Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systemic Review and Meta-Analysis

Background: International Board Certified Lactation Consultants (IBCLC) are healthcare professionals who are highly trained in lactation science; however, little is known about the efficacy of IBCLC-specific support on breastfeeding outcomes. Research aims: This systematic review and meta-analysis aimed to describe interventions containing direct support by IBCLCs during the postpartum period and to analyze the association between study characteristics and the prevalence breastfeeding outcomes. Methods: Electronic databases were searched for studies published between January 2001 and December 2018. Meta-analysis and meta-regression were performed on studies containing breastfeeding prevalence data at 3 or 6 months postpartum. Results: Seventeen interventions met all inclusion and exclusion criteria and eight research teams reported the prevalence of any or exclusive breastfeeding at 3 and/or 6 months. For any breastfeeding at 6 months, the pooled difference was 0.08 [0.04, 0.12] meaning we’d expect to observe 1 additional case of any breastfeeding at 6 months postpartum for every 12 women who received an IBCLC intervention, 95% CI [8, 25] rather than control conditions. Results differed depending on which outcome variable was used to measure breastfeeding and the timing of that measurement. Conclusions: Breastfeeding interventions that include IBCLC support in the postpartum period have potential for improving breastfeeding outcomes; however, when designing interventions, the timing and method of data collection for measures of breastfeeding are instrumental to study sensitivity and need to be based on the aims of the intervention itself

Family-based obesity prevention for infants: Design of the “Mothers & Others” randomized trial

Objective Our goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life. Design, participants, and methods The design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37 weeks gestation and when infants are 1, 3, 6, 9, 12, and 15 months of age. Results The primary outcome is infant/toddler growth and likelihood of overweight at 15 months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention. Conclusions If successful in promoting healthy infant growth and enhancing caregiver behaviors, “Mothers and Others” will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2 years, including interventional research and federal, state, and community health programs. Trial Registration ClinicalTrials.gov, NCT01938118, August 9, 2013

⁸⁹Zr-Trastuzumab PET/CT Imaging of HER2-Positive Breast Cancer for Predicting Pathological Complete Response after Neoadjuvant Systemic Therapy:A Feasibility Study

Background: Approximately 20% of invasive ductal breast malignancies are human epidermal growth factor receptor 2 (HER2)-positive. These patients receive neoadjuvant systemic therapy (NAT) including HER2-targeting therapies. Up to 65% of patients achieve a pathological complete response (pCR). These patients might not have needed surgery. However, accurate preoperative identification of a pCR remains challenging. A radiologic complete response (rCR) on MRI corresponds to a pCR in only 73% of patients. The current feasibility study investigates if HER2-targeted PET/CT-imaging using Zirconium-89 (89Zr)-radiolabeled trastuzumab can be used for more accurate NAT response evaluation. Methods: HER2-positive breast cancer patients scheduled to undergo NAT and subsequent surgery received a 89Zr-trastuzumab PET/CT both before (PET/CT-1) and after (PET/CT-2) NAT. Qualitative and quantitative response evaluation was performed. Results: Six patients were enrolled. All primary tumors could be identified on PET/CT-1. Four patients had a pCR and two a pathological partial response (pPR) in the primary tumor. Qualitative assessment of PET/CT resulted in an accuracy of 66.7%, compared to 83.3% of the standard-of-care MRI. Quantitative assessment showed a difference between the SUVR on PET/CT-1 and PET/CT-2 (ΔSUVR) in patients with a pPR and pCR of −48% and −90% (p = 0.133), respectively. The difference in tumor-to-blood ratio on PET/CT-1 and PET/CT-2 (ΔTBR) in patients with pPR and pCR was −79% and −94% (p = 0.133), respectively. Three patients had metastatic lymph nodes at diagnosis that were all identified on PET/CT-1. All three patients achieved a nodal pCR. Qualitative assessment of the lymph nodes with PET/CT resulted in an accuracy of 66.7%, compared to 50% of the MRI. Conclusions: NAT response evaluation using 89Zr-trastuzumab PET/CT is feasible. In the current study, qualitative assessment of the PET/CT images is not superior to standard-of-care MRI. Our results suggest that quantitative assessment of 89Zr-trastuzumab PET/CT has potential for a more accurate response evaluation of the primary tumor after NAT in HER2-positive breast cancer.</p

Photochemical smog in Europe - an overview

SIGLEAvailable from TIB Hannover: RR 838(2) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Protection of Salvia Miltiorrhiza against aflatoxin-B1-induced hepatocarcinogenesis in Fischer 344 rats - Dual mechanisms involved

10.1016/S0024-3205(01)01116-XLife Sciences693309-326LIFS

Kriterienkatalog zur Beurteilung von Gefahren in Einzugsgebieten von Trinkwassergewinnungsanlagen am Beispiel militaerischer Altlasten

During the 'cold war' the two power blocs of the world held a colossal potential of weapons and technology in Europe, particularly at the German border and the hinterland. Up to the disintegration of the eastern military alliance, the West Group of the Soviet Armies, together with the National People's Army of the German Democratic Republic (GDR) and its paramilitary unities, represented a high fighting strength and battle readiness on a military area of about 5000 Km&quot;2. Together with the properties of the western Allies (U.S. Forces, the British and the French Army, and others) and the Federal Armed Forces in the former Federal Republic of Germany, the total military area was approx. 10.000 Km&quot;2 (=approximately 4-times the surface of the federal state of Saarland). With the year 1990 the fears have been confirmed that particularly the military or former military sites held considerable dangers for the human health. Besides pollution from former production sites, other causes within the last decades were improper handling of toxic and water endangering substances. The gradual discount of the western group of the Soviet army was realized in close cooperation with the Federal Environmental Agency. Once this phase was finished, the Governments of the Laender, the Federal authorities for environment and health, the Federal Army, and the Federal Committee for Immediate Help (FKST) on Drinking Water (FKST), more than 40 sites of drinking water extraction were assessed as being acutely at risk. Since then, the interest has driven from such openly manifesting dangers to those being still unrecognised but of at least the same risk potential, called latent dangers. The significance of these military 'hangovers' is due to long-term effect chains on the soil/ground -water/drinking water path. Experts assessed, that the surface of the former GDR could comprise at least 100 out of 10.000 objects (combined properties of WGT, NVA, bordering troops, department for security of the state and others) with potentially serious consequences for human health. The aim of the criterions catalogue is to counteract such unhealthy effects on the man prospectively. (orig.)Available from TIB Hannover: RO 2237(1996,6) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Optimierung der thermischen Behandlung organischer fluorhaltiger Problemabfaelle

Organische Fluorverbindungen werden in den letzten Jahren zunehmend in verschiedenen Bereichen, vor allem der Industrie, eingesetzt. Die Bedeutung solcher Verbindungen in der Atmosphaere - besonders der ungewoehnlich langlebigen vollstaendig fluorierten Alkane fuer den Treibhauseffekt - kommt erst langsam in die wissenschaftliche Diskussion. Ueber die Entsorgung solcher Fluorverbindungen weiss man noch verhaeltnismaessig wenig. Deshalb wurde das Verhalten der ausgewaehlten Fluorverbindungen Perfluoroctan, Perfluordodecan, Perfluorbenzol, Polytetrafluorethylen, bei Pyrolyse und Verbrennung naeher untersucht. Dazu wurden mit verschiedenen Methoden im Labormassstab u.a. der Einfluss von Zuschlaegen, Temperatur, Verweilzeit und der Sauerstoffgehalt variiert, um Art und Menge der Produkte, die bei der Zersetzung dieser fluorhaltiger Verbindungen entstehen, zu bestimmen und die thermische Zersetzung zu leicht entsorgbaren Verbindungen zu optimieren. (orig./SR)During the past few years organic fluorocompounds have found increasing use in various fields, notably in industry. Science has been slow to recognise the relevance of such compounds when emitted into the atmosphere, particularly the contribution to global warming of the unusually longevous fully fluorinated alkanes. At present relatively little is known on the best means of disposal for these fluorocompounds. The following fluorocompounds were therefore selected for a study of their behaviour during pyrolysis and combustion: perfluorooctane, perfluorododecane, perfluorobenzene, and polytetrafluoroethylene. In laboratory-scale experiments various methods were used to vary, amongst other parameters, the influence of loading materials, temperature, retention time, and oxygen content in order to determine the types and quantities of products arising from the decomposition of these fluorocompounds and optimise the employed processes with regard to the proportion of easily disposable compounds. (orig./SR)SIGLEAvailable from TIB Hannover: RO 4361(1994,3) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Variation in Precursor Lesions of Pancreatic Cancer among High-Risk Groups

Cellular mechanisms in basic and clinical gastroenterology and hepatolog