Breastfeeding problems are extremely common among first-time moms, often causing them to introduce formula or completely abandon breastfeeding within two months, report researchers at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center.
Mother and newborn infant © iStockphoto
Strategies should be developed for evaluating infant breastfeeding and alleviating the concerns of the new, breastfeeding mothers soon after birth, recommend the researchers, who report their findings online this week in the journal Pediatrics.
“Findings from our study indicate that certain breastfeeding problems or concerns are experienced almost universally by first-time mothers, and some of those problems greatly increase the chances they will stop breastfeeding earlier than they planned,” said study co-author Caroline Chantry, a pediatrician at the UC Davis Medical Center, where the research with the first-time mothers was based.
“If we can enable mothers to achieve their breastfeeding goals, we will have a healthier nation,” Chantry said. She noted that although 75 percent of mothers in the United States initiate breastfeeding, only 13 percent of those women ultimately breastfeed exclusively for the recommended first six months of the child’s life.
The new study, based on a sample of 532 first-time mothers, included interviews while the women were pregnant and at six other times between birth and 60 days after the babies were born.
Ninety-two percent of the new moms reported at least one breastfeeding concern three days after birth. The most predominant concern was that the infants were not feeding well at the breast (52 percent), followed by breastfeeding pain (44 percent) and perceived lack of sufficient milk (40 percent).
The researchers collected reports of thousands of breastfeeding problems and concerns from the mothers. The concerns that were reported at interviews conducted at days three and seven after the baby’s birth were strongly associated with the moms’ subsequent decisions to supplement with formula or stop breastfeeding altogether.
“These interviews at three and seven days were conducted at a time when there may be a gap between hospital- and community-based lactation support resources,” said co-author Kathryn Dewey, a UC Davis nutrition professor and authority on maternal and infant nutrition. (More)
NEWS | September 16, 2013
UC Davis study applies timely cost-effectiveness analysis to state breast cancer screening program
(SACRAMENTO, Calif.) —
When public health budgets are constrained, mammography screening should begin later and occur less frequently, a cost-effectiveness analysis for California’s Every Woman Counts (EWC) program concludes.
Joy Melnikow © UC Regents
As outlined in a paper published in Value in Health, the analysis focused on several policy questions, including the effect on EWC program costs and outcomes of starting screening at age 50 years instead of 40 and of screening every two years instead of every year. The study was conducted in response to recent government funding cutbacks.
“This was not a clinical recommendation, but rather was intended to help a public health program use its resources to the greatest effectiveness,” said lead author Joy Melnikow, director of the UC Davis Center for Healthcare Policy and Research.
EWC, administered through the California Department of Public Health Cancer Detection Section, is one of the largest of 68 Centers for Disease Control and Prevention-funded programs across the country. It reimburses providers at Medi-Cal rates (Medi-Cal is the California version of Medicaid) for screening and diagnostic services for breast and cervical cancers. It provides services to women who are not eligible for Medi-Cal, who otherwise lack coverage for breast and cervical cancer screening, and whose income is less than 200 percent of the federal poverty threshold.
The study, conducted by UC Davis and EWC researchers, was based on a sophisticated microsimulation model that projected outcomes based on existing program data. It found that starting mammography screening biennially at age 50 was strongly supported by the model results, given that program funding did not allow screening of the full population of eligible women beginning at age 40.
“Because breast cancer incidence goes up with age, using program funds to screen all eligible women over age 50 will have a greater impact on reducing breast cancer deaths,” said Melnikow. “The goal was to advise a public health program in a timeframe that could be helpful, given that cost-effectiveness analysis typically takes a long time to conduct — often too long to be of use in a quickly changing policy environment.”
The United States Preventive Services Task Force, a government medical task force, in 2009 recommended the same changes in breast cancer screening guidelines, suggesting that most women should not begin getting routine mammograms until age 50, and then only once every two years.
“The task force was asking a different question,” explains Melnikow, who became a member of the task force after the breast cancer screening recommendations vote. “In that case, cost-effectiveness and policy weren’t factors. Instead, the Task Force looked at recommendations for screening of women exclusively from a clinical point of view.”
Melnikow, a UC Davis professor of Family and Community medicine, points out that the EWC analysis has implications for other budget-constrained public programs around the country.
“This study is important for administrators who are doing their best to run public health programs with limited resources. We found that, although it can be challenging, it is by no means impossible to create carefully constructed cost-effectiveness analysis models quickly enough to be useful to programs and policy makers as they render important resource allocation decisions.”
Other study authors were Daniel J. Tancredi, Zhuo Yang, Dominique Ritley, Yun Jiang and Christina Slee, all of the UC Davis Center for Healthcare Policy and Research, UC Davis; and Svetlana Popova, Phillip Rylett, Kirsten Knutson and Sherie Smalley, of the Every Woman Counts program, Cancer Detection Section.
Funding for the study was provided by the California Program on Access to Care , UC Berkeley School of Public Health in cooperation with the UC Office of the President.
The Center for Health Policy Research conducts research on health-care access, delivery, costs, outcomes and related health policy to improve the organization, quality and effectiveness of the practice of medicine, especially primary care. The center is a resource for the university and health system on comparative effectiveness research. Center faculty conduct original research, offer consulting services to agencies in both public and private sectors, and provide research training to fellows, graduate students and junior faculty. Established as an interdisciplinary unit, the center includes more than 80 health-care researchers who represent disciplines ranging from business management and psychiatry to preventive medicine, epidemiology and statistics. For more information, visit http://www.ucdmc.ucdavis.edu/chpr.
"Incidental findings" rare but significant events in pediatric CT scans
Four percent of head-trauma scans have unexpected results that may need follow up
(SACRAMENTO, Calif.) —
The largest study of computed tomographic (CT) scans taken in emergency departments across the country for children with head injuries describes the prevalence of “incidental findings” — results that were not expected from the injury — and categorizes them by urgency.
Nathan Kuppermann © UC Regents
The article, titled “Incidental findings in children with blunt head trauma evaluated with cranial CT scans,” was published in the August issue of Pediatrics, and provides a context for doctors in emergency departments who encounter these situations.
“Incidental findings are a rare but significant event,” said Nathan Kuppermann, professor and chair of emergency medicine at the UC Davis Medical Center and principal investigator of the study. “It is important for doctors to look for abnormalities other than what they expect to find and to be prepared to interpret and communicate these findings to families.”
The study involved nearly 44,000 children seen for a head injury in 25 hospital emergency departments nationwide. Nearly 16,000 had CT scans to evaluate an injury, and about 4 percent of the scans revealed incidental findings ranging from enlarged tonsils to life-threatening cancers. Children with a known pre-existing brain abnormality were excluded from the analysis.
Researchers also stratified the incidental findings into three categories: those that needed immediate evaluation or treatment, those that needed appropriate timely outpatient follow up, and those that merited further investigation only if the problems were causing symptoms. Only 0.1 percent of the overall sample of CTs fell into the most serious category. (More)
UC Davis researchers receive $2.5 million grant to study telepsychiatry
Researchers at UC Davis have received a five-year, $2.5 million grant to study whether viewing videotaped interviews with patients to assess them and guide their mental-health treatment is more cost-effective and better for patient outcomes and satisfaction than real-time telepsychiatric evaluation.
The study will involve videotaping interviews of patients and their providers in their primary-care clinic that later are viewed and evaluated by psychiatrists, who will make diagnostic evaluations and treatment plans that can be carried out by primary-care doctors and community therapists. This approach is called “store-and-forward,” or asynchronous telepsychiatry, because the patient is not being evaluated in real time.
The research will compare the effectiveness of this style of telepsychiatry to real-time, or synchronous telepsychiatry, in which a psychiatrist evaluates patients via live, interactive videoconferencing. In both approaches, the psychiatrist provides primary-care providers with assessments and treatment plans and is available for follow-up consultation by phone or email. (More)
School of Nursing professor named director of new center devoted to boost women's numbers in academia
Professor Mary Lou de Leon Siantz was recently appointed by UC Davis Chancellor Linda P.B. Katehi as director for the new Center for the Advancement of Multicultural Perspectives on Science (CAMPOS). The center is part of a new effort, led by Katehi, to increase the participation of women, especially Latinas, in academic science, technology, engineering and mathematics (STEM) careers.
Established by a grant of $3.725 million over five years from the National Science Foundation’s ADVANCE program, CAMPOS is a research center aimed at attracting women and Latina STEM scholars to UC Davis by providing an accessible and inclusive community of research collaborators and mentors throughout their careers.
CAMPOS is planned to be both a physical location for networking and exchanging ideas and a faculty-hiring initiative to increase diversity in key STEM fields. In making up to 16 new faculty hires, CAMPOS aims to build coalitions of STEM faculty who want to apply their research to serve underrepresented communities. (FULL STORY)
Reducing unnecessary and high-dose pediatric CT scans
could cut associated cancers by 62 percent
A study examining trends in X-ray computed tomography (CT) use in children in the United States has found that reducing unnecessary scans and lowering the doses for the highest-dose scans could lower the overall lifetime risk of future imaging-related cancers by 62 percent. The research by a UC Davis Health System scientist is published online today in JAMA Pediatrics. It is accompanied by a journal editorial.
The 4 million CT scans of the most commonly imaged organs conducted in children each year could result in approximately 4,870 future cancers, the study found. Reducing the highest 25 percent of radiation doses could prevent 2,090 — or 43 percent — of these future cancers. By also eliminating unnecessary imaging, 3,020 — or 62 percent — of cancers could be prevented, said Diana Miglioretti, lead study author and Dean’s Professor in Biostatistics in the Department of Public Health Sciences at UC Davis Health System.
“There are potential harms from CT, meaning that there is a cancer risk, albeit very small in individual children, so it’s important to reduce this risk in two ways,” said Miglioretti, who is a member of the UC Davis Comprehensive Cancer Center. “The first is to only do a CT when it’s medically necessary, and use alternative imaging when possible. The second is to dose CT appropriately for children.” (FULL STORY)
Emergency medicine faculty honored at national meeting
Three members of the UC Davis Department of Emergency Medicine, including two members of the Center for Healthcare Policy and Research, were honored recently for their achievements and leadership at this year’s annual Society for Academic Emergency Medicine (SAEM) meeting in Atlanta.
Daniel Nishijima, assistant professor of emergency medicine, received the society’s Young Investigator Award for his early career accomplishments in clinical research in emergency medicine. Nishijima, who came to UC Davis as a research fellow in 2008, is becoming known as an investigator with expertise in the evaluation and management of patients with blunt head trauma. One of his current projects is a cost-effectiveness analysis of using a decision rule for CT scanning in children with blunt head trauma versus routine care. Nishijima has published 18 manuscripts (including those in press), and has been the first author on 11 of those studies. He is currently an awardee of a competitive CTSC K12 career development award, and has been successful in obtaining highly competitive intramural grants as well as securing important extramural research funding.
James Holmes, professor of emergency medicine, was elected to the society’s board of directors. Holmes is well known for both his clinical-care expertise and research accomplishments. In addition to investigating various approaches to improving trauma care of both adults and children in emergency departments, he is working with department Chair Nathan Kuppermann to oversee a five-year, NIH training grant for research education in emergency medicine, pediatric emergency medicine and associated disciplines. His research is highly collaborative, frequently using multicenter research networks, and focuses on the care of adults and children with acute traumatic injuries. (FULL STORY)
2013 Outcomes Research Pilot Awards
The CHPR is proud to announce the recipients of the 2013 Outcomes Research Pilot Awards:
Stephen G. Henry, M.D., M.Sc. (Department of Internal Medicine)
"Characterizing opioid dose escalation during early chronic opioid therapy for pain"
Caroline Chantry, M.D. (Department of Pediatrics)
"Delayed umbilical cord clamping for term infants: Evaluating the impact of adopting a hospital policy for vaginal delieveries and a pilot trial during Cesarean deliveries"
Garth Utter, M.D., M.Sc. (Department of Surgery)
"Anemia, transfusion and outcomes from traumatic brain injury"