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Aims: To describe the process of breastfeeding relationships among stay-at-home mother and infant dyads at 1, 3, 5 and 6 months., Design: A longitudinal qualitative online survey design was used., Methods: Data were obtained at 1, 3, 5 and 6 months from 26 breastfeeding mothers who stayed home with their infants and directly breastfed at least once a day for the first 6 months between June 2022 and August 2023. Mothers' written responses to 3 open-ended questions were analysed to assess breastfeeding experiences at home, thoughts/comments while directly breastfeeding and breastfeeding concerns/problems and strategies they used. Based on grounded theory, inductive content analysis was used to analyse the data. Trustworthiness of results was established by coding to consensus, formal peer debriefing and maintaining an audit trail., Results: 'Breastfeeding Relationships at Home,' the core construct, was identified and organized the process of breastfeeding relationships into 5 domains: (1) mothers' emotional well-being while breastfeeding, (2) infant-led feeding, (3) alternatives to breastfeeding, (4) evaluation of breastfeeding and (5) changes in breastfeeding as infants grow older., Conclusion: Breastfeeding is not simply about feeding breast milk but also involves nurturing and developing a relationship between mother and infant. Across the domains, mutual responsiveness, a central element of the breastfeeding relationship was clear. Mothers who were committed to breastfeeding with embedded infant suckling reached emotional well-being in return for their engagement which has potential to reduce maternal stress and prevent postpartum depression., Impact: Findings from the current study add to nurses' knowledge about the relationship building process between stay-at-home mothers and their infants in the first 6 months of breastfeeding during the COVID-19 pandemic. Nurses must remain sensitive to aid the development of breastfeeding relationships in the home environment to maximize mutual responsiveness., Patient or Public Contribution: No patients or public involved., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objectives: This study examined the relationship among constructs of the Breastfeeding Relationship Scale and exclusive direct breastfeeding (EDBF) while controlling for covariates in US breastfeeding dyads in the first 3 months., Background: The Breastfeeding Relationship Scale was developed to measure mother-infant mutual responsiveness during breastfeeding in response to perceived insufficient milk, but there is no clear understanding about the relationships between the Breastfeeding Relationship Scale's constructs and EDBF., Methods: A cross-sectional design was used. The convenience sample of 589 directly breastfeeding mothers in the US whose infants were between 1 and 12 weeks of age were included for analysis using a structural equation model. Covariates for EDBF included mother's age, education, marital status, parity, prior breastfeeding experience, infant's age, weight, and sex., Results: Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity were related (β = 0.33, p  < .001), as were Breastfeeding Synchronicity and Perceived Adequate Milk Supply (β = 0.35, p  < .001) and Mother-Infant Breastfeeding Interaction and Perceived Adequate Milk Supply (β = 0.08, p  = .05). The relationship between Mother-Infant Breastfeeding Interaction and Breastfeeding Synchronicity with EDBF was fully mediated by Perceived Adequate Milk Supply, where the odds of EDBF was higher for mothers with higher scores on Perceived Adequate Milk Supply (OR = 1.61, p  < .001) and prior breastfeeding experience (OR = 2.31, p  = .006)., Conclusions: Perceived Adequate Milk Supply and prior breastfeeding experience are major determinants of EDBF in the first 3 months. Breastfeeding Synchronicity can bolster Mother-Infant Breastfeeding Interaction and promote Perceived Adequate Milk. More attention should be paid to breastfeeding relationship to be the result of EDBF.

Aims: To apply videoconferencing as a new verification method prior to enrollment for an online survey-based study., Design: A prospective-observational, mixed methods, three group, repeated measures study involved recruiting a population-based sample of breastfeeding mothers and infants (N = 81). Twenty-seven mothers were recruited for each group: mothers returning to work outside of the home, mothers returning to work from home and mothers staying home with their infants full-time., Methods: Data were collected at four time points, infant age 4, 12, 20 and 24 weeks, via online survey. Participating mothers received a $10 gift card for completing each survey. Social media, word of mouth and brochures promoted United States-based recruitment nationwide. A publicly available direct link to the survey was initially provided to interested mothers. After the suspicion of online fraud, videoconferencing was instituted for self-referrals and phone calls for professional referrals., Results: The survey was invaded by response fraud 3 weeks after the initial survey deployment. Out of 109 respondents who visited the survey site during that timeframe, only eight mothers (10%) were eligible (22 June 2022 to 14 July 2022). After recruitment modification, 313 individuals emailed the study team with 65 self-referred mothers (80%) enrolled in the study via videoconferencing while eight mothers (10%) had a professional referral and enrolled via phone call (23 August 2022 to 30 March 2023)., Conclusion: Providing a direct survey link, even with CAPTCHA-protection, evoked fraudulent responses. Videoconferencing is an emerging verification method that can be readily applied to the enrollment of breastfeeding dyads for an online study., Impact: The emergence of fraudulent respondents and internet bots threatens data quality. This study addressed the strategy of videoconferencing as a new verification method for recruitment and enrollment of breastfeeding dyads. This knowledge can be applied by researchers to secure sample validity and data integrity., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background/Objective: Low breastfeeding initiation and duration of exclusivity put rural mothers and infants at risk for morbidity and mortality and significant economic costs. This scoping study aimed to identify determinants of breastfeeding disparities among rural dyads in high-income countries and their modifiable factors. Methods: The Arksey and O'Malley methodological framework was used. A literature review was conducted using PubMed, CINAHL Complete, Embase, and APA PsycInfo databases to identify studies related to rural breastfeeding that met criteria published between 2012 and 2022. Results: Twenty-five studies were included. Rural mothers from high-income countries are more likely to be younger, be unmarried, have lower educational attainment, have lower socioeconomic status, smoke, and have a higher prepregnancy body mass index than their urban counterparts. Rural mothers across White, Black, and Hispanic racial and ethnic groups have significantly lower breastfeeding rates compared to urban mothers. Maternal physiological preparedness, breastfeeding problems, lifestyle choices, support from family, evidence-based practice, workplace support, and policy development and implementation for breastfeeding promotion were identified as modifiable factors. Interventions using technology are an emerging field to overcome rurality. Conclusions: Although breastfeeding disparities are prevalent in rural dyads, the basic challenges mothers face when breastfeeding are universal, despite geographical locations in high-income countries. More specific support needs to be provided for breastfeeding dyads to continue breastfeeding. Resource allocation needs to be improved to increase access to care. Patient-centered technology interventions may decrease breastfeeding barriers in rural areas.

Background and Purpose : The Breastfeeding Relationship Scale (BFRS) was developed to measure mother-infant mutual responsiveness during breastfeeding. The purpose of this study was to develop and test the psychometric properties of the BFRS. Methods : Construct validity of a 16-item three-factor model (Mother-Infant Breastfeeding Interaction, Perceived Adequate Milk Supply, and Breastfeeding Synchronicity) was assessed using confirmatory factor analysis (CFA) and reliability (Cronbach's alpha) across two independent samples. Results : CFA of the hypothesized three-factor model demonstrated good fit in both samples (comparative fit index >.90, root mean square error of approximation <.06, square root mean residual < .061). Cronbach's alpha for the constructs ranged between .73 and .83. Conclusion : The BFRS is a valid measure of breastfeeding relations between mother and infant. Reliability was acceptable for all constructs in both samples., (© Copyright 2022 Springer Publishing Company, LLC.)

Objective: To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States., Design: A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019., Participants: We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion., Measurements: The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences., Results: Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26])., Conclusion: Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding., (Copyright © 2022 AWHONN. Published by Elsevier Inc. All rights reserved.)

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace., (Copyright © 2021 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Purpose: Perceived insufficient milk is the predominant risk factor for early breastfeeding discontinuation globally. The purpose of this study was to explore the association between perceived insufficient milk in the first 3 months and infant factors, maternal factors, professional support, parenting decisions, and breastfeeding concerns. Sixty-nine mothers who had perceived insufficient milk and 301 mothers who did not were included., Study Design and Methods: A cross-sectional online survey design was used in a convenience sample of 370 U.S. mothers with a healthy singleton infant between 1 and 12 weeks who were breastfeeding directly on the breast as part of their feeding methods., Results: Using stratified multivariable logistic regression, we found that among 102 mothers of infants < 4 weeks of age, planned breastfeeding duration < 6 months (OR = 13.17; 95% CI [1.42, 122.48], p = .024), and concerns about infant crying or fussing (OR = 4.72; 95% CI [1.10, 20.00], p = .03) were associated with perceived insufficient milk. Among 256 mothers of infants 4 to 12 weeks of age, concerns about frequent feedings (OR = 4.05; 95% CI [1.95, 8.40], p = .000) and latching difficulty (OR = 2.95; 95% CI [1.33, 6.54], p = .008) were associated with perceived insufficient milk., Clinical Implications: Association between factors and perceived insufficient milk differed based on infant age. Maternal perceptions of crying or fussing, frequent feedings, and latching difficulty need to be assessed because of its attribution to perceived insufficient milk., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

In this article, I describe the effects of home interventions on latching difficulty that persisted for 27 days for a mother-neonate dyad. The neonate manifested latching difficulty immediately after cesarean birth, and it became worse when nipple shields, bottles, and pacifiers were introduced. Manual expression and an electric pump were implemented when the neonate started losing weight, resulting in reduced frequency of breastfeeding directly at the breast. Additionally, the neonate continued to have latching difficulty after frenotomy. The use of home-based interventions supported ongoing educational opportunities for optimal latch, and I recommend that this type of health education be consistent among health professionals., (Copyright © 2019 AWHONN. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this review was to examine outcome measures used in interventions focusing on enhancement of breastfeeding initiation, duration, and exclusivity., Methods: A literature search guided by search terms on outcome measures of breastfeeding interventions was conducted using PubMed, CINAHL Plus, & PsycINFO databases on publications between 2006 and 2017., Results: Nine studies were included in this review, using PRISMA guidelines. Rates of breastfeeding initiation, duration, and exclusivity were measured during specific points in time. Data collection methods involve interviews, self-report, observations, and/or feeding logs. Although breastfeeding types (exclusive breastfeeding, predominant breastfeeding, and complementary breastfeeding) were measured, methods of infant feeding (breastfeeding and bottle feeding) were rarely assessed, ignoring significant mediators or moderators of breastfeeding., Conclusions: There were methodological limitations to the reviewed studies: (1) a 24-hour recall bias, (2) misclassification of breastfeeding categories, (3) lack of consistency in breastfeeding definitions, and (4) few reports of the reason for breastfeeding discontinuation. Future studies should focus on the modifiable cause of the problem: outcome measures attributed to the targets of the intervention, followed by breastfeeding initiation, duration, and/or exclusivity.

Perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. This study evaluated the short-term impact of mother-infant interactions through home interventions designed to overcome PIM as a result of the infant's behavior, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. A single group, three-occasion prepost design was used. Mother-infant interactions were measured by the Nursing Child Assessment Feeding Scale (NCAFS) at 6, 13, and 27 days postpartum. There were significantly increased mother-infant interactions during intervention. Specifically, significant growth over the intervention occurred for mother's sensitivity to cues, cognitive growth fostering, infant's clarity of cues, and responsiveness to caregiver. The NCAFS total score was also significantly improved. Although modifications are required, the three home intervention sessions showed promise in improving mother-infant interactions during breastfeeding. Further investigation using a randomized experimental design is warranted.

Problem: Although the World Health Organization and American Academy of Pediatrics recommend exclusive breastfeeding for the first six months, only 22% of U.S. mothers do so. Mothers' perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. There are two changeable causes of PIM: (1) mothers' misinterpretation of their infant's behavior, and (2) mothers' lack of confidence in their ability to breastfeed., Aim: The purpose of this study was to evaluate the short-term effect of a home-based intervention designed to prevent and/or reduce PIM., Methods: A mixed-methods, single-group, pretest-midtest-posttest design was used for evaluating a home-based breastfeeding program. The program was implemented during three 1.0- to 1.5-h home intervention sessions at 6, 13, and 27 days postpartum, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants., Findings: We found significant increases over time in mothers' sensitivity to infant behavior and breastfeeding self-efficacy as well as significant decreased attribution of infant crying to PIM. Exit interviews indicated that the program was accepted by participating mothers., Discussion: This is the first intervention study that has directly targeted the causes of PIM. The home-based intervention has the potential to add to maternal competencies both in correctly assessing their infants' behavior, thereby preventing erroneous attribution of infant behavior to PIM, as well as simultaneously bolstering maternal confidence in breastfeeding skills., Conclusion: By building maternal competencies, the home-based intervention has a longer-range potential to prevent breastfeeding discontinuation. Further evaluation is warranted., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Objective: The purpose of this review was to evaluate breastfeeding interventions trialed to date and recommend directions for future needs in breastfeeding research., Methods: A literature review was conducted using PubMed, CINAHL Plus, and PsycINFO databases to identify studies that evaluated efficacy or effectiveness of breastfeeding interventions on breastfeeding initiation, duration, or exclusivity as a primary, secondary, or tertiary outcome. Combinations of search terms included breastfeeding, feeding behavior, prenatal/patient education, health promotion, social support, perinatal/prenatal/intrapartum/postnatal care, and postpartum period., Results: Six studies were included in this review, using PRISMA guidelines. Acquisition of knowledge and skills, emotional support by healthcare providers, and self-efficacy over maternal confidence in her ability to breastfeed were factors the intervention studies relied on to affect breastfeeding practices. Although these factors were addressed in the studies, breastfeeding mothers had difficulty transferring what they gained from interventions into their real-life breastfeeding practices as evidenced by the highest drop-off rate of exclusive breastfeeding in the early postpartum., Conclusions: There were conceptual limitations to the reviewed studies: (1) lack of understanding of maternal perception of infant behavior and (2) perceived insufficient milk as a remaining primary reason for breastfeeding discontinuation. There were methodological limitations: (1) lack of theory-based interventions and (2) lack of intervention fidelity. Future studies involving breastfeeding should focus on the causes of the problems driven by theory-based interventions integrated with intervention fidelity.

Climatic oscillations, heterogeneity in elevation, topographical position, and isolation time in southwestern Patagonia have been important in promoting diversification of the biota. Geological studies have shown that this region had wide ice-free areas during periods of the last glacial maximum and provided forested refugia for the biota during Pleistocene glaciations. In this study, we sampled the endemic frog Eupsophus calcaratus from 20 localities, covering most of its distribution and including glaciated and non-glaciated regions. We collected DNA sequences for three mitochondrial regions (D-loop, cyt b, 16S), and describe patterns of variation consistent with a history of both the displacement to glacial refugia and recent recolonization to extensively glaciated regions. The inferred demographic history and divergence times of the lineages of E. calcaratus suggest that the Pleistocene had profound effects on the genetic patterns within this taxon in which some populations were able to survive in refugia within colder regions followed by demographic increases but without evidence of significant range expansion. The mtDNA gene tree recovers six major haploclades of E. calcaratus, which we consider diagnostic of species lineages. These results contribute to our understanding of how geological events, predominately glacial oscillations, have influenced current population structure of a broad-ranging, ectothermic vertebrate in the Valdivian Forest region of southern South America., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The cure rate for oral cancers remains dismally low at approximately 50%. The dental profession is, to a large extent, responsible for decreasing the morbidity and mortality of oral cancer even though 50% of the population do not present for routine examination and care. The dental office team must accept the charge of educating all patients concerning the devastating role of tobacco and ethanol in promoting oral cancer, as well as malignancies at other sites. Dental clinicians play a vital role on the oral cancer team. Therefore, they must make themselves well aware of the diverse nature of oral cancer and must have an appropriate triage protocol in place so that lesions will be identified and managed correctly or referred promptly to the correct tertiary health care professionals. Early detection and prompt proper management can make a difference as we await the development of new and better ways of treating oral and oropharyngeal cancers.

A case of an expansile facial lesion discovered in the more than 600 years old skeletal remains of a 22-25-year-old female is discussed. Gross, radiographic and histological studies were accomplished on the specimen. Although a definitive diagnosis could not be derived because of the age and condition of the specimen, differential diagnoses are discussed and a probable diagnosis rendered.

Surgical blades were contaminated by doing incisional biopsies on DMBA-induced cheek pouch carcinomas in hamsters. Contaminated blades were then used to: (1) make cytologic smears; (2) make incisions in the mucosal surface of the lower lip; (3) make incisions in the ventral surface of the tongue; (4) make incisions in the untreated left cheek pouch; and (5) make incisions in the pre-shaved back. One group of animals was killed three hr post-surgery. The second group was killed seven wk post-surgery. Tissues were excised and processed for microscopic study. Malignant cells were found in many of the incision sites of animals from the first group. In the animals of the second group, several tumors growing from the transplanted tumor cells were observed in the incision sites of the lower lips and the tongue. None was observed in the incision sites of the left cheek pouch or the back. Cervical lymph node metastases were found in approximately 50% of the animals of the second group.

After cheek pouch carcinomas were induced in hamsters by the application of dimethylbenzanthracene (DMBA) to the right pouch for 13 weeks, the animals were divided into four groups and observed for seven more weeks. The control group received no further treatment, two experimental groups had incisional biopsies performed on tumors in their pouches, one of these also received injections of cortisone throughout the 20-week experimental period, and a fourth group received cortisone only. The wet weights of the cancerous cheek pouches were determined, and the submandibular and parotid salivary glands with associated cervical lymph nodes, the lungs, and the liver were examined with light microscopy. The cancerous pouches of the animals that received cortisone weighed significantly less than those of animals that received no cortisone but had incisional biopsies of the tumors. There was no significant difference in the degree of histodifferentiation of the tumors among the four groups. The animals in the two groups that received cortisone had significantly more tumors that were invasive than did the animals that did not receive cortisone. Cervical lymph node metastasis occurred in 21% to 38% of the animals but was not significantly different in the four groups. Distant metastases to the lungs or the liver were not found. Incisional biopsy of the tumors stimulated local growth of the cheek pouch tumors, and systemic cortisone administration produced more invasive cheek pouch tumors.

A/Jax mice were injected with 50 muCi of 3H cortisol and 10 mg of cortisone acetate on day 12 of gestation. At various intervals after injection, the maternal liver, placenta, yolk sac, and the fetal jaws were removed and analyzed by thin-layer chromatography in conjunction with oxidative combustion and liquid scintillation counting to identify and measure the amount of labeled corticoid metabolites. The results support the thesis that these corticoids may induce clefts by an individual or combined direct action on the fetal jaws and palatal shelf tissue.

A case of an expansile, multilocular lesion in a condyle recovered in skeletal remains more than 700 years old is discussed. Gross, radiologic, and histologic studies were accomplished on the specimen. Although a definitive diagnosis could not be arrived at because of the age of the specimen, differential diagnoses are presented.