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1.
Medicine (Baltimore) ; 98(23): e15841, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169687

RESUMO

OBJECTIVE: The aim of the study was to determine whether exclusive breastfeeding or exclusive formula feeding is more cost-effective when a Canadian mother with HIV is adherent to antiretroviral therapy and has full virologic suppression. DESIGN: Current Canadian guidelines recommend that mothers with HIV practice exclusive formula feeding. This contradicts the updated World Health Organization (WHO) guidelines which recommend that mothers with HIV should breastfeed for ≥12 months while receiving support for antiretroviral therapy adherence. Due to the economic and health risks and benefits associated with each modality, there remains expert disagreement on whether the WHO recommendations should be adopted in high-income countries. METHODS: A microsimulation model was developed to estimate lifetime costs and effectiveness (i.e., infant's quality-adjusted life years) of a hypothetical group of 1,000,000 initially healthy, HIV-negative infants, if the mother with HIV was on antiretroviral therapy with full virologic suppression and either exclusive breastfeeding or exclusive formula feeding. The model was developed from the economic perspective of the Ontario Ministry of Health, taking into account direct costs associated with infant feeding modality as well as related indirect costs born out of the child's lifetime health outcomes. Uncertainties related to model parameters were evaluated using one-way and probabilistic sensitivity analyses. RESULTS: In comparison to exclusive formula feeding, exclusive breastfeeding was the dominant feeding modality (i.e., less costly and more effective) yielding cost-savings of $13,812 per additional quality-adjusted life year gained. Neither one-way nor probabilistic sensitivity analyses altered the conclusions. CONCLUSIONS: Despite the risk of HIV transmission, exclusive breastfeeding was more cost-effective than exclusive formula feeding. These findings merit review of current infant feeding guidelines for mothers with HIV living in high-income countries.


Assuntos
Antirretrovirais/uso terapêutico , Aleitamento Materno/economia , Fórmulas Infantis/economia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Mães , Resposta Viral Sustentada , Antirretrovirais/administração & dosagem , Canadá , Simulação por Computador , Análise Custo-Benefício , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Metanálise como Assunto , Modelos Econométricos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Anos de Vida Ajustados por Qualidade de Vida , Literatura de Revisão como Assunto
2.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31088893

RESUMO

BACKGROUND AND OBJECTIVES: Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines. METHODS: We performed purposive sampling of low-income Hispanic mothers (n = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached. RESULTS: Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies. CONCLUSIONS: Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.


Assuntos
Aleitamento Materno/economia , Abastecimento de Alimentos/economia , Hispano-Americanos , Mães , Obesidade Pediátrica/economia , Pobreza/economia , Adulto , Aleitamento Materno/tendências , Pré-Escolar , Feminino , Hospitais Públicos/economia , Hospitais Públicos/tendências , Humanos , Lactente , Masculino , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Pobreza/tendências , Gravidez
3.
Am J Med ; 132(8): 912-920, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30853481

RESUMO

Breastfeeding seems to be a low-cost intervention that provides both short- and long-term health benefits for the breastfeeding woman. Interventions to support breastfeeding can increase its rate, exclusivity, and duration. Internists often have a longitudinal relationship with their patients and can be important partners with obstetricians and pediatricians in advocating for breastfeeding. To play their unique and critical role in breastfeeding promotion, internists need to be knowledgeable about breastfeeding and its maternal health benefits. In this paper, we review the short- and long-term maternal health benefits of breastfeeding. We also discuss special considerations in the care of breastfeeding women for the internist.


Assuntos
Aleitamento Materno/tendências , Medicina Interna/educação , Aleitamento Materno/economia , Aleitamento Materno/métodos , Humanos , Medicina Interna/métodos , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Leite Humano/metabolismo , Leite Humano/microbiologia
4.
Matern Child Nutr ; 15(2): e12745, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30381867

RESUMO

Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a free breast pump service might be an acceptable and feasible incentive intervention to improve breastfeeding outcomes and reduce heath inequalities. To inform intervention development, we conducted an online survey with women recruited via social media using snowball sampling. Data were analysed descriptively (closed questions) with qualitative thematic analysis (free text). The survey was completed by 666 women, most of whom had recently breastfed and used a breast pump. Participants agreed that free pump hire (rental/loan; 567 women; 85.1%) or a free pump to keep (408; 61.3%) should be provided. Free text comments provided by 408 women (free pump) and 309 women (free hire) highlighted potential benefits: helping women to continue breastfeeding; express milk; overcome difficulties; and pump choice. Concerns are possible effect on breast milk supply, reduced breastfeeding, pumps replacing good support for breastfeeding, and pump hire hygiene. Personal and societal costs are important issues. Some suggested a pump service should be for low-income mothers, those with feeding difficulties or sick/preterm infants. A one-size service would not suit all and vouchers were proposed. Some suggested fees and deposits to prevent waste. To our knowledge, this is the first study reporting views about the acceptability of providing a free breast pump hire service. Mothers support and wish to have a say in breast pump service development. Future evaluations should address impact on feeding outcomes, professional support, hygiene for hired pumps, and costs.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Leite Humano , Mães/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Reino Unido , Adulto Jovem
5.
Breastfeed Med ; 13(8): 532-534, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30335485

RESUMO

In recent years, there has been renewed attention to the central role that clinicians and healthcare institutions can play to support women in initiating and sustaining breastfeeding through the first year of their infant's life. There has been, however, considerably less focus on how to support the breastfeeding needs of new mothers who return to work, particularly those who go back shortly after the birth of their infant. While many women intend to continue breastfeeding when they go back to work, about one-third report breastfeeding as a major challenge. For many women, the lack of paid family leave, limited flexibility with their work hours, and workplaces that offer few accommodations can make it especially hard for them to sustain breastfeeding. The Affordable Care Act (ACA) included many provisions that strengthened coverage for pregnant women and new mothers. In addition to coverage improvements, The ACA amended the Fair Labor Standards Act to require employers with 50 or more workers to provide reasonable break time and a private space that is not a bathroom for expressing milk. For women who breastfeed or who must express milk while they work, having health insurance benefits and Medicaid policies that cover the costs of lactation supplies and support services can make a difference in the decision to continue to provide their infants with breast milk through the first year of their lives and ultimately improve both maternal and infant outcomes in the long run.


Assuntos
Aleitamento Materno/economia , Política de Saúde , Cobertura do Seguro , Mulheres Trabalhadoras , Local de Trabalho/legislação & jurisprudência , Feminino , Humanos , Medicaid/economia , Patient Protection and Affordable Care Act/economia , Apoio Social , Estados Unidos
6.
Breastfeed Med ; 13(8): 544-548, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30335490

RESUMO

Breastfeeding rates in the United States continue to rise, but still fall short of goals for both initiation and continuation. Many different maternal demographic characteristics have been identified as risk factors for not breastfeeding, but the literature remains inconsistent. National and even state-level data may not reflect patterns seen at the local level. Clinicians and breastfeeding advocates should be aware of the general trends, but should more importantly become familiar with the predominant risk patterns in their local area and populations. This presentation for the Breastfeeding Summit reports on our findings regarding the influence of race and economic status on breastfeeding behavior among women in inner city Philadelphia, and makes a case for advocates and clinicians to explore these trends in their own, local populations.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/etnologia , Status Econômico/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Philadelphia , Fatores de Risco , Meio Social
8.
Curr Opin Pediatr ; 30(4): 591-596, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29782384

RESUMO

PURPOSE OF REVIEW: The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months after an infant is born. Although the recommendations are well known, mothers face barriers that make breastfeeding difficult. This article reviews the recent literature on barriers to breastfeeding as well as strategies for pediatricians to use to help women overcome them. RECENT FINDINGS: The mode of delivery, mother's socioeconomic status, return to work, and prenatal breastfeeding education have been reported as factors that influence breastfeeding. Family-centered models for breastfeeding, peer support groups, and technology have been studied as potential ways to help women meet their breastfeeding goals. SUMMARY: Pediatricians are the first providers to care for babies after hospital discharge and are likely the first doctors that mothers see after childbirth. These early visits create opportunities for pediatricians to learn about the barriers that their patients face and open the doors to addressing these barriers.


Assuntos
Aleitamento Materno/psicologia , Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Cuidado Pós-Natal/métodos , Grupos de Autoajuda , Aleitamento Materno/economia , Aleitamento Materno/etnologia , Feminino , Humanos , Lactente , Recém-Nascido , Pediatria
9.
PLoS One ; 13(4): e0194231, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29649245

RESUMO

BACKGROUND: Increasing breastfeeding rates have been associated with reductions in disease in babies and mothers as well as in related costs. 'Nourishing Start for Health (NoSH)', a financial incentive scheme has been proposed as a potentially effective way to increase both the number of mothers breastfeeding and duration of breastfeeding. AIMS: To establish women's relative preferences for different aspects of a financial incentive scheme for breastfeeding and to identify importance of scheme characteristics on probability on participation in an incentive scheme. METHODS: A discrete choice experiment (DCE) obtained information on alternative specifications of the NoSH scheme designed to promote continued breastfeeding duration until at least 6 weeks after birth. Four attributes framed alternative scheme designs: value of the incentive; minimum breastfeeding duration required to receive incentive; method of verifying breastfeeding; type of incentive. Three versions of the DCE questionnaire, each containing 8 different choice sets, provided 24 choice sets for analysis. The questionnaire was mailed to 2,531 women in the South Yorkshire Cohort (SYC) aged 16-45 years in IMD quintiles 3-5. The analytic approach considered conditional and mixed effects logistic models to account for preference heterogeneity that may be associated with a variation in effects mediated by respondents' characteristics. RESULTS: 564 women completed the questionnaire and a response rate of 22% was achieved. Most of the included attributes were found to affect utility and therefore the probability to participate in the incentive scheme. Higher rewards were preferred, although the type of incentive significantly affected women's preferences on average. We found evidence for preference heterogeneity based on individual characteristics that mediated preferences for an incentive scheme.Conclusions Although participants' opinion in our sample was mixed, financial incentives for breastfeeding may be an acceptable and effective instrument to change behaviour. However, individual characteristics could mediate the effect and should therefore be considered when developing and targeting future interventions.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Comportamento de Escolha , Mães , Adolescente , Adulto , Atitude Frente a Saúde , Feminino , Custos de Cuidados de Saúde , Humanos , Pessoa de Meia-Idade , Motivação , Pesquisa Qualitativa , Recompensa , Inquéritos e Questionários , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 18(1): 20, 2018 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-29310619

RESUMO

BACKGROUND: A cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6-8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial. METHODS: Semi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach. RESULTS: Women reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations. They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months. CONCLUSIONS: The scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry, number 44898617 , https://www.isrctn.com.


Assuntos
Aleitamento Materno/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Motivação , Logro , Adolescente , Adulto , Aleitamento Materno/economia , Comportamento de Escolha , Tomada de Decisões , Feminino , Humanos , Entrevistas como Assunto , Infuência dos Pares , Relações Profissional-Paciente , Pesquisa Qualitativa , Recompensa , Adulto Jovem
12.
Pharmacogenomics J ; 18(3): 391-397, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-28696420

RESUMO

Mothers with a CYP2D6 ultrarapid metabolizer phenotype may expose their infants to risk of adverse events when taking codeine while breastfeeding, by producing more of the active metabolite, morphine. Pharmacogenetic testing may be a valuable tool to identify such mothers, but testing can be costly. The objective of the study was to determine the incremental costs of genotyping to avert neonatal adverse events during maternal pharmacotherapy. A cost-effectiveness analysis, using a decision model, was performed with a hypothetical cohort of prenatal subjects. Parameter estimates, costs and ranges for sensitivity analyses were ascertained from the literature and expert opinion. Sensitivity analyses were conducted to assess the robustness of the results. Probabilistic sensitivity analysis revealed an incremental cost-effectiveness (ICER) of $10 433 (Canadian dollars) for genotyping compared to no genotyping per adverse event averted. Results were sensitive to hospital admission costs. The ICER was lower when evaluating only subjects having caesarean deliveries or those from ethnic populations known to have a high prevalence of ultra-rapid metabolizers. Although genotyping to guide pharmacotherapy was not cost saving, the cost to avert an infant adverse event may represent good value for money in specific populations. With a growing demand for personalized medicine, these findings are relevant for decision makers, clinicians and patients.


Assuntos
Citocromo P-450 CYP2D6/genética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética , Dor/tratamento farmacológico , Período Pós-Parto/genética , Aleitamento Materno/economia , Canadá , Codeína/efeitos adversos , Análise Custo-Benefício , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Feminino , Testes Genéticos/economia , Técnicas de Genotipagem/economia , Humanos , Lactente , Morfina , Dor/economia , Dor/genética , Dor/patologia , Período Pós-Parto/efeitos dos fármacos , Gravidez
13.
Matern Child Nutr ; 14(2): e12524, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28976114

RESUMO

There is limited and inconsistent empirical evidence regarding the role of economic factors in breastfeeding practices, globally. Studies have found both negative and positive associations between low income and exclusive breastfeeding (EBF). Employment, which should improve household income, may reduce EBF due to separation of mother and infant. In the context of a randomized controlled study of lipid-based complementary feeding in an urban slum in Cap Haitien, Haiti, we examined the economic factors influencing breastfeeding practices using mixed methods. Findings demonstrate relationships between urban context, economic factors, and breastfeeding practices. Poverty, food insecurity, time constraints, and limited social support create challenges for EBF. Maternal employment is associated with lower rates of EBF and less frequent breastfeeding. Extreme food insecurity sometimes leads to increased exclusive breastfeeding among Haitian mothers, what we call "last resort EBF." In this case, women practice EBF because they have no alternative food source for the infant. Suggested policies and programs to address economic constraints and promote EBF in this population include maternal and child allowances, quality child care options, and small-scale household urban food production.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Emprego/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Feminino , Abastecimento de Alimentos/economia , Haiti , Humanos , Lactente , Masculino , Pobreza/economia , População Urbana/estatística & dados numéricos
14.
Matern Child Nutr ; 14(1)2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28685958

RESUMO

Peer support is recommended by the World Health Organization for the initiation and continuation of breastfeeding, and this recommendation is included in United Kingdom (U.K.) guidance. There is a lack of information about how, when, and where breastfeeding peer support was provided in the U.K. We aimed to generate an overview of how peer support is delivered in the U.K. and to gain an understanding of challenges for implementation. We surveyed all U.K. infant feeding coordinators (n = 696) who were part of U.K.-based National Infant Feeding Networks, covering 177 National Health Service (NHS) organisations. We received 136 responses (individual response rate 19.5%), covering 102 U.K. NHS organisations (organisational response rate 58%). We also searched NHS organisation websites to obtain data on the presence of breastfeeding peer support. Breastfeeding peer support was available in 56% of areas. However, coverage within areas was variable. The provision of training and ongoing supervision, and peer-supporter roles, varied significantly between services. Around one third of respondents felt that breastfeeding peer-support services were not well integrated with NHS health services. Financial issues were commonly reported to have a negative impact on service provision. One quarter of respondents stated that breastfeeding peer support was not accessed by mothers from poorer social backgrounds. Overall, there was marked variation in the provision of peer-support services for breastfeeding in the U.K. A more robust evidence base is urgently needed to inform guidance on the structure and provision of breastfeeding peer-support services.


Assuntos
Aleitamento Materno , Acesso aos Serviços de Saúde , Educação de Pacientes como Assunto , Infuência dos Pares , Sistemas de Apoio Psicossocial , Grupos de Autoajuda , Adulto , Pessoal Técnico de Saúde/economia , Pessoal Técnico de Saúde/educação , Aleitamento Materno/economia , Estudos Transversais , Feminino , Apoio Financeiro , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/economia , Humanos , Internet , Determinação de Necessidades de Cuidados de Saúde , Educação de Pacientes como Assunto/economia , Guias de Prática Clínica como Assunto , Pesquisa Qualitativa , Grupos de Autoajuda/economia , Fatores Socioeconômicos , Medicina Estatal/economia , Reino Unido
15.
JAMA Pediatr ; 172(2): e174523, 2018 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-29228160

RESUMO

Importance: Although breastfeeding has a positive effect on an infant's health and development, the prevalence is low in many communities. The effect of financial incentives to improve breastfeeding prevalence is unknown. Objective: To assess the effect of an area-level financial incentive for breastfeeding on breastfeeding prevalence at 6 to 8 weeks post partum. Design, Setting, and Participants: The Nourishing Start for Health (NOSH) trial, a cluster randomized trial with 6 to 8 weeks follow-up, was conducted between April 1, 2015, and March 31, 2016, in 92 electoral ward areas in England with baseline breastfeeding prevalence at 6 to 8 weeks post partum less than 40%. A total of 10 010 mother-infant dyads resident in the 92 study electoral ward areas where the infant's estimated or actual birth date fell between February 18, 2015, and February 17, 2016, were included. Areas were randomized to the incentive plus usual care (n = 46) (5398 mother-infant dyads) or to usual care alone (n = 46) (4612 mother-infant dyads). Interventions: Usual care was delivered by clinicians (mainly midwives, health visitors) in a variety of maternity, neonatal, and infant feeding services, all of which were implementing the UNICEF UK Baby Friendly Initiative standards. Shopping vouchers worth £40 (US$50) were offered to mothers 5 times based on infant age (2 days, 10 days, 6-8 weeks, 3 months, 6 months), conditional on the infant receiving any breast milk. Main Outcomes and Measures: The primary outcome was electoral ward area-level 6- to 8-week breastfeeding period prevalence, as assessed by clinicians at the routine 6- to 8-week postnatal check visit. Secondary outcomes were area-level period prevalence for breastfeeding initiation and for exclusive breastfeeding at 6 to 8 weeks. Results: In the intervention (5398 mother-infant dyads) and control (4612 mother-infant dyads) group, the median (interquartile range) percentage of women aged 16 to 44 years was 36.2% (3.0%) and 37.4% (3.6%) years, respectively. After adjusting for baseline breastfeeding prevalence and local government area and weighting to reflect unequal cluster-level breastfeeding prevalence variances, a difference in mean 6- to 8-week breastfeeding prevalence of 5.7 percentage points (37.9% vs 31.7%; 95% CI for adjusted difference, 2.7% to 8.6%; P < .001) in favor of the intervention vs usual care was observed. No significant differences were observed for the mean prevalence of breastfeeding initiation (61.9% vs 57.5%; adjusted mean difference, 2.9 percentage points; 95%, CI, -0.4 to 6.2; P = .08) or the mean prevalence of exclusive breastfeeding at 6 to 8 weeks (27.0% vs 24.1%; adjusted mean difference, 2.3 percentage points; 95% CI, -0.2 to 4.8; P = .07). Conclusions and Relevance: Financial incentives may improve breastfeeding rates in areas with low baseline prevalence. Offering a financial incentive to women in areas of England with breastfeeding rates below 40% compared with usual care resulted in a modest but statistically significant increase in breastfeeding prevalence at 6 to 8 weeks. This was measured using routinely collected data. Trial Registration: International Standard Randomized Controlled Trial Registry: ISRCTN44898617.


Assuntos
Aleitamento Materno/psicologia , Promoção da Saúde/métodos , Motivação , Recompensa , Adolescente , Adulto , Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Análise por Conglomerados , Inglaterra , Feminino , Promoção da Saúde/economia , Humanos , Recém-Nascido , Pobreza/estatística & dados numéricos , Adulto Jovem
16.
Nurs Womens Health ; 21(6): 431-437, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29223206

RESUMO

Many new mothers returning to school after childbirth face barriers within their academic settings to meeting their goals for exclusive breastfeeding. Potential barriers to breastfeeding faced by student-mothers include lack of legal protection, lack of breastfeeding-friendly university policies, inadequate availability of breastfeeding facilities, and insufficient awareness of the importance of breastfeeding among mothers, health care providers, and university administrators and faculty. Here we advocate for six action steps to help remove barriers to breastfeeding faced by student-mothers.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adulto , Aleitamento Materno/economia , Feminino , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Formulação de Políticas , Apoio Social , Universidades/organização & administração , Universidades/estatística & dados numéricos
18.
Breastfeed Med ; 12(10): 645-658, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28906133

RESUMO

OBJECTIVE: We sought to determine the impact of changes in breastfeeding rates on population health. MATERIALS AND METHODS: We used a Monte Carlo simulation model to estimate the population-level changes in disease burden associated with marginal changes in rates of any breastfeeding at each month from birth to 12 months of life, and in rates of exclusive breastfeeding from birth to 6 months of life. We used these marginal estimates to construct an interactive online calculator (available at www.usbreastfeeding.org/saving-calc ). The Institutional Review Board of the Cambridge Health Alliance exempted the study. RESULTS: Using our interactive online calculator, we found that a 5% point increase in breastfeeding rates was associated with statistically significant differences in child infectious morbidity for the U.S. population, including otitis media (101,952 cases, 95% confidence interval [CI] 77,929-131,894 cases) and gastrointestinal infection (236,073 cases, 95% CI 190,643-290,278 cases). Associated medical cost differences were $31,784,763 (95% CI $24,295,235-$41,119,548) for otitis media and $12,588,848 ($10,166,203-$15,479,352) for gastrointestinal infection. The state-level impact of attaining Healthy People 2020 goals varied by population size and current breastfeeding rates. CONCLUSION: Modest increases in breastfeeding rates substantially impact healthcare costs in the first year of life.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Internet , Saúde da População/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Método de Monte Carlo , Software , Estados Unidos
19.
Pediatrics ; 139(3)2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28167511

RESUMO

BACKGROUND AND OBJECTIVE: Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers. METHODS: A randomized, 2-arm parallel-group design, from February 2015 through February 2016. Half of the randomized participants received monthly financial incentives contingent on observed breastfeeding for 6 months (Incentive), and the other half received usual WIC services only (Control). Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled. Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $20 to $70 for a total possible of $270. RESULTS: The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits). CONCLUSIONS: Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.


Assuntos
Aleitamento Materno/economia , Promoção da Saúde/economia , Mães , Motivação , Adulto , Feminino , Assistência Alimentar , Hispano-Americanos , Humanos , Recém-Nascido , Philadelphia/epidemiologia , Pobreza , Porto Rico/etnologia , Adulto Jovem
20.
Matern Child Nutr ; 13(1)2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27647492

RESUMO

The aim of this study was to quantify the excess cases of pediatric and maternal disease, death, and costs attributable to suboptimal breastfeeding rates in the United States. Using the current literature on the associations between breastfeeding and health outcomes for nine pediatric and five maternal diseases, we created Monte Carlo simulations modeling a hypothetical cohort of U.S. women followed from age 15 to age 70 years and their children from birth to age 20 years. We examined disease outcomes using (a) 2012 breastfeeding rates and (b) assuming that 90% of infants were breastfed according to medical recommendations. We measured annual excess cases, deaths, and associated costs, in 2014 dollars, using a 2% discount rate. Annual excess deaths attributable to suboptimal breastfeeding total 3,340 (95% confidence interval [1,886 to 4,785]), 78% of which are maternal due to myocardial infarction (n = 986), breast cancer (n = 838), and diabetes (n = 473). Excess pediatric deaths total 721, mostly due to Sudden Infant Death Syndrome (n = 492) and necrotizing enterocolitis (n = 190). Medical costs total $3.0 billion, 79% of which are maternal. Costs of premature death total $14.2 billion. The number of women needed to breastfeed as medically recommended to prevent an infant gastrointestinal infection is 0.8; acute otitis media, 3; hospitalization for lower respiratory tract infection, 95; maternal hypertension, 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented. Policies to increase optimal breastfeeding could result in substantial public health gains. Breastfeeding has a larger impact on women's health than previously appreciated.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Saúde da Criança/economia , Saúde Materna/economia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Lactente , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos , Adulto Jovem
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