Interventions for supporting the initiation and continuation of breastfeeding among women who are overweight or obese

Background Exclusive breastfeeding is recommended for all infants until six months of age due to the many health benefits for both the mother and infant. Evidence suggests that mothers who are overweight (body mass index (BMI) 25.0 to 29.9 kg/m²) or obese (BMI ≥ 30.0 kg/m²)are less likely to initiate breastfeeding and to breastfeed for a shorter duration. Considering the rising prevalence of overweight and obesity globally and the known benefits of breastfeeding particularly in reducing the long-term risks of obesity and diabetes for infants, establishing effective ways to support and promote breastfeeding in women who are overweight or obese is paramount in achieving the goal of healthier communities. Objectives To assess the effectiveness of interventions to support the initiation or continuation of breastfeeding in women who are overweight or obese. Search methods On 23 January 2019 we searched Cochrane Pregnancy and Childbirth’s Trials Register,ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and reference lists of retrieved trials. Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs that compared interventions to support the initiation and continuation of breastfeeding in women who are over weight or obese. Interventions included social support, education, physical support, or any combination of these. Interventions were compared either with each other or against a control group.Data collection and analysis. We assessed all potential trials identified from the search strategy. Two review authors extracted data from each included trial and assessed risk of bias. We resolved discrepancies through discussion with the third review author. We assessed the quality of the evidence using the GRADE approach. Main results We found no trials comparing one type of support versus another. We included seven RCTs (including one cluster-RCT) involving831 women. The number of women in each trial ranged from 36 to 226. The trials were conducted in high-income countries: USA(5 trials); Denmark (1 trial) and Australia (1 trial), between 2006 and 2015. Three trials only included women who were obese prior to pregnancy and four trials included both women who were overweight and women who were obese. We judged risk of bias in the included trials to be mixed; only one trial was judged to be low risk of bias for random sequence generation, allocation concealment and attrition bias. Physical breastfeeding support (manual or electric breast pump) versus usual care (no breast pump)Very low-certainty evidence from one small trial (39 women) looking at a physical support intervention (manual or electric breast pump) versus usual care (no pump) means it is unclear whether physical support improves exclusive breastfeeding at four to six weeks(risk ratio (RR) 0.55, 95% confidence interval (CI) 0.20 to 1.51) or any breastfeeding at four to six weeks (RR 0.65, 95% CI 0.41to 1.03). The trial did not report other important outcomes of interest in this review: non-initiation of breastfeeding, exclusive or any breastfeeding at six months postpartum. Multiple methods of breastfeeding support versus usual care. Six trials (involving 792 women) used multiple methods of support including education and social support through telephone or face-to-face contact. One of these trials also provided physical support through providing a breast pump and a baby sling and one trial provided a small gift to the women at each trial visit. Support in the trials was provided by a professional (four trials) or a peer (two trials). One trial provided group support, with the other five trials supporting women individually. One trial (174 women) did not report on any of our main outcomes of interest. We are unclear about the effects of the intervention because we identified very low-certainty evidence for all of the important outcomes in this review: rate of non-initiation of breastfeeding (average RR 1.03, 95% CI 0.07 to 16.11; 3 trials, 380 women); exclusive breastfeeding at four to six weeks (average RR 1.21, 95% CI 0.83 to 1.77; 4 trials, 445 women); any breastfeeding at four to six weeks(average RR 1.04, 95% CI 0.57 to 1.89; 2 trials, 103 women); r ate of exclusive breastfeeding at six months postpartum (RR 7.23, 95%CI 0.38 to 137.08; 1 trial, 120 women); and any breastfeeding at six months postpartum (average RR 1.42, 95% CI 1.08 to 1.87; 2trials, 223 women).The included trials under the above comparisons al so reported on some of this review’s secondary outcomes but very low-certainty evidence means that we are unclear about the effects of the intervention on those outcomes. Authors’ conclusions There is insufficient evidence to assess the effectiveness of physical interventions, or multiple methods of support (social, educational or physical) for supporting the initiation or continuation of breastfeeding in women who are overweight or obese. We found no RCTs comparing one type of support to another type of support. All of our GRADE assessments resulted in very low-certainty evidence, with downgrading decisions based on limitations in trial design (e.g. risk of attrition bias), imprecision, inconsistency. The available trials were mostly of variable quality with small numbers of participants, confounded by poor adherence within both the intervention and control groups. Well designed, adequately powered research is needed to answer questions about the social, educational, physical support, or any combination of these interventions that could potentially help mothers who are overweight or obese to achieve optimal breastfeeding outcomes. We need trials that examine interventions designed specifically for women who are overweight or obese, delivered by people with training about how to overcome some of the challenges these women face when establishing and maintaining breastfeeding. Particular attention could be given to the assessment of antenatal interventions aimed at improving breastfeeding initiation in women with a raised BMI, and not just focusing on recruiting women who have an intention to breastfeed. Given that the majority of current trials were undertaken in the USA, further trials in a diverse range of countries and settings are required. Future trials need to give consideration to the theoretical basis of the intervention using established frameworks to enable replicability by others and to better determine the components of effective interventions

Radical Listening, Action, and Reflection at the Boundaries of Youth Violence Prevention

The purpose of this article is to make visible collaborative pedagogical and research practices that opened space for community members to be co-educators and researchers with students and a professor on a youth violence assessment. We use Third Generation Cultural Historical Activity Theory (CHAT) as a conceptual framework to examine the learning that occurred in the boundary zone of our eight differently situated organizations. As we demonstrate through the inclusion of boundary dialogue excerpts, this process generated more authentic understandings of why racial inequity has persisted in youth violence outcomes. The assessment questions we asked, the key informants we engaged, the data analysis process we undertook, and the substantially different types of findings that emerged were a function of relationship building and radical listening in the boundary zone of our collaboration. We conclude that practices that foster radical listening in boundary work can reframe experiential learning for racial justice

No letter today I have waited since dawn, I\u27ve waited [first line of chorus]

Performers: Les Paul, Mary FordPiano, Voice and Chord

S-h-i-n-e

https://digitalcommons.library.umaine.edu/mmb-vp-copyright/4616/thumbnail.jp

Radical Listening, Action, and Reflection at the Boundaries of Youth Violence Prevention

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No letter today / Frankie Brown. Genuine love / Charles Singleton, Rose-Marie Mac Coy ; Les Paul et Mary Ford

BnF-Partenariats, Collection sonore - BelieveContient une table des matière

Detection of chromosomal aneuploidy in ancient genomes.

Ancient DNA is a valuable tool for investigating genetic and evolutionary history that can also provide detailed profiles of the lives of ancient individuals. In this study, we develop a generalised computational approach to detect aneuploidies (atypical autosomal and sex chromosome karyotypes) in the ancient genetic record and distinguish such karyotypes from contamination. We confirm that aneuploidies can be detected even in low-coverage genomes ( ~ 0.0001-fold), common in ancient DNA. We apply this method to ancient skeletal remains from Britain to document the first instance of mosaic Turner syndrome (45,X0/46,XX) in the ancient genetic record in an Iron Age individual sequenced to average 9-fold coverage, the earliest known incidence of an individual with a 47,XYY karyotype from the Early Medieval period, as well as individuals with Klinefelter (47,XXY) and Down syndrome (47,XY, + 21). Overall, our approach provides an accessible and automated framework allowing for the detection of individuals with aneuploidies, which extends previous binary approaches. This tool can facilitate the interpretation of burial context and living conditions, as well as elucidate past perceptions of biological sex and people with diverse biological traits