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There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs. Key messages: Women with severe mental illness (SMI) are less likely to initiate and maintain breastfeeding compared to women without SMI.Challenges were identified among women with SMI including poor professional support with infant feeding.Education and training are required for health care professionals to individualise infant feeding support for women with SMI and should include information regarding medication and optimising sleep while breastfeeding.No evidence of effective interventions to support breastfeeding in women with SMI were identified and there was limited evidence of women's experiences of infant feeding.Further research is required with larger sample sizes and clearly defined measures of infant feeding outcomes. [ABSTRACT FROM AUTHOR]

The potential complications related to unplanned conversion to thoracotomy remains a major concern in thoracoscopic lobectomy and may limit the wide adoption of this strategy. We reviewed the literature from 1990 until February 2022, analyzing all papers comparing successful thoracoscopic lobectomy versus converted thoracoscopic lobectomy and/or upfront thoracotomy lobectomy to establish whether unplanned conversion negatively affected outcomes. Thirteen studies provided the most applicable evidence to evaluate this issue. Conversion to thoracotomy was reported to occur in up to 23% of cases (range, 5%–16%). Vascular injury, calcified lymph nodes, and dense adhesions were the most common reasons for conversion. Converted thoracoscopic lobectomy compared to successful thoracoscopic lobectomy was associated with longer operative time and hospital stay in all studies, with higher postoperative complication rates in seven studies, and with higher perioperative mortality rates in four studies. No significant differences were found between converted thoracoscopic lobectomy and upfront thoracotomy lobectomy. Five studies evaluated long‐term survival, and in all papers conversion did not prejudice survival. Surgeons should not fear unplanned conversion during thoracoscopic lobectomy, but to avoid unexpected conversion that may negatively impact surgical outcome, a careful selection of patients is recommended–especially for frail patients. [ABSTRACT FROM AUTHOR]

Policy PointsMany studies have explored the impact of message strategies to build support for policies that advance racial equity, but few studies examine the effects of richer stories of lived experience and detailed accounts of the ways racism is embedded in policy design and implementation.Longer messages framed to emphasize social and structural causes of racial inequity hold significant potential to enhance support for policies to advance racial equity.There is an urgent need to develop, test, and disseminate communication interventions that center perspectives from historically marginalized people and promote policy advocacy, community mobilization, and collective action to advance racial equity. Context: Long‐standing racial inequities in health and well‐being are shaped by racialized public policies that perpetuate disadvantage among Black, Brown, Indigenous, and people of color. Strategic messaging can accelerate public and policymaker support for public policies that advance population health. We lack a comprehensive understanding of lessons learned from work on policy messaging to advance racial equity and the gaps in knowledge it reveals. Methods: A scoping review of peer‐reviewed studies from communication, psychology, political science, sociology, public health, and health policy that have tested how various message strategies influence support and mobilization for racial equity policy domains across a wide variety of social systems. We used keyword database searches, author bibliographic searches, and reviews of reference lists from relevant sources to compile 55 peer‐reviewed papers with 80 studies that used experiments to test the effects of one or more message strategies in shaping support for racial equity–related policies, as well as the cognitive/emotional factors that predict their support. Findings: Most studies report on the short‐term effects of very short message manipulations. Although many of these studies find evidence that reference to race or use of racial cues tend to undermine support for racial equity–related policies, the accumulated body of evidence has generally not explored the effects of richer, more nuanced stories of lived experience and/or detailed historical and contemporary accounts of the ways racism is embedded in public policy design and implementation. A few well‐designed studies offer evidence that longer‐form messages framed to emphasize social and structural causes of racial inequity can enhance support for policies to advance racial equity, though many questions require further research. Conclusions: We conclude by laying out a research agenda to fill numerous wide gaps in the evidentiary base related to building support for racial equity policy across sectors. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) has become increasingly important in the development, delivery and improvement of healthcare. PPI is used in healthcare innovation; yet, how it is used has been under‐reported. The aim of this scoping review is to identify and map the current available empirical evidence on the role of PPI during different stages of healthcare innovation. Methods: The scoping review was conducted in accordance with PRISMAScR and included any study published in a peer‐reviewed journal between 2004 and 2021 that reported on PPI in healthcare innovation within any healthcare setting or context in any country. The following databases were searched: Medline, EMBASE, CINAHL, PsycInfo, HMIC and Google Scholar. We included any study type, including quantitative, qualitative and mixed‐method studies. We excluded theoretical frameworks, conceptual, scientific or grey literature as well as discussion and opinion papers. Results: Of the 87 included studies, 81 (93%) focused on or were conducted by authors in developed countries. A wide range of conditions were considered, with more studies focusing on mental health (n = 18, 21%) and cancer care (n = 8, 9%). The vast majority of the studies focused on process and service innovations (n = 62, 71%). Seven studies focused on technological and clinical innovations (8%), while 12 looked at both technological and service innovations (14%). Only five studies examined systems innovation (5%) and one study looked across all types of innovations (1%). PPI is more common in the earlier stages of innovation, particularly problem identification and invention, in comparison to adoption and diffusion. Conclusion: Healthcare innovation tends to be a lengthy process. Yet, our study highlights that PPI is more common across earlier stages of innovation and focuses mostly on service innovation. Stronger PPI in later stages could support the adoption and diffusion of innovation. Patient or Public Contribution: One of the coauthors of the paper (S. S.) is a service user with extensive experience in PPI research. S. S. supported the analysis and writing up of the paper. [ABSTRACT FROM AUTHOR]

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding 'support' could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional 'antennae' if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters. [ABSTRACT FROM AUTHOR]

Breastfeeding rates in many Global North countries are low. Qualitative research highlights that breastfeeding in public is a particular challenge, despite mothers often having the legal right to do so. To identify barriers and facilitators, we systematically searched the qualitative research from Organisation for Economic Co‐operation and Development countries relating to breastfeeding in public spaces from 2007 to 2021. Data were analysed using the Thematic Synthesis technique. The review was registered with PROSPERO (registration number: CRD42017081504). Database searching identified 3570 unique records. In total, 74 papers, theses, or book chapters, relating to 71 studies, were included, accounting for over 17,000 mothers. Overall, data quality was high. Our analysis identified that five core factors influenced mothers' thought processes and their breastfeeding in public behaviour: legal system; structural (in)equality; knowledge; beliefs and the social environment. Macro‐level factors relating to legislation and inequality urgently require redress if breastfeeding rates are to be increased. Widespread culture change is also required to enhance knowledge, change hostile beliefs and thus the social environment in which mother/infant dyads exist. In particular, the sexualisation of breasts, disgust narratives and lack of exposure among observers to baby‐led infant feeding patterns resulted in beliefs which created a stigmatising environment. In this context, many mothers felt unable to breastfeed in public; those who breastfed outside the home were usually highly self‐aware, attempting to reduce their exposure to conflict. Evidence‐based theoretically informed interventions to remove barriers to breastfeeding in public are urgently required. Key messages: In OECD countries, there was limited evidence that women routinely breastfed outside of the home; for those who did, this experience was often uncomfortable.Legal protections for breastfeeding in public, where present, were not widely known and appeared to be under‐enforced.Mothers were aware of stigma relating to breastfeeding in public and feared conflict with strangers. This fear was not felt evenly, with mothers who were young, poor, and from marginalised ethnicities reporting increased surveillance and stigma.There is limited and dichotomous evidence relating to partners, family, and friends' roles in supporting mothers to breastfeed in public.Observers of breastfeeding in public had poor understanding of normal infant feeding behaviour and the associated need to breastfeed in public spaces. They also experienced disgusted reactions to viewing breastfeeding. [ABSTRACT FROM AUTHOR]

Breastfeeding support is a key component in meeting the public health responsibility of increasing breastfeeding rates, with access to individualised, convenient and linked support across services central to improved outcomes. With the rise of new technology and the COVID‐19 pandemic, social media (SM) support for breastfeeding has become increasingly popular and it is important to understand how and why mothers access such support, and from whom, to optimise services and to meet mothers' needs. Increasing research is building on women's use and experience of SM for breastfeeding, although there is a paucity of UK data. This systematic review aimed to understand the impacts of SM support for breastfeeding, including benefits and challenges, to establish the evidence for wider provision within maternity services. The search was limited to studies published in English and focused on the self‐directed use of social media groups for breastfeeding (defined as platforms that facilitate group support via interactivity, allowing for user‐generated content and subsequent responses). Of 327 papers retrieved, 13 studies were included for review. The six themes identified were: breastfeeding context, including factors impacting women's decision making; the relational impact of belonging to an online community; increased self‐efficacy; critiques of SM; the nature and types of support commonly sought and received; and breastfeeding duration as an outcome. The findings confirm that mothers value SM groups for community support, which normalises breastfeeding and provides the support they attribute to improved outcomes, and highlight that UK research focused on provision linked to wider services is needed. Key messages: Joining a social media (SM) group to seek support is common among those mothers intending to breastfeed. For these mothers SM groups have the potential to provide valued support where it is lacking, or in addition to their existing networks.SM groups offer reciprocity of knowledge sharing and esteem support. Belonging to a supportive online community promotes emotional wellbeing and self‐efficacy, improving breastfeeding outcomes.Online peer support is valued and trusted as a complementary source of information and shared experience. Mothers are aware of issues of reliability, lack of regulation and the need to be discerning of online advice. [ABSTRACT FROM AUTHOR]

Background: Health‐care providers increasingly have to discuss uncertainty with patients. Awareness of uncertainty can affect patients variably, depending on how it is communicated. To date, no overview existed for health‐care professionals on how to discuss uncertainty. Objective: To generate an overview of available recommendations on how to communicate uncertainty with patients during clinical encounters. Search strategy: A scoping review was conducted. Four databases were searched following the PRISMA‐ScR statement. Independent screening by two researchers was performed of titles and abstracts, and subsequently full texts. Inclusion criteria: Any (non‐)empirical papers were included describing recommendations for any health‐care provider on how to orally communicate uncertainty to patients. Data extraction: Data on provided recommendations and their characteristics (eg, target group and strength of evidence base) were extracted. Recommendations were narratively synthesized into a comprehensible overview for clinical practice. Results: Forty‐seven publications were included. Recommendations were based on empirical findings in 23 publications. After narrative synthesis, 13 recommendations emerged pertaining to three overarching goals: (a) preparing for the discussion of uncertainty, (b) informing patients about uncertainty and (c) helping patients deal with uncertainty. Discussion and conclusions: A variety of recommendations on how to orally communicate uncertainty are available, but most lack an evidence base. More substantial research is needed to assess the effects of the suggested communicative approaches. Until then, health‐care providers may use our overview of communication strategies as a toolbox to optimize communication about uncertainty with patients. Patient or public contribution: Results were presented to stakeholders (physicians) to check and improve their practical applicability. [ABSTRACT FROM AUTHOR]

Policy Points: Historically, reforms that have increased the duration of job‐protected paid parental leave have improved women's economic outcomes. By targeting the period around childbirth, access to paid parental leave also appears to reduce rates of infant mortality, with breastfeeding representing one potential mechanism. The provision of more generous paid leave entitlements in countries that offer unpaid or short durations of paid leave could help families strike a balance between the competing demands of earning income and attending to personal and family well‐being. Context: Policies legislating paid leave from work for new parents, and to attend to individual and family illness, are common across Organisation for Economic Co‐operation and Development (OECD) countries. However, there exists no comprehensive review of their potential impacts on economic, social, and health outcomes. Methods: We conducted a systematic review of the peer‐reviewed literature on paid leave and socioeconomic and health outcomes. We reviewed 5,538 abstracts and selected 85 published papers on the impact of parental leave policies, 22 papers on the impact of medical leave policies, and 2 papers that evaluated both types of policies. We synthesized the main findings through a narrative description; a meta‐analysis was precluded by heterogeneity in policy attributes, policy changes, outcomes, and study designs. Findings: We were able to draw several conclusions about the impact of parental leave policies. First, extensions in the duration of paid parental leave to between 6 and 12 months were accompanied by attendant increases in leave‐taking and longer durations of leave. Second, there was little evidence that extending the duration of paid leave had negative employment or economic consequences. Third, unpaid leave does not appear to confer the same benefits as paid leave. Fourth, from a population health perspective, increases in paid parental leave were consistently associated with better infant and child health, particularly in terms of lower mortality rates. Fifth, paid paternal leave policies of adequate length and generosity have induced fathers to take additional time off from work following the birth of a child. How medical leave policies for personal or family illness influence health has not been widely studied. Conclusions: There is substantial quasi‐experimental evidence to support expansions in the duration of job‐protected paid parental leave as an instrument for supporting women's labor force participation, safeguarding women's incomes and earnings, and improving child survival. This has implications, in particular, for countries that offer shorter durations of job‐protected paid leave or lack a national paid leave entitlement altogether. [ABSTRACT FROM AUTHOR]

Micronutrient deficiencies remain common among women and children in Sub‐Saharan Africa (SSA); in pregnant/lactating women, the intakes of essential fatty acids may also be low. Enriching home‐prepared foods with small‐quantity lipid‐based nutrient supplements (SQ‐LNSs) is a promising new strategy of delivering additional micronutrients, essential fatty acids and good quality protein to women and children. This narrative review aimed to examine the impact of SQ‐LNSs supplementation among women and infants and young children in SSA, and to discuss the differential impact of SQ‐LNS consumption across different settings. Papers reporting randomized trials conducted in SSA in which apparently healthy women and/or ≥6‐mo‐old children received SQ‐LNSs were identified through electronic and manual searches. Prenatal SQ‐LNS consumption reduced the prevalence of low gestational weight gain in Ghana when compared with multiple micronutrients supplementation, and was associated with poorer iron/hemoglobin status when compared with iron‐plus‐folic acid supplementation. SQ‐LNSs received alone or as intervention package improved infant/child growth in two trials in Ghana and one trial each in Burkina Faso, Kenya, Zimbabwe and South Africa, but had no impact on growth in two trials in Malawi. SQ‐LNSs supplementation improved motor development in Ghana, Burkina Faso, Malawi, Kenya, and South Africa, but had no impact on language, socio‐emotional, and executive functions in Ghana and Malawi and on Griffiths' developmental scores in Malawi. SQ‐LNSs may contribute to improving child growth in SSA. More research is needed to determine the iron level in SQ‐LNSs effective for improving both maternal hemoglobin/iron status and birth outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Insulin pump therapy (IPT) is a technological advancement that has been developed to help people manage Type 1 diabetes (T1D). However, ways of managing diabetes requiring the implementation of health technologies bring new complexities and a need to understand the factors which enable people with T1D to incorporate a novel device. This new comprehension could provide an exemplar for people with long‐term conditions to incorporate new technologies more generally. Objective: To determine what influences the incorporation, adaptation and use of IPT into the everyday lives of people living with diabetes. Design: Critical interpretive synthesis (CIS) using systematic searches undertaken in 7 electronic databases of literature, published 2008 onwards. Results: A total of 4998 titles were identified, 274 abstracts reviewed, 39 full articles retrieved and 22 papers selected for analysis. Three themes emerged which were of relevance to the introduction and use of IPT; Tensions between expectations and experiences in adoption and early adaptation; Negotiation of responsibility and accessing support; Reflexivity, active experimentation and feedback. Conclusions: This CIS builds on earlier reviews on lived experiences of IPT. Novel insights are offered through examination of the experiences of pump users from children through to adults, their families and health‐care professionals. Expectations of what the device can do to improve self‐management impacts on the early stages of adoption as the reality of the technology requires substantial thought and action. Areas for intervention to improve IPT incorporation include establishing who is responsible for management tasks of the device and enabling navigation to further means of support and resources. [ABSTRACT FROM AUTHOR]

Abstract: Background: The United Kingdom has been at the forefront of enhancing pharmacist roles and community pharmacy services, particularly over the past decade. However, patient and public awareness of community pharmacy services has been limited. Objective: To identify and synthesize the research literature pertaining to patient and public perspectives on: existing community pharmacy services, extended pharmacist roles and strategies to raise awareness of community pharmacy services. Search strategy: Systematic search of 8 electronic databases; hand searching of relevant journals, reference lists and conference proceedings. Inclusion criteria: UK studies investigating patient or public views on community pharmacy services or pharmacist roles from 2005 to 2016. Data extraction and synthesis: Data were extracted into a grid and subjected to narrative synthesis following thematic analysis. Main results: From the 3260 unique papers identified, 30 studies were included. Manual searching identified 4 additional studies. Designs using questionnaires (n = 14, 41%), semi‐structured interviews (n = 8, 24%) and focus groups (n = 6, 18%) made up the greatest proportion of studies. Most of the studies (n = 28, 82%) were published from 2010 onwards and covered perceptions of specific community pharmacy services (n = 31). Using a critical appraisal checklist, the overall quality of studies was deemed acceptable. Findings were grouped into 2 main themes “public cognizance” and “attitudes towards services” each with 4 subthemes. Discussion and conclusions: Patients and the public appeared to view services as beneficial. Successful integration of extended pharmacy services requires pharmacists’ clinical skills to be recognized by patients and physicians. Future research should explore different approaches to increase awareness. [ABSTRACT FROM AUTHOR]

Studies have identified an association between watching television (TV) and childhood obesity. This review adds context to existing research by examining the associations between TV viewing, whilst eating, and children's diet quality. Web of Science and PubMed databases were searched from January 2000 to June 2014. Cross-sectional trials of case control or cohort studies, which included baseline data, measuring the associations between eating whilst watching TV and children's food and drink intake. Quality of selected papers was assessed. Thirteen studies, representing 61,674 children aged 1-18 yrs, met inclusion criteria. Of six studies reporting overall food habits, all found a positive association between TV viewing and consumption of pizza, fried foods, sweets, and snacks. Of eight studies looking at fruit and vegetable consumption, seven identified a negative association with eating whilst watching TV ( p < .0001). Four out of five studies identified a positive association between watching TV whilst eating and servings of sugar-sweetened beverages ( p < .0001). Four studies identified an association between low socioeconomic status and increased likelihood of eating whilst watching TV ( p ≤ .01). Family meals did not overcome the adverse impact on diet quality of having the TV on at mealtimes. Eating whilst watching television is associated with poorer diet quality among children, including more frequent consumption of sugar-sweetened beverages and high-fat, high-sugar foods and fewer fruits and vegetables. Although these differences in consumption are small, the cumulative effect may contribute to the positive association between eating whilst watching TV and childhood obesity. [ABSTRACT FROM AUTHOR]

Pregnancy and lactation are a time when adequate calcium consumption is essential for the development of the fetus and to ensure the health of the mother. Over 50% of Canadian women of childbearing and rearing age fail to meet the recommended daily intake of calcium. Identification of effective behavioural intervention strategies for increasing calcium intake is needed within this specific population. This paper brings together all published behavioural interventions designed to increase calcium consumption in pregnant, lactating or post‐partum mothers in a systematic review. Relevant studies were obtained through searches of MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library with no date restrictions. Studies were evaluated using previously published criteria for evaluating calcium behaviour change interventions. This systematic literature review identified five behavioural calcium interventions conducted within this population. Three interventions aimed to improve overall dietary behaviours, the fourth aimed to promote breastfeeding (including increasing calcium consumption) and the fifth aimed to increase daily servings of yoghurt. Only one of the five interventions yielded large effect sizes, with a mean change of 954 mg of calcium per day post‐intervention. The number of behavioural change techniques did not appear to be related to intervention efficacy. Only one study used a theoretical framework to guide the intervention. This review highlights the lack of research examining behaviour change interventions aimed at increasing calcium consumption in pregnant, lactating and post‐partum women and provides practical suggestions for researchers wishing to intervene with this population in the future. [ABSTRACT FROM AUTHOR]

Dietary intake during pregnancy influences maternal health. Poor dietary practices during pregnancy have been linked to maternal complications. The objective was to determine the effect of dietary intervention before or during pregnancy on pregnancy outcomes. A systematic review was conducted without date restrictions. Randomised controlled trials (RCTs) evaluating whole diet or dietary components and pregnancy outcomes were included. Two authors independently identified papers for inclusion and assessed methodological quality. Meta‐analysis was conducted separately for each outcome using random effects models. Results were reported by type of dietary intervention: (1) counselling; (2) food and fortified food products; or (3) combination (counselling + food); and collectively for all dietary interventions. Results were further grouped by trimester when the intervention commenced, nutrient of interest, country income and body mass index. Of 2326 screened abstracts, a total of 28 RCTs were included in this review. Dietary counselling during pregnancy was effective in reducing systolic [standardised mean difference (SMD) −0.26, 95% confidence interval (CI) −0.45 to −0.07; P < 0.001] and diastolic blood pressure (SMD −0.57, 95% CI −0.75 to −0.38; P < 0.001). Macronutrient dietary interventions were effective in reducing the incidence of preterm delivery (SMD −0.19, 95% CI −0.34 to −0.04; P = 0.01). No effects were seen for other outcomes. Dietary interventions showed some small, but significant differences in pregnancy outcomes including a reduction in the incidence of preterm birth. Further high‐quality RCTs, investigating micronutrient provision from food, and combination dietary intervention, are required to identify maternal diet intakes that optimise pregnancy outcomes. [ABSTRACT FROM AUTHOR]