scholarly journals ‘Optimising’ breastfeeding: what can we learn from evolutionary, comparative and anthropological aspects of lactation?

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mary S. Fewtrell ◽  
Nurul H. Mohd Shukri ◽  
Jonathan C. K. Wells
Keyword(s):  
Health Professionals ◽  
Conflicts Of Interest ◽  
Phenotypic Variability ◽  
Public Health Intervention ◽  
Main Body ◽  
Anthropological Perspective ◽  
Infant Crying ◽  
Cultural Aspects ◽  
Human Lactation ◽  
Breastfeeding Problems

Abstract Background Promoting breastfeeding is an important public health intervention, with benefits for infants and mothers. Even modest increases in prevalence and duration may yield considerable economic savings. However, despite many initiatives, compliance with recommendations is poor in most settings – particularly for exclusive breastfeeding. Mothers commonly consult health professionals for infant feeding and behavioural problems. Main body We argue that broader consideration of lactation, incorporating evolutionary, comparative and anthropological aspects, could provide new insights into breastfeeding practices and problems, enhance research and ultimately help to develop novel approaches to improve initiation and maintenance. Our current focus on breastfeeding as a strategy to improve health outcomes must engage with the evolution of lactation as a flexible trait under selective pressure to maximise reproductive fitness. Poor understanding of the dynamic nature of breastfeeding may partly explain why some women are unwilling or unable to follow recommendations. Conclusions We identify three key implications for health professionals, researchers and policymakers. Firstly, breastfeeding is an adaptive process during which, as in other mammals, variability allows adaptation to ecological circumstances and reflects mothers’ phenotypic variability. Since these factors vary within and between humans, the likelihood that a ‘one size fits all’ approach will be appropriate for all mother-infant dyads is counterintuitive; flexibility is expected. From an anthropological perspective, lactation is a period of tension between mother and offspring due to genetic ‘conflicts of interest’. This may underlie common breastfeeding ‘problems’ including perceived milk insufficiency and problematic infant crying. Understanding this – and adopting a more flexible, individualised approach – may allow a more creative approach to solving these problems. Incorporating evolutionary concepts may enhance research investigating mother–infant signalling during breastfeeding; where possible, studies should be experimental to allow identification of causal effects and mechanisms. Finally, the importance of learned behaviour, social and cultural aspects of primate (especially human) lactation may partly explain why, in cultures where breastfeeding has lost cultural primacy, promotion starting in pregnancy may be ineffective. In such settings, educating children and young adults may be important to raise awareness and provide learning opportunities that may be essential in our species, as in other primates.

scholarly journals Sustainable healthcare – Time for ‘Green Podiatry’

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Angela Margaret Evans
Keyword(s):  
Climate Change ◽  
Carbon Dioxide ◽  
Greenhouse Gases ◽  
Health Professionals ◽  
Carbon Dioxide Emissions ◽  
Allied Health ◽  
World Health ◽  
Main Body ◽  
Allied Health Professionals ◽  
Foot Health

Abstract Background Healthcare aims to promote good health and yet demonstrably contributes to climate change, which is purported to be ‘the biggest global health threat of the 21st century’. This is happening now, with healthcare as an industry representing 4.4% of global carbon dioxide emissions. Main body Climate change promotes health deficits from many angles; however, primarily it is the use of fossil fuels which increases atmospheric carbon dioxide (also nitrous oxide, and methane). These greenhouse gases prevent the earth from cooling, resulting in the higher temperatures and rising sea levels, which then cause ‘wild weather’ patterns, including floods, storms, and droughts. Particular vulnerability is afforded to those already health compromised (older people, pregnant women, children, wider health co-morbidities) as well as populations closer to equatorial zones, which encompasses many low-and-middle-income-countries. The paradox here, is that poorer nations by spending less on healthcare, have lower carbon emissions from health-related activity, and yet will suffer most from global warming effects, with scant resources to off-set the increasing health care needs. Global recognition has forged the Paris agreement, the United Nations sustainable developments goals, and the World Health Organisation climate change action plan. It is agreed that most healthcare impact comes from consumption of energy and resources, and the production of greenhouse gases into the environment. Many professional associations of medicine and allied health professionals are advocating for their members to lead on environmental sustainability; the Australian Podiatry Association is incorporating climate change into its strategic direction. Conclusion Podiatrists, as allied health professionals, have wide community engagement, and hence, can model positive environmental practices, which may be effective in changing wider community behaviours, as occurred last century when doctors stopped smoking. As foot health consumers, our patients are increasingly likely to expect more sustainable practices and products, including ‘green footwear’ options. Green Podiatry, as a part of sustainable healthcare, directs us to be responsible energy and product consumers, and reduce our workplace emissions.

scholarly journals The gut microbiome: a key player in the complexity of amyotrophic lateral sclerosis (ALS)

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sarah L. Boddy ◽  
Ilaria Giovannelli ◽  
Matilde Sassani ◽  
Johnathan Cooper-Knock ◽  
Michael P. Snyder ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Gut Microbiota ◽  
Gut Microbiome ◽  
Phenotypic Variability ◽  
Personalised Medicine ◽  
Main Body ◽  
Body Of Knowledge ◽  
Environmental Component ◽  
Health And Disease ◽  
Lateral Sclerosis

Abstract Background Much progress has been made in mapping genetic abnormalities linked to amyotrophic lateral sclerosis (ALS), but the majority of cases still present with no known underlying cause. Furthermore, even in families with a shared genetic abnormality there is significant phenotypic variability, suggesting that non-genetic elements may modify pathogenesis. Identification of such disease-modifiers is important as they might represent new therapeutic targets. A growing body of research has begun to shed light on the role played by the gut microbiome in health and disease with a number of studies linking abnormalities to ALS. Main body The microbiome refers to the genes belonging to the myriad different microorganisms that live within and upon us, collectively known as the microbiota. Most of these microbes are found in the intestines, where they play important roles in digestion and the generation of key metabolites including neurotransmitters. The gut microbiota is an important aspect of the environment in which our bodies operate and inter-individual differences may be key to explaining the different disease outcomes seen in ALS. Work has begun to investigate animal models of the disease, and the gut microbiomes of people living with ALS, revealing changes in the microbial communities of these groups. The current body of knowledge will be summarised in this review. Advances in microbiome sequencing methods will be highlighted, as their improved resolution now enables researchers to further explore differences at a functional level. Proposed mechanisms connecting the gut microbiome to neurodegeneration will also be considered, including direct effects via metabolites released into the host circulation and indirect effects on bioavailability of nutrients and even medications. Conclusion Profiling of the gut microbiome has the potential to add an environmental component to rapidly advancing studies of ALS genetics and move research a step further towards personalised medicine for this disease. Moreover, should compelling evidence of upstream neurotoxicity or neuroprotection initiated by gut microbiota emerge, modification of the microbiome will represent a potential new avenue for disease modifying therapies. For an intractable condition with few current therapeutic options, further research into the ALS microbiome is of crucial importance.

Understanding vaccine hesitancy: the evidence

2021 ◽  
Vol 32 (7) ◽  
pp. 282-287
Author(s):  
Alison While
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
Herd Immunity ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Vaccine Hesitancy ◽  
Important Public Health ◽  
Positive Attitudes ◽  
The Uk

Vaccine hesitancy is a concern both globally and within the UK. Alison While reviews the evidence relating to vaccine hesitancy, its underlying factors and the sociodemographic variations Vaccination is an important public health intervention, but its effectiveness depends upon the uptake of vaccination reaching sufficient levels to yield ‘herd’ immunity. While the majority of the UK hold positive attitudes about vaccination, some people, including health professionals, decline vaccinations. This article reviews the evidence relating to vaccine hesitancy, its underlying factors and the sociodemographic variations.

Mobbing in labor relations

2020 ◽  
pp. 13-19
Author(s):  
Alla Yushko ◽  
Daryna Chekhun
Keyword(s):  
Labor Relations ◽  
Conflicts Of Interest ◽  
Sense Of Self ◽  
Legal Regulation ◽  
Psychological Climate ◽  
Professional Activity ◽  
Main Body ◽  
Wrong Decision ◽  
Psychosocial Risks ◽  
Psychological Pressure

Problem setting. The success of any work team depends on the WORK of each employee. One of the destabilizing factors of the work process, which leads to a tense situation in the team, reduce employee efficiency and increase the likelihood of making the wrong decision, is psychological pressure. This phenomenon is called “mobbing”. In modern conditions, the legal regulation of protection against psychosocial risks in the workplace is an important trend in creating safe and healthy working conditions. Analysis of resent researches and publications. Despite recent research and publications as foreign scholars (D. Burton, M. Wilson, F. Gabriel, T. Doyle, R.S. Kessler, I.Y. Kiselyov, X. Leimann, M.A. Murray, R. D. Schwartz) and domestic researchers (V. O. Evdokimov, L. P. Garashchenko, T.A. Kolyada, O.S. Kravchenko, I.V. Lagutina, A.I. Marenich, I.S. Saharuk, S. I. Simakova, M.P. Fedorov, A.V. Shamshieva and others), legal regulation of mobbing in Ukraine is still almost absent. Target of research. The purpose of this article is to identify problems of legal regulation of mobbing in labor relations, highlight the causes of mobbing, as well as the preparation of proposals for legislation in this area on the possibility of preventing harassment in the workplace. Article’s main body. The paper conducts research the problems of mobbing (or harassment in the workplace). The legislation of Ukraine does not provide for liability for harassment in the workplace. Bills submitted to the Verkhovna Rada of Ukraine to regulate this phenomenon have never been adopted. The paper considers the causes of harassment of workers in the workplace, the main types of mobbing (vertical and horizontal), the responsibilities of the manager to detect and combat mobbing among subordinates, suggested ways to prevent it. Conclusions and prospects for the development. Based on the above, the following conclusions are made: (1) the productivity of professional activity of the employee largely depends on the psychological climate in the team. Problems that arise due to misunderstandings with colleagues or management, conflicts of interest of the employee and the company, lack of help, cause psychological discomfort, varying levels of stress or even provoke mental disorders in employees; (2) enshrining in laws, local regulations norms and rules that provide each employee with maximum social and psychological comfort in the workplace and guarantee the inadmissibility of mobbing, is a necessary step in the legal regulation of labor in Ukraine at the present stage; (3) such norms will reflect the level of culture of society, its civilization, as well as a qualitatively new nature of modern labor relations, in which the employee is a well-educated, highly qualified, welldeveloped person with a sense of self-worth.

Integrating immunizations into the programme

2019 ◽  
Author(s):  
Helen Bedford ◽  
David Elliman
Keyword(s):  
Health Professionals ◽  
Social Inequalities ◽  
Public Health Intervention ◽  
Vaccine Uptake ◽  
Health Visitors ◽  
Herd Protection ◽  
Uptake Rates ◽  
Timely Fashion ◽  
Child Health Programme ◽  
Health Programme

Immunization is a highly successful public health intervention providing protection against serious infectious diseases. UK vaccine uptake rates are generally high, although pockets of lower uptake and social inequalities remain which compromise herd protection. The child health programme provides health professionals opportunities to introduce immunization to parents, offer ongoing information and advice, and remind them when vaccines are due. Improving and maintaining high vaccine rates depends on multicomponent strategies. In view of their relationship with families, health visitors are the key professionals to work with them to ensure that children are immunized fully and in a timely fashion, although in practice they now do not usually deliver vaccines.

scholarly journals Randomised clinical trial of community-based peer-led and psychologist-led group treatment for hoarding disorder

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 285-293 ◽  
Author(s):  
Carol A. Mathews ◽  
Robert Scott Mackin ◽  
Chia-Ying Chou ◽  
Soo Y. Uhm ◽  
Larry David Bain ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Effect Size ◽  
Health Professionals ◽  
Conflicts Of Interest ◽  
Post Treatment ◽  
Research Support ◽  
Hoarding Disorder ◽  
Study Section ◽  
Severity Scores

BackgroundTreatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.AimsWe aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).MethodWe randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.ResultsG-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points,t= −1.71, d.f. = 245,P= 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t= 2.79, d.f. = 175,P= 0.006;t= 2.89, d.f. = 175,P= 0.004).ConclusionsPeer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.Declaration of interestC.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.

Understanding vaccine hesitancy: the evidence

2021 ◽  
Vol 26 (6) ◽  
pp. 278-282
Author(s):  
Alison While
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
Herd Immunity ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Vaccine Hesitancy ◽  
Important Public Health ◽  
Positive Attitudes ◽  
Vaccination Acceptance ◽  
The Uk

Vaccination is an important public health intervention, but its effectiveness depends upon the uptake of vaccination reaching sufficient levels to yield ‘herd’ immunity. While the majority of the UK hold positive attitudes about vaccination, some people, including health professionals, decline vaccinations. This article reviews the evidence relating to vaccine hesitancy, its underlying factors and the sociodemographic variations. A second article will review the evidence relating to strategies to address vaccine hesitancy and promote vaccination acceptance.

Molecular Analysis of Type 1 VWD Mutations: Effects of Mutant:Wild-Type Transfection Ratio and Protein Degradation

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1210-1210
Author(s):  
Tara C White-Adams ◽  
Paula M Jacobi ◽  
Sandra L Haberichter ◽  
Jorge A Di Paola
Keyword(s):  
Conflicts Of Interest ◽  
Phenotypic Variability ◽  
Statistical Significance ◽  
Von Willebrand Disease ◽  
Incomplete Penetrance ◽  
Shear Stresses ◽  
Dependent Manner ◽  
Von Willebrand

Abstract Abstract 1210 Background: Von Willebrand disease (VWD), the most frequently diagnosed bleeding disorder, is characterized by variable expressivity and incomplete penetrance. Bleeding severity in type 1 VWD does not always correlate with plasma VWF levels, except in cases of severe deficiency. It is possible that the phenotypic variability observed in type 1 VWD is related to the final ratio of mutant vs. wild-type (WT) subunits in the mature VWF multimeric structure. The aim of this study was to determine the role of mutant:WT transfection ratio on von Willebrand factor (VWF) expression, secretion and degradation in VWD type 1 mutations. Methods: Type 1 VWD mutations with reported normal multimer distribution were chosen from the D'-D3 region of VWF. Mutations of cysteine residues were eliminated to avoid interference with inter- and intra-chain disulfide linkages. Mutations were generated by performing site-directed mutagenesis on full-length human VWF cDNA within the pcDNA3.1(-)A vector, which appends VWF with a Myc-His tag (denoted mH). The following mutations were generated: M771I, R782Q, R924W, I1094T and T1156M. Mutant VWF was co-transfected with WT VWF contained within the pCIneo vector (mutant mH:WT pCIneo ratios investigated were 1:3, 2:2, 3:1, 4:0). Recombinant (r)VWF expression was measured using ELISA and concentrations were determined by comparison to a standard curve generated with pooled normal plasma. Multimer composition was analyzed using SDS-agarose gel electrophoresis followed by Western blot. Statistical significance was determined using one-way ANOVA with post-hoc Tukey test. Results: Homozygous expression of R924W or I1094T had no effect on rVWF expression or secretion compared to WT, while M771I, R782Q and T1156M significantly increased intracellular protein retention. Co-expression of M771I or R782Q at varying ratios with WT was able to partially correct rVWF secretion, although intracellular retention remained significantly higher than WT at all ratios (n=3, * p<0.05, Figure 1). Co-expression with WT cDNA was also able to correct T1156M retention in a dose-dependent manner (n=3, Figure 1), as described previously [Lethagen, Thromb and Haemost, 2002]. Multimer analysis of co-transfection supernatants exhibited normal and full distribution of multimers, as expected for type 1 VWD mutations. Others have shown previously that heterodimers of WT and C1149R VWF, a type 1 VWD mutation, are degraded by the proteasome [Bodo et al, Blood, 2001], presumably via recognition of a folding defect within the mutant subunit. In order to determine the role of proteasomal degradation in the decreased secretion levels of our mutants, we performed experiments in the presence of the proteasome inhibitor MG-132. Treatment of co-transfected cells (mutant:WT 2:2) with 1 mM MG-132 for 16 hours prior to harvesting did not significantly affect secretion or overall expression of rVWF, suggesting that this pathway is not involved in the regulation of the expression of our mutants. Discussion: Our data demonstrate that M771I, T1156M and R782Q induce a significant increase in intracellular retention compared to WT protein, which could contribute to a quantitative deficiency in type 1 VWD, while R924W and I1094T do not appear to interfere with VWF production or secretion. Variable levels of intracellular retention have been observed in a previous study of VWF mutations identified in type 1 VWD patients [Eikenboom, et al, J Thromb Haemost, 2009]. While one interpretation of these results is that R924W or I1094T may not be causative mutations in type 1 VWD, other mechanisms including protein clearance and function remain to be explored. Although type 1 VWD mutations variably affect expression and secretion levels in vitro, studying platelet rolling on these mutants at a range of physiological shear stresses will provide valuable information regarding whether the degree of incorporation of mutant subunits into VWF multimers can affect supramolecular structure, and ultimately, hemostatic function. Disclosures: No relevant conflicts of interest to declare.

Maternal Emotions and Experiences of Mothers Who Had Breastfeeding Problems: A Qualitative Study

2020 ◽  
Vol 34 (1) ◽  
pp. 3-20
Author(s):  
Gamze Durmazoğlu ◽  
Kerziban Yenal ◽  
Hülya Okumuş
Keyword(s):  
Health Professionals ◽  
Post Partum ◽  
Early Period ◽  
Structured Interview ◽  
Interview Method ◽  
Interview Methods ◽  
Theory Of Human Caring ◽  
Breastfeeding Problems ◽  
Human Caring

Background and PurposeMany women are ceasing to breastfeed in the early period due to the breastfeeding problems and difficulties they perceive. Consequently, the approach and support of health professionals to mothers in the post-partum period is very important. The objective of the study is to determine the emotions and experiences of mothers who had breastfeeding problems by using Watson's Theory of Human Caring.MethodsThe research is a descriptive and qualitative type of study. The data were collected from 20 women with the semi-structured interview method based on Watson's Theory. The data were analyzed according to the Caritas Processes of Watson's Theory.ResultsIt was determined that the health professionals did not show enough assistance, support and interest to the mothers who had breastfeeding problems and that the mothers expected respect, empathy, sincerity, understanding, trust, and assistance during this period.Implication for PracticeThe use of the interview methods based on Watson's Theory of Human Caring in the determination of the difficulties and emotions experienced by the women who had breastfeeding problems will be a guide for the health professionals. It is thought that the approaches based on Watson's Caritas Processes that would be made to women who had breastfeeding problems would be effective for understanding their experience and emotions.

Capital Markets and Sovereign Defaults

2016 ◽  
pp. 480-512
Author(s):  
Juan H. Flores Zendejas
Keyword(s):  
Capital Markets ◽  
Sovereign Debt ◽  
Conflicts Of Interest ◽  
Main Body ◽  
Liquidity Provision ◽  
History Of ◽  
Sovereign Defaults ◽  
The Relationship ◽  
Supply Side Factors

This chapter provides a historical perspective on the relationship between capital markets and sovereign defaults. While the main body of the sovereign debt literature has rarely incorporated supply side factors, such as market distortions or conflicts of interest, we argue that the history of sovereign defaults cannot be understood without including the evolutionary structure of capital markets. The southern European debt crises and the recent controversy surrounding the role of holdouts demonstrate that certain proposals raised in previous default episodes deserve further discussion, in particular, those aiming to deal with problems of collective action, liquidity provision, and information flaws.

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