Process-oriented training in breastfeeding for health professionals decreases women’s experiences of breastfeeding challenges

Background

The World Health Organization recommends promoting exclusive breastfeeding for six months. Women often end breastfeeding earlier than planned, however women who continue to breastfeed despite problems often experience good support and counselling from health professionals. The aim of this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, on women’s satisfaction with breastfeeding counselling, problems with insufficient breast milk and nipple pain in relation to exclusive breastfeeding shorter or longer than 3 months.

Methods

An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. This study was conducted in Sweden, in 2000 - 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n?=?540) were invited to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n?=?162) started before the intervention was initiated. Data for control group B (n?=?172) were collected simultaneously with the intervention group (IG) (n?=?206). Women were also divided into two groups depending on whether they exclusive breastfed?<?3 months or?≥?3 months.

Results

Women in IG were more satisfied with the breastfeeding counselling (p?=?0.008) and felt the breastfeeding counselling was more coherent (p?=?0.002) compared to control groups, when exclusive breastfeeding was?<?3 months. In addition fewer women in the IG, among the group exclusively breastfeeding?<?3 months, had problems with insufficient breast milk compared to the control groups (p?=?0.01).

Conclusion

A process-oriented training for health professionals in support influenced women’s ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting?≥?3 months more often had breastfeeding duration in line with their planned breastfeeding duration, compared to women who had breastfeeding duration?<?3 months.

Trial registration

ACTRN12611000354987

     

Mothers’ experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: a mixed-method study

Background

After discharge from a neonatal intensive care unit (NICU), many mothers of preterm infants (gestational age?<?37 weeks) experience a lack of support for breastfeeding. An intervention study was designed to evaluate the effects of proactive (a daily telephone call initiated by a member of a breastfeeding support team) and/or reactive (mothers could call the breastfeeding support team) telephone based breastfeeding support for mothers after discharge from the NICU. The mothers in the intervention group had access to both proactive and reactive support; the mothers in the control group only had access to reactive support. The aim of this study was to explore the mothers’ experiences of the proactive and reactive telephone support.

Methods

This study was a qualitatively driven, mixed-method evaluation using three data sources: questionnaires with qualitative open-ended questions, visual analogue scales and telephone interviews. In total, 365 mothers contributed data for this study. The qualitative data were analysed with an inductive thematic network analysis, while the quantitative data were analysed with Student’s t-test and the chi-square test.

Results

Proactive support contributed to greater satisfaction and involvement in breastfeeding support. The mothers who received proactive support reported that they felt strengthened, supported and secure, as a result of the continuous care provided by staff who were knowledgeable and experienced (i.e., in breastfeeding and preterm infants), which resulted in the global theme ‘Empowered by proactive support’. The mothers who received reactive support experienced contradictory feelings; some felt secure because they had the opportunity to call for support, whereas others found it difficult to decide when and if they should use the service, which resulted in the global theme; ‘Duality of reactive support’.

Conclusion

There were positive aspects of both proactive (i.e., greater satisfaction and feelings of empowerment) and reactive support (i.e., the opportunity to call for support); however, the provision of reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to access it.

Trial registration

NCT01806480 on 5 March 2013.

     

Employers’ perspective of workplace breastfeeding support in Karachi,Pakistan: a cross-sectional study

Background

Breastfeeding is considered to be an important measure to achieve optimum health outcomes for children, women’s return to work has frequently been found to be a main contributor to the early discontinuation of breastfeeding. The aim of the study is to assess workplace breastfeeding support provided to working mothers in Pakistan.

Method

A workplace based cross-sectional survey was conducted from April through December 2014. Employers from a representative sample of 297 workplaces were interviewed on pre-tested and structured questionnaire. The response rate was 93.7 %. Prevalence of workplace breastfeeding facilities were assessed in the light of World Alliance for Breastfeeding Action (WABA) guidelines.

Results

Among non-physical facilities, all workplaces offered 3 months paid maternity leave, 45 % of the sites were offering task adjustment to mothers during lactation period. Only 15 % of the sites were offering breastfeeding breaks to working mothers. Physical facilities that include a breastfeeding corner, refrigerator for storing breast milk, breast milk pump and nursery for childcare were provided in less than 7 % of the sites. Multinational organizations provided better support compared to national organizations.

Conclusion

Support for continuation of breastfeeding by working women at workplaces is inadequate; hence, women discontinue breastfeeding earlier than planned. Policies need to be developed and enforced, employers and employees need to be educated and supportive environment needs to be created to encourage and facilitate breastfeeding friendly worksite environment.

     

Measurement of breastfeeding initiation: Ethiopian mothers’ perception about survey questions assessing early initiation of breastfeeding

Background

Although breastfeeding is almost universal in Ethiopia, only 52% newborns benefited from early initiation in 2011. Early initiation is one of the recommended interventions for saving newborn lives but its potential seems not yet realized for Ethiopian newborns and there is a need for continued efforts to increase coverage. To do so, it is also relevant to focus on consistent and accurate reporting of coverage in early initiation.WHO recommends the question “how long after birth did you first put [name] to the breast?” in order to assess coverage in early initiation. It is designed to measure the time after birth when the mother attempted to initiate breastfeeding regardless of whether breast milk had arrived or not. However, it is unclear how mothers perceive this question and what their responses of time refer to. In this study, we assessed Ethiopian mothers’ perception about the question assessing early initiation.

Methods

Cognitive interviews were conducted between April and May 2013 with eligible mothers in Basona and Debrebirhan woredas (districts), 120 km away from Addis Ababa, Ethiopia.

Results

A total of 49 mothers, most from Basona (n =?36) and the rest from Debrebirhan woredas (n =?13) were interviewed. No probes or follow on questions were required for mothers to understand what the WHO recommended question was about. However, further probing was needed to ascertain what maternal responses of time refer to. Accordingly, mothers’ response about the timing of early initiation was related to the first time the newborn received breast milk rather than their first attempt to initiate breastfeeding. In addition, considerable probing was required to approximate and code responses of time based on the WHO coding format because some mothers were unable to assess time in minutes or hours.

Conclusion

The existing question is not adequate to identify intended attempts of mothers to initiate breastfeeding. We recommend revising the question as “how long after birth did you first put [name] to the breast even if your breast milk did not arrive yet?” Standard probes or follow on questions are required to avoid subjective interpretation of the indicator.

     

A person-centered exploration of children of immigrants’ social experiences and their school-based well-being

This study aimed to explore commonalities among discrimination, stereotyping, and peer-related social experiences of children of immigrants, and to see if these experiences might relate to children’s school-based well-being. Two age-based cohorts of 294 children and their immigrant parents from Portugal, the Dominican Republic, and Cambodia were interviewed. Person-centered analyses resulted in four unique clusters of children’s social experiences. Notably, children in clusters with positive views of cultural in-group and out-group members also reported positive school-based well-being. Person-centered analyses on parent variables found three clusters based on parents’ ethnic/racial socialization practices. There was no overlap between parent and child clusters, indicating unique profiles between parent socialization and child social experiences within immigrant families. Implications of connections among social experiences and school-based emotional well-being for children of immigrants are discussed.     

The ‘greenhouse effect’ and UK agriculture

Book Review

The greenhouse effect and UK agricultureR.M. Bennett (Ed.), Reading: Centre for Agricultural Strategy, 1989. 144 pages, paperback. £15.00. ISBN 0-7049-0988-X     

The hyoid arch and braincase anatomy of Acanthodes support chondrichthyan affinity of ‘acanthodians’

Solving the evolutionary relationships of the acanthodians is one of the key problems in reconstructing ancestral anatomical conditions for the jawed vertebrates (gnathostomes). Current debate concerns whether acanthodians are an assemblage of stem chondrichthyans, or a more generalized grade encompassing some early stem osteichthyans. The skull anatomy of Acanthodes bronni has been pivotal in these debates, owing to tension between chondrichthyan- and osteichthyan-like models of reconstruction. We use computed tomography scanning and traditional palaeontological techniques to resolve the long-standing debate about the anatomy of the jaw suspension. We establish the correct length of the hyomandibula and show that it attaches to a process on the ventrolateral angle of the braincase below the jugular vein groove. This condition corresponds precisely to that in chondrichthyans. This character represents an unambiguously optimized synapomorphy with chondrichthyans given current gnathostome phylogenies, corroborating the growing consensus of the chondrichthyan affinity of acanthodians.     

Memory and war: Tamil women’s experiences of Sri Lanka’s civil war

This article explores how Tamil women in Australia reconstruct memories of Sri Lanka’s war through postmemory and personal experiences. Tamil women’s understandings of war are important for unravelling multiple sites of marginalization across social and political landscapes that challenge dominant perspectives of being Tamil-Australian. The article draws on sixteen in-depth interviews with Tamil women resettled in Australia as children in the 1980s and 1990s, foregrounding their unique position as part of a war generation. It shows that Tamil women’s experiences of political engagement during the final stages of war were motivated by memories of individual and collective sufferings. However, loss, exclusion and forced migration characterize their ambivalent connections to homeland. Not always tied to dominant memories of war, victimhood and subordination, the article concludes that each Tamil woman represents ongoing resistances, survival and renegotiations of Tamil diasporic experiences of war that are produced by their memory and memory work.     

Effects of training and weight support on muscle activation in Parkinson’s disease

The aim of this study was to investigate the effect of high-intensity locomotor training on knee extensor and flexor muscle activation and adaptability to increased body-weight (BW) support during walking in patients with Parkinson’s disease (PD). Thirteen male patients with idiopathic PD and eight healthy participants were included. The PD patients completed an 8-week training program on a lower-body, positive-pressure treadmill. Knee extensor and flexor muscles activation during steady treadmill walking (3 km/h) were measured before, at the mid-point, and after training. Increasing BW support decreased knee extensor muscle activation (normalization) and increased knee flexor muscle activation (abnormal) in PD patients when compared to healthy participants. Training improved flexor peak muscle activation adaptability to increased (BW) support during walking in PD patients. During walking without BW support shorter knee extensor muscle off-activation time and increased relative peak muscle activation was observed in PD patients and did not improve with 8 weeks of training. In conclusion, patients with PD walked with excessive activation of the knee extensor and flexor muscles when compared to healthy participants. Specialized locomotor training may facilitate adaptive processes related to motor control of walking in PD patients.     

Residents’ support for wolf and bear conservation: the moderating influence of knowledge

This article examines the combined influence of cognitions (i.e., impact beliefs) and affect (i.e., feelings) on normative beliefs (i.e., support for management options) about wolves and brown bears. Data were obtained from stratified random face-to-face interviews (n = 1,611). The survey was conducted in the Abruzzo Lazio and Molise National Park (central Italy), where people have a long history of coexistence with large carnivores. Knowledge was hypothesized to moderate the relationships of beliefs and feelings on support for management actions. Path analyses supported the role of affect in mediating perceived impact beliefs and support for the protection of large carnivores. Knowledge moderated these relationships in the case of wolves but not brown bears. Residents of the national park had more knowledge about bears than wolves, which might partly explain both the stronger effect that knowledge had on the affective component and its lack of a moderating effect on the bear model. Overall, our findings show the positive attitude of residents toward large carnivores and support the idea of affect being more important than cognition in predicting normative beliefs.     

Acts and practices of citizenship: Muslim women’s activism in the UK

Drawing on the growing literature on Muslim women’s activism, this paper explores grammars of action that frame political mobilizations of Muslim women in the UK. By taking a broad view of political activism, we identify acts and practices of citizenship through which Muslim women activists engage with, reinterpret and challenge social norms. The article critically engages with dominant readings of post-migration minorities’ political mobilization through the lens of citizenship regimes and draws attention to more processual and agency-centred perspectives on citizenship. We focus on two salient themes that Bristol-based Muslim activists were concerned with: mobilizing against violence against women, manifested in the anti-FGM campaign by Integrate Bristol, and attempts to re-negotiate the terms of participation in religious spaces, manifested in claims for more inclusive mosques. In both instances, mobilization was not confined to the local community or national level, but supported by and embedded in related transnational struggles.     

Cancer patients’ attitudes towards euthanasia and physician-assisted suicide: The influence of question wording and patients’ own definitions on responses

Objectives: The aims of this study were to: (1) investigate patients' views on euthanasia and physician-assisted suicide (PAS), and (2) examine the impact of question wording and patients' own definitions on their responses. Design: Cross-sectional survey of consecutive patients with cancer. Setting: Newcastle (Australia) Mater Hospital Outpatients Clinic. Participants: Patients over 18 years of age, attending the clinic for follow-up consultation or treatment by a medical oncologist, radiation oncologist or haematologist. Main Outcome Measures: Face-to-face patient interviews were conducted examining attitudes to euthanasia and PAS. Results: 236 patients with cancer (24% participation rate; 87% consent rate) were interviewed. Though the majority of participants supported the idea of euthanasia, patient views varied significantly according to question wording and their own understanding of the definition of euthanasia. Conclusions: Researchers need to be circumspect about framing and interpreting questions about support of 'euthanasia', as the term can mean different things to different people, and response may depend upon the specifics of the question asked.     

An exploration of instructor perceptions of community college students’ attitudes towards evolution

Background

Faculty perception of student knowledge and acceptance of subject matter affects the choice of what to teach and how to teach it. Accurate assessment of student acceptance of evolution, then, is relevant to how the subject should be taught. To explore the accuracy of such assessment, we compared how community college instructors of life sciences courses perceive students’ attitudes towards evolution with those students’ actual attitudes towards evolution.

Results

The research had two components: (1) a survey of students of several biology classes at a community college about their acceptance of evolutionary theory and (2) interviews with the biology faculty teaching those classes about their perceptions of their students’ attitudes towards evolution. Results of the study indicate relatively high levels of acceptance of evolution among community college students at this West Coast institution. We also found that community college instructors of life sciences courses varied in accuracy of their perceptions of their students’ attitudes towards evolution–but not systematically. Although one professor assessed each class quite accurately, the other two professors frequently underestimated the acceptance of evolution among their students.

Conclusions

Errors in perception seemed independent of whether the class was composed of majors, nonmajors, or a combination. Clearly, in our sample there is much idiosyncrasy regarding community college instructor accuracy concerning student opinions about evolution.

     

Women’s perception and risk factors for delayed initiation of breastfeeding in Arba Minch Zuria,Southern Ethiopia

Background

Breastfeeding is one of the components of Primary Health Care in Ethiopia. In Ethiopia a wide range of harmful infant feeding practices has been documented despite the implementation of infant and young child feeding guidelines. However, there is no well documented study of women’s perception of breastfeeding patterns and factors associated with delayed initiation of breastfeeding (with timely initiation of breastfeeding being within the first hour) in rural communities of Arba Minch Zuria.

Methods

A community-based cross-sectional study was carried out in Arba Minch Zuria from January to February, 2012. Quantitative data were collected from a sample of 383 respondents supplemented by qualitative data generated using in-depth interviews of 10 key informants. A multivariate logistic regression analysis was used to identify the predictors of delayed initiation of breastfeeding practices. Qualitative data were analyzed using thematic frameworks.

Results

In the rural communities of Arba Minch Zuria almost all mothers (98.2%) have ever breastfed their children. More than three-fourth (89%) of mothers provided colostrum to their infants while others discarded the first milk until the white milk was produced. A large number of mothers (42.8%) started breastfeeding one hour after childbirth. Delayed initiation of breastfeeding was positively associated with lack of maternal education (AOR 1.91; 95% CI 1.02, 3.44). Maternal knowledge about the duration of exclusive breastfeeding (AOR 0.39; 95% CI 0.15, 0.93), attending a primary health education (AOR 0.74; 95% 0.15, 0.98) and health personnel support for women at delivery time (AOR 0.52; 95% CI 0.21, 0.58) were inversely associated with delayed initiation of breastfeeding practices.

Conclusions

A large number of mothers (42.8%) were short of the national and global recommendations about breastfeeding initiation. Therefore, sustained health and community based nutritional education is recommended for pregnant and lactating mothers to promote optimal breastfeeding for the initiation of breastfeeding practices using health extension workers and local community resource people as key actors.

     

Postpartum women’s perception of antenatal breastfeeding education: a descriptive survey

Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered nurses and nurse technicians (i.e. unit of analysis) on July 2016 (n = 529) and post-training between March and April 2017 (n = 211). A 19-item telephone questionnaire assessed providers’ general knowledge about breastfeeding, breastfeeding benefits and clinical aspects of breastfeeding, clinical ability to solve problems and abilities to overcome breastfeeding challenges. The effects of the training were assessed through a propensity score matching (PSM) stratified by types of providers (i.e. physicians, registered nurses, nurse technicians). The PSM analysis showed significant improvements among all providers in the general knowledge about breastfeeding (around 20 percentage points [pp]) and knowledge about breastfeeding benefits (approximately 50 pp). In addition, physicians improved their knowledge about clinical aspects of breastfeeding (7 pp), while registered nurses improved in their ability to solve breastfeeding problems (14 pp) and in helping mothers overcome breastfeeding challenges (12 pp). Promoting a breastfeeding enabling environment in Mexico to improve breastfeeding rates will require improving the knowledge and skills of healthcare providers. While a semi-virtual training showed large improvements in knowledge, developing skills among providers may require a more intensive approach.     

‘For her protection and benefit’: the regulation of marriage-related migration to the UK

This paper argues that a two-tier system has evolved dividing intra-UK/EU marriages from extra-UK/EU marriages. For the former, marriage is a contract between two individuals overseen by a facilitating state. For the latter, marriage has become more of a legal status defined and controlled by an intrusive and obstructive state. I argue that this divergence in legislating regulation is steeped in an ethnicized imagining of ‘Britishness’ whereby the more noticeably ‘other’ migrants (by skin colour or religion) are perceived as a threat to the national character. The conceptualization of women as legally ‘disabled’ citizens (1870 Naturalisation Act) for whom a state must act as responsible patriarch, is a fundamental part of this imagining of the nation. The paper therefore examines the social (gendered and ethnicized) assumptions and political aims embedded within the legislation.     

An overview of commercial fishers’ attitudes towards marine protected areas

Marine protected areas (MPAs) are attracting widespread attention worldwide as a tool for fishery management and marine ecosystem conservation. The establishment of MPAs has increased greatly in recent years mostly due to international commitments to the establishment of a global network of MPAs by 2012. MPAs have the potential to strongly affect the fishing industry, and their success depends, at least partly, on fishers’ attitudes towards this management measure. However, research on MPAs tends to focus on the ecological and conservation aspects of this management approach and not on its human dimensions. Studies in attitudes, perceptions, beliefs and preferences related to MPA issues have been identified as priority social science topics in need of research. We present a ‘rapid review’, conducted systematically, of the literature published up to September 2009 and aimed at identifying the most investigated topics related to commercial fishers’ attitudes towards MPAs, describing the main findings from these studies, and analysing the implications for management. Most published work focuses on fishers’ attitudes towards issues of governance, conservation of biodiversity and the environment, and the impact of MPAs on fishing activity. Despite the recent increase in the literature on the human dimensions of MPAs, the present review reveals that little of this literature originates from empirical studies. Hence, given the forthcoming increase in the implementation of MPAs in the near future, research on fishers’ attitudes towards these management measures is critically needed.