Workforce Survey of Connecticut Midwives.

INTRODUCTION: Midwives in Connecticut lack resources for current, state-specific data regarding compensation, benefits, work hours, and scope of practice. The primary purpose of this study was to provide detailed information about the work and services provided by midwives in Connecticut and how they are compensated. METHODS: Certified nurse-midwives (CNMs) licensed in Connecticut were recruited for a 53-question online survey between October 2021 and February 2022. The survey included topics such as compensation, benefits, practice patterns, and precepting. RESULTS: For full-time salaried CNMs in Connecticut, compensation was higher than the national average for midwives. A majority of CNMs in the state work 40 hours per week or less in physician-owned private practices and are preceptors. DISCUSSION: For midwives planning to negotiate contracts in Connecticut, this report provides important information to ensure fair compensation and work hours. The survey also serves as a roadmap for midwives in other states who wish to collect and disseminate similar workforce data.

Comparison of obstetrician-gynecologists and family physicians regarding weight-related attitudes, communication, and bias.

OBJECTIVES: To assess physician perceptions regarding weight-related communication, quality of care, and bias in obstetrics-gynecology (OBGYN) and family physician (FP) practices. METHODS: A cross-sectional survey study based on a convenient sampling of OBGYN and FP was conducted. Physicians completed a 40-question survey assessing perceived obesity management and weight bias in caring for female patients with body mass index ≥25kg/m2. RESULTS: Reponses from 51 physicians (25 OBGYN and 26 FP) were received. There was no difference between specialties in satisfaction with care or level of confidence in treating patients with obesity. However, OBGYNs reported more negative perceptions of patients with obesity (mean score 19.2±3.3 vs. 15.0±4.0, p<0.001) and greater weight bias (11.8±2.0 vs. 9.7±2.5, p<0.01) compared to FPs. OBGYNs were also more likely to expect less favorable treatment outcomes (13.3±2.5 vs. 15.5±2.8. p<0.01). Physicians between 31-50 years old displayed a significantly higher perception of weight bias in their profession when compared to the reference 21-30year olds, and for each unit increase in self-reported BMI there was a 0.18 average increase in the composite score for perceived weight bias. CONCLUSIONS: OBGYN physicians reported significantly higher levels of weight bias than FP physicians, indicating a need for improved education in OBGYN training. CLINICAL TRIAL REGISTRATION: N/A.

Language exposure outside the home becomes more English-dominant from 30 to 60 months for children from Spanish-speaking homes in the United States.

Purpose: The purpose of the present study was to document the out-of-home exposure to English and Spanish experienced by children from Spanish-speaking homes in the United States during the preschool years. Methodology: Primary caregivers of 149 children from Spanish-speaking homes in South Florida reported on their children's language exposure. Data and analysis: Descriptive statistics and paired-samples t-tests described and compared children's exposure to English and Spanish outside the home. Multi-level modeling described trajectories of change and the influence of family characteristics on English and Spanish out-of-home exposure. Findings: Children heard more English than Spanish outside of their homes. Grandparents were the primary out-of-home source of exposure to Spanish. Language exposure in preschool and extracurricular activities was primarily English. From 30 to 60 months, English exposure increased, while Spanish exposure decreased. Within this general pattern, there was variability in children's out-of-home language exposure as a function of parents' language backgrounds and maternal education. Originality: Studies of bilingual children's language exposure have focused on home language use. The present study shows that out-of-home experiences are a significant source of exposure to societal language (SL) for children from language minority homes. Implications: For children in immigrant families, the home and family members outside the home are the primary sources of heritage language exposure. Out-of-home language experience is SL-dominant and increasingly so as children get older, although the degree to which this is the case differs depending on parental characteristics.

Clinical techniques in veterinary dermatology: regional anaesthesia of the canine and feline distal limb.

BACKGROUND: Local anaesthesia for procedures involving the distal limb are a useful component of balanced protocols to achieve effective procedural analgesia for patients. A ring block is an effective and straightforward technique. HYPOTHESIS/OBJECTIVE: To review and describe the ring block technique for local anaesthesia of the canine and feline distal limb. ANIMALS: Images of hospitalized patients were used. These photographs were obtained with owner permission. RESULTS: The clinical technique for the ring block of the canine or feline distal limb is described. CONCLUSIONS AND CLINICAL IMPORTANCE: The ring block can be implemented simply and successfully for a variety of procedures involving the distal limb to provide effective analgesia.

Implementing Delayed Umbilical Cord Clamping in Cesarean Birth Using a Novel Method: A Pilot Study of Feasibility and Safety.

INTRODUCTION: Although delayed cord clamping (DCC) is regarded as the standard of care for all vigorous newborns, those born via cesarean birth are less likely to be afforded this option, especially for longer than 30 to 60 seconds. This pilot study was undertaken to determine whether removal of the placenta before cord clamping to allow for DCC of at least 3 minutes during term, uncomplicated cesarean birth is feasible and without apparent safety issues in order to support a large prospective study on the benefits of this method. METHODS: Women having a term, uncomplicated cesarean birth who consented to the study were enrolled. Safety was assessed by comparing estimated maternal blood loss, newborn Apgar scores, temperatures, transcutaneous bilirubin levels, need for phototherapy, and neonatal intensive care unit admissions with a matched historical control group of women whose newborns had immediate cord clamping. Feasibility was measured by evaluating staff and maternal comfort with the intervention and by the ability to complete the protocol steps. RESULTS: Seventeen women consented to participate. The protocol was successfully completed in 94% of births. There were no differences in maternal and neonatal safety outcome measures between groups. There was high comfort level with the protocol among staff, and there was universal maternal satisfaction. DISCUSSION: This method of DCC in cesarean birth appears feasible and safe in this small pilot study and was associated with high maternal satisfaction and clinician comfort. Major organizations such as the American College of Nurse-Midwives and the World Health Organization have called for DCC of up to 3 to 5 minutes in all births, and this simple method has the potential to reach that goal in cesarean birth with minimal apparent risk. A large randomized controlled trial is warranted to determine the neonatal and maternal benefits and safety of this technique compared with a 30-to-60-second delay.

Expressive Vocabulary Development in Children from Bilingual and Monolingual Homes: A Longitudinal Study from Two to Four Years.

The early course of language development among children from bilingual homes varies in ways that are not well described and as a result of influences that are not well understood. Here, we describe trajectories of relative change in expressive vocabulary from 22 to 48 months and vocabulary achievement at 48 months in two groups of children from bilingual homes (children with one and children with two native Spanish-speaking parents [ns = 15 and 11]) and in an SES-equivalent group of children from monolingual English homes (n = 31). The two groups from bilingual homes differed in their mean levels of English and Spanish skills, in their developmental trajectories during this period, and in the relation between language use at home and their vocabulary development. Children with two native Spanish-speaking parents showed steepest gains in total vocabulary and were more nearly balanced bilinguals at 48 months. Children with one native Spanish- and one native English-speaking parent showed trajectories of relative decline in Spanish vocabulary. At 48 months, mean levels of English skill among the bilingual children were comparable to monolingual norms, but children with two native Spanish-speaking parents had lower English scores than the SES-equivalent monolingual group. Use of English at home was a significant positive predictor of English vocabulary scores only among children with a native English-speaking parent. These findings argue that efforts to optimize school readiness among children from immigrant families should facilitate their access to native speakers of the community language, and efforts to support heritage language maintenance should include encouraging heritage language use by native speakers in the home.