WORKPLACE LACTATION SUPPORT AND BREASTFEEDING PRACTICES IN EMPLOYED MOTHERS

Low rates of breastfeeding are a global public health issue. Despite national and international health agency recommendations for breastfeeding until infants are six months of age when solid foods are introduced and continued breastfeeding until 12 months of age or older, many mothers in the United States discontinue breastfeeding at an early age. Return to work after childbirth is one of the leading contributing factors to early cessation of breastfeeding in employed mothers. Understanding the association between individual and organizational factors and breastfeeding practices in employed mothers is essential for the development, implementation, and evaluation of programs and policies to promote, support, and encourage continued breastfeeding consistent with national and international health recommendations. The purpose of this dissertation was to: 1) review literature on the psychometric properties of existing instruments used to measure nursing mothers’ perceptions of workplace lactation support; 2) perform psychometric testing on a 9-item Breastfeeding and Employment Scale used in the Infant Feeding Practices Study II (IFPS II); and 3) examine the association between individual and organizational factors and breastfeeding practices in employed mothers who participated in the IFPS II. This dissertation has three components; a systematic review of the psychometric properties of workplace lactation support instruments; an analysis of the psychometric properties of the IFPS II Breastfeeding and Employment Scale; and a secondary analysis of the IFPS II examining individual and organizational factors associated with breastfeeding practices in employed mothers. First, a search of literature published between 1993 and May 2020 on psychometric properties of existing instruments used to measure nursing mothers’ perceptions of workplace lactation support was conducted using the electronic databases, PubMed, CINAHL and PsycINFO, with key words, breastfeeding AND support AND instrument”; “breastfeeding support AND workplace”; “breastfeeding AND instrument AND workplace”; “perceived AND breastfeeding support AND instrument”. Lactation was used in the place of “breastfeeding” for a repeated search. Of 26 full text eligible articles, 10 articles were included in the review. Four instruments including the 12-item Workplace Breastfeeding Support Scale (five articles); 41-item Employee Perceptions of Breastfeeding Support (two articles); 29-item Perceived Breastfeeding Assessment Tool (two articles); and 9-item IFPS II Breastfeeding and Employment Scale (one article) were identified and reviewed for scope and conceptual definitions, reliability, and validity. The modified 18-item Workplace Breastfeeding Support Scale was selected as the preferred instrument based on adequate reliability demonstrated in multiple studies, limited respondent burden and cross-cultural application outside the U.S. Additional psychometric testing and research are needed to strengthen the adaptation and applicability of the various instruments in cross-cultural settings. Next, psychometric testing was conducted on the IFPS II 9-item Breastfeeding and Employment Scale including internal consistency reliability; test-retest reliability; construct validity using factor analysis; and convergent validity of the 9-item scale and an IFPS II item measuring perceived level of breastfeeding support in the workplace. The sample was comprised of employed breastfeeding mothers in the U.S. who completed the 9-item Breastfeeding and Employment Scale and an IFPS II survey item measuring perceived level of breastfeeding support in the workplace at two time intervals (3-month [n=498] and 6-month [n=413] assessment). Kuder-Richardson 20 was used as the measure of internal consistency due to the dichotomous nature of the responses. Test-rest reliability (3- and 6-month assessments) was conducted using chi-square and Spearman’s rank correlation coefficient. Construct validity was conducted using a tetrachoric correlational matrix. Spearman’s rho correlation coefficient was used to evaluate convergent validity to associate the 9-item Breastfeeding and Employment Scale with a survey item measuring perceived level of breastfeeding support in the workplace at the 3-month assessment (n=266). The Breastfeeding and Employment Scale was reliable and valid in a sample of employed breastfeeding mothers (N=498) in the U.S. who participated in the IFPS II. Additional testing is warranted to further evaluate the reliability and validity of the instrument in cross-cultural and more diverse populations. Finally, a secondary analysis was conducted on a sample of 953 employed mothers who participated in the IFPS II to compare infant feeding status (breastfeeding/feeding pumped milk vs. not breastfeeding/feeding pumped milk) over a 12-month postpartum period. The purpose was to identify individual (e.g., prenatal infant feeding intentions and smoking status) and organizational (e.g., employment status, occupation type, and perceived level of breastfeeding support in workplace) factors, guided by the Socio-Ecological Model, associated with breastfeeding practices in a sample of employed mothers who participated in the IFPS II. At baseline (3-months postpartum survey), 57% of employed mothers were breastfeeding/feeding pumped milk. At this time point, employed breastfeeding mothers were significantly older, more likely to be married and they had higher SES compared to non-breastfeeding employed mothers; and they expressed prenatal infant feeding intentions to breastfeed only, were nonsmokers, employed part-time in a professional/executive occupation, and reported a higher level of perceived breastfeeding support in the workplace. In a subsample of employed mothers who worked either part-time (≤ 34 hours/week) or full-time (\u3e 35 hours/week) over the 12-month postpartum period (n=302), generalized linear mixed modeling (GLMM) revealed that predictors of breastfeeding over time were individual factors of prenatal breastfeeding intention and non-smoking, and organizational factors of part-time employment and perceived support for breastfeeding in the workplace. Employed mothers who were non-smokers were 291% more likely to breastfeed/feed pumped milk over the 12-month period (OR= 3.91, p \u3c 0.001) compared to smokers. Employed mothers who expressed prenatal feeding intentions to only breastfeed their infants were 953% more likely to report sustained breastfeeding over time (OR=10.53, p \u3c 0.001) compared to those who did not. In regard to organizational factors, employed mothers who were employed part-time (compared to full-time) were 97% more likely to continue breastfeed over the follow-up period (OR=1.97, p = 0.002). Finally, employed mothers who perceived high levels of breastfeeding support in the workplace (‘somewhat supportive’ or ‘very supportive’) were 178% more likely to continue breastfeeding over the 12-month follow up period compared to those with low levels of perceived breastfeeding support in the workplace (OR=2.78, p \u3c 0.001). In summary, occupational health nurses are instrumental in promoting breastfeeding supportive workplace environments. Future research is needed to examine individual, interpersonal, organizational, community, and public policy components of the Socio-Ecological Model to better understand the complex processes influencing breastfeeding continuation in employed mothers. Additional research is needed to develop, implement, and evaluate breastfeeding supportive workplace programs; guide public health policy; and better understand the relationship between multi-level factors of workplace lactation, breastfeeding practices, and maternal and child health outcomes

Looking for Stars and Finding the Moon: Effects of Lunar Gamma-ray Emission on Fermi LAT Light Curves

We are conducting a search for new gamma-ray binaries by making high signal-to-noise light curves of all cataloged Fermi LAT sources and searching for periodic variability using appropriately weighted power spectra. The light curves are created using a variant of aperture photometry where photons are weighted by the probability that they came from the source of interest. From this analysis we find that the light curves of a number of sources near the ecliptic plane are contaminated by gamma-ray emission from the Moon. This shows itself as modulation on the Moon's sidereal period in the power spectra. We demonstrate that this contamination can be removed by excluding times when the Moon was too close to a source. We advocate that this data screening should generally be used when analyzing LAT data from a source located close to the path of the Moon.Comment: 2012 Fermi Symposium proceedings - eConf C12102

Pharmacists' role in transgender healthcare: a scoping review

Background: Transgender patients have unique healthcare needs, providing pharmacists with the opportunity to play an important role in transgender care through addressing the healthcare disparities observed in this patient group. Objective: This scoping review aimed to explore the role of pharmacists in transgender healthcare. Methods: Six databases were searched from inception: Emcare, Informit, MEDLINE (Ovid), PubMed, Scopus, and Web of Science. The first author performed screening and data extraction in consensus with co-authors. Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was utilised to report this review. Themes related to the role of pharmacists in transgender healthcare were identified. Results: A total of 356 studies were identified; however, only 15 studies, all from the USA met the selection criteria and were included in this review. Study types included empirical research, practice reports and opinion pieces such as commentaries, editorials, and reports. Pharmacists were found to practise in two different care settings: community and interdisciplinary clinics, performing various roles in transgender healthcare, including patient education and counselling, management of cross-sex hormonal therapy, patient advocacy and provision of preventative care. They were also responsible for the provision of culturally sensitive care in an inclusive and welcoming environment. Although pharmacists considered their role important, they lacked confidence in their knowledge to provide appropriate care to this patient group. Conclusion: This review has highlighted that there is a need for education in transgender care for both pharmacists and pharmacy students, so that they are both confident and comfortable to play a meaningful role in transgender care. Pharmacists’ involvement in addressing the health disparities experienced will contribute to improving the overall health outcomes for this group

Is Financial Reporting Shaped by Equity Markets or By Debt Markets? An International Study of Timeliness and Conservatism

We hypothesize debt markets – not equity markets – are the primary influence on “association” metrics studied since Ball and Brown (1968). Debt markets demand high scores on timeliness, conservatism and Lev’s (1989) R2, because debt covenants utilize reported numbers. Equity markets do not rate financial reporting consistently with these metrics, because (among other things) they control for the total information incorporated in equity process. Single-country studies shed little light on the relative influences of debt and equity, because their firms operate under a homogeneous reporting regime. International data are consistent with our hypothesis. This is a fundamental issue in accounting

Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations

BACKGROUND: People living in rural and remote locations are disadvantaged in accessing palliative care. This can be attributed to several factors including the role diversity and the low numbers of patients with specific conditions, as well as the difficulties rural health practitioners have in accessing opportunities for professional education. A program of multidisciplinary palliative care video conferences was presented to health practitioners across part of northern Australia in an effort to address this problem. METHOD: The educational content of the video conferences was developed from participant responses to an educational needs assessment. Following cycles of four consecutive video conferences, 101 participants completed evaluative on-line surveys. The quantitative data were analysed using frequencies and analysis of variance tests with post-hoc analyses where appropriate, and an accessibility and remoteness index was used to classify their practice location. RESULTS: All participants found the content useful regardless of their remoteness from the tertiary centre, their years of experience caring for palliative care patients or the number of patients cared for each year. However, change in confidence to provide palliative care as a result of attending the video conferences was significant across all disciplines, regardless of location. Doctors, medical students and allied health professionals indicated the greatest change in confidence. CONCLUSIONS: The provision of professional education about palliative care issues via multidisciplinary video conferencing increased confidence among rural health practitioners, by meeting their identified need for topic and context specific education. This technology also enhanced the networking opportunities between practitioners, providing an avenue of ongoing professional support necessary for maintaining the health workforce in rural and remote areas. However, more attention should be directed to the diverse educational needs of allied health professionals

“Treat us as a person”: A narrative inquiry of experiences and expectations of interactions with pharmacists and pharmacy staff among people who are transgender

Background: Despite the increased visibility of transgender and gender diverse (TGD) people, little is known about their interactions with pharmacists and pharmacy staff while accessing care from the pharmacies. Objectives: The objective of this study was to explore the experiences and expectations of the TGD people regarding their interactions with pharmacists and pharmacy staff in Queensland, Australia. Methods: This study is situated in a transformative paradigm and utilized narrative inquiry to conduct semi-structured interviews with TGD participants. An interview guide based on the relevant literature and the constructs of the Theoretical Framework of Accessibility was developed. Purposive and snowball sampling was used to recruit people who identified as TGD and had previously visited pharmacies to access care. Depending on participants' preferences, interviews were conducted face-to-face or via phone or Zoom application. Interviews were recorded, transcribed, and organized in chronological stories. Data were analyzed to derive themes from the participant stories. Results: A total of 22 participants (transwomen = 11, transmen = 8, non-binary trans masculine = 3) were interviewed. Two major themes were identified, (1) Challenges of accessing care from the pharmacy and (2) Making the most of the interactions between TGD people and pharmacists. Major challenges of accessing care from pharmacies included anticipated anxiety of accessing care, healthcare system constraints, compromised privacy and confidentiality at the pharmacy, and being challenged about their gender. Many avoided interacting with pharmacists and staff or kept their interactions minimal. Participants recognized that pharmacists play a meaningful role in TGD health and provided insights about how pharmacists can improve care provision to TGD people. Conclusion: Cultural and pharmacotherapeutic education in transgender health are crucial for Australian pharmacists and staff to provide inclusive, respectful, and person-centered care to TGD people

Barriers and facilitators experienced by migrants and refugees when accessing pharmaceutical care: A scoping review

Background: Pharmacists in the community are often among the first health professionals encountered by new arrivals. Their accessibility and the longevity of the relationship gives pharmacy staff unique opportunities to work with migrants and refugees to meet their health needs. While the language, cultural and health literacy barriers that cause poorer health outcomes are well documented in medical literature, there is a need to validate the barriers to accessing pharmaceutical care and to identify facilitators for efficient care in the migrant/refugee patient-pharmacy staff interaction. Objective: The purpose of this scoping review was to investigate the barriers and facilitators that migrant and refugee populations experience when accessing pharmaceutical care in host countries. Methods: A comprehensive search of Medline, Emcare on Ovid, CINAHL and SCOPUS databases, guided by the PRISMA-ScR statement, was undertaken to identify the original research published in English between 1990 and December 2021. The studies were screened based on inclusion and exclusion criteria. Results: A total of 52 articles from around the world were included in this review. The studies revealed that the barriers to migrants and refugees accessing pharmaceutical care are well documented and include language, health literacy, unfamiliarity with health systems, and cultural beliefs and practises. Empirical evidence was less robust for facilitators, but suggested strategies included improvement of communication, medication review, community education and relationship building. Conclusions: While barriers experienced are known, there is a lack of evidence for facilitators for provision of pharmaceutical care to refugees and migrants and poor uptake of available tools and resources. There is a need for further research to identify facilitators that are effective in improving access to pharmaceutical care and practical for implementation by pharmacies

Negativity about the outcomes of extreme prematurity a persistent problem - a survey of health care professionals across the North Queensland region

Background: Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP) who counsel parents will influence decision making depending on their individual perceptions of the outcome for the baby. This paper aims to explore the knowledge and attitudes towards extremely preterm babies of HCP who care for women in pregnancy in a tertiary, regional and remote setting in North Queensland. Methods: A cross sectional electronic survey of HCP was performed. Perceptions of survival, severe disability and intact survival data were collected for each gestational age from 22 to 27 completed weeks gestation. Free text comment enabled qualitative content analysis. Results: Almost all 113 HCP participants were more pessimistic than the actual outcome data suggests. HCP caring for women antenatally were the most pessimistic for survival (p = 0.03 at 23 weeks, p = 0.02 at 25,26 and 27 weeks), severe disability (p = 0.01 at 24 weeks) and healthy outcomes (p = 0.01 at 24 weeks), whilst those working in regional and remote centres were more negative than those in tertiary unit for survival (p = 0.03 at 23,24,25 weeks). Perception became less negative as gestational age increased. Conclusion: Pessimism of HCP may be negatively influencing decision making and will negatively affect the way in which parents perceive the chances of a healthy outcome for their offspring

Compliance and surgical team perceptions of WHO Surgical Safety Checklist: systematic review

This systematic review aimed to assess surgical safety checklist compliance and evaluate surgical team perceptions and attitudes, post-checklist implementation in the operating room. The World Health Organization (WHO) surgical safety checklist (SSC) has decreased complications and mortality. However, it is unclear whether this reduction is influenced by the vicarious enhancement in teamwork, communication, and staff awareness established by SSC implementation. The preferred reporting items for systematic reviews and meta-analyses model of review guided a search across MEDLINE, PubMed, and Embase databases. English-language studies using any adapted form of the WHO-SSC in operating rooms were reviewed by abstract and full text. Twenty-six studies, 13 assessing SSC compliance and 13 investigating surgical team perceptions of SSC, were evaluated. Compliance studies showed a checklist initiation rate of >90%, but actual observed completion rate varied widely across studies. Sign out was the most poorly performed phase of the checklist (90%) of compliance across studies, but "verification of team-members'' was significantly less compliant. Studies assessing surgical team perceptions found that SSC improved participants' perception of teamwork, communication, patient safety, and staff awareness of adverse events. However, when stakeholders placed differing degrees of importance on SSC completion, results indicated the SSC might actually antagonize team relationships. SSC compliance varies significantly across studies, being highly dependent on staff perceptions, training, and effective leadership. Surgical teams have positive perceptions of SSC; thus with effective implementation strategies, compliance rates across all phases can be substantially improved

What do beginning students, in a rurally focused medical course, think about rural practice?

Background: Medical schools may select students for their attitudes towards rural medical practice, yet the rural–urban disparity in availability of medical practitioners and services has not diminished in recent times despite government initiatives and increasing numbers being trained for a career in medicine. One medical school, with a focus on rural and remote medicine, aims to select students with positive perceptions for rural medical practice. A research project collected data on the perceptions of these medical students in the first week of their medical studies. Methods: Students completed a low stakes essay on the life and work of a rural doctor. Initially, this formed part of a literacy assessment to determine any students requiring remediation. All students were asked if they would consent to their essay being reviewed for a research project. Data was obtained from those students who consented and handed their essays in for review. The 103 student essays underwent thematic analysis and sentences were coded into three main themes of rural lifestyle, doctor role and rural practice. Second level themes were further elicited and results were quantified according to whether they were positive or negative. Positive themes included rural lifestyle, doctor role, views of doctor, impact on community, broader work and skills knowledge, and better relationships with community and patients. Negative themes included doctor's health, pressure on doctor, family problems, greater workload, privacy and confidentiality issues, cultural issues, isolation, limited resources and financial impacts. Quantitisation of this data was used to transform essay sentences into a numerical form which allowed statistical analysis and comparison of perceptions using Z tests. Results: No significant differences on the number of positive and negative responses for rural lifestyle and rural practice were found. The rural doctor role had a significantly more positive than negative views. Significant differences were found for positive views of the rural doctor role and negative views of rural practice. Participants from a capital city background reported a significantly higher percentage of responses related to negative views of rural practice than their regional and rural counterparts. Students from capital city areas had significantly more negative views about the rural doctor role, especially related to workload, limited resources and isolation than students from rural and regional areas. Conclusion: Students entering medical school already have both positive and negative views about the life and work of a rural doctor. Those students from capital city areas have significantly more negative views despite being selected to enter a medical course with a rural focus based on their expressed rural perceptions. Further work is required to refine selection criteria and the year level experiences and learning opportunities which may positively influence student perceptions about rural medical practice to overcome early negative perceptions at the beginning of medical school