Costa Rica officially the Republic of Costa Rica is a country in Central America, bordered by Nicaragua to the north, the Caribbean Sea to the northeast, Panama to the southeast, the Pacific Ocean to the southwest, and maritime border with Ecuador to the south of Cocos Island. It has a population of around five million in a land area of 51,060 km2 (19,710 sq mi). An estimated 333,980 people live in the capital and largest city, San José, with around two million people in the surrounding metropolitan area.
The sovereign state is a unitary presidential constitutional republic. It is known for its long-standing and stable democracy, and for its highly educated workforce. The country spends roughly 6.9% of its budget (2016) on education, compared to a global average of 4.4%. Its economy, once heavily dependent on agriculture, has diversified to include sectors such as finance, corporate services for foreign companies, pharmaceuticals, and ecotourism. Many foreign manufacturing and services companies operate in Costa Rica’s Free Trade Zones (FTZ) where they benefit from investment and tax incentives.
Costa Rica provides universal health care to its citizens and permanent residents. Both the private and public health care systems in Costa Rica are continually being upgraded. Statistics from the World Health Organization (WHO) frequently place Costa Rica in the top country rankings in the world for long life expectancy. WHO’s 2000 survey ranked Costa Rica as having the 36th best health care system, placing it one spot above the United States at the time. In addition, the UN (United Nations) has ranked Costa Rica’s public health system within the top 20 worldwide and the number 1 in Latin America.
Our blog this month is focused on the Global Healthcare Workforce Shortage Crisis.
Kat and I would not be writing this blog were it not for the life-saving care she received by skilled healthcare providers at and after her birth. Each and every one of you who has experienced a preterm birth knows the value of care access. Our healthcare provider workforce deserves our attention and support.
The Global Healthcare Workforce Shortage Crisis pre-existed the Covid pandemic. The pandemic has severely impacted the shortage of healthcare providers and the further development of the healthcare workforce. The need for healthcare access has substantially increased due to provider shortages, delayed medical assessment and care, postponed access to “elective” surgeries, fear of seeking treatment due to Covid exposure risks, worsening of untreated conditions, and mental health barriers resulting from the stresses the pandemic has created in our lives.
Preterm birth accounts for 11-12% of the global births at large and connected to our preemie survivors is a much larger population of family members, healthcare providers, teachers, scientists, community members, employers and so on that also have a critical need for healthcare access. We are and will continue to be significantly impacted by our lack of access to healthcare provider care, and it is absolutely vital that all of us have access to healthcare services that are not limited to pharmaceutical options. We must protect, value, and build our healthcare workforce by making becoming a healthcare provider affordable, accessible, safe, humane, attractive, and available to all economic classes in order to build a healthy, vital, educated, effective and sustainable healthcare workforce that represents our populations at large.
Investing in our Healthcare Workforce is essential. Thank you for supporting our healthcare workforce in ways that are meaningful to you and impactful to our Preterm Birth Family.
Elsevier Health’s first “Clinician of the Future” global report reveals current pain points, predictions for the future and how the industry can come together to address gaps
New York, March 15, 2022
“There has never been a greater need for lifting the voices of healthcare professionals. The global study found 71% of doctors and 68% of nurses believe their jobs have changed considerably in the past 10 years, with many saying their jobs have gotten worse. One in three clinicians are considering leaving their current role by 2024, with as many as half of this group in some countries leaving healthcare entirely. This comes on top of the existing global healthcare workforce shortage, where clinicians continue to experience severe levels of fatigue and burnout since COVID-19 was declared a pandemic”.
The Play’s the Thing for Nurses Coping with Pandemic’s Sting
— How the age-old themes of a Greek tragedy can spark new conversations
by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today March 23, 2022
Last Thursday, Amy Smith, MS, APRN, took part in a virtual reading of Sophocles’ ancient Greek tragedy “Antigone.” But the production wasn’t ordinary theater.
Smith and more than 3,000 attendees sat in on a Zoom webinar of “The Nurse Antigone” as part of a new effort to help frame and spark discussions about the challenges faced by nurses, especially during the pandemic.
“Antigone” is a famed Greek tragedy for a reason. Its young titular heroine risks her life to stand up for what she believes is right, and the play focuses on her quest to properly bury and mourn her deceased brother. Many themes from the play resonate with nurses, especially today.
Smith, who acted in the performance as part of the chorus, said that she feels many nurses who took park in the inaugural event “saw in Antigone the kind of anguish that a lot of people felt when we were in the middle of the pandemic, especially in the hospital setting.”
Nurses were “unable to get past one horrible tragedy when the next person would code, or the next person would come in,” Smith said. It’s “this concept of delayed healing.”
After her own experience with the production, Smith, director of the Sexual Assault Nurse Examiner (SANE) Program at the Hofstra Northwell School of Nursing and Physician Assistant Studies, told MedPage Today that she believes many other nurses will want to take part.
The production was one of 12 that have been scheduled over the coming year. Though “The Nurse Antigone” features headliners such as author Margaret Atwood, and actresses Tracie Thoms and Taylor Schilling, in addition to a chorus comprised of working nurses, the performance itself is hardly the main event.
That’s according to Bryan Doerries, artistic director for Theater of War Productions, which for the past 14 years, has produced community-focused theater projects designed to address public health and social justice issues.
“The performance is the table dressing for the conversation that follows it,” Doerries told MedPage Today.
Some of the themes present in “Antigone” that resonate with the nurse workforce today include deferred grief, moral injury, structural violence and misogyny, as well as women speaking out and living up to standards of care, he said.
“Talking about these things requires energy, and sometimes nurses who are overworked don’t have the energy … the play provides the energy,” Doerries said.
The actors commit emotionally to the material, so that the nurses can then follow them, he explained.
Though each event is expected to be different and yield varying discussions due to the unique makeup and interpretation of each audience, the general format will remain the same, Doerries said.
The chorus of the play is performed by nurses, who are joined by a community panel, also comprised of nurses, after the reading to respond to what they heard that spoke to them, he said. There are then a series of questions posed to the audience and a discussion of themes important to nursing. The performance itself runs about 45 minutes, and the discussions that follow consist of about 15 minutes for the community panel and about 1 hour for the audience discussion.
“We’re not asking people to agree,” Doerries said. And “it’s not therapy, to be clear.”
“The point is that, once people have walked through the door of this project, the hope is that they may be open to walking through the other door to healing,” he said.
Cynda Rushton, PhD, RN, lead nursing advisor on the project, concurred.
“The use of the Greek tragedy, particularly ‘Antigone,’ seemed like a really important way to engage nurses to explore their experiences during the pandemic — and before the pandemic — and to create a space where we could really honor their challenges and sacrifices,” Rushton said.
Rushton, professor of clinical ethics at the Johns Hopkins Berman Institute of Bioethics and School of Nursing, said that, as a nurse herself, she “feels very committed to helping our profession heal.”
In addition to connecting nurses with each other, another goal of the production is to “invite the public to bear witness to the experiences of nurses,” Rushton said.
Theater of War Productions, the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and the Resilient Nurses Initiative – Maryland, have partnered to co-present “The Nurse Antigone.” The production is supported by the Laurie M. Tisch Illumination Fund, and the theater’s digital programming is provided, in part, by The Andrew W. Mellon Foundation.
All of “The Nurse Antigone” events are free and have unlimited capacity, Doerries said.
The next event is scheduled for April 21, and is being hosted by the Greater NYC Black Nurses Association.
“It’s not therapy, but it is therapeutic,” Smith said of “The Nurse Antigone.” “Certainly it was for me, and I hope other people felt that as well.”
Added benefits of the production include helping others to feel like they’re not alone in their experiences, and making difficult discussions easier to have, she noted.
“The reason that the themes keep recurring is because nobody talks about it,” Smith said.
Preterm Birth and Low Birth Weight
Health at a Glance: Latin America and the Caribbean 2020 (Book)
Globally, preterm birth (i.e. birth before 37 completed weeks of gestation) is the leading cause of death in children under 5 years of age, responsible for approximately 1 million deaths in. In almost all countries with reliable data, preterm birth rates are increasing. Many survivors of preterm births also face a lifetime of disability, including learning disabilities and visual and hearing problems as well as long-term development (WHO, 2018).
In LAC, most countries are near the regional average of 9.5% of births being preterm. Colombia is the only country significantly above average with near 15% of preterm births, followed by Brazil with 11%. The lowest rates were observed in Cuba (6%) and Mexico (7%) Most LAC countries rates are lower than the global rate, but there are opportunities for further improvements through interventions such as a national focus on improved obstetric and neonatal care, and the systematic establishment of referral systems with higher capacity of neonatal care units and staff and equipment (Howson, Kinney and Lawn, 2012). On average, 10 new-borns out of 100 had low weight at birth across LAC countries. There are very significant differences between countries in the region, ranging from a low 5% in Cuba and 6% in Chile, to the highest rate of 23% in Haiti, followed by Guyana with 16%.
Low birth weight has decreased an average of 0.4 percentage points in LAC26 countries in the 2000-15 period, suggesting that, overall, the region still has room for improvement in regards to this indicator. Chile, Brazil, Venezuela and Costa Rica are the only LAC countries to have increased low birth weight new-borns, while the largest reduction happened in Surinam, Guatemala and Honduras with more than 1 percentage point of decrease between 2000 and 2015.
Antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth. Higher coverage of antenatal care is associated with higher birth weight in LAC countries, suggesting the significance of antenatal care over infant health status across countries . However, the correlation does not apply equally in all countries. For instance, Trinidad and Tobago and Barbados report to have 100% and 98% of at least four antenatal care visits, but their low birth weight prevalence is 12%, over the LAC average of 10%. This might be explained partly by a low quality of care in their antenatal care visits. On the other hand, countries like Grenada, Paraguay and Bolivia show an antenatal care coverage below the LAC24 average of 87%, but also a low birth weight prevalence of 7-9%. Some of the differences between countries can be attributed to cultural practices and preferences, such as different approaches to privacy or perceptions about what antenatal and postnatal care entail.
Preterm birth can be largely prevented. Effective interventions to reduce preterm births include smoking cessation, progesterone supplementation, cervical cerclage, preterm surveillance clinics and screening, diagnosis and preparation, corticosteroids, magnesium sulphate, and tocolysis (Osman, Manikam and Watters, 2018). Most of these exist in several LAC countries and could be further developed. In addition, three-quarters of deaths associated with preterm birth can be saved even without intensive care facilities. Current cost-effective interventions include kangaroo mother care (continuous skin-to-skin contact initiated within the first minute of birth), early initiation and exclusive breastfeeding (initiated within the first hour of birth) and basic care for infections and breathing difficulties (WHO, 2018), all of which can also be scaled up in LAC countries.
COVID-19: Health workers face ‘dangerous neglect’, warn WHO, ILO
21 February 2022
Health teams worldwide need much safer working conditions to combat the “dangerous neglect” they have faced during the COVID-19 pandemic, the UN health and labour agencies said on Monday.
Approximately 115,500 health workers died from COVID-19 in the first 18 months of the pandemic, linked to a “systemic lack of safeguards”, they noted.
In a joint call for action from the World Health Organization (WHO) and the International Labour Organization (ILO), the UN bodies insisted that the coronavirus crisis had contributed to “an additional heavy toll” on health workers.
“Even before the COVID-19 pandemic, the health sector was among the most hazardous sectors to work in,” said WHO’s Maria Neira, Director, Department of Environment, Climate Change and Health.
Physical injury and burnout
“Only a few healthcare facilities had programmes in place for managing health and safety at work,” Dr. Neira continued. “Health workers suffered from infections, musculoskeletal disorders and injuries, workplace violence and harassment, burnout, and allergies from the poor working environment.”
To address this, WHO and ILO have released new country guidelines for health centres at national and local levels.
“Such programmes should cover all occupational hazards – infectious, ergonomic, physical, chemical, and psycho-social,” the agencies noted, adding that States that have either developed or are actively implementing occupational health and safety programmes in health settings had seen reductions in work-related injuries and absences due to sickness and improvements in the work environment, productivity and retention of health workers.
“Like all other workers, should enjoy their right to decent work, safe and healthy working environments and social protection for health care, sickness absence and occupational diseases and injuries,” insisted ILO’s Alette van Leur, Director, ILO Sectoral Policies Department.
The development comes as the agencies indicated that more than one-in-three health facilities lack hygiene stations at the point of care, while fewer than one-in-six countries had a national policy in place for healthy and safe working environments within the health sector.
“Sickness absence and exhaustion exacerbated pre-existing shortages of health workers and undermined the capacities of health systems to respond to the increased demand for care and prevention during the crisis,” said James Campbell, Director, WHO Health Workforce Department.
“This guide provides recommendations on how to learn from this experience and better protect our health workers.”
Debi Nova, Pedro Capó – Quédate (Official Video)
Premiered Nov 21, 2019 Debi Nova
When the Brain Sees a Familiar Face
Los Angeles, Mar 18, 2022
Cedars-Sinai Investigators Show How the Action of the Eye Triggers Brain Waves to Help Remember Socially Important Information.
In a study led by Cedars-Sinai, researchers have uncovered new information about how the area of the brain responsible for memory is triggered when the eyes come to rest on a face versus another object or image. Their findings, published in the peer-reviewed journal Science Advances, add to scientific understanding of how memory works, and to evidence supporting a future treatment target for memory disorders.
While vision feels continuous, people move their eyes from one distinct spot to another three to four times per second. In this study, investigators found that when the eyes land on a face, certain cells in the amygdala, a part of the brain that processes social information, react and trigger memory-making activity.
“You could easily argue that faces are one of the most important objects we look at,” said Ueli Rutishauser, PhD, director of the Center for Neural Science and Medicine at Cedars-Sinai and senior author of the study. “We make a lot of highly significant decisions based on looking at faces, including whether we trust somebody, whether the other person is happy or angry, or whether we have seen this person before.”
To conduct their experiments, the investigators worked with 13 epilepsy patients who had electrodes implanted in their brains to help determine the focus of their seizures. The electrodes also allowed investigators to record the activity of individual neurons within the patients’ brains. While doing so, the researchers tracked the position of the subjects’ eyes using a camera to determine where on the screen they were looking.
The researchers also recorded the study participants’ theta wave activity. Theta waves, a distinct type of electrical brain wave, are created in the hippocampus and are key in processing information and forming memories.
Investigators first showed study participants groups of images that included human and primate faces and other objects, such as flowers, cars and geometric shapes. They next showed participants a series of images of human faces, some of which they had seen during the first activity and asked whether or not they remembered them.
The investigators found that each time participants’ eyes were about to land on a human face—but not on any other type of image—certain cells in the amygdala fired. And every time these “face cells” fired, the pattern of theta waves in the hippocampus reset or restarted.
“We think that this is a reflection of the amygdala preparing the hippocampus to receive new socially relevant information that will be important to remember,” said Rutishauser, the Board of Governors Chair in Neurosciences and a professor of Neurosurgery and Biomedical Sciences.
“Studies in primates have shown that theta waves restart or reset every time they make an eye movement,” said Juri Minxha, PhD, a postdoctoral scholar in neurosurgery at Cedars-Sinai and co-first author of the study. “In this study, we show that this also happens in humans, and that it is particularly strong when we look at faces of other humans.”
Importantly, the researchers showed that the more quickly a subject’s face cells fired when their eyes fixed on a face, the more likely the subject was to remember that face. When a subject’s face cells fired more slowly, the face they had fixed on was likely to be forgotten.
Subjects’ face cells also fired more slowly when they were shown faces they had seen before, suggesting those faces were already stored in memory and the hippocampus didn’t need to be prompted.
Rutishauser said these results suggest that people who struggle to remember faces could have a dysfunction in their amygdala, noting that this type of dysfunction has been implicated in disorders related to social cognition, such as autism.
“If theta waves in the brain are deficient, this process triggered by the amygdala in response to faces might not take place,” Rutishauser said. “So restoring theta waves could prove to be an effective treatment target.”
The study was funded by National Institute of Mental Health Grands number R01MH110831 and P50MH100023, National Science Foundation Grant number 1554105, National Institute of Neurological Disorders and Stroke Grant number U01NS117839, a Center for Neural Science and Medicine Fellowship and European Research Council Grant number 802681.
PREEMIE FAMILY PARTNERS
On parenting preemies: Gratitude, fear and a lingering sense that nothing is in your control
My son was born at 8:15 a.m. on Halloween, a long, skinny four pounds and crying in great angry gulps. With a kindness I’ve never forgotten, the anesthesiologist leaned down and said to me, “A lot of full-term babies don’t even sound that loud.”
The doctors laid my baby on my chest in his footprint-patterned swaddle, and for a moment he stopped crying. Then he was whisked away to the neonatal intensive care unit and I didn’t see him for 30 hours.
That’s how my life as a parent started.
In the United States, 10 percent of babies, or more than 380,000 a year, are born premature, before 37 weeks of gestation. The majority will need time in the NICU, meaning parents are shut out from many of the rituals surrounding a birth. You don’t leave the hospital with your child. Grandparents and friends can’t hold your newborn.
Now that my son is 7 and my daughter is 5 (she was born 19 months later, also premature), I think about how much support our family received in those early weeks, but how little guidance there was about how the experience could impact us over time. I wonder if who I am as a mother was influenced by that early start.
I interviewed parents of preemies, and while each experience was different, there were many consistent themes. Here are some of their stories.
The delay of grief
More than a year after my son was born, one of my closest friends had a placenta abruption and delivered her son at 34 weeks. She called me while I was in the car, and I tried to be as calm and loving as possible. Afterward, though, I pulled over in a parking lot and starting sobbing. My hands were shaking.
I cried with a force I’d never felt when my own pregnancy was going off the rails and all my focus had been on my baby. Until that morning, I hadn’t realized that my son’s premature birth, which I’d filed away as a bumpy start to an otherwise normal parenting journey, had imprinted in my brain like a trauma.
Other mothers said it was not until they had a full-term child that they fully processed their grief. “I didn’t really have a sense of loss or understand what I had missed until I had my son,” says Ame McClune, whose twin girls were born at 24 weeks and required feeding tubes and full-time nursing care for several years. “With my twins, I took it in stride because it was all I knew. Now, here was a baby I could hold and breast-feed and cuddle. I loved it. I had no idea.”
Teira Gunlock, whose daughter Lake was born at 29 weeks when Gunlock developed severe preeclampsia, was diagnosed nine months later with PTSD. “While everything worked out, it was a traumatic experience,” says Gunlock, who for six days had not been able to see her baby. “It makes me emphasize my daughter’s emotional health and growth in my own parenting more than I likely would have.”
Taking setbacks in stride, supercharged gratitude
At some point in everyone’s parenting journey, things don’t go according to plan. But preemie parents get that message early.
“Nothing is a crushing blow,” McClune says. Instead, when there are challenges, she just thinks, “Okay, how do we deal with this?”
In my experience, it was freeing to step off the hamster wheel of worry over milestones, because my children weren’t going to hit any of them. Instead, the NICU distilled things: Are we healthy? Are we happy(ish)? Are we okay? Given the anxiety many parents have over their children’s accomplishments, that perspective can feel like a gift.
Preemie parents also occupy a strange space between intense thankfulness and the early recognition that things can go wrong. In the NICU, most parents understand that there are babies in more precarious positions that their own and are sensitive to that.
The experience also yields daily opportunities for gratitude — to the nurses and doctors caring for your child; to the progress your baby is making; to the much-anticipated car-seat day when you get to take your baby home.
“I think about how lucky we are that both my daughter and my wife survived, and that hits me hard sometimes,” says Michael Zimmer, Gunlock’s husband. “We benefited from scientific advances that stemmed from a lot of tragedy in the past. That provides perspective — our daughter, and my wife, frankly — have a chance at life they might not have had 50 or even 25 years ago.”
If having a preemie makes you more resilient as a parent, it can also put you in a defensive crouch, waiting for the other shoe to drop.
When we brought my son home from the NICU after two weeks, my husband and I felt the normal terror of first-time parents with our own, special terror thrown in. He had been hooked up to monitors and cared for by professionals since he was born. Once he was home, though, he had to rely only on our loving, possibly incompetent care. That first night, my husband slept on the floor next to the bassinet while I feverishly pumped milk.
Gunlock and Zimmer spent the first year on high alert after their daughter had a choking episode in the NICU, and then again a few days after she came home.
Several parents told me that the strengths of the NICU — the care your baby receives; the nurses you learn from — can also feel like a weakness when you leave, because you think you will never measure up. That fades over time, outweighed by the support and confidence you built during those early weeks, but a tiny part of you always remains on alert.
Naming the sadness
All these years after my children were born, I still feel sad my body didn’t get them over the finish line. Not guilty, not angry, just sad. Is this normal? Is this weird? I don’t know.
I regret that I never got those final weeks of nesting, that I missed my baby shower, that I never felt a contraction. To many people, I’m sure that skipping labor twice makes me lucky. But it feels strange.
Stacey D. Stewart, chief executive of the March of Dimes, a nonprofit that works to improve maternal and infant health outcomes and supports more than 50,000 families a year who are in the NICU, says there needs to be more attention given to the impact the experience has on parents’ mental health.
“You’re pregnant and then one day you’re not, sooner than it was supposed to happen,” she says. “There’s a lot of anxiety and grief and helplessness and fear. It takes an immense emotional toll.”
It can also be very isolating. “I found it incredibly lonely,” says Kate Bosanquet, who had her daughter at 31 weeks. “I missed out on most of my prenatal classes, and while my group was very sweet and continued to meet, we weren’t having the same shared experiences you hope for.”
It doesn’t help that the entire baby industrial complex caters to parents of full-term babies. There’s the books and websites telling you your baby should be doing things months before she will. The carrier that requires your child to be a monstrous eight pounds. The email updates that continue to cheerfully inform you about the progress of your pregnancy when your baby is already out in the world. It can all hurt. One mother told me she wished there was a switch to turn off all the marketing and email that assumed she’d delivered full-term. (March of Dimes has a My NICU Baby app for parents of premature and full-term babies that started out in the NICU.)
And yet many of us hope and believe that these birth stories will become a source of strength for our children.
When my son was in kindergarten and it was his turn to be “Friend of the Week,” he shared that he weighed four pounds at birth, telling his class he “surprised us” seven weeks early. To him, it was an interesting fact and also, I think, a small source of pride.
It should be. Preemie babies, and their parents, have to come so far. I hope that every mom and dad who started out that way — confused, scared, fierce, loving — feels pride in their parenting. They’ve earned it.
Determinants of mothers knowledge about breastfeeding in neonatology intensive care
European Journal of Public Health, Volume 31, Issue Supplement_3, October 2021, ckab165.285, https://doi.org/10.1093/eurpub/ckab165.285
20 October 2021
Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. In Morocco the BF rate decreased from 51% to 27,8% between 1992 and 2011. The breast feeding rate in neonatal intensive care unit (NICU) is lower 12,4%. Studies showed if we improve the mothers knowledge, the BF practice rate increase in NICU. We aim to determine associated factors of mothers knowledge about BF in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco).
A cross-sectional study was conducted between 04 January and 23 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan mothers who can practice the BF presents during the study period. We used face to face interview using questionnaire. A scoring system from 0 to 16 points was used to measure the knowledge. The student, ANOVA, Mann-Whitney-Wilcoxon, Kruskal Wallis, Pearson and spearman correlation tests were used to test association between BF and potential associated factors. Associated factors with p ≤ 0.05 were considered as determinants of BF. Data were analyzed using R 3.6.3.
We included 111 mothers. The mean score of knowledge was 10.38 ± 2.31. Associated factors with BF knowledge were: healthcare staffs support (yes mean score =11.06 and no = 9.72; p = 0.002); getting prior information about BF (yes mean score =10.53 and no = 9; p = 0.012). The knowledge increase with age of mother (correlation coefficient = 0.26; p = 0.005) and parity (correlation coefficient = 0.30; P = 0.001).
Mothers and specifically younger primiparous should receive more attention from training program and healthcare staffs in NICU to improve the knowledge and practice of BF.
- we can enhance significantly the survival and health of newborn hospitalized in NICU by simple actions as advices, encouragement toward the newborn mothers to improve their knowledge about BF.
- Healthcare staffs and facilities have to be the teachers and school about breast feeding.
Your Premature Baby’s Sense of Vision
Babies born preterm (before 37 weeks) are still developing their sense of vision. Babies born before the age of 32 weeks are unable to limit the amount of light entering their eyes even when their eyes are closed. It is therefore important to protect premature babies from bright lights.
Effects of Vision on your Baby
- Babies born at term have a preference for looking at faces. Older premature babies too can fixate on your face briefly if you are holding them closely (approximately 25-30cm or 10-12 inches from your face), as they are very near sighted at this stage.
- Your baby is likely to have an incubator cover over their incubator whilst in intensive care. This reduces their exposure to bright light and aims to recreate the conditions of the womb. As your baby matures these incubator covers are pulled back.
- It is important that you enjoy your baby. Talk to them, smile, be expressive; your baby learns from watching your facial expressions.
March of Dimes/Signs of Preterm Labor
HEALTH CARE PARTNERS
Risks of Delays in Emergency Neonatal Blood Transfusions Highlighted in New Safety Report
Priscilla Lynch March 04, 2022
New recommendations on emergency neonatal blood transfusions have been issued by the Healthcare Safety Investigation Branch (HSIB) following a number of serious adverse outcomes including brain injury and death following delays in such transfusions.
Concerns around emergency neonatal blood transfusions were highlighted in 22 of the HSIB’s maternity investigation programme reports between 2018 and 2021.
This latest HSIB national investigation explored issues influencing timely administration of blood transfusion to newborn babies following acute blood loss during labour and/or delivery. Delays in the administration of a blood transfusion in this scenario can result in brain injury caused by lack of oxygen to the baby’s brain.
Whilst it is rare, and there is a gap in data on incidences of neonatal blood transfusion delays, the impact can be significant. As a reference event, the HSIB investigation examined the experience of a couple, Alex and Robert, whose baby, Aria, was born by emergency caesarean section following an acute blood loss, and sadly died.
Specifically, the investigation examined communication between the different medical teams involved in the care of women/pregnant people and their babies during labour and birth; and national guidance for medical staff on when to consider the option of a blood transfusion for a newborn baby.
The HSIB’s investigation found that administration of a blood transfusion as part of resuscitation requires a number of preparatory steps, including collecting the blood and undertaking various checks before using it, which can cause delays in emergency situations. Inclusion in resuscitation training of a prompt for clinicians to consider the need for a transfusion, and to prepare for it if appropriate, may help reduce any delay, the HSIB said.
The investigation also found that involving members of neonatal teams in multidisciplinary training in maternity units is not routine. Standardising their inclusion in such training would promote a shared understanding of relevant clinical information and ways of working, the HSIB advised.
The HSIB’s final report made two key safety recommendations which focus on training between multidisciplinary maternity and neonatal teams, and through the Newborn Life Support training course.
- HSIB recommends that NHS Resolution, working with relevant specialities through the clinical advisory group, amends the maternity incentive scheme guidance for year five to include the neonatal team as one of the professions required to attend multi-professional training.
- HSIB recommends that the Resuscitation Council (UK)’s Newborn Life Support training course highlights that neonatal resuscitation teams should consider fetal blood loss in the event of neonatal resuscitation that includes chest compressions. In addition, this consideration should be included in the guidance to support the newborn life support algorithm.
Commenting on the report’s findings, Melanie Ottewill, National Investigator at HSIB, said: “The need for blood transfusions during resuscitation is rare, but the impact of a delay can be devastating as we heard from Alex and Robert, Aria’s parents.
“Our report forms an important piece of literature in an area with limited research and can support any future work that explores safety issues relating to neonatal blood transfusions.
“The aim is that our safety recommendations can raise awareness of the issue and prompt clinicians to consider the option of a blood transfusion in the early stages of resuscitation.”
A previous report by the HSIB identified a key safety risk in maternity care relating to delays to intrapartum intervention once foetal compromise is suspected.
The report was compiled by the HSIB after a review of 289 of its maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries, which found that in 14.9% of the cases the delay was a contributory factor.
In this episode Kenneth Zoucha, MD, FAAP, a recognized leader in addiction medicine for the state of Nebraska, talks about the stigmas around substance use disorder and Neonatal Opioid Withdrawal Syndrome. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Tamela Milan-Alexander, MPPA, about her history with opioid use disorder, which led to a high-risk pregnancy, and her subsequent advocacy for mothers and their babies.
PEDIATRICS ON CALL Acknowledging Stigma and Embracing Empathy When Treating Neonatal Opioid Withdrawal Syndrome – Ep. 106
Residency Is Broken. We’re Unionizing to Fix It.
More fair working conditions and pay are long overdue
by Dipavo Banerjee, DO, MS, and Pratiksha Yalakkishettar, MD – March 19, 2022
On its website, UMass Memorial Health states that the hospital system was created to “make health and healthcare available to everyone.” This mission is made possible by the “people of UMass Memorial Health” and their “relentless pursuit of healing in all its forms.”
As frontline resident physicians who work day in and day out to care for patients at UMass Memorial, this mission is also at the core of our values. That’s why we are bargaining for our first union contract: In order to ultimately improve residency for ourselves, those that come after us, and the people of central Massachusetts who need quality healthcare most. But unfortunately, since the bargaining process began this fall, the hospital system’s leaders have not been as responsive to our proposals as we would have hoped.
A Wave of Resident Physician Organizing
While the COVID-19 crisis dramatically exacerbated issues UMass residents face, our struggle to make ends meet and stay well during residency is nothing new. Before the pandemic, we came together and started the process of unionizing with the Committee of Interns and Residents (CIR/SEIU) to gain a voice at the table where we could better advocate for ourselves and our patients. When the pandemic struck, securing better conditions became even more urgent, as the inequities in our healthcare system were laid bare — and in light of the rapid changes that left residents scrambling to keep up within traumatizing and sometimes dangerous practice conditions.
UMass residents are not alone. In just the past few weeks, hundreds of frontline physicians at Stanford University Medical Center, the University of Vermont Medical Center, and the University of Southern California-Keck recently demanded union recognition with a supermajority of support — a landmark residents and fellows celebrated at UMass not too long ago. In labor organizing, this means over 65% of the bargaining unit voted to unionize, but so far, all of these employers have refused to voluntarily recognize their union. This refusal then forces workers to move to an arduous National Labor Relations Board (NLRB) election process, which can draw out for months and creates an array of complications. (Residents at nearby Greater Lawrence Family Health Center recently won their union through an NLRB election).
Importantly, establishing a union is only the first step. Next, the workers who are organizing must prepare to negotiate with management to approve a collective bargaining agreement, which is a contract between the workers and the organization or company that sets pay, benefits, and other conditions over a period of time. Although we have been organizing for years at UMass, our union protections won’t truly be secure until we sign our first contract.
At the Top of Our List of Demands
Among the most important demands in our contract negotiations with management is the pay we need to live and work in an area with an increasing cost of living. Currently, UMass resident physicians are barely making the state minimum wage when our hours are considered. But so far, UMass has denied residents the basic ask of a fair wage. Instead, they’ve made only a meager wage proposal that fails to keep pace with the cost of living in Worcester — where the main UMass Memorial campus is located — while continually refusing to acknowledge several of our proposals. However, this disregard is perhaps unsurprising given how undervalued resident physicians’ labor is nationwide, a fact reflected in everything from our pay and working conditions to the gaps in our labor protections and benefits.
During residency, many of us are working to establish ourselves in a new location, while in some cases starting families or bringing families with us. We must stretch our dollars to cover the cost of essentials, from rent to childcare to gas to groceries. According to RentData.org, the fair market rent for a two-bedroom apartment in Worcester was $1,450 per month in 2021, which is more expensive than 96% of areas the site calculates. At the same time, the average student loan debt for graduating physicians is almost a quarter of a million dollars.
It is disheartening, to say the least, that the hospital system has so far refused to give us what we need after all we’ve sacrificed during this global catastrophe. We have worked sometimes to the point of physical and emotional exhaustion while witnessing far too many patient deaths during multiple COVID-19 surges.
Working Conditions Impact Patient Care and Health Equity
This pandemic has made it clearer than ever that resident physician well-being and patient care are inseparable. UMass Memorial residents are willing to work 80 hours per week because we know exceptional care is critical to community well-being, but we are significantly underpaid for doing so. A meaningful pay increase and adequate health and leave benefits would mean that we would be able to better focus on caring for our patients without burning out or completely neglecting our families and our own well-being.
Fair pay and benefits for residents is also a matter of health equity. Currently, residency at UMass is unaffordable, which limits who can come work and train here. UMass Memorial cannot claim to care about the most vulnerable communities in Massachusetts while helping to entrench inequities during residency. Through our union, we hope to foster a more diverse body of residents within the historically oppressive systems of healthcare — starting with UMass.
Hospitals Must Respect Resident Physicians’ and Fellows’ Labor Power
The surge in resident physician and fellow organizing around the country shows it is long past time for hospitals like UMass Memorial Health to respect the labor power of residents — first by recognizing our unions and then by agreeing to contracts that reflect the importance of our work and patient well-being. Graduate medical education should not be a burden on would-be physicians. At UMass Memorial, we hope to ultimately make residency more sustainable financially and otherwise, so we can continue to provide the highest quality care to our communities without burning out.
We won’t stop fighting until UMass agrees to invest in its future physician workforce and to treat us with the respect and dignity we deserve. Our families can’t wait — and neither can the communities in Massachusetts who need quality healthcare the most.
Difficult Times Without Easy Solutions: Nurses Want to Be Heard!
Annette M. Bourgault, PhD, RN, CNL, FAAN Editorial February, 2022
Crit Care Nurse (2022) 42 (1): 7–9. https://doi.org/10.4037/ccn2022577
Many articles have been written during the COVID-19 pandemic about the serious workplace and personal issues experienced by nurses. Although I have mentioned some of these struggles in previous Critical Care Nurse (CCN) editorials, I have not dedicated a full column to the deplorable situation in which so many nurses find themselves. I mistakenly assumed readers were overloaded with pandemic-related information and aware that many organizations are advocating on behalf of nurses to improve the environment and overall working conditions. I now realize that many nurses at the bedside are justifiably concerned that your voices are not being heard.
A national US survey of critical care nurses reported physical and emotional symptoms of exhaustion, anxiety, sleeplessness, and moral distress.1 Working conditions have become increasingly demanding during the pandemic, patient acuity is high, the nursing shortage continues, nurse-to-patient ratios regularly exceed recognized standards, nurses are working extreme amounts of overtime, and many nurses have seen too much death, feel disrespected and undervalued, and are frustrated that they cannot provide the level of excellent care required for positive patient outcomes. In other words, many of you are working in unhealthy and unsafe work environments.
Nurses are angry. I hear you and I hear your pain. As a nurse, I share your deep concerns about the future of nursing. As Editor of CCN, I recognize the importance and privilege of having a national platform to call for positive change for all critical care nurses.
I should explain one of the realities of publishing, however. Early in the pandemic, I often sat down to write these editorials thinking the worst of the pandemic might be over by the time my words were printed. It is clear now that we will not be out of this mess by the time this editorial goes to press. A recent quote I encountered resonated with me: “Any effort to predict a future course beyond 30 days relies on pixie dust for its basis.” To meet deadlines for print, I am typically writing editorials 3 to 4 months before the final version will be seen by readers, leaving me to guess what lies ahead. Sometimes I miss the mark.
Thus far, COVID-19 waves have fluctuated throughout the country with respect to timing and impact. During various waves of the pandemic, we hoped for a final resolution. While our government instructed the vaccinated public to resume elements of usual life, the work environment for nurses and other health care providers continued to worsen. Nurses in one state might be breathing easier and hoping the pandemic was ending while nurses in another city or state might be experiencing a huge influx of acutely ill patients and worsening work conditions. Each wave came and went leaving more destruction in its path. Some of our international readers experienced virus-related surges before their arrival in the United States. Due to geography and other variables, some of the situations I discuss may not apply to all readers in all places at all times, and sometimes I may overgeneralize about your experience.
Our System Needs an Overhaul
One thing is clear: many critical care nurses have been working in unfathomable work environments that appear to be worsening. A major overhaul of acute and critical care nursing is needed. Nurses have told us loud and clear that they do not want to be heroes—you want a healthy, sustainable work environment. You are willing to work hard, but you also need time to care for yourselves. You deserve the simple things that other professions take for granted, such as having time to eat a meal or empty your bladder during a shift. You deserve to be fairly compensated for the difficult work you perform. You deserve to work in a healthy work environment that supports you and allows you to provide expert nursing care to the best of your ability.
In the spirit of the American Association of Critical-Care Nurses (AACN) Healthy Work Environment standards, health care organizations must strive for skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. As the health care system is revamped, it is critical to ensure that adequate support and leadership are provided not only for bedside nurses, but the entire team, including nurse managers. Strong consideration should be given to other supportive roles such as clinical nurse specialists, whose engagement in patient care has been associated with improved patient outcomes and decreased cost.
No Easy Answers
This editorial does not contain answers to fix our broken health care system; there are no easy answers. Major changes will take time, not only to create a system that works for all, but to create changes that are sustainable. Across the globe, nursing associations, hospitals, schools of nursing, and others are working to make substantive changes to acute and critical care nursing practice. They also are exploring how we train new nurses and looking to models that have worked in other health care disciplines. Frontline nurses have been involved in many of these initiatives. Your input is important to help create a system that works for you.
Many nurses I talk to believe we already had a nursing crisis before the pandemic. Now we have a crisis on steroids. Our nursing shortage was exacerbated by the pandemic, and the current situation is unsustainable. If changes are not made quickly, we risk losing more nurses, including experienced, expert nurses. Intensive care unit nurse and advocate Sandy Summers expressed this well: “Without nurses, an ICU bed is just a bed.” Obviously we cannot continue to work within this broken system; radical and meaningful change is needed. Many are trying to develop innovative ways to provide safe nursing care to acute and critically ill patients and their families.
A number of solutions have been implemented and others are under development. Some institutions have reduced documentation requirements to free up nursing time for direct patient care, which is a great example of de-implementation to remove or revise current practices to free up valuable nursing time. There may be other opportunities to de-implement tradition-based practices that are not evidence based. Also, other practices or tasks that do not require critical thinking or high levels of nursing skill might be delegated to trained assistants.
Team nursing models are being used to manage increasing workloads with fewer registered nurses.9 In some cases, one nurse leads a team of nurses and/or health care providers from other disciplines to care for critically ill patients. I have heard stories of patient care being provided by student nurses, medical residents, and other allied health professionals. Although such solutions are intended to support nurses, they risk increasing nurse workload and stress depending on how thoughtfully they are implemented.
Although travel nurses and military nurses are being used to fill some of our patient care needs, this situation is not sustainable either. Some of you have reported working with travel nurses who have no experience caring for critically ill patients. This type of situation places additional burdens on the entire team, including local intensive care unit nurses and the nurse manager, not only to help the travel nurse become familiar with the local work environment and policies, but to become familiar with safe, evidence-based critical care nursing. The additional discrepancy in financial compensation between travel nurses and local nurses has become another great source of frustration.
Giving Nurses a Voice
Internationally, organizations such as Johnson & Johnson have been working with nurses and others to create a more sustainable workforce. Here at home, AACN has worked tirelessly throughout the pandemic to advocate for nurses, beginning with a board member’s visit to the White House in March 2020 to brief officials and the Coronavirus Task Force, demand safe work environments, and advocate for adequate personal protective equipment for frontline health care workers.
AACN also has launched campaigns, educational efforts, and well-being resources during the pandemic to provide various opportunities to improve working conditions and to give nurses a voice. Here are examples:
- An online portal for nurses to share stories in writing or through use of video
- The Hear Us Out Campaign to encourage vaccination in an unthreatening way
- Healthy Work Environment resources including implementation of a fifth national survey to capture nurses’ feedback during the crisis and recommend strategies for action
- A national staffing initiative co-led with the American Nurses Association to identify lasting solutions to chronic challenges to provide for safe and appropriate nurse staffing in the future
- Partnerships on the American Nurses Foundation’s Nurse Well-Being Initiative and the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience
- Relationships with organizations such as the Office of the Surgeon General to ensure that your voices are heard at high-profile tables of influence
Nurses collectively have a powerful voice and want to be heard. You want employers, administrators, policy makers, government, nursing associations (including AACN), schools of nursing, the public, and other stakeholders to recognize that your current work situation is unhealthy and unsustainable. We cannot afford to lose more nurses, but we also cannot continue to expect nurses to work within this broken health care system without meaningful change.
In closing, I strongly echo the sentiments expressed by Sandy Summers and others: “We must treat nurses as a vital resource.” Nurses want to be heard. They want ACTION and they need it NOW!
Risk of preterm birth in relation to history of preterm birth: a population-based registry study of 213 335 women in Norway
First published: 14 November 2021 https://doi.org/10.1111/1471-0528.17013
To assess the association between preterm first birth and preterm second birth according to gestational age and to determine the role of placental disorder in recurrent preterm birth.
Population-based registry study.
Medical Birth Registry of Norway and Statistics Norway.
Women (n = 213 335) who gave birth to their first and second singleton child during 1999–2014 (total n = 426 670 births).
Multivariate logistic regression analyses, adjusted for placental disorders, maternal, obstetric and socio-economic factors.
Main outcome measures
Extremely preterm (<28+0 weeks), very preterm (28+0–33+6 weeks) and late preterm (34+0–36+6 weeks) second birth.
Preterm birth (<37 weeks) rates were 5.6% for first births and 3.7% for second births. Extremely preterm second births (0.2%) occurred most frequently among women with an extremely preterm first birth (aOR 12.90, 95% CI 7.47–22.29). Very preterm second births (0.7%) occurred most frequently after an extremely preterm birth (aOR 12.98, 95% CI 9.59–17.58). Late preterm second births (2.8%) occurred most frequently after a previous very preterm birth (aOR 6.86, 95% CI 6.11–7.70). Placental disorders contributed 30–40% of recurrent extremely and very preterm births and 10–20% of recurrent late preterm birth.
A previous preterm first birth was a major risk factor for a preterm second birth. The contribution of placental disorders was more pronounced for recurrent extremely and very preterm birth than for recurrent late preterm birth. Among women with any category of preterm first birth, more than one in six also had a preterm second birth (17.4%).
Increased Severe Neonatal Hyperbilirubinemia During Social Distancing
By Sara K. Berkelhamer, Department of Pediatrics, University of Washington, Seattle
Feb 21, 2022
As a neonatologist, I was concerned about an apparent increase in the number of neonates being readmitted to the hospital with severe hyperbilirubinemia during the COVID-19 pandemic and social distancing mandate. I envisioned that the postpartum social support provided by visiting family and friends was being disrupted, impacting successful breastfeeding and the recognition of jaundice in infants. I was also worried about inadequate access to professional support coupled with apprehension to seeking medical care. As severely elevated bilirubin levels can impact an infant’s neurodevelopment, early identification and intervention (including feeding supplementation, lactation support, and phototherapy) is key to avoiding both long-term sequelae and hospitalization. Therefore, there was a need to explore if an increase in severe hyperbilirubinemia cases was truly occurring, if these cases represented more severe disease, and if risk factors could be identified to guide targeted counseling and closer follow up.
For a paper published in the Journal of Paediatrics and Child Health, my colleagues and I aimed to determine rates of severe hyperbilirubinemia admission during social distancing in comparison to historical norms. A retrospective chart review identified all readmissions for hyperbilirubinemia between January 2018 and April 2020 in Western New York. Our study team collected both maternal and infant data as well as details on the infant’s admission to the hospital and clinical course. Infants were categorized according to the period of hospital admission, which was characterized as pre-pandemic or control. In addition, 19 outpatient clinics were surveyed regarding lactation support.
Rates of Readmission Nearly Tripled
While rates of readmission for hyperbilirubinemia nearly tripled during early social distancing mandates, we found that there was no change in the severity of disease as determined by signs of dehydration, rates of suspected sepsis, peak bilirubin levels, duration of phototherapy, rates of bilirubin above exchangeable levels, use of IV immunoglobulin or exchange transfusion, and length of hospital stay.
Mothers who had infants readmitted during social distancing were observed to be younger than mothers of infants readmitted before the pandemic (25.8±3.3 vs 31.3±4.7 for COVID-19 and controls, respectively), with rates of primiparity and exclusive breastfeeding higher than national norms, but not significantly higher than controls in the cohort (62.5% vs 37.0% for primiparity; 87.5 % vs 81.5 for breastfeeding). A survey of outpatient clinics in the region identified limited options for access to lactation support via telemedicine; of the 19 clinics surveyed, only six offered a telemedicine option for lactation support.
Greater Access to Virtual Lactation Support Needed
To our knowledge, this is first study to examine increased rates of readmission for hyperbilirubinemia during the stay-at-home mandate. Our data supported our hypothesis that social distancing impacted access to healthcare, critical social support, and utilization of services for at-risk cohorts, which included young, primiparous women who breastfeed.
Based on our observations, there is a critical need for proactive identification and monitoring of at-risk mother-infant dyads during recurrent COVID-19 surges, not only during the postpartum period in the hospital but after discharge into the community. Our data further advocates for greater expansion of access to virtual lactation support, an option that has grown exponentially for physician visits during the pandemic.
Going forward, we would like to see more research on the design and application of remote lactation support, as well as on the clinical and cost efficacy of these programs. As our data represents a regional experience, we would welcome a secondary analysis comparing severity of disease in cases of hyperbilirubinemia that occurred before and during COVID-19 and the demographics associated with at-risk populations.
Building Baby Brains With smallTalk: From Foreign Language Learning at Home to Bridging Gaps in the NICU
January 28, 2022 Jessica Nye, PhD
The best language learners on the planet are children — especially babies. Your brain is most active in creating the language center of your brain, connecting neurons and creating the highways and pathways for processing language, during infancy. In fact, language learning begins in utero. The developing brain of a fetus starts to wire language circuitry around the speech sounds and rhythms of its mother’s voice. This process accelerates when a baby is born.
The brain does more language-associated wiring during the first year of life than any other time in a person’s life. These brain changes occur rapidly as a result of exposure to adult voices speaking to the baby in “infant-directed speech,” characterized by a higher pitch and more melodic, emotional tones.
Ohio-based startup smallTalk (formerly Thrive Neuromedical) is developing the SmallTalk™ platform to enrich the neurological development of babies who don’t have regular, consistent access to their parents’ voices. smallTalk has licensed technology developed at Nationwide Children’s Hospital that delivers recorded voices to infants via devices intended for use in the neonatal intensive care unit (NICU) and at home. These devices support critical brain development for language.
Around 10% of all infants spend some amount of time in the NICU, where they may be exposed to more passing adult speech and sounds of alarms and machinery than infant-directed speech during critical periods for language-associated brain development. This lack of exposure to infant-directed speech may, in part, be responsible for the documented association between NICU care and developmental language delays.
At Nationwide Children’s, where the average stay in the NICU exceeds 100 days, researchers developed and studied an infant-safe, unibody, Bluetooth-enabled speaker device to increase babies’ exposure to their caregivers’ voices with the appropriate sound characteristics to provide a clinical, therapeutic effect. The speaker can easily fit into an incubator and uses technology and volumes that is safe for babies and their sensitive ears.
Beginning this year, nurses and therapists in the NICU will be able to use a specially designed iPad application to help parents or caregivers record lullabies, songs or stories. Playlists of these recordings can be transferred wirelessly to egg-shaped speaker devices placed with the babies in the NICU and played for them several times each day.
The technology has also led to the development of an innovative foreign language learning product, the smallTalk Egg™, designed to help parents plan expose their babies to foreign language learning before age two.
“This is the only time of life when language learning actually helps babies brains develop differently. Infants in bilingual or multilingual household environments develop much broader speech sound recognition capabilities. By 1 or 2 years of age, they’re able to hear and verbalize more speech sounds and adapt to those languages very quickly,” says Dean Koch, CEO of smallTalk.
Infants can be exposed to these songs and stories passively, but studies have shown the most effective changes to the brain occur during interaction. Because the smallTalk Egg™ comes with a sensor device which fits into three different commercially available types of pacifiers, infants can request additional content by sucking on their pacifiers during 20-minute educational sessions. As the infant sucks, they are rewarded with 10 seconds of the foreign language lullaby, which then fades away. The baby recognizes this contingency quickly and will happily engage for a 20-minute learning session.
“Our research on brain imaging and how babies process speech sounds found that 20 sessions of 10-20 minutes over a month or month and a half is all that’s required to make a real, lasting, positive brain change,” says Koch.
The smallTalk Egg™, which will also be available this year, will allow parents and caregivers to bring this brain-enhancing technology into their homes. Currently, content is available in seven languages for use on the smallTalk Egg™, and there are plans to expand to include more languages spoken around the world.
Discover Your Learning Style
In this video, you’ll learn more about the different types of learning styles, to see which one works best for you! Visit https://www.gcflearnfree.org/ to learn even more.
Traditionally western academic institutions have not adequately developed teaching methods that are geared towards visual, kinesthetic, and combined learning styles. The world is composed of people with diverse, meaningful, and valuable learning styles. Often academic teaching, testing, and programming is aimed towards auditory learning. I propose that we transition from labeling students as “learning disabled” and focusing on the possibility that our education systems are teaching disabled. We can do better.
4/10/2020 by Surfing Republica