Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

[A novel transcutaneous vagus nerve stimulation leads to brainstem and cerebral activations measured by functional MRI].

BACKGROUND: Left cervical vagus nerve stimulation (VNS) using the implanted NeuroCybernetic Prosthesis (NCP) can reduce epileptic seizures and has recently been shown to give promising results for treating therapy-resistant depression. To address a disadvantage of this state-of-the-art VNS device, the use of an alternative transcutaneous electrical nerve stimulation technique, designed for muscular stimulation, was studied. Functional magnetic resonance imaging (MRI) has been used to test non-invasively access nerve structures associated with the vagus nerve system. The results and their impact are unsatisfying due to missing brainstem activations. These activations, however, are mandatory for reasoning, higher subcortical and cortical activations of vagus nerve structures. The objective of this study was to test a new parameter setting and a novel device for performing specific (well-controlled) transcutaneous VNS (tVNS) at the inner side of the tragus. This paper shows the feasibility of these and their potential for brainstem and cerebral activations as measured by blood oxygenation level dependent functional MRI (BOLD fMRI). MATERIALS AND METHODS: In total, four healthy male adults were scanned inside a 1.5-Tesla MR scanner while undergoing tVNS at the left tragus. We ensured that our newly developed tVNS stimulator was adapted to be an MR-safe stimulation device. In the experiment, cortical and brainstem representations during tVNS were compared to a baseline. RESULTS: A positive BOLD response was detected during stimulation in brain areas associated with higher order relay nuclei of vagal afferent pathways, respectively the left locus coeruleus, the thalamus (left >> right), the left prefrontal cortex, the right and the left postcentral gyrus, the left posterior cingulated gyrus and the left insula. Deactivations were found in the right nucleus accumbens and the right cerebellar hemisphere. CONCLUSION: The method and device are feasible and appropriate for accessing cerebral vagus nerve structures, respectively. As functional patterns share features with fMRI BOLD, the effects previously studied with the NCP are discussed and new possibilities of tVNS are hypothesised.

The needs of carers: a comparison between eating disorders and schizophrenia.

OBJECTIVE: This pilot study compares the level of distress and the need for support between carers of patients with anorexia (AN) and bulimia nervosa (BN) and carers of patients with schizophrenia. METHODS: Thirty-two carers of patients suffering from AN and BN and 30 carers of patients with schizophrenia filled out the general health questionnaire (GHQ-12) and the burden inventory (BI). In addition, they were interviewed with a semi-structured research interview, the carers' needs assessment (CNA), to assess relevant problem areas as well as the need for helpful interventions. Patients with an eating disorder were interviewed with the eating disorder examination (EDE) and patients with schizophrenia with the positive and negative syndrome scale (PANSS) to assess the severity of the disorder. RESULTS: The mean duration of illness was 5.3 years in the patients with eating disorders and 7.3 years in the patients with schizophrenia. Most of the carers were mothers or partners. In the CNA we found high numbers of problems as well as high numbers of unmet needs for interventions. The most frequently mentioned problem areas in all groups of carers were "disappointment caused by the chronic course of the illness, concerns about the patient's future" and "problems in communication with the patient". The most frequently reported need for support in all groups was "counseling and support by a professional". Carers of patients with BN reported a significantly lower number of problems and of needs for interventions compared to the carers of patients with AN and schizophrenia. Also in the BI and the GHQ-12 we found significantly lower total scores in carers of patients with BN. Carers of patients with AN and schizophrenia did not differ significantly in any of the assessments. The severity or duration of illness of the patients did not correlate with the carers' burden or needs. CONCLUSIONS: Carers of patients with an eating disorder and carers of patients with schizophrenia are burdened with similar problems and have high levels of unmet needs which are usually not addressed in clinical practice. Carers of anorectic patients have higher levels of difficulties in various areas compared to carers of bulimic patients and did not differ from carers of patients with schizophrenia.