative phenomenological approach involving working mothers in Kota Bharu who fulfilled the inclusion criteria and consented to participate in the study were recruited using purposive sampling. Sixteen participants aged 24 to 46 years were interviewed using semi-structured in-depth interviews in the study. All interviews were recorded in digital audio, transcribed verbatim and analyzed using thematic analysis.FindingsThree main themes emerged from the data analysis: perception of breastfeeding, challenges in breastfeeding, and support for breastfeeding. Two subthemes for perceptions were perception towards breastfeeding and towards infant formula. Challenges had two subthemes too which were related to perceived insufficient milk and breastfeeding difficulty. Where else, two subthemes for support were internal support (spouse and family) and external support (friends, employer, and healthcare staff).ConclusionsMaintaining breastfeeding after return to work is challenging for working mothers and majority of them need support to continue breastfeeding practice. Support from their spouses and families' influences working mothers' decision to breastfeed. Employers play a role in providing a support system and facilities in the workplace for mothers to express and store breast milk. Both internal and external support are essential for mothers to overcome challenges in order to achieve success in breastfeeding.
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Project description:BackgroundAccurate and thorough surgical ward round documentation is crucial for maintaining quality clinical care. Accordingly, checklists have been proposed to improve ward round documentation. This systematic review aimed to evaluate the literature investigating the use of checklists to improve surgical ward round documentation.MethodsMEDLINE, EMBASE, and PsycINFO were searched on August 16, 2021. Study selection, data extraction, and risk of bias assessment were performed in duplicate. We included English studies that investigated the use of checklists during ward rounds in various surgical subspecialties compared to routine care, where the rates of documentation were reported as outcomes. We excluded studies that used checklists in outpatient, non-surgical, or pediatric settings. Due to heterogeneity of outcome measures, meta-analysis was precluded. This study was registered with PROSPERO (ID: CRD42021273735) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) reporting guidelines.ResultsA total of 206 studies were identified, only 9 were suitable for inclusion. All included studies were single-center observational studies, spanning across seven surgical specialties. Rates of documentation on 4-23 parameters were reported. Documentation for all measured outcomes improved in 8/9 studies; however, statistical analyses were not included. There was a high risk of bias due to the nature of observational studies.ConclusionWard round checklists can serve as a useful tool to improve inpatient care and safety. Currently, there is no high-level evidence showing the effectiveness of checklists on ward round documentation. The synthesis of results indicates that further high-quality research is imperative.
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Project description:BackgroundMany organizations have prioritized health equity and the social determinants of health (SDoH). These organizations need information to inform their planning, but, relatively few quantifiable measures exist. This study was conducted as an environmental scan to inform the American Academy of Family Physician's (AAFP's) health equity strategy. The objectives of the study were to identify and prioritize a comprehensive list of strategies in four focus areas: health equity leadership, policy, research, and diversity.MethodsA Delphi study was used to identify and prioritize the most important strategies for reducing health inequities among the four aforementioned focus areas. Health equity experts were purposefully sampled. Data were collected in three rounds for each focus area separately. A comprehensive list of strategy statements was identified for each focus area in round one. The strategy statements were prioritized in round two and reprioritized in a final third round. Quantitative and qualitative data were integrated for the final analysis.ResultsFifty strategies were identified across the four focus areas. Commitment to health equity, knowledge of health inequities, and knowledge of effective strategies to address the drivers of health inequities were ranked the highest for leadership. Universal access to health care and health in all policies were ranked highest for policy. Multi-level interventions, the effect of policy, governance, and politics, and translating and disseminating health equity interventions into practice were ranked the highest for research. Providing financial support to students from minority or low-socioeconomic backgrounds, commitment from undergraduate and medical school leadership for educational equity, providing opportunities for students from minority or low-socioeconomic backgrounds to prepare for standardized tests, and equitable primary and secondary school funding were ranked highest for diversity.ConclusionsThe AAFP and other medical specialty societies have an important opportunity to advance health equity. They should develop a health equity policy agenda, equip physicians and other stakeholders, use their connections with practice-based research networks to identify and translate practical solutions to address the SDoH, and advocate for a more diverse medical workforce.Trial registrationNot applicable.
| S-EPMC6588858 | biostudies-literature
Project description:The global energy system changes towards renewables-dominated and liberalized markets. This requires making novel trade-offs between the profitable development of hydropower and its environmental effects on the natural flow regime. Here, we used a pristine river as a model for how these future changes will affect the natural flow regime and identify future changes on previously overlooked levels. We found that damming and discharging based on market prices leads to first- and second-level deviation from natural flows. Beyond these effects, we identified a third level of distance from natural flow. This third level is created by the transition towards a renewables-dominated energy system. The volatile energy input from renewables incentivizes hydropower plant operators to discharge based on more flexible trading behavior. We conclude that novel economic models be combined with tailored implementations of environmental flows. This will allow to find novel solutions for the trade-off between market liberalization and sustainable hydropower development.
| S-EPMC7406062 | biostudies-literature
Project description:BackgroundMichigan is facing a Medicaid budget shortfall. Evidence suggests that the underlying factors causing reliance on Medicaid and cost of treatment to increase are getting worse. A tax on Michigan physicians has been proposed by legislators to meet the budget demands of Michigan's Medicaid program.Questions/purposesThis paper looks at the legal basis of such a tax, studies the successes and failures of other states that have implemented similar taxes, and attempts to assess the effect this tax would have on Michigan doctors and patients.ConclusionWith current Medicaid rules, such a tax would increase federal matching funds and potentially reimbursement rates. However, the cost of a tax on physicians would not be born equally, and there are no guarantees that the revenue would provide a funding solution.
| S-EPMC3772163 | biostudies-literature
Project description:The aviation industry faces a formidable challenge to cap its climate impact in the face of continued growth in passengers and freight. Liquid hydrogen (LH2) is one of the alternative jet fuels under consideration as it does not produce carbon dioxide upon combustion. We conducted a well-to-wake life cycle assessment of CO2 emissions and non-CO2 climate change impacts per passenger-distance for 17 different hydrogen production routes, as well as conventional jet fuel and biofuels. Six other environmental and health impact categories were also considered. The Boeing 787-800 was used as the reference aircraft, and a range of flight distances were explored. Contrail cirrus contributes around 81 ± 31% of the combustion climate impacts for LH2, compared to 32 ± 7% for conventional jet fuel, showing that research is needed to reduce uncertainty in the case of LH2. The life cycle impacts of the two dominant commercial LH2 pathways are on average 8 and 121% larger than conventional jet fuel. Some novel LH2 pathways do show considerable potential for life cycle climate impact reductions versus conventional fuel (up to -205 ± 78%). LH2 from renewable energy is not climate neutral, though, at best -67 ± 10% compared to conventional over the life cycle.
| S-EPMC10324299 | biostudies-literature
Project description:Recent research has highlighted associations of breastfeeding with IQ, schooling, and income, but uncertainty about such links remains. The Indonesian Family Life Survey, representative of 83% of the Indonesian population, provides data on breastfeeding, parents' years of schooling, wealth, and other family characteristics in 1993-1994, as well as schooling and income in 2014-2015 for 5,421 children of those families. Using linear regressions and controlling for village or neighbourhood, as well as propensity score matching, we analysed breastfeeding associations for boys and girls separately, when regularly fed foods/beverages other than breast milk is significantly associated with years of schooling in 2014-2015 for girls, but not for boys, after controlling for the village or neighbourhood of residence in 1993-1994. For girls, ages 1 to 1.9, 2 to 2.9, 3 to 3.9, and >4 months, relative to ages <1 month, are associated with an additional 0.41 to 0.46 years of schooling, with p values of 0.086, 0.071, 0.043, and 0.026, respectively. No comparable estimate for boys attains statistical significance. Using propensity score matching yields similar results. Associations with annual income in 2014-2015 are not statistically significant, either for all children, or for either sex. Our finding suggests that delaying regular feeding of foods/beverages other than breast milk beyond 1 month may help girls' schooling but has no observable association with annual income, perhaps because of lower labour force participation by women. Also, the inclusion of controls for village or neighbourhood of residence reduces confounding.
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Project description:Rain, snow, or ice may discourage older adults from leaving their homes with potential consequences for social isolation, decreased physical activity, and cognitive decline. This study is the first to examine potential links between annual precipitation exposure and cognitive function in a large population-based cohort of older Americans. We examined the association between precipitation (percent of days with snow or rain in the past year) and cognitive function in 25,320 individuals aged 45+ from the Reasons for Geographic and Racial Differences in Stroke Study. Linear mixed models assessed the relationship between precipitation and cognitive function, as well as rates of change in cognitive function with age. We found a non-linear relationship between precipitation and cognitive function. Compared to those exposed to infrequent precipitation (less than 20% of days with rain/snow in the past year), cognitive function was higher among older adults experiencing moderately frequent precipitation (20-40% of annual days with precipitation). However, beyond more than about 45% of days with precipitation in the past year, there was a negative association between precipitation and cognitive function, with faster rates of cognitive decline with age. These exploratory findings motivate further research to better understand the complex role of precipitation for late-life cognitive function.
| S-EPMC7730226 | biostudies-literature