Use of herbal preparations during pregnancy: Focus group discussion among expectant mothers attending a hospital antenatal clinic in Norwich,UK

BackgroundThe extent of herbal medicine use in pregnancy has been widely researched throughout the world but little research has been published about the motivations for this use.MethodsFocus group discussion. Women who participated in a survey at an antenatal clinic were asked to participate in a focus group discussion to elaborate further on some of the results from the survey. Six women participated.ResultsThe major themes identified were: the “underground” nature of taking herbal remedies, reliance on family and friends for information, perceived safety of herbal remedies whilst acknowledging the lack of trial evidence and a desire for the NHS to be more open minded.ConclusionHerbal medicines are pharmacologically active and pregnant women frequently take these without informing their pregnancy care provider. If doctors want to obtain a full medical picture which includes herb use then non-judgemental responses to such behaviour is required.     

Application of Sex Aids in Men With Sexual Dysfunction: A Review

BackgroundAlthough sex aids have been used in clinical practice for ages, the scientific literature assessing their application in men with sexual dysfunction is limited.AimTo summarize medical literature regarding scientific uses of the most common sex aids in men with sexual dysfunction and assess their clinical applicability.MethodsAn extensive literature review was performed with regard to the use of sex aids in sexual medicine. Our search included journal articles, books, and guidelines in different databases: Embase, PubMed, and Cochrane. The key words were “sex aids,” “sex toys,” “pornography,” “lubricants,” “constriction bands,” “dildos,” “vibrators,” “vacuum devices,” “external penile devices,” and “sex swings” were searched. Date of last search was December 4, 2018.Main Outcome MeasuresWe assessed the utility of sex aids in men with sexual dysfunction and formulated recommendations for clinicians.ResultsVarious sex aids are available for men with sexual dysfunction. We present a comprehensive review of the most common sex aids currently available: pornography, lubricants, constriction bands, dildos, vibrators, vacuum devices, external erectile support devices, and aids to positioning. We discuss their indications, outcomes, precautions, and complications.Clinical implicationsThis review is intended to provide sexual medicine practitioners and academics an overview of sex aids for men with sexual dysfunction for use in both clinical practice and research.Strengths & LimitationsThis is a compilation of scientific data for a topic that has broad application in sexual medicine and yet has been poorly addressed in the scientific literature. Because of the lack of sufficient data and the heterogeneous nature of different sex aids, a systematic review could not be performed.ConclusionHaving a comprehensive understanding of the sexual dynamics of individuals and couples combined with the appropriate integration of sex aids may have a positive effect in the treatment of male sexual dysfunctions.Miranda EP, Taniguchi H, Cao DL, et al. Application of Sex Aids in Men With Sexual Dysfunction: A Review. J Sex Med 2019;16:767–780.     

Initiating and Sustaining Breastfeeding in African American Women

Objective:To explore issues related to initiating and sustaining breastfeeding in African American women.Design:Qualitative design using focus groups, guided by Leininger's theory of culture care diversity and universality.Setting:Three different regions of a southeastern state in the United States.Participants:Fifteen self‐identified African American women who had recently breastfed were recruited by lactation consultants and by word of mouth.Methods:Three focus groups were conducted with initial guiding questions. New ideas that emerged were fully explored in the group and included as a guiding question for the next group.Results:Categories identified from the data were reasons to start and stop breastfeeding, advice about breastfeeding that was useful or not useful, and cultural issues related to breastfeeding that were perceived to be unique among African Americans. Three overall themes were identified that cut across categories: perceived lack of information about benefits and management of breastfeeding, difficulties breastfeeding in public, and lack of a support system for continued breastfeeding.Conclusion:Women need to be taught early in their pregnancies about the benefits of breastfeeding and offered continuing support and teaching once breastfeeding is established. Peer support groups for breastfeeding African American women should be established.     

Adulteration of Purported Herbal and Natural Sexual Performance Enhancement Dietary Supplements with Synthetic Phosphodiesterase Type 5 Inhibitors

IntroductionMany products labeled “herbal” or “all natural” (herbal/natural) that claim to enhance sexual performance and imply use for the treatment of erectile dysfunction (ED) are marketed as over-the-counter (OTC) dietary supplements. However, adulteration with undeclared phosphodiesterase type 5 (PDE5) inhibitors appears widespread.AimTo assess the availability, cost, origin, categorical content, and adulteration with PDE5 inhibitors of purported herbal/natural OTC dietary supplements claiming to naturally enhance sexual performance.MethodsPfizer Global Security coordinated sample collection (all from convenience stores and filling stations in two U.S. metropolitan areas except for seven from U.S. Customs seizures) and liquid chromatography/mass spectrometry examination.Main Outcome MeasureAdulteration with synthetic PDE5 inhibitors.ResultsNinety-one samples labeled as 58 distinct products and priced from $2.99 to $17.99 were evaluated. Origin/manufacture was claimed as United States (n = 62), apparently Asian (n = 15), and not clearly identified (n = 14). Although no sample claimed to include synthetic substances, 74 (81%) contained PDE5-inhibitor pharmaceutical ingredients, including tadalafil and/or sildenafil (n = 40, of which 18 contained >110% of the highest approved drug product strength) or PDE5-inhibitor analogs (n = 34). Pronounced heterogeneity of contents between samples within individual products indicated minimal quality control during manufacture. Labeling was inadequate (e.g., lacking lot number and/or expiry date) for 17 products (23 samples) and inconsistent between samples within a given product (e.g., in manufacturer, lot number, and/or expiry date) for seven of 17 products having multiple samples. Only 14 samples warned against concomitant nitrate use.ConclusionsEthical pharmaceutical companies are concerned for an unsuspecting public when their products are counterfeited, mislabeled, and illegally offered for sale in an unsafe manner. Because of the dangers of adulteration with synthetic PDE5 inhibitors, absent safety warnings, and lack of quality or consistent manufacture, men with ED unknowingly risk their health by using OTC herbal/natural products that claim to enhance sexual performance. Campbell N, Clark JP, Stecher VJ, Thomas JW, Callanan AC, Donnelly BF, Goldstein I, and Kaminetsky JC. Adulteration of purported herbal and natural sexual performance enhancement dietary supplements with synthetic phosphodiesterase type 5 inhibitors.     

Initiation de l’allaitement maternel et sevrage précoce : étude prospective du réseau périnatalité Loire–Nord Ardèche

ObjectivesThe World Health Organization recommends exclusive breastfeeding of infants up to 6 months. The proportion of breastfeeding initiation and duration increased more slowly in France than in neighboring European countries. The perinatal network data are incomplete. The objective of this study is to evaluate within the perinatal network “Loire–Nord Ardèche” (ELENA), breastfeeding rates in hospital discharge and at 2 months, and identify needs for maternal support.Patients and methodsProspective and declarative study by written questionnaire, with all the women volunteers who gave birth in October 2011 in a maternity of our perinatal network.ResultsPopulation concerns 426 women volunteers of 968 new mothers. Two hundred and ninety-four questionnaires were used: 69% of women initiated breastfeeding, 63% have continued after the stay in the maternity and 50% at 2 months. Eighty percent chose to breastfeed before pregnancy, mainly for child health, 65% with the support of their spouse, 58% if their mother had breastfed. Simple pathologies of breastfeeding and childbirth were responsible for weaning. A third of women in difficulty have not consulted anyone, one third wanted more practical help and systematic support motherhood.Discussion and conclusionThe rate of initiation of breastfeeding or duration and the great influence of the surroundings of the mother, similar in this study to literature data, call for enhanced prenatal information for parents and systematic “lactation” consultation in the early post-partum, by trained professionals and with the help of support associations for breastfeeding. This study showed a clear need to support breastfeeding. It has also allowed targeting actions that would be able to avoid the majority of early weaning.     

Confident Commitment Is a Key Factor for Sustained Breastfeeding

Background: The characteristics that distinguish women who breastfeed successfully from those who do not are just beginning to be identified in breastfeeding literature. The objective of this study was to identify the processes contributing to breastfeeding decisions among Caucasian and African American women. Methods: Data were initially collected through 24 focus groups consisting of separate groups of African American and Caucasian pregnant women, and breastfeeding and formula‐feeding mothers from three major United States cities. The focus group study was initiated by the U.S. Department of Health and Human Services to obtain data on salient messages that would inform a national campaign to promote breastfeeding. This study was a secondary analysis of those data using a modified grounded theory approach. Results: The process that emerged associated with successful breastfeeding was labeled “confident commitment.” This process included several components: a) confidence in the process of breastfeeding, b) confidence in their ability to breastfeed, and c) commitment to making breastfeeding work despite obstacles. Conclusions: Contrary to popular conceptions, breastfeeding appears to be a learned skill. If mothers achieved a level of “confident commitment” before the birth, they were able to withstand lack of support by significant others and common challenges that occurred as they initiated breastfeeding. Without the element of “confident commitment,” a decision to breastfeed appeared to fall apart once challenged.     

Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants

ObjectiveTo systematically review the literature related to the effectiveness of parents’ active involvement during painful interventions for their preterm infants.Data SourcesWe performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords “preterm infants,” “pain,” and “parents.”Study SelectionArticles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures.Data ExtractionWe used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute.Data SynthesisIn total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant.ConclusionThe current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures.     

Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers

ObjectiveTo synthesize the extant research on the support of breastfeeding and breast milk feeding and related practices in child care centers (i.e., daycare centers) in the United States and globally.Data SourcesWe used key terms to search Ovid, CINAHL, and PubMed for articles that met eligibility criteria. When potentially relevant articles were identified in PubMed, we used the cited by and similar articles features to identify additional articles. We also examined the reference lists of reviewed studies.Study SelectionWe included original research articles on breastfeeding or breast milk feeding in child care centers published in 2000 or after and available in English. We reviewed titles and/or abstracts of 1,984 articles and abstracted 37 for full-text review. Of these, 16 studies met eligibility criteria and were included in the review.Data ExtractionWe abstracted data from the 16 articles to facilitate comparison and identification of patterns related to support of breastfeeding/breast milk feeding and related practices in child care centers. These data included year of publication, setting, design/methodology (and methodologic limitations), type of respondent/sampling unit (e.g., directors and staff members of child care centers, mothers), sample size, outcome measures, and pertinent study findings.Data SynthesisWe categorized study findings into three themes: Knowledge, Attitudes, and Experiences of Staff Members in Child Care Centers; Implementation and Adherence to Policies, Practices, and Regulations in Child Care Centers; and Prevalence of Breastfeeding in Child Care Centers. Findings indicated staff members generally had positive attitudes toward breastfeeding but tended to remain neutral regarding encouragement and support of breastfeeding. Training and knowledge about breastfeeding among staff members in child care centers appears limited and focused mainly on the storage and preparation of breast milk; however, staff members indicated the desire to obtain additional education about breastfeeding. Few U.S. child care centers or states have comprehensive, evidence-based policies and regulations to address support for breast milk feeding and breastfeeding. The prevalence of breastfeeding in U.S. child care centers is less than that in other child care settings (home-based child care, etc.), child care centers in other developed countries, and national breastfeeding averages.ConclusionWe found a general lack of policies and practices to support breastfeeding in child care centers, particularly in the United States. The degree to which this policy/practice deficit contributes to suboptimal breastfeeding rates among women who use child care centers requires further study.     

An Evaluation of a Breastfeeding Privacy Sign to Prevent Interruptions and Promote Successful Breastfeeding

ObjectiveTo determine if using a breastfeeding privacy sign during breastfeeding sessions improves breastfeeding outcomes and maternal satisfaction.DesignQuasi‐experimental, posttest design.SampleA convenience sample of 46 healthy, English speaking, exclusively breastfeeding, term (>37 0/7 weeks gestation) dyads were included.MethodsThe control group received routine hospital care and completed a feeding diary and questionnaire. The intervention group received the same treatment and was given a breastfeeding privacy sign to use during breastfeeding sessions.ResultsThe total number of interruptions was significantly less in the intervention group. Significantly more intervention participants documented “strong agreement” when reporting that their breastfeeding sessions were successful. No difference was noted regarding the number of breastfeeding sessions, total minutes of breastfeeding sessions, or percentage of infant weight loss at day 2 of life.ConclusionsThe number of interruptions during breastfeeding sessions was significantly decreased with the use of a breastfeeding privacy sign, and the mothers who used the sign strongly agreed that their breastfeeding sessions were successful.     

Cannabidiol for the Management of Endometriosis and Chronic Pelvic Pain

ObjectiveTo review the available literature on the effect of cannabis-based products on the female reproductive system and establish whether there is any evidence that they benefit or harm patients with endometriosis and, therefore, whether there is sufficient evidence to recommend them.Data SourcesAn electronic-based search was performed in PubMed, Embase, and the Cochrane Database. Reference lists of articles retrieved were reviewed, and a gray literature search was also performed.Methods of Study SelectionThe original database search yielded 264 articles from PubMed, Embase, and the Cochrane Database, of which 41 were included. One hundred sixty-one studies relating to gynecologic malignancy, conditions unrelated to endometriosis, or therapies unrelated to cannabis-based products were excluded. Twelve articles were included from a gray literature search and review of references.Tabulation, Integration, and ResultsMost available evidence is from laboratory studies aiming to simulate the effects of cannabis-based products on preclinical endometriosis models. Some show evidence of benefit with cannabis-based products. However, results are conflicting, and the impact in humans cannot necessarily be extrapolated from these data. Few studies exist looking at the effect of cannabis or its derived products in women with endometriosis; the majority are in the form of surveys and are affected by bias. National guidance was also reviewed: at present, this dictates that cannabis-based products can only be prescribed for conditions in which there is clear published evidence of benefit and only when all other treatment options have been exhausted.ConclusionCurrent treatment options for endometriosis often affect fertility and/or have undesirable side effects that impede long-term management. Cannabis-based products have been suggested as a novel therapeutic option that may circumvent these issues. However, there is a paucity of well-designed, robust studies and randomized controlled trials looking at their use in the treatment of endometriosis. In addition, cannabis use has a potential for harm in the long term, with a possible association with “cannabis use disorder,” psychosis, and mood disturbances. At present, national guidance cannot recommend cannabis-based products to patients in the UK owing to lack of clear evidence of benefit. More comprehensive research into the impact of endocannabinoids in the context of endometriosis is required before their use can be recommended or prescribed.     

Probiotics in pregnancy and maternal outcomes: a systematic review

Abstract

Objectives: To systematically review the literature on the use of probiotics in pregnancy and their impact on maternal outcomes.

Methods: Online databases were searched in April 2012 using the following terms to identify eligible studies: “probiotics”, “pregnancy”, “maternal outcomes” and “metabolism”. Primary outcomes of selected studies were maternal fasting glucose during pregnancy and rates of gestational diabetes mellitus (GDM). Secondary outcomes were rates of pre-eclampsia, maternal inflammatory markers and lipid profiles and gestational weight gain. Studies whose primary outcomes were bacterial vaginosis, pre-term delivery and infant atopy were excluded. Only English-language articles were included. The limited number of eligible studies and varying outcomes precluded formal meta-analysis of these data.

Results: Initially, 189 articles were identified and screened. Seven articles met inclusion criteria and are included in the present review. Results demonstrated that probiotic use in pregnancy could significantly reduce maternal fasting glucose, incidence of GDM and pre-eclampsia rates and levels of C-reactive protein.

Conclusions: Probiotics hold potential as a safe therapeutic tool for the prevention of pregnancy complications and adverse outcomes related to maternal metabolism. Further randomised controlled trials are urgently required, particularly among those at high risk of metabolic disorders, such as overweight and obese pregnant women.     

Providing evidence for use of Echinacea supplements in Hajj pilgrims for management of respiratory tract infections

ObjectiveTo evaluate potential applicability of Echinacea use for management of respiratory tract infections in Hajj travelers.MethodThe PubMed database was explored with Mesh terms “Echinacea” and “Respiratory Tract Infections”.ResultsA hundred journal articles were yielded but only 66 most relevant ones used for the review.ConclusionThere is a considerable amount of evidence that shows effectiveness of Echinacea products in prevention and treatment of respiratory tract infections in this setting. Although there are some controversial findings, utilization of standardized products with adequate dose or combinations with other immune-stimulants in controlled and well-designed trials will be highly encouraging.     

Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy

ObjectiveTo synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes.Data SourcesWe searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid.Study SelectionWe included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review.Data ExtractionWe extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT.Data SynthesisWe identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors.ConclusionThe results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.     

Breastfeeding Promotion for Management of Neonatal Abstinence Syndrome

ObjectiveTo review the literature about the association between breastfeeding and neonatal abstinence syndrome (NAS) severity, need for pharmacologic treatment for NAS, and length of hospital stays in neonates with in‐utero exposure to methadone or buprenorphine opioid replacement therapy.Data SourcesPubMed, CINAHL, and Medline were searched for articles published between January 1990 and April 2013 using the terms opioid dependency in pregnancy, neonatal abstinence syndrome, methadone, buprenorphine, neonatal length of stay, breastfeeding, methadone in breast milk, buprenorphine in breast milk, swaddling, and rooming‐in.Study SelectionInclusion criteria included studies written in English on the topic of breastfeeding for management of NAS.Data ExtractionThe author independently reviewed each article.Data SynthesisBreastfeeding can effectively decrease NAS symptoms because methadone and buprenorphine are transferred to the breast milk. Maternal contact while breastfeeding also plays a role in ameliorating the NAS symptoms. Interventions that also support breastfeeding in the treatment of NAS include skin‐to‐skin contact, swaddling, and rooming‐in.ConclusionsUnderstanding the benefits of breastfeeding for opioid‐dependent pregnant women and their neonates will enable clinicians to safely recommend breastfeeding for long‐term health of these high‐risk women and their infants. This review of the effects of in‐utero exposure to opioids on infant development can assist clinicians to more effectively support opioid‐dependent women to breastfeed their infants.     

Systematic Review of Contraceptive Use Among Sex Workers in North America

ObjectiveTo systematically review the literature regarding contraceptive use by sex workers in North America and to understand factors that limit reproductive agency and affect contraceptive use and decision making.Data SourcesWe searched PubMed, CINAHL, and Embase databases using the search terms “sex work(ers),” “transactional sex,” “exchange sex,” “prostitution,” “contraception,” “contraceptive agents,” “birth control,” “female,” and “women.”Study SelectionArticles were eligible for inclusion in this review if they (a) reported quantitative or qualitative studies based in North America, (b) were written in English, (c) included sex workers (self-identified sex workers or engaged in sex work behavior) as the primary or secondary population of the study, (d) included a population assigned female sex at birth, (e) reported contraceptive outcomes for sex workers, and (f) were published in peer-reviewed journals. The initial search yielded 2,455 articles, and seven met the inclusion criteria.Data ExtractionTwo authors independently reviewed the articles and organized data in a table to capture study design, sample size and study population, study aims, and contraceptive use. We applied Connell’s theory of gender and power as an analytic framework to further identify factors that limited reproductive agency.Data SynthesisCondoms were the most common method of contraceptive used across studies. The use of contraceptives varied by partner type (client vs. nonpaying intimate partners). Access to highly effective contraception was limited by perceived stigma, financial constraints, and substance use. Reproductive and harm reduction services that were co-located where women worked improved contraceptive use. Contraceptive use was affected by factors that limited reproductive agency, including stigma, substance use, intimate partner violence, and condom coercion.ConclusionThe reliance of sex workers on partner-dependent contraception, such as condoms, combined with factors that limit reproductive agency over contraceptive use and decision making contribute to high potential for contraceptive failure and unintended pregnancy. More research is needed to understand the influence of different sexual partner types, pregnancy intention, and contraceptive decision making on the reproductive agency of sex workers.     

Perception and attitude of Jordanian physicians towards complementary and alternative medicine (CAM) use in oncology

PurposeTo determine general perception and attitudes to CAM among Jordanian physicians at King Hussein Cancer Center (KHCC), and challenges facing formal integration of CAM into conventional practice.MethodA cross-sectional survey of KHCC physicians using a semi-structured questionnaire.ResultsResponse rate was 71%(71/100). 84%(41/49) defined CAM as “not evidence-based” treatments and/or “Herbs”. More than 80% reported interest to learn about CAM. 70% believed that herbal remedies were harmful, though only 17%(12/71) reported some knowledge about their composition. Physicians' concern of harmful interactions was the most significant reason for asking their patients about use (p < 0.0001). >90%(32/35) of physicians who estimated a low rate (<10%) of CAM usage by patients had minimal knowledge of herbal remedies (p = 0.06).ConclusionKHCC physicians have very little knowledge but high interest to learn about CAM use in oncology. An educational component will be crucial for the implementation of a formal CAM program at KHCC.     

Obstétriciens-gynécologues et allaitement maternel : pratique,attitudes, formation et connaissances

ObjectiveSole use of breastfeeding is recommended during the first six months of life. The treating physician’s opinion influences whether or not the patient will opt for breastfeeding. We wanted to ascertain if obstetricians-gynaecologists and obstetrics and gynaecology residents from Quebec offered counselling on breastfeeding and to examine various aspects of their disposition towards such counselling.MethodsA questionnaire evaluating five aspects of physicians’ disposition towards breastfeeding was used: practice and confidence, attitudes, training, knowledge. We emailed obstetrics and gynaecology residents from Quebec and members of the Association des obstétriciens et gynécologues du Québec who had a valid email address to invite them to complete the questionnaire, which was offered on a secured website.ResultsOnly 49% of obstetricians-gynaecologists and 35% of residents periodically offer counselling on breastfeeding. Furthermore, 56% and 35% respectively of both groups have confidence in their ability to meet the needs of breastfeeding patients, while 79% of the former and 93% of the latter believe that such counselling comes under their authority On average, obstetricians-gynaecologists answered correctly 82% of the questions concerning theoretical knowledge Only 16% of obstetricians-gynaecologists and 22% of residents believe they have received an “at least adequate” training on how to support breastfeeding women.ConclusionRespondents have not adequately integrated breastfeeding counselling into their practice, in spite of the fact that they had adequate theoretical knowledge on the matter and that they were convinced that such a role was important and that it came under their authority. A more practical form of training could enhance their confidence level and encourage them to integrate such counselling into the obstetrical follow-up.