Providing effective lactation care: The Merton NHS Specialist Breastfeeding Clinic

2021 ◽  
Vol 9 (12) ◽  
pp. 516-524
Author(s):  
Indira Lopez-Bassols ◽  
Iona de Wet ◽  
Gayle Subramaniam ◽  
Iman Hikal
Keyword(s):  
Clinical Review ◽  
Specialist Care ◽  
Lactation Consultants ◽  
Underlying Causes ◽  
Mother’S Own Milk ◽  
The Impact

The aim of this review was to assess the impact of an NHS specialist breastfeeding clinic staffed by International Board Certified Lactation Consultants, and to identify whether it improves breastfeeding outcomes and duration. This retrospective clinical review evaluated data from consultations at the Merton Specialist Breastfeeding Clinic. The data from each consultation forms the basis of the analysis. In the majority of cases (76%; n=56), the clinician findings differed from the mother's presenting concerns. This highlights the importance of specialist care to correctly identify issues and underlying causes. The majority (83%) of infants in this cohort were receiving some mother's own milk beyond 6 months. Women who faced complex breastfeeding challenges reached their breastfeeding goals with the support of specialist lactation care.

Effectiveness of the IBCLC: Have we Made an Impact on the Care of Breastfeeding Families Over the Past Decade?

2019 ◽  
Vol 35 (3) ◽  
pp. 441-452 ◽  
Author(s):  
Barbara Haase ◽  
Emily Brennan ◽  
Carol L. Wagner
Keyword(s):  
Scoping Review ◽  
Physician Education ◽  
Future Research ◽  
Positive Role ◽  
Quantitative Studies ◽  
Lactation Consultants ◽  
Evidenced Based ◽  
Outpatient Settings ◽  
Breastfeeding Problems ◽  
The Impact

Background: International Board Certified Lactation Consultants (IBCLCs) have been in existence for over 3 decades, are currently represented in 110 countries, and have the only internationally recognized certification to provide safe and evidenced-based care for breastfeeding women and their infants. Research aim: To review the literature about the efficacy of IBCLCs on breastfeeding outcomes as well as studies that have examined the effectiveness of the IBCLC’s role. Methods: The design was a scoping review of the literature and critical analysis using PRISMA guidelines of existing studies published from 2008–2019. Qualitative and quantitative studies were reviewed. Results: Twelve ( N =12) studies met inclusion criteria. Seven themes emerged in the analysis including studies of the role of IBCLCs in resident physician education; IBCLC’s role in breastfeeding interventions and the management of breastfeeding problems; the impact of IBCLCs in inpatient and outpatient settings; and the impact of geographic access to IBCLCs on breastfeeding rates. Certification of and ongoing professional development of IBCLCs are also discussed. Conclusion: In this scoping review of existing literature assessing the effectiveness of IBCLCs in promoting and supporting breastfeeding, it is clear that IBCLCs play a positive role in supporting breastfeeding throughout the world. However, there are certain limitations that must be addressed. Recommendations for future research and clinical practice are discussed in the context of present limitations to breastfeeding expertise and support.

scholarly journals Genomic imbalances in the placenta are associated with poor fetal growth

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Giulia F. Del Gobbo ◽  
Yue Yin ◽  
Sanaa Choufani ◽  
Emma A. Butcher ◽  
John Wei ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Sex Chromosome ◽  
Copy Number Variants ◽  
Placental Insufficiency ◽  
Potential Contribution ◽  
Genomic Imbalances ◽  
Significant Difference ◽  
Underlying Causes ◽  
Risk Of Disease ◽  
The Impact

Abstract Background Fetal growth restriction (FGR) is associated with increased risks for complications before, during, and after birth, in addition to risk of disease through to adulthood. Although placental insufficiency, failure to supply the fetus with adequate nutrients, underlies most cases of FGR, its causes are diverse and not fully understood. One of the few diagnosable causes of placental insufficiency in ongoing pregnancies is the presence of large chromosomal imbalances such as trisomy confined to the placenta; however, the impact of smaller copy number variants (CNVs) has not yet been adequately addressed. In this study, we confirm the importance of placental aneuploidy, and assess the potential contribution of CNVs to fetal growth. Methods We used molecular-cytogenetic approaches to identify aneuploidy in placentas from 101 infants born small-for-gestational age (SGA), typically used as a surrogate for FGR, and from 173 non-SGA controls from uncomplicated pregnancies. We confirmed aneuploidies and assessed mosaicism by microsatellite genotyping. We then profiled CNVs using high-resolution microarrays in a subset of 53 SGA and 61 control euploid placentas, and compared the load, impact, gene enrichment and clinical relevance of CNVs between groups. Candidate CNVs were confirmed using quantitative PCR. Results Aneuploidy was over tenfold more frequent in SGA-associated placentas compared to controls (11.9% vs. 1.1%; p = 0.0002, OR = 11.4, 95% CI 2.5–107.4), was confined to the placenta, and typically involved autosomes, whereas only sex chromosome abnormalities were observed in controls. We found no significant difference in CNV load or number of placental-expressed or imprinted genes in CNVs between SGA and controls, however, a rare and likely clinically-relevant germline CNV was identified in 5.7% of SGA cases. These CNVs involved candidate genes INHBB, HSD11B2, CTCF, and CSMD3. Conclusions We conclude that placental genomic imbalances at the cytogenetic and submicroscopic level may underlie up to ~ 18% of SGA cases in our population. This work contributes to the understanding of the underlying causes of placental insufficiency and FGR, which is important for counselling and prediction of long term outcomes for affected cases.

scholarly journals The Impact of Vitiligo on Patients' Psychological Status and Sexual Function: Cross-Sectional Questionnaire-Based Study

2021 ◽  
Vol 15 (1) ◽  
pp. 23-30
Author(s):  
Ghadah I Alhetheli
Keyword(s):  
Regression Analysis ◽  
Sexual Function ◽  
Female Gender ◽  
Psychological Status ◽  
Roc Curve Analysis ◽  
Cross Sectional ◽  
Sexual Dissatisfaction ◽  
Life Threatening ◽  
Underlying Causes ◽  
The Impact

Introduction: Vitiligo is a chronic pigmentary cutaneous disorder. Although vitiligo is not a life-threatening disease, it seriously affects patients' psychological status and Quality-of-Life (QoL). Moreover, the effect of vitiligo on genital image severely affects sexual function, especially in females. Patients & Methods: This cross-sectional questionnaire-based study had targeted patients with vitiligo of both genders. 173 patients who had responded to the given questionnaires were included and their responses were statistically analyzed. Patients’ files were revised for extraction of demographic and clinical data and the previous evaluation of the Vitiligo Area Scoring Index (VASI) score. Results and Discussion: Median VIS-22 score was in the range of 21-49, but 109 patients had a median score of 28. Seventy-eight patients had mild and 15 patients had moderate depression. Regression analysis defined the sense of being unattractive, disappointed in self and discouragement about the future as the most significant underlying causes of depression. Ninety-two patients had sexual dysfunction and scoring of satisfaction by the sexual act was the highest while scoring for the desire was the lowest. Regression analysis revealed that female gender, high ASEX and VASI scores are the significant predictors for high BDI-II. ROC curve analysis defined a high ASEX score as a significant predictor for a high BDI-II score. Conclusion: The obtained results indicated a deleterious effect of vitiligo on patients’ psychological status that may progress to depression. The effects of the disease on body image, especially the genital area, induced sexual dissatisfaction with an impact on sexual function. Altogether, raise a suggested adjuvant role for psychotherapy in patients with vitiligo which might even indirectly lead to improvement of vitiligo.

scholarly journals Feasibility, Acceptability, and Clinical Trends of a Mindfulness-Informed Child Welfare Intervention: Implications for Trauma-Focused Practice

2017 ◽  
Vol 18 (1) ◽  
pp. 369-386 ◽  
Author(s):  
Samantha M. Brown ◽  
Jennifer Bellamy
Keyword(s):  
Child Welfare ◽  
Early Life ◽  
Substance Misuse ◽  
Child Welfare System ◽  
Stress Coping ◽  
Early Life Trauma ◽  
Trauma Informed ◽  
Underlying Causes ◽  
Single Intervention ◽  
The Impact

Exposure to stress and early life trauma have been linked to child maltreatment and parental substance misuse. These issues often co-occur, yet few child welfare services target their shared underlying causes in a single intervention. Teaching mindfulness-informed strategies to substance-misusing families in the child welfare system may be one promising trauma-informed approach. As part of a larger pilot study testing the initial efficacy of a mindfulness-informed intervention for parents in public child welfare, this study explored the feasibility, acceptability, and clinical trends of the intervention using weekly reports of stress, coping, and mindfulness. Findings show support for the feasibility and acceptability of the intervention as well as positive responses to the intervention on measures of stress and mindfulness. However, the impact of the intervention varied with regard to improving weekly coping among participants. Implications for the integration of mindfulness into child welfare practice as a trauma-informed approach are discussed.

The Impact of the Court of Justice of the European Union on the Turkish Legal System

2020 ◽  
pp. 115-140
Author(s):  
Ulaş Karan
Keyword(s):  
European Union ◽  
Legal System ◽  
Government Procurement ◽  
Eu Law ◽  
The European Union ◽  
Court Of Justice ◽  
System P ◽  
Underlying Causes ◽  
Accession Process ◽  
The Impact

This chapter explores whether the case law of the Court of Justice of the European Union (CJEU) produces any impact on the Turkish legal system and, if so, its possible underlying causes. Protection of intellectual, industrial, and commercial property rights, competition, trade defence instruments, government procurement, direct and indirect taxation have been regarded as the main areas of ‘approximation of legislation’. Accordingly, laws adopted mostly in the past three decades show that the influence of EU law is valid only in certain fields of law, such as intellectual property law, labour law, and competition law, and this is also where we find most CJEU citations. This influence forms part of the EU accession process, which requires Turkey to harmonize its laws with the acquis. According to the research, despite the existence of a long-standing accession process and legislation based on the acquis in certain fields of law, on the whole, the Turkish judiciary does not seem committed to follow EU law in general or CJEU jurisprudence in particular.

The Impact of Clinical Review Bias on Child Language Grammaticality

2019 ◽  
Vol 41 (4) ◽  
pp. 214-221
Author(s):  
Anny P. Castilla-Earls ◽  
Brittany Harvey ◽  
Katrina Fulcher-Rood ◽  
Christopher D. Barr
Keyword(s):  
Clinical Review ◽  
Language Impairment ◽  
Binary Data ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Child Language ◽  
Communication Disorders ◽  
The Impact ◽  
English Students ◽  
Language Sample

The purpose of this study was to examine the impact of clinical review bias on the coding of grammaticality in child language. Seventy-four native-English students studying communication disorders and sciences made judgments about the grammaticality of 250 utterances presented in five language samples. Each language sample included grammatical, ungrammatical, and ambiguous utterances. Participants were randomly assigned to a blind or nonblind group. The nonblind group was presented with diagnostic information, whereas the blind group was not. We employed a generalized linear mixed model to examine the binary data. Our results suggest that both blind and nonblind participants were accurate in judging grammatical and ungrammatical utterances. However, nonblind participants were slightly more likely to judge ambiguous utterances as ungrammatical when the language sample identified the child as having a language impairment, suggesting that there was an effect of clinical review bias in this study. This effect, although statistically significant, was small.

Use of Predictive and Simulation Models to Develop Strategies for Better Access Specialists Care

2020 ◽  
pp. 109-136
Author(s):  
Siang Li Chua ◽  
Wai Leng Chow
Keyword(s):  
Lead Time ◽  
Discrete Event ◽  
Simulation Models ◽  
Multiple Logistic Regression ◽  
Specialist Care ◽  
Event Simulation ◽  
Patients At Risk ◽  
The Impact ◽  
Specialist Outpatient Clinic ◽  
Des Model

No-shows are patients who miss scheduled Specialist Outpatient Clinic (SOC) appointments. No-shows can impact patients' access to care and appointment lead time. This chapter describes a data-driven strategy of improving access to specialist care through first developing a stratified predictive scoring model to identify patients at risk of no-shows; second, studying the impact of a dynamic overbooking strategy that incorporates the use of the no-show prediction model using discrete event simulation (DES) on lead time. Seventeen variables related to new SOC appointments for subsidized patients in 2016 were analyzed. Multiple logistic regression (MLR) found eight variables independently associated with no-shows with area under receiver operation curve (AUC) 70%. The model was tested and validated. DES model simulated the appointment overbooking strategy as applied to the top highest volume specialties and concluded that lead time of Specialty 1 and 2 can be shortened by 27.5 days (49% improvement) and 21.3 (33%) respectively.

scholarly journals An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes?

2020 ◽  
Vol 35 (4) ◽  
pp. 438-441 ◽  
Author(s):  
Parisa Maleki Dana ◽  
Fatemeh Sadoughi ◽  
Jamal Hallajzadeh ◽  
Zatollah Asemi ◽  
Mohammad Ali Mansournia ◽  
...  
Keyword(s):  
Sex Differences ◽  
Sex Hormones ◽  
Severe Form ◽  
Immune Functions ◽  
Angiotensin Converting Enzyme 2 ◽  
Underlying Causes ◽  
Disaggregated Data ◽  
The Impact ◽  
Insight Into ◽  
Hormonal Levels

AbstractStudies have reported a sex bias in case fatalities of COVID-19 patients. Moreover, it is observed that men have a higher risk of developing a severe form of the disease compared to women, highlighting the importance of disaggregated data of male and female COVID-19 patients. On the other hand, other factors (eg, hormonal levels and immune functions) also need to be addressed due to the effects of sex differences on the outcomes of COVID-19 patients. An insight into the underlying causes of sex differences in COVID-19 patients may provide an opportunity for better care of the patients or prevention of the disease. The current study reviews the reports concerning with the sex differences in COVID-19 patients. It is explained how sex can affect angiotensin converting enzyme-2 (ACE2), that is a key component for the pathogenesis of COVID-19, and summarized the gender differences in immune responses and how sex hormones are involved in immune processes. Furthermore, the available data about the impact of sex hormones on the immune functions of COVID-19 cases are looked into.

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