Perceived Health Risks, Health Behaviors, and BMI Among Diverse Adults in Israel.

INTRODUCTION: Obesity is associated with an increased relative risk of COVID-19-related mortality. The interplay of culture and religion in the overweight/obesity context has been minimally examined. The purpose of this study was to examine the association between preventive health behaviors, sociodemographic factors, and obesity among religiously diverse adults in Israel. METHODS: Using a quantitative cross-sectional design, an online survey was distributed to diverse adults in Israel during the pandemic using social media, email, and snowball methods. RESULTS: Participants included 635 adults: 69.1% Jewish, 26.5% Muslim, and 4.4% "other." Jewish adults scored lower than others on perceived personal risk (p < .001), infection spread risk (p < .001), and preventive behaviors engagement (p < .005). Higher body mass index (BMI) predicted higher personal risk and higher likelihood of preventive behaviors engagement (p < .001). DISCUSSION: Results demonstrate the association between religion, health risk perceptions, and COVID-19-related health behaviors. Nurses should consider the influence of culture and religion on health practices and recommend relevant lifestyle modifications to reduce COVID-19 risks.

Influence of the Quality of Antenatal Care on Early Breastfeeding Initiation and Exclusive Breastfeeding Among Haitian Women.

OBJECTIVE: To assess the influence of the quality of antenatal care on early breastfeeding initiation and exclusive breastfeeding among Haitian women. DESIGN: Secondary analysis of a cross-sectional household survey. SETTING: Haiti Demographic and Health Survey, 2016 to 2017. PARTICIPANTS: Women (N = 2,489) who were 15 to 49 years of age with children younger than 24 months of age. METHODS: We used multivariable adjusted logistic regression analysis to examine the independent associations between quality of antenatal care and early breastfeeding initiation and exclusive breastfeeding. RESULTS: The prevalence of early breastfeeding initiation and exclusive breastfeeding were 47.7% and 39.9%, respectively. Approximately 76.0% of the participants received intermediate antenatal care. The odds of early breastfeeding initiation were greater among participants who received antenatal care of intermediate quality than among those who did not receive antenatal care, adjusted OR (AOR) = 1.58, 95% confidence interval (CI) [1.13, 2.20]. Additionally, maternal age of 35 to 49 years (AOR = 1.53, 95% CI [1.10, 2.12]) was positively associated with early breastfeeding initiation. Factors negatively associated with early breastfeeding initiation were cesarean birth (AOR = 0.23, 95% CI [0.12, 0.42]), birth at home (AOR = 0.75, 95% CI [0.34, 0.96]), and birth in a private facility (AOR = 0.57, 95% CI [0.34, 0.96]). Factors negatively associated with exclusive breastfeeding were employment (AOR = 0.57, 95% CI [0.36, 0.90]) and birth in a private facility (AOR = 0.21, 95% CI [0.08, 0.52]). CONCLUSION: Antenatal care of intermediate quality was positively associated with early breastfeeding initiation among women in Haiti, which highlights the influence that care during pregnancy can have on breastfeeding outcomes.

Factors associated with men's opinion about female genital mutilation in Ethiopia.

BACKGROUND: Female genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men's opinion about FGM in Ethiopia. OBJECTIVE AND AIMS: The present cross-sectional study used secondary data to identify factors associated with men's opinions about the practice of FGM. METHODS: Secondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men's opinion about FGM. Demographic, socioeconomic, and other characteristics were examined. RESULTS: Variables associated with men's support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = <0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = <0.001). CONCLUSION: Lack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Differences in Human Milk Lactose and Citrate Concentrations Based on Gestational Diabetes Status.

Background: Exclusive breastfeeding is the optimal manner of early infant nutrition but women with gestational diabetes mellitus (GDM) often experience challenges with lactation in the early postpartum period. Increases in the colostral metabolites of lactose and citrate have been found to indicate increased milk production. Materials and Methods: A follow-up study of 133 postpartum women with and without GDM was conducted to examine differences in specific colostral metabolite levels using enzymatic methods to determine transition to lactogenesis II during the first week postpartum. We used linear mixed models for repeated measures over time to examine the effect of GDM on colostral metabolite levels at baseline and follow-up with fixed effects of GDM status, time, covariates, and interactions between time and GDM, between time and time, and between time, time and GDM into the model allowing quadratic trends over time. Results: Over time, lactose and citrate levels increased for all mothers (p < 0.001 and p < 0.001, respectively), although mothers with GDM had consistently lower lactose and citrate levels compared with nondiabetic mothers (p = 0.004 and p = 0.014, respectively). Age, prepregnancy body mass index, mode of birth, and parity did not independently influence colostral concentrations of lactose and citrate. Conclusions: Findings suggest that the rate of change overtime in lactose and citrate concentrations differ by GDM status. Further research examining the trajectory of colostral metabolite levels by GDM status is warranted.

Infant feeding among women with a history of breast cancer.

PURPOSE: Health professional organizations recommend exclusive breastfeeding for 6 months, but there are mothers, such as those with a history of breast cancer, who are unable to exclusively provide their milk for their infants. Minimal research has been published on mothers' experience with lactation, breastfeeding, and bottle-feeding after breast cancer. This study explored mothers' perspectives of infant feeding after a history of breast cancer. METHODS: Qualitative interviews were completed with 20 mothers who had experience with infant feeding after breast cancer, including exclusive breastfeeding, partial provision of human milk with formula supplementation, and exclusive formula feeding. RESULTS: Mothers shared their perceptions, barriers, and experiences of infant feeding. Four themes were identified: miracle of motherhood after breast cancer, medical misinformation or no available information contributing to the exacerbation of mothers' worries, post-breast-cancer feeding challenges, and desire for infant-feeding support rather than pressure. CONCLUSIONS: Mothers who have had breast cancer and have since given birth face specific challenges to infant feeding which are compounded by limited resources and knowledge among healthcare providers. Findings of the study highlight the importance of healthcare professionals becoming more educated to provide adequate support and evidence-based information on lactation and infant feeding for women with a history of breast cancer. IMPLICATIONS FOR CANCER SURVIVORS: Understanding the experiences of women who have given birth after breast cancer can help women in similar situations know that they are not alone, identify resources, access peer support, and seek evidence-based infant feeding advice from healthcare providers involved in their care.

Association Between Type of Health Professional at Birth and Exclusive Breastfeeding.

INTRODUCTION: Although benefits of breastfeeding for infants, women, and society are well established, breastfeeding rates in the United States remain below the Healthy People 2020 goals. Various factors are known to influence breastfeeding practices. Limited research has been conducted to examine the influence of type of birth attendant on exclusive breastfeeding. METHODS: A cross-sectional analysis was conducted using data from the Infant Feeding Practices Study II collected between May 2005 and June 2007. RESULTS: The study sample included 2026 women, aged 18 years or older. At discharge, 74.6% of women exclusively breastfed, and 27.6% exclusively breastfed at 3 months postpartum. Bivariate analysis showed a statistically significant association between type of health professional at birth and exclusive breastfeeding at discharge (P = .001) and 3 months postpartum (P < .001). After adjusting for potential confounders, the association between type of health professional at birth and exclusive breastfeeding at discharge was no longer significant. However, the odds of exclusive breastfeeding at 3 months postpartum were higher among women whose birth was attended by a midwife or nurse-midwife compared to those whose birth was attended by an obstetrician (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.34-2.61; P < .001). DISCUSSION: Exclusive breastfeeding continuation may be influenced by the type of health professional attending the birth. In addition to having a skilled workforce, health care professionals involved in perinatal care need to be educated and trained to promote and support exclusive breastfeeding as recommended. The complex and multifactorial nature of the maternal decision to exclusively breastfeed requires broader understanding of contextual factors.

Influence of gestational diabetes mellitus on fatty acid concentrations in human colostrum.

OBJECTIVE: The aim of this study was to examine differences in fatty acid concentrations in colostrum of women with and without gestational diabetes mellitus (GDM). The effect of GDM on fatty acid composition of colostrum is not fully understood, although rates of GDM are increasing globally. METHODS: A prospective case-control study was conducted of postpartum women with and without GDM. Gas chromatographic analysis was conducted to examine differences in colostral fatty acids of the colostrum samples of 29 women with and 34 without GDM. RESULTS: Analyses of the fatty acid composition revealed significantly higher concentrations of four essential ω-6 polyunsaturated fatty acids-γ-linolenic, eicosatrienoic, arachidonic, and docosatetraenoic-in the colostrum of GDM women compared with non-GDM women. Timing of collection influenced saturated medium chain fatty acid and monounsaturated fatty acid levels. CONCLUSIONS: Differences in concentrations of ω-6 fatty acids but not in dietary linoleic fatty acid or ω-3 fatty acids suggest that altered concentrations are attributed to changes in specific endogenous metabolic pathways. Implications of higher concentrations of ω-6 fatty acids in the colostrum of women with GDM have yet to be determined. Timing of colostrum collection is critical in determining colostral fatty acid and metabolite concentrations.

Association of Breastfeeding and the Federal Poverty Level: National Survey of Family Growth, 2011-2013.

Breastfeeding is strongly endorsed in the Healthy People 2020 goals; however, there remain many disparities in breastfeeding prevalence. The purpose of this study was to examine the association between breastfeeding and the Federal Poverty Level in the United States. Data from 5,397 women in the National Survey of Family Growth 2011-2013 survey were included in this study. The data were analyzed for descriptive features and logistic regressions of the Federal Poverty Level on breastfeeding. There were 64.1% of women who reported breastfeeding. Over one-third (35.2%) of women reported having a household income of 0-99% of the Federal Poverty Level. There were 15.2% of women who reported an income of 400% and above the Federal Poverty Level. With statistical adjustment for maternal age, race/ethnicity, education, marital status, parity, preterm birth, birth weight, insurance, and dwelling, the Federal Poverty Level was not significantly associated with breastfeeding. In this recent survey of mothers, Federal Poverty Level was not shown to be a significant factor in breastfeeding.

Association between History of Gestational Diabetes and Exclusive Breastfeeding at Hospital Discharge.

BACKGROUND: Exclusive breastfeeding is recommended in the first 6 months of life, especially for infants born to women with a history of gestational diabetes mellitus (GDM). Yet, women with a history of GDM face challenges with exclusive breastfeeding in the early postpartum period, a critical period for setting up longer term breastfeeding success. Minimal research has been published on associated risk factors for not exclusively breastfeeding. OBJECTIVE: The purpose of this study was to examine the association between GDM and exclusive breastfeeding at hospital discharge. METHODS: We conducted a cross-sectional analysis including 2038 women who participated in the population-based Infant Feeding Practices Study II between May 2005 and June 2007. RESULTS: Gestational diabetes mellitus prevalence was 5.8%. The crude prevalence of exclusive breastfeeding at hospital discharge was 62.2% among women with GDM compared to 75.4% of women without GDM (P < .01). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding were lower among women with GDM compared to women without diabetes (odds ratio = 0.59; 95% confidence interval, 0.39-0.92). Furthermore, women who had gestational weight gain (GWG) below the Institute of Medicine guidelines had lower odds of exclusive breastfeeding compared to women who had normal GWG (odds ratio = 0.62; 95% confidence interval, 0.45-0.85). CONCLUSION: Women with GDM history and women with inadequate GWG may need additional education to promote exclusive breastfeeding during maternal hospital stay. It is important for health care providers to assess both factors when providing education on exclusive breastfeeding and to support these women's breastfeeding efforts in the early postpartum period to maximize potential for longer term breastfeeding success.

Women's Experiences With Early Breastfeeding After Gestational Diabetes.

OBJECTIVE: To explore the lived experience of early breastfeeding for postpartum women who had gestational diabetes mellitus (GDM) in pregnancy. DESIGN: A qualitative phenomenological research design. SETTING: Participants were recruited from community hospitals, postpartum clinics, and lactation clinics in rural and urban facilities in the Midwest and Atlantic Regions of the United States. PARTICIPANTS: A purposive sample of 27 women who had been diagnosed with GDM and who had initiated breastfeeding following delivery. METHODS: Questions were used as prompts to initiate conversation and to provide structure for focus group discussions and interviews. Data were analyzed independently and then collaboratively with the researchers and experts to compare findings, including interpretations and concerns before revisions were made in preparation of the final, composite description. RESULTS: Three themes emerged from the data reflecting the participants' interpreted experience: Breastfeeding Challenges and Breastfeeding Support, Milk Supply Challenges, and Concern for Infant Health. Delayed lactogenesis II was reported by 30% of the women, and 44% perceived decreased milk supply. CONCLUSIONS: Participants identified breastfeeding facilitators and barriers, many of which could have been modified. The women expressed a need for consistent lactation advice, education, assistance, and strategies to address breastfeeding challenges and milk supply issues.

The human colostrum whey proteome is altered in gestational diabetes mellitus.

Proteomics of human milk has been used to identify the comprehensive cargo of proteins involved in immune and cellular function. Very little is known about the effects of gestational diabetes mellitus (GDM) on lactation and breast milk components. The objective of the current study was to examine the effect of GDM on the expression of proteins in the whey fraction of human colostrum. Colostrum was collected from women who were diagnosed with (n = 6) or without (n = 12) GDM at weeks 24-28 in pregnancy. Colostral whey was analyzed for protein abundances using high-resolution, high-mass accuracy liquid chromatography tandem mass spectrometry. A total of 601 proteins were identified, of which 260 were quantified using label free spectral counting. Orthogonal partial least-squares discriminant analysis identified 27 proteins that best predict GDM. The power law global error model corrected for multiple testing was used to confirm that 10 of the 27 proteins were also statistically significantly different between women with versus without GDM. The identified changes in protein expression suggest that diabetes mellitus during pregnancy has consequences on human colostral proteins involved in immunity and nutrition.

OSA symptoms associated with and predictive of anxiety in middle-aged men: secondary analysis of NHANES data.

OBJECT: This population-based study examined obstructive sleep apnea (OSA) symptoms predictive of anxiety in middle-aged men. METHOD: Secondary analyses were conducted on the National Health and Nutrition Examination Survey (NHANES) 2007-2008 data using weighted samples and complex sample analysis techniques (unweighted N=1,217). FINDINGS: Nonrefreshing sleep (χ(2)=69.333, p<0.001), excessive daytime sleepiness (χ(2)=47.766, p<0.001), and sleep fragmentation (χ(2)=30.692, p<0.001) were significantly associated with anxiety. Nonrefreshing sleep (OR 3.582, p<0.001) and awakenings due to apneic episodes (OR 2.047, p=0.001) were predictive of anxiety. CONCLUSION: Comorbid anxiety and OSA symptoms are common and have implications for activities of daily living, social responsibilities, and quality of life. Screening for anxiety among men with OSA symptoms is recommended.

Review of interventions to increase hearing protective device use in youth who live or work on farms.

AIMS AND OBJECTIVES: To identify and compare hearing protection interventions for youth working and living on farms. BACKGROUND: Noise-induced hearing loss represents a significant risk factor for injury, disability and death in agricultural populations due to an inability to receive sensory information that can indicate dangerous situations. Despite the availability of hearing protection devices, rates of utilisation remain low, while rates of noise-induced hearing loss are high within the agricultural youth population. DESIGN: Comprehensive review of the literature. METHOD: Electronic database searches were conducted to identify research studies of hearing protection interventions for youth living or working on farms. RESULTS: Three intervention studies were identified as meeting the review criteria, with additional reanalysis studies based on the original intervention studies. The intervention studies demonstrated increased use of hearing protection devices among youth who received the interventions compared to the control groups although audiometry testing results were not improved as a result of the intervention. CONCLUSIONS: The findings of this review highlight the need for additional research into the effectiveness of hearing protection device use as a noise-induced hearing loss preventative measure in youth who live or work on farms and the creation of effective interventions to increase hearing protection device use and decrease Noise-induced hearing loss risk. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurses be educated in the areas of health promotion relevant to farming communities to be able to effectively meet their rural clients' needs in relation to noise-induced hearing loss. Working with youth, families, and schools, as well as developing community partnerships, can facilitate the dissemination of hearing protection promotion.

Academic integrity in the online learning environment for health sciences students.

BACKGROUND: The online learning environment not only affords accessibility to education for health sciences students, but also poses challenges to academic integrity. Technological advances contribute to new modes of academic dishonesty, although there may be a lack of clarity regarding behaviors that constitute academic dishonesty in the online learning environment. OBJECTIVE: To evaluate an educational intervention aimed at increasing knowledge and improving attitudes about academic integrity in the online learning environment among health sciences students. DESIGN: A quasi-experimental study was conducted using a survey of online learning knowledge and attitudes with strong reliability that was developed based on a modified version of a previously developed information technology attitudes rating tool with an added knowledge section based on the academic integrity statement. SETTING: Blended-learning courses in a university health sciences center. PARTICIPANTS: 355 health sciences students from various disciplines, including nursing, pre-medical, and exercise physiology students, 161 in the control group and 194 in the intervention group. METHOD: The survey of online learning knowledge and attitudes (SOLKA) was used in a pre-post test study to evaluate the differences in scores between the control group who received the standard course introduction and the intervention group who received an enhanced educational intervention about academic integrity during the course introduction. RESULTS: Post-intervention attitude scores were significantly improved compared to baseline scores for the control and intervention groups, indicating a positive relationship with exposure to the information, with a greater improvement among intervention group participants (p<0.001). There was a significant improvement in the mean post-intervention knowledge score of the intervention group compared to the control group (p=0.001). CONCLUSION: Recommendations are provided for instructors in promoting academic integrity in the online environment. Emphasis should be made about the importance of academic integrity in the online learning environment in preparation for professional behavior in the technologically advancing health sciences arena.

Sexual health behaviors in a random sample of students at a Mid-Atlantic university: 2010-2011.

College students represent a unique population of interest to researchers, college health clinic and wellness program directors, as well as policy makers who are interested in promoting sexual health and well-being in young adults. In order to better understand the needs of this population, a large public, Land-grant University in the Mid-Atlantic region participated in the National College Health Assessment survey during 2010 and 2011. A stratified random sample of full-time undergraduate and graduate students was invited to participate in an online survey. The final sample included 2,304 students. Descriptive statistics using Chi-square highlight the relationships between student sexual practices, sexual health screening and prevention practices, and receipt of sexual health education at the university. Regression analysis was conducted to examine the factors associated with receipt of sexual health education. Implications for college health and wellness stakeholders are discussed.