Breastfeeding in women with HIV infection: A qualitative study of barriers and facilitators.

BACKGROUND: Until recently, breastfeeding has been contraindicated for women living with HIV (WHIV) in the U.S. However, given the numerous health benefits of breastfeeding, recommendations have changed to support parental choice to breastfeed through shared decision-making. Although specific guidelines for managing the care of these women and their infants are not yet available, various approaches have been successful without infants acquiring HIV from their virologically suppressed mothers, thus, establishing breastfeeding as a viable option for the rising number of interested WHIV. This descriptive qualitative study aimed to identify factors influencing infant feeding choices decisions among WHIV in a multiethnic and multicultural population. METHODS AND FINDINGS: A qualitative description design was used. WHIV who had given birth within 6 months were recruited using purposeful sampling. Data were collected using a semistructured interview guide in the participant's preferred language. Content analysis was used, and barriers and facilitators were separated and used to generate the themes and categories. In total, 20 participants were interviewed, and from these interviews, 11 barriers and 14 facilitators that influenced the decision to breastfeed were identified. Major barriers were related to the interference with daily activities, fear of transmission, lack of a standardized approach to education, and maternal concerns. Key facilitators included the benefits and advantages of breastmilk, access to more scientific research information on breastfeeding in the context of HIV, advice from a lactation consultant, emotional connection and attachment with the child, support from family and partners, empowering and supporting autonomy and decision-making about infant feeding, providing feeding choices, access to the lived experiences of women who have successfully breastfed their infants, and collaborative relationship with the physician and other healthcare providers. CONCLUSION: The study identified barriers and facilitators to breastfeeding among WHIV that may influence their infant feeding decision-making process. More research is needed to guide the standardization of institutional policies and develop strategies to support breastfeeding in this population.

Lesiones dentales no cariosas: etiología y diagnóstico clínico. Revisión de literatura / Non-carious dental lesions: etiology and clinical diagnosis. Literatura reviews

Las lesiones dentales no cariosas comprenden un conjunto de procesos que se caracterizan por la pérdida o el desgaste patológico de los tejidos duros del diente, como ser el esmalte y la dentina. En la etapa inicial es difícil el diagnóstico, cuando la lesión va en aumento y si no es tratada a tiempo ni se modifican los factores de riesgo pueden llegar afectar de manera progresiva la pulpa dental. Estas lesiones han aumentado en los últimos años, debido al mayor tiempo de dientes en boca, acompañado de hábitos parafuncionales y dietas altamente acidas, a esto se le agrega el estrés que también provoca perdida de estructura dental. Por lo que no toda perdida de tejido mineralizado de los diente es provocada por una carga bacteriana. Estas lesionesno cariosas difieren en su etiología, se debe ser muy minucioso en su evaluación clínica y descripción, ya que muchas características clínicas pueden generar un diagnóstico erróneo y por ende un tratamiento no predecible, se debe tomar en consideración la existencia de combinaciones entre lesiones. Objetivo: Conocer la etiología y características clínicas propias de cada lesión, para poder realizar un diagnóstico oportuno y seguro. La revisión se realizó por medio de una búsqueda en internet en los buscadores de Hinari, Science Direct, Google académico, revisando artículos originales y revisiones bibliográficas entre los años de 2014-2019. Conclusiones: Las lesiones dentales no cariosas tienen etiologías multi factoriales, características clínicas diferenciales y puede haber una combinación de varias patologías...(AU)

The Effects of Advance Notice on Problem Behavior Occasioned by Interruptions of an Ongoing Activity in a Young Girl with Autism.

The current study describes a trial-based functional analysis of problem behavior conducted in a home setting for a 7-year-old girl with autism. Problem behavior was occasioned by interruptions to an ongoing activity. Advance notice, in the form of a 2-min warning, and the sound of a timer were used to signal termination of a current activity and were effective at reducing problem behavior along with increasing compliance to the interruptive demands. A trial-based functional analysis, which are not common in the applied literature, was conducted in a home setting for young girl with autism, using antecedent and consequence modifications described by Hagopian, Bruzek, Bowman, and Jennett (2007), identified the variables that occasioned and maintained problem behavior were interruptions to an ongoing activity followed by regaining uninterrupted access to the previous activity. Mixed findings have been reported regarding the effectiveness of advance notice for decreasing problem behavior. Results of the current study show that an advance notice treatment package was effective for a child with autism; no escape extinction was necessary. Interruptions are part of everyday life and tolerating these changes is critical for habilitation for individuals with autism.