“She was giving my child the essence of life”: A mixed-methods investigation of human milk sharing experiences, practices, and risk perspectives

255 pagesHuman milk sharing (HMS) is a poorly understood, emergent infant-feeding practice involving the commerce-free exchange of expressed human milk (HM). In this dissertation, we took an exploratory mixed-methods approach to investigate HMS experiences, practices, and risk perspectives among milk-sharing parents. Ethnographic interviews were conducted with 30 HMS recipients in Washington, DC. Interviews were recorded, transcribed, and iteratively analyzed using an inductive approach to identify and analyze emergent themes. These data were used to inform the development of a quantitative online survey of milk-sharing practices that was distributed to 168 HMS participants (98 recipients, 70 donors) in Washington, DC. Descriptive analyses were used to summarize the data by donor/recipient status. Latent profile analysis (LPA) was used to identify discrete risk perspectives among donors and recipients. Our survey results demonstrated that HMS participants achieved a high duration of lactation and HM-feeding and recipients engaged in a wide variety of risk-mitigation practices. While sociodemographically similar, donors and recipients differed substantially in their maternal experiences and infant-feeding practices. The LPA detected heterogeneity in risk perspectives among HMS participants, which underscored the complexity of infant feeding risk constructions. The LPA results confirmed that HMS risk is interpreted relative to infant-formula risk. Beliefs about infant formula and the importance of donor familiarity emerged as important constructs in parents’ risk perspectives. Our qualitative study demonstrated that the experience of HMS recipients is often a product of infant-feeding challenges that evoke feelings of guilt and shame. Emergent themes about recipient decision-making revealed careful and thoughtful analysis of infant-feeding options. Trust of breastfeeding mothers, a high value placed on human milk, and mistrust of infant formula played key roles in the decision to milk share. These findings highlight important features of the milk-sharing experience and emphasize the need for evidence-based, non-judgmental support for families who experience breastfeeding challenges or seek alternative infant-feeding options. Better understanding of the risk perspectives held by HMS participants is critical for elucidating parental decision-making processes and developing more targeted approaches to patient care and messaging about infant feeding

Charting the Chronology of Research on Added Sugars: A Scoping Review and Evidence Map

The objective of this study was to conduct a scoping review and produce a publicly available database characterizing the design and reporting elements of the literature on dietary added sugars and select health outcomes. Relevant studies published from 1990 to 2021 were identified to create a database containing information on study and population characteristics, reported added sugars source and concentrations, dietary energy balance, total energy intake, and outcome measures related to body composition, obesity, cardiovascular disease, and diabetes mellitus. There were 245 publications identified, 22% of which describe interventions, and 78% describe observational studies. Publications pertaining to added sugars have risen dramatically since 2010, led by studies primarily assessing body composition (36%) or cardiovascular health (32%), including adults (65%), measuring liquid-only sources of added sugars (56%). Over 65% of studies reported total energy intake, 61% controlled for total energy intake in the design and analysis, and fewer than 5% of studies reported the energy balance of subjects. There has been a significant increase in research on added sugars since 2010, with substantial heterogeneity across all facets of methodology—study designs, exposures and outcomes of interest, terminology, and reporting of dietary intake data—thus limiting the ability to synthesize evidence in this scope of the literature. This evidence map highlights gaps and important areas for improvement to strengthen the state of research and better inform future policies and dietary recommendations on added sugars

Abnormal Fasting Glucose Increases Risk of Unrecognized Myocardial Infarctions in an Elderly Cohort

Objectives: To investigate glucose levels as a risk factor for unrecognized myocardial infarctions (UMIs). Design: Cohort Setting: Cardiovascular Health Study. Participants: Individuals aged 65 and older with fasting glucose measurements (N=4,355; normal fasting glucose (NFG), n = 2,041; impaired fasting glucose (IFG), n = 1,706; DM: n = 608; 40% male, 84% white, mean age 72.4 ± 5.6). Measurements: The relationship between glucose levels and UMI was examined. Participants with prior coronary heart disease (CHD) or UMI on initial electrocardiography were excluded. Using Minnesota codes, UMI was identified according to the presence of pathological Q-waves or minor Q-waves with ST-T abnormalities. Crude and adjusted hazard ratios (HRs) were calculated. Analyses were adjusted for age, sex, body mass index (BMI), hypertension, antihypertensive and lipid-lowering medication use, total cholesterol, high-density lipoprotein cholesterol, and smoking status. Results: Over a mean follow-up of 6 years, there were 459 incident UMIs (NFG, n=202; IFG, n=183; DM, n=74). Participants with IFG were slightly more likely than those with NFG to experience a UMI (hazard ratio (HR)=1.11, 95% confidence interval (CI)=0.91–1.36, p = .30), and those with DM were more likely than those with NFG to experience a UMI (HR=1.65, 95% CI=1.25–2.13, p \u3c .001). After adjustment HR for UMI in IFG those with IFG were no more likely than those with NFG to experience a UMI (HR=1.01, 95% CI=0.82–1.24, p = .93), whereas those with DM were more likely than those with NFG to experience a UMI (HR=1.37, 95% CI=1.02–1.81, p = .03). The 2-hour oral glucose tolerance test was not statistically significantly associated with UMI. Conclusion: Fasting glucose status, particularly in the diabetic range, forecasted UMI during 6 years of follow-up in elderly adults. Further studies are needed to clarify the level of glucose at which risk is greater. J Am Geriatr Soc 67:43–49, 2019

Development of Imageable Beads for Transcatheter Embolotherapy

Purpose: To develop and characterize radiopaque embolization microspheres capable of in vivo detection with intraprocedural fluoroscopy and computed tomography (CT) imaging and to evaluate their spatial distribution inside target tissues during and after transcatheter embolization. Materials and Methods: Polyvinyl alcohol hydrogel microspheres were loaded with Lipiodol and examined for iodine content, stability of loading, and conspicuity with fluoroscopy and CT in vitro. Transcatheter embolization of swine liver and kidney was performed with the radiopaque microspheres and spatial distribution was evaluated with intraprocedural fluoroscopy and CT. Ex vivo evaluation was performed with light microscopy and micro-CT. Results: In vitro analyses demonstrated that radiopaque microspheres could be loaded with sufficient iodine content to be detected with routine fluoroscopy and CT imaging and that such loading was relatively stable. Radiopaque microspheres were visible in vivo with fluoroscopy and CT during transcatheter embolization. CT imaging during embolization procedures demonstrated a dose-dependent relationship in the number and size of visualized embolized arteries. Imaging features of radiopaque microsphere distribution inside target tissues correlated well with ex vivo light microscopic and micro-CT evaluation of microsphere distribution. Conclusions: Radiopaque embolization microspheres are visualized during transcatheter embolization with routine intraprocedural fluoroscopy and CT. These radiopaque microspheres provided the three-dimensional spatial distribution of embolic material inside target organs during the procedure, and therefore can provide real-time intraprocedural feedback for the interventional radiologist. These microspheres may be useful for demonstrating the influence of material and technical variability in transcatheter embolization in addition to providing intraprocedural identification of tissue at risk of undertreatment. © 2010 SIR