Parental leave policies in general surgery residencies.

BACKGROUND: Prospective residents use program websites to glean information regarding parental leave policies. This study investigates the online availability and content of parental leave policies for general surgery residency programs. METHODS: Parental leave policy information was collected from general surgery residency program and Graduate Medical Education (GME) websites. Descriptive statistics and multivariable logistic regression were used for analysis. RESULTS: Of the 344 general surgery residency programs, parental leave policies were found on 6% of program and 52% of GME websites. Family Medical Leave Act policies were reported the most, followed by maternity, then paternity, and then adoption/other clauses. Academic programs, program location in the Southeastern US and larger program size were all significant predictors of online policy availability. CONCLUSIONS: General surgery parental leave policies vary and are not readily available online. These findings identify a significant opportunity for surgery residency programs to improve the disclosure of parental leave policy information.

Pregnancy in physicians: A scoping review.

BACKGROUND: The personal health and professional impact of physician pregnancy requires further study. We performed a comprehensive scoping review of physician pregnancy to synthesize and assess the evidence to aid decision-making for relevant stakeholders. METHODS: A search of 7 databases resulted in 3733 citations. 407 manuscripts were included and scored for evidence level. Data were extracted into themes using template analysis. RESULTS: Physician pregnancy impacted colleagues through perceived increased workload and resulted in persistent stigmatization and discrimination despite work productivity and academic metrics being independent of pregnancy events. Maternity leave policies were inconsistent and largely unsatisfactory. Women physicians incurred occupational hazard risk and had high rates of childbearing delay, abortion, and fertility treatment; obstetric and fetal complication rates compared to controls are conflicting. CONCLUSIONS: Comprehensive literature review found that physician pregnancy impacts colleagues, elicits negative perceptions of productivity, and is inadequately addressed by current parental leave policies. Data are poor and insufficient to definitively determine the impact of physician pregnancy on maternal and fetal health. Prospective risk-matched observational studies of physician pregnancy should be pursued.

Impacto de la extensión del postnatal en la adherencia a la lactancia materna: estudio de cohorte / The impact of the extension of the post-natal in the adherence to breastfeeding: cohort study

INTRODUCCIÓN: En Chile, el año 2011 entró en vigencia la ley 20.545, correspondiente a la extensión del postnatal de 12 a 21 semanas. La Encuesta Nacional de Lactancia Materna (ENALMA), aplicada posterior al postnatal extendido, reportó un aumento del 12% en la adherencia a la lactancia materna exclusiva (LME) al sexto mes. Sin embargo, un 63% de las mujeres encuestadas eran laboralmente inactivas, por lo que las principales causas de cese de LM (lactancia materna) no estaban relacionadas con el tiempo de descanso materno. OBJETIVOS: Calcular el impacto de los cambios en la adherencia a la LME en pacientes atendidos en control sano, en el período previo y posterior a la entrada en vigencia del post natal extendido. MATERIALES Y MÉTODOS: Se realizó la extracción de datos de las fichas electrónicas del Centro Médico San Joaquín entre los años 2009 a 2013, los cuales fueron reclutados según criterios de inclusión y exclusión especificados (n = 938 pacientes). Posteriormente, fueron divididos en 2 grupos, según la presencia o ausencia de postnatal extendido, con seguimiento a los 3, 6 y 12 meses. Mediante tablas de frecuencia se realizó la caracterización de los grupos al comienzo del periodo de observación. Para evaluar homogeneidad de grupos, las variables del estudio se compararon entre los grupos mediante los test de chi cuadrado y Wilcolxon Mann-Whitney. Se comparó la prevalencia de mantención de LME mediante pr-test entre los grupos a los 3, 6 y 12 meses. Mediante análisis de sobrevida y regresión de Cox, se calculó el impacto del efecto del postnatal extendido entre ambos grupos en los primeros 12 meses. RESULTADOS: Al comienzo de los periodos de observación, no se observaron diferencias entre los grupos en las variables estudiadas. Al comparar ambos grupos, sin y con postnatal extendido, no se encontraron diferencias significativas en la adherencia a la LME a los 3 meses: 327(66%) vs 302(68%), p = 0,492, respectivamente. En contraste, en el seguimiento a 6 y 12 meses se evidenció un aumento en la adherencia a la LME: 164 (33%) a 187 (42%), p = 0,004 y a los 12 meses; de 51 (10%) a 72 (16%), p = 0,007. Al analizar el impacto de la extensión del postnatal en la adherencia a la lactancia materna, determinado por la razón de riesgo, el postnatal extendido podría influir positivamente en la adherencia a la LME en el tiempo, con un HR < 1 (HR: 0,852, p = 0,04 IC 95%: 0,728-0,996). CONCLUSIÓN: el aumento del tiempo de descanso materno, podría influir como factor protector de la adherencia a la LME.

INTRODUCTION: In Chile, Law 20,545 came into force in 2011, extending the maternity leave from 12 to 21 weeks. The National Breastfeeding Survey (ENALMA, in Spanish), applied after the exten ded maternity leave, reported a 12% increase in adherence to exclusive breastfeeding (EBF) at the sixth month. However, 63% of the women surveyed were unemployed, therefore, the main causes of cessation of breastfeeding (BF) were not related to maternal rest time. OBJECTIVES: To calculate the impact of changes in the EBF adherence in patients who attend to well-child visits in the period before and after the entry into force of the extended maternity leave. MATERIALS AND METHODS: Data were collected from electronic medical records of the San Joaquin Health Center between 2009 and 2013, which were recruited according to specified inclusion and exclusion criteria (n = 938 patients). Subsequently, they were divided into two groups according to the presence or absence of the ex tended maternity leave and with follow-up at three, six and 12 months. Using frequency tables, the characterization of the groups was carried out at the beginning of the observation period. To evaluate group homogeneity, study variables were compared between groups using Chi-square and Wico- lxon Mann-Whitney tests. The prevalence of EBF maintenance was compared by pr-test between the groups with follow-up at three, six and 12 months. Using survival analysis and Cox regression, the impact of the extended maternity leave effect between both groups in the first 12 months was cal culated. RESULTS: At the beginning of the observation periods, no differences were observed between the groups in the studied variables. When comparing groups, without and with extended maternity leave, there were no significant differences in EBF adherence at three months: 327 (66%) versus 302 (68%), p = 0.492, respectively. However, in the groups in follow-up at six and 12 months, there was an increase in EBF adherence from 164 (33%) to 187 (42%), p = 0.004 and from 51 (10%) to 72 (16), p = 0.007, respectively. Analyzing the impact of the maternity leave extension on the adherence to breastfeeding, determined by risk ratio, this extension may positively influence on the adherence to EBF over time, with a HR < 1 (HR: 0.852, p=0.04 CI 95%: 0.728-0.996). CONCLUSION: Increased ma ternal resting time may influence as a protective factor for adherence to EBF.

Tendencia de la lactancia materna exclusiva en Chile antes y después de la implementación de la Ley postnatal parental / Trend of exclusive breastfeeding in Chile before and after the parental postnatal law

INTRODUCCIÓN: Dada la implementación de la ley postnatal parental en niños atendidos en sistema público de salud, el objetivo de este estudio es describir la tendencia de la lactancia materna exclusiva (LME) al sexto de mes de vida en Chile antes y después de la implementación de la ley postnatal parental. MATERIAL Y MÉTODO: Estudio observacional de tipo poblacional, a partir de los datos de LME hasta el sexto mes obtenidos de los registros estadísticos mensuales (REM), disponibles en el Departamento de Información y Estadísticas en Salud de niños atendidos en el sistema público de salud. Se determinó la prevalencia y la prevalencia ponderada por región y país. Se analizó la variación porcentual acumulada (VP) y variación porcentual anual (VPA) de la prevalencia utilizando un modelo de regresión lineal en el período antes (2008-2011) y después (2011-2013) de la implementación de la ley. RESULTADOS: La mayor prevalencia de LME se observó en los años 2008 (49,1%) y 2009 (45,1%) y la menor en el año 2011(41,1%). Las regiones de Antofagasta (33,6%) y Atacama (31,6%) presentaron la menor prevalencia ponderada del período 2008-2013. Se observó una VPA negativa en el período 2008-2011 y una VPA positiva en el período 2011-2013 en todas las regiones y en el país, con excepción de la región del Gral. Libertador B. O'Higgins. CONCLUSIONES: La promulgación de la ley que aumenta el postnatal de 12 a 24 semanas revierte la tendencia decreciente de la LME al sexto mes. Esto podría incentivar a otros gobiernos para invertir recursos y esfuerzos en la primera infancia aportando a la equidad y la salud.

INTRODUCTION: To describe the trend of exclusive breastfeeding (EBF) until sixth month of life in Chile before and after the implementation of the parental postnatal law in children treated in the public health system. MATERIAL AND METHOD: An observational and population-based study, using the EBF data up to the sixth month obtained from monthly statistical records (MSR), available at the Department of Information and Statistics on Health of children treated in the public health system. Prevalence and weighted prevalence were determined by region and country. Cumulative percentage variation (PV) and annual percentage variation (APV) of prevalence were analyzed using a linear regression model in the period before (2008-2011) and after (2011-2013) of the implementation of the law. RESULTS: The highest prevalence of EBF was observed in 2008 (49.1%) and 2009 (45.1%) and the lowest in 2011 (41.1%). The Antofagasta (33.6%) and Atacama Region (31.6%) had the lowest weighted prevalence of the period. A negative APV was observed in the period 2008-2011 and a positive APV in the period 2011-2013 in all regions and in the country, except for the B. O'Higgins Region. CONCLUSIONS: The enactment of the law that increases EBF until 24 weeks of life reverses the decreasing tendency previosly observed until the sixth month. This could encourage other governments to invest resources and efforts in early childhood by providing equity and health.

[Surgery During Pregnancy - Regulations and Requirements]. / Operieren während der Schwangerschaft ­ Regelungen und Bedarfe.

Due to the marked increase in the numbers of women in medicine, professional and political discussions on equality among doctors are gaining increasing attention. One such issue is "operating during pregnancy". As a result of existing legislation and federal regulations, it has been virtually impossible for pregnant surgeons to continue their surgical work. After approval by the Federal Council or Bundesrat, the revised Maternity Protection Act will come into force on 01.01.2018. It will thereafter be easier for surgeons to operate during pregnancy. The focus will now be on the transformation of workplace practices, in which individual risk assessments of the participating surgeons will be carried out in order to achieve a risk-adapted operation, and thus to prevent premature and unwanted restrictions on the employment of pregnant female surgeons.

Custos da ampliação da licença-paternidade no Brasil / Costs of the extension of the paternity leave in Brazil / Los costos de la ampliación del permiso de paternidad en Brasil

Resumo Há uma crescente literatura empírica documentando que educação e cuidado parental de qualidade estão associados com um melhor desenvolvimento emocional e cognitivo da criança. Diante disso, governos de vários países vêm promovendo mudanças nas suas leis trabalhistas, com o objetivo de dar suporte financeiro e legal (proteção do emprego) para as mães e também os pais com crianças recém-nascidas. O Brasil aprovou recentemente o Marco Legal da Primeira Infância (Lei n. 13.257/2016), que ampliou a licença-paternidade de 5 para 20 dias. Pouco se sabe, entretanto, sobre o impacto econômico desse tipo de política pública. O presente trabalho procura quantificar os custos intertemporais do custo econômico direto da extensão da licença-paternidade para o Brasil. Para isso utilizam-se microdados da Pesquisa Nacional por Amostra de Domicílios, indicadores do mercado de trabalho brasileiro e uma série de projeções populacionais para construir cenários estáticos para estimativas da probabilidade de os pais solicitarem o uso da licença. Os resultados indicam que a extensão da licença-paternidade para 20 dias tem baixo custo – cerca de R$ 100 milhões por ano no cenário mais provável, o que representa 0,01% da arrecadação federal em 2014. Conquanto a magnitude dos benefícios seja ainda desconhecida no Brasil, os resultados sugerem que esse tipo de intervenção será provavelmente custo-efetiva.

Resumen Existe una creciente documentación en la literatura empírica sobre la asociación entre la educación de calidad y el cuidado de los padres con un mejor desarrollo emocional y cognitivo de los niños. Por lo tanto, los gobiernos de varios países promueven cambios en sus leyes laborales destinadas al apoyo financiero y legal (protección del empleo) para madres y padres con hijos recién nacidos. Brasil aprobó recientemente el Marco da Primeira Infância (Ley 13.257/2016) que amplió el permiso parental de cinco a veinte días. Sin embargo, poco se sabe sobre el impacto económico de este tipo de política pública. Este artículo pretende cuantificar los costos de la extensión temporal del permiso de paternidad. A partir de datos de la Pesquisa Nacional por Amostra de Domicilios, de indicadores del mercado de trabajo y de las proyecciones de población, se estimó el costo de la extensión del permiso. Los resultados indican que el costo de esta ampliación de la licencia es bajo —cerca de R$ 100 millones por año en el escenario más probable, lo que representa 0,01% de los ingresos federales en 2014—. Aunque la magnitud de los beneficios de este tipo de intervención sea desconocida en Brasil, los resultados muestran que es probable que sea costo-efectiva.

Abstract There is a growing empirical literature documenting that quality in early education and parental care are associated with better emotional and cognitive development later in life. With this in mind, governments in several countries have changed labor laws in order to give more employment security for parents of the newborns aiming to give financial and legal support (employment protection). A law recently passed in Brazil has increased paternity leave from 5 to 20 working days of paid leave (Marco da Primeira Infância, Law 13.257/2016). Little is known, however, about the economic impacts of such a law. This paper aims at quantifying the costs of such increase in paternity leave. By utilizing the annual household survey microdata (Pesquisa Nacional por Amostra de Domicílios), some labor market indicators and a population projections series it is calculated fathers’ probability of claiming paternity benefits. Several long-range forecasts about the costs implementation produced. The results indicates that the increase in paid paternity leave, due to this change in the law, has relatively low cost – around 100 million Brazilian reais per year in the most likely scenario, an amount that is 0.01% of federal revenues in 2014. While the benefits of increasing paid paternity leave are still unknown in Brazil, the results suggest that this kind of intervention is likely to be cost-effective.

Public policy and breast-feeding: a straightforward and significant solution.

Ensuring working mothers' ability to breast-feed is crucial given that breast-feeding substantially reduces infant morbidity and mortality while promoting maternal health. Working conditions, rules on the job, supervisors and co-workers can all raise or lower barriers to breast-feeding. Around the world, 127 countries guarantee working women the right to breast-feed. Canada does not provide this assurance, despite the fact that the majority of infants are born to women in the labour force. This has profound implications for the health of infants and mothers alike. Solutions exist: extending current policies to ensure adequate maternity leave is available for all Canadians, legislating a right to breast-feed while working, and adapting workplaces to make this practical.

Evaluación económica de la prolongación del postnatal / Economic evaluation of prolonging the postnatal period

This study was ordered by the Board of Directors from the Chilean Paediatrics Society and sponsored by UMCEF. It reviews the medical benefits of breast feeding and the evidence of international maternity legislation in different countries, in order to expose the principal conclusions of this analysis. Besides, it reviews the Chilean situation in terms of rules, protection and political alternatives for promoting breast feeding. An evaluation of costs and benefits is performed for breast feeding, with special attention on savings in less artificial milk consumption, less infant morbidity and decrease in nursery school attendance. With this information, many recommendations promoting the benefits of a longer postnatal license are delivered.

Este estudio fue encargado por el directorio de la Sociedad Chilena de Pediatría con los auspicios de UMCEF. Revisa los beneficios médicos de la lactancia materna y la evidencia internacional de legislación durante la maternidad en diferentes países del mundo para entregar las principales conclusiones de este análisis. De igual manera se revisa la situación en Chile sobre normas y propuestas, aspectos de la protección, estudios realizados e identificación de alternativas de política para promover la lactancia materna. Se hace una evaluación de beneficios y costos de promover la lactancia materna con énfasis en el ahorro por menor consumo de leche de fórmula, el ahorro por menor morbilidad de los niños, las alternativas para promover la lactancia materna en las mujeres que trabajan, el ahorro por concepto de sala cuna y los costos asociados al beneficio. Con estos antecedentes se entregan principales recomendaciones que surgen de esta evaluación con claros beneficios en la prolongación del permiso postnatal.

[Impact of parent organisations in social aspects of cancer childhood care]. / Rô1e des associations de parents ans les aspects sociaux de la prise en charge des enfants cancéreux.

Since 1980, childhood cancer parent organisations study children and familial needs in the cancer of children context and give responses for all members of these families. Today, implications of parent organisations are done professionally and are varied. In regards with two examples, one in French social domain nd another in European therapeutic field, European regulation on medicinal products for paediatric use, we want to demonstrate how high quality partnerships build good developments and take part in "the best cure" for these children. The parents and medical staff are thus relieved of stress and daily preoccupations.

Radiología de esófago, estómago y duodeno en el estudio del lactante con regurgitación y/o vómitos habituales / Upper gastrointestinal radiography study rol in the vomiting children evaluation

El papel de la radiografía de esófago, estómago y duodeno (RxEED) en el estudio del niño con vómitos o regurgitación habitual, suele ser confuso en nuestro medio y en especial, en lo que se refiere a la pesquisa y valoración del reflujo gastroesofágico (RGE). El RGE es una condición fisiológica en el lactante menor; la Academia Americana de Pediatría considera a la RxEED como un procedimiento útil para la pesquisa de anormalidades anatómicas, y reitera que en los lactantes regurgitadores o con vómitos, su evaluación con mediciones antropométricas más una historia clínica y un examen físico cuidadoso son suficientes para formular el diagnóstico e iniciar tratamiento. El examen de RxEED puede ser molesto para los niños e implica la exposición a radiación ionizante. En nuestro medio es un examen muchas veces innecesario y sus resultados no son adecuadamente interpretados, ya sea por desconocimiento o por la insólita situación propia de Chile e inédita en el resto del mundo: la de una errada interpretación de la normativa legal en cuanto a la extensión de la licencia maternal en “enfermedades graves del hijo menor de un año”. Además de estandarizar la técnica del examen, es necesario un consenso en cuanto a sus indicaciones e interpretación. Un estudio reciente afirma que el uso de la RxEED en el niño, ha sido desvirtuado, tanto desde el punto de vista médico como económico y social, ya que es solicitado sin causas médicas justificadas en la inmensa mayoría de los casos y su indicación muchas veces sólo sirve de pretexto para documentar una condición fisiológica –que en este caso se instrumentaliza como patológica– con el fin de conceder licencias de trabajo maternales. La normativa vigente debería ser modificada para extender el período de licencia maternal postnatal a todas las madres sin excepción o bien buscar otras herramientas que permitan reconocer los casos que realmente requieren una extensión de ella y de esta manera terminar con esta práctica técnica, económica y éticamente discutible.