Health professionals need to target exclusive breastfeeding
Notice bibliographique
Résumé
Leading health authorities all recommend infants be breastfed exclusively for the first 6 months of life. The strong endorsement is based on compelling evidence that breastfeeding offers important health-promoting, disease-preventing benefits. Despite these salutary effects, many mothers discontinue breastfeeding or introduce supplementation early in the postpartum period. Suboptimal breastfeeding rates are a long-standing clinical issue. A Cochrane systematic review that examined 52 breastfeeding support trials from 21 countries, and included 56 451 mother–infant pairs, has recently been updated (Renfrew et al. Cochrane Database Syst Rev 2012;5:CD001141). Meta-analyses demonstrated a beneficial effect on breastfeeding duration and exclusivity up to 6 months postpartum with the implementation of any form of extra support; however, trials comparing an intervention of extra professional support to standard care in preventing the discontinuation of any breastfeeding showed a beneficial effect early in the postpartum period, between 4 and 6 weeks postpartum, but this was not sustained to 6 months. Professional support also did not significantly influence exclusive breastfeeding outcomes. The study conducted by Fu et al. is consistent with these Cochrane review results. The purpose of this cluster randomised controlled trial was to evaluate the effect of extra professional support on breastfeeding duration and exclusivity among 722 mothers in Hong Kong. Primiparous women were randomised to: (1) standard postpartum care (control group); (2) standard care plus three in-hospital breastfeeding sessions; or (3) standard care plus weekly telephone calls for the first 4 weeks postpartum. All extra breastfeeding support was provided by highly trained nurses. Whereas breastfeeding duration and exclusivity rates were proportionately higher for mothers who received extra support, these mothers were no more likely to continue to breastfeed, and to do so exclusively, to 6 months than those who received standard care (table 2). Contrary to the preceding Cochrane review, mothers who received telephone-based support had better outcomes than those who received face-to-face support in hospital. Telephone-based interventions (including text messaging) warrant further investigation given that they are a cost-effective way to provide community-based care to new mothers, especially those in rural and remote areas; however, neither intervention with extra support improved breastfeeding exclusivity rates up to 6 months. This finding is not surprising given that 42.3% of all mothers had no intention to exclusively breastfeed their infants. How can we improve breastfeeding exclusivity rates when many mothers actually do not want to exclusively breastfeed? Health professionals have made significant gains in educating women about the benefits of breastfeeding, resulting in improved initiation rates; however, exclusive breastfeeding is rare and far from universal, even in middle- and low-income countries. Perhaps mothers today think ‘any’ breastfeeding is just as good as ‘exclusive’ breastfeeding – but is it? If exclusive breastfeeding rates are to improve, we need to concentrate our efforts on establishing the unique benefits of ‘exclusivity’ over ‘any’ breastfeeding. Furthermore, breastfeeding support trials should focus their primary outcome on breastfeeding exclusivity at 6 months with interventions specifically targeting increasing a mother's goal to breastfeed exclusively and enhancing her self-efficacy to breastfeed without supplementation. We need to actively target exclusive breastfeeding if we want to see improvements in this important clinical outcome. None to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,018 | 0,074 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,005 | 0,007 |
| Science ouverte | 0,002 | 0,006 |
| Intégrité de la recherche | 0,008 | 0,015 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,016 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».