Latching Medical Students onto a Virtual Breastfeeding Elective during the COVID-19 Pandemic.

Objectives: To describe the implementation of a successful two-week virtual breastfeeding elective for medical students during the COVID-19 pandemic and characterize student demographics, objective knowledge, and perspectives on breastfeeding before and after the elective. Study Design: We adapted the Santa Rosa Kaiser Permanente Family Medicine breastfeeding residency curriculum to create a two-week virtual medical student elective using Kern's six steps of curriculum development and a competency-based education framework. Educational components included self-paced modules, shadowing experiences, and group didactics. Objective knowledge was assessed with multiple-choice tests before and after the elective compared using a paired t-test. Reflective writing pieces were qualitatively analyzed using the six phases of thematic analysis developed by Braun and Clarke. Results: From 2020 to 2023, 40 medical students completed the elective. Breastfeeding knowledge increased significantly from the pre-test 72% (95% CI: 52-92%) to post-test 91% (95% CI: 81-100%) (p < 0.001). Over 90% of students felt that learning objectives were met well or very well and agreed or strongly agreed that the elective increased their knowledge and confidence in providing anticipatory guidance to breastfeeding parents. Similar themes were shared across students' reflective writing pieces, with nearly 30% (n = 23) of the student essays addressing socio-cultural and racial differences in beliefs surrounding breastfeeding. Conclusion: A virtual breastfeeding curriculum for medical students is well-received by stakeholders (patients, lactation consultants, students, etc.) and improves breastfeeding knowledge and confidence. A virtual elective is an innovative and effective way to deliver breastfeeding education and can be used even when institutional breastfeeding or lactation support is unavailable.

Direct breastfeeding frequency of late preterm and term infants in the neonatal intensive care unit and availability of mother's own milk at six months of age. a retrospective cohort study.

BACKGROUND: Mother's Own Milk (MOM) reduces the risk of complications in premature infants. Breastfeeding rates for late preterm and term infants in the neonatal intensive care unit (NICU) are significantly lower than that of breastfed healthy term newborns at 6 months of age. DESIGN: This was a retrospective cohort study of neonates born at 34 weeks 0 days or later. Infants who were directly breastfed in the NICU and were discharged on breast milk were included. Logistic regression modeling was used to determine the significance of association. RESULTS: 171 mother-infant dyads were included. After adjusting for confounders, the number of breastfeeding attempts during the NICU stay was significantly associated with the availability of MOM at six months of age (p = 0.003, 95% CI 1.02 to 1.14). CONCLUSION: This study is the first to show an association between the number of direct breastfeeding attempts in the NICU and availability of MOM at six months of age.

Association Between Length of Maternity Leave and Breastfeeding Duration in the United States: A Systematic Review.

OBJECTIVE: To perform a systematic review to assess the association between the length of maternity leave and breastfeeding duration in the United States. DATA SOURCES AND METHODS OF STUDY SELECTION: This review was conducted with a five-stage model for reviews. We included publications from 2000 to 2023, U.S.-based studies written in English, and primary research and peer-reviewed articles. In February 2023, a medical librarian conducted a search across seven databases, yielding 1,540 results. ClinicalTrials.gov was later searched, yielding no results. After duplicates were removed, 835 abstracts were screened. A full-text article review was then conducted of the remaining 34 articles. TABULATION, INTEGRATION, AND RESULTS: Twenty-three articles met inclusion criteria, two of which were reviews. Of the nonreview articles, all found a positive relationship between increased maternity leave and duration of breastfeeding. Data showed that earlier return to work for the birth parent decreased the odds of breastfeeding dyads meeting breastfeeding recommendations. Many studies adjusted for confounders (eg, race, socioeconomic status); however, Black or Latinx mothers still experience shorter breastfeeding durations or lower breastfeeding exclusivity when given equal leave compared with White mothers. CONCLUSION: Results show a positive relationship between length of maternity leave and breastfeeding duration. Advocacy for longer, paid parental leave and more robust research rooted in rigorous methods are needed.

A new policy update on breastfeeding: What all clinicians need to know.

Although the 2022 policy statement on breastfeeding from the American Academy of Pediatrics primarily addresses clinicians caring for pediatric patients, the Academy urges clinicians of all disciplines who may interact with breastfeeding mothers and babies to increase their understanding of breastfeeding and their ability to support this population. Studies published since the 2012 update continue to reinforce the cumulative short-term and long-term infant and maternal health benefits of breastfeeding and human milk consumption.

Pediatric Rhabdomyolysis.

Pediatric rhabdomyolysis is a common diagnosis that pediatricians need to be able to recognize because prompt treatment can prevent potential complications, such as acute kidney injury. The triggers for rhabdomyolysis are extensive, with viruses being the most common cause in pediatric patients. The pathophysiology behind rhabdomyolysis is complex and still being researched, but having a firm understanding of the cascade that results when muscle injury occurs is essential for proper management. Guidelines for managing pediatric rhabdomyolysis currently do not exist, but this article aims to review the available literature and give clinicians a general approach to aid in history taking, physical examination, diagnosis, acute management, follow-up, and prevention.

Takayasu Arteritis in the pediatric population: a contemporary United States-based single center cohort.

BACKGROUND: Takayasu Arteritis is an idiopathic, chronic, large vessel vasculitis involving the aorta and its primary branches. Few studies have been done in pediatric patients to date with the largest case series of US patients published in 2003 consisting of only 6 patients. METHODS: A retrospective chart review was performed on all patients seen at Cleveland Clinic Children's up until 2012 who met EULAR/PRINTO/PRES classification criteria for childhood Takayasu Arteritis. RESULTS: Twenty-one patients with a mean follow up of 2.3 years were studied. Weight loss, fatigue, and anorexia were the most common presenting complaints. 57.1% of patients were hypertensive at first visit. The most common examintation finding was diminished pulses (61.9%), followed by bruits, and then murmurs. Thoracic aorta stenosis was the most common vascular abnormality. Seven of twenty-one patients responded well to methotrexate and prednisone alone. Ten of twenty-one patients required an additional medication for symptom and disease control (infliximab most commonly). About two-thirds of patients required at least one anti-hypertensive medication. Eight of the twenty-one patients required surgical intervention for severe disease refractory to medications (renal artery stenosis being the most common indication). Almost all patients reported symptomatic improvement after surgical intervention. Two of the eight patients required a second surgery for return of symptoms. Disease sequelae included arterial aneurysms, resolved heart failure, and hypertensive emergencies. CONCLUSION: Our study emphasizes that constitutional symptoms coupled with objective findings of diminished pulses, bruits, and hypertension should raise clinical suspicion for Takayasu Arteritis in pediatric patients. Pharmacologic therapy alone can be successful in controlling disease progression, however surgery was successful in minimizing symptoms when medical therapies failed.

Effect of inositol hexakisphosphate kinase 2 on transforming growth factor beta-activated kinase 1 and NF-kappaB activation.

We previously showed that inositol hexakisphosphate kinase 2 (IHPK2) functions as a growth-suppressive and apoptosis-enhancing kinase during cell stress. Overexpression of IHPK2 sensitized ovarian carcinoma cell lines to the growth-suppressive and apoptotic effects of interferon beta (IFN-beta), IFN-alpha2, and gamma-irradiation. Expression of a kinase-dead mutant abrogated 50% of the apoptosis induced by IFN-beta. Because the kinase-dead mutant retained significant response to cell stressors, we hypothesized that a portion of the death-promoting function of IHPK2 was independent of its kinase activity. We now demonstrate that IHPK2 binds to tumor necrosis factor (TNF) receptor-associated factor (TRAF) 2 and interferes with phosphorylation of transforming growth factor beta-activated kinase 1 (TAK1), thereby inhibiting NF-kappaB signaling. IHPK2 contains two sites required for TRAF2 binding, Ser-347 and Ser-359. Compared with wild type IHPK2-transfected cells, cells expressing S347A and S359A mutations displayed 3.5-fold greater TAK1 activation following TNF-alpha. This mutant demonstrated a 6-10-fold increase in NF-kappaB DNA binding following TNF-alpha compared with wild type IHPK2-expressing cells in which NF-kappaB DNA binding was inhibited. Cells transfected with wild type IHPK2 or IHPK2 mutants that lacked S347A and S359A mutations displayed enhanced terminal deoxynucleotidyltransferase-mediated dUTP nick end-labeling staining following TNF-alpha. We believe that IHPK2-TRAF2 binding leads to attenuation of TAK1- and NF-kappaB-mediated signaling and is partially responsible for the apoptotic activity of IHPK2.