A qualitative examination of barriers against effective medical education and practices related to breastfeeding promotion and support in Lebanon.

Background: Insufficient breastfeeding promotion and support by physicians contribute to suboptimal breastfeeding rates globally. Understanding setting-specific barriers against breastfeeding promotion and support from the perspective of medical students and addressing those that can be modified through undergraduate medical education may help improve learning outcomes, medical practice, and ultimately health outcomes associated with breastfeeding.Objectives: We selected the underserved and under-supported public medical school in Lebanon to explore psychosocial, institutional, and societal barriers hindering effective preventative medicine practices using breastfeeding promotion and support as an exemplar case.Methods: One-on-one semi-structured interviews, each lasting around 60 min, were conducted with medical interns (in Med III and Med IV) at their training hospitals. Interviews were voice-recorded, transcribed verbatim, coded, and analyzed thematically based on Theory of Planned Behavior.Results: Interns (n= 49; 96% response rate) completed the study. Five major themes emerged addressing barriers at various levels. At the health care system level at large, interns identified the predominant focus on pathophysiology and treatment rather than on disease prevention and health promotion as a barrier. At the level of trainees and their education experiences, interns reported limited and optional clerkship training in obstetrics/gynecology and in neonatology which contributes to their insufficient knowledge and low self-efficacy. Competing financial interests from infant formula companies and social pressures to promote infant formula were identified as two main barriers at the level of physicians and clinical practice.Conclusions: Our work using breastfeeding as an exemplary case highlights how undergraduate medical education and its learning outcomes and how medical practices and patient behavior are highly intertwined with psychosocial, institutional, and social drivers and constraints. Re-evaluating the success of undergraduate medical curricula in light of overcoming these constraints and not only based on meeting national accreditation and certification guidelines might prove helpful in improving medical education and ultimately clinical practice

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools.

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long-term by targeting children and adolescents' knowledge, attitudes, skills, and intentions. Breastfeeding rates in Lebanon are suboptimal. Psychosocial drivers of breastfeeding intention among the youth are unknown. We administered a survey to 658 high school students (448 females; 210 males) at two large Lebanese schools to understand intentions, intention drivers, and views on SBBE as means to guide SBBE programme design on the basis of the theory of planned behaviour. We collected information on demographics, intention to breastfeed/support wife to breastfeed future. Intention was predicted by attitude related to breastfeeding health outcomes and family normative beliefs-χ2 (25) = 115, P < .001 for males, and χ2 (39.3) = 186, P < .001 for females. Among females, intention was also positively associated with being breastfed, higher socio-economic status, and being more accepting of public breastfeeding. Seventy-eight per cent of students felt they were not learning enough about breastfeeding in school but were interested in SBBE through didactic teaching methods and interactive experiences. Findings indicate that breastfeeding intention among adolescent students is not merely influenced by the extent of knowledge but by more complicated psychosocial drivers that may differ by gender. Our findings also suggest a misalignment exists between what schools are providing with what students feel they need, thereby opening up a potential space for intervention

Estrategias didácticas para disminuir la ansiedad en los exámenes en estudiantes de Ciencias Básicas de la Facultad de Medicina Humana de la UNPRG

El presente estudio fue realizado con la finalidad de aplicar estrategias didácticas que disminuyan la ansiedad ante los exámenes en estudiantes de primer año (ciencias básicas) de la facultad de medicina de la Universidad Nacional Pedro Ruiz Gallo- Lambayeque. El estudio de tipo cuasi-experimental, se realizó a 60 estudiantes, los cuales fueron divididos en dos grupos de 30 alumnos cada uno (grupo control y grupo experimental), a quienes se les aplicó el cuestionario para evaluación de ansiedad ante exámenes (CAEX), elaborado por Luis Valero Aguayo. Este test fue aplicado con la finalidad de determinar el nivel de ansiedad ante los exámenes de los estudiantes antes y después de la aplicación de estrategias didácticas, las cuales fueron aplicadas al grupo experimental. Las estrategias didácticas fueron desarrolladas en 4 talleres, uno por semana con un tiempo de duración de una hora aproximadamente. En cada sesión se aplicaron temas diferentes dentro de los cuales tenemos: Autoestima, técnicas de estudio, técnicas de relajación y relajación progresiva. Para realizar la comparación de resultados pre y pos test se utilizó la T de student para muestras independientes e idénticamente distribuidas a partir de las dos poblaciones a ser comparadas. Se concluyó que la aplicación de estrategias didácticas fue eficaz en disminuir la ansiedad ante exámenes en los estudiantes de ciencias básicas de la facultad de medicina humana de la Universidad Nacional Pedro Ruiz Gallo de manera estadísticamente significativa, comprobándose la hipótesis planteada. Este estudio brindó beneficios a la población de estudiantes que participaron en él

Sources and Mechanisms of Low-Flow River Phosphorus Elevations:A Repeated Synoptic Survey Approach

peer-reviewedHigh-resolution water quality monitoring indicates recurring elevation of stream phosphorus concentrations during low-flow periods. These increased concentrations may exceed Water Framework Directive (WFD) environmental quality standards during ecologically sensitive periods. The objective of this research was to identify source, mobilization, and pathway factors controlling in-stream total reactive phosphorus (TRP) concentrations during low-flow periods. Synoptic surveys were conducted in three agricultural catchments during spring, summer, and autumn. Up to 50 water samples were obtained across each watercourse per sampling round. Samples were analysed for TRP and total phosphorus (TP), along with supplementary parameters (temperature, conductivity, dissolved oxygen, and oxidation reduction potential). Bed sediment was analysed at a subset of locations for Mehlich P, Al, Ca, and Fe. The greatest percentages of water sampling points exceeding WFD threshold of 0.035 mg L−1 TRP occurred during summer (57%, 11%, and 71% for well-drained, well-drained arable, and poorly drained grassland catchments, respectively). These percentages declined during autumn but did not return to spring concentrations, as winter flushing had not yet occurred. Different controls were elucidated for each catchment: diffuse transport through groundwater and lack of dilution in the well-drained grassland, in-stream mobilization in the well-drained arable, and a combination of point sources and cumulative loading in the poorly drained grassland. Diversity in controlling factors necessitates investigative protocols beyond low-spatial and temporal resolution water sampling and must incorporate both repeated survey and complementary understanding of sediment chemistry and anthropogenic phosphorus sources. Despite similarities in elevation of P at low-flow, catchments will require custom solutions depending on their typology, and both legislative deadlines and target baselines standards must acknowledge these inherent differences

A Randomized Controlled Trial on the Effects of Yoga on Stress Reactivity in 6th Grade Students

There is an increasing interest in developing school programs that improve the ability of children to cope with psychosocial stress. Yoga may be an appropriate intervention as it has demonstrated improvements in the ability of children to manage psychosocial stress. Yoga is thought to improve the control of reactivity to stress via the regulation of the autonomic nervous system. The current study examined the effects of yoga compared to a physical education class on physiological response (blood pressure (BP) and heart rate (HR)) to behavioral stressor tasks (mental arithmetic and mirror tracing tasks). Data analysis of BP and HR was performed using a 2 × 2 × 4 repeated measures ANOVA (time × group × stressor time points). 30 (17 male) 6th graders participated in the study. Yoga did not provide significant differences in stress reactivity compared to a physical education class (group × time: systolic (F(1,28)=.538, P=.470); diastolic (F(1,28)=.1.061, P=.312); HR (F(1,28)=.401, P=.532)). The lack of significant differences may be due to the yoga intervention failing to focus on stress management and/or the stressor tasks not adequately capturing attenuation of stressor response

Induction of Genes Encoding Plant Cell Wall-Degrading Carbohydrate-Active Enzymes by Lignocellulose-Derived Monosaccharides and Cellobiose in the White-Rot Fungus Dichomitus squalens

Fungi can decompose plant biomass into small oligo-and monosaccharides to be used as carbon sources. Some of these small molecules may induce metabolic pathways and the production of extracellular enzymes targeted for degradation of plant cell wall polymers. Despite extensive studies in ascomycete fungi, little is known about the nature of inducers for the lignocellulolytic systems of basidiomycetes. In this study, we analyzed six sugars known to induce the expression of lignocellulolytic genes in ascomycetes for their role as inducers in the basidiomycete white-rot fungus Dichomitus squalens using a transcriptomic approach. This identified cellobiose and L-rhamnose as the main inducers of cellulolytic and pectinolytic genes, respectively, of D. squalens. Our results also identified differences in gene expression patterns between dikaryotic and monokaryotic strains of D. squalens cultivated on plant biomass-derived monosaccharides and the disaccharide cellobiose. This suggests that despite conservation of the induction between these two genetic forms of D. squalens, the fine-tuning in the gene regulation of lignocellulose conversion is differently organized in these strains. IMPORTANCE Wood-decomposing basidiomycete fungi have a major role in the global carbon cycle and are promising candidates for lignocellulosic biorefinery applications. However, information on which components trigger enzyme production is currently lacking, which is crucial for the efficient use of these fungi in biotechnology. In this study, transcriptomes of the white-rot fungus Dichomitus squalens from plant biomass-derived monosaccharide and cellobiose cultures were studied to identify compounds that induce the expression of genes involved in plant biomass degradation.Peer reviewe

Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series.

BACKGROUND: Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited. METHODS: We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population. RESULTS: Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, (P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia (P = .50). CONCLUSION: Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings