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Breastfeeding Initiation, Duration, and Supplementation Among Mexican-Origin Women in Texas

BACKGROUND:

Mexican-origin women breastfeed at similar rates as white women in the United States, yet they usually breastfeed for less time. In our study, we seek to identify differences in Mexican-origin women’s breastfeeding intentions, initiation, continuation, and supplementation across nativity and country-of-education groups.

METHODS:

The data are from a prospective cohort study of postpartum women ages 18 to 44 recruited from 8 Texas hospitals. We included 1235 Mexican-origin women who were born and educated in either Texas or Mexico. Women were interviewed at delivery and at 3, 6, 12, 18, and 24 months post partum. Breastfeeding intentions and initiation were reported at baseline, continuation was collected at each interview, and weeks until supplementation was assessed for both solids and formula. Women were classified into 3 categories: born and educated in Mexico, born and educated in the United States, and born in Mexico and educated in the United States.

RESULTS:

Breastfeeding initiation and continuation varied by nativity and country of birth, although all women reported similar breastfeeding intentions. Women born and educated in Mexico initiated and continued breastfeeding in higher proportions than women born and educated in the United States. Mexican-born and US-educated women formed an intermediate group. Early supplementation with formula and solid foods was similar across groups, and early supplementation with formula negatively impacted duration across all groups.

CONCLUSIONS:

Nativity and country of education are important predictors of breastfeeding and should be assessed in pediatric and postpartum settings to tailor breastfeeding support. Support is especially warranted among US-born women, and additional educational interventions should be developed to forestall early supplementation with formula across all acculturation groups.




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Costs and Use for Children With Medical Complexity in a Care Management Program

BACKGROUND AND OBJECTIVES:

Children with medical complexity (CMC) comprise only 6% of the pediatric population, account for ~40% of pediatric health care spending, and provide an important opportunity for cost saving. Savings in this group can have an important impact on pediatric health care costs. The objective of this study was to assess the impact of a multicenter care management program on spending and use in CMC.

DESIGN AND METHODS:

We conducted a prospective cohort analysis of a population of 4530 CMC enrolled in a learning collaborative designed to improve care for CMC ages 0 to 21 years identified using 3M Clinical Risk Group categories 5b through 9. The primary outcome was total per-member per-year standardized spending; secondary outcomes included inpatient and emergency department (ED) spending and use. We used a 1:1 propensity score match to compare enrolled patients to eligible nonenrolled patients and statistical process control methods to analyze spending and usage rates.

RESULTS:

Comparison with the matched group showed a 4.6% (95% confidence interval [CI]: 1.9%–7.3%) decrease in total per-member per-year spending (P < .001), a 7.7% (95% CI: 1.2%–13.5%) decrease in inpatient spending (P = .04), and an 11.6% (95% CI: 3.9%–18.4%) decrease in ED spending (P = .04). Statistical process control analysis showed a decrease in hospitalization rate and ED visits.

CONCLUSIONS:

CMC enrolled in a learning collaborative showed significant decreases in total spending and a significant decrease in the number of hospitalizations and ED visits. Additional research is needed to determine more specific causal factors for the results and if these results are sustainable over time and replicable in other settings.




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Validation of a Prediction Rule for Mortality in Congenital Diaphragmatic Hernia

BACKGROUND:

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with a mortality of ~27%. The Congenital Diaphragmatic Hernia Study Group (CDHSG) developed a simple postnatal clinical prediction rule to predict mortality in newborns with CDH. Our aim for this study is to externally validate the CDHSG rule in the European population and to improve its prediction of mortality by adding prenatal variables.

METHODS:

We performed a European multicenter retrospective cohort study and included all newborns diagnosed with unilateral CDH who were born between 2008 and 2015. Newborns born from November 2011 onward were included for the external validation of the rule (n = 343). To improve the prediction rule, we included all patients born between 2008 and 2015 (n = 620) with prenatally diagnosed CDH and collected pre- and postnatal variables. We build a logistic regression model and performed bootstrap resampling and computed calibration plots.

RESULTS:

With our validation data set, the CDHSG rule had an area under the curve of 79.0%, revealing a fair predictive performance. For the new prediction rule, prenatal herniation of the liver was added, and absent 5-minute Apgar score was taken out. The new prediction rule revealed good calibration, and with an area under the curve of 84.6%, it had good discriminative abilities.

CONCLUSIONS:

In this study, we externally validated the CDHSG rule for the European population, which revealed fair predictive performance. The modified rule, with prenatal liver herniation as an additional variable, appears to further improve the model’s ability to predict mortality in a population of patients with prenatally diagnosed CDH.




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Predicting School-Aged Cognitive Impairment in Children Born Very Preterm

BACKGROUND AND OBJECTIVES:

Children born very preterm (VPT) are at high risk of cognitive impairment that impacts their educational and social opportunities. This study examined the predictive accuracy of assessments at 2, 4, 6, and 9 years in identifying preterm children with cognitive impairment by 12 years.

METHODS:

We prospectively studied a regional cohort of 103 children born VPT (≤32 weeks’ gestation) and 109 children born term from birth to corrected age 12 years. Cognitive functioning was assessed by using age-appropriate, standardized measures: Bayley Scales of Infant Development, Second Edition (age 2); Wechsler Preschool and Primary Scale of Intelligence (ages 4 and 6); and Wechsler Intelligence Scale for Children, Fourth Edition (ages 9 and 12).

RESULTS:

By 12 years, children born VPT were more likely to have severe (odds ratio 3.9; 95% confidence interval 1.1–13.5) or any (odds ratio 3.2; 95% confidence interval 1.8–5.6) cognitive impairment compared with children born term. Adopting a severe cognitive impairment criterion at age 2 under-identified 44% of children born VPT with later severe impairment, whereas a more inclusive earlier criterion identified all severely affected children at 12 years. Prediction improved with age, with any delay at age 6 having the highest sensitivity (85%) and positive predictive value (66%) relative to earlier age assessments. Inclusion of family-social circumstances further improved diagnostic accuracy.

CONCLUSIONS:

Cognitive risk prediction improves with age, with assessments at 6 years offering optimal diagnostic accuracy. Intervention for children with early mild delay may be beneficial, especially for those raised in socially disadvantaged family contexts.




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The Infantile Hemangioma Referral Score: A Validated Tool for Physicians

OBJECTIVES:

Infantile hemangiomas (IHs) are common; some cases require timely referral and treatment to prevent complications. We developed and validated a reliable instrument for timely and adequate referral of patients with IH to experts by nonexpert primary physicians.

METHODS:

In this multicenter, cross-sectional, observational study, we used a 3-stage process: (1) development of the Infantile Hemangioma Referral Score (IHReS) tool by IH experts who selected a representative set of 42 IH cases comprising images and a short clinical history, (2) definition of the gold standard for the 42 cases by a second independent committee of IH experts, and (3) IHReS validation by nonexpert primary physicians using the 42 gold standard cases.

RESULTS:

A total of 60 primary physicians from 7 different countries evaluated the 42 gold standard cases (without reference to the IHReS tool); 45 primary physicians evaluated these cases using the IHReS questionnaire, and 44 completed retesting using the instrument. IHReS had a sensitivity of 96.9% (95% confidence interval 96.1%–97.8%) and a specificity of 55.0% (95% confidence interval 51.0%–59.0%). The positive predictive value and negative predictive value were 40.5% and 98.3%, respectively. Validation by experts and primary physicians revealed substantial agreement for interrater reliability and intrarater repeatability.

CONCLUSIONS:

IHReS, a 2-part algorithm with a total of 12 questions, is an easy-to-use tool for primary physicians for the purpose of facilitating correct and timely referral of patients with IH. IHReS may help practitioners in their decision to refer patients to expert centers.




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Trivantis Lectora Inspire

Trivantis Lectora Inspire is more expensive than fellow Editors' Choice pick Articulate Storyline 2. With that said, it's still worth checking out as it is a very powerful eLearning authoring tool.




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Wix Stores

Wix Stores has a smooth offering that's strongly geared toward beginners who just want to get off the ground quickly. More advanced users or those who need more in-depth customizability, however, will need to look elsewhere.




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GoDaddy GoCentral Online Store

Given that GoDaddy's GoCentral Online Store is an add-on service to its web hosting product, you'll find its features a little more limited than much of the competition. But if you're a GoDaddy customer, then it's a great way to start quickly.




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Have a Question for PCMag?

Need help with what to buy? On Twitter, reach out to @PCMag using the #PCMagPicks hashtag, and we'll track down an answer for you.




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Whistle GO Explore

The Whistle GO Explore pet tracker improves on the previous generation in nearly every while, while adding a few new tricks in the process.




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Salesforce Pardot

Although it's pricey, the intuitive Salesforce Pardot offers standout features, making it a leader among today's marketing automation platforms.




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Campaign Monitor

Campaign Monitor is a satisfactory marketing tool, especially with email marketing features and analytics, but it trails the competition in areas like direct online support.




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HostGator Web Hosting

HostGator is an excellent web hosting service that's simple to use and offers an array of useful plans for consumers and small businesses. It's our top pick for shared web hosting and for novice webmasters in general.




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Champions League Fantasy: Who's in form?

With the UEFA Champions League resuming next week, UEFA.com looks at which players have been hitting the heights on the domestic front.




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Paris v Dortmund facts

Two Erling Braut Haaland strikes have given Dortmund an advantage to take to Paris, although Neymar's away goal could prove crucial.




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Fantasy Football Matchday 7 lessons: Forwards

Erling Braut Haaland and Robert Lewandowski continued to hit the net, although injury means the latter is likely to miss the second leg.




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A transformed heart

An Albanian man's heart is forever changed after suffering a heart attack and meeting Jesus in his recuperation.




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An architect explores using his passion in missions

For years, Gustavo, an architect from Central America, felt drawn to working in the Arabian Peninsula. Then, on a short-term trip, he saw what it could be like to use his profession overseas.




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The God of India, Singapore and the Middle East

Doron's experience on Logos Hope shows him God's faithfulness and uncovers leadership abilities he is using today in a new role.




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God called you, and God has a plan for you

An OM worker in Cambodia shares about how a new training she is attending is transforming the way she does ministry.




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Seizing every opportunity

Buenos Aires, Argentina :: Maintenance crew share Christ's love with local welders helping repair Logos Hope.




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Ordinary woman, extraordinary journey

God uses Janet to reach people through one-on-one encounters at a bookshop in a closed country.




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'To the whole world’

Tinashe disciples and shows Zimbabweans that they, too, are called to serve; everyone can share their own stories with others to show the love of Christ. 




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Response: 'Embracing Technology' as a Tool for Differentiation

Elizabeth Stringer Keefe, Becky Shiring, Katie Robinson, Dr. Sonny Magana and Dr. Monica Burns contribute their suggestions on using tech to differentiate instruction.




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4 Reasons for Technology Integration

Second year teacher, Christine Pinto, shares some reasons she integrates technology in her classroom.




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Michelle Darnell named director of Smeal's new Tarriff Center

Michelle R. Darnell, associate clinical professor in management and director of honor and integrity at Smeal, has been appointed as the inaugural director of the Tarriff Center for Business Ethics and Social Responsibility.




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Penn State Smeal names spring 2020 Senior Award honorees

The Penn State Smeal College of Business has announced the recipients of its spring 2020 Senior Awards.




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Hintzes commit $100,000 for emergency aid to students

Two of Penn State’s most generous supporters and prominent alumni leaders have made a new commitment to support students impacted by the COVID-19 crisis. Helen S. Hintz, 1960, and Edward “Ed” R. Hintz, 1959, have directed $100,000 to the Student Care and Advocacy Emergency Fund.




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Penn State Smeal panel explores pandemic's effects on sustainability, business

The Penn State Smeal College of Business Center for the Business of Sustainability recently hosted the first in a series of virtual fireside discussions titled “The Impact of Coronavirus on Sustainability and Social Impact,” to explore how recent momentum in sustainability efforts has been altered.




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Smeal supply chain student marshal points to professor as guiding force

Rachel Hooker, who will graduate May 9 with a 3.99 GPA in supply chain and information systems, has been selected as the Smeal College of Business’ spring 2020 supply chain and information systems student marshal.




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COVID-19: Researchers to model novel coronavirus for spread mitigation

In an effort to help mitigate the disruptive effects of the deadly COVID-19 virus, an interdisciplinary team of Penn State researchers are developing a novel methodology to analyze its spread and the impacts on policy to create better-prepared and more-resilient health care systems.




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Penn State Health selects president for its new Hampden Medical Center

Penn State Health has appointed Don McKenna as president of Penn State Health Hampden Medical Center.




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New guide curates COVID-19 related resources for researchers

Penn State University Libraries has developed a curated guide to COVID-19 related resources for researchers, including ongoing research at Penn State.




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Penn State researchers collaborate to distribute COVID-19 survey globally

To assess public perceptions about COVID-19 and identify populations whose behaviors put them at risk of infection, researchers at Penn State have released an online survey for the general public.




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New decontamination protocol permits reuse of N95 respirators

A new protocol using aerosolized hydrogen peroxide to decontaminate N95 respirators could allow them to be safely reused in hospital settings. The protocol, optimized by a team of Penn State researchers, inactivates viruses without deforming or damaging the respirator and could help hospitals overcome the current respirator shortage due to the COVID-19 pandemic.




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PSU-LV faculty and staff support students during pandemic

Both in and out of the virtual classroom, Penn State Lehigh Valley departments are connecting with students during remote learning




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Lehigh Valley LaunchBox grant recipients help COVID-19 relief efforts

Using their unique skills and experiences, three LaunchBox grant recipients are providing a variety of COVID-19 relief efforts.




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Faculty member earns doctorate, selected as Fulbright specialist

Beth E. Michalec, lecturer of corporate communication at Penn State Lehigh Valley, earned a doctorate in rhetoric from Duquesne University. Michalec was selected as a Fulbright specialist in June 2019 by the U.S. Department of State.




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Fin24.com | Credit ombud rakes in millions for consumers

Are you unhappy with your credit provider? Have you been given more debt than you can afford to pay back? Help is at hand, and it’s just an SMS away.




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Fin24.com | What you need to know when selling or buying

The onus is on you to uncover any defects before you buy, writes Angelique Ruzicka.




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Fin24.com | REVEALED: Africa's wealthiest and poorest people

Mauritians are Africa's wealthiest individuals, while Zimbabweans count as the poorest, according to the latest Africa Wealth Report.




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Fin24.com | Watch out for loan scam, warns Sanlam

Unsuspected consumers are being targeted by fraudsters using the name of Sanlam to swindle cash out of them, the financial service provider has warned.




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Fin24.com | Gauteng, Western Cape and KZN top list for card fraud

Gauteng, the Western Cape and KwaZulu-Natal are the hot spots for card fraud in South Africa, according to a report on global fraud activity.




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Fin24.com | SA inequality grows as rich take larger share - report

New research has found that inequality in SA has increased, with wealth becoming ever more concentrated among the rich.




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Fin24.com | South Africans are big borrowers and poor savers - expert

Reducing indebtedness and improving savings in South Africa is a major socio-economic challenge, warns an industry expert.




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Fin24.com | Debit order fraud: Beware of sharing your banking details

Payments Association of South Africa has warned consumers to be cautious when sharing personal information which can be used by fraudsters to make unauthorised debit orders.




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Fin24.com | Debit order fraud: Consumers 'frustrated' and 'annoyed' with banks

Fin24 users speak of their frustrations with banks, calling for a crackdown on debit order fraud that sees payments they didn't authorise being deducted from their bank accounts each month.




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Fin24.com | Credit card fraud is getting worse. Here's how you can protect yourself

With credit card fraud rising at an alarming rate in the first quarter of the year, the Ombudsman for Banking Services has provided 10 tips to avoid becoming a victim of scammers.




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Deals: Lenovo Flex 14, Dell Gaming Monitor, New Nintendo Switch

Today you can save $120 on the Lenovo Flex 14 2-in-1 laptop. Also, the 24-inch Dell S2419HGF 1080p monitor dropped is now just $149.99. Finally, the new Nintendo Switch, featuring improved battery life, is now available.




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Fitbit Charge 3 Fitness Tracker on Sale for Less Than $120

Save $30 on this Editors' Choice fitness tracker, which is safe to wear in the pool and shower. It's normally $149.95, but you can grab it now for just $119.95 with free shipping.