Factors Associated with Breastfeeding Duration and Satisfaction after Gestational Diabetes among Women Living in Northwest Ohio

Background: Given the potential for type 2 diabetes and the protective benefits of breastfeeding after gestational diabetes mellitus (GDM), there is a need to promote and support breastfeeding; however, delayed lactogenesis and postpartum experiences may challenge breastfeeding success. We aimed to describe factors that influence breastfeeding duration and satisfaction after GDM.Methods: A cross-sectional survey, informed by an elicitation phase and subject matter expert review, was conducted to evaluate factors associated with breastfeeding satisfaction and duration after GDM. The study included women (n = 50) from Northwest Ohio who delivered a living child from a singleton pregnancy at greater than or equal to 34 weeks gestation, who intended to breastfeed after GDM. Spearman correlation and Mann-Whitney U test were calculated to evaluate factors associated with breastfeeding duration and satisfaction.Results: Women described a lack of breastfeeding support, and there appeared to be a lack of awareness on the benefits of breastfeeding after GDM. Attitudes were associated with breastfeeding duration and satisfaction. Negative experiences in the child’s first week of life were associated with shorter duration and lower level of satisfaction. Delayed lactogenesis, barriers after delivery, and negative normative influences were significantly associated with a lower level of breastfeeding satisfaction.Conclusion: More work is needed to deliver breastfeeding education and support after GDM. Interventions tailored for GDM are recommended to promote positive breastfeeding beliefs and realistic breastfeeding expectations. Ongoing support to address early experiences and barriers after GDM is recommended. Further work should examine these factors in a larger, more diverse sample

End-of-Life Training in US Internal Medicine Residency Programs: A National Study

Background: End-of-life care is a required and important component of medical training for internal medicine residents; many of whom will go on to provide care for adults at the end-of-life stage. Although a body of past research suggests that physician training in end-of-life care needs significant improvement, a comprehensive national study of end-of-life education within US internal medicine residency programs has never been published. Objective: To determine the status of end-of-life education in internal medicine residency programs in the United States. Method: The study was a cross-sectional, observational study of all internal medicine Residency Program Directors in the US as of May 2015. Postal mail and email were used to disseminate a multi-wave survey to program directors. Results: More than half (52%) of all program directors completed the survey. Although directors strongly believed in the benefits of residents integrating end-of-life care components into clinical practice, only 36% of programs reported having formal end-of-life curriculum in place for more than three years. Of those programs that taught end-of-life topics or skills, the majority did not formally evaluate residents’ competence. Moreover, 24% of residency programs did not have an end-of-life curriculum; 34% did not offer a rotation in hospice care; and 31% did not have structured conference teaching on topics dealing with end-of-life. Conclusions: Although end-of-life training of physicians has improved over the years, deficiencies remain within US internal medicine residency programs

Full-depth eddy kinetic energy in the global ocean estimated from altimeter and Argo observations

Although the surface eddy kinetic energy (EKE) has been well studied using satellite altimeter and surface drifter observations, our knowledge of EKE in the ocean interior is much more limited due to the sparsity of subsurface current measurements. Here we develop a new approach for estimating EKE over the full depth of the global ocean by combining 20 years of satellite altimeter and Argo float data to infer the vertical profile of eddies. The inferred eddy profiles are surface-intensified at low latitudes and deep-reaching at mid- and high latitudes. They compare favorably to the first empirical orthogonal function obtained from current meter velocities. The global-integrated EKE estimated from the inferred profiles is about 3.1 × 1018 J, which is close to that estimated from the surface mode (3.0 × 1018 J) but about 30% smaller than that estimated from the traditional flat bottom modes (4.6 × 1018 J)

Smoking cessation education and training in obstetrics and gynecology residency programs in the United States

Background: OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States. Methods: The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%. Results: The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation. Conclusion: Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians

Prevalence and determinants of frozen shoulder in patients with diabetes: An original research

Introduction: Adhesive capsulitis is a group of symptoms involving the glenohumeral joint which is a musculoskeletal problem that can affect the diabetics. The goal of this study is to determine the prevalence of FS and compare the disease's factors in a diabetic community. Materials and Methods: We piloted an observational cross-sectional study among 100 diabetics of both genders. The study was done for a period of 2 years, at a territary care center. We designed a questionnaire that collected the patients’ responses. These questions were formulated considering the important factors that may cause the Adhesive capsulitis among diabetics with an increased rate. Results: We observed that nearly 40% of the subject complained of the Adhesive capsulitis. The prevalence was at the department was 52.1%. The factors that were that were seen more associated among these cases of the Adhesive capsulitis were positive family history, uncontrolled blood glucose, insulin dependence and females. Greater number of the subjects had unilateral Adhesive capsulitis and was at stage 1 for the Adhesive capsulitis. Conclusion: Within the limitations of our study we observed a greater incidence of the Adhesive capsulitis among diabetics. This greater occurrence may be attributed to the poor glycemic control, lack of facilities, awareness, socio economic levels. Awareness camps are suggested to create education about these conditions targeting the female diabetics. Early intervention may alter the disease course and may favor a good prognosis. Further studies are suggested to find association of the diabetes and the Adhesive capsulitis