The role of state breastfeeding laws and programs on exclusive breastfeeding practice among mothers in the special supplemental nutrition program for Women, Infants, and Children (WIC)

Background: It is unclear if state laws supporting breastfeeding are associated with exclusive breastfeeding (EBF) practice among low-income mothers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The main objectives of our study were to assess the relationship between such laws and EBF among WIC-participating mothers and to assess whether this association varied by employment status. We also assessed how mother’s exposure to WIC breastfeeding consultation was associated with EBF. Methods: A cross-sectional study was conducted across seven WIC program locations (i.e., Georgia, Massachusetts, Nevada, Pennsylvania, Wisconsin, Wyoming, Chickasaw Nation) between July–August 2020. Data were collected using convenient sampling from each program location and surveys were administered electronically or on paper to WIC-participating mothers. We restricted our analysis to data from 1161 WIC-participating mothers with infants aged zero to five months old. Multivariable mixed models were used to estimate the relationship between our exposures of interest (i.e., number of laws supporting breastfeeding, employment-related breastfeeding laws, WIC breastfeeding consultation) and EBF, while controlling for potential confounders and accounting for clustering by program location. Effect modification by employment status was assessed on the additive and multiplicative scales. Results: Among WIC-participating mothers living in program locations with no employment-related breastfeeding laws, EBF was 26% less prevalent for employed mothers compared to unemployed mothers (adjusted prevalence ratios [aPR]: 0.74, 95% CI: 0.67,0.83). Among all mothers, a one-unit increase in laws supporting breastfeeding was not associated with EBF (aPR: 0.88, 95% CI: 0.71,1.10). However, among employed mothers, living in areas with more employment-related laws was associated with a higher prevalence of EBF (aPR: 1.43, 95% CI: 0.83, 2.44). Infants whose mothers received a WIC breastfeeding consultation had 33% higher prevalence of being exclusively breastfed compared to infants whose mothers did not receive a WIC breastfeeding consultation (aPR: 1.33, 95% CI: 1.05,1.70). Conclusions: Infants whose WIC-participating mothers were employed, were less likely to be exclusively breastfed, but our effect modification analyses showed that laws supporting breastfeeding at the workplace may promote EBF among employed women. EBF was more prevalent among mothers who received a WIC breastfeeding consultation compared to those who did not receive such a consultation

Women’s preferences for antenatal care in Tanzania: a discrete choice experiment

Background: The stillbirth rate in Tanzania remains high. Greater engagement with antenatal care may help to reduce stillbirths. We investigated which characteristics of antenatal care clinics are preferred by pregnant women in Tanzania. Methods: We conducted an unlabelled discrete choice experiment (DCE) with think-aloud interviews. Participants were pregnant women, regardless of parity/gestation, from the Mwanza and Manyara regions of Tanzania. We asked participants to choose which of two hypothetical antenatal clinics they would rather attend. Clinics were described in terms of transport mode, cleanliness, comfort, visit content, and staff attitude. Each participant made 12 choices during the experiment, and a purposively selected sub-set simultaneously verbalised the rationale for their choices. We analysed DCE responses using a multinomial logit model adjusted for study region, and think-aloud data using the Framework approach. Results: We recruited 251 participants split evenly between the 2 geographical regions. Staff attitude was the most important attribute in clinic choice and dominated the think-aloud narratives. Other significant attributes were mode of transport (walking was preferred) and content of clinic visit (preference was stronger with each additional element of care provided). Cleanliness of the clinic was not a significant attribute overall and the think-aloud exercise identified a willingness to trade-off cleanliness and comfort for respectful care. Conclusion: Women would prefer to attend a clinic with kind staff which they can access easily. This study suggests that exploration of barriers to providing respectful care, and enabling staff to deliver it, are important areas for future investment. The DCE shows us what average preferences are; antenatal care that is aligned with identified preferences should increase uptake and engagement versus care which does not acknowledge them

Dense sampling of ethnic groups within African countries reveals fine-scale genetic structure and extensive historical admixture

Previous studies have highlighted how African genomes have been shaped by a complex series of historical events. Despite this, genome-wide data have only been obtained from a small proportion of present-day ethnolinguistic groups. By analyzing new autosomal genetic variation data of 1333 individuals from over 150 ethnic groups from Cameroon, Republic of the Congo, Ghana, Nigeria, and Sudan, we demonstrate a previously underappreciated fine-scale level of genetic structure within these countries, for example, correlating with historical polities in western Cameroon. By comparing genetic variation patterns among populations, we infer that many northern Cameroonian and Sudanese groups share genetic links with multiple geographically disparate populations, likely resulting from long-distance migrations. In Ghana and Nigeria, we infer signatures of intermixing dated to over 2000 years ago, corresponding to reports of environmental transformations possibly related to climate change. We also infer recent intermixing signals in multiple African populations, including Congolese, that likely relate to the expansions of Bantu language-speaking peoples

The association of urinary cadmium with sex steroid hormone concentrations in a general population sample of US adult men

<p>Abstract</p> <p>Background</p> <p>Studies investigating the association of cadmium and sex steroid hormones in men have been inconsistent, but previous studies were relatively small.</p> <p>Methods</p> <p>In a nationally representative sample of 1,262 men participating in the morning examination session of phase I (1998–1991) of the third National Health and Nutrition Examination Survey, creatinine corrected urinary cadmium and serum concentrations of sex steroid hormones were measured following a standardized protocol.</p> <p>Results</p> <p>After adjustment for age and race-ethnicity, higher cadmium levels were associated with higher levels of total testosterone, total estradiol, sex hormone-binding globulin, estimated free testosterone, and estimated free estradiol (each p-trend < 0.05). After additionally adjusting for smoking status and serum cotinine, none of the hormones maintained an association with urinary cadmium (each p-trend > 0.05).</p> <p>Conclusion</p> <p>Urinary cadmium levels were not associated with sex steroid hormone concentrations in a large nationally representative sample of US men.</p

Tanzania's first Marburg Viral Disease outbreak response: Describing the roles of FELTP graduates and residents.

Viral Haemorrhagic Fever Outbreak presents a significant public health threat, requiring a timely, robust, and well-coordinated response. This paper aims to describe the roles of the Tanzania Field Epidemiology and Laboratory Training Program (TFELTP) graduates and residents in responding to Tanzania's first Marburg Viral Disease (MVD) outbreak. We performed a secondary data analysis using a range of documents, such as rosters of deployed responders and the TFELTP graduate and resident database, to count and describe them. Additionally, we conducted an exploratory textual analysis of field deployment reports and outbreak situational reports to delineate the roles played by the residents and graduates within each response pillar. A total of 70 TFELTP graduates and residents from different regions were involved in supporting the response efforts. TFELTP graduates and residents actively participated in several interventions, including contact tracing and follow up, sensitising clinicians on surveillance tools such as standard case definitions, alert management, supporting the National and Kagera Regional Public Health Emergency Operations Centres, active case search, risk communication, and community engagement, coordination of logistics, passenger screening at points of entry, and conducting Infection Prevention and Control (IPC) assessments and orientations in 144 Health Facilities. The successes achieved and lessons learned from the MVD response lay a foundation for sustained investment in skilled workforce development. FELTP Training is a key strategy for enhancing global health security and strengthening outbreak response capabilities in Tanzania and beyond

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Flexible Tenacity in Goal Pursuit

Goal-directed behavior possesses various observable features (Gollwitzer and Moskowitz, 1996). First and foremost, it is characterized by persistent striving until the goal is reached. Second, goal-directedness expresses itself in energization when situations or means that can be used to reach the goal are encountered. And third,goal-directed organisms show appropriateness: If one route to goal attainment is blocked, another course of action to the same goal is taken. Alternatively, if the goal changes, the goal-directed individual readily adapts to these changes by performing different actions. It is the aspect of appropriateness that is scrutinized in the present chapter. We assume that goal pursuits, conscious as well as nonconscious (Gollwitzer & Bargh, 2005), possess much flexibility. But we want to carry this issue one step further. We raise the question of whether very tenacious goal pursuits do still possess the feature of appropriateness, or whether such determined goal pursuits are characterized by rigidity. The kind of heightened tenacity we analyze is not that of increased energization, which is experienced in the face of difficulty (Wright, 1996). Rather, we focus on the tenacity that originates from planning out an intended goal pursuit in advanee. As research on implementation intentions (i.e., if-then plans) has observed (see summaries by Gollwitzer, 1999; Gollwitzer, Bayer, and McCulloch, 2005; Gollwitzer and Sheeran, 2006), individuals who furnish their goals with implementation intentions achieve higher goal attainment rates than individuals who act on the basis of mere goals (or goal intentions). The question we want to answer first in the present chapter is therefore the following: Are the benefits of forming implementation intentions associated with costs in terms of reduced flexibility (appropriateness)? Once we have found an answer to this first question, we turn in the second part of the chapter to the possibility of using implementation intentions to achieve flexible tenacity. The second question raised is thus quite different: Can forming an implementation intention be used as an effective selfregulatory strategy to protect a focal goal pursuit from disruptions (i.e., spontaneous attention responses to distraetions, bad habits, and detrimental self-states such as emotional experiences) that reduce flexibility in achieving the goal? In order to find answers to both of these questions, we first present an overview of research on the effeets of implementation intentions and the psychological mechanisms on which these rest

Flexible Tenacity in Goal Pursuit

Chapter 21 in Handbook of Motivation Science, edited by James Y. Shah and Wendi L. Gardner. More about the book: Integrating significant advances in motivation science that have occurred over the last two decades, this volume thoroughly examines the ways in which motivation interacts with social, developmental, and emotional processes, as well as personality more generally. The Handbook comprises 39 clearly written chapters from leaders in the field. Cutting-edge theory and research is presented on core psychological motives, such as the need for esteem, security, consistency, and achievement; motivational systems that arise to address these fundamental needs; the process and consequences of goal pursuit, including the role of individual differences and contextual moderators; and implications for personal well-being and interpersonal and intergroup relations

Prevalence, Risk Factors and Short-term Outcomes of Acute Kidney Injury in Women with Obstetric Complications in Dar es Salaam, Tanzania.

Introduction In keeping abreast with the International Society of Nephrology “0by25” initiative that aims at achieving zero preventable deaths from Acute Kidney Injury (AKI) by the year 2025, we investigated on Pregnancy-Related Acute Kidney Injury (PRAKI), a potentially preventable cause of AKI but still commonly reported in developing countries as a significant contributor to both maternal and fetal morbidity and mortality. In this study, we report on the prevalence, risk factors and outcomes of PRAKI among pregnant women with obstetric complications at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. Methodology This was a hospital-based descriptive cross-sectional study involving women with obstetric complications in late pregnancy at MNH, Dar es Salaam, Tanzania from August 2015 to February 2016. Acute Kidney Injury Network (AKIN) criterion was used to define acute kidney injury (AKI). Data analysis was done using the Statistical Package of Social Sciences (SPSS) version 23. Results During the study period a total of 5448 deliveries occurred at MNH amongst whom 1150 (21.1%) women had obstetric complications. Overall, AKI occurred in 99(8.6%) and was stage-wise categorized into AKIN Stage I in 55/99(55.5%), Stage II in 8/99(8.1%), and Stage III in 36/99 (36.4%). Hemolysis, Elevated Liver enzymes, Low Platelet count (HELLP) syndrome and severe pre-eclampsia were the most frequent obstetric complications among patients with PRAKI. PRAKI was associated with advanced maternal age, being HIV positive, having history of hypertension and/or having elevated blood pressure, albuminuria and having anemia detected during antenatal clinic (ANC) visits. Among patients who developed PRAKI; hemodialysis therapy was offered to 6/99(6.1%) patients who after several rounds of therapy were able to recover their renal function; 66/99 (66.7%) had partial recovery of renal function whereas 27/99 (27.3%) had complete spontaneous recovery of their renal function without need of hemodialysis therapy. On considering fetal outcome; PRAKI was associated with delivering a stillbirth baby. Conclusion In this novel study on PRAKI in Tanzania, we found that PRAKI is common among women with obstetric complications and strong associated with advanced maternal age, being HIV positive, having history of hypertension, albuminuria or anemia detected during antenatal clinic visits. Early recognition and treatment of PRAKI may help prevent associated poor maternal and fetal outcomes and in a broader sense, it a significant step forward into achieving the ISN “0by25” global initiative in Tanzani

Dysglycaemias among Patients with Chronic Kidney Disease in Tanzania.

Background Chronic Kidney Disease (CKD) contributes to significant morbidity and mortality around the globe and especially so in the sub-Saharan Africa region. CKD influences the control of blood glucose levels resulting in glycemic dysregulation (causing either hypoglycemia or hyperglycemia) through various proposed pathways. In this study we investigated on prevalence, patterns and factors associated with dysglycaemias among patients with CKD attended at the tertiary Muhimbili National Hospital, Dar es Salaam, Tanzania. Materials and Methods We carried out a hospital based cross-sectional study between July 2017 and January 2018. Employing a systematic sampling method, we enrolled a total of 328 patients with CKD who were attended at the Renal Unit of the Muhimbili National Hospital in Dar es Salaam, Tanzania. We performed Oral Glucose Tolerance Test (OGTT) to selected patients and recorded their respective glycemic levels. We used SPSS version 20.0 for data analysis. Results Of the 328 selected patients; 128 (39%) were patients with known (established) diabetes mellitus, 7 (2.1%) were (newly) diagnosed to have diabetes mellitus and 17 (5.2%) were found to have impaired glucose tolerance by OGTT during this study. Furthermore, of the 128 patients with established diabetes mellitus; 7(5.5%) were found to have hypoglycemia and 20 (15.6%) had developed “burnt-out” diabetes mellitus, respectively. On multivariate analysis; age 50 years or more (OR 2.92, 95% C.I. (1.71 - 4.99)), having co-existent hypertension (OR 2.96 (1.71 - 4.99)) and having a positive family history of diabetes mellitus (OR 7.8 (3.74 – 17.02)) were found to be independent factors associated with presence of dysglycaemias. Conclusion Diabetes mellitus, impaired glucose tolerance, hypoglycemia and “burnt out” diabetes mellitus are all prevalent among patients with CKD attended at the Renal Unit of Muhimbili National Hospital, Dar es Salaam, Tanzania. Having age 50 years or older, family history of diabetes and co-existent hypertension are independent predictors of dysglycaemias among these patients