Systematic Review of Peer Support for Breastfeeding Continuation: Metaregression Analysis of the Effect of Setting, Intensity, and Timing

Objective To examine the effect of setting, intensity, and timing of peer support on breast feeding. Design Systematic review and metaregression analysis of randomised controlled trials. Data sources Cochrane Library, Medline, CINAHL, the National Research Register, and British Nursing Index were searched from inception or from 1980 to 2011. Review methods Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Risk ratios and 95% confidence intervals were calculated for individual studies and pooled. Effects were estimated for studies grouped according to setting (high income countries, low or middle income countries, and the United Kingdom), intensity (<5 and ≥5 planned contacts), and timing of peer support (postnatal period with or without antenatal care), and analysed using metaregression for any and exclusive breast feeding at last study follow-up. Results Peer support interventions had a significantly greater effect on any breast feeding in low or middle income countries (P<0.001), reducing the risk of not breast feeding at all by 30% (relative risk 0.70, 95% confidence interval 0.60 to 0.82) compared with a reduction of 7% (0.93, 0.87 to 1.00) in high income countries. Similarly, the risk of non-exclusive breast feeding decreased significantly more in low or middle income countries than in high income countries: 37% (0.63, 0.52 to 0.78) compared with 10% (0.90, 0.85 to 0.97); P=0.01. No significant effect on breast feeding was observed in UK based studies. Peer support had a greater effect on any breastfeeding rates when given at higher intensity (P=0.02) and only delivered in the postnatal period (P<0.001), although no differences were observed of its effect on exclusive breastfeeding rates by intensity or timing. Conclusion Although peer support interventions increase breastfeeding continuation in low or middle income countries, especially exclusive breast feeding, this does not seem to apply in high income countries, particularly the United Kingdom, where breastfeeding support is part of routine postnatal healthcare. Peer support of low intensity does not seem to be effective. Policy relating to provision of peer support should be based on more specific evidence on setting and any new peer services in high income countries need to undergo concurrent evaluation

Lay support for pregnant women with social risk: a randomised controlled trial

OBJECTIVES We sought evidence of effectiveness of lay support to improve maternal and child outcomes in disadvantaged families. DESIGN Prospective, pragmatic individually randomised controlled trial. SETTING Three Maternity Trusts in West Midlands, UK. PARTICIPANTS Following routine midwife systematic assessment of social risk factors 1324 nulliparous women were assigned, using telephone randomisation, to standard maternity care or addition of referral to a Pregnancy Outreach Worker (POW) service. Under 16 years and teenagers recruited to the Family Nurse Partnership trial were excluded. INTERVENTIONS Pregnancy Outreach Workers were trained to provide individual support and case management for the women including home visiting from randomisation to six weeks after birth. Standard maternity care (control) included provision for referring women with social risk factors to specialist midwifery services, available to both arms. MAIN OUTCOME MEASURES Primary outcomes were antenatal visits attended and Edinburgh Postnatal Depression Scale (EPDS) 8–12 weeks postpartum. Pre–specified, powered subgroup comparison was among women with two or more social risks. Secondary outcomes included maternal and neonatal birth outcomes; maternal self-efficacy and mother-to-infant bonding at 8-12 weeks; child development assessment at six weeks, breastfeeding at six weeks and immunisation uptake at 4 months, all collected from routine child health systems. RESULTS Antenatal attendances were high in the standard care control and did not increase further with addition of the POW intervention (10·1 versus 10·1 (MD) –0·00, 95% CI, (95% CI, –0·37, 0·37)). In the powered sub-group of women with two or more social risk factors, mean EPDS (MD –0·79 (95% CI, –1·56, –0·02) was significantly better, although for all women recruited no significant differences were seen (mean difference (MD) –0·59 (95% CI, –1·24, 0·06)). Mother-to-infant bonding was significantly better in the intervention group for all women (MD-0.30 (95% CI, -0.61, -0.00) p=0.05) and there were no differences in other secondary outcomes. CONCLUSIONS This trial demonstrates differences in depressive symptomatology with addition of the POW service in the powered sub-group of women with two or more social risk factors. Addition to existing evidence indicates benefit from lay interventions in preventing postnatal depression. This finding is important for women and their families given the known effect of maternal depression on longer term childhood outcomes

School Playground Surfacing and Arm Fractures in Children: A Cluster Randomized Trial Comparing Sand to Wood Chip Surfaces

In a randomized trial of elementary schools in Toronto, Andrew Howard and colleagues show that granitic sand playground surfaces reduce the risk of arm fractures from playground falls when compared with wood fiber surfaces

Genetic diversity within and genetic differentiation between blooms of a microalgal species

The field of genetic diversity in protists, particularly phytoplankton, is under expansion. However, little is known regarding variation in genetic diversity within populations over time. The aim of our study was to investigate intrapopulation genetic diversity and genetic differentiation in the freshwater bloom-forming microalga Gonyostomum semen (Raphidophyceae). The study covered a 2-year period including all phases of the bloom. Amplified fragment length polymorphism (AFLP) was used to determine the genetic structure and diversity of the population. Our results showed a significant differentiation between samples collected during the two blooms from consecutive years. Also, an increase of gene diversity and a loss of differentiation among sampling dates were observed over time within a single bloom. The latter observations may reflect the continuous germination of cysts from the sediment. The life cycle characteristics of G. semen, particularly reproduction and recruitment, most likely explain a high proportion of the observed variation. This study highlights the importance of the life cycle for the intraspecific genetic diversity of microbial species, which alternates between sexual and asexual reproduction.Postprin

Every picture tells a story: Content analysis of medical school website and prospectus images in the United Kingdom

This is the final version. Available on open access from Springer via the DOI in this recordIntroduction: The decision-making process for students as to which medical schools to apply to is open to many factors and influences. Research has identified several factors which influence prospective students’ choice of medical school and career. There is also evidence that websites and prospectuses may be creating potential barriers to widening access. Methods: The websites and prospectuses of 33 medical schools in the United Kingdom were searched for relevant images. These images and the people in them were subjected to inclusion/exclusion criteria. Data about the images and people were recorded so that a content analysis could be performed. The relative proportions were compared with pre-existing data relating to the medical profession and society. Results: From 33 medical schools, 650 images were included, with 1,817 people depicted. The largest group for the assumed roles was ‘student’, as expected, with 1,423 people (78%). For the overall theme of the image, community placement themed images made up only 2% of images (14) and hospital placement themed images made up 24% (154). Chi-squared goodness of fit showed statistically significant results for most groups of data when comparing ethnicity, the overall theme of the image and assumed specialty group, but not when comparing gender. Discussion: In conclusion, for gender, medical schools are accurately reflecting national data. However, for ethnicity medical schools fail to accurately represent national data, leading to incorrect signalling about the ethnic makeup of their students. Additionally, medical schools are signalling to students a strong preference for hospital-based settings, despite a strong national drive to recruit more general practitioners

Fluctuation induces evolutionary branching in a modeled microbial ecosystem

The impact of environmental fluctuation on species diversity is studied with a model of the evolutionary ecology of microorganisms. We show that environmental fluctuation induces evolutionary branching and assures the consequential coexistence of multiple species. Pairwise invasibility analysis is applied to illustrate the speciation process. We also discuss how fluctuation affects species diversity.Comment: 4 pages, 4 figures. Submitted to Physical Review Letter

Interseismic quiescence and triggered slip of active normal faults of Kīlauea Volcano's south flank during 2001-2018

The mobile south flank of Kīlauea Volcano hosts two normal fault systems, the Koa'e fault system (KFS) and the Hilina fault system (HFS). In historical time, at least three M>6.5 earthquakes have occurred on the basal detachment of the Kīlauea Volcano's south flank, with the most recent being the 4 May 2018 M6.9 earthquake. Here we analyze kinematic Global Positioning System data collected from 2001 to 2017 and interferometric synthetic aperture radar data before, during, and after the 2018 M6.9 earthquake to determine the crustal motion across the HFS and KFS faults. Our results indicate that the HFS faults did not significantly slip during the interseismic period from 2007 to 2011. Despite its substantial magnitude, interferometric synthetic aperture radar (InSAR) data show that the 2018 M6.9 earthquake triggered subcentimeter level slip along sections of the previously mapped HFS branches. Up to 20 cm of offset occurred on what appears to be a newly formed (or previously unknown) fault near the eastern end of the HFS. During the 3 months following the M6.9 earthquake, up to ~30 cm of slip occurred along the KFS, which helps accommodate rapid large‐scale subsidence of Kīlauea's summit region as large volumes of summit reservoir magma fed the lower East Rift Zone eruption. The HFS appears to activate only in concert with large earthquakes on the basal detachment. The KFS, on the other hand, moves both seismically during small local earthquakes and aseismically in response to nearby earthquakes and caldera subsidence

Instability of insular tree communities in an Amazonian mega-dam is driven by impaired recruitment and altered species composition

Mega-dams create highly fragmented archipelagos, affecting biodiversity and ecosystem functioning in remnant forest isolates. This study assessed the long-term impact of dam-induced fragmentation on insular tropical tree communities, with the aim of generating robust recommendations to mitigate some of the detrimental biodiversity impacts associated with future dam development. We inventoried adult and sapling trees across 89 permanent plots, located on 36 islands and in three mainland continuous forest sites in the Balbina Dam, Brazilian Amazon. We examined differences in recruitment, structure, and composition of sapling and adult tree communities, in relation to plot-, patch- and landscape-scale attributes including area, isolation, and fire severity. Islands harboured significantly lower sapling (mean ± 95% CI 48.6 ± 3.8) and adult (5 ± 0.2) tree densities per 0.01 ha, than nearby mainland continuous forest (saplings, 65.7 ± 7.5; adults, 5.6 ± 0.3). Insular sapling and adult tree communities were more dissimilar than in mainland sites, and species compositions showed a directional shift away from mainland forests, induced by fire severity, island area, and isolation. Insular sapling recruitment declined with increasing fire severity; tree communities with higher community-weighted mean wood density showed the greatest recruitment declines. Our results suggest that insular tree communities are unstable, with rare species becoming extinction-prone due to reduced tree recruitment and density on islands, potentially leading to future losses in biodiversity and ecosystem functioning across Balbina's >3,500 reservoir islands. Policy implications. In Balbina, fire and reduced habitat area and connectivity were drivers of tree community decay after only 28 years of insularization, despite strict protection provided by the ~940,000 ha Uatumã Biological Reserve. Given that many dams are planned for lowland, moderately undulating Amazonia, we recommend that dam development strategy explicitly considers (a) dam location, aiming to minimize creation of small (<10 ha) and isolated islands, (b) maintaining reservoir water levels during droughts to reduce fire risk, and (c) including aggregate island area in environmental impact and offset calculations. Ideally, we recommend that alternatives to hydropower be sought in lowland tropical regions, due to the far-reaching biodiversity losses and ecosystem disruption caused by river impoundment