Missed care and equitable breastfeeding support: An integrative review of exposure to in-hospital care by patient characteristics and breastfeeding outcomes.

AIM: To synthesize the literature on breastfeeding outcomes associated with exposure to internationally recognized best practices, such as the Baby-Friendly Hospital Initiative, for patients in the United States during the postpartum period, contextualized within the Missed Care Model. DESIGN: The authors employed Whittemore and Knafl's integrative review framework and the 2020 PRISMA guidelines for data extraction, synthesis, reporting and assessment. METHODS: Five electronic databases were searched for articles published between 2007 and 2023. Eligible articles reported on exposure to breastfeeding best practices and outcomes or the experiences, views, perceptions and attitudes of parents, nurses or lactation consultants regarding hospital breastfeeding support. Extracted data were compared to identify in-hospital exposure to breastfeeding best practices and breastfeeding outcomes, and differences in exposure and outcomes based on patient and provider characteristics. RESULTS: Twenty-one quantitative, qualitative and mixed methods articles met inclusion criteria. A higher reported adherence to best practices was associated with greater odds of breastfeeding; some practices demonstrated greater effects overall or for specific groups. Higher exposures to best practices and higher breastfeeding rates were found for non-Hispanic white patients, and those with more education, private insurance and who live in urban areas. Disparities in support and outcomes were related to patients' race/ethnicity, language, weight and age. Qualitative findings reflected missed care concepts, such as internal processes related to habits and group norms, relevant to breastfeeding support. CONCLUSION: Review findings also include an adapted Missed Care Model specific to breastfeeding support, which can inform future research related to providers' internal processes that may influence breastfeeding or equitable breastfeeding care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Missed care can be influenced by a variety of factors, including providers' internal values and beliefs. Study findings suggest the existence of inequities in breastfeeding care and underscore the need to address and eliminate breastfeeding disparities. IMPACT: This study addressed how patient exposure to best practices in breastfeeding support relates to breastfeeding outcomes and whether exposure and outcomes differ by patient or provider characteristics, connecting this to the Missed Care in Breastfeeding Support Model. The main findings were that higher reported exposure to best practices in breastfeeding support related to improved breastfeeding outcomes; inequities exist in exposure to best practices; and patients and providers identify the importance of providers' internal processes in the delivery of breastfeeding support, which aligns with the Missed Care in Breastfeeding Support Model. Study findings will have the potential to impact how nurses, lactation consultants and other providers who deliver breastfeeding support in the postpartum hospital setting. REPORTING METHOD: The authors adhered to relevant 2020 PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Participant-generated timelines as a novel strategy for assessing youth resilience factors: A mixed-methods, community-based study.

PURPOSE: The purpose of this study was to explore youth perceptions of resilience through participant-generated timelines as a potential new strategy for nursing research and practice. DESIGN AND METHODS: We used a concurrent triangulation design to collect and analyze qualitative and quantitative data from a statewide, community-based sample of 448 youth ages 8 to 17 years. We collected three sources of data during two waves of data collection in 2019 and 2021: a participant-generated timeline, a brief structured interview, and a PROMIS pediatric global health measure. RESULTS: The timeline activity was easy to administer and well accepted by youth in a community setting. Youth reporting an adverse experience or mental health challenge in the previous year had unique patterns of variability in the timelines, and more frequently reported certain resilience factors, including family support and regulatory, interpersonal, and meaning-making assets. Pandemic-related differences were noted between the two cohorts. CONCLUSIONS: The timeline drawing activity reflects and extends findings from a standard measure of global health. This activity benefits both the participant and the clinician or researcher by helping youth to communicate how they make sense of the world, honoring different ways of knowing and prompting recollection of coping appraisals and resilience factors. PRACTICE IMPLICATIONS: Participant-generated timelines are a developmentally appropriate and interactive strategy for assessing youth perceptions of their internal strengths. In conjunction with traditional assessments, this strategy may support the identification of malleable targets for intervention in practice with youth who have experienced adversity or mental health challenges.

Outcomes research on children with medical complexity: A scoping review of gaps and opportunities.

BACKGROUND: There has been a recent, rapid increase in the number of studies of children with medical complexity (CMC) and their families. There is a need for attention to gaps and patterns in this emerging field of study. OBJECTIVES: The purpose of this scoping review was to identify patterns and gaps in the evidence related to classification systems, data, and outcomes in studies of CMC. DATA SOURCES: We searched peer-reviewed journals for reports of quantitative studies focused on CMC outcomes published between 2008 and 2018. On the basis of a structured screening process, we selected 63 reports that met our inclusion criteria. STUDY APPRAISAL AND SYNTHESIS: We used the methodological framework for scoping studies described by Arskey and O'Malley to map relevant literature in the field and the ECHO model to categorize studies according to three health outcome domains (economic, clinical, and humanistic). RESULTS: The terminology used to describe and classify CMC differed across studies depending on outcome domain. Two thirds of the reports focused on economic outcomes; fewer than a quarter included child or family quality of life as an outcome. A majority of studies used a single source of data, with robust analyses of administrative, payer, and publicly available data. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Research on CMC and their families would benefit from standardization of terms and classification systems, the use of measurement strategies that map humanistic outcomes as trajectories, and more attention to outcomes identified as most meaningful to CMC and their families.

Parents' beliefs about and associations to their elementary children's home technology usage.

This study sought to gather information through a survey of how newcomer parents' beliefs about technology usage and how they engage with technology as they support their children with twenty-first century literacies. Parent respondents (N = 70) were drawn from two publicly funded schools in the Niagara Region, Ontario, Canada, where the population tends to be immigrant, visible minority, with post-secondary education, but unemployed and low income. Descriptive statistics quantified daily technology activities as being communication-oriented with the majority of parents holding distinct beliefs about the amount and type of their children's technology usage. Chi-square tests indicated significant associations for demographic characteristics such as the gender, age, education, first language, and ethnicity of the parents as determinants of their beliefs about their children's technology usage (e.g., social media, mobile phones, television). As well, levels of access and use varied in terms of the number of new technologies and the types of literacy practices that families engage in. Immigrant parents might hold misconceptions about twenty-first century literacies, therefore there should be an attempt to assist them to provide responsive twenty-first century literacy and technology support for their children.

Bridging and Bonding: A Case for Prioritizing Social and Organizational Connectedness in Non-Profit Literacy Programming.

The present study contributes to the existing literature by highlighting the ways in which non-profit community literacy organizations can benefit individuals and communities in ways that transcend their stated missions. We employed a qualitative research design whereby data were collected via in-depth individual interviews and focus groups with program users (n = 72), staff (n = 11), and program leads (n = 8). Findings revealed that, in addition to supporting traditionally defined notions of literacy, programs presented participants with opportunities to cultivate bridging and bonding social capital. By way of the conditions created and programmatic measures employed within programs, bridging social capital often strengthened into deeper bonding ties between and amongst service users and, in many cases, staff and volunteers. Administrators and staff described efforts to create program cultures conducive to the development of social capital. The research illuminates how non-profit community entities can empower individual service users and their communities beyond their stated missions by fostering social and organizational connectedness, promoting communal cohesion and social trust, and cultivating typically unacknowledged talents, strengths and assets within marginalized communities.

Reporting of Classroom-Based Morphological Awareness Instruction and Intervention for Kindergarten to Grade 3 Students in the Literature: A Scoping Review.

PURPOSE: The purpose of this scoping review was to document how the literature reports morphological awareness instruction and interventions delivered by speech-language pathologists (SLPs) and/or educators in classroom settings for kindergarten to Grade 3 students. METHOD: We followed the Joanna Briggs Institute's methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. Six relevant databases were searched systematically with article screening and selection completed by two reviewers calibrated for reliability. For data charting, one reviewer extracted content and a second reviewer verified it was pertinent to the review question. Charting for the reported elements of morphological awareness instruction and interventions was guided by the Rehabilitation Treatment Specification System. RESULTS: The database search yielded 4,492 records. After removal of duplicates and screening, 47 articles were selected for inclusion. Interrater reliability for source selection exceeded the pre-established criterion of k = .61. Our analysis generated a comprehensive description of the elements of morphological awareness instruction as reported in the included articles. CONCLUSIONS: Our findings provide school-based SLPs and educators a systematic means of reviewing the literature to identify key elements of morphological awareness instruction in published articles for application of evidence-based practices with fidelity, thus helping to close the research-to-practice gap. Our manifest content analysis revealed reporting of the elements for classroom-based morphological awareness instruction was varied, and in some cases, underspecified in the articles included in our study. Implications for clinical practice and future research to advance knowledge and promote implementation of evidence-based practices by SLPs and educators in today's classrooms are discussed. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22105142.

Importance of human milk for infants in the clinical setting: Updates and mechanistic links.

INTRODUCTION: Human milk (HM) is the optimal source of nutrition for infants and has been implicated in multiple aspects of infant health. Although much of the existing literature has focused on the individual components that drive its nutrition content, examining HM as a biological system is needed for meaningful advancement of the field. Investigation of the nonnutritive bioactive components of HM and the maternal, infant, and environmental factors which affect these bioactives is important to better understand the importance of HM provision to infants. This information may inform care of clinical populations or infants who are critically ill, hospitalized, or who have chronic diseases and may benefit most from receiving HM. METHODS: In this narrative review, we reviewed literature examining maternal and infant influences on HM composition with a focus on studies published in the last 10 years that were applicable to clinical populations. RESULTS: We found multiple studies examining HM components implicated in infant immune and gut health and neurodevelopment. Additional work is needed to understand how donor milk and formula may be used in situations of inadequate maternal HM. Furthermore, a better understanding of how maternal factors such as maternal genetics and metabolic health influence milk composition is needed. CONCLUSION: In this review, we affirm the importance of HM for all infants, especially clinical populations. An understanding of how HM composition is modulated by maternal and environmental factors is important to progress the field forward with respect to mechanistic links between HM biology and infant health outcomes.

Exploring Adolescents' Critical Reading of Socioscientific Topics Using Multimodal Texts.

This qualitative within-individual case design study involved six adolescents (age 10-14 years) engaging in a think-aloud observational protocol to read two texts on climate change from contrasting viewpoints. The participants completed a prior knowledge assessment and survey of technology used to assess potential mediating factors. Survey and observational data are presented as participant profiles. Results illustrated the effect of participants' background knowledge, emotional elicitation of text features, cognitive dissonance argument analysis due to the contrasting multimodal texts, and impact of visual images on participants' comprehension. Our data analyses revealed that there is an interconnected and nuanced relationship amongst many text and individual factors when adolescents engage in critical reading of SSI multimodal texts. This research provides direction for future science education research that support learners in critical reading of complex socioscientific topics as presented in multimodal texts with adolescent learners. Supplementary Information: The online version contains supplementary material available at 10.1007/s10763-022-10280-8.

Human Milk Glucose, Leptin, and Insulin Predict Cessation of Full Breastfeeding and Initiation of Formula Use.

Objective: We aimed to investigate prospective associations between milk bioactives related to metabolic health (glucose, insulin, leptin, C reactive protein [CRP], and interleukin 6 [IL-6]) and incident formula initiation at 3 and 6 months postpartum. Design: This study included 363 mother-infant dyads who were fully breastfed at 1 month and participated in the prospective Mothers and Infants Linked for Healthy Growth study from pregnancy to 6 months postpartum. Associations between milk glucose, leptin, insulin, CRP, and IL-6 at 1 and 3 months and incident formula feeding (FF) at 3 and 6 months, respectively, were tested using multiple logistic regression, adjusting for numerous potential confounders such as maternal age and prepregnancy body mass index. Results: At 3 months postpartum, 1-month glucose (odds ratio [OR] 0.45 [95% confidence interval (CI): 0.27-0.75], p ≤ 0.01) and smaller decreases in glucose from 1 to 3 months (OR 0.51 [95% CI: 0.28-0.92], p = 0.03) were associated with lower odds of FF, whereas 1-month leptin (OR 2.30 [95% CI: 1.30-4.07], p < 0.01) and larger increase in insulin (OR 1.86 [95% CI: 1.23-2.81], p < 0.01) and leptin (OR 2.17 [95% CI: 1.29-3.68], p < 0.01) from 1 to 3 months were associated with increased odds of FF. At 6 months, insulin increases (OR 2.08 [95% CI: 1.03-4.17], p = 0.04) were associated with higher odds of FF. Conclusions: In a cohort of women with established lactation, 1-month milk glucose, insulin, and leptin predicted initiation of FF at 3 months. Early milk composition may provide a window into mammary gland function, allowing identification of women at risk of not meeting their breastfeeding goals.