Guilt, shame, and postpartum infant feeding outcomes: A systematic review

Abstract Negative maternal affect (e.g., depression and anxiety) has been associated with shorter breastfeeding duration and poorer breastfeeding intention, initiation, and exclusivity. Other affective states, including guilt and shame, have been linked with formula feeding practice, though existing literature has yet to be synthesised. A narrative synthesis of quantitative data and a framework synthesis of qualitative and quantitative data were conducted to explore guilt and/or shame in relation to infant feeding outcomes. Searches were conducted on the DISCOVER database between December 2017 and March 2018. The search strategy was rerun in February 2020, together yielding 467 studies. The study selection process identified 20 articles, published between 1997 and 2017. Quantitative results demonstrated formula feeders experienced guilt more commonly than breastfeeding mothers. Formula feeders experienced external guilt most commonly associated with healthcare professionals, whereas breastfeeding mothers experienced guilt most commonly associated with peers and family. No quantitative literature examined shame in relation to infant feeding outcomes, warranting future research. The framework synthesis generated four distinct themes which explored guilt and/or shame in relation to infant feeding outcomes: ‘underprepared and ineffectively supported’, ‘morality and perceived judgement’ (breastfeeding), ‘frustration with infant feeding care’ and ‘failures, fears and forbidden practice’ (formula feeding). Both guilt and shame were associated with self‐perception as a bad mother and poorer maternal mental health. Guilt and shame experiences were qualitatively different in terms of sources and outcomes, dependent on infant feeding method. Suggestions for tailored care to minimise guilt and shame, while supporting breastfeeding, are provided

123 + CuO → 124 conversion slowed by lanthanum substitution

The rate of formation of YBa2Cu4O8 (124) by solid state reaction of YBa2Cu3O7-δ (123) with CuO is dramatically slowed by substitution of La 3+ at Ba2+ sites. This is not an ion size effect, since substitution of Sr2+ for Ba2+ does not reduce the 123 + CuO → 124 conversion rate. The reaction kinetics have been studied as a function of La concentration and oxygen pressure. Higher oxygen pressure enhances the formation rate of 124. This is expected because conversion to 124 involves oxygen uptake since 123 is oxygen deficient at the reaction temperature. The reverse reaction 124 → 123 + CuO has been studied by thermogravimetry; the rate of this decomposition reaction remains unaffected by La substitution

Twelve Tips for Inclusive Practice in Healthcare Settings

This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association’s diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.Brahmaputra Marjadi, Joanne Flavel, Kirsten Baker, Kristen Glenister, Melissa Morns, Mel Triantafyllou, Penelope Strauss, Brittany Wolff, Alexandra Marie Procter, Zelalem Mengesha, Scott Walsberger, Xiaoxi Qiao, and Paul A. Gardine