The significance of early breastfeeding experiences on breastfeeding self‐efficacy one week postpartum

Many new mothers do not reach their breastfeeding goals. Breastfeeding self‐efficacy is a modifiable determinant influenced by prior and new breastfeeding experiences. More knowledge about factors associated with early breastfeeding experiences and breastfeeding self‐efficacy would allow us to qualify breastfeeding counselling and increase breastfeeding duration. This study aimed to identify prevalence and factors associated with early negative breastfeeding experience, low breastfeeding self‐efficacy in the first week postpartum, and drop in self‐efficacy from late pregnancy to early postpartum period. A prospective longitudinal study was performed in Denmark from 2013 to 2014, including 2, 804 mothers. Results showed that 1 week postpartum almost 10% of mothers had negative breastfeeding experiences, 36% had low breastfeeding self‐efficacy, and 26% drop in self‐efficacy from pregnancy. Negative breastfeeding experiences were significantly associated with epidural analgesia, interrupted skin‐to‐skin contact immediately postpartum, short previous breastfeeding duration, and lacking social support. Low breastfeeding self‐efficacy was associated with low breastfeeding intention, short previous breastfeeding duration, and negative breastfeeding experiences in the first week postpartum. Finally, significant associations of drop in breastfeeding self‐efficacy from late pregnancy were no or short education, early negative breastfeeding experiences, prior short breastfeeding duration, and low general breastfeeding self‐efficacy in pregnancy. Negative breastfeeding experiences in the first week postpartum is crucial for maternal breastfeeding self‐efficacy 1 week following birth. It is important to identify and support mothers at risk of negative breastfeeding experiences in the first week following birth and address factors that might increase the probability of early successful breastfeeding experiences.     

Pathogen Stimulation History Impacts Donor‐Specific CD8+ T Cell Susceptibility to Costimulation/Integrin Blockade–Based Therapy

Recent studies have shown that the quantity of donor‐reactive memory T cells is an important factor in determining the relative heterologous immunity barrier posed during transplantation. Here, we hypothesized that the quality of T cell memory also potently influences the response to costimulation blockade‐based immunosuppression. Using a murine skin graft model of CD8⁺ memory T cell–mediated costimulation blockade resistance, we elicited donor‐reactive memory T cells using three distinct types of pathogen infections. Strikingly, we observed differential efficacy of a costimulation and integrin blockade regimen based on the type of pathogen used to elicit the donor‐reactive memory T cell response. Intriguingly, the most immunosuppression‐sensitive memory T cell populations were composed primarily of central memory cells that possessed greater recall potential, exhibited a less differentiated phenotype, and contained more multi‐cytokine producers. These data, therefore, demonstrate that the memory T cell barrier is dependent on the specific type of pathogen infection via which the donor‐reactive memory T cells are elicited, and suggest that the immune stimulation history of a given transplant patient may profoundly influence the relative barrier posed by heterologous immunity during transplantation.     

Prospective evaluation of implants connected to teeth

PURPOSE: This prospective clinical trial examined the effect on teeth and implants when rigidly or non-rigidly connected in a cross-arch model. MATERIALS AND METHODS: Thirty patients received 2 implants, 1 on each side of the mandible, and were restored with 3-unit fixed partial dentures connected either rigidly or non-rigidly to an abutment tooth. Patients were followed for at least 5 years post-restoration. RESULTS: Repeated-measures analysis revealed no significant difference in crestal bone loss at implants (rigid versus non-rigid methods). An overall significant difference (P < .001) was found comparing methods for teeth. Paired t tests revealed no significant differences in crestal bone levels for implants or teeth at the 5-year recall. Kaplan-Meier methods and the Cox proportional hazards model showed no differences between attachment methods with regard to success based on survival and bone loss criteria. During the 5-year recall period, 1 implant (rigid side) was removed. Four implants developed bone loss greater than 2 mm during the course of this trial. One tooth on the rigid side and 2 teeth on the non-rigid side had greater than 2 mm of crestal bone loss and were removed secondary to fractures. In all, 5 abutment teeth were removed, all of which had been treated with root canal therapy and fractured at the interface of the post within the tooth. There was no clear relationship of tooth fracture to attachment. Repeated-measures analysis of mobility values revealed no significant changes over the time course of this study, and paired t tests revealed no statistically significant differences between implants for mobility. Repeated-measures analysis and paired t tests for probing depth revealed no significant changes over the time course of this study. There were no significant differences in soft tissue indices for either attachment method. The percentage of patients who had measurable intrusion was 66% for the non-rigid group, and 44% for the rigid group; 25% of the non-rigid teeth had greater than 0.5 mm intrusion, compared with 12.5% for the rigid group. For the 2 time periods evaluated, there was no significant increase in intrusion over time. The non-rigid-side implant required more nonscheduled visits to treat problems than the rigid implant and the teeth. Discussion: Most patients were treated successfully with rigid or non-rigid attachment of implants to teeth. CONCLUSION: The high incidence of intrusion and non-scheduled patient visits suggest that alternative treatments without connecting implants to teeth may be indicated.