Bio: Anne Fallon is an academic researcher from National University of Ireland, Galway. The author has contributed to research in topics: Breastfeeding & Nursing care. The author has an hindex of 6, co-authored 16 publications receiving 96 citations.
TL;DR: The findings concurred with the literature to suggest that control is indeed important in the experience of childbirth, and highlights the need for greater midwifery input into antenatal care in an attempt to prepare women for childbirth.
Abstract: This qualitative study used a phenomenological approach to interpret the lived experience of control in labour and childbirth. Semistructured interviews were carried out with nine primigravid women who gave birth in a maternity hospital in Ireland. The interviews were transcribed verbatim, and the data were analysed using frameworks influenced by Smith et al (2009) and van Manen (1990). The themes that emerged were then categorized into what Smith et al (2009) referred to as superordinate themes. The participants’ experiences of control in childbirth were both positive and negative and the findings concurred with the literature to suggest that control is indeed important in the experience of childbirth. The study highlights the need for greater midwifery input into antenatal care in an attempt to prepare women for childbirth. This preparation should not be limited to antenatal education—it also involves the provision of emotional and psychological support. It is the role of the midwife to prepare women fo...
TL;DR: The key findings of this review are that breastfeeding as the first feed and exclusive breastfeeding are beneficial to meeting physiological needs and self-actualisation or success with breastfeeding has been achieved by women with diabetes.
Abstract: The aim of this literature review was to identify breastfeeding practices that support women with diabetes to breastfeed. A search was undertaken of CINAHL and Medline databases to identify studies that inform breastfeeding practice for women with diabetes. This resulted in 14 studies (19 records). Most studies focused on women with GDM and T1D with some consideration of T2D. The review has been organised using Maslow's Hierarchy of Needs, to enable a clear focus on the needs of women while identifying supportive practices. The key findings of this review are that breastfeeding as the first feed and exclusive breastfeeding are beneficial to meeting physiological needs. Preparations such as having food nearby and having someone to call on can help meet the woman's safety and security needs. A sense of love and belonging is supported by the practice of an early first breastfeed, but antenatal breast milk expression is currently not recommended. The woman's self-esteem can be enhanced through informed multidisciplinary support. Finally, self-actualisation or success with breastfeeding has been achieved by women with diabetes. Common breastfeeding concerns rather than diabetes have been identified as reasons for cessation of breastfeeding. Practices that support women deal with these concerns are recommended.
TL;DR: The origins and evolution of neonatology is reviewed and the role of the neonatal nurse within this specialty is considered, which has made a crucial and steadfast contribution to marked improvements in neonatal outcomes.
Abstract: This article reviews the origins and evolution of neonatology and considers the role of the neonatal nurse within this specialty. Neonatal nurses are a vital part of the neonatal team that provides care for sick babies. The nursing care required by sick babies and their families on a neonatal unit can be variable and complex. The past century has seen significant changes in the role of the neonatal nurse. This has come about through dramatic technological developments on neonatal units, an increased understanding of neonatal physiology and pathology, changes in the education of neonatal nurses, and active and ongoing clinical research within the specialty. The resulting significant advances in neonatal care, including that provided by neonatal nurses, have made a crucial and steadfast contribution to marked improvements in neonatal outcomes.
TL;DR: There is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.
Abstract: Background Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that mothers are provided with high-quality evidence to inform their feeding decisions. Objectives To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2013), CINAHL (1981 to 13 November 2013), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (6 November 2013). Selection criteria Randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form were eligible for inclusion if sufficient data were available. Studies using a cross-over design were not eligible for inclusion. Data collection and analysis We independently assessed for inclusion all the potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary. Main results No studies were identified that were eligible for inclusion in this review. Authors' conclusions This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns, therefore no conclusions could be taken at this point. It is recommended that no changes are made to current practice guidelines without undertaking further robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Further research is needed to also evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding on successful breastfeeding, for healthy newborns. However, conducting such a study, particularly a randomised controlled trial is unlikely to receive ethical approval, as the issue of obtaining informed consent from new mothers or mothers-to-be for randomisation between baby-led and scheduled breastfeeding is a difficult one and it is likely that the Baby Friendly Hospital Initiative practices would prohibit such a study.
TL;DR: The study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing, which insight into how nurse prescribers feel about prescriptive authority is provided.
Abstract: Aims and objectives To explore the experiences of nurse prescribers in an acute service setting. Design A descriptive phenomenological design underpinned by Husserl's philosophy was used as the guiding framework. Methods Data were collected using semistructured interviews and purposive sampling of 11 current registered nurse prescribers from two acute hospitals. Colaizzi's seven steps were employed to analyse the data and develop themes which reflected the participants' experiences of prescribing. Results The study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing. The nurses interviewed were proud to be prescribers and perceived their prescribing practice as safe. This was a unique finding, not described by other research. Increased job satisfaction was also important to those interviewed as identified in previous studies pertaining to prescriptive authority. Ongoing challenges affecting prescribers included staff shortages, extra workload arising from prescribing and the need to educate colleagues about nurse prescribing. Those interviewed also suggested standardising both the prescribing course and local Drugs and Therapeutics Committees nationally, to overcome identified issues. Conclusions Further research into the safety of nurse prescribing is recommended to ascertain if what was described locally applies nationally. A larger study into the experiences of nurse and midwife prescribers is also required, to promote and maintain this practice and to ensure future prescribers embrace this extended scope of practice. Relevance to clinical practice Insight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.
TL;DR: In this article, the authors provide an update on the clinical and epidemiological features of tuberculosis in the diabetic population and relate them to recent advances in understanding the mechanistic basis of tuberculosis susceptibility and other complications of diabetes.
Abstract: The dual burden of tuberculosis and diabetes has attracted much attention in the past decade as diabetes prevalence has increased dramatically in countries already afflicted with a high burden of tuberculosis. The confluence of these two major diseases presents a serious threat to global public health; at the same time it also presents an opportunity to learn more about the key elements of human immunity to tuberculosis that may be relevant to the general population. Some effects of diabetes on innate and adaptive immunity which are potentially relevant to tuberculosis defense have been identified, but have yet to be verified in humans and are unlikely to fully explain the interaction of these two disease states. This review provides an update on the clinical and epidemiological features of tuberculosis in the diabetic population and relates them to recent advances in understanding the mechanistic basis of tuberculosis susceptibility and other complications of diabetes. Issues that merit further investigation, such as geographic host and pathogen differences in the diabetes/tuberculosis interaction, the role of hyperglycemia-induced epigenetic reprogramming in immune dysfunction and the impact of diabetes on lung injury and fibrosis caused by tuberculosis, are highlighted in this review.
TL;DR: To investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight, a large number of children are diagnosed withExecutive function deficits.
Abstract: Aim To investigate the magnitude of executive function deficits and their dependency on gestational age, sex, age at assessment, and year of birth for children born preterm and/or at low birthweight. Method PubMed, PsychINFO, Web of Science, and ERIC were searched for studies reporting on executive functions in children born preterm/low birthweight and term controls born in 1990 and later, assessed at a mean age of 4 years or higher. Studies were included if five or more studies reported on the same executive function measures. Results Thirty-five studies (3360 children born preterm/low birthweight, 2812 controls) were included. Children born preterm/low birthweight performed 0.5 standardized mean difference (SMD) lower on working memory and cognitive flexibility and 0.4 SMD lower on inhibition. SMDs for these executive functions did not significantly differ from each other. Meta-regression showed that heterogeneity in SMDs for working memory and inhibition could not be explained by study differences in gestational age, sex, age at assessment, or year of birth. Interpretation Children born preterm/low birthweight since 1990 perform half a SMD below term-born peers on executive function, which does not seem to improve with more recent advances in medical care or with increasing age. What this paper adds Children born preterm/low birthweight perform below term-born children on core executive functions. Lower gestational age or male sex are not risk factors for poorer executive functions. Executive function difficulties in children born preterm/low birthweight remain stable across childhood. Executive function difficulties are similar for children born recently and children born in earlier eras.
01 Jan 2016
TL;DR: The benefits of exclusive breastfeeding for child health and survival, particularly in the post-neonatal period, are established as discussed by the authors, but the independent beneficial effect of early breastfeeding initiation remains unclear.
Abstract: Background: Initiation of breastfeeding within one hour of birth and exclusive breastfeeding for the first six months are currently recommended. The benefits of exclusive breastfeeding for child health and survival, particularly in the post-neonatal period, are established. The independent beneficial effect of early breastfeeding initiation remains unclear. Methods: We examined associations between timing of breastfeeding initiation, post-enrolment neonatal mortality (enrolment-28 days) and post-neonatal mortality up to six months of age (29-180 days) in a large cohort from three neonatal vitamin A trials in Ghana, India and Tanzania. Breastfeeding initiation was categorized as: at ≤1 hour, 2-23 hours, and 24-96 hours. Breastfeeding patterns were defined as exclusive, predominant or partial breastfeeding at four days, one month and three months of age. Relative risks were estimated using log binomial regression and Poisson regression with robust variances. Multivariate models controlled for site and potential confounders. Infants who initiated breastfeeding after 96 hours, did not initiate, or had missing initiation status were excluded. Results Of 99,938 enrolled infants, 57.0% initiated breastfeeding at ≤1 hour, 38.1% at 2-23 hours, and 4.6% at 24-96 hours. 306 infants who did not initiate breastfeeding by 96 hours age were excluded. Compared with infants initiating breastfeeding within the first hour of life, neonatal mortality between enrolment and 28 days was higher among infants initiating at 2-23 hours (adjusted relative risk=1.41 [95% Confidence Interval 1.24,1.62], p value <0.001), and among those initiating at 24-96 hours (1.79, [1.39, 2.30], p value <0.001). These relationships were not different when deaths in the first four days of life were excluded, or when data were stratified by exclusive breastfeeding status at four days of age (p value for interaction=0.690). Exclusive breastfeeding was associated with lower post-enrolment neonatal mortality, and both early breastfeeding initiation and exclusive breastfeeding were associated with lower mortality between 29 and 180 days. Conclusions Our findings suggest that early initiation of breastfeeding reduces neonatal and early infant mortality both through increasing rates of exclusive breastfeeding and by additional mechanisms. Both practices should be promoted by public health programmes and should be used in models to estimate lives saved.
TL;DR: Network“Healthy Start – Young Family Network” is a component of “IN FORM – Germany’s national initiative to promote healthy diets and physical activity” of the German government and is funded by the Federal Ministry of Food and Agriculture.
Abstract: „Gesund ins Leben – Netzwerk Junge Familie“ ist ein Bestandteil von „IN FORM – Deutschlands Initiative fur gesunde Ernahrung und mehr Bewegung“ der Bundesregierung und wird durch das Bundesministerium fur Ernahrung und Landwirtschaft gefordert. In diesem bundesweiten Netzwerk haben sich medizinische und wissenschaftliche Fachgesellschaften, Berufsverbande sowie fachlich ausgerichtete Institutionen zusammengeschlossen, um Eltern rund um die Geburt mit Informationen zur Ernahrung, zur Bewegung und zur Allergiepravention zu begleiten und zu unterstutzen. Die 2010 erstmals erschienenen Handlungsempfehlungen zu Sauglingsernahrung und Ernahrung der stillenden Mutter wurden auf Basis aktueller Empfehlungen relevanter Fachorganisationen und Institutionen sowie einschlagiger wissenschaftlicher Publikationen von den Mitgliedern des wissenschaftlichen Beirats des Netzwerks diskutiert, uberarbeitet und im Konsens formuliert. Diese Empfehlungen werden zum einen als anwendungsorientierte, alltagsbezogene Botschaften an junge Familien weitergegeben, zum anderen in der Fortbildung der Multiplikatoren, erganzt durch weiterfuhrende Informationen, eingesetzt. Die Empfehlungen umfassen die Themen Stillen, Sauglingsnahrung, Beikost, Getranke (erganzende Flussigkeitszufuhr), Essenlernen, Ernahrung der stillenden Frau, Nahrstoffsupplemente fur den Saugling und die stillende Mutter sowie Alkohol, Rauchen und Medikamente in der Stillzeit. Des Weiteren gehoren allgemeine Empfehlungen zur Allergiepravention beim Kind sowie Empfehlungen zur Bewegung im Sauglingsalter und zur Bewegung der stillenden Frau dazu.
TL;DR: The evidence that longer and exclusive lactation may be beneficial for type 2 diabetes mellitus prevention in women with previous GDM is supported, however, the evidence relies only on observational studies and further studies are required to address the true causal effect.
Abstract: Summary Lactation may protect women with previous gestational diabetes mellitus (GDM) from developing type 2 diabetes mellitus, but the results of existing studies are inconsistent, ranging from null to beneficial. We aimed to conduct a systematic review to gather available evidence. Databases MEDLINE, CINAHL, PubMed, and EMBASE were searched on December 15, 2015, without restriction of language or publication year. A manual search was also conducted. We included observational studies (cross-sectional, case-control, and cohort study) with information on lactation and type 2 diabetes mellitus incidence among women with previous GDM. We excluded case studies without control data. Data synthesis was conducted by random-effect meta-analysis. Fourteen reports of 9 studies were included. Overall risk of bias using RoBANS ranged from low to unclear. Longer lactation for more than 4 to 12 weeks postpartum had risk reduction of type 2 diabetes mellitus compared with shorter lactation (OR 0.77, 95% CI 0.01-55.86; OR 0.56, 95% CI 0.35-0.89; OR 0.22, 95% CI 0.13-0.36; type 2 diabetes mellitus evaluation time 5 y, respectively). Exclusive lactation for more than 6 to 9 weeks postpartum also had lower risk of type 2 diabetes mellitus compared with exclusive formula (OR 0.42, 95% CI 0.22-0.81). The findings support the evidence that longer and exclusive lactation may be beneficial for type 2 diabetes mellitus prevention in women with previous GDM. However, the evidence relies only on observational studies. Therefore, further studies are required to address the true causal effect.