ABSTRACT Objective The aim of this study was to determine if and what kind of scientific evidence there is for the advice that breast-feeding can reduce the risk of sudden infant death syndrome (SIDS). The aim was to investigate research on the subject published in the last 15 years. Method A systematic review without meta-analysis with relevant original articles published in the last 15 years. Main results After searching for articles 26 relevant articles were used for this study and two were excluded because of poor quality. Mixed results were shown on breast feeding and the risk of SIDS. Breast-feeding seems to have some protective effect but can’t be separated from known risk factors of SIDS. Plain language summary Breast feeding can be regarded as a preventive measure against SIDS. However socioeconomic factors may play a bigger part than breast feeding alone in the protection against SIDS. Mothers should be given the advice to breast feed as a preventive measure of SIDS. The authors suggest that more research is needed. / ABSTRACT Syfte Syftet med denna studie är att undersöka om och i så fall vilket vetenskapligt stöd det finns för rådet om amning som preventiv åtgärd mot plötslig spädbarnsdöd (sudden infant death syndrome, SIDS). Studien syftar till att undersöka de senaste 15 årens forskning i ämnet. Metod En systematisk litteraturstudie utan meta-analys med relevanta originalartiklar publicerade de senaste 15 åren. Resultat Antalet relevanta artiklar var 26, två artiklar exkluderades på grund av låg kvalitet. Sex kategorier relaterade till amning kunde identifieras. De granskade studierna har visat varierande resultat gällande amningens inverkan på risken för SIDS. Amningen har visats ha skyddande effekter som inte kan särskiljas från kända riskfaktorer för SIDS. Slutsats Amning kan fungera som en preventiv åtgärd mot SIDS. Dock verkar socioekonomiska faktorer ha en större roll än amning enskilt för att ge ett skydd mot SIDS. Rådet om att amning skyddar mot SIDS är adekvat och denna litteraturöversikt kan ge ökad kunskap om olika aspekter av amningens effekter. Författarna menar att det finns ett behov av ökad kunskap inom detta område.

Breastfeeding initiation rates in the United States remain below the Healthy People 2010 goals. Research indicates patient interaction with health care providers may play an important role in womens ultimate feeding choice. This study sought to examine the impact of provider counseling regarding breastfeeding during the prenatal period on feeding outcome by evaluating: 1) if providers addressed womens concerns regarding breastfeeding; and 2) how providers responded to a womans feeding choice. We also sought to examine whether the type of counseling provided by providers regarding infant feeding is influenced by patient socio-demographics and stated feeding plans. This study is cross-sectional with convenience sampling of all English or Spanish speaking women on the postpartum floor at Yale-New Haven Hospital. A total of 130 women participated. Overall, 95.4% of women identified a concern they had about breastfeeding during the prenatal period, and one quarter of patients had their concerns about breastfeeding addressed. The majority of patients (74.6%) were asked about their feeding plans, and 50.5% were encouraged to breastfeed. Unlike the majority of studies that indicate young, African American, poorly educated, unmarried and low income women are less likely to receive counseling from providers to breastfeed, providers in our study area focused their efforts on this population. In multivariate analysis, neither having concerns addressed nor being encouraged to breastfeed were associated with increased likelihood of breastfeeding. Addressing patients concerns may be most relevant in the small subset of patients who make their feeding choice during pregnancy. Finally, women who were asked about their plans and had their concerns addressed (p=.010) or were encouraged to breastfeed (p=.040) were more likely to make their decision during pregnancy compared to before pregnancy than women whose providers did not discuss these issues. Likewise, mixed feeders were more likely to make their decision regarding infant feeding during rather than before pregnancy. This data suggests providers may be encouraging women to think more thoroughly about the possibility of breastfeeding, thus delaying their decision. In conclusion, many women are not being encouraged to breastfeed or having their concerns about breastfeeding addressed. All women would benefit from prenatal discussion of these topics; however, the effect may be most profound in women who make their decision regarding feeding during pregnancy.

Thesis--University of Oklahoma. / Bibliography: leaves 74-76.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Autoimmune hepatitis (AIH) was identified as an entity by the Swedish professor Jan Waldenström in the 1950s. It was then denoted lupoid hepatitis, characterized by liver inflammation and most often affecting young women. During the years the diagnosis has become more defined (as the non A non B hepatitis has been identified as Hepatitis C) and now can be safely separated from other diseases with liver inflammation. Studies of epidemiological data and long term prognosis have been scarce in the literature. Within a collaboration between the university hospitals in Sweden, we collected what we believe is the largest cohort in the world of patients with AIH. Data from the medical records of 473 individuals was, after AIH-score calculations where the diagnosis was confirmed, collected in a data base, in which most of the analysis was done. Data from the Swedish national registers of cancer, death cause, and birth register was searched for these patients as well as controls. The aim of the thesis was to explore epidemiological and clinical outcome of AIH.The onset of AIH may be at any age, but the incidence seems to increase after 50 years of age; 75% are females, the overall incidence (0.85/ 100,000 inhabitants and year) and prevalence (11/100,000 inhabitants) are figures that are within the range of another but smaller Scandinavian study. Approximately 30 % had cirrhosis already at diagnosis and 87% displayed at some time positive auto-antibodies indicating AIH (Smooth muscle ab and or antinuclear ab).  Indications of future risk for liver transplantation or death is an advanced AIH at diagnosis with liver cirrhosis, decompensated liver disease, elevated PK INR as well as age. Acute hepatitis-like onset seems to carry a lower risk for later liver transplantation or death. Current Swedish national therapy traditions with immune suppression seem to be well tolerated. Five and ten years overall life expectancy does not differ from controls. Thirty-five women gave birth to 63 children, for 3 after liver transplantation of the mother. Thirteen of the women had liver cirrhosis. Current pharmacological treatment seems to be safe both for the patient and the foetus. Thirty percent of the patients experienced flair after delivery. It has been supposed that there is an overrisk for hepatocellular cancer (HCC) associated with AIH. Our figures are the first in the world to be presented that confirms a twenty-three fold overrisk (95% Confidence Interval 7.5-54.3) for hepatobiliar cancer. We found as well an overrisk of non-Hodgkin lymphomas of 13.09 (95% CI 4.2-30.6).Conclusion:  Our epidemiological results confirm that AIH is a fairly uncommon disease, and that many already at time of diagnosis have an advanced disease with liver cirrhosis. There is a clear overrisk for HCC and lymphoma. For those women with AIH who become pregnant the prognosis for the child as well as for the mother is good, even for those women who already have compensated cirrhosis. There is a risk for relapse after delivery. The overall survival for AIH patients with current therapy is good.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Nutritional insults and conditions in fetal life and infancy may influence later growth and body composition as well as the development of chronic diseases in adult life. We studied the effects of maternal food and micronutrient supplementation and exclusive breast-feeding counseling on offspring growth 0-54 months and body composition at 54 months of age. We also validated and developed equations for a leg-to-leg bioimpedance analyzer in order to assess body composition of Bangladeshi children aged 4-10 years. In the MINIMat trial in Matlab, Bangladesh, pregnant women were randomized to Early (around 9 weeks) or a Usual invitation (around 20 weeks) to food supplementation and to one of three daily micronutrient supplementations with capsules of either 30 mg Fe and 400 µg folic acid, or 60 mg Fe and 400 µg folic acid, or multiple micronutrient supplements (MMS) (15 micronutrients including 30 mg Fe and 400 µg folic acid). They were also randomized to exclusive breastfeeding counseling (EBC) or to usual health messages (UHM). Growth of their children was measured from birth to 54 months, when body composition also was assessed. There were no differences in background characteristics across the different intervention groups. There was no differential effect by prenatal interventions on birth weight or length. Early invitation to food supplementation reduced stunting from early infancy up to 54 months for boys (average difference 6.5 percent units, 95% CI=1.7 to 11.3, p=0.01), but not for girls (average difference 2.4 percent units, 95% CI=-2.2 to 7.0, p=0.31). MMS resulted in more stunting than standard Fe60F (average difference 4.8 percent units, 95% CI=0.8 to 8.9, p=0.02). Breast-feeding counseling prolonged the duration of exclusive breastfeeding (difference 35.0 days, 95% CI 30.6-39.5, p<0.001). Neither the pregnancy interventions nor the breast-feeding counseling influenced body composition at 54 months. Early food supplementation in pregnancy reduced the occurrence of stunting in boys 0-54 months, while prenatal MMS increased the proportion of stunting. Early food and multiple micronutrient supplementation or exclusive breastfeeding intervention provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age. The effects on postnatal growth suggest programming effects in early fetal life.

Background: Differences in health and living conditions between urban and rural settings can be seen as an important example of gaps between population groups. Birth weight and child growth are important predictors for the future health of a person and at aggregate level, for the public health of a population.The general aim of this thesis is to describe and discuss birth weight, physical growth and breastfeeding of children, as well as associated factors, from birth to 24 months of age in urban and rural areas of Vietnam, thus contributing to the evidence base for health strategy and policy. Methods: Two Health and Demographic Surveillance Sites in Hanoi were used; urban Dodalab and FilaBavi in the rural part. To study rural birth weight 1999 to 2010 information was obtained for 10,114 newborn in FilaBavi. To study urban rural growth disparities 2008-2010, 1,466 children were followed for two years after birth with measurements of weight and length. A study of breastfeeding included 2,572 mothers followed for one year after delivery. Background information about households and mothers was taken from routine surveys in the two sites. Results: The mean birth weight in FilaBavi remained stable at about 3,100 grams, over the 12 years studied despite rapid economic and technological development. At the individual level we found birth weight to be associated with household economy and the education of mothers. In the urban rural comparison, the mean birth weight for urban boys and girls were 3,298 and 3,203 g as compared with 3,105 and 3,057 g for the rural infants. Children in the urban area grew faster than those in the rural area. There were markedly higher frequencies of stunting in the rural area compared with the urban. The initiation of breastfeeding during the first hour of life was more frequent in the urban area. Exclusive breastfeeding during the first three months of age was more commonly reported in the rural than in the urban area. Both birth weight and child growth were statistically significantly and positively associated with economic conditions and mother’s education. Conclusion: The results of the studies presented in this thesis show that there are large and important differences in child birth weight, child growth and infant breastfeeding between urban and rural areas. There are also major differences between the areas with respect to education and economic resources. All predictors of child birth weight and growth discussed are directly or indirectly associated with the social and economic conditions. Globalization and urbanization means obvious risks for increasing gaps between as well as within the rural and urban areas. Large discrepancies in a society will lead to serious public health problems in all segments of the population, not only the underprivileged.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 6 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.