No description available.

This study was concerned with establishing the extent to which various components of the environment were exposed to the three toxic minerals, arsenic, mercury and lead. The concentration of these three elements were determined in groundwater and surface water, soil, plants, animals such as goats, and humans in potentially contaminated areas in the Limpopo Province of South Africa. The focus of the study was to assess the possible exposure to infants through ingestion to arsenic, mercury and lead. Comparison of the mineral content of water at the study sites with international and national drinking water standards, indicated water from Rooiberg, Leeupoort and Gravelotte are not fit for human consumption due to high arsenic and lead concentrations. Water at Gravelotte also has unacceptably high levels of mercury. The soil, plants, goat’s milk and mother’s milk at Rooiberg have higher levels of arsenic and lead than have been recorded for many other countries. Mother’s milk and goat’s milk are the main sources of arsenic, lead and mercury contamination at Rooiberg. It is therefore newborns and toddlers who are most at risk from exposure to arsenic and lead. This is a cause for environmental and health concerns, but as this research is only a base-line study, it is imperative that more comprehensive surveys of potentially toxic mineral contamination be conducted in the province. / Environmental Sciences / (M.Sc. (Environmental Science))

Le tire-lait est un appareil conçu pour aider les mères durant l’allaitement. Selon la recherche préliminaire effectuée, c’est un thème très peu exploré dans les études; il est donc difficile d’affirmer si le produit répond correctement aux besoins reliés à son usage et à son utilité ou comment il s’intègre dans l’allaitement. Les fondements de l’étude exploratoire ont été bâtis sur ces enjeux dans le but de comprendre l’expérience d’usage du tire-lait. Inspirée de l’approche phénoménologique centrée sur l’usager, l’étude a permis d’amasser des données qualitatives à travers des entrevues semi-dirigées auprès de sept participantes. L’analyse de ces données a permis d’identifier les thèmes importants qui ont mené à des constats, rédigés dans une optique de design. L’étude a trouvé que c’est souvent quand la réalité de l’allaitement au sein rattrape les mères qu’elles vont vouloir se procurer un tire-lait, en s’inspirant des marques utilisées dans les hôpitaux par manque de temps. Le tire-lait devient alors principalement utile pour se désengorger et pour la liberté qu’il procure, s’intégrant dans une routine. Le tire-lait est par contre peu ergonomique; il semble y avoir un décalage entre le concept proposé et les manipulations réelles, notamment au niveau de la mise en marche, des bouteilles et des embouts. Ces résultats de l’étude pourraient être intégrés dans le tire-lait pour mieux représenter la réalité du contexte, de la pratique et de l’usage du produit. Ils pourraient ainsi nourrir le processus de conception dans un projet futur afin d’améliorer le design du tire-lait. / The breast pump is an apparatus which can help mothers breast feeding. According to a preliminary study, breast pumping has not been explored a lot in previous studies; thus, it is hard to tell if the product responds well to the needs of its use and utility, or how it is combined with breastfeeding. The basis of the exploratory study was built on those stakes with the purpose of understanding the experience of use of the breast pump. Inspired by the user centered phenomenological approach, qualitative date with semi-structured interviews involving seven participants were cumulated. The analysis of the data made it possible to identify the important themes, which led to statements that have been interpreted from a design perspective. The study found that it is often when the reality of breast feeding overtakes mothers that they will feel the need to get a breast pump, inspired by the brands used in hospitals because au lack of time. The breast pump is mainly used to ease breast congestion and is valued for the liberty it provides, getting integrated in a routine. The breast pump is not ergonomic; there seems to be an offset between its design and its real manipulations. Those results of the study could be integrated in the breast pump to represent better the reality of the context, the practice and the use of the product. They could also nurture the process of conception in future project to improve the breast pump design.

O aleitamento materno está associado a benefícios de ordem nutricional, imunológica, afetiva, econômica e social. Grande parte das drogas lícitas e ilícitas consumidas pela lactante pode ser transferida para o leite, o que pode representar potenciais efeitos nocivos para a criança em curto e longo prazos. Embora o conhecimento a respeito de substâncias psicoativas durante a lactação venha sendo ampliado, ainda há poucas informações sobre as concentrações de substâncias excretadas por essa via e muitas dúvidas sobre os efeitos delas em crianças durante o período de amamentação. O leite materno é uma matriz não convencional que pode ser usada para avaliar a exposição de crianças a substâncias durante o aleitamento e sua principal vantagem é a coleta simples e não-invasiva. Contudo, a extração destas a partir do leite materno é um desafio analítico devido ao seu alto conteúdo lipídico e proteico, bem como a alteração na sua composição durante o período pós-parto. No presente trabalho, técnicas analíticas miniaturizadas foram desenvolvidas visando a detecção das substâncias psicoativas cocaína, cocaetileno, norcocaína, tetraidrocanabinol, canabinol, canabidiol em amostras de leite materno, utilizando cromatografia gasosa acoplada à espectrometria de massas (GC-MS). A microextração em fase líquida (LPME) foi aplicada para analitos de cocaína e a microextração em fase sólida (SPME) para canabinoides. Após o desenvolvimento e validação dos métodos, as análises foram aplicadas em amostras de leite coletadas no hospital municipal Dr. Arthur Ribeiro de Saboya (n=109). Além das técnicas terem se mostrado adequadas à extração e detecção dos analitos, confirmou-se a excreção de cocaína no leite materno em quantidades moderadas com resultado positivo para uma amostra (138 ng/mL). Bem como foi detectado tetraidrocanabinol nas concentrações de 20 ng/mL e 31 ng/mL em amostras de leite humano. / Maternal breastfeeding is related with nutritional, immunological, affective, economic, and social benefits. Most licit and illicit substances consumed by the nursing mother might be excreted in breast milk, which may cause potential harmful effects to the breastfed infant at short and long terms. Although the knowledge about the psychoactive substances during lactation is increasing, there is still few information on the levels in which these substances are excreted in breast milk and many questions about the possible effects of these substances in the infant during the nursing period still remain unanswered. Breast milk is an unconventional matrix that can be used to assess infant exposure to drugs, and its main advantage is its easy and non-invasive collection. However, the extraction of substances from breast milk is an analytical challenge because of its high protein and fat content and changing composition during the postpartum period. In this study, miniaturized analytical techniques will be carried out to determine psychoactive substances such as cocaine, cocaethylene, norcocaine, tetrahydrocannabinol, cannabinol, and cannabidiol in milk samples by using gas chromatography-mass spectrometry (GC-MS). Liquid-phase microextraction (LPME) was applied to cocaine analytes and solid-phase microextraction (SPME) was applied to cannabinoids. After the development and validation, the methods were applied in milk samples collected from municipal hospital Dr. Arthur Ribeiro de Saboya (n=109). These techniques have proved to be suitable for analyte extraction and detection. Cocaine excretion in breast milk has been confirmed given that one sample was positive to cocaine in moderate amounts (138 ng/mL), as well as, two samples could be confirmed positive to tetrahydrocannabinol at 20 ng/mL and 31 ng/mL.

O aleitamento materno está associado a benefícios de ordem nutricional, imunológica, afetiva, econômica e social. Grande parte das drogas lícitas e ilícitas consumidas pela lactante pode ser transferida para o leite, o que pode representar potenciais efeitos nocivos para a criança em curto e longo prazos. Embora o conhecimento a respeito de substâncias psicoativas durante a lactação venha sendo ampliado, ainda há poucas informações sobre as concentrações de substâncias excretadas por essa via e muitas dúvidas sobre os efeitos delas em crianças durante o período de amamentação. O leite materno é uma matriz não convencional que pode ser usada para avaliar a exposição de crianças a substâncias durante o aleitamento e sua principal vantagem é a coleta simples e não-invasiva. Contudo, a extração destas a partir do leite materno é um desafio analítico devido ao seu alto conteúdo lipídico e proteico, bem como a alteração na sua composição durante o período pós-parto. No presente trabalho, técnicas analíticas miniaturizadas foram desenvolvidas visando a detecção das substâncias psicoativas cocaína, cocaetileno, norcocaína, tetraidrocanabinol, canabinol, canabidiol em amostras de leite materno, utilizando cromatografia gasosa acoplada à espectrometria de massas (GC-MS). A microextração em fase líquida (LPME) foi aplicada para analitos de cocaína e a microextração em fase sólida (SPME) para canabinoides. Após o desenvolvimento e validação dos métodos, as análises foram aplicadas em amostras de leite coletadas no hospital municipal Dr. Arthur Ribeiro de Saboya (n=109). Além das técnicas terem se mostrado adequadas à extração e detecção dos analitos, confirmou-se a excreção de cocaína no leite materno em quantidades moderadas com resultado positivo para uma amostra (138 ng/mL). Bem como foi detectado tetraidrocanabinol nas concentrações de 20 ng/mL e 31 ng/mL em amostras de leite humano. / Maternal breastfeeding is related with nutritional, immunological, affective, economic, and social benefits. Most licit and illicit substances consumed by the nursing mother might be excreted in breast milk, which may cause potential harmful effects to the breastfed infant at short and long terms. Although the knowledge about the psychoactive substances during lactation is increasing, there is still few information on the levels in which these substances are excreted in breast milk and many questions about the possible effects of these substances in the infant during the nursing period still remain unanswered. Breast milk is an unconventional matrix that can be used to assess infant exposure to drugs, and its main advantage is its easy and non-invasive collection. However, the extraction of substances from breast milk is an analytical challenge because of its high protein and fat content and changing composition during the postpartum period. In this study, miniaturized analytical techniques will be carried out to determine psychoactive substances such as cocaine, cocaethylene, norcocaine, tetrahydrocannabinol, cannabinol, and cannabidiol in milk samples by using gas chromatography-mass spectrometry (GC-MS). Liquid-phase microextraction (LPME) was applied to cocaine analytes and solid-phase microextraction (SPME) was applied to cannabinoids. After the development and validation, the methods were applied in milk samples collected from municipal hospital Dr. Arthur Ribeiro de Saboya (n=109). These techniques have proved to be suitable for analyte extraction and detection. Cocaine excretion in breast milk has been confirmed given that one sample was positive to cocaine in moderate amounts (138 ng/mL), as well as, two samples could be confirmed positive to tetrahydrocannabinol at 20 ng/mL and 31 ng/mL.

Le tire-lait est un appareil conçu pour aider les mères durant l’allaitement. Selon la recherche préliminaire effectuée, c’est un thème très peu exploré dans les études; il est donc difficile d’affirmer si le produit répond correctement aux besoins reliés à son usage et à son utilité ou comment il s’intègre dans l’allaitement. Les fondements de l’étude exploratoire ont été bâtis sur ces enjeux dans le but de comprendre l’expérience d’usage du tire-lait. Inspirée de l’approche phénoménologique centrée sur l’usager, l’étude a permis d’amasser des données qualitatives à travers des entrevues semi-dirigées auprès de sept participantes. L’analyse de ces données a permis d’identifier les thèmes importants qui ont mené à des constats, rédigés dans une optique de design. L’étude a trouvé que c’est souvent quand la réalité de l’allaitement au sein rattrape les mères qu’elles vont vouloir se procurer un tire-lait, en s’inspirant des marques utilisées dans les hôpitaux par manque de temps. Le tire-lait devient alors principalement utile pour se désengorger et pour la liberté qu’il procure, s’intégrant dans une routine. Le tire-lait est par contre peu ergonomique; il semble y avoir un décalage entre le concept proposé et les manipulations réelles, notamment au niveau de la mise en marche, des bouteilles et des embouts. Ces résultats de l’étude pourraient être intégrés dans le tire-lait pour mieux représenter la réalité du contexte, de la pratique et de l’usage du produit. Ils pourraient ainsi nourrir le processus de conception dans un projet futur afin d’améliorer le design du tire-lait. / The breast pump is an apparatus which can help mothers breast feeding. According to a preliminary study, breast pumping has not been explored a lot in previous studies; thus, it is hard to tell if the product responds well to the needs of its use and utility, or how it is combined with breastfeeding. The basis of the exploratory study was built on those stakes with the purpose of understanding the experience of use of the breast pump. Inspired by the user centered phenomenological approach, qualitative date with semi-structured interviews involving seven participants were cumulated. The analysis of the data made it possible to identify the important themes, which led to statements that have been interpreted from a design perspective. The study found that it is often when the reality of breast feeding overtakes mothers that they will feel the need to get a breast pump, inspired by the brands used in hospitals because au lack of time. The breast pump is mainly used to ease breast congestion and is valued for the liberty it provides, getting integrated in a routine. The breast pump is not ergonomic; there seems to be an offset between its design and its real manipulations. Those results of the study could be integrated in the breast pump to represent better the reality of the context, the practice and the use of the product. They could also nurture the process of conception in future project to improve the breast pump design.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objective: Primary: To investigate the effect of pasteurisation on the composition of expressed breast milk from HIV positive mothers and its adequacy in relation to the growth of their VLBW premature infants. Methods: A descriptive, prospective case-controlled pilot study was performed in 3 regional state hospitals in the Western Cape, South Africa. The control and study groups consisted of 12 HIV negative and 11 HIV positive mothers, with their VLBW premature infants, respectively. All mothers (19 - 35 years old) belonged to the Xhosa ethnic group. All infants were born <34 weeks gestation and birth weight <1500g. Eight breast milk samples were collected on days 6, 7, 13, 14, 20, 21, 27 and 28 from all mothers during the first 28 days after birth. Breast milk was expressed by hand or pump from either the right or left breast. Half of each breast milk sample was kept raw. The remaining sample was Pretoria pasteurised, after which both samples were subdivided into 3 or 4 aliquots to determine energy, protein, carbohydrate, fat, folate, calcium, phosphorus, magnesium, sodium, otassium, iron, copper, zinc content and HI viral load (study group only). The mothers’ dietary intake during pregnancy and lactation was obtained by means of a quantitative food frequency questionnaire and repeated 24-hour recall respectively. The infants’ dietary intake was recorded daily. Mothers’ anthropometric measurements taken at study entry and exit were weight, height and mid-upper arm circumference. All infants’ daily weight, as well as length and head circumference at birth and on day 28 postpartum was obtained. Biochemical analysis was performed on the blood samples obtained at study entry and exit from all mothers and infants. For statistical analysis, Statistica® (release no 7, 2006) was used for repeated measures analysis of variance (ANOVA) to determine the effect of HIV, pasteurisation, milk expression and time on the composition of the breast milk. Results: There was no significant difference in the studied macro- and micronutrient composition between raw or pasteurised expressed breast milk from HIV positive and HIV negative mothers with premature infants. A significant decline in breast milk protein (p<0.01), magnesium (p=0.045), potassium (p=0.002), zinc (p<0.01) and copper (p=0.03) content was observed for the whole study population over time, while folic acid content increased significantly (p=0.012) over time. The sodium/potassium ratio of both groups remained strongly indicative of the presence of sub-clinical mastitis. A significant (p=0.03) greater mean volume of milk was obtained with pump [42.5 Standard Deviation (SD) 18.1 ml], compared to hand expression [36.7 (16.7) ml]. Method of expression did not result in a significant difference in breast milk composition for any of the nutrients studied. Eight (35%) infants were born SGA while 21 (91%) infants were SGA on day 28. The infants gained a mean of 16.37 (4.5) g/kg/day (i.e. 91% of the recommended growth rate of >18g/kg/day) from the day on which birth weight was regained. The control and study group infants respectively consumed a mean of 3.27 (1.36) and 3.21 (1.36) g protein/kg/day and 138.1 (33.8) and 142.3 (33.8) kcal total energy/kg/day. This corresponds to a PER of 2.6 (control group) and 2.5 (study group) respectively, which cannot provide for the increased growth needs of the SGA infant in need of catch-up growth. Six infants experienced an incident of Grade 1 NEC which resolved and all completed the study. Two (18%) HIV-exposed infants were found to be HIV positive at 28 days post delivery. Four participating infants died. No adverse event or mortality was related to the study protocol as no intervention was undertaken. Conclusion: HIV positive Xhosa mothers provide as nutritious breast milk to their VLBW premature infants as HIV negative Xhosa mothers. Maternal nutrient intake during pregnancy and lactation did not have a significant effect on the nutritional composition of breast milk, except for folate content.

This study was concerned with establishing the extent to which various components of the environment were exposed to the three toxic minerals, arsenic, mercury and lead. The concentration of these three elements were determined in groundwater and surface water, soil, plants, animals such as goats, and humans in potentially contaminated areas in the Limpopo Province of South Africa. The focus of the study was to assess the possible exposure to infants through ingestion to arsenic, mercury and lead. Comparison of the mineral content of water at the study sites with international and national drinking water standards, indicated water from Rooiberg, Leeupoort and Gravelotte are not fit for human consumption due to high arsenic and lead concentrations. Water at Gravelotte also has unacceptably high levels of mercury. The soil, plants, goat’s milk and mother’s milk at Rooiberg have higher levels of arsenic and lead than have been recorded for many other countries. Mother’s milk and goat’s milk are the main sources of arsenic, lead and mercury contamination at Rooiberg. It is therefore newborns and toddlers who are most at risk from exposure to arsenic and lead. This is a cause for environmental and health concerns, but as this research is only a base-line study, it is imperative that more comprehensive surveys of potentially toxic mineral contamination be conducted in the province. / Environmental Sciences / (M.Sc. (Environmental Science))

Hintergrund Ein rascher enteraler Nahrungsaufbau bei Frühgeborenen verkürzt die Zeit der parenteralen Ernährung. Somit lassen sich bestimmte Risikofaktoren beeinflussen, die evt. die Morbiditätshäufigkeit der Kinder senken könnten. Mehrere Kohortenstudien zeigten, dass ein standardisierter Nahrungsaufbau mit einer geringeren Komplikationsrate und einem schnelleren Nahrungsaufbau assoziiert ist. Ziel der Studie ist zu überprüfen, ob ein standardisiertes Ernährungsprogramm einen rascheren und komplikationsärmeren enteralen Nahrungsaufbau bei Frühgeborenen ermöglicht. Patienten und Methode In die vorliegende randomisierte, kontrollierte Studie wurden 99 Frühgeborene mit einem Geburtsgewicht von ≤1750 g aufgenommen. In der Gruppe mit standardisierter Ernährung (ST) wurde der enterale Nahrungsaufbau mit Muttermilch oder gespendeter Frauenmilch nach einem speziell ausgearbeiteten Protokoll durchgeführt. In der Gruppe mit der individuellen Ernährungsform (IN) wurde je nach Bedarf und Zustand des Kindes auch semi-elementare Nahrung (Pregomin®) gefüttert. Über die Steigerungsdynamik und Nahrungspausen wurde hier individuell entschieden. Primäres Zielkriterium war die Dauer bis zum Erreichen der vollenteralen Ernährung. Ergebnisse In der ST-Gruppe war die vollständig enterale Ernährung nach 14,93 ± 9,95 (Median 12) Tagen, in der IN-Gruppe nach 16,23 ± 10,86 (Median 14) Tagen möglich. Es konnte kein signifikanter Unterschied gefunden werden. Nur bei hypotrophen Frühgeborenen erwiesen sich die Unterschiede bei der ST-Gruppe gegenüber der IN-Gruppe als statistisch signifikant: 10,20 ± 4,78 (Median 8,5) vs. 16,73 ± 8,57 (Median 15) Tage (p = 0,045). Die Gewichtsentwicklung verlief in beiden Studiengruppen nicht different. Die Kinder in der ST-Gruppe konnten bei einem Gewicht von 116% des Geburtsgewichtes vollständig enteral ernährt werden, in der IN-Gruppe bei einem Gewicht von 122% des Geburtsgewichtes. Die Inzidenz der nekrotisierenden Enterokolitis (4%) und anderer Komplikationen blieb in beiden Studiengruppen niedrig. Die Diagnose „Ernährungsschwierigkeiten“ wurde mit klaren Symptomen definiert und in der IN-Gruppe doppelt so oft gestellt, wie in der ST-Gruppe (14 vs. 7) Schlussfolgerung Das Standardisieren führte unter den Studienbedingungen nicht zu einer Beschleunigung des Nahrungsaufbaus. Anhand unserer Ergebnisse ist es möglich, dass die hypotrophen Frühgeborenen von der standardisierten Ernährung entsprechend des Ernährungsprotokolls profitieren. Diese Hypothese muss in einer neuen Studie überprüft werden. Diese Kinder konnten schneller vollständig enteral ernährt werden, als Frühgeborene, mit individuellem enteralem Nahrungsaufbau. Ein standardisiertes Nahrungsprotokoll ist im klinischen Alltag durchsetzbar, und darauf aufbauend ein enteraler Nahrungsaufbau unter strenger klinischer Beobachtung ohne Komplikationen erfolgreich durchführbar.

Les enfants sont exposés au p,p’-dichlorodiphényltrichloroéthane (p,p’-DDT) et au p,p’-dichlorodiphényldichloroéthylène (p,p’-DDE) par transfert placentaire et par le lait maternel. Plusieurs études laissent croire que cette exposition pourrait avoir un impact sur l’indice de masse corporelle (IMC) pendant l’enfance. Le but de notre étude était d’évaluer l’association entre l’exposition par le lait maternel et l’IMC des enfants japonais âgés de 42 mois. Nous avons utilisé les données d’une étude pilote (n=290) de la Japan Environment and Children Study (JECS). Le p,p’-DDT et le p,p’-DDE ont été mesurés dans le lait maternel, et les concentrations chez l’enfant ont été estimées pour trois périodes (0-6 mois, 6-12 mois, 12-24 mois) à l’aide d’un modèle de toxicocinétique. Les associations avec l’IMC à 42 mois ont été évaluées à l’aide de modèles de régression linéaire multivariée. Aucune association n’a été observée avec les concentrations de p,p’-DDT mesurées dans le lait maternel, ni avec les concentrations estimées chez les enfants. Des associations positives avec les concentrations de p,p’-DDE estimées ont été observées chez les filles. Chaque augmentation d’un logarithme naturel dans les concentrations estimées était associée avec une augmentation du score z de l’IMC de 0.23 (I.C. 95% : 0.01, 0.45) pour la période d’exposition 0-6 mois, de 0.26 (I.C. 95% : 0.06, 0.47) pour la période 6-12 mois, et de 0.24 (I.C. 95% : 0.05, 0.43) pour la période de 12-24 mois. Ces associations étaient dans le même ordre de grandeur que l’association observée dans une méta-analyse publiée récemment (augmentation du score z de l’IMC de 0.13 par augmentation d’un logarithme naturel dans l’exposition prénatale), ce qui supporte l’hypothèse que l’exposition développementale au p,p’-DDE est associée avec une augmentation de l’IMC durant l’enfance. / Children are exposed to p,p’-dichlorodiphenyltrichloroethane (p,p’-DDT) and p,p’-dichlorodiphenyldichloroethylene (p,p’-DDE) through placental and lactational transfer. Studies have revealed that these exposures could lead to increased body mass index (BMI) during childhood. Our aim was to assess whether exposure through breast milk is associated with BMI in Japanese children at 42 months of age. We used data from a pilot study (n=290) of the Japanese Environment and Children Study (JECS). p,p’-DDT and p,p’-DDE levels were measured in breast milk, and levels in children were estimated using a toxicokinetic model for three exposure periods (0-6 months, 6-12 months, 12-24 months). Associations with BMI at 42 months of age were assessed using multivariate linear regression models. Our study revealed no significant association with levels of p,p’-DDT measured in breast milk or estimated in children. Positive associations with p,p’-DDE were found in girls during all exposure periods. For each log increase in the estimated p,p’-DDE levels, BMI z-score increased by 0.23 (C.I. 95%: 0.01, 0.45) for the 0-6 months exposure period, 0.26 (C.I. 95%: 0.06, 0.47) for the 6-12 months exposure period and 0.24 (C.I. 95%: 0.05, 0.43) for the 12-24 months exposure period. Our results in girls were similar to those found in a previous meta-analysis that included boys and girls (BMI z-score increase of 0.13 by log increase in prenatal p,p’-DDE levels), supporting that early-life exposure to p,p’-DDE may be associated with increased BMI during childhood.