RESUMEN
INTRODUCTION: Successful breastfeeding provides multiple health benefits to Servicewomen and their infants and has positive indirect benefits to the military. Workplace lactation support influences breastfeeding continuation after a Servicewoman's return to work. MATERIALS AND METHODS: This study evaluated the breastfeeding practices and workplace breastfeeding support among primiparous women serving in the U.S. Army. The study was a subanalysis of a non-blinded randomized controlled trial designed to determine the effect of postpartum appointment timing (either 2-3 or 6-8 weeks after delivery) on breastfeeding rates 6 months post-delivery. Subanalysis results were obtained through a telephonic follow-up survey 5-6 months after delivery; Servicewomen were queried to assess their breastfeeding/lactation practices and perception of unit and service support. RESULTS: Eighty of the 97 (82.5%) enrolled Servicewomen participated in the survey. Among respondents, 43.8% were still breastfeeding and 93.6% of those indicated an intent to breastfeed for a duration of 6 months or longer. Among respondents who provided feedback on their workplace, unit, and Army support for breastfeeding/lactation, only 13% reported they had access to a private room, sink, and refrigerator; 53% of respondents felt "mostly" or "very" supported by their assigned unit and 50% felt "mostly" or "very" supported by the Army. CONCLUSION: While almost half of the respondents were still breastfeeding and planned to continue 5-6 months postpartum and the majority of respondents felt "mostly" or "very" supported in their breastfeeding by their unit and the Army, comprehensive physical support for lactation in the workplace was inconsistent. This study provides feedback to inform ongoing implementation of the existing Army breastfeeding support directive.
Asunto(s)
Conducta Alimentaria/psicología , Lactancia/psicología , Personal Militar/psicología , Percepción , Lugar de Trabajo/normas , Adulto , Lactancia Materna/métodos , Lactancia Materna/psicología , Femenino , Humanos , Lactante , Recién Nacido , Satisfacción en el Trabajo , Personal Militar/estadística & datos numéricos , Lugar de Trabajo/psicología , Lugar de Trabajo/estadística & datos numéricosRESUMEN
OBJECTIVE: To compare the effect of early versus traditional postpartum follow-up intervals on breastfeeding continuation rates 6 months postpartum. METHODS: This randomized controlled trial enrolled primiparous women planning to breastfeed to a postpartum appointment either 2-3 weeks or 6-8 weeks after delivery. The primary outcome was the breastfeeding rate in each group 5-6 months after delivery. The study was powered to detect a 50% difference between groups assuming a 34% rate of breastfeeding at 6 months. Participants were contacted by phone 5-6 months after delivery to assess outcomes. RESULTS: From March 2014 to July 2016, 649 women were screened and 344 enrolled as follows: 172 to 2-3 week and 172 to 6-8 week follow-up. Demographic, delivery, and support characteristics were similar between groups; however, average infant birth weight and the distribution of gestational ages at the time of delivery were different between groups (p < 0.05). Participants in the 2-3 week group had a breastfeeding rate of 57.7% 6 months following delivery and participants in the 6-8 week group had a rate of 59.3%. Early follow-up was associated with a relative risk of 0.97 (95% CI 0.79-1.19, p = 0.80) and an adjusted relative risk of 1.45 (95% CI 0.71-2.95, p = 0.31), when adjusted for confounding variables, for breastfeeding continuation at 5-6 months. CONCLUSIONS: Breastfeeding rates at 5-6 months postpartum were comparable between both groups; early follow-up was not associated with an increased rate of breastfeeding. At 6 months postpartum, the breastfeeding rate in both groups approximated the Surgeon General's Healthy People 2020 goal of 60.6%. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (Identifier NCT02221895).
Asunto(s)
Lactancia Materna/estadística & datos numéricos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Parto , Periodo Posparto , Factores de Tiempo , Washingtón , Adulto JovenRESUMEN
INTRODUCTION: Women's roles continue to increase within the U.S. Army. Medical readiness contributes to individual readiness and supports the Army's warfighting mission. Army physician assistants are often the first-line medical providers for Soldiers and their practices, including women's health practices, should support optimal Soldier readiness. Our objective was to survey Army physician assistants' knowledge and practices related to female reproductive health care. MATERIALS AND METHODS: This was a descriptive survey-based study of Army physician assistants conducted from February to June 2017. This study was an addendum to a prior study examining women's health care knowledge and skills among physicians serving as general medical officers. Surveys were distributed via e-mail. The survey was anonymous and included 22 questions describing provider knowledge and practices in the areas of family planning and women's health screening. RESULTS: Out of 198 distributed surveys, 100 (51%) were returned. Most respondents were male (67%), 75% practiced in a troop-based medical clinic, and 73% had current or past practice experience in a military operational/deployed environment. The majority of respondents indicated that they provide family planning services to their reproductive-aged female patients. Combined hormonal contraceptives and depo-medroxyprogesterone had the highest percentage of respondents who reported comfort discussing the method. The highest percentage of respondents indicated discomfort discussing the copper intrauterine device and emergency contraception. Only 10, 17, and 33% of respondents were trained to place the copper intrauterine device, levonorgestrel intrauterine device, and etonogestrel contraceptive implant, respectively. Most respondents offered cervical cancer (74%) and chlamydia (91%) screening to their female patients. CONCLUSION: Most study respondents practiced in a troop-based primary care clinic and most reported experience as a deployed health care providers. Although most respondents indicated comfort discussing combined hormonal contraception and depo medroxyprogesterone, fewer reported comfort discussing long-acting reversible and emergency contraception. Only a minority of respondents reported prior training to place the copper or levonorgestrel intrauterine device or contraceptive implant and, of those trained, most had not placed a device for which they were trained in the preceding 12 months. Chlamydia and cervical cancer screening were offered by most respondents but was not universally offered among the respondents. These findings are consistent with our previous study evaluating women's health knowledge among general medical officers and highlight a need for improved training in the field of women's health for physician assistants serving the active duty population.
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Conducta Anticonceptiva/estadística & datos numéricos , Personal Militar/psicología , Asistentes Médicos/psicología , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Personal Militar/estadística & datos numéricos , Asistentes Médicos/estadística & datos numéricos , Encuestas y Cuestionarios , Salud de la MujerRESUMEN
In primary cell cultures of the avian (Gallus gallus) renal proximal tubule parathyroid hormone and cAMP activation generate a Cl(-)-dependent short circuit current (I(SC)) response, consistent with net transepithelial Cl(-) secretion. In this study we investigated the expression and physiological function of the Na-K-2Cl (NKCC) transporter and CFTR chloride channel, both associated with Cl(-) secretion in a variety of tissues, in these proximal tubule cells. Using both RT-PCR and immunoblotting approaches, we showed that NKCC and CFTR are expressed, both in proximal tubule primary cultures and in a proximal tubule fraction of non-cultured (native tissue) fragments. We also used electrophysiological methods to assess the functional contribution of NKCC and CFTR to forskolin-activated I(SC) responses in filter grown cultured monolayers. Bumetanide (10 µM), a specific blocker of NKCC, inhibited forskolin activated I(SC) by about 40%, suggesting that basolateral uptake of Cl(-) is partially mediated by NKCC transport. In monolayers permeabilized on the basolateral side with nystatin, forskolin activated an apical Cl(-) conductance, manifested as bidirectional diffusion currents in the presence of oppositely directed Cl(-) gradients. Under these conditions the apical conductance appeared to show some bias towards apical-to-basolateral Cl(-) current. Two selective CFTR blockers, CFTR Inhibitor 172 and GlyH-101 (both at 20 µM) inhibited the forskolin activated diffusion currents by 38-68%, with GlyH-101 having a greater effect. These data support the conclusion that avian renal proximal tubules utilize an apical CFTR Cl(-) channel to mediate cAMP-activated Cl(-) secretion.