Objective: To review the effect of pacifier use in healthy term infants on breastfeeding duration and the risk of Sudden Infant Death Syndrome (SIDS). Keywords: Breastfeeding, infant, pacifier, SIDS, sudden infant death syndrome, systematic literature review
The aim of the present study was to develop a consensus report to guide dietetic management of overweight or obese individuals with chronic kidney disease (CKD).Six statements relating to weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥75% agreement. The recommendations were developed via a mini Delphi process.Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective.There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian.
Prior to conducting this research project the knowledge I had of counterproductive behaviour was limited. It was based on employee relationships and behaviours within teams. Leadership was a separate topic which I thought I understood and had a wide knowledge of but upon beginning my research I realise my knowledge focused mainly on the qualities of a good leader. I understood that good leadership traits promote productive behaviour but had I never considered the traits of leadership that can impact employee behaviour negatively.
My first encounter with the term counterproductive behaviour was while in the second year of my business degree. The recommended course textbook discussed dysfunctional behaviours in the workplace. It describes these behaviours as “those that detract from rather than contribute to organisational performance” (Moorehead and Griffin, 2010, pp. 75). This definition is similar to other definitions explaining either deviant or counterproductive workplace behaviour. This textbook however mentions factors such as poor person job fit and the attitudes of the individual but mentions no other causes or factors of this behaviour. This shows counterproductive behaviour from the perspective that employee personality is the root of counterproductive behaviour. This perspective to me seems incomplete. My theory of counterproductive behaviour includes other factors which will affect the behaviour of employees. If we observe the counterproductive behaviour one can experience in other areas of their personal life for example, in schools children often misbehave in class and if they do not have a good relationship with a teacher or superior, they tend to misbehave even more. I also thought of the family unit; many children know the people in their family they can behave differently around. For example, sometimes they do not obey the rules set by their mother because they know she is lenient about punishments but often will strictly follow the rules set by their father because they know that he will reprimand them for their behaviour. This can change if the relationship between families becomes strained, for example if teenagers feel the rules are becoming too strict the often act out by not following any rules and behaving badly in their parents’ eyes. Each of the figures I have mentioned in these examples are leaders of some form at different stages of a person’s life, and I have seen in my own experience that relationships and the way these leaders treat me has a huge impact on how I will behave towards them. Could it therefore be the case that leadership in the workplace should be considered in the same way?
The aim of my research is to complete the picture of counterproductive behaviour and conclude whether poor leadership can lead to counterproductive behaviour of subordinates in the workplace, and therefore good leadership can lead to more productivity from subordinates in the workplace. I am under the impression that employees who are well motivated, satisfied in their role and satisfied with their relationship with their leaders will be less likely to engage in behaviour such as tardiness, absenteeism and working slowly. I also presume that if employees are unmotivated, dissatisfied with their role leader relationships they will become less positive about work, work much more slowly, become disengaged with their tasks, are more likely to be late and absent from work. Therefore, the question I am asking is “How will different Leadership Styles Impact Counterproductive Behaviour in the Workplace?’.
The custom of providing prelacteal feeds is a long-held tradition throughout many parts of China. Prelacteal feeds are not recommended because they can interfere with the establishment of breastfeeding, increase the risk of infection and change the composition of the human microbiome. The objective of this paper is to review the rate of offering prelacteal feeds in different areas in China and the influence this custom has on breastfeeding outcomes. Keywords: Breastfeeding, china, first feed, infant, prelacteal feed
Breastfeeding should be promoted widely to improve health across Asia. In the Western Pacific Region breastfeeding prevalence is considered suboptimal, however, there is no consensus on the actual level. This review compared breastfeeding rates as reported to the Western Pacific Region of WHO with the rates obtained from other research organizations. There was considerable variability observed between the different methods of data collection. For example, the WHO and UNICEF data from the Western Pacific Region which pools information mainly from national and regional survey that are cross-sectional in nature, reported the exclusive breastfeedingrate in infants less than six months of age to be 56% in China and 41% in Japan. Whereas, studies undertaken by the Curtin School of Public Health which have limited sample sizes but all use cohort methodology, reported the rate of exclusive breastfeeding at six months to be 6% in China and 15% in Japan. The large discrepancies among results indicate that representative, accurate and reproducible datais required. This implies the use of standard WHO definitions of categories of breastfeeding and a combination of routine surveillance and cohort studies in sentinel districts. Obtaining reliable data on infant feeding in the Asia-Pacific will highlight areas of focus, target interventions more appropriately and assist health professionals and parents to continue advocating for improved breastfeeding outcomes. Keywords: Asia, breastfeeding, rates
Background Variant transthyretin amyloidosis (ATTRv) is a hereditary multisystem disorder with clinical spectrum ranging from predominant cardiomyopathy to polyneuropathy. In the Irish population, the T60A mutation has been previously recognised as the most common genotype. Objectives The aim of this study is to describe the diagnostic and phenotypic spectrum of patients with T60A ATTRv attending an Irish Expert Amyloidosis Network. Methods In this observational study design, the medical, laboratory and radiological records of patients enrolled in our amyloidosis registry with a confirmed genotype diagnosis of T60A ATTRv were reviewed. Results A cohort of 24 patients (12 female) met criteria for inclusion. The median age at diagnosis was 65 years (IQR 59.5–66.5) and median follow-up 44 months (IQR 31–58). Carpal tunnel syndrome was the initial manifestation in almost half (46%) of patients. Overall, a mixed cardioneuro phenotype was demonstrated including autonomic (75%), small (58%) and large fibre (46%) neuropathy largely predating a cardiac phenotype consisting of heart failure (63%), atrial arrhythmia (42%) and bradycardia (13%). Conclusion The contemporary clinical spectrum of T60A ATTRv in Ireland is one of patients typically presenting in the seventh decade with an already manifest neuropathy phenotype, largely predating a cardiac phenotype dominated by heart failure.
Abstract Aims: Cardiomyopathy is universally penetrant in young adults with Duchenne muscular dystrophy (DMD), and is increasingly the preponderant cause of death. We sought to determine the rates of, and reasons for, failed diagnostic cardiac imaging in our DMD multidisciplinary care centre as well as the level of agreement between imaging modalities, in order to guide the optimal strategy for cardiac imaging in these patients. Methods and results: We followed all patients attending a Comprehensive Multidisciplinary Adult DMD clinic over 4 years. All attendees underwent transthoracic echocardiography (TTE) and were offered referral for cardiac MRI (CMR). Age, cardiac medications, left ventricular ejection fraction (LVEF), ambulatory status, airway adjuncts and presence and degree of cardiac fibrosis were recorded. A total of 33 patients enrolled, median age 20, with mean follow-up of 3 years and 3 months. Mean LVEF was 51% at enrollment and 45% at follow-up. Presence of any degree of mitral regurgitation correlated strongly to left ventricular systolic dysfunction. CMR was completed in just 25% of patients, all of whom had extensive midwall fibrosis. Of those in whom CMR failed, 52% were unable to lie flat or position correctly for scanning, predominantly due to muscle contractures. Despite suboptimal TTE imaging in 75%, there was good agreement in LVEF between CMR and TTE. Conclusion: We found a high rate of failure to complete diagnostic cardiac imaging in this group of patients with impaired mobility. Our study highlights the importance of multimodality imaging, and practical strategies to overcome environmental obstacles to diagnostic imaging, to better guide aggressiveness of treatment for DMD and its inherent cardiomyopathy.
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