Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form

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LM: lactancia materna." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Josep Vicent Balaguer-Martínez, Rubén García-Pérez, Ana Gallego-Iborra, Elena Sánchez-Almeida, María Dolores Sánchez-Díaz, Edurne Ciriza-Barea" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Josep Vicent" "apellidos" => "Balaguer-Martínez" ] 1 => array:2 [ "nombre" => "Rubén" "apellidos" => "García-Pérez" ] 2 => array:2 [ "nombre" => "Ana" "apellidos" => "Gallego-Iborra" ] 3 => array:2 [ "nombre" => "Elena" "apellidos" => "Sánchez-Almeida" ] 4 => array:2 [ "nombre" => "María Dolores" "apellidos" => "Sánchez-Díaz" ] 5 => array:2 [ "nombre" => "Edurne" "apellidos" => "Ciriza-Barea" ] 6 => array:1 [ "colaborador" => "Red de Investigación en Pediatría de Atención Primaria (PAPenRed)" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287921002106" "doi" => "10.1016/j.anpede.2020.12.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287921002106?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320305361?idApp=UINPBA00005H" "url" => "/16954033/0000009600000001/v3_202201060630/S1695403320305361/v3_202201060630/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2341287921002131" "issn" => "23412879" "doi" => "10.1016/j.anpede.2021.11.002" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "3236" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2022;96:59.e1-59.e10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "SPANISH ASSOCIATION OF PAEDIATRICS" "titulo" => "Immunization schedule of the Pediatric Spanish Association: 2022 recommendations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "59.e1" "paginaFinal" => "59.e10" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calendario de vacunaciones de la Asociación Española de Pediatría: Recomendaciones 2022" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1890 "Ancho" => 2333 "Tamanyo" => 463333 ] ] "descripcion" => array:1 [ "en" => "Routine immunisation schedule of the Spanish Association of Pediatrics 2022. (1) Hepatitis B vaccine (HB).- Three doses of hexavalent vaccine at ages 2, 4 and 11 months. Children of HBsAg-positive mothers or mothers of unknown serologic status will also be given one dose of monovalent HB vaccine at birth, in addition to 0.5mL of hepatitis B immune globulin (HBIG) if maternal HBsAg-positive status is confirmed. Infants vaccinated at birth will adhere to the routine schedule for year 1 of life, and thus will receive 4 doses of HB vaccine. Unvaccinated children and adolescents should be given 3 doses of monovalent vaccine on a 0, 1 and 6-month schedule. (2) Diphtheria, tetanus and acellular pertussis vaccine (DTaP/Tdap).- Five doses: primary vaccination with 2 doses, at 2 and 4 months, of DTaP-IPV-Hib-HB (hexavalent) vaccine; booster at 11 months (third dose) with DTaP (hexavalent) vaccine; at 6 years (fourth dose) with the standard load vaccine (DTaP-IPV), preferable to the low diphtheria and pertussis antigen load vaccine (Tdap-IPV), and at 12–14 years (fifth dose) with Tdap. In children previously vaccinated with the 3+1 schedule (at 2, 4, 6 and 18 months), it is possible to use the Tdap for the booster at age 6 years, as they do not need additional doses of IPV. (3) Inactivated poliovirus vaccine (IPV).- Four doses: primary vaccination with 2 doses, at 2 and 4 months, and booster doses at 11 months (with hexavalent vaccine) and 6 years (with DTaP-IPV or Tdap-IPV). Children previously vaccinated with the 3+1 schedule (at 2, 4, 6 and 18 months), require no additional doses of IPV. (4) Haemophilus influenzae type b conjugate vaccine (Hib).- Three doses: primary vaccination at 2 and 4 months and booster dose at 11 months (with hexavalent vaccine). (5) Pneumococcal conjugate vaccine (PCV).- Three doses: the first two at 2 and 4 months, with a booster dose starting at 11 months of age. The vaccine recommended in Spain by the CAV-AEP continues to be the PCV13. (6) Rotavirus vaccine (RV).- Two or three doses of rotavirus vaccine: at 2 and 3–4 months with the monovalent vaccine or at 2, 3 and 4 months or 2, 3-4 and 5–6 months with the pentavalent vaccine. It is very important to start vaccination between 6 and 12 weeks of life in order to minimise risks, and to complete it before 24 weeks for the monovalent vaccine or 32 weeks for the pentavalent vaccine. Doses must be given at least 4 weeks apart. Both vaccines may be given at the same time as any other vaccine. (7) Meningococcal B vaccine (MenB).- 4CMenB. Three doses: start at age 2 months, with a primary series of 2 doses 2 months apart and a booster starting at age 12 months and at least 6 months after the last dose in the primary series. It can be administered at the same time as other vaccines in the schedule, although this could increase the frequency of fever, so another option in patients up to age 12 months is to administer it 1 or 2 weeks apart from other injectable inactivated vaccines to minimise potential reactogenicity. The separation by 1-2 weeks is not necessary for the MenACWY, MMR, varicella and rotavirus vaccines. Vaccination is also recommended at any age in risk groups: anatomic or functional asplenia, complement deficiency, treatment with eculizumab or ravulizumab, haematopoietic stem cell transplant recipients, infection by HIV, prior episode of IMD caused by any serogroup, and contacts of an index case of IMD caused by serogroup B in the context of an outbreak. (8) Meningococcal C conjugate vaccine (MenC) and meningococcal ACWY conjugate vaccine (MenACWY).- One dose of conjugate MenC-TT at age 4 months. The CAV-AEP recommends 1 dose of the MenACWY conjugate vaccine at age 12 months and 12–14 years, and a progressive catch-up vaccination schedule to be completed by age 18 years. In ACs where vaccination with MenACWY is not included in the routine schedule, if parents choose not to administer the MenACWY vaccine at 12 months, the MenC-TT vaccine funded by the regional government must be administered instead. Administration of the MenACWY vaccine is still particularly recommended in children and adolescents that are to live in countries where the vaccine is administered at this age (United States, Canada, Argentina, United Kingdom, Austria, Greece, Netherlands, Italy and Switzerland) and for children with risk factors for IMD: anatomic or functional asplenia, complement deficiency, treatment with eculizumab or ravulizumab, hematopoietic stem cell transplant recipients, HIV infection, prior episode of IMD caused by any serogroup, and contacts of an index case of IMD caused by serogroup A, C, W or Y in the context of an outbreak. Individuals traveling to Mecca for religious reasons and to the African meningitis belt during the dry season should also receive the MenACWY vaccine. (9) Influenza vaccine.- Recommended in all children, with administration of the parenteral inactivated influenza vaccine in children aged 6 to 59 months and, if available, the intranasal live attenuated vaccine from age 2 years. Children who are being vaccinated for the first time and children under 9 years should receive 2 doses administered 4 weeks apart. Subsequently, only 1 dose is needed each season. The dose is 0.5mL in the case of the inactivated vaccine and 0.1mL in each nostril in the case of the attenuated vaccine. Information on the risk groups for influenza is available in the online Vaccine Manual of the AEP. (10) Measles, mumps and rubella vaccine (MMR).- Two doses of MMR vaccine. The first at age 12 months and the second at age 3–4 years. The quadrivalent MMRV vaccine may be administered for the second dose. Susceptible patients outside the specified ages will be vaccinated with 2 doses of MMR at least 1 month apart. (11) Varicella vaccine (Var).- Two doses: the first at age 15 months (age 12 months is also acceptable) and the second at age 3–4 years. The quadrivalent vaccine (MMRV) may be used for the second dose. Susceptible patients outside the specified ages will be vaccinated with 2 doses of monovalent Var vaccine at least 1 month apart. (12) Human papillomavirus vaccine (HPV).- Universal routine vaccination of all girls and boys, at age 12 years with a 2-dose series. The vaccines currently available are the HPV2 and HPV9. They are both authorised for use in male individuals. Vaccination with 2 doses of 2-valent or 9-valent vaccine at 0 and 6 months in children aged 9 to 14 years or a 3-dose series at 0, 1-2 and 6 months in those aged ≥15 years. The HPV vaccine may be administered at the same time as the MenC, MenACWY, hepatitis A and B and Tdap vaccines. There are no data on the coadministration with the varicella vaccine, although it should not cause any problems. (13) SARS-CoV-2 vaccine.- Currently, two vaccines are authorized in our country from the age of 12, Comirnaty-30 microgr (Pfizer) and Spikevax-100 microgr (Moderna) and another between 5 and 11 years with another presentation with a lower amount of antigen (Comirnaty-10 microgr) . Two doses will be applied, separated by three weeks in the first and third and by four weeks in the second. The Public Health Commission of Spain has decided that the separation between the 2 doses of Comirnaty 10 mcgr is 8 weeks, but if it is administered after 21 days it would be valid. They can be administered with other vaccines on the same day or with the desired separation." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco José Álvarez García, María José Cilleruelo Ortega, Javier Álvarez Aldeán, María Garcés-Sánchez, Elisa Garrote Llanos, Antonio Iofrío de Arce, Abián Montesdeoca Melián, María Luisa Navarro Gómez, Valentín Pineda Solas, Irene Rivero Calle, Jesús Ruiz-Contreras, Pepe Serrano Marchuet" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Francisco José" "apellidos" => "Álvarez García" ] 1 => array:2 [ "nombre" => "María José" "apellidos" => "Cilleruelo Ortega" ] 2 => array:2 [ "nombre" => "Javier" "apellidos" => "Álvarez Aldeán" ] 3 => array:2 [ "nombre" => "María" "apellidos" => "Garcés-Sánchez" ] 4 => array:2 [ "nombre" => "Elisa" "apellidos" => "Garrote Llanos" ] 5 => array:2 [ "nombre" => "Antonio" "apellidos" => "Iofrío de Arce" ] 6 => array:2 [ "nombre" => "Abián" "apellidos" => "Montesdeoca Melián" ] 7 => array:2 [ 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[ 0 => array:3 [ "entidad" => "CAP Sant Ildefons, Cornellà de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Txurdinagako Osasun Zentroa, Bilbao, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CS Trinidad, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CS la Guancha-San Juan de la Rambla, Tenerife, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "CS Parquesol, Valladolid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "CS Ansoain, Navarra, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Capacidad predictiva para la lactancia y determinación del mejor punto de corte de la escala BSES-SF" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1434 "Ancho" => 2175 "Tamanyo" => 153111 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flowchart of study participants. BF, breastfeeding." ] ] ] "textoCompleto" => "IntroductionThe prevalence of breastfeeding (BF) in Spain has been increasing progressively in recent years. The frequency of exclusive BF at 6 months of life has increased from 28.5% in 2011 to 39% in 2017.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> However, we are still far from fulfilling the recommendation of the World Health Organization to maintain exclusive BF through age 6 months.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Multiple factors have been found to be associated with early discontinuation of BF, including maternal age, educational attainment or psychosocial status.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Although these are not modifiable factors, it is important to be aware of them in order to identify mothers at risk of discontinuing BF. On the other hand, there are modifiable factors on which it is possible to act to attempt to minimise this risk.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>One of the modifiable risk factors for early BF discontinuation is the lack of support to mothers from health care professionals.<a class="elsevierStyleCrossRefs" href="#bib0015">3,5</a> Providers in maternity wards play an important role in the successful establishment of BF, and primary care providers in its successful maintenance over time.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> To achieve this goal, it is essential that validated tools be available to objectively assess BF. At present, there are several scales that assess BF technique through the direct observation of a feed by a health care professional.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> The use of scales facilitates the standardization of assessment criteria and objective identification of aspects in need of improvement.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> We recommend observation of at least one full feed in the maternity ward and another one when the infant enters the primary care system.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>There is another important factor at play in the maintenance and exclusivity of BF: self-efficacy. The level of this trait in mothers is also a good predictor of early BF discontinuation.<a class="elsevierStyleCrossRefs" href="#bib0050">10,11</a> Self-efficacy refers to how competent and confident women feel about their ability to breastfeed. The main aspects that contribute to this factor are previous personal experience BF, past vicarious experience of BF in others, the physical and psychological condition of the mother and verbal persuasion by others.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Previous studies have demonstrated that self-efficacy is a modifiable factor and that interventions that improve self-efficacy achieve an increase in BF duration and exclusive BF.<a class="elsevierStyleCrossRefs" href="#bib0020">4,13,14</a> Thus, instruments for assessment of self-efficacy can be useful and help identify mothers at risk of premature discontinuation of BF.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>The scale used most frequently for this purpose is the Breastfeeding Self-Efficacy scale-short form (BSES-SF), developed in Canada in 2003.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> The BSES-SF has been translated to different languages and adapted to different cultures and exhibited an adequate validity and reliability.<a class="elsevierStyleCrossRefs" href="#bib0075">15–21</a> There is also a validated version of the scale in Spanish.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> In addition, the BSES-SF has been found to be a good predictor of early BF discontinuation, with lower scores in the scale associated with an increased risk of discontinuation.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19,23,24</a>This motivated us to assess the potential usefulness of the BSES-SF as a predictor of BF practices at the primary care level. The BSES-SF is a simple and feasible scale that could be very helpful to health care professionals. In addition, we sought to establish the optimal cut-off point to identify mothers at risk of BF discontinuation.MethodsThe data used in this study were obtained in the context of the study Lactancia y Desarrollo Infantil (Breastfeeding and Infant Development, LAyDI), so the results presented here are from a secondary analysis of the data obtained in said project.Design and settingThe LAyDI is a single cohort study with the primary objective of establishing whether there is an association between the feeding modality in infancy and future developmental outcomes. This study was conducted through the Primary Care Paediatrics Research Network (Spanish abbreviation, PAPenRed) of the Asociación Española de Pediatría de Atención Primaria. PAPenRed is composed of 320 paediatricians of the Spanish public health system with a distribution that matches the population distribution by autonomous community, leading us to assume that the results of the study are representative of the entire Spanish territory.Study periodData collection started on April 1, 2017 and ended on March 31, 2020.Sample selection and data collectionThroughout the period under study, collaborating paediatricians each recruited up to 12 newborn infants. Since we intended to analyse morbidity data, in order to eliminate seasonal bias we decided that, for a full year, paediatricians would recruit the first infant born each month that met all the eligibility criteria. We followed up the resulting cohort through age 2 years.Data were collected in the first primary care visit (within 15 days post birth) and at 1, 2, 4, 6, 12, 18 and 24 months post birth. In our study, we used the data collected through age 6 months. The BSES-SF was completed by mothers in the initial appointment. During this appointment, the paediatricians also collected information regarding the pregnancy and delivery in addition to information on the neonate and the parents. In subsequent visits, paediatricians collected information on the feeding modality of the infant. In each visit, data were collected in a form developed for the purpose. Once data collection was completed, each paediatrician submitted a report. The sources of information used to fill out these forms were the mothers themselves, labour and delivery discharge summaries, official child health notebooks, patient health records and emergency department reports.The inclusion criteria were: infant born at term (>37 weeks gestational age) brought for the initial paediatric primary care visit before 15 days post birth and written informed consent signed by the mother.The exclusion criteria were low birth weight (less than 2400 g in boys and 2100 g in girls), multiple birth, length of stay in maternity ward or neonatal unit greater than 5 days, presence of malformations or severe disease, history of moderate to severe disease in the mother during pregnancy or the postpartum period, language barrier, refusal of family to participate and families whose usual geographical mobility patterns precluded follow-up.SampleIn 2015, a total of 426 303 children were born in Spain. Given a 2.5% margin of error for a 95% level of confidence for the entire paediatric population residing in Spain, we estimated that we needed a minimum sample size of 1500 to represent the entire paediatric population of Spain.Study variablesThe LAyDI study collected data on a large number of variables. The variables that we used for our study were the following:Primary outcomes:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Exclusive BF: defined as the infant being exclusively breastfed in the past 7 days.</li><li class="elsevierStyleListItem" id="lsti0010">•Mixed feeding: defined as the infant having been breastfed in the past seven days, but also fed any amount of artificial formula, other water-based fluids or any other form of nutrition other than BF.</li><li class="elsevierStyleListItem" id="lsti0015">•Score in the BSES-SF: unidimensional scale consisting of 14 items that present statements about BF to be rated by the mothers on a Likert scale ranging from “not at all confident” (1 point) to “always confident” (5 points). Thus, the total score can range from a minimum of 14 points to a maximum of 70.</li></ul>Other variables analysed in the study:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">•Maternal characteristics: age, educational attainment, immigration status, employment status, marital status.</li><li class="elsevierStyleListItem" id="lsti0025">•Pregnancy and delivery: primiparity, weeks of gestation, hospital where infant was born, type of delivery.</li><li class="elsevierStyleListItem" id="lsti0030">•Infant characteristics: Apgar score, sex, birth weight, age at first visit.</li></ul>Ethical considerationsThe PAPenRED project obtained overall approval from the Scientific Research Ethics Committee of Aragon (File 19/2013; C.P.-C.I. PI13/00154). The LAyDI study was approved by the Research Ethics Committee of the Principality of Asturias (project no. 213/16). It also received a positive review from the Central Research Commission of the Department of Health of Madrid. All the collected data were anonymised and confidentiality safeguarded in adherence with Regulation (EU) 2016/679. Mothers received adequate information about the study, and those who expressed an interest in participating were asked to sign an informed consent form.Statistical analysisWe performed a descriptive analysis of the cohort under study. We calculated the total score in the BSES-SF and the differences in the scores obtained by mothers that offered exclusive BF versus those offering mixed feeding by means of the t test. We considered p-values of 0.05 and less statistically significant.We used the BSES-SF scores obtained in the initial visit to generate receiver operating characteristic (ROC) curves for each age group (1, 2, 4 and 6 months) for both the exclusive BF and the mixed feeding groups. For each curve, we calculated the area under the curve (AUC) with the corresponding 95% confidence interval (CI). We considered that the predictive power of a ROC curve was poor if the AUC was less than 0.59, fair if the AUC was between 0.6 and 0.74, good if the AUC was between 0.75 and 0.89 and very good if the AUC was greater than 0.9.If the AUC showed a good or very good predictive power, we also calculated the sensitivity and specificity for those curves starting from scores of 30 points in the BSES-SF. We established a minimum sensitivity threshold of 80% for the calculation of the optimal cut-off point.We performed the statistical analysis of the data with the software Statistical Package for the Social Sciences (SPSS) version 22.0.ResultsA total of 210 paediatricians of the network participated in the LAyDI study. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> presents a flowchart of the sample under study. We found the following rates of BF in the initial primary care visit: exclusive BF, 67.2% (65.1%–69.2%), mixed feeding, 22.1% (20.4%–24.0%) and formula feeding 10.7% (9.4%–12.1%). The mean age of the infants in the initial visit was 10.8 days (standard deviation [SD], 4.0). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the main characteristics of the participants at the beginning of the study.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The mean BSES-SF score in the total sample was 59.76 points (SD, 9.95). The mean score in each of the groups was 62.54 points (SD, 7.91) in the exclusive BF group compared to 51.79 points (SD, 10.88) in the mixed feeding group. This corresponds to a difference between the 2 groups of 10.42 points (P < .001).<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows the ROC curves obtained from the BSES-SF scores of mothers that exclusively breastfed their infants. We ought to note that only the curves corresponding to the visits at 1 and 2 months had an AUC above the threshold established to define good predictive power (0.75).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> presents the ROC curves of mixed feeding group. In this instance, there were no AUCs greater than 0.75 in any infant age group.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Since the only curves with AUCs above the threshold for good predictive power were those in the exclusive BF group at 1 and 2 months, these were the age groups for which we calculated the sensitivity and specificity of BSES-SF scores ranging from 30 to 70 points. The results are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. As can be seen in the table, a sensitivity of 80% was achieved with a score of 59 points at 1 month and 58 points at 2 months.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionThe BSES-SF score found in our study (59.76 points) was above the scores reported in other studies conducted in Spain. In the validation study conducted by Oliver-Roig et al., the mean score in the BSES-SF was 51.94 points,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> while Marco-Alegría et al. reported a mean of 50.03 points.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> In these studies, the BSES-SF was administered in the maternity ward before day 5 post birth. This may explain the observed differences, as in the LAyDI study, mothers completed the BSES-SF on day 10 post birth, when they had been breastfeeding longer and presumably felt more competent. Ideally, the initial newborn evaluation in primary care centres should take place 48–72 h after discharge.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> The results of our study suggest that the time elapsed between both care settings (maternity ward and primary care centre) is longer than recommended, which poses a risk to infant health and may contribute to early BF discontinuation.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Studies conducted in other countries have produced heterogeneous results, with the lowest scores found in Asian countries (where the prevalence of BF is substantially lower): 47.3 points China<a class="elsevierStyleCrossRef" href="#bib0095">19</a> and 42.39 points in Japan.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> In other European countries, scores are similar to those in our study: 54.8 points in Italy,<a class="elsevierStyleCrossRef" href="#bib0090">18</a> 57.4 in Sweden<a class="elsevierStyleCrossRef" href="#bib0075">15</a> and 63.6 in Portugal.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Therefore, the scores obtained in the scale seem to be associated with the prevalence of BF in the region where self-efficacy is being assessed.The BSES-SF performed adequately for prediction of BF maintenance. Some studies have found that the scale offers a good predictive power through 3 months post birth,<a class="elsevierStyleCrossRefs" href="#bib0085">17,18,23,27</a> compared to 1 month in others.<a class="elsevierStyleCrossRefs" href="#bib0095">19,22</a> In our study, the BSES-SF exhibited a good predictive power through 2 months post birth in mothers that breastfed exclusively. We did not find any studies that analysed the predictive power of the scale differentiating between mothers that practiced exclusive BF and mothers that practiced mixed feeding. Given the substantial differences we observed in the BSES-SF scores between these 2 groups of mothers, we thought it would be prudent to make a separate analysis for each. Based on the results, the scale does not seem to be a good predictor in the case of mixed feeding.As for the optimal cut-off point in the BSES-SF, a similar study estimated a cut-off score of 50 points.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> However, this study was conducted in the Asian population, in which BF trends, as we mentioned above, are very different compared to Western countries. Considering that for the purpose of prediction the cut-off point should be selected with the aim of detecting the highest possible number of mothers at risk of BF discontinuation, we decided to use the sensitivity as the parameter used to select the optimal cut-off value. The ultimate purpose of identifying mothers at risk of discontinuing BF is to offer increased BF support.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> We arbitrarily selected a minimum sensitivity of 80% to define adequate predictive power, although any other of the values presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> could be applied. Thus, we propose using a cut-off score of 58 points, as it offers a sensitivity greater than 80% in the 2 age groups in which we calculated the threshold.Most studies on scales used for assessment of BF have been made in the hospital setting and in the first days post birth.<a class="elsevierStyleCrossRefs" href="#bib0025">5,18–22,27</a> We only found one study conducted in the primary care setting that used the BSES-SF to assess factors that affect BF.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Our analysis revealed that the application of scales in the primary care setting to predict BF outcomes can be useful. The BSES-SF is completed in a short time and can be administered in the first visit of newborn infants that are exclusively breastfed. However, the best approach would be to implement follow-up plans developed and implemented by hospital maternity departments in collaboration with primary care services.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Breastfeeding assessment data collected in hospital should reach the primary care system, ensuring continuity of care. The best way to convey this information would be through standardised instruments<a class="elsevierStyleCrossRef" href="#bib0030">6</a> like the BSES-SF or scales used to assess observed feeds.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>One of the limitations of this study was the loss to follow-up of some patients, a common limitation of longitudinal studies that also affected the LAyDI project. Although 17.4% of the initial sample did not complete the follow-up, the number of participants that continued in the study at 6 months post birth was greater than the estimated minimum necessary sample size. Thus, although there were losses to follow-up, the results are still valid. On the other hand, since we analysed secondary data, we did not perform a sample size calculation specifically for our study. As a result, there were considerable differences between the participants in the 2 feeding modality groups that we analysed separately (exclusive BF and mixed feeding). Nevertheless, due to its substantial size, the sample yielded BSES-SF scores representative of the population despite the disparities between the feeding modality groups.Due to all of the above, we conclude that the BSES-SF is a useful instrument at the primary care level to identify mothers at risk of discontinuing BF before 2 months post birth. Mothers with scores of 58 points or lower should receive additional BF support.FundingThe LAyDI study was awarded one of the research grants of the Asociación Española de Pediatría de Atención Primaria-Fundación Pediatría y Salud (AEPap-FPS) in 2017.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1652538" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1469229" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1652539" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1469230" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and setting" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study period" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Sample selection and data collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Sample" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Study variables" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethical considerations" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-11-16" "fechaAceptado" => "2020-12-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1469229" "palabras" => array:5 [ 0 => "Pediatrics" 1 => "Primary health care" 2 => "Breast feeding" 3 => "Self efficacy" 4 => "Surveys and questionnaires" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1469230" "palabras" => array:5 [ 0 => "Pediatría" 1 => "Atención primaria" 2 => "Lactancia materna" 3 => "Autoeficacia" 4 => "Encuestas y cuestionarios" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). This study assesses the relationship between the BSES-SF score and the risk of breastfeeding (BF) cessation and determines the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations. MethodsSecondary data analysis of the LAyDI study. Cohort study carried out through a research network of primary care pediatricians (PAPenRed). A newborn was recruited every month for one year by 210 pediatricians. The cohort was followed for 24 months. Mothers responded to the BSES-SF at the first visit. General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first 6 months. ResultsN = 1845. The Area Under the ROC Curve for the exclusive BF was 0.790 (0.765-0.815) the first month and 0.760 (0.734-0.786) the second month. For 4 and 6 months, as well as for any age in mothers who give supplemented BF, the Area Under the Curve was less than 0.75 and its predictive capacity was not considered to be good. For a sensitivity of 80% in detecting mothers at risk of BF cessation with the BSES-SF, the cut-off score was 58. ConclusionsMothers with a BSES-SF score below 58 points in primary health care, are at risk of early withdrawal of exclusive BF within two months." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl instrumento utilizado habitualmente para valorar la autoeficacia de la lactancia materna es la Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Este estudio valora la relación entre la puntuación de la BSES-SF y el riesgo de abandono de la lactancia. También se determina el punto de corte en la puntuación de la escala que optimiza la detección de este riesgo desde Atención Primaria. MétodosAnálisis secundario de datos del estudio LAyDI. Estudio de cohorte única realizado a través de la red de investigación de pediatras de Atención Primaria (PAPenRed). Cada pediatra reclutó un recién nacido cada mes durante un año. Se siguió la cohorte 24 meses. Las madres respondieron la BSES-SF en la primera visita. Se recogieron datos generales de embarazo y parto y se valoró la lactancia materna (suplementada o exclusiva) hasta los 6 meses. Resultadosn = 1845. El Área Bajo la Curva ROC para la LM exclusiva fue al primer mes de 0,79 (0,77–0,82) y al segundo mes de 0,760 (0,734-0,786). Para los 4 y 6 meses, así como para cualquier edad en madres que dan LM suplementada, el Área Bajo la curva fue menor de 0,75 y su capacidad predictiva no se consideró adecuada. Para una sensibilidad del 80% en la detección de madres en riesgo de abandono de la lactancia la puntuación de corte fue 58. ConclusionesLas madres que en Atención Primaria presenten una puntuación en la BSES-SF por debajo de 58 puntos tienen riesgo de abandono de la lactancia materna exclusiva antes de los dos meses." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Balaguer-Martínez JV, García-Pérez R, Gallego-Iborra A, Sánchez-Almeida E, Sánchez-Díaz MD, Ciriza-Barea E. Capacidad predictiva para la lactancia y determinación del mejor punto de corte de la escala BSES-SF. An Pediatr. 2022;96:51–58." ] 1 => array:2 [ "etiqueta" => "⋆⋆" "nota" => "Previous presentation: the results of this study were presented at the 17th Congress of the AEPap, February 13–15, 2020, Madrid, Spain." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "Abad-Balaguer B., AcitoresSuz E., Acosta-Navas B., Aguilera-López L., Albaladejo- Beltrán S., Albañil-Ballesteros M.R., Alcaraz-Quiñonero M., Álvarez-Bueno E., Angulo-Moreno M.E., Anllo-Lago J., Aparicio-Rodrigo M., Arana-Cañedo-Argüelles C., Arranz-Sanjuan R., Arroyo-Úbeda R., Asensi-Monzo M.T., Astiz-Blanco M.I., Azor-Martínez E., Baliela-García B.C., Barea-García J.J., Barrios-González E.M., Batalla-Fadó L., Bejarano-López M.A., Belda-García M.T., Benítez-Rubio M.R., Bercedo-Sanz A., BernadUsoz J.V., Biosca-Pàmies M., Blesa-Baviera L.C., Bombín-Granado J.M., Bonet-Garrosa A., Botella-Serrano B., Bravo-Acuña J., Bretón-Peña A.I., Burgaleta-Sagaseta A.M., Calvo-Lorenzo M.T., Canadell-Villaret D., Carballal-Mariño M., Carmona-Cedrés N., Carrera-Polanco M., Carretero-Carretero L., Casado-Sánchez M.L., Casares-Alonso I., Castillo-Marcalain A., CaubetBusquet I., Cayuela-Guerrero C., Coto-Fuente M.M., Cruz-Navarro I., De Haro-López M.A., De La Serna-Higuera P.M., Del Castillos-Aguas G., Del Toro-Calero C., Diaz-Cirujano A.I., Díaz-Pedrouzo A., Díez-Zaera O., Duelo-Marcos M., Edo-Jimeno M.J., Elorz-Ibáñez A.C., Escanciano- García Y., Escribano-Romero M.J., Esparza-Olcina M.J., Espinazo-Ramos O., Espínola-Docio B., Esquivel-Ojeda J.N., Fabregat-Ferrer E., Fernández-Francés M., Fernández-León A., Fernández-López F.J., Fernández-Pastor F., Fernández-Rodríguez M., Fernández-Segura M.E., Ferrándiz-Cerdá B., Flores-Erro U., Galán-Calvo M.J., Galán-Rico J., Galardi-Andonegui M.S., Garach-Gómez., García-Arroyo I., García- Lara G.M., García-Mérida M.J., García-Merino A., García-Rebollar C.A., García- Santiago M., García-Onieva-Artázcoz M., García-Vera C., Garnelo-Suarez L., Garrido- Redondo M., Gatell-Carbo A., Gil-Alexandres I., Giribet-Folch M., Gómez-Casares R., Gómez-Sorrigueta P., González-Marcos M.I., González-Rodríguez M.P., Gracia-Alfonso M.A., Grau-García A.I., Gutiérrez-Abad C., Heras-Galindo J.A., Hernández- Ortiz M.Y., Hernando-Helguero P., Herrero-Rey S., Iribarren-Udobro I., Jaramillo- Hidalgo D., Jiménez-Alés R., Jiménez-Hereza J.M., Jové-Naval J., Juanes-De Toledo B., Ledesma-Albarrán J.M., Lobera-Navaz P., López-Alonso R., López-Vilar P., Lorente-García-Mauriño A.M., Manero-Oteiza A., Marco-Puche A., Marfil-Olink S., Márquez-Moreno M.D., Martín-Carballo G., Martín-Cuesta B., Martín-Ibáñez I., Martín-Peinador Y., Martín-Rial S., Martínez-Espligares L., Martínez-Moral N., Martínez-Rubio M.V., Martínez-Ruiz M.M., Menéndez-Bada T., Menéndez-González N., Mengual-Gil J., Merino-Villeneuve I., Mínguez-Verdejo R., Miranda- Berrioategortua I., Moneo-Hernández I., Monje C., Montañés-Sánchez A.M., Montes- Peña M., Montoro-Romero M.S., Monzón-Bueno A.I., Morell-Bernabé J.J., Muñoz- García N.P., Muñoz-Hiraldo M.E., Mustieles-Moreno C., Navarro-Cabañas G., Navas- Heredia C.M., Nóvoa-García E., Oliva-Alfonso A., Olmos-García J.M., Ordoñez- Alonso M.A., Padilla-Esteban M.L., Padilla-Sánchez M.C., Palomares-Gimeno M.J., Palomino-Urda N., Panizo-Santos M.B., Parejo-Carranza R., Pavía-Lafuente M., Pavo- García M.R., PeixSambola M.A., PeñarrojaPeirats S., Pérez-Candás J.I., Pérez-de Saracho-Taramona M., Pérez-Gavilán J., Puig-García C., Puyuelo-Del Val P., Quintanilla Sánchez MM, Ramos Zugasti M, Rey Del Castillo C, Ribera Sirvent C, Ripoll-Lozano A., Rivas-Abraldes N., Riveros-Huckstadt M.P., Robles-García J., Rodríguez-Delgado J., Rodríguez-Fernández M.M., Rodríguez-Fernández-Oliva C.R., Rodríguez-Pérez E.G., Rodríguez-Santana Y., Rodríguez-López-Márquez G.A., Rodríguez-Salinas-Pérez E., Rojo-Portolés P., Rubio-Remiro O., Ruiz-Chércoles E., Sáenz-de Urturi-Sánchez A., Sáez-de Lafuente-Arriazu A., Salcedo-Pacheco I., Sánchez-Andrés M.T., Sánchez-Calderón M., Sánchez-Cordero N., Sánchez-Echenique M., Sánchez-Fuentes V., Sánchez-González B., Sánchez-Jiménez M.C., Sánchez-Pina C., Sánchez-Precioso S., Sánchez-Prieto E.I., Sancho-Madrid B., Satrústegui-Gamboa F., Serna-Saugar M.C., Servera-Ginard C.I., Suárez-Vicent E., Surribas-Murillo C., Torres-Álvarez-de Arcaya M.L., Valerio-Hernández E., Vaquerizo-Pollino M.J., Vega- Pérez M.S., Velasco-Guijarro O., Viar-Urieta M., Villafruela-Álvarez C., Villaizán- Pérez C., Viver-Gómez S." "etiqueta" => "Appendix A" "titulo" => "Paediatricians member of the PAPenRed that participated in the study" "identificador" => "sec0070" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1434 "Ancho" => 2175 "Tamanyo" => 153111 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flowchart of study participants. BF, breastfeeding." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 856 "Ancho" => 2925 "Tamanyo" => 134162 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curves of BSES-SF scores in the exclusive breastfeeding group at different infant ages. AUC, area under the curve (with 95% confidence interval); BSES-SF, breastfeeding self-efficacy scale-short form." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 860 "Ancho" => 2925 "Tamanyo" => 136638 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "ROC curves of BSES-SF scores in the mixed feeding group at different infant ages. AUC, area under the curve (with 95% confidence interval); BSES-SF, breastfeeding self-efficacy scale-short form." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "EBF, exclusive breastfeeding; supplemental feeding: MF, mixed feeding." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">MF \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">EBF \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n = 457 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n = 1388 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]Maternal characteristics</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]Age, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><20 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (1.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20−24 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 (4.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25−29 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (13.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">176 (12.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30−34 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">159 (34.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">536 (38.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35−39 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">157 (34.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">473 (34.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40−44 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (10.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (8.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 44 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (0.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]Educational attainment, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No education \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (0.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elementary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48(10.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104 (7.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secondary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">199 (43.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">536 (38.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">University \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">208 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">743 (53.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immigrant, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">119 (26.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">299 (21.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Employed, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">381 (83.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1158 (83.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Single, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (1.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]Pregnancy and delivery</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First pregnancy, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">172 (37.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">722 (52.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weeks of gestational age (median) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delivery in public hospital, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">385 (84.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1188 (85.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of delivery, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaginal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">346 (75.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1169 (84.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elective caesarean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 (10.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83 (6.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Emergency caesarean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (13.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">136 (9.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">[0.1−3]Infant characteristics</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1-minute Apgar (Median) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5- minute Apgar (Median) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female sex, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">224 (49.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">692 (49.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Birth weight in g \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3279 ± 417 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3324 ± 389 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (standard deviation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Days of age at initial visit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.7 ± 3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.5 ± 3.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean (standard deviation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2808658.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main characteristics of the sample by feeding modality." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BSES-SF, breastfeeding self-efficacy scale-short form; EBF, exclusive breastfeeding; Sen, sensitivity; Spe, specificity." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Cut-off \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EBF first month</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EBF second month</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sen \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spe \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sen \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spe \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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Original Article

Predictive capacity for breastfeeding and determination of the best cut-off point for the breastfeeding self-efficacy scale-short form

Capacidad predictiva para la lactancia y determinación del mejor punto de corte de la escala BSES-SF

Josep Vicent Balaguer-Martíneza,

Corresponding author

jbalaguer70@gmail.com

Corresponding author.

, Rubén García-Pérezb, Ana Gallego-Iborrac, Elena Sánchez-Almeidad, María Dolores Sánchez-Díaze, Edurne Ciriza-Bareaf, Red de Investigación en Pediatría de Atención Primaria (PAPenRed)

a CAP Sant Ildefons, Cornellà de Llobregat, Barcelona, Spain

b Txurdinagako Osasun Zentroa, Bilbao, Spain

c CS Trinidad, Málaga, Spain

d CS la Guancha-San Juan de la Rambla, Tenerife, Spain

e CS Parquesol, Valladolid, Spain

f CS Ansoain, Navarra, Spain

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The vaccine recommended in Spain by the CAV-AEP continues to be the PCV13&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">&#40;6&#41; Rotavirus vaccine &#40;RV&#41;&#46;-</span> Two or three doses of rotavirus vaccine&#58; at 2 and 3&#8211;4 months with the monovalent vaccine or at 2&#44; 3 and 4 months or 2&#44; 3-4 and 5&#8211;6 months with the pentavalent vaccine&#46; It is very important to start vaccination between 6 and 12 weeks of life in order to minimise risks&#44; and to complete it before 24 weeks for the monovalent vaccine or 32 weeks for the pentavalent vaccine&#46; Doses must be given at least 4 weeks apart&#46; Both vaccines may be given at the same time as any other vaccine&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">&#40;7&#41; Meningococcal B vaccine &#40;MenB&#41;&#46;- 4CMenB&#46;</span> Three doses&#58; start at age 2 months&#44; with a primary series of 2 doses 2 months apart and a booster starting at age 12 months and at least 6 months after the last dose in the primary series&#46; 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Human papillomavirus vaccine &#40;HPV&#41;&#46;-</span> Universal routine vaccination of all girls and boys&#44; at age 12 years with a 2-dose series&#46; The vaccines currently available are the HPV2 and HPV9&#46; They are both authorised for use in male individuals&#46; Vaccination with 2 doses of 2-valent or 9-valent vaccine at 0 and 6 months in children aged 9 to 14 years or a 3-dose series at 0&#44; 1-2 and 6 months in those aged &#8805;15 years&#46; The HPV vaccine may be administered at the same time as the MenC&#44; MenACWY&#44; hepatitis A and B and Tdap vaccines&#46; There are no data on the coadministration with the varicella vaccine&#44; although it should not cause any problems&#46;</p> <p id="spar0130" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">&#40;13&#41; SARS-CoV-2 vaccine&#46;-</span> Currently&#44; two vaccines are authorized in our country from the age of 12&#44; Comirnaty-30 microgr &#40;Pfizer&#41; and Spikevax-100 microgr &#40;Moderna&#41; 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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of breastfeeding &#40;BF&#41; in Spain has been increasing progressively in recent years&#46; The frequency of exclusive BF at 6 months of life has increased from 28&#46;5&#37; in 2011 to 39&#37; in 2017&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; we are still far from fulfilling the recommendation of the World Health Organization to maintain exclusive BF through age 6 months&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Multiple factors have been found to be associated with early discontinuation of BF&#44; including maternal age&#44; educational attainment or psychosocial status&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although these are not modifiable factors&#44; it is important to be aware of them in order to identify mothers at risk of discontinuing BF&#46; On the other hand&#44; there are modifiable factors on which it is possible to act to attempt to minimise this risk&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the modifiable risk factors for early BF discontinuation is the lack of support to mothers from health care professionals&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a> Providers in maternity wards play an important role in the successful establishment of BF&#44; and primary care providers in its successful maintenance over time&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> To achieve this goal&#44; it is essential that validated tools be available to objectively assess BF&#46; At present&#44; there are several scales that assess BF technique through the direct observation of a feed by a health care professional&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> The use of scales facilitates the standardization of assessment criteria and objective identification of aspects in need of improvement&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> We recommend observation of at least one full feed in the maternity ward and another one when the infant enters the primary care system&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is another important factor at play in the maintenance and exclusivity of BF&#58; self-efficacy&#46; The level of this trait in mothers is also a good predictor of early BF discontinuation&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> Self-efficacy refers to how competent and confident women feel about their ability to breastfeed&#46; The main aspects that contribute to this factor are previous personal experience BF&#44; past vicarious experience of BF in others&#44; the physical and psychological condition of the mother and verbal persuasion by others&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Previous studies have demonstrated that self-efficacy is a modifiable factor and that interventions that improve self-efficacy achieve an increase in BF duration and exclusive BF&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;13&#44;14</span></a> Thus&#44; instruments for assessment of self-efficacy can be useful and help identify mothers at risk of premature discontinuation of BF&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The scale used most frequently for this purpose is the Breastfeeding Self-Efficacy scale-short form &#40;BSES-SF&#41;&#44; developed in Canada in 2003&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The BSES-SF has been translated to different languages and adapted to different cultures and exhibited an adequate validity and reliability&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;21</span></a> There is also a validated version of the scale in Spanish&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In addition&#44; the BSES-SF has been found to be a good predictor of early BF discontinuation&#44; with lower scores in the scale associated with an increased risk of discontinuation&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19&#44;23&#44;24</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This motivated us to assess the potential usefulness of the BSES-SF as a predictor of BF practices at the primary care level&#46; The BSES-SF is a simple and feasible scale that could be very helpful to health care professionals&#46; In addition&#44; we sought to establish the optimal cut-off point to identify mothers at risk of BF discontinuation&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">The data used in this study were obtained in the context of the study Lactancia y Desarrollo Infantil &#40;Breastfeeding and Infant Development&#44; LAyDI&#41;&#44; so the results presented here are from a secondary analysis of the data obtained in said project&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design and setting</span><p id="par0040" class="elsevierStylePara elsevierViewall">The LAyDI is a single cohort study with the primary objective of establishing whether there is an association between the feeding modality in infancy and future developmental outcomes&#46; This study was conducted through the Primary Care Paediatrics Research Network &#40;Spanish abbreviation&#44; PAPenRed&#41; of the Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a de Atenci&#243;n Primaria&#46; PAPenRed is composed of 320 paediatricians of the Spanish public health system with a distribution that matches the population distribution by autonomous community&#44; leading us to assume that the results of the study are representative of the entire Spanish territory&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study period</span><p id="par0045" class="elsevierStylePara elsevierViewall">Data collection started on April 1&#44; 2017 and ended on March 31&#44; 2020&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sample selection and data collection</span><p id="par0050" class="elsevierStylePara elsevierViewall">Throughout the period under study&#44; collaborating paediatricians each recruited up to 12 newborn infants&#46; Since we intended to analyse morbidity data&#44; in order to eliminate seasonal bias we decided that&#44; for a full year&#44; paediatricians would recruit the first infant born each month that met all the eligibility criteria&#46; We followed up the resulting cohort through age 2 years&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Data were collected in the first primary care visit &#40;within 15 days post birth&#41; and at 1&#44; 2&#44; 4&#44; 6&#44; 12&#44; 18 and 24 months post birth&#46; In our study&#44; we used the data collected through age 6 months&#46; The BSES-SF was completed by mothers in the initial appointment&#46; During this appointment&#44; the paediatricians also collected information regarding the pregnancy and delivery in addition to information on the neonate and the parents&#46; In subsequent visits&#44; paediatricians collected information on the feeding modality of the infant&#46; In each visit&#44; data were collected in a form developed for the purpose&#46; Once data collection was completed&#44; each paediatrician submitted a report&#46; The sources of information used to fill out these forms were the mothers themselves&#44; labour and delivery discharge summaries&#44; official child health notebooks&#44; patient health records and emergency department reports&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; infant born at term &#40;&#62;37 weeks gestational age&#41; brought for the initial paediatric primary care visit before 15 days post birth and written informed consent signed by the mother&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The exclusion criteria were low birth weight &#40;less than 2400&#8239;g in boys and 2100&#8239;g in girls&#41;&#44; multiple birth&#44; length of stay in maternity ward or neonatal unit greater than 5 days&#44; presence of malformations or severe disease&#44; history of moderate to severe disease in the mother during pregnancy or the postpartum period&#44; language barrier&#44; refusal of family to participate and families whose usual geographical mobility patterns precluded follow-up&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sample</span><p id="par0070" class="elsevierStylePara elsevierViewall">In 2015&#44; a total of 426 303 children were born in Spain&#46; Given a 2&#46;5&#37; margin of error for a 95&#37; level of confidence for the entire paediatric population residing in Spain&#44; we estimated that we needed a minimum sample size of 1500 to represent the entire paediatric population of Spain&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study variables</span><p id="par0075" class="elsevierStylePara elsevierViewall">The LAyDI study collected data on a large number of variables&#46; The variables that we used for our study were the following&#58;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Primary outcomes&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Exclusive BF&#58; defined as the infant being exclusively breastfed in the past 7 days&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Mixed feeding&#58; defined as the infant having been breastfed in the past seven days&#44; but also fed any amount of artificial formula&#44; other water-based fluids or any other form of nutrition other than BF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Score in the BSES-SF&#58; unidimensional scale consisting of 14 items that present statements about BF to be rated by the mothers on a Likert scale ranging from &#8220;not at all confident&#8221; &#40;1 point&#41; to &#8220;always confident&#8221; &#40;5 points&#41;&#46; Thus&#44; the total score can range from a minimum of 14 points to a maximum of 70&#46;</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">Other variables analysed in the study&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">Maternal characteristics&#58; age&#44; educational attainment&#44; immigration status&#44; employment status&#44; marital status&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Pregnancy and delivery&#58; primiparity&#44; weeks of gestation&#44; hospital where infant was born&#44; type of delivery&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Infant characteristics&#58; Apgar score&#44; sex&#44; birth weight&#44; age at first visit&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical considerations</span><p id="par0120" class="elsevierStylePara elsevierViewall">The PAPenRED project obtained overall approval from the Scientific Research Ethics Committee of Aragon &#40;File 19&#47;2013&#59; <span class="elsevierStyleSmallCaps">C</span>&#46;P&#46;-C&#46;I&#46; PI13&#47;00154&#41;&#46; The LAyDI study was approved by the Research Ethics Committee of the Principality of Asturias &#40;project no&#46; 213&#47;16&#41;&#46; It also received a positive review from the Central Research Commission of the Department of Health of Madrid&#46; All the collected data were anonymised and confidentiality safeguarded in adherence with Regulation &#40;EU&#41; 2016&#47;679&#46; Mothers received adequate information about the study&#44; and those who expressed an interest in participating were asked to sign an informed consent form&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">We performed a descriptive analysis of the cohort under study&#46; We calculated the total score in the BSES-SF and the differences in the scores obtained by mothers that offered exclusive BF versus those offering mixed feeding by means of the <span class="elsevierStyleItalic">t</span> test&#46; We considered <span class="elsevierStyleItalic">p-</span>values of 0&#46;05 and less statistically significant&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We used the BSES-SF scores obtained in the initial visit to generate receiver operating characteristic &#40;ROC&#41; curves for each age group &#40;1&#44; 2&#44; 4 and 6 months&#41; for both the exclusive BF and the mixed feeding groups&#46; For each curve&#44; we calculated the area under the curve &#40;AUC&#41; with the corresponding 95&#37; confidence interval &#40;CI&#41;&#46; We considered that the predictive power of a ROC curve was poor if the AUC was less than 0&#46;59&#44; fair if the AUC was between 0&#46;6 and 0&#46;74&#44; good if the AUC was between 0&#46;75 and 0&#46;89 and very good if the AUC was greater than 0&#46;9&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">If the AUC showed a good or very good predictive power&#44; we also calculated the sensitivity and specificity for those curves starting from scores of 30 points in the BSES-SF&#46; We established a minimum sensitivity threshold of 80&#37; for the calculation of the optimal cut-off point&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We performed the statistical analysis of the data with the software Statistical Package for the Social Sciences &#40;SPSS&#41; version 22&#46;0&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0145" class="elsevierStylePara elsevierViewall">A total of 210 paediatricians of the network participated in the LAyDI study&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> presents a flowchart of the sample under study&#46; We found the following rates of BF in the initial primary care visit&#58; exclusive BF&#44; 67&#46;2&#37; &#40;65&#46;1&#37;&#8211;69&#46;2&#37;&#41;&#44; mixed feeding&#44; 22&#46;1&#37; &#40;20&#46;4&#37;&#8211;24&#46;0&#37;&#41; and formula feeding 10&#46;7&#37; &#40;9&#46;4&#37;&#8211;12&#46;1&#37;&#41;&#46; The mean age of the infants in the initial visit was 10&#46;8 days &#40;standard deviation &#91;SD&#93;&#44; 4&#46;0&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the main characteristics of the participants at the beginning of the study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">The mean BSES-SF score in the total sample was 59&#46;76 points &#40;SD&#44; 9&#46;95&#41;&#46; The mean score in each of the groups was 62&#46;54 points &#40;SD&#44; 7&#46;91&#41; in the exclusive BF group compared to 51&#46;79 points &#40;SD&#44; 10&#46;88&#41; in the mixed feeding group&#46; This corresponds to a difference between the 2 groups of 10&#46;42 points &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;001&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the ROC curves obtained from the BSES-SF scores of mothers that exclusively breastfed their infants&#46; We ought to note that only the curves corresponding to the visits at 1 and 2 months had an AUC above the threshold established to define good predictive power &#40;0&#46;75&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> presents the ROC curves of mixed feeding group&#46; In this instance&#44; there were no AUCs greater than 0&#46;75 in any infant age group&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Since the only curves with AUCs above the threshold for good predictive power were those in the exclusive BF group at 1 and 2 months&#44; these were the age groups for which we calculated the sensitivity and specificity of BSES-SF scores ranging from 30 to 70 points&#46; The results are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; As can be seen in the table&#44; a sensitivity of 80&#37; was achieved with a score of 59 points at 1 month and 58 points at 2 months&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">The BSES-SF score found in our study &#40;59&#46;76 points&#41; was above the scores reported in other studies conducted in Spain&#46; In the validation study conducted by Oliver-Roig et al&#46;&#44; the mean score in the BSES-SF was 51&#46;94 points&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> while Marco-Alegr&#237;a et al&#46; reported a mean of 50&#46;03 points&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> In these studies&#44; the BSES-SF was administered in the maternity ward before day 5 post birth&#46; This may explain the observed differences&#44; as in the LAyDI study&#44; mothers completed the BSES-SF on day 10 post birth&#44; when they had been breastfeeding longer and presumably felt more competent&#46; Ideally&#44; the initial newborn evaluation in primary care centres should take place 48&#8211;72&#8239;h after discharge&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> The results of our study suggest that the time elapsed between both care settings &#40;maternity ward and primary care centre&#41; is longer than recommended&#44; which poses a risk to infant health and may contribute to early BF discontinuation&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Studies conducted in other countries have produced heterogeneous results&#44; with the lowest scores found in Asian countries &#40;where the prevalence of BF is substantially lower&#41;&#58; 47&#46;3 points China<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and 42&#46;39 points in Japan&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In other European countries&#44; scores are similar to those in our study&#58; 54&#46;8 points in Italy&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> 57&#46;4 in Sweden<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and 63&#46;6 in Portugal&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Therefore&#44; the scores obtained in the scale seem to be associated with the prevalence of BF in the region where self-efficacy is being assessed&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The BSES-SF performed adequately for prediction of BF maintenance&#46; Some studies have found that the scale offers a good predictive power through 3 months post birth&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18&#44;23&#44;27</span></a> compared to 1 month in others&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;22</span></a> In our study&#44; the BSES-SF exhibited a good predictive power through 2 months post birth in mothers that breastfed exclusively&#46; We did not find any studies that analysed the predictive power of the scale differentiating between mothers that practiced exclusive BF and mothers that practiced mixed feeding&#46; Given the substantial differences we observed in the BSES-SF scores between these 2 groups of mothers&#44; we thought it would be prudent to make a separate analysis for each&#46; Based on the results&#44; the scale does not seem to be a good predictor in the case of mixed feeding&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">As for the optimal cut-off point in the BSES-SF&#44; a similar study estimated a cut-off score of 50 points&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> However&#44; this study was conducted in the Asian population&#44; in which BF trends&#44; as we mentioned above&#44; are very different compared to Western countries&#46; Considering that for the purpose of prediction the cut-off point should be selected with the aim of detecting the highest possible number of mothers at risk of BF discontinuation&#44; we decided to use the sensitivity as the parameter used to select the optimal cut-off value&#46; The ultimate purpose of identifying mothers at risk of discontinuing BF is to offer increased BF support&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We arbitrarily selected a minimum sensitivity of 80&#37; to define adequate predictive power&#44; although any other of the values presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> could be applied&#46; Thus&#44; we propose using a cut-off score of 58 points&#44; as it offers a sensitivity greater than 80&#37; in the 2 age groups in which we calculated the threshold&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Most studies on scales used for assessment of BF have been made in the hospital setting and in the first days post birth&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;18&#8211;22&#44;27</span></a> We only found one study conducted in the primary care setting that used the BSES-SF to assess factors that affect BF&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Our analysis revealed that the application of scales in the primary care setting to predict BF outcomes can be useful&#46; The BSES-SF is completed in a short time and can be administered in the first visit of newborn infants that are exclusively breastfed&#46; However&#44; the best approach would be to implement follow-up plans developed and implemented by hospital maternity departments in collaboration with primary care services&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Breastfeeding assessment data collected in hospital should reach the primary care system&#44; ensuring continuity of care&#46; The best way to convey this information would be through standardised instruments<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> like the BSES-SF or scales used to assess observed feeds&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">One of the limitations of this study was the loss to follow-up of some patients&#44; a common limitation of longitudinal studies that also affected the LAyDI project&#46; Although 17&#46;4&#37; of the initial sample did not complete the follow-up&#44; the number of participants that continued in the study at 6 months post birth was greater than the estimated minimum necessary sample size&#46; Thus&#44; although there were losses to follow-up&#44; the results are still valid&#46; On the other hand&#44; since we analysed secondary data&#44; we did not perform a sample size calculation specifically for our study&#46; As a result&#44; there were considerable differences between the participants in the 2 feeding modality groups that we analysed separately &#40;exclusive BF and mixed feeding&#41;&#46; Nevertheless&#44; due to its substantial size&#44; the sample yielded BSES-SF scores representative of the population despite the disparities between the feeding modality groups&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Due to all of the above&#44; we conclude that the BSES-SF is a useful instrument at the primary care level to identify mothers at risk of discontinuing BF before 2 months post birth&#46; Mothers with scores of 58 points or lower should receive additional BF support&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0205" class="elsevierStylePara elsevierViewall">The LAyDI study was awarded one of the research grants of the <span class="elsevierStyleGrantSponsor" id="gs0005">Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a de Atenci&#243;n Primaria-Fundaci&#243;n Pediatr&#237;a y Salud</span> &#40;AEPap-FPS&#41; in 2017&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-11-16"
    "fechaAceptado" => "2020-12-23"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1469229"
          "palabras" => array:5 [
            0 => "Pediatrics"
            1 => "Primary health care"
            2 => "Breast feeding"
            3 => "Self efficacy"
            4 => "Surveys and questionnaires"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1469230"
          "palabras" => array:5 [
            0 => "Pediatr&#237;a"
            1 => "Atenci&#243;n primaria"
            2 => "Lactancia materna"
            3 => "Autoeficacia"
            4 => "Encuestas y cuestionarios"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The most widely used tool for assessing breastfeeding self-efficacy is the Breastfeeding Self-Efficacy Scale-Short Form &#40;BSES-SF&#41;&#46; This study assesses the relationship between the BSES-SF score and the risk of breastfeeding &#40;BF&#41; cessation and determines the cut-off point in the scale score that optimizes detection of this risk in primary health care pediatric consultations&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Secondary data analysis of the LAyDI study&#46; Cohort study carried out through a research network of primary care pediatricians &#40;PAPenRed&#41;&#46; A newborn was recruited every month for one year by 210 pediatricians&#46; The cohort was followed for 24 months&#46; Mothers responded to the BSES-SF at the first visit&#46; General pregnancy and delivery data were collected and assessed to determine whether breastfeeding was exclusive or supplemented during the first 6 months&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">N&#8239;&#61;&#8239;1845&#46; The Area Under the ROC Curve for the exclusive BF was 0&#46;790 &#40;0&#46;765-0&#46;815&#41; the first month and 0&#46;760 &#40;0&#46;734-0&#46;786&#41; the second month&#46; For 4 and 6 months&#44; as well as for any age in mothers who give supplemented BF&#44; the Area Under the Curve was less than 0&#46;75 and its predictive capacity was not considered to be good&#46; For a sensitivity of 80&#37; in detecting mothers at risk of BF cessation with the BSES-SF&#44; the cut-off score was 58&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Mothers with a BSES-SF score below 58 points in primary health care&#44; are at risk of early withdrawal of exclusive BF within two months&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El instrumento utilizado habitualmente para valorar la autoeficacia de la lactancia materna es la Breastfeeding Self-Efficacy Scale-Short Form &#40;BSES-SF&#41;&#46; Este estudio valora la relaci&#243;n entre la puntuaci&#243;n de la BSES-SF y el riesgo de abandono de la lactancia&#46; Tambi&#233;n se determina el punto de corte en la puntuaci&#243;n de la escala que optimiza la detecci&#243;n de este riesgo desde Atenci&#243;n Primaria&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis secundario de datos del estudio LAyDI&#46; Estudio de cohorte &#250;nica realizado a trav&#233;s de la red de investigaci&#243;n de pediatras de Atenci&#243;n Primaria &#40;PAPenRed&#41;&#46; Cada pediatra reclut&#243; un reci&#233;n nacido cada mes durante un a&#241;o&#46; Se sigui&#243; la cohorte 24 meses&#46; Las madres respondieron la BSES-SF en la primera visita&#46; Se recogieron datos generales de embarazo y parto y se valor&#243; la lactancia materna &#40;suplementada o exclusiva&#41; hasta los 6 meses&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">n&#8239;&#61;&#8239;1845&#46;&#8239;El &#193;rea Bajo la Curva ROC para la LM exclusiva fue al primer mes de 0&#44;79 &#40;0&#44;77&#8211;0&#44;82&#41; y al segundo mes de 0&#44;760 &#40;0&#44;734-0&#44;786&#41;&#46; Para los 4 y 6 meses&#44; as&#237; como para cualquier edad en madres que dan LM suplementada&#44; el &#193;rea Bajo la curva fue menor de 0&#44;75 y su capacidad predictiva no se consider&#243; adecuada&#46; Para una sensibilidad del 80&#37; en la detecci&#243;n de madres en riesgo de abandono de la lactancia la puntuaci&#243;n de corte fue 58&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Las madres que en Atenci&#243;n Primaria presenten una puntuaci&#243;n en la BSES-SF por debajo de 58 puntos tienen riesgo de abandono de la lactancia materna exclusiva antes de los dos meses&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Balaguer-Mart&#237;nez JV&#44; Garc&#237;a-P&#233;rez R&#44; Gallego-Iborra A&#44; S&#225;nchez-Almeida E&#44; S&#225;nchez-D&#237;az MD&#44; Ciriza-Barea E&#46; Capacidad predictiva para la lactancia y determinaci&#243;n del mejor punto de corte de la escala BSES-SF&#46; An Pediatr&#46; 2022&#59;96&#58;51&#8211;58&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#8902;&#8902;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Previous presentation&#58; the results of this study were presented at the 17th Congress of the AEPap&#44; February 13&#8211;15&#44; 2020&#44; Madrid&#44; Spain&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
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          0 => array:4 [
            "apendice" => "<p id="par0215" class="elsevierStylePara elsevierViewall">Abad-Balaguer B&#46;&#44; AcitoresSuz E&#46;&#44; Acosta-Navas B&#46;&#44; Aguilera-L&#243;pez L&#46;&#44; Albaladejo- Beltr&#225;n S&#46;&#44; Alba&#241;il-Ballesteros M&#46;R&#46;&#44; Alcaraz-Qui&#241;onero M&#46;&#44; &#193;lvarez-Bueno E&#46;&#44; Angulo-Moreno M&#46;E&#46;&#44; Anllo-Lago J&#46;&#44; Aparicio-Rodrigo M&#46;&#44; Arana-Ca&#241;edo-Arg&#252;elles C&#46;&#44; Arranz-Sanjuan R&#46;&#44; Arroyo-&#218;beda R&#46;&#44; Asensi-Monzo M&#46;T&#46;&#44; Astiz-Blanco M&#46;I&#46;&#44; Azor-Mart&#237;nez E&#46;&#44; Baliela-Garc&#237;a B&#46;C&#46;&#44; Barea-Garc&#237;a J&#46;J&#46;&#44; Barrios-Gonz&#225;lez E&#46;M&#46;&#44; Batalla-Fad&#243; L&#46;&#44; Bejarano-L&#243;pez M&#46;A&#46;&#44; Belda-Garc&#237;a M&#46;T&#46;&#44; Ben&#237;tez-Rubio M&#46;R&#46;&#44; Bercedo-Sanz A&#46;&#44; BernadUsoz J&#46;V&#46;&#44; Biosca-P&#224;mies M&#46;&#44; Blesa-Baviera L&#46;C&#46;&#44; Bomb&#237;n-Granado J&#46;M&#46;&#44; Bonet-Garrosa A&#46;&#44; Botella-Serrano B&#46;&#44; Bravo-Acu&#241;a J&#46;&#44; Bret&#243;n-Pe&#241;a A&#46;I&#46;&#44; Burgaleta-Sagaseta A&#46;M&#46;&#44; Calvo-Lorenzo M&#46;T&#46;&#44; Canadell-Villaret D&#46;&#44; Carballal-Mari&#241;o M&#46;&#44; Carmona-Cedr&#233;s N&#46;&#44; Carrera-Polanco M&#46;&#44; Carretero-Carretero L&#46;&#44; Casado-S&#225;nchez M&#46;L&#46;&#44; Casares-Alonso I&#46;&#44; Castillo-Marcalain A&#46;&#44; CaubetBusquet I&#46;&#44; Cayuela-Guerrero C&#46;&#44; Coto-Fuente M&#46;M&#46;&#44; Cruz-Navarro I&#46;&#44; De Haro-L&#243;pez M&#46;A&#46;&#44; De La Serna-Higuera P&#46;M&#46;&#44; Del Castillos-Aguas G&#46;&#44; Del Toro-Calero C&#46;&#44; Diaz-Cirujano A&#46;I&#46;&#44; D&#237;az-Pedrouzo A&#46;&#44; D&#237;ez-Zaera O&#46;&#44; Duelo-Marcos M&#46;&#44; Edo-Jimeno M&#46;J&#46;&#44; Elorz-Ib&#225;&#241;ez A&#46;C&#46;&#44; Escanciano- Garc&#237;a Y&#46;&#44; Escribano-Romero M&#46;J&#46;&#44; Esparza-Olcina M&#46;J&#46;&#44; Espinazo-Ramos O&#46;&#44; Esp&#237;nola-Docio B&#46;&#44; Esquivel-Ojeda J&#46;N&#46;&#44; Fabregat-Ferrer E&#46;&#44; Fern&#225;ndez-Franc&#233;s M&#46;&#44; Fern&#225;ndez-Le&#243;n A&#46;&#44; Fern&#225;ndez-L&#243;pez F&#46;J&#46;&#44; Fern&#225;ndez-Pastor F&#46;&#44; Fern&#225;ndez-Rodr&#237;guez M&#46;&#44; Fern&#225;ndez-Segura M&#46;E&#46;&#44; Ferr&#225;ndiz-Cerd&#225; B&#46;&#44; Flores-Erro U&#46;&#44; Gal&#225;n-Calvo M&#46;J&#46;&#44; Gal&#225;n-Rico J&#46;&#44; Galardi-Andonegui M&#46;S&#46;&#44; Garach-G&#243;mez&#46;&#44; Garc&#237;a-Arroyo I&#46;&#44; Garc&#237;a- Lara G&#46;M&#46;&#44; Garc&#237;a-M&#233;rida M&#46;J&#46;&#44; Garc&#237;a-Merino A&#46;&#44; Garc&#237;a-Rebollar C&#46;A&#46;&#44; Garc&#237;a- Santiago M&#46;&#44; Garc&#237;a-Onieva-Art&#225;zcoz M&#46;&#44; Garc&#237;a-Vera C&#46;&#44; Garnelo-Suarez L&#46;&#44; Garrido- Redondo M&#46;&#44; Gatell-Carbo A&#46;&#44; Gil-Alexandres I&#46;&#44; Giribet-Folch M&#46;&#44; G&#243;mez-Casares R&#46;&#44; G&#243;mez-Sorrigueta P&#46;&#44; Gonz&#225;lez-Marcos M&#46;I&#46;&#44; Gonz&#225;lez-Rodr&#237;guez M&#46;P&#46;&#44; Gracia-Alfonso M&#46;A&#46;&#44; Grau-Garc&#237;a A&#46;I&#46;&#44; Guti&#233;rrez-Abad C&#46;&#44; Heras-Galindo J&#46;A&#46;&#44; Hern&#225;ndez- Ortiz M&#46;Y&#46;&#44; Hernando-Helguero P&#46;&#44; Herrero-Rey S&#46;&#44; Iribarren-Udobro I&#46;&#44; Jaramillo- Hidalgo D&#46;&#44; Jim&#233;nez-Al&#233;s R&#46;&#44; Jim&#233;nez-Hereza J&#46;M&#46;&#44; Jov&#233;-Naval J&#46;&#44; Juanes-De Toledo B&#46;&#44; Ledesma-Albarr&#225;n J&#46;M&#46;&#44; Lobera-Navaz P&#46;&#44; L&#243;pez-Alonso R&#46;&#44; L&#243;pez-Vilar P&#46;&#44; Lorente-Garc&#237;a-Mauri&#241;o A&#46;M&#46;&#44; Manero-Oteiza A&#46;&#44; Marco-Puche A&#46;&#44; Marfil-Olink S&#46;&#44; M&#225;rquez-Moreno M&#46;D&#46;&#44; Mart&#237;n-Carballo G&#46;&#44; Mart&#237;n-Cuesta B&#46;&#44; Mart&#237;n-Ib&#225;&#241;ez I&#46;&#44; Mart&#237;n-Peinador Y&#46;&#44; Mart&#237;n-Rial S&#46;&#44; Mart&#237;nez-Espligares L&#46;&#44; Mart&#237;nez-Moral N&#46;&#44; Mart&#237;nez-Rubio M&#46;V&#46;&#44; Mart&#237;nez-Ruiz M&#46;M&#46;&#44; Men&#233;ndez-Bada T&#46;&#44; Men&#233;ndez-Gonz&#225;lez N&#46;&#44; Mengual-Gil J&#46;&#44; Merino-Villeneuve I&#46;&#44; M&#237;nguez-Verdejo R&#46;&#44; Miranda- Berrioategortua I&#46;&#44; Moneo-Hern&#225;ndez I&#46;&#44; Monje C&#46;&#44; Monta&#241;&#233;s-S&#225;nchez A&#46;M&#46;&#44; Montes- Pe&#241;a M&#46;&#44; Montoro-Romero M&#46;S&#46;&#44; Monz&#243;n-Bueno A&#46;I&#46;&#44; Morell-Bernab&#233; J&#46;J&#46;&#44; Mu&#241;oz- Garc&#237;a N&#46;P&#46;&#44; Mu&#241;oz-Hiraldo M&#46;E&#46;&#44; Mustieles-Moreno C&#46;&#44; Navarro-Caba&#241;as G&#46;&#44; Navas- Heredia C&#46;M&#46;&#44; N&#243;voa-Garc&#237;a E&#46;&#44; Oliva-Alfonso A&#46;&#44; Olmos-Garc&#237;a J&#46;M&#46;&#44; Ordo&#241;ez- Alonso M&#46;A&#46;&#44; Padilla-Esteban M&#46;L&#46;&#44; Padilla-S&#225;nchez M&#46;C&#46;&#44; Palomares-Gimeno M&#46;J&#46;&#44; Palomino-Urda N&#46;&#44; Panizo-Santos M&#46;B&#46;&#44; Parejo-Carranza R&#46;&#44; Pav&#237;a-Lafuente M&#46;&#44; Pavo- Garc&#237;a M&#46;R&#46;&#44; PeixSambola M&#46;A&#46;&#44; Pe&#241;arrojaPeirats S&#46;&#44; P&#233;rez-Cand&#225;s J&#46;I&#46;&#44; P&#233;rez-de Saracho-Taramona M&#46;&#44; P&#233;rez-Gavil&#225;n J&#46;&#44; Puig-Garc&#237;a C&#46;&#44; Puyuelo-Del Val P&#46;&#44; Quintanilla S&#225;nchez MM&#44; Ramos Zugasti M&#44; Rey Del Castillo C&#44; Ribera Sirvent C&#44; Ripoll-Lozano A&#46;&#44; Rivas-Abraldes N&#46;&#44; Riveros-Huckstadt M&#46;P&#46;&#44; Robles-Garc&#237;a J&#46;&#44; Rodr&#237;guez-Delgado J&#46;&#44; Rodr&#237;guez-Fern&#225;ndez M&#46;M&#46;&#44; Rodr&#237;guez-Fern&#225;ndez-Oliva C&#46;R&#46;&#44; Rodr&#237;guez-P&#233;rez E&#46;G&#46;&#44; Rodr&#237;guez-Santana Y&#46;&#44; Rodr&#237;guez-L&#243;pez-M&#225;rquez G&#46;A&#46;&#44; Rodr&#237;guez-Salinas-P&#233;rez E&#46;&#44; Rojo-Portol&#233;s P&#46;&#44; Rubio-Remiro O&#46;&#44; Ruiz-Ch&#233;rcoles E&#46;&#44; S&#225;enz-de Urturi-S&#225;nchez A&#46;&#44; S&#225;ez-de Lafuente-Arriazu A&#46;&#44; Salcedo-Pacheco I&#46;&#44; S&#225;nchez-Andr&#233;s M&#46;T&#46;&#44; S&#225;nchez-Calder&#243;n M&#46;&#44; S&#225;nchez-Cordero N&#46;&#44; S&#225;nchez-Echenique M&#46;&#44; S&#225;nchez-Fuentes V&#46;&#44; S&#225;nchez-Gonz&#225;lez B&#46;&#44; S&#225;nchez-Jim&#233;nez M&#46;C&#46;&#44; S&#225;nchez-Pina C&#46;&#44; S&#225;nchez-Precioso S&#46;&#44; S&#225;nchez-Prieto E&#46;I&#46;&#44; Sancho-Madrid B&#46;&#44; Satr&#250;stegui-Gamboa F&#46;&#44; Serna-Saugar M&#46;C&#46;&#44; Servera-Ginard C&#46;I&#46;&#44; Su&#225;rez-Vicent E&#46;&#44; Surribas-Murillo C&#46;&#44; Torres-&#193;lvarez-de Arcaya M&#46;L&#46;&#44; Valerio-Hern&#225;ndez E&#46;&#44; Vaquerizo-Pollino M&#46;J&#46;&#44; Vega- P&#233;rez M&#46;S&#46;&#44; Velasco-Guijarro O&#46;&#44; Viar-Urieta M&#46;&#44; Villafruela-&#193;lvarez C&#46;&#44; Villaiz&#225;n- P&#233;rez C&#46;&#44; Viver-G&#243;mez S&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Paediatricians member of the PAPenRed that participated in the study"
            "identificador" => "sec0070"
          ]
        ]
      ]
    ]
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        "etiqueta" => "Figure 1"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart of study participants&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BF&#44; breastfeeding&#46;</p>"
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ROC curves of BSES-SF scores in the exclusive breastfeeding group at different infant ages&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AUC&#44; area under the curve &#40;with 95&#37; confidence interval&#41;&#59; BSES-SF&#44; breastfeeding self-efficacy scale-short form&#46;</p>"
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      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ROC curves of BSES-SF scores in the mixed feeding group at different infant ages&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">AUC&#44; area under the curve &#40;with 95&#37; confidence interval&#41;&#59; BSES-SF&#44; breastfeeding self-efficacy scale-short form&#46;</p>"
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        "identificador" => "tbl0005"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">EBF&#44; exclusive breastfeeding&#59; supplemental feeding&#58; MF&#44; mixed feeding&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&#8239;&#61;&#8239;1388&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1&#8722;3&#93;<span class="elsevierStyleBold">Maternal characteristics</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1&#8722;3&#93;<span class="elsevierStyleItalic">Age&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;20 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;1&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20&#8722;24 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;5&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>25&#8722;29 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;13&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">176 &#40;12&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30&#8722;34 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">159 &#40;34&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">536 &#40;38&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>35&#8722;39 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157 &#40;34&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">473 &#40;34&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40&#8722;44 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;10&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;8&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 44 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;1&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;0&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1&#8722;3&#93;<span class="elsevierStyleItalic">Educational attainment&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No education&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Elementary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#40;10&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">199 &#40;43&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">536 &#40;38&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">208 &#40;45&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">743 &#40;53&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Immigrant&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">119 &#40;26&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">299 &#40;21&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Employed&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">381 &#40;83&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1158 &#40;83&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Single&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;1&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1&#8722;3&#93;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#91;0&#46;1&#8722;3&#93;<span class="elsevierStyleBold">Pregnancy and delivery</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">First pregnancy&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">172 &#40;37&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">722 &#40;52&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Weeks of gestational age &#40;median&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Delivery in public hospital&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">385 &#40;84&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1188 &#40;85&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Type of delivery&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vaginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">346 &#40;75&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1169 &#40;84&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2020.12.018

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Year/Month	Html	Pdf	Total

2024 October	69	62	131
2024 September	70	60	130
2024 August	64	69	133
2024 July	45	38	83
2024 June	57	44	101
2024 May	53	43	96
2024 April	41	54	95
2024 March	29	40	69
2024 February	61	36	97
2024 January	46	34	80
2023 December	61	25	86
2023 November	43	47	90
2023 October	44	41	85
2023 September	39	39	78
2023 August	34	16	50
2023 July	42	31	73
2023 June	23	28	51
2023 May	48	32	80
2023 April	33	19	52
2023 March	65	31	96
2023 February	38	23	61
2023 January	34	48	82
2022 December	66	46	112
2022 November	51	55	106
2022 October	74	58	132
2022 September	50	41	91
2022 August	74	62	136
2022 July	67	48	115
2022 June	62	70	132
2022 May	83	32	115
2022 April	99	52	151
2022 March	97	62	159
2022 February	135	41	176
2022 January	169	78	247
2021 December	96	20	116

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