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

Hit the Ground Running: A Novella and Other Stories

This creative thesis contains a collection of short stories divided into two parts. The first half, a novella entitled Clothes on a Line, consists of a series of linked vignettes that depict the life of a young, unnamed Appalachian girl and her relationship with her promiscuous mother. Throughout the work, the narrator struggles to create and come to terms with her identity as she experiences the adversities of sexual abuse, death, alcoholism, and the looming “secret” of her unknown father. The second half, Consumed and Other Stories, features several short pieces that, while not inter-related like those in the novella, are tied together because they deal in some way with the idea of being consumed, be it emotionally or physically. Often, the stories are grounded within the realm of possibility, but assume unexpected, even bizarre, dimensions

Self-Management and Adherence with Exercise-Based Falls Prevention Programmes for Older People with Long-Term Conditions: A Framework for Physiotherapy Practice

Introduction This study aimed to work with older people attending a regional falls and syncope service, older people with the falls-associated chronic liver disease primary biliary cirrhosis, relatives and local physiotherapy practitioners to develop a framework for physiotherapy practice to promote self-management and adherence with an exercise based falls prevention programme for older people with a long-term condition. Methods Focus groups were conducted with older people attending a regional falls and syncope service (3 groups, total 12 participants), relatives (1 group, total 4 participants) and local physiotherapists (4 groups, total 18 participants). Participants were asked to propose strategies to promote self-management and adherence with an exercise-based falls prevention programme. These strategies were tested and refined in an experimental case-series for 10 older people with primary biliary cirrhosis. Findings The older people participating in the focus group research expressed a long-term commitment to exercise-based falls prevention programmes. They valued approaches that promoted self-efficacy and self-management. The physiotherapists indicated that the older people they came into contact with were poorly motivated to participate in an exercise-based falls prevention programme. They demonstrated a limited awareness of strategies to promote self-efficacy and self-management. Visual analysis of the experimental case-series data revealed unstable baselines and fluctuations throughout the treatment and follow up phases in keeping with variations in disease-specific quality of life measures, suggesting that long-term conditions interact with measures that predict and monitor falls-risk and selfefficacy. The exercise-based falls prevention programmes had perceived benefit for older people with primary biliary cirrhosis. However, this was not evident in the measures selected, many of which demonstrated a ceiling effect in the population group under investigation. The self-management strategies had low levels of perceived acceptability. Participants indicated that they lacked the necessarily skills to monitor their progress with an exercise-based falls prevention programme on completion of the experimental case-series. Conclusion This study demonstrated that self-management does not sit comfortably within the philosophy of routine clinical practice. The framework for physiotherapy practice developed during the course of the current study has the potential to empower physiotherapists and older people with long-term conditions identified as being at increased risk of falling to work in partnership to challenge existing approaches to clinical service delivery

Prognostic significance of short-term blood pressure variability in acute stroke

Background and Purpose— Blood pressure variability (BPV) may be an important prognostic factor acutely after stroke. This review investigated the existing evidence for the effect of BPV on outcome after stroke, also considering BPV measurement techniques and definitions. Methods— A literature search was performed according to a prespecified study protocol. Two reviewers independently assessed study eligibility and quality. Where appropriate, meta-analyses were performed to assess the effect of BPV on poor functional outcome. Results— Eighteen studies from 1359 identified citations were included. Seven studies were included in a meta-analysis for the effect of BPV on functional outcome (death or disability). Systolic BPV was significantly associated with poor functional outcome: pooled odds ratio per 10-mm Hg increment, 1.2; confidence interval (1.1–1.3). A descriptive review of included studies also supports these findings, and in addition, it suggests that systolic BPV may be associated with increased risk of intracranial hemorrhage in those treated with thrombolytic therapy. Conclusions— This systematic review and meta-analysis suggest that greater systolic BPV, measured early from ischemic stroke or intracerebral hemorrhage onset, is associated with poor longer-term functional outcome. Future prospective studies should investigate how best to measure and define BPV in acute stroke, as well as to determine its prognostic significance. </jats:sec

Murdering Crows: Pauli Murray, Intersectionality, and Black Freedom

What is intersectionality’s origin story and how did it make its way into human rights? Beginning in the 1940s, Pauli Murray (1910–1985) used Jane Crow to capture two distinct relationships between race and sex discrimination. One Jane used the race-sex analogy to show that race and sex were both unconstitutionally arbitrary. The other Jane captured Black women’s experiences and rights deprivations at the intersection of race and sex. Both Janes were based on Murray’s fundamental belief that the struggles against race and sex discrimination were different phases of the fight for human rights. In 1966, Murray was part of the American Civil Liberties Union team that litigated White v. Crook. In White, a three-judge federal district court panel declared Lowndes County, Alabama’s jury selection process discriminated against the county’s Black residents based on both race and sex in violation of the Fourteenth Amendment. What appeared to be an intersectional victory for Black women, was, in fact, an analogical victory for white women. The reasoning and the remedy erased the Black women litigants and the Lowndes County Black Freedom Movement, both of which were essential to the litigation. By situating White in the context of the Lowndes County movement, this Article demonstrates the centrality of Black feminist praxis to the county’s Black Freedom politics. The women in the movement took aim at Jane Crow which personified their intersectional experiences. Freedom for the county’s Black female majority did not require white women’s subjugation. By contrast, white women’s equality was a claim to share power with white men which included the power to maintain Jim and Jane Crow. Therefore, intersectional Jane and analogical Jane were on opposite sides of the fight for Black freedom in Lowndes County where white Jane’s equality required Black Jane to remain unfree

HIV/STI Risk Factors Among African-American Students Attending Predominantly White Universities

Introduction: The majority of African American college students in the U.S. attend predominantly white institutions (PWIs). However, there is minimal research examining this population’s HIV/STI risk behaviors. The purpose of this investigation was to assess HIV/STI behavioral risk factors among African American college students (aged 18 – 24years) attending PWIs. (n = 2,568) Methods: Backwards step-wise logistic regression analyses were conducted to determine factors associated with a positive HIV/STI diagnosis (past year) among sexually active African American college students who participated in the Spring, 2006 National College Health Assessment. Findings: Nine factors were significantly associated with an HIV/STI diagnosis among African American college students attending PWIs. Different risk factors were associated with having a HIV/STI diagnosis among African American male and female college students. These results may be useful to HIV/STIs prevention programs targeting African American college students attending PWIs