Breastfeeding: Expressing and supplementing.

BACKGROUND: Breastfeeding provides positive outcomes and is recommended by the World Health Organization and Australian health guidelines. While breastfeeding is the physiologically normal way to feed an infant, there are multiple reasons that supplemental feeds (ie feeds given in addition to breastmilk) may need to be given. OBJECTIVE: The aim of this article is to outline the current evidence and resources to support general practitioners to provide advice on breastfeeding when patients are expressing and supplementing. DISCUSSION: There are only a few absolute and relative contraindications to breastfeeding; however, breastfeeding may be disrupted because of lactation risk factors as well as physiological, psychological and socioeconomic reasons. If breastfeeding needs to be supplemented, families can use expressed breastmilk, donor milk or formula. Supplemental devices should be chosen on the basis of cost, ease of use and access, parental preference and preferably a method that aids breastfeeding. If breastfeeding difficulties can be rectified, decreasing supplements can be considered.

An RCT of a decision aid to support informed choices about taking aspirin to prevent colorectal cancer and other chronic diseases: a study protocol for the SITA (Should I Take Aspirin?) trial.

BACKGROUND: Australian guidelines recommend that all people aged 50-70 years old actively consider taking daily low-dose aspirin (100-300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical practice. We aim to test the efficacy of a health consultation and decision aid, using a novel expected frequency tree (EFT) to present the benefits and harms of low dose aspirin prior to a general practice consultation with patients aged 50-70 years, on informed decision-making and uptake of aspirin. METHODS: Approximately five to seven general practices in Victoria, Australia, will be recruited to participate. Patients 50-70 years old, attending an appointment with their general practitioner (GP) for any reason, will be invited to participate in the trial. Two hundred fifty-eight eligible participants will be randomly allocated 1:1 to intervention or active control arms using a computer-generated allocation sequence stratified by general practice, sex, and mode of trial delivery (face-to-face or teletrial). There are two co-primary outcomes: informed decision-making at 1-month post randomisation, measured by the Multi-dimensional Measure of Informed Choice (MMIC), and self-reported daily use of aspirin at 6 months. Secondary outcomes include decisional conflict at 1-month and other behavioural changes to reduce CRC risk at both time points. DISCUSSION: This trial will test the efficacy of novel methods for implementing national guidelines to support informed decision-making about taking aspirin in 50-70-year-olds to reduce the risk of CRC and other chronic diseases. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001003965 . Registered on 10 October 2020.

The frequency distribution of presenting symptoms in children aged six months to six years to primary care.

BACKGROUND: Primary care providers and researchers wishing to estimate study recruitment rates need estimates of illness frequency in primary care. Previous studies of children's symptoms have found that presentations are most common for the symptoms: cough, fever, earache, rash, diarrhoea and vomiting. Since 2000, primary care provision in the United Kingdom has changed with the introduction of Walk-in-Centres (WICs) and new Out of Hours (OoHs) providers. AIMS: To describe the type and frequency of parent-reported presenting symptoms at a range of primary care sites between 2005 and 2007. METHODS: Parent-reported presenting symptoms, recorded in their own words, were extracted from data collected from all children aged six months to six years during recruitment to a randomised controlled trial. Presenting symptoms were coded and presented as frequency per 100 'consulting sessions' by type of primary care site. FINDINGS: Results were evaluated from 2491 episodes of illness at 35 sites. When grouped by primary care site, respiratory symptoms were the most common at OoHs centres, the WIC and general practitioner (GP) surgeries. Trauma symptoms were common in the Emergency Department, but unexpectedly, diarrhoea and vomiting were more common in the Emergency Department and skin presenting symptoms more common at the WIC than at GP sites. CONCLUSIONS: We report the relative frequency of acute symptoms by type of primary care provider. These data may be useful to those planning recruitment to primary care paediatric studies and policy makers for planning primary care service provision.