Perinatal Nurses: Key to Increasing African American Breast-Feeding Rates

Breast milk is the ideal source of nutrition for infants for at least the first 6 months of life. Despite women in the United States reaching national objectives for breast-feeding initiation (75%), racial disparities persist. According to the most recent data, 83% of white mothers initiated breast-feeding whereas only 66% African American mothers did so. Breast-feeding initiation may be amenable to perinatal nursing intervention. Breast-feeding may be a practice that helps bridge the racial divide in perinatal outcomes among African American families. Nurses have an essential role in embracing breast-feeding promotion and support to patients who are least likely to initiate

The Gender Pay Gap for Private Sector Employees in Canada and Britain

This paper uses British and Canadian linked employer-employee data to investigate the importance of the workplace for the gender wage gap. Implementing a novel decomposition approach, we find substantial unexplained wage gaps in the private sector of both countries. Whilst this wage differential is partially offset by women, on average, receiving a workplace specific return which is relatively higher than that paid to men, a substantial and significant unexplained within workplace wage gap remains which is considerably higher in Britain than in Canada. The results are consistent with a prima facie argument that country-specific factors, such as the wage setting environment, are important determinants in explaining the relative size of the gender wage gap.

The Gender Pay Gap for Private Sector Employees in Canada and Britain

This paper uses British and Canadian linked employer-employee data to investigate the importance of the workplace for the gender wage gap. Implementing a novel decomposition approach, we find high levels of unexplained wage inequality in the private sector of both countries, which is related to women receiving relatively lower wages within workplaces than do men. Whilst this inequality is partially offset by women, on average, receiving a workplace specific return which is relatively higher than that paid to men, a substantial and significant unexplained within workplace wage gap remains which is considerably higher in Britain than in Canada. The results are consistent with a prima facie argument that country-specific factors, such as the wage setting environment, are important determinants in explaining the relative size of the gender wage gap.workplaces, gender earnings gap, Britain, Canada

The reported expression of pain and distress by people with an intellectual disability

Aims and objectives.  To explore the assumption that people with ID are unable to communicate effectively about pain by examining the extent to which they were reported as using language and behaviour that was readily understandable to others to communicate pain as distinct from distress. Background.  The healthcare needs of people with an intellectual disability (ID) are frequently overlooked or dealt with inappropriately. One proposed reason is the difficulty that such individuals have in communicating about their pain. Design.  A postal questionnaire-based mixed method design was used. Methods.  Data from carer reports (n = 29) of the ways people with ID supported expressed pain and distress were categorised and analysed using descriptive statistics and thematic content analysis. Results.  Nineteen of the 22 people who used verbal communication were reported to express pain using words that would be understandable to someone else, often accompanied by behavioural indications of the location of the pain. The language and behaviour that were reported as being used to express distress was more idiosyncratic, and there was little overlap between this and the ways in which pain was expressed. Conclusion.  The results provide some challenges to the view that people with ID are necessarily unable to communicate effectively about their pain and support the view that pain and distress can be conceptually distinguished and differentially communicated by some people with ID. Relevance to clinical practice.  The results suggest that many people with ID can be active participants in describing their experience of pain and that nurses should attempt to obtain this information directly from the individual during the diagnostic process. Nurses should be mindful of the distinction between pain and distress and should not respond to signs of distress in this group as being indicative of pain, without carrying out further assessment

Health Care Opinion Leaders' Views on Delivery System Innovation and Improvement

Presents survey results on healthcare experts' views on strategies and models for fostering coordination and integration, such as accountable care systems, medical homes, and bundled payments; priorities among reform provisions; and market concerns

Wind tunnel wall interference (January 1980 - May 1988): A selected, annotated bibliography

This selected bibliography lists 423 entries on the subject of wall interference during testing in wind tunnels. It is the third in a series of bibliographies on the subject. The first, NASA TM-87639, August 1986, is concerned with the reduction of wall interference by the use of adaptive walls. The second, NASA TP-89066, December 1986, is on wall interference in V/STOL and high lift testing. This, the third in the series, covers the wall interference literature published during the period January 1980 through May 1988, generally excluding those topics covered in the first two parts

Effectiveness of CenteringPregnancy on Breast-Feeding Initiation Among African Americans: A Systematic Review and Meta-analysis

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiationamong only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed

The impact of maternal BMI, gestational weight gain, and breastfeeding on early childhood weight: Analysis of a statewide WIC dataset

Early childhood obesity is a persistent health concern with more frequent and significant impact on low-income families. Maternal weight factors impact offspring weight status, but evidence on whether breastfeeding protects against this impact is mixed. This analysis examined a model to predict early childhood obesity risk, simultaneously accounting for maternal pre-pregnancy body mass index (BMI), gestational weight gain, and breastfeeding. The team analyzed 27,016 unique maternal-child dyadic records collected via the Supplemental Nutrition Program for Wisconsin Women, Infants, and Children (WIC) between 2009 and 2011. Generalized Linear Modeling, specifically logistic regression, was used to predict a child\u27s risk of obesity given the mother\u27s pre-pregnancy BMI, gestational weight gain, and duration of breastfeeding. For each 1 kg/m2 increase in pre-pregnancy BMI, there was a 4.5% increase in risk of obesity compared to children with mothers of normal BMI. Children whose mothers had excessive gestational weight gain were 50% more likely to have obesity compared to those whose mothers had ideal weight gain. For each week of additional breastfeeding, there was a 1.9% increased risk of obesity. The risk models did not differ by race. In this model, accounting for pre-pregnancy weight, gestational weight gain, and breastfeeding among a diverse, low-income sample, women with pre-pregnancy overweight and obesity or who had excessive gestational weight gain had the highest risk of early childhood obesity. While breastfeeding is healthy for many reasons, providers should focus on maternal weight-related behaviors when counseling mothers about how to avoid risk of early childhood obesity