Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Wisconsin--Madison, 1984. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 68-72).

Orientador: Antonio Carlos Pereira / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-06T18:11:44Z (GMT). No. of bitstreams: 1 Rochelle_IsauraMariaFerraz_M.pdf: 3369046 bytes, checksum: 65d2306d307bbf52edebc50b79f6ab28 (MD5) Previous issue date: 2006 / Resumo: Os objetivos deste trabalho foram: a) estimar a freqüência das oclusopatias na dentição decídua e variáveis a elas associadas, como o tipo e o período de amamentação, hábitos deletérios bucais e informações recebidas pelas mães no período do pré-natal; b) avaliar a direção dos movimentos mandibulares no plano frontal, na oclusão decídua, mensurando e relacionando os Ângulos Funcionais Mastigatórios Planas - AFMP com oclusopatias e presença de desgastes fisiológicos; e c) desenvolver um aparato para medir os Ângulos Funcionais Mastigatórios Planas - AFMP na dentição decídua. A amostra constituiu-se de 186 crianças de ambos os sexos, que representaram toda a população de crianças de 5 anos de idade, regularmente matriculadas nas Creches Municipais da cidade de São Pedro, São Paulo, Brasil. A prevalência de oclusopatias na amostra foi alta (95,7%), sendo que 58,6% das crianças apresentaram oclusopatias leves. As oclusopatias mais freqüentes foram em ordem decrescente de freqüência: ligeiro apinhamento ou espaçamentos (23,4%), mordida aberta (22,2%), sobremordida (19,7%), mordida cruzada uni ou bilateral (14,8%), e overjet positivo (12,9%). Na classificação de degrau de molares, o terminal reto apresentou valor epidemiológico alto (84,5%), mostrando uma provável etiologia ambiental dessas oclusopatias. O aleitamento natural acima de 6 meses (33,3%) e o aleitamento natural exclusivo por mais de 3 meses (45,1%) apresentaram valores epidemiológicos baixos, enquanto que a presença de hábitos deletérios bucais mostrou alta freqüência (95,6%) na população estudada. No presente estudo, observou-se que, quando se associavam diversas variáveis independentes em relação à ocorrência de hábitos deletérios bucais, na análise uni variada apenas o tempo de amamentação exclusiva apresentou-se estatisticamente significativo (p= 0,0035). Já em relação à ocorrência das oclusopatias mais freqüentes na amostra, quanto às categorias "ligeiro apinhamento e espaçamento", o tempo de chupeta foi estatisticamente significante (p=0,0320); enquanto que para a "mordida aberta" o tempo de chupeta (p=O,OOI), para a "sobremordida", o tempo de aleitamento (p=0,0152) e o tempo de amamentação exclusiva (p=0,0233) e, para o "overjet positivo," o tempo de amamentação (p=0,0476) se apresentaram estatisticamente significativos. A freqüência dos Ângulos Funcionais Mastigatórios Planas (AFMP) iguais e próximos de zero, que sugerem mastigação bilateral e alternada, foi muito baixa: apenas 10% das crianças apresentou oclusão funcional equilibrada. Quando se associavam diversas variáveis independentes em relação à ocorrência de Ângulos Funcionais Mastigatórios Planas (AFMP) iguais e próximos de zero, verificou-se, na análise univariada, que oclusão normal (p=O,OOII), ligeiro apinhamento ou espaçamento (p=O,OOOI) e presença de desgastes fisiológicos (p=O,OOOOOI) apresentaram-se estatisticamente significativos, enquanto que na análise de regressão logística as crianças que usaram chupeta por mais de 3 anos apresentaram 5,25 maior probabilidade de apresentarem mais mordida aberta que as demais, e existe 19,33 maior probabilidade de apresentarem Ângulos Funcionais Mastigatórios Planas (AFMP) iguais e próximos de zero aquelas crianças que apresentaram oclusão normal classificadas pela OMS. O aparato para medir Ângulos Funcionais Mastigatórios Planas (AFMP) na dentição decídua apresentou estabilidade durante a mensuração e aceitação junto a todas as crianças em que foi aplicado. Conclui-se que a amostra apresentou uma alta prevalência de oclusopatias, bem como presença de hábitos deletérios bucais, sendo que o tempo de amamentação e aleitamento exclusivo foram variáveis importantes associadas ao aparecimento de algumas oclusopatias e hábitos deletérios bucais. Finalmente, pode-se sugerir uma ação mais organizada dos Serviços de Saúde, buscando-se ferramentas capazes de propiciar um diagnóstico mais precoce desses problemas, evitando, desse modo, grande parte das oclusopatias / Abstract: The aim of the present study was a) to estimate the prevalence of "occ1usopathy" in children with deciduous dentition as well as the associated variables, such as type and period of breastfeeding, deleterious mouth habits, and information mothers received during the prenatal period, b) to evaluate the functional balance of the deciduous occ1usion, measuring Planas' masticatory functional angle (MF A) relationship with occ1usopathy and the incidence of physiologic erosion, and c) to measure the MF A in deciduous dentition. The sample consisted of 186 children, both genders, aged 5 years, selected from day care centers in São Pedro, São Paulo, Brazil. A very high prevalence (95.7%) of occ1usopathies was observed among the children, 58.6% of whom presented light occ1usopathy. The most prevalent malocc1usions, or occ1usopathy, were: slight crowding or spacing (23.4%); openbite (22.2%); overbite (19.7%); uni or bilateral crossbite (14.8%); and positive overjet (12.9%). In the c1assification of molar degree, the straight terminal presented a high epidemiological value, showing a probable environrnental etiology of these "occ1usopathies". Natural breastfeeding longer than 3 months showed low epidemiological values (45.1 %), while deleterious mouth habits were very prevalent (95.6%) among the population studied. In the present study, when several independent variables were associated, conceming deleterious mouth habits in the uni-varied analysis, only the time for natural breastfeeding (exc1usive) was statistically significant (p=0.0035). In relation to the most prevalent "occ1usopathies", in the swift apinhamento and spacing, the time for the pacifier has been statistically significant (p=0.0320), while for the open biting the pacifier timing (p=O,OOl) for the sobremordida, the breast-feeing time (p=0.0152) and the wxc1usive time for breast-feeding (p=0,0233) and, for the overjet, the breast-feeding time (p=0,0476) are presenting statistically significant. The frequency of the MF A equal to or near zero, suggests bilateral and altemate mastication was very low: only 10% of the childreen presented "equilibrated functional occ1usion". When independent variables were associated in relation to the MF A equal or near zero, in the univaried analysis, the normal occ1usion (p=O,OOl1), slight crowding or spacing (p=0,0001) and the presence ofphysiologic erosions (p=0,000001) were statistically significant, while in the logistic regression analysis children using the pacifier longer than 3 years presented 5.25 times fold chances to have openbite when compared to the others, and a higher probability of presenting MF A equal or near zero than children presenting normal occlusion. The apparatus used for the measurement of MF A in the deciduous dentition showed stability during the measuring process and was approved by alI the childreen assessed. In conclusion, a high prevalence of occlusopathy was observed among the individuaIs, as welI as the presence of deleterious mouth habits. Breastfeeding and exclusive breastfeeding were important variables, with some occlusopathies and deleterious habits, suggesting that more approaches are needed in the public health services focusing on a more precocious diagnosis of these probblems, avoiding most ofthese malocclusions / Mestrado / Odontologia em Saude Coletiva / Mestre em Odontologia

The evidence that breastfeeding reduces mortality and short and long-term morbidity among premature and small babies is well established but breastfeeding rates in neonatal units in the UK remain low. The aim of this study was to develop and evaluate an eLearning module that addresses the learning needs of neonatal clinicians to support breastfeeding on Neonatal Intensive Care Units (NICU). The module focussed on the knowledge areas of anatomy and physiology of lactation and expression. Mixed methodology was used to evaluate the eLearning module and inform its iterative development. This consisted of quasi-experimental pre-test/post-test studies using The Neonatal Unit Clinical Assessment Tool (NUCAT), an on-line objective knowledge test with self ratings of confidence to test the effects of the eLearning module on knowledge, confidence in knowledge and confidence in practice. Semi-structured interviews explored neonatal clinicians’ experiences of undertaking the eLearning module and their perceptions of the feasibility and applicability of the eLearning module as well as their opinions and experiences of breastfeeding support and training. In total 101 neonatal clinicians, including neonatal nurses, doctors, Advanced Neonatal Nurse Practitioners (ANNPs), nursery nurses and students undertook the initial NUCAT assessment of knowledge and confidence. A further 90 clinicians went on to complete the training and post intervention assessment, 60 repeated the post intervention assessment at 6-8 weeks. Baseline knowledge was greater in the area of breast milk expression than in the anatomy and physiology of lactation. Neonatal nurses were found to have greater baseline knowledge of breast milk expression than doctors or nursery nurses. Doctors/ANNPs were more knowledgeable about the anatomy and physiology of lactation. Following the training intervention doctors/ANNPs showed the greatest improvement in knowledge scores and nursery nurses the least. Knowledge and confidence was significantly increased immediately following the intervention and at 6-8 weeks in all groups. The semi-structured interviews conducted after the study showed the feasibility and applicability of the eLearning module for clinicians in NICU. On-line assessment and training provide a potentially effective multidisciplinary training method to improve breastfeeding knowledge and confidence. Nursery nurse may have differing learning needs and require further support and training.

>Magister Scientiae - MSc / The Malawi Multiple Indicator Cluster Survey (MICS) in 2007 indicated that the prevalence of underweight in Lilongwe District was 29%, stunting was 49% and Global Acute Malnutrition was 11%. The aim of the study therefore was to determine the risk factors for malnutrition amongst children aged 0 to 5 years in Lilongwe district in Malawi. Study design It was a case-control study, conducted in randomly selected Community Therapeutic Care (CTC) Sites (Nutrition Rehabilitation Units (NRUs)) and Under-five Clinics at health facilities of the district. The study sample was comprised of 50 underweightfor- age children (25 girls and 25 boys) aged 0 to 5 years from NRUs of the district selected randomly. The controls were comprised of 44 normal weight-for-age children (22 girls and 22 boys) randomly selected within the same age group, routinely attending under-five growth monitoring and immunization sessions during the same period as the cases. The cases and controls were identified using the NRU and under-five clinic registers respectively. Data Collection There was a face to face interview with the mother/guardians of the children, conducted by trained NRU nurse specialists, the researcher and a research assistant, using a structured questionnaire. Questions about socio-economic status of the mother/caregiver, child feeding practices, nutritional status and diseases of the child were asked. Analysis of results Data was analyzed using EpiInfo 2002 software. Ethical approval for the study was requested from the Ethical committee of the University of the Western Cape. Informed written consent was obtained from all the participants.

Title: Assessing Resident Physician Knowledge about Breastfeeding Medicine in a Rural Family Medicine Clinic Authors: Samantha Jensen, MD and Amanda Stoltz, MD, Bristol Family Medicine Residency Program, Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN Introduction: Many residents and faculty encourage the long-term goal of breastfeeding, and our residency program provides extensive training in obstetrics and newborn nursery. However, there is little structure and direct guidance for breastfeeding medicine already built in to the family medicine residency training. We aimed to develop a dedicated breastfeeding medicine longitudinal curriculum to improve the effectiveness of family medicine physician residents as teachers and advocates by improving residents’ fund of knowledge, provide structure for encouraging breastfeeding at prenatal visits, and incorporate breastfeeding into our family medicine practice by improving the on-site locations for breastfeeding and pumping. Method: The method of research was pre-lecture and post-lecture surveys comprised of 15 questions, including knowledge-based questions, assessment of confidence level, and a question on perceived barriers to breastfeeding. Participants attending two educational sessions during the study, and additional educational sessions have continued after study conclusion. The post-lecture survey was completed 12 weeks after first lecture. Lecture topics included an overview of breastfeeding medicine, how to encourage breastfeeding at prenatal appointments, contraindications, maternal nutritional supplements, formula supplementation, galatogogues, and the storage of breastmilk. Results: Results were compiled from the responses of 20 pretests and 9 posttest surveys. Results showed an increase in correct responses to the knowledge portion 61.15% pretest versus 77.69% posttest (t(28) 3.41, p<0.01). Resident physician confidence also increased by the conclusion of the study (t=28, p<.01). Conclusions: It can be concluded that educational lectures increase knowledge and confidence in resident physicians with regards to breastfeeding medicine. Areas for future study include specific research focusing on methods to increase access to resources for breastfeeding mothers.

INTRODUCTION: Health professionals emphasize the importance of breastfeeding in the development of children up to 6-months of age. It is known that short chain volatile fatty acids (SCVFAs) are a byproduct of nutrient fermentation by gut microbiome. These SCVFAs interact with the gut/brain axis and are known to influence infant development. Therefore, a reflection of maternal gut microbiome could likely be found in breastmilk (BM) due to diffusion of SCVFAs across the gut wall into the blood. Previous research in our laboratory has shown differences in the SCVFA fecal fermentation profile between individuals with normal (N) versus overweight/obese (OWOB) body mass index (BMI). Therefore, our research question is: Is there a difference in the relative amount and diversity of SCVFAs in the BM of N compared to OWOB women? We hypothesized that women of N will have a more diverse SCVFA profile than OWOB women in their BM. METHODS: BM samples (200 ml) were collected from 44 women (22 N (BMI 22.0) and 22 OWOB (BMI 33.7) p2 while OWOB participants had a pre-gravid BMI of greater than 25.0 kg/m2. A 300 mg aliquot of lyophilized BM was placed in a separatory funnel with 5 ml of hexane and 5 ml of volatile fatty acid solution (VFA, (oxalic acid (0.1M/L), sodium azide (40mM/L))). The funnel was rocked back and forth 50 times and placed on a ring stand to rest for 10 minutes. The bottom phase of the solution was collected and freeze-dried. Five hundred µL of VFA solution was added to the samples to resuspend, centrifuged (4,000 x g) for 20 minutes, the supernatant was removed and transferred to a microcentrifuge tube then centrifuged (12,000 x g) for 15 minutes and decanted. Three hundred µL of supernatant was transferred to autoinjector vials fitted with a 350 µL insert and analyzed for SCVFAs via gas chromatography (GC) (Shimadzu) using a Phenomenex ZB-Wax Plus glass capillary column. RESULTS: SCVFAs acetate, propionate, isobutyrate, isovalerate and caproate were not different (p>0.10), while valerate (p< 0.02), isocaproate (pCONCLUSION:To our knowledge, this is the first time that SCVFAs have been quantified in the milk of lactating women using GC with an FID detector. This data supports the argument that the pre-gravid BMI of a mother can correlate to the SCVFA profile of her BM. It is unknown if the concentration observed in the mother’s BM in this study has an influence on the neonate’s gut/brain axis and neurological signals, however, we have demonstrated that the SCVFA profile is more diverse in the N BMI mother. Further research is warranted on the influence of maternal BM SCVFA composition on the growth and neurological development of her infant.

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