Early breastfeeding cessation: validation of Breastfeeding Assessement Score (BAS) on an Italian validation cohort of women

Introduction The World Health Organization recommends exclusive breastfeeding for the first 6 months of life because of the numerous benefits of breastfeeding for the mother and the child 2,3. A prognostic approach to identify the mothers at risk of early breastfeeding cessation is needed to provide preventive support to these women. The BAS1, elaborate in Kansas, is a score useful for this approach. Aim of the study To assess the accuracy of the BAS1, in an Italian validation cohort of women. Methods This is a bicentric, prospective study. Italian and healthy mothers who gave birth to a single child from 25th June 2008 to 15th January 2009, with a gestational age of at least 35 weeks, were included. Exclusion criteria, on the convenience sample, were: mothers with a non-Italian background, preterm delivery (<35 weeks) or twin birth.The authors have calculated the BAS on 386 women just before hospital discharge, at least 48 hours post-delivery age, in Mangiagalli and in S. Gerardo hospitals. The primary outcome measured was how many women stopped the breastfeeding, and it was assessed using structured follow-up telephone interviews after 4 weeks. The predictive value of the BAS1 is ok, if it identifies the 80% of the women that stop to breastfeed. This study was carried out from 25th June 2008 to 15th February 2009. Results For a cut point of 8, recommended by the authors of the BAS1, 119 mother-infant pairs were categorized at high risk to early breastfeeding cessation, with a RR 5,24. The BAS has a sensibility of 0.69, a specificity of 0.79, a positive predictive value of 43% and a negative predictive value of 91%. Conclusions / discussion The intrinsic properties of the BAS1 are strong, but the study cannot validate this score because in the studied population, there is a low sensibility versus the authors expectation. Practical relevance Italian midwives need to individualize the mothers at risk of early breastfeeding cessation, for a special support. Research implications This study confirms the necessity to identify a score for the Italian population

'POPPATA DIFFICOLTOSA' NELL'ALLATTAMENTO AL SENO:QUALE ESPERIENZA DAL PUNTO DI VISTA DELLE MADRI ITALIANE.UNO STUDIO QUALITATIVO

Introduction Many professional organizations recommend breastfeeding for the first 6 months due to the numerous benefits it has for mother and child. The mother\u2019s breastfeeding experiences in the early postpartum period, are crucial in deciding to continue it. It is important to identify, in the first days after childbirth, women who send messages that are likely to early stop breastfeeding. Many women have said to have breastfeeding difficulties in the first days after birth. Several studies (Mozingo et al,2000; Hauck et al, 2002; Kong e Lee, 2004; Nelson, 2006) have explored the motivation of early breastfeeding cessation but little is known on what "breastfeeding difficulty" really means for women. Aim of the study The aim of this qualitative study was to understand what does "latching difficulty" mean for the Italian mothers. Exploring this meaning could consent to correctly utilize Breastfeeding Assessment Score, in which the investigation of \u201clatching difficulty\u201d is comprised. In addition, further investigation of this topic is aimed to understand how healthcare professional could help women with latching difficulties. Methods The women who received a Breastfeeding Assessment Score (BAS) (Hall et al, 2002) less than 8, and reported \u201clatching difficulties\u201d, were invited to participate in the study. With purposive sampling we recruited 15 women, 48-72 hours after childbirth. We conducted semi-structured interviews which were tape-recorded and verbatim transcribed. The transcripts were read and analyzed using the fenomenologic - ermeneutic approach. Results "Latching difficulty" is related to issues including both mother\u2019s and infant\u2019s difficulties. Nipple-pain and infant\u2019s sleepiness were the most reported difficulties. In spite of these difficulties, the sensation related to breastfeeding was \u201chappiness\u201d when the baby sucked the breast, but concern and anxiety were common too. The women reported more impediment in overcoming the breastfeeding difficulty when there was an idealization of breastfeeding, during pregnancy. The analysis resulted in the emergence of six themes, sixteen category and fifty-nine labels. The six themes was the \u201cbreastfeeding can be difficult due to the mother or the newborn\u201d, \u201cbreastfeeding can generate positive and negative experiences\u201d, \u201cbreastfeeding change/not change the relationship between infant and mother, who is still favoured by rooming-in\u201d, \u201cthe mothers have developed theories about colostrum, breast milk, breastfeeding and infant formula\u201d, \u201cthe women have developed different strategies to overcome difficulties and continue during breastfeeding\u201d, \u201csupport during breastfeeding is very important to continue breastfeeding\u201d. Conclusion This study enriches the theoretical framework in understanding the dynamics that can contribute to early failure of breastfeeding in Italy. Practical relevance Understanding the meaning of the item \u201clatching difficulty\u201d consents to a more correct interpretation of the BAS (Hall et al, 2002) by the Italian midwives and allows a more accurate identification of the mothers who need support and education during breastfeeding Research implications Since this is a qualitative study, more research is needed to understand the \u201clatching difficulty\u201d in the Italian environment and in other cultures

Delivery in pregnant women infected with SARS-CoV-2: A fast review

Background: Few case reports and clinical series exist on pregnant women infected with SARS-CoV-2 who delivered. Objective: To review the available information on mode of delivery, vertical/peripartum transmission, and neonatal outcome in pregnant women infected with SARS-CoV-2. Search strategy: Combination of the following key words: COVID-19, SARS-CoV-2, and pregnancy in Embase and PubMed databases. Selection criteria: Papers reporting cases of women infected with SARS-CoV-2 who delivered. Data collection and analysis: The following was extracted: author; country; number of women; study design; gestational age at delivery; selected clinical maternal data; mode of delivery; selected neonatal outcomes. Main results: In the 13 studies included, vaginal delivery was reported in 6 cases (9.4%; 95% CI, 3.5\u201319.3). Indication for cesarean delivery was worsening of maternal conditions in 31 cases (48.4%; 95% CI, 35.8\u201361.3). Two newborns testing positive for SARS-CoV-2 by real-time RT-PCR assay were reported. In three neonates, SARS-CoV-2 IgG and IgM levels were elevated but the RT-PCR test was negative. Conclusions: The rate of vertical or peripartum transmission of SARS-CoV-2 is low, if any, for cesarean delivery; no data are available for vaginal delivery. Low frequency of spontaneous preterm birth and general favorable immediate neonatal outcome are reassuring

The Midwifery Traditional Methods

\u201cMidwifery traditional method\u201d is the only one which supports clinical certainty and that can introduce to a hands on care. Kind Editor, we think it is fundamental help obstetricians and midwives to develop competencies for birth and encourage to make use of the precious cultural baggage which is the obstetric semeiotic

In gravidanza: studio epidemiologico sugli aspetti ansiosi e depressivi

Il percorso formativo di un\u2019ostetrica ha da sempre sottolineato l\u2019attenzione alla sfera emotiva della persona, quale punto di forza della sua arte e del suo \u2018saper essere\u2019, nell\u2019incontro empatico con l\u2019altro. La scelta di approfondire la tematica dei disturbi ansiosi e depressivi, si pone a difesa di quell\u2019intimo contatto e di quella protezione essenziale nei confronti dell\u2019io delle donne, cui la figura dell\u2019ostetrica \ue8 preposta. L\u2019obiettivo di questo lavoro si incentra principalmente sull\u2019evidenza di una necessit\ue0 reale di supporto emotivo alle donne gi\ue0 nel corso della gravidanza, e poi successivamente nel puerperio. Lo studio epidemiologico mira a porre l\u2019accento sull\u2019effettivo riscontro di sintomatologie depressive o ansiose nel corso del periodo gestazionale, quali specchio di un\u2019incertezza diffusa, di un bisogno silente di attenzione e cura. Si mira cos\uec a rendere coscienti gli operatori sanitari dell\u2019evidente necessit\ue0 di supporto e informazione alle future madri, spingendo in particolare le ostetriche nella direzione di un\u2019assistenza completa, che includa una pi\uf9 scrupolosa attenzione alla sfera emotiva della persona. Lo studio intrapreso si pone come indagine epidemiologica e di screening, inserita all\u2019interno di un progetto pi\uf9 ampio, volto alla sensibilizzazione ad un tema tanto complesso quanto poco indagato nella pratica clinica. Il fine ultimo \ue8 quello di proporre l\u2019istituzione di un vero e proprio servizio di supporto dedicato alle donne in gravidanza ed alle mamme nel dopo parto, volto all\u2019approfondimento della tematica della depressione e dell\u2019ansia, alla prevenzione ed alla cura dei disturbi di tipo psichico, ed all\u2019adattamento sereno alla condizione di maternit\ue0

A Self-Consistent First-Principles Technique Having Linear Scaling

An algorithm for first-principles electronic structure calculations having a computational cost which scales linearly with the system size is presented. Our method exploits the real-space localization of the density matrix, and in this respect it is related to the technique of Li, Nunes and Vanderbilt. The density matrix is expressed in terms of localized support functions, and a matrix of variational parameters, L, having a finite spatial range. The total energy is minimized with respect to both the support functions and the elements of the L matrix. The method is variational, and becomes exact as the ranges of the support functions and the L matrix are increased. We have tested the method on crystalline silicon systems containing up to 216 atoms, and we discuss some of these results.Comment: 12 pages, REVTeX, 2 figure

Maternal and paternal caffeine intake and art outcomes in couples referring to an Italian fertility clinic: A prospective cohort

Caffeine intake, a frequent lifestyle exposure, has a number of biological effects. We designed a cohort study to investigate the relation between lifestyle and assisted reproduction technique (ART) outcomes. From September 2014 to December 2016, 339 subfertile couples referring to an Italian fertility clinic and eligible for ART procedures were enrolled in our study. Sociodemographic characteristics, smoking, and usual alcohol and caffeine consumption in the year prior to ART were recorded. The mean age of participants was 36.6 \ub1 3.6 years in women and 39.4 \ub1 5.2 years in men. After oocytes retrieval, 293 (86.4%) underwent implantation, 110 (32.4%) achieved clinical pregnancy, and 82 (24.2%) live birth. Maternal age was the main determinant of ART outcome. In a model including women\u2019s age and college degree, smoking habits, calorie and alcohol intake for both partners, previous ART cycles, and partner\u2019s caffeine intake, we did not observe any association between caffeine intake and ART outcome. Using the first tertile of caffeine intake by women as a reference, the adjusted rate ratio (ARR) for live birth was 1.09 (95% confidence interval (CI) 0.79\u20131.50) in the second and 0.99 (95% CI 0.71\u20131.40) in the third tertiles. In conclusion, a moderate caffeine intake by women and men in the year prior to the ART procedure was not associated with negative ART outcomes

Reply: On the Reporting of Odds Ratios and Risk Ratios, Nutrients 2018, 10, 10

In response to the letter of Pace and Multani, in general, we cannot disagree with their considerations about the use of odds ratios, risk ratios, and rate ratios. [...]

Review of AdS/CFT Integrability, Chapter IV.3: N=6 Chern-Simons and Strings on AdS4xCP3

We review the duality and integrability of N=6 superconformal Chern-Simons theory in three dimensions and IIA superstring theory on the background AdS4xCP3. We introduce both of these models and describe how their degrees of freedom are mapped to excitations of a long-range integrable spin-chain. Finally, we discuss the properties of the Bethe equations, the S-matrix and the algebraic curve that are special to this correspondence and differ from the case of N=4 SYM theory and strings on AdS5xS5.Comment: 22 pages, see also overview article arXiv:1012.3982, v2: references to other chapters updated, v3: references added, v4: brief discussion of giant magnons added, further minor changes, published version, v5: union of v3 and v4 because changes made in v3 were accidentally lost in v

Breastfeeding Determinants in Healthy Term Newborns

Breastfeeding is the normative standard for infant feeding. Despite its established benefits, different factors can affect breastfeeding rates over time. The purpose of this study was to evaluate breastfeeding determinants in healthy term newborns during the first three months of life. A prospective, observational, single-center study was conducted in the nursery of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. The mother-baby dyads that were admitted to the Clinic in January and February 2017 were enrolled. Only healthy term babies with birth weight 6510th percentile for gestational age were included. Data were collected through medical records and questionnaires administered during the follow-up period. Then, we fitted univariate and multivariate logistic models and calculated odds ratios. 746 dyads were included but 640 completed the study. The factors found to be favoring breastfeeding were a previous successful breastfeeding experience, a higher level of education of the mother, attending prenatal classes, no use of pacifier, rooming in practice, and breastfeeding on demand. Factors acting negatively on breastfeeding were advanced maternal age, non-spontaneous delivery, perception of low milk supply, mastitis, and nipple fissures. This study highlights the need to individualize the assistance provide to breastfeeding mothers, paying special attention to personal experiences