Breastfeeding And Obesity Among Mothers And Children: A Double-Edged Sword

Obesity continues to be a public health issue, especially among children and women of childbearing age. Breastfeeding results in weight loss among postpartum women, as well as protects growing children from obesity. To date, no reviews have simultaneously analyzed the impact of breastfeeding on obesity for mothers and children. In addition, this review is novel in that it provides evidence from both observational and intervention studies. The primary objectives of this systematic review of studies in the United States (2000-2013) are to: (1) describe the association between obesity and breastfeeding across the developmental lifespan (2) identify the impact of breastfeeding interventions for mothers the literature on breastfeeding and obesity interventions for mothers and children. Twenty-three studies met inclusion criteria. There was moderate evidence for intervention studies for obese women to exclusively breastfeed as well as lose weight, with a modest weight loss of 0.39 kilograms on average. Conversely, there was strong evidence for creating future interventions for childhood obesity that incorporate breastfeeding, with a dose-response relationship between the amount of time breastfed and the protective effect against obesity, ranging from 0.49 to 0.90. More emphasis needs to be placed on breastfeeding as beneficial for both mother and child, and this can be done by creating more comprehensive intervention studies with strong designs and large sample sizes

Radiologists' Training, Experience, and Attitudes About Elder Abuse Detection

Elder abuse is underrecognized, and identification of subtle cases requires a high index of suspicion among all health care providers. Because many geriatric injury victims undergo radiographic imaging, diagnostic radiologists may be well positioned to identify injury patterns suggestive of abuse. Little is known about radiologists' experience with elder abuse. Our goal was to describe knowledge, attitudes, training, and practice experience in elder abuse detection among diagnostic radiologists. We conducted 19 interviews with diagnostic radiologists at a large urban academic medical center using a semistructured format. Data from these sessions were coded and analyzed to identify themes. Only two radiologists reported any formal or informal training in elder abuse detection. All subjects believed they had missed cases of elder abuse. Even experienced radiologists reported never having received a request from a referring physician to assess images for evidence suggestive of elder abuse. All subjects reported a desire for additional elder abuse training. Also, subjects identified radiographic findings or patterns potentially suggestive of elder abuse, including high-energy injuries such as upper rib fractures, injuries in multiple stages of healing, and injuries inconsistent with reported mechanism. Radiologists are uniquely positioned to identify elder abuse. Though training in detection is currently lacking, providers expressed a desire for increased knowledge. In addition, radiologists were able to identify radiographic findings suggestive of elder abuse. On the basis of these findings, we plan to conduct additional studies to define pathognomonic injury patterns and to explore how to empower radiologists to incorporate detection into their practice

Funding Community Health Workers: Best Practices and the Way Forward (Southwestern Area Health Education Center)

Community health workers (CHWs), in their delivery of culturally competent care, play an integral role in promoting the health of communities. Many states have successfully utilized CHWs to reduce health disparities and promote health among low-income communities. Connecticut, in contrast, has a fragmented CHW workforce that is poorly understood and likely underutilized. Southwestern Area Health Education Center (SWAHEC), Inc. partnered with a student team at the Yale School of Public Health to identify initiatives and progress made by various states around the US related to funding mechanisms for CHW positions. Key informant interviews were conducted with representatives from Massachusetts, Vermont, Rhode Island, New York, California, and Texas to identify best practices and challenges faced when organizations and other agencies seek funds to pay CHWs. CHWs and those who work with CHWs are still facing poor recognition and lack of understanding, which contributes to difficulty in paying CHWs; as they are not a recognized professional workforce, it is challenging to identify funding sources for CHW positions. When funding for CHW positions is available, it is often in the form of short-term, soft money from sources such as grants. This theme appeared in the majority of interviews, suggesting that this remains a challenge in many, if not the majority, of states in the US. An important consequence for this type of funding is that positions for CHWs are often temporary and unstable, which affects their ability to work continuously within their communities. This is detrimental for both the CHWs and the communities they work in. Those working towards organizing CHWs in CT should ensure CHWs are the primary driving force behind CHW initiatives. In addition to educating health care professionals about the capacity of CHWs, establishment of formal training/certification programs may help facilitate the recognition and acceptance of CHWs as not only cost saving but integral to promoting the health of communities.https://elischolar.library.yale.edu/ysph_pbchrr/1043/thumbnail.jp