Use of the theory of planned behavior framework to understand breastfeeding decision-making among mothers of preterm infants

Background: Mothers of preterm infants face significant challenges to breastfeeding. The theory of planned behavior (TPB) is a well-known framework comprising three domains (attitudes, perceived control, and social norms), which has been used to conceptualize the array of factors that influence health-related behaviors and develop interventions to promote behaviors. Aim: We used the TPB framework to determine the array of factors that contribute to breastfeeding among mothers of preterm infants. Materials and Methods: Using qualitative research methods, we conducted in-depth, semistructured interviews with mothers regarding their experiences feeding their preterm infants according to TPB domains. We developed themes based on an iterative process of review of transcripts and conducted interviews until thematic saturation was reached. Results: We interviewed 23 mothers in 3 states 2 to 6 months after hospital discharge; 22 mothers initiated milk production and 6 were breastfeeding at the time of the interview. Factors that were positive and negative toward breastfeeding were present for all three TPB domains. Regarding attitudes, mothers felt that breastfeeding was a way to bond, that breast milk was healthy and protective, and that breast milk alone was insufficient for a growing preterm infant. Regarding perceived control, mothers felt empowered to breastfeed due to encouragement from hospital staff, friends, and family, and had difficulty overcoming their infant's immature oral feeding skills, competing responsibilities, and perceived infant preference for bottle feeding. Regarding social norms, mothers reported support for and against breastfeeding among hospital and Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) providers, family, friends, and the media. Conclusion: Interventional studies geared toward breastfeeding promotion among mothers of preterm infants may focus on addressing barriers to direct breastfeeding during the neonatal intensive care unit and early post-discharge time periods

Racial and ethnic differences in internal medicine residency assessments

IMPORTANCE: Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education. OBJECTIVE: To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022. MAIN OUTCOMES AND MEASURES: The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes. RESULTS: The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P \u3c .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P \u3c .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P \u3c .001). By the final year 3 assessment, the gap between White and Asian and URiM residents\u27 scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training. CONCLUSIONS AND RELEVANCE: In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity

Fabrication of Copper Window Electrodes with ≈10⁸Apertures cm⁻² for Organic Photovoltaics

A powerful approach to increasing the far‐field transparency of copper film window electrodes which simultaneously reduces intraband absorption losses for wavelengths 550 nm is reported. The approach is based on incorporation of a random array of ≈100 million circular apertures per cm2 into an optically thin copper film, with a mean aperture diameter of ≈500 nm. A method for the fabrication of these electrodes is described that exploits a binary polymer blend mask that self‐organizes at room temperature from a single solution, and so is simple to implement. Additionally all of the materials used in electrode fabrication are low cost, low toxicity, and widely available. It is shown that these nanostructured copper electrodes offer an average far‐field transparency of ≥80% and sheet resistance of ≤10 Ω sq−1 when used in conjunction with a conventional solution processed ZnO electron transport layer and their utility in inverted organic photovoltaic devices is demonstrated

Consommation, interactions sociales et préférences

The notion of need often characterizes the strict minimum amount of food and shelter to survive. Needs have however recurrently been described as essentially relative and context-driven. Indeed, cultural and social incentives tend to provide powerful motivations for individuals to engage in choices sometimes detrimental to their short- or long-term fitness. These choices reveal certain needs which are beyond mere sustenance. My thesis aims at better understanding these decisions by including cultural and social components to a standard theory of consumption. By doing so, it contributes to bridge the gap between two important branches of the literature: demand analysis and behavioral/social economics. The different chapters adress questions such as: Why do malnourished people spend a significant portion of their budget on conspicuous goods (first chapter)? Why do people of different social groups choose to consume different types of goods, given similar prices, income and demographics (second chapter)? Do social interactions contribute to the persistence of localized tastes (third chapter)? And does market integration contribute to taste convergence (fourth chapter)? These topics require to take into account the social meaning of consumption choices, aside from income, prices and functionality. In other words, they require to consider consumption as a language.La notion de besoin caractérise souvent une nécessité biologique, le strict minimum pour se nourrir et se loger. Les besoins ont pourtant souvent été définis comme relatifs et propres à une situation donnée. Les incitations culturelles et sociales tendent à fournir des motivations puissantes aux individus, les conduisant à prendre des décisions parfois à leur détriment au plus ou moins long-terme. Ces choix révèlent certains besoins allant au-delà de la seule survie. Ma thèse a pour objectif de mieux comprendre ces décisions en incluant des composants sociaux ou culturels à la théorie standard de la consommation. Elle contribue à faire le lien entre deux branches importantes de la littérature économique: l'analyse de la demande, et l'économie comportementale/sociale. Les différents chapitres répondent à des questions telles que : pourquoi les personnes souffrant de malnutrition dépensent une part significative de leur budget en biens ostentatoires (premier chapitre) ? Pourquoi des personnes différant seulement par le groupe social auquel elles appartiennent ne consomment pas les mêmes biens (deuxième chapitre) ? Les interactions sociales contribuent-elles à la persistance de goûts locaux (troisième chapitre) ? Et l'intégration commerciale contribue-t-elle à la convergence des goûts (quatrième chapitre) ? Ces sujets requièrent de considérer la signification sociale des choix de consommation, en plus de l'effet du revenu, des prix et de leur valeur fonctionnelle. En d'autres termes, ils requièrent de penser la consommation comme un langage

Faculty Perspectives about Facilitators and Barriers to Interprofessional Education of Students

In this paper, I introduce the importance of interprofessional education and the need to establish effective interprofessional curricula at institutions educating healthcare professional students. This is followed by the evidence that while national and international organizations recommend interprofessional education, change at the local level can be difficult. For this reason, using Kern’s framework for curriculum development (1), we undertook a needs assessment to understand better our own local context as a preliminary step for curriculum design and implementation. Using qualitative methods, we identified predisposing, enabling and reinforcing factors important to recognize and to address in order to achieve our goal of institutionalizing an effective interprofessional curriculum. In the discussion, I suggest that these factors might most effectively be addressed using a framework for change, such as the eight steps proposed by Kotter

Safe Infant Sleep Interventions: What is the Evidence for Successful Behavior Change?

Sudden infant death syndrome (SIDS) and other sleep-related infant deaths, such as accidental suffocation and strangulation in bed and ill-defined deaths, account for \u3e4000 deaths annually in the USA. Evidence-based recommendations for reducing the risk of sleep-related deaths have been published, but some caregivers resist adoption of these recommendations. Multiple interventions to change infant sleep-related practices of parents and professionals have been implemented. In this review, we will discuss illustrative examples of safe infant sleep interventions and evidence of their effectiveness. Facilitators of and barriers to change, as well as the limitations of the data currently available for these interventions, will be considered

Refusal of Vitamin K by Parents of Newborns: A Qualitative Study

ObjectiveDespite American Academy of Pediatrics recommendations, some parents refuse intramuscular (IM) vitamin K as prophylaxis against vitamin K deficiency bleeding for their newborns. The purpose of our study was to describe attitudes and perceptions of parents who choose to defer IM vitamin K for their newborns.MethodsUsing qualitative methodology, we conducted in-depth semi-structured interviews with parents of newborns in 3 hospitals in Connecticut and California. We used the grounded theory approach and the constant comparative method until saturation was reached.ResultsNineteen participants (17 mothers and 2 fathers) of 17 newborns were interviewed; 14 newborns did not receive IM vitamin K due to refusal by the parents, and for 3 newborns IM vitamin K administration was delayed due to initial hesitation by the parents. Four major themes emerged: 1) risk-to-benefit ratio, where parents refused IM vitamin K due to a perceived risk to their newborn from preservatives, for example; 2) "natural" approaches, which led to seeking oral vitamin K or increasing the mother's own prenatal dietary vitamin K intake; 3) placement of trust and mistrust, which involved mistrust of the medical and pharmaceutical community with overlapping concerns about vaccines and trust of self, like-minded allopathic and non-allopathic health care providers, the social circle, the internet, and social media; and 4) informed by experiences, reflecting hospital experiences with prior pregnancies and communication with health care providers.ConclusionsParents' perception of risk, preference for alternative options, trust, and communication with health care providers were pivotal factors when making decisions about IM vitamin K