Effect of antenatal peer support on breastfeeding initiation: a systematic review

Background

Our objective was to examine the effect of antenatal peer support on rates of breastfeeding initiation.

Methods

We performed a systematic review of randomized controlled trials, quasi-randomized trials and cohort studies with concurrent controls. We searched the Cochrane Library, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Research Register and the British Nursing Index from inception or from 1980 to 2009. We carried out study selection, data abstraction and quality assessment independently and in duplicate. We defined high-quality studies as those that minimized the risk of at least three of the following types of bias: selection, performance, measurement and attrition bias. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for individual studies and undertook separate meta-analyses for high-quality trials of universal peer support and targeted peer support. We did not include low-quality studies.

Results

We selected 11 studies, which involved 5445 women in total. Seven of these studies (involving 4416 women in total) evaluated universal peer support, and four studies (involving 1029 women in total) targeted antenatal peer support. In the three high-quality studies of universal peer support, all involving low-income women, the relative risk for not initiating breastfeeding was 0.96 (95% CI 0.76–1.22). In the three high-quality studies of antenatal peer support that targeted women considering breastfeeding, the relative risk for not initiating breastfeeding was 0.64 (95% CI 0.41 – 0.99).

Interpretation

Universal antenatal peer support does not appear to improve rates of breastfeeding initiation, but targeted antenatal peer support may be beneficial. This effect may be related to context, however, so any new peer-support program should undergo concurrent high-quality evaluation.Breastfeeding confers numerous benefits for mother and infant,^1–3 yet many women still do not initiate breastfeeding.⁴ The World Health Organization recommends exclusive breastfeeding to six months,⁵ and national governments have implemented initiatives to increase initiation rates.^6,7 Peer support has been examined as one intervention to increase breastfeeding rates, but there have been few high-quality randomized controlled trials (RCTs) examining initiation. One systematic review⁸ (published in 2000) concluded, based only on two nonrandomized studies, that antenatal peer support had a positive effect on breastfeeding initiation. Another⁹ (published in 2005 and updated in 2007) included only RCTs but excluded those whose primary purpose was to affect duration. Based only on one RCT, that review concluded that peer support is likely to result in improvements in initiation of breastfeeding among low-income women where baseline breastfeeding rates are low. These weaknesses in the available evidence make recommendations uncertain. Despite this uncertainty, antenatal peer support for breastfeeding is being incorporated into routine maternity care in some parts of the world.¹⁰Antenatal peer support can be provided as a universal service or targeted to women who are considering breastfeeding. Although trials have made this distinction, previous reviews have not. New evidence has become available, and it appears appropriate to re-examine antenatal peer support through a systematic review. The purpose of our review was to assess the effectiveness of antenatal peer support, as either a universal or a targeted service, including all studies that examined breastfeeding initiation using concurrent controls.     

Timely initiation of breastfeeding and its association with birth place in Ethiopia: a systematic review and meta-analysis

Background

Timely initiation of breastfeeding is defined as putting the newborn to the breast within 1 h of birth. In Ethiopia, different studies have been conducted to assess the prevalence of timely initiation of breastfeeding and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of timely initiation of breastfeeding and its association with birth place in Ethiopia using the available studies.

Methods

Databases, including PubMed, Google scholar, Science direct and Cochrane library were systematically searched. All original studies reporting the prevalence of timely initiation of breastfeeding in Ethiopia were considered. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 11 statistical software was used to analyze the data. The Cochrane Q test statistics and I ² test were used to assess the heterogeneity between the studies. A random effect model was computed to estimate the pooled prevalence of timely initiation of breastfeeding. In addition, the associations between timely initiation of breastfeeding and place of birth were determined.

Results

Sixteen studies were finally included in the meta-analysis. The findings of this meta-analysis revealed that, the pooled prevalence of timely initiation of breastfeeding in Ethiopia was 61.4% (CI: 51.4, 71.5%). The study also indicated that rural mothers had lower rate of initiating breastfeeding within the first 1 h after delivery as compared to their urban counterparts. Additionally, mothers who gave birth at health institution were almost 2.11 times more likely to initiate breastfeeding within 1 h as compared to mothers who did not give birth at health institution.

Conclusion

In this study, timely initiation of breastfeeding in Ethiopia was significantly low compared to the current global recommendation on breastfeeding. Women from rural area were less likely to initiate breastfeeding within 1 h as compared with women from urban areas. Mothers who give birth at health institution were more likely to initiate breastfeeding timely.

     

Electrodes in external electrohysterography: a systematic literature review

BackgroundIn low-income countries, pregnant women do not have easy access to health care, especially in rural and peri-urban areas. In this context, they can be surprised by the uterine contractions that precede childbirth and sometimes find themselves giving birth at home or on the way to the nearest health facility (located miles away from their home). In view of the development of an external uterine electrohysterogram acquisition system for labour prediction, a review of the literature on electrodes and their characteristics is necessary.MethodsA comprehensive literature review was conducted to collate information on the use of electrodes in external EHG recording and their characteristics.ResultsWet electrodes based on Ag/AgCl redox chemistry are the most common type of electrodes for EHG, employed in different configurations on the pregnant woman’s abdomen. All positioning configurations are around the vertical median axis if they are not placed directly on it. Positioning below the navel seems to be the most efficient. The number of source, reference, and ground electrodes used varies from one author to another, as does the distance between the electrodes.ConclusionTwo well-positioned source electrodes on the vertical median axis, with ground electrode on the right side of the hip and reference one on the left side, are able to generate a good external EHG recording signal. The minimum allowed inter-electrode distance is approximately 17.5 to 25mm.     

Clinical criteria for Mucosal Leishmaniasis diagnosis in rural South America: A systematic literature review

BackgroundMucosal Leishmaniasis (ML), a neglected tropical disease caused by Leishmania parasites, impairs the quality of life of under-resourced populations in South America. If not treated promptly, this disease progresses to facial deformities and death. The low sensitivity of microscopy results and the unavailability of other accurate tests hamper the diagnosis. As clinical criteria are readily available in any setting, these may be combined in a syndromic algorithm, which in turn can be used as a diagnostic tool. We explore potential clinical criteria for a syndromic diagnostic algorithm for ML in rural healthcare settings in South America.Methodology/Principal findingsThe protocol for this systematic review was pre-registered in PROSPERO with the number: CRD42017074148. In patients with ML, described in case series identified through a systematic retrieval process, we explored the cumulative ML detection rates of clinical criteria. Participants: all patients with active mucosal disease from an endemic area in South America. Any original, non-treatment study was eligible, and case reports were excluded. PUBMED, EMBASE, Web of Science, SCIELO, and LILACS databases were searched without restrictions. The risk of bias was assessed with the JBI checklist for case series. We included 10 full texts describing 192 ML patients. Male gender had the highest detection rate (88%), followed by ulcer of the nasal mucosa (77%), age >15 (69%), and symptom duration >4 months (63%).SignificanceWithin this selection of patients, we found that the male gender, ulcer of the nasal mucosa, age >15, and symptom duration >4 months lead to the highest detection rates. However, higher detection comes -naturally- with a higher rate of false positives as well. As we only included ML patients, this could not be verified. Therefore, the criteria that we found to be most promising should be validated in a well-designed prospective study.     

Injury incidence and risk factors in youth soccer players: a systematic literature review. Part II: Intrinsic and extrinsic risk factors

Injury is defined as a complex phenomenon determined by the non-linear interaction of several intrinsic and extrinsic factors. The objective of the present study was to perform a systematic literature review on the injury risk factors in young soccer players. After electronic database searching, articles in line with the inclusion criteria were selected for the systematic review. Injury risk factor data were extracted and grouped in intrinsic and extrinsic risk factors. The main findings of the current review are as follows: (1) alteration in neuromuscular control such as limb asymmetry and dynamic knee valgus are important intrinsic risk factors; (2) maturation status may impair neuromuscular control and increase the risk of injury; (3) fatigue and poor recovery contribute to the onset of overuse injuries; (4) the impact of anthropometric factors is still unclear; (5) previous injuries increase the risk of re-injuries; (6) highly skilled players are more exposed to risk of injuries; (7) high external workloads increase the risk of injuries; (8) playing position, as well as sport specialization, exposes young soccer players to greater injury risk. Many factors (e.g., neuromuscular control, training load, maturity status) can modify the susceptibility to injury in young soccer players. Being aware of the complex interaction between these factors is essential to identify players at higher risk of injury, develop adequate prevention strategies, and from a scientific point of view move from a reductionist to a complex system approach.     

Optimal loading dose for the initiation of warfarin: a systematic review

Background

Selection of the right warfarin dose at the outset of treatment is not straightforward, and current evidence is lacking to determine the optimal strategy for initiation of therapy.

Methods

We included randomized controlled trials in patients commencing anticoagulation with warfarin, comparing different loading dose or different regimens. We searched Medline, EMBASE, the Cochrane Library and the NHS Health Economics Database up to June 2009. Primary outcomes were time to stable INR and adverse events. We summarised results as proportion of INRs in range from date of initiation and compared dichotomous outcomes using relative risks (RR) and calculated 95% confidence intervals (CIs).

Results

We included 11 studies of 1,340 patients newly initiated on warfarin. In two studies that used single INR measures, a loading dose of 10 mg compared to 5 mg led to more patients in range on day five. However, in two studies which measured two consecutive INRs, a loading dose of 10 mg compared to 5 mg did not lead to more patients in range on day five (RR = 0.86, 95% CI, 0.62 to 1.19, p = 0.37). Patients receiving a 2.5 mg initiation does took longer to achieve the therapeutic range, whilst those receiving a calculated initiation dose achieved target range 0.8 days quicker (4.2 days vs. 5 days, p = 0.007). More elderly patients receiving an age adjusted dose achieved a stable INR compared to the Fennerty protocol (48% vs. 22% p = 0.02) and significantly fewer patients on the age adjusted regimens had high out-of-range INRs. Two studies report no significant differences between genotype guided and 5 mg or 10 mg initiation doses and in the one significant genotype study the control group INRs were significantly lower than expected.

Conclusion

Our review findings suggest there is still considerable uncertainty between a 10 mg and a 5 mg loading dose for initiation of warfarin. In the elderly, lower initiation doses or age adjusted doses are more appropriate, leading to less higher INRs. Currently there is insufficient evidence to warrant genotype guided initiation, and adequately powered trials to detect effects on adverse events are currently warranted.     

Injury incidence and risk factors in youth soccer players: a systematic literature review. Part I: epidemiological analysis

The analysis of the epidemiological data and the risk factors underlying injuries is crucial to promote prevention strategies in young soccer players. The objective of the present study was to perform a systematic literature review on the epidemiological data, described in the first part, and injury risk factors, presented in the second part. After electronic database searching, articles in line with the inclusion criteria were selected for the systematic review. Epidemiological data were extracted and discussed in this first part of the review. Data were grouped as follows: injury incidence, injury severity, and re-injury, injury types, injury mechanisms, and anatomical location. The principal findings of this first part of the review are as follows: (1) injury incidence is higher in older players and during matches than during training; (2) sex and maturity status may increase risk of injury; (3) male soccer players are more prone to muscle strains and ligament sprains while female players suffer more ligament sprains; (4) most injuries are located in the ankle and thigh in young male soccer players, and in the ankle and knee in female players; (5) severe injuries are less frequent but the incidence increases in older players. Re-injuries represent only a small percentage. Although soccer is considered a safe sport, many injuries are recorded in young soccer players every year. Injury predisposition changes in relation to age, sex, and biological age. Coaches and physical trainers should be aware of individual differences in order to promote prevention strategies and personalised training.     

Early newborn ritual foods correlate with delayed breastfeeding initiation in rural Bangladesh

Background

Early and exclusive breastfeeding may improve neonatal survival in low resource settings, but suboptimal breastfeeding still exists in areas with high infant mortality. Prelacteal feeding, the practice of giving a non-breastmilk food as a neonate’s first food, has been associated with suboptimal breastfeeding practices. We examined the association of feeding a non-breastmilk food in the first three days of life (early neonatal food, or ENF) with time from birth to initiation of breastfeeding among 25,286 Bangladeshi mother-neonate pairs, in a secondary analysis of a randomized controlled trial in northwestern rural Bangladesh conducted from 2001–2007.

Methods

Trained interviewers assessed the demographic characteristics during pregnancy. At three months postpartum, the interviewers visited participants again and retrospectively assessed demographic and breastfeeding characteristics surrounding the birth. We assessed the relationship between ENF and time to initiation of breastfeeding in hours in both unadjusted and adjusted linear regression analyses. We also calculated reverse cumulative distribution curves for time to initiation of breastfeeding and analyses were stratified by an infant’s ability to breastfeed normally at birth.

Results

The mean?±?SD time from birth to initiation of breastfeeding was 30.6?±?27.9 hours. Only 2,535 (10.0%) of women reported initiating breastfeeding in the first hour after birth and 10,207 (40.4%) reported initiating breastfeeding in the first 12 hours after birth. In adjusted linear regression analyses, feeding ENF was associated with a significant increase in time, in hours, to breastfeeding initiation both among children not able to breastfeed at birth (37.4; 95% CI 33.3, 41.5) and among children able to breastfeed at birth (13.3; 95% CI 12.7, 14.0).

Conclusions

Feeding ENF was strongly associated with delayed initiation of breastfeeding, even after adjusting for other related factors and stratifying on the neonate’s ability to suckle normally after birth. More research is needed to understand the impact of these findings on optimal breastfeeding in this setting. It is possible that ENF feeding and the ability to breastfeed immediately after birth are interrelated in their respective associations to suboptimal breastfeeding initiation. This study in a large population representative of other populations in rural South Asia, demonstrates significantly longer times to breastfeeding initiation than previously appreciated, with a possible important role of ENF feeding.

Trial registration

The randomized controlled trial on which this analysis is based, “Impact of Maternal Vitamin A or Beta-Carotene Supplementation on Maternal and Infant Mortality in Bangladesh”, was registered with ClinicalTrials.gov as trial number ID GHS-A-00-03-00019-00 and identifier NCT00198822. The identifier was first received September 12, 2005 (retrospectively registered). The first participant was enrolled in August 2001.

     

Schistosomal appendicitis: Case series and systematic literature review

BackgroundGlobally, schistosomiasis affects at least 240 million people each year with a high proportion of cases in sub-Saharan Africa. The infection presents a wide range of symptoms mainly at the gastrointestinal and urogenital level. Cases of schistosomiasis-related appendicitis are seldom reported. The aim of the present study is to identify the prevalence of schistosomiasis-related appendicitis in Beira, Mozambique and compare to global prevalence.MethodsWe retrospectively reviewed all cases of appendicitis recorded from January 2017 to March 2020 at a single pathology department located in Beira in order to assess the prevalence of schistosomiasis. Moreover, we performed a systematic review on the prevalence of schistosomiasis-related appendicitis in all countries.FindingsA total of 145 appendicitis cases in Beira showed a 13.1% prevalence of schistosomal-related appendicitis. The mean age of patients was 29.1 years, and 14 (73.7%) were male. The systematic review identified 20 studies with 34,790 inpatients with schistosomiasis-related appendicitis with a global prevalence of 1.31% (95% confidence interval (CI): 0.72 to 2.06); a high heterogeneity (I² = 96.0%) was observed. Studies carried out in Africa reported a significantly higher prevalence of schistosomiasis-related appendicitis (2.75%; 95% CI: 1.28 to 4.68) than those in Middle East (0.49%; 95% CI: 0.18 to 0.95) (p for interaction < 0.0001).ConclusionsSchistosomiasis infection should be considered as possible cause of appendicitis not only in endemic areas but also in developed countries. Considering that prevention is the best way to control the infection, more efforts should be put in place in order to increase the prevention coverage and avoid the cascading implications for health. This is even more so important in this Coronavirus Disease 2019 (COVID-19) era where the majority of attention and funds are used to fight the pandemic.     

Physiological substrates of executive functioning: a systematic review of the literature

Executive function (EF) is a multifaceted construct that has been defined as a set of higher-order cognitive processes that allow for flexibility, self-regulation, strategic planning, and goal-directed behaviors. EFs have been studied in numerous clinical disorders using a variety of neuropsychological tasks and, more recently, neuroimaging techniques. The underlying physiological substrates of EF were historically attributed to the frontal lobes; however, recent studies suggest more widespread involvement of additional brain regions. The purpose of the present study was to conduct a systematic review (using PRISMA 2009 guidelines) of neuroimaging studies employing functional magnetic resonance imaging and diffusion tensor imaging methods investigating the physiological substrates of EFs in attention-deficit/hyperactivity disorder compared to other clinical groups and non-clinical participants. Research articles were retrieved using PsycINFO, PsycARTICLES, MEDLINE, and ScienceDirect, beginning February 2015 through May 2016. A total of 42 studies met eligibility. Of those 42 studies, 22 studies included clinical participants and 20 studies included non-clinical participants. Results revealed increased activation of the frontal brain region in the majority of non-clinical studies and approximately 50% of the clinical studies, albeit with some inconsistencies across subregions, tasks, and age groups. Implications, methodological limitations, and suggestions for future research are discussed.     

Resource scheduling methods in cloud and fog computing environments: a systematic literature review

In recent years, cloud computing can be considered an emerging technology that can share resources with users. Because cloud computing is on-demand, efficient use of resources such as memory, processors, bandwidth, etc., is a big challenge. Despite the advantages of cloud computing, sometimes it is not a proper choice due to its delay in responding appropriately to existing requests, which led to the need for another technology called fog computing. Fog computing reduces traffic and time lags by expanding cloud services to the network and closer to users. It can schedule resources with higher efficiency and utilize them to impact the user's experience dramatically. This paper aims to survey some studies that have been done in the field of scheduling in fog/cloud computing environments. The focus of this survey is on published studies between 2015 and 2021 in journals or conferences. We selected 71 studies in a systematic literature review (SLR) from four major scientific databases based on their relation to our paper. We classified these studies into five categories based on their traced parameters and their focus area. This classification comprises 1—performance 2—energy efficiency, 3—resource utilization, 4—performance and energy efficiency, and 5—performance and resource utilization simultaneously. 42.3% of the studies focused on performance, 9.9% on energy efficiency, 7.0% on resource utilization, 21.1% on both performance and energy efficiency, and 19.7% on both performance and resource utilization. Finally, we present challenges and open issues in the resource scheduling methods in fog/cloud computing environments.

     

The genomic basis of cerebral palsy: a HuGE systematic literature review

Cerebral palsy has been associated with a number of candidate genes. To date, no systematic review has been conducted to synthesise genetic polymorphism associations with cerebral palsy. We apply the HuGE NET guidelines to search PubMed and EMBASE databases for publications investigating single nucleotide polymorphisms (SNPs) and cerebral palsy outcome. 22 papers were identified and are discussed in this review. Candidate genes were grouped as (1) thrombophilic, (2) cytokine, (3) apolipoprotein E or (4) other SNPs, largely related to cardiovascular physiology/pathophysiology and the functioning of the immune system. Of the studies identified, cohorts were usually small, without adequate control and ethnically diverse, making direct comparison between studies difficult. The most promising candidate genes include factor V Leiden, methylenetetrahydrofolate reductase, lymphotoxin-α, tumour necrosis factor-α, eNOS and mannose binding lectin. Large case–control studies are needed to confirm these candidates with attention given to cohort ethnicity, cerebral palsy subtype analysis and possible multiple gene and gene–environment interactions.

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Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review

Background

Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression.

Methods

We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and based on the original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed the normalization process theory (NPT).

Results

We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers.

Conclusions

The following areas require special attention when planning collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co-location. There is a need for well-sampled, in-depth qualitative studies on the implementation of collaborative care in settings outside the USA and the UK.