Maternal perspectives on postnatal breastfeeding support: Integrating perceptions for a mother-friendly ten steps framework

Integrating a maternal perspective into breastfeeding support is important for improving the quality and relevance of the support provided, which may, in turn, enhance breastfeeding outcomes. The aim of this study was to examine mothers' perceptions of postnatal breastfeeding support and factors associated with exclusive breastfeeding. Furthermore, the study investigated the impact of the Baby-Friendly Hospital Initiative (BFHI) on breastfeeding support. The findings were integrated into the Ten Steps framework, thereby incorporating a maternal perspective. The study comprised four sub-studies. A cross-sectional study examined mothers' (n=160) perceptions of breastfeeding support in a non-Baby-Friendly hospital. An integrative literature review synthesized the existing literature on mothers' perceptions of breastfeeding support in Baby-Friendly hospitals. A quasi-experimental study compared mothers' perceptions of breastfeeding support before (n=162) and after (n=163) implementation of BFHI, and a correlational study investigated the continuation of breastfeeding among postpartum mothers (n=80) following discharge from a Baby-Friendly hospital. Breastfeeding support in the immediate and early postnatal period was of great significance, contributing to exclusive breastfeeding. Early skin-to-skin contact and breastfeeding initiation were common practices, but further support did not meet mothers' needs. A family-centered care approach, which fosters parenting self-efficacy, was identified important in the promotion of exclusive breastfeeding. The implementation of BFHI improved breastfeeding support from the maternal perspective. After hospital discharge, mothers preferred more timely face-to-face breastfeeding support from professionals. The results provided evidence for improvements needed in postnatal breastfeeding support to make it more mother-friendly. Implementation of BFHI in accordance with the needs of the mother and a family-centered approach is recommended to ensure evidence-based breastfeeding support and to promote breastfeeding.Kymmenen askelta kohti äiti- ja vauvamyönteistä imetyksen tukemista: äitinäkökulma synnytyksen jälkeiseen imetystukeen Äitien näkökulman sisällyttäminen imetystukeen on tärkeää, jotta imetystuen laatua ja siten imetyksen toteutumista voidaan parantaa. Tutkimuksen tarkoituksena oli kuvata äitien näkemyksiä ammattilaisten tarjoamasta synnytyksen jälkeisestä imetystuesta ja täysimetykseen yhteydessä olevia tekijöitä. Lisäksi tutkimuksessa kuvattiin Vauvamyönteisyysohjelman vaikutusta imetyksen tukemiseen sairaalassa. Tulokset integroitiin Kymmenen askelta onnistuneeseen imetykseen-käytäntöihin suosituksina äitimyönteisemmän imetystuen toteuttamiseksi. Tutkimus sisälsi neljä osatutkimusta. Poikkileikkaustutkimuksessa kuvattiin äitien (n=160) näkemyksiä imetystuesta ei-vauvamyönteisessä synnytyssairaalassa. Integratiivisessa kirjallisuuskatsauksessa koottiin yhteen aiempi tutkimusnäyttö äitien näkemyksistä imetystuesta vauvamyönteisiksi sertifioiduissa sairaaloissa. Kvasikokeellisessa tutkimuksessa verrattiin äitien näkemyksiä sairaalan imetystuesta ennen (n=162) Vauvamyönteisyysohjelman käyttöönottoa ja sen jälkeen (n=163). Korrelatiivisessa tutkimuksessa selvitettiin vauvamyönteisestä sairaalasta kotiutuneiden äitien (n=80) imetyksen toteutumista. Imetystuella oli keskeinen merkitys täysimetyksen toteutumisessa. Varhainen ihokontakti ja ensi-imetys toteutuivat hyvin, mutta vuodeosastolla toteutunut imetystuki oli riittämätöntä eikä aina vastannut äitien tarpeita. Perhekeskeinen hoito synnytyssairaalassa ja vanhemmuuden minäpystyvyyden vahvistaminen ovat tärkeitä tekijöitä täysimetyksen edistämisessä. Vauvamyönteisyysohjelman käyttöönotto paransi imetystukea sairaalassa. Sairaalasta kotiutumisen jälkeen äidit toivoivat, että kasvotusten toteutettavaa imetystukea olisi ammattilaisten taholta saatavilla nykyistä oikea-aikaisemmin. Tulosten perusteella synnytyksen jälkeistä imetystukea voidaan kehittää äitimyönteisemmäksi. Vauvamyönteisyysohjelman käyttöönotto, joka huomioi äitien yksilölliset tarpeet ja perhekeskeisen toteutuksen, on suositeltavaa näyttöön perustuvan imetystuen varmistamiseksi ja imetyksen edistämiseksi

Ortstrohet hos en migrerande art till specifika delar av dess hemområde

Site fidelity, the behaviour of animals to return to areas where they have been before is a common trait in many species. The Scandinavian moose is known to show fidelity to its range, but to what extent, is little known. The landscape in Sweden changes in a predictable and unpredictable way and hence gives the opportunity to test the existence of fidelity. I used the kernel Brownian bridge method to estimate the home ranges of individual moose over consecutive years and estimated the overlap at the home range level. I also used Euclidian distance to look on calving site fidelity. The moose in Sweden show fidelity to the different parts of their annual range at different levels. The overall pattern is that fidelity towards seasonal range increased with increasing latitude in winter, with a reversed pattern in summer, but the southern populations of moose show high fidelity, all year round. The calving site fidelity also follows the pattern of high fidelity in the south and lower fidelity to the north. This could be explained by the different movement strategies and the predictability of resources vital to the moose across the landscape. The increased knowledge could be used to better manage the Swedish moose population and provide information of the causes of fidelity.Ortstrohet, beteendet när djur återkommer till ett tidigare använt område, är ett vanligt hos många djurarter. Den skandinaviska älgpopulationen visar trohet till olika delar av sitt hemområde. I Sverige förändrars landskapet på e tt förutsägbart såväl som oförutsägbart sätt och ger således bra förutsättningar för att testa några påstående gällande orts trohet. Jag använde mig av en kernel Brownian bridge metod för att beräkna hur hemområdena ser ut från år till år och beräknade seda n hur mycket hemområde år ett överlappar hemområdet år två. För att titta på kalvningsplatstrohet använde jag mig av de euklidiska avstånden mellan två års kalvningsplatser. Det övergripande mönstret är att älgar visar trohet till alla delar av sitt hemomr åde i olika grad. Ett annat tydligt framträdande mönster är en ökad trohet till vinterområden ju längre norrut du kommer. Detta kan antagligen bindas till fördelningen av bete i landskapet och de migrerande rörelsemönstren. I de södra delarna av landet är troheten till hemområdena alltid hög. Detta beror antagligen på de små hemområdena tillsammans med den höga födotillgången och den mer stationära livsstillen. Trohet till kalvningsplatser är högst i de södra delarna av landet, troligtvis beror detta på den högre nivån av mänsklig aktivet i området. Resultatet från denna studie kan användas för att förbättra den svenska älgförvaltningen och ge värdefull information om orsakerna bakom ortstrohet

Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative : A quasi-experimental study

Objective: The purpose of this study was to examine maternal perceptions of postnatal breastfeeding support in the hospital before and after designation to the Baby-Friendly Hospital Initiative (BFHI). Further maternal and infant characteristics associated with the maternal perception of breastfeeding support were investigated. Our hypothesis was that mothers would perceive breastfeeding support more adherent to the standards of the BFHI after the hospital was designated to the BFHI compared with before.Design: The study had a quasi-experimental non-equivalent two-group design.Setting: The study was conducted in one postnatal ward and one neonatal intensive care unit in a public birth hospital in Finland. Participants: Postpartum mothers giving birth in the hospital before (pre-test group, n = 162) and after (post-test group, n = 163) designation to the BFHI participated. Intervention: The aim of the BFHI is to support and promote breastfeeding by implementing the Ten Steps to Successful Breastfeeding into routine care. Implementation in the study hospital required staff training and revision of current hospital practices, which took place during 2017-2018. The postnatal ward and neonatal intensive care unit were designated to the Baby-Friendly Hospital in February 2019. Measurements: Maternal perceptions of postnatal breastfeeding support were measured with a 20-item questionnaire developed for this study. Items were based on maternal self-report of the breastfeeding support in the hospital. A sum variable was created to measure the maternal perception of the support (scale 1-7), and higher scores indicated perception of breastfeeding support that is more adherent to the standards of the BFHI. Descriptive statics, nonparametric statistical tests, and multiple linear regression analysis were used to analyse data.Findings: Mothers in the post-test group (median 6.1, IQR 5.4-6.4) perceived breastfeeding support more adherent to the standards the BFHI compared with mothers in the pre-test group (median 5.0, IQR 4.25.8) (p 35 years) (median 4.4 vs 5.8, p = 7). After the BFHI designation, mothers who experienced preterm birth (GA < 37 weeks) perceived breastfeeding support less adherent to the BFHI standards compared with mothers who experienced a full-term birth. Key conclusions: Designation to the BFHI had a positive impact on breastfeeding support from the maternal perspective. Designation improved particularly multiparas' perceptions of receiving breastfeeding support that is in adherence with the standards of the BFHI. However, more emphasis should be placed, and further research should be conducted to ensure that mothers giving birth to a preterm infant receive breastfeeding support that is adherent to the BFHI standards. Implications for practice: Birth hospitals are recommended to implement the BFHI as it improves breastfeeding support in the hospital and provides mothers with a good basis and continuation for breastfeeding, even after hospital discharge. Maternal perceptions about the impact of BFHI designation are important to consider because mother - infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful. Results of this study indicate that designation to BFHI improves breastfeeding support from the maternal perspective.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Peer reviewe

A comparative study of media, media use and ethnolinguistic vitality in bilingual communities

This paper presents some preliminary results from acomparative study of interrelations between identity (in terms of subjectively identified identity); media (in terms of completeness in supply); media use (in terms of choice of language); and EV among bilingual speakers of autochthonous minority languages. It builds on studies that are carried out among German speakers in South Tyrol, Hungarian speakers in Romania and Swedish speakers in Finland, combining institutional analysis and quantitative surveys in a comparative perspectiv

Maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals: An integrative review

BackgroundThe Baby-Friendly Hospital Initiative aims to improve breastfeeding by implementing the Ten Steps to Successful Breastfeeding (Ten Steps) into routine breastfeeding support in birth hospitals. Maternal perspective to breastfeeding support is important to consider as mothers and their infants are in the center of that support.ObjectivesTo review and synthesize the existing literature on maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals. A sub-aim was to describe differences in breastfeeding support between Baby-Friendly hospitals and non-Baby-Friendly hospitals from maternal perspective.Data sources and review methodsAn integrative literature review. A systematic literature search was conducted in October 2021 in five databases: PubMed, CINAHL, Cochrane, Scopus, Web of Science. Original peer-reviewed studies published in English exploring maternal viewpoints on breastfeeding support in Baby-Friendly hospitals were included. Two reviewers independently screened the titles (n=914), abstracts (n=226), and full texts (n=47). The review comprised of seventeen studies and includes both quantitative studies (n=14) and qualitative studies (n=3). Inductive content analysis and descriptive synthesis were conducted.ResultsMost studies (n=14) measured hospitals’ compliance with the Ten Steps practices from maternal perspective. Mothers were provided with breastfeeding information and encouragement, however, a qualitative finding indicated that information focused on positive aspects of breastfeeding. Early skin-to-skin contact between the mother and infant was well facilitated although often not lasting more than 30 min. Breastfeeding was facilitated by practical support but according to findings of two qualitative studies, support was not always adequate to address mothers’ problems with breastfeeding. Most mothers were exclusively breastfeeding during the hospital stay and no supplemental milk was offered to infant. Mothers were roomed-in together with their infant and were mostly encouraged to breastfeed on demand. Differences between Baby-Friendly hospitals and non-Baby-Friendly hospitals were observed particularly for steps 6 and 9: supplementary feeding and pacifier use were less common in Baby-Friendly hospitals.ConclusionsFrom the maternal perspective, breastfeeding support in the Baby-Friendly hospitals was mainly but not completely in adherence with the Ten Steps practices. Low compliance with some of the Ten Steps indicates a need for a more frequent assessment of the breastfeeding support practices and consideration of strategies facilitating a more sustainable implementation of the initiative. Regardless of some shortcomings with the breastfeeding support, mothers were mainly satisfied with the support in the hospital. Mothers in the Baby-Friendly hospitals perceived that breastfeeding support was more adherent to the Ten Steps compared to mothers in non-Baby-Friendly hospitals.</p

Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative: A quasi-experimental study

Objective: The purpose of this study was to examine maternal perceptions of postnatal breastfeeding support in the hospital before and after designation to the Baby-Friendly Hospital Initiative (BFHI). Further maternal and infant characteristics associated with the maternal perception of breastfeeding support were investigated. Our hypothesis was that mothers would perceive breastfeeding support more adherent to the standards of the BFHI after the hospital was designated to the BFHI compared with before.Design: The study had a quasi-experimental non-equivalent two-group design.Setting: The study was conducted in one postnatal ward and one neonatal intensive care unit in a public birth hospital in Finland.Participants: Postpartum mothers giving birth in the hospital before (pre-test group, n = 162) and after (post-test group, n = 163) designation to the BFHI participated. Intervention: The aim of the BFHI is to support and promote breastfeeding by implementing the Ten Steps to Successful Breastfeeding into routine care. Implementation in the study hospital required staff training and revision of current hospital practices, which took place during 2017-2018. The postnatal ward and neonatal intensive care unit were designated to the Baby-Friendly Hospital in February 2019.Measurements: Maternal perceptions of postnatal breastfeeding support were measured with a 20-item questionnaire developed for this study. Items were based on maternal self-report of the breastfeeding support in the hospital. A sum variable was created to measure the maternal perception of the support (scale 1-7), and higher scores indicated perception of breastfeeding support that is more adherent to the standards of the BFHI. Descriptive statics, nonparametric statistical tests, and multiple linear regression analysis were used to analyse data.Findings: Mothers in the post-test group (median 6.1, IQR 5.4-6.4) perceived breastfeeding support more adherent to the standards the BFHI compared with mothers in the pre-test group (median 5.0, IQR 4.25.8) (p 35 years) (median 4.4 vs 5.8, p = 7). After the BFHI designation, mothers who experienced preterm birth (GA Key conclusions: Designation to the BFHI had a positive impact on breastfeeding support from the maternal perspective. Designation improved particularly multiparas' perceptions of receiving breastfeeding support that is in adherence with the standards of the BFHI. However, more emphasis should be placed, and further research should be conducted to ensure that mothers giving birth to a preterm infant receive breastfeeding support that is adherent to the BFHI standards.Implications for practice: Birth hospitals are recommended to implement the BFHI as it improves breastfeeding support in the hospital and provides mothers with a good basis and continuation for breastfeeding, even after hospital discharge. Maternal perceptions about the impact of BFHI designation are important to consider because mother - infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful. Results of this study indicate that designation to BFHI improves breastfeeding support from the maternal perspective.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )</p

Simultaneous sleep study and nasoendoscopic investigation in a patient with obstructive sleep apnoea syndrome refractory to continuous positive airway pressure: a case report

<p>Abstract</p> <p>Introduction</p> <p>The standard treatment for obstructive sleep apnoea syndrome is nasal continuous positive airway pressure. In most cases the obstruction is located at the oropharyngeal level, and nasal continuous positive airway pressure is usually effective. In cases of non-response to nasal continuous positive airway pressure other treatments like mandibular advancement devices or upper airway surgery (especially bi-maxillary advancement) may also be considered.</p> <p>Case presentation</p> <p>We report the case of a 38-year-old Caucasian man with severe obstructive sleep apnoea syndrome, initially refractory to nasal continuous positive airway pressure (and subsequently also to a mandibular advancement devices), in which the visualization of the upper airway with sleep endoscopy and the concomitant titration of positive pressure were useful in the investigation and resolution of sleep disordered breathing. In fact, there was a marked reduction in the size of his nasopharynx, and a paresis of his left aryepiglotic fold with hypertrophy of the right aryepiglotic fold. The application of bi-level positive airway pressure and an oral interface successfully managed his obstructive sleep apnoea.</p> <p>Conclusion</p> <p>This is a rare case of obstructive sleep apnoea syndrome refractory to treatment with nocturnal ventilatory support. Visualization of the endoscopic changes, during sleep and under positive pressure, was of great value to understanding the mechanisms of refractoriness. It also oriented the therapeutic option. Refractoriness to obstructive sleep apnoea therapy with continuous positive airway pressure is rare, and each case should be approached individually.</p

The consolidation of implicit sequence memory in obstructive sleep apnea

Obstructive Sleep Apnea (OSA) Syndrome is a relatively frequent sleep disorder characterized by disrupted sleep patterns. It is a well-established fact that sleep has beneficial effect on memory consolidation by enhancing neural plasticity. Implicit sequence learning is a prominent component of skill learning. However, the formation and consolidation of this fundamental learning mechanism remains poorly understood in OSA. In the present study we examined the consolidation of different aspects of implicit sequence learning in patients with OSA. We used the Alternating Serial Reaction Time task to measure general skill learning and sequence-specific learning. There were two sessions: a learning phase and a testing phase, separated by a 10-hour offline period with sleep. Our data showed differences in offline changes of general skill learning between the OSA and control group. The control group demonstrated offline improvement from evening to morning, while the OSA group did not. In contrast, we did not observe differences between the groups in offline changes in sequence-specific learning. Our findings suggest that disrupted sleep in OSA differently affects neural circuits involved in the consolidation of sequence learning