Search

Background: No consensus on the definitions of nipple trauma has been reported. Thus, different individuals assess identical events inconsistently. Research Aims: To establish clear definitions for the seven signs of nipple trauma related to breastfeeding-erythema, swelling, scabbing, blistering, fissure, purpura, and peeling-and to reach consensus among multiple specialists. Methods: We implemented a longitudinal, prospective survey design using a 3-step Delphi method. In the first survey we targeted specialists in breastfeeding, dermatology, and cosmetics, and we presented images as representative cases during a set of semi-structured interviews. In the second and third surveys, we questioned midwives who were certified as "advanced midwives" through mail, using a questionnaire prepared based on the results of the first survey. The agreement criteria of this study were as follows: (1) a median of 2.0 or below; (2) an interquartile range of 1.0 or below; and (3) at least 51% showing responses of either "strongly agree" or "agree." Results: Based on the responses of the 42 experts, we reached a consensus on 48 items: eight related to erythema, 10 to swelling, nine to scabbing, seven to blistering, seven to fissure, four to purpura, and three to peeling. We then classified these items based on the condition or possible mechanism of the wound. Finally, we developed an observation tool: "seven signs of nipple trauma associated with breastfeeding," along with images. Conclusions: Application of this tool for breastfeeding support could improve objectivity in observing and evaluating nipple trauma.

Background: To clarify the impact of the COVID-19 pandemic on the policies and practices of delivery facilities in Japan from April 2020 to March 2021. Methods: We conducted an online survey of midwives working in obstetric wards nationwide between May 15, 2021, and July 31, 2021. We analyzed the 376 valid responses. Results: With the COVID-19 pandemic, most facilities have barred or partially restricted families and other visitors from being present (patient companions) in outpatient clinics, prenatal classes, during delivery, inpatient care, and inpatient visits. These changes were implemented nationwide, regardless of regional differences in the pandemic state of COVID-19. Meanwhile, by facility classification, prenatal classes, companion at birth, and inpatient visits were more likely to be canceled at perinatal centers than at clinics. The acceptance of satogaeri deliveries (a custom in Japan where pregnant women return to their natal homes for labor and childbirth) was partially restricted to about 40% of facilities, although this rate was lower in the four Kanto prefectures (Tokyo, Kanagawa, Saitama, and Chiba). Conclusions: With the COVID-19 pandemic, the differences in Japan's policies and practices of delivery facilities were attributed more to the role played by facilities in the regional perinatal system than to regional pandemic status.

Background: No consensus on the definitions of nipple trauma has been reported. Thus, different individuals assess identical events inconsistently. Research Aims: To establish clear definitions for the seven signs of nipple trauma related to breastfeeding-erythema, swelling, scabbing, blistering, fissure, purpura, and peeling-and to reach consensus among multiple specialists. Methods: We implemented a longitudinal, prospective survey design using a 3-step Delphi method. In the first survey we targeted specialists in breastfeeding, dermatology, and cosmetics, and we presented images as representative cases during a set of semi-structured interviews. In the second and third surveys, we questioned midwives who were certified as "advanced midwives" through mail, using a questionnaire prepared based on the results of the first survey. The agreement criteria of this study were as follows: (1) a median of 2.0 or below; (2) an interquartile range of 1.0 or below; and (3) at least 51% showing responses of either "strongly agree" or "agree." Results: Based on the responses of the 42 experts, we reached a consensus on 48 items: eight related to erythema, 10 to swelling, nine to scabbing, seven to blistering, seven to fissure, four to purpura, and three to peeling. We then classified these items based on the condition or possible mechanism of the wound. Finally, we developed an observation tool: "seven signs of nipple trauma associated with breastfeeding," along with images. Conclusions: Application of this tool for breastfeeding support could improve objectivity in observing and evaluating nipple trauma.

Background: To clarify the impact of the COVID-19 pandemic on the policies and practices of delivery facilities in Japan from April 2020 to March 2021. Methods: We conducted an online survey of midwives working in obstetric wards nationwide between May 15, 2021, and July 31, 2021. We analyzed the 376 valid responses. Results: With the COVID-19 pandemic, most facilities have barred or partially restricted families and other visitors from being present (patient companions) in outpatient clinics, prenatal classes, during delivery, inpatient care, and inpatient visits. These changes were implemented nationwide, regardless of regional differences in the pandemic state of COVID-19. Meanwhile, by facility classification, prenatal classes, companion at birth, and inpatient visits were more likely to be canceled at perinatal centers than at clinics. The acceptance of satogaeri deliveries (a custom in Japan where pregnant women return to their natal homes for labor and childbirth) was partially restricted to about 40% of facilities, although this rate was lower in the four Kanto prefectures (Tokyo, Kanagawa, Saitama, and Chiba). Conclusions: With the COVID-19 pandemic, the differences in Japan's policies and practices of delivery facilities were attributed more to the role played by facilities in the regional perinatal system than to regional pandemic status.

application/pdf, Nutrients. 2021, 13 (12), P.4377(1-13)

Microbes in the human gut play a role in the production of bioactive compounds, including some vitamins. Although several studies attempted to identify definitive markers for certain vitamin deficiencies, the role of gut microbiota in these deficiencies is unclear. To investigate the role of gut microbiota in deficiencies of four vitamins, B2, B6, folate, and B12, we conducted a comprehensive analysis of metabolites in mice treated and untreated with antibiotics. We identified glycolate (GA) as a novel marker of vitamin B2 (VB2) deficiency, and show that gut microbiota sense dietary VB2 deficiency and accumulate GA in response. The plasma GA concentration responded to reduced VB2 supply from both the gut microbiota and the diet. These results suggest that GA is a novel marker that can be used to assess whether or not the net supply of VB2 from dietary sources and gut microbiota is sufficient. We also found that gut microbiota can provide short-term compensation for host VB2 deficiency when dietary VB2 is withheld.