Use of telelactation interventions to improve breastfeeding outcomes among mothers: A mixed-studies systematic review.

BACKGROUND: Breastfeeding has multiple positive impacts on infants, mothers, and the economy. PROBLEM: However, the global breastfeeding rates fall short of the World Health Organization's recommendations. Telelactation interventions have been shown to improve breastfeeding outcomes, yet this field has not been systematically reviewed. AIM: This mixed-studies systematic review aims to consolidate and synthesize findings on the available evidence of telelactation interventions on breastfeeding outcomes, uptake of these interventions, and provide recommendations for future lactation interventions. METHODS: A literature search was conducted in six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and Scopus) and one gray literature (Mednar) from their inception date to October 2021. Thirteen articles met the selection criteria, and thematic synthesis was conducted to consolidate and synthesize findings from the included studies. FINDINGS: Three themes and nine subthemes were identified: (1) Attributes and receptivity of telelactation interventions, (2) Benefits associated with telelactation interventions, and (3) Recommendations and improvement opportunities. DISCUSSION: Telelactation interventions were well-received by stakeholders (mothers, fathers, and healthcare providers), and receptivity was found to be influenced by primiparity and the perceived usefulness of telelactation consultations (extrinsic motivation). These interventions showed promising improvement in the provider-user relationship and breastfeeding outcomes. Future studies should make telelactation user-friendly, secure their telelactation platforms, increase communication options and built-in functions, and improve care continuity. CONCLUSION: This review highlighted the advantages, recommendations, and future considerations for telelactation interventions. More research is needed to pilot telelactation interventions in various regions and obtain longitudinal data with different time points.

Childhood vaccinations: Hidden impact of COVID-19 on children in Singapore.

Although the direct health impact of Coronavirus disease (COVID-19) pandemic on child health is low, there are indirect impacts across many aspects. We compare childhood vaccine uptake in three types of healthcare facilities in Singapore - public primary care clinics, a hospital paediatric unit, and private paediatrician clinics - from January to April 2020, to baseline, and calculate the impact on herd immunity for measles. We find a 25.6% to 73.6% drop in Measles-Mumps-Rubella (MMR) uptake rates, 0.4 - 10.3% drop for Diphtheria-Tetanus-Pertussis-inactivated Polio-Haemophilus influenza (5-in-1), and 8.0-67.8% drop for Pneumococcal conjugate vaccine (PCV) across all 3 sites. Consequent herd immunity reduces to 74-84% among 12-month- to 2-year-olds, well below the 95% coverage that is protective for measles. This puts the whole community at risk for a measles epidemic. Public health efforts are urgently needed to maintain efficacious coverage for routine childhood vaccines during the COVID-19 pandemic.

Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: A mixed-method study.

BACKGROUND: End-of-life care is becoming more prevalent in the Emergency Department. Quality end-of-life care includes spiritual support. As spirituality is a relatively vague concept, understanding healthcare professionals' spiritual perspectives is important. AIMS: To explore the perspectives of Emergency Department doctors and nurses in (i) spirituality, (ii) spiritual care domain in end-of-life care and (iii) factors influencing spiritual care provision in the Emergency Department. DESIGN: A sequential explanatory mixed-method design was used. SETTING: An Emergency Department of a tertiary teaching hospital in Singapore, which treats more than 120,000 patients annually. PARTICIPANTS: This study involved Emergency Department doctors and nurses who meet the eligibility criteria. In phase one, 64 doctors and 112 nurses were recruited. In phase two, 14 doctors and 15 nurses participated. METHODS: The quantitative phase was conducted first using a socio-demographic form and validated Spiritual Care-Giving Scale on all potential participants. The Spiritual Care-Giving Scale explores one's perspectives of spirituality and spiritual care. Using a six-point Likert scale, participants would indicate their degree of agreement towards the statements. The qualitative phase was then conducted using focus group discussions on a convenience sample of 14 doctors and 15 nurses. RESULTS: Overall, participants had positive attitudes and understanding of spirituality and spiritual care, as the mean total Spiritual Care-Giving Scale score was 167.87 (SD=24.35) out of 210. Some knowledge deficits were observed in the focus group discussions as several participants equated spirituality to religion and had limited understanding about spiritual care. Significant differences between the spiritual perspectives of doctors and nurses were reported in Spiritual Perspectives (p-value=0.018) and Spiritual Care Values (p-value=0.004) of the Spiritual Care-Giving Scale. Scores by nurses were higher than those of doctors. CONCLUSION: The study findings emphasized the need for education regarding spirituality and spiritual care across different cultures. This may help healthcare professionals feel more competent to broach such issues and cope with the emotional burden when providing spiritual care.