Objectives Studies of the carbon and nitrogen stable isotope ratios (δ13C and δ15N) of modern tissues with a fast turnover, such as hair and fingernails, have established the relationship between these values in mothers and their infants during breastfeeding and weaning. Using collagen from high-resolution dentine sections of teeth which form in the perinatal period we investigate the relationship between diet and physiology in this pivotal stage of life. Materials and Methods Childhood dentine collagen δ13C and δ15N profiles were produced from horizontal sections of permanent and deciduous teeth following the direction of development. These were from two 19th-century sites (n = 24) and a small number (n = 5) of prehistoric samples from Great Britain and Ireland. Results These high-resolution data exhibit marked differences between those who survived childhood and those who did not, the former varying little and the latter fluctuating widely. Discussion Breastfeeding and weaning behavior have a significant impact on the morbidity and mortality of infants and the adults they become. In the absence of documentary evidence, archaeological studies of bone collagen of adults and juveniles have been used to infer the prevalence and duration of breastfeeding. These interpretations rely on certain assumptions about the relationship between isotope ratios in the bone collagen of the adult females and the infants who have died. The data from this study suggest a more complex situation than previously proposed and the potential for a new approach to the study of maternal and infant health in past populations.

<p>  </p> <p>Maternal and infant health continues to be a compelling and urgent topic in the United States with prenatal care at its forefront for prevention of adverse outcomes. This study explored differences in adverse infant birth outcomes (i.e., preterm birth, low birthweight, and NICU stays) and postpartum maternal wellbeing outcomes (i.e., social support, depression, and confidence) related to the sociodemographic and baseline factors of mothers and their prenatal care experiences. </p> <p>Data was analyzed from the publicly available <em>Listening to Mothers III </em>dataset. Comprised of 2400 online-survey participants who gave birth to singleton infants in U.S. hospitals between 2011 and 2012. Structural equation modeling was employed with FIML to account for missing data. The model examined mediators of prenatal care (i.e., responsive provider behavior, week of first visit, duration of visits, group prenatal care; GPC) between maternal predictors and outcomes.</p> <p>Of infants in the sample, 8% were born preterm, 8% were born low birthweight, and 18% were admitted into the NICU. Depression and smoking during pregnancy, as well as participating in GPC, resulted in 15%, 20% and 18% greater proportions of infant NICU stays, respectively. For postpartum maternal wellbeing, participating in GPC increased the proportion of maternal confidence by 18%. Mothers who received responsive provider behavior had higher rates of social support (<em>b </em>= 0.28, <em>p </em>< .001), reported less depression (<em>b </em>= -0.19, <em>p </em>< .001), and felt more confident (<em>b </em>= 0.07, <em>p </em>= .02). </p> <p>Findings from this study suggest that the most impactful actions for prenatal care providers to take would be to provide increased support to mothers who identify as needing treatment for depression or smoking during pregnancy to best improve infant health through fewer admissions into the NICU, and to continue to bolster the responsiveness in which providers interact with patients to improve overall postpartum maternal wellbeing. </p>

No description available.

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to a policy change. Utilizing a difference-in-difference-in-difference (DDD) estimation, this study found initial evidence in a competitive MCO environment of Traditional Medicaid average birth charges substantially more than births under a Medicaid MCO, while outcomes also revealed the incidence of normal delivery increased almost identical to that of private insurance. However, after a short time, average birth charges for infants born under Medicaid MCO climb higher than other payer-types and infant health begins to decline. Outcomes of this study signal that Managed Care infants are actually less healthy and cost substantially more than anticipated but it is possible that these outcomes can be attributed to insurance selection.

Thesis (MCur)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Nurses are being held responsible and accountable for the quality of nursing care, which includes quality infection control nursing, they provide. This change in accountability has been brought about by the need to reduce the ever escalating costs of health care. During the 1980's, health care services created a demand for high-quality, efficient, cost-effective and competitively priced health services. In order to provide these services, health care organisations are forced to consider new strategies. This is a process that produces outcomes. Quality improvement methods, which include infection control, help organisations to produce these outcomes. Donabedian (1980) defined high-quality care as "that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts" (Grossman, 1998: 43). Quality improvement in infection control relates to the activities employed to improve the performance of a process, and includes the process of planning and control. Management is responsible and accountable for providing resources In order to implement quality infection control nursing care. The purpose of the study was to identify factors influencing the implementation of an effective infection control process in aNICU. An exploratory and descriptive design with a qualitative orientation was implemented. It consisted of a narrative and a literature study by means of which factors have been identified to influence the implementation of an infection control process in a NICU. The case study design, an indepth analysis of a single unit of study, was utilised in this study as part of the data-gathering process. Recommendctions were made on the macro, meso and micro levels, which included quality circles, hand hygiene and antibiotic usage, in-service education, recognition of personnel, mission statement and the infection control manual. The shortage of human and physical resources in nursing is a global problem. In S.A. there has been no previous study to emphasise the importance of an effective infection control process, and therefore no solutions to the problem have been suggested. The Japanese view with regard to quality circles is recommended. / AFRIKAANSE OPSOMMING: Verpleegkundiges is verantwoordelik en aanspreeklik vir die gehalte van verpleging wat gelewer word, insluitende gehalte infeksiebeheer verpleging. Hierdie verandering in aanspreeklikheid het voortgespruit uit die behoefte om die voortdurende styging in gesondheidskoste te verminder. Gedurende die 1980s, het 'n aanvraag vir hoë gehalte, kosteeffektiewe en kompeterende gesondheidsorgdienste ontstaan. Gesondheidsorg dienste moes nuwe strategieë oorweeg om in hierdie dienste te kan voorsien. Uitkomste word op hierdie proses gebaseer. Om hierdie uitkomste te bereik, behoort organisasies gehalteverbetering metodes, wat infeksie beheer insluit, te implemeteer. Donabedian (1980) definieer hoë gehalte as "that kind of care which is expected to maximise an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts" (Grossman, 1998: 43). Gehalteverbetering in infeksiebeheer , verwys na die aktiwitieite wat geimplementeer word om die uitvoer van In proses te verbeter, insluitende beplanning en beheer. Bestuur is verantwoordelik en aanspreeklik vir die voorsiening van hulpbronne, om gehalte infeksiebeheer verpleegsorg te implementeer. Die doel van die studie was om faktore wat die implementering van 'n effektiewe infeksie beheer proses in 'n NICU beinvloed, te identifiseer. In Verkennende en beskrywende ontwerp, met 'n kwalitatiewe orientering, is geimplementeer. Dit het bestaan uit In narratief en In literatuur studie, waardeur faktore wat die implementering van In effektiewe infeksie beheer proses in 'n NICU beinvloed, geidentifiseer word. Die gevallestudie ontwerp, wat 'n in-diepte ondersoek van In enkele eenheid van studie is, is in hierdie studie gebruik as deel van die data-insamelings proses. Aanbevelings is gemaak of makro, meso en mikro vlak, en sluit in gehalte sirkels, handhigiëne en antibiotika gebruik, indiensopleiding, erkenning van personeel, In missieverklarin~ en ten opsigte van die infeksiebeheerhand- leiding in. Die tekort aan menslike en fisiese hulpbronne in verpleging is I n globale probleem. Aangesien daar nog nie voorheen In studie in S.A. gedoen is om die belang van I n effektiewe infeksiebeheerproses te beklemtoon nie, is daar nog nooit oplossings vir die probleem voorgestel nie. Die Japanese siening van gehalte sirkels word aanbeveel.

Purpose: The purpose of this study is to examine the baseline oral health status of infants and the level of their caregiver's oral health knowledge for families who received preventive oral health services in a medical setting. Methods: Using a prospective cohort study, children 0-3 years of age received an oral health screening, risk assessment, caregiver education, and a fluoride varnish treatment in an ambulatory pediatric medical clinic. A 16-item oral health knowledge and socio-demographic questionnaire was delivered to the caregiver of child. This questionnaire included knowledge, behavior and opinion items on risk factors for dental diseases, care of child's teeth, and socio-demographic characteristics of the family. Six-months after the medical visit, dental claims were examined to see if children had made a dental visit. Results: One hundred and ninety-five children received preventive oral health services in this clinic. Of these, 103 caregivers agreed to complete the oral health knowledge and socio-demographic questionnaire. Twenty-percent of children screening had visible signs of tooth decay, according to risk-assessment 72% were categorized as high-risk for tooth decay, and 83% received a fluoride varnish treatment. At 6-months, 9% of children were found to have had a dental visit. According to the caregiver questionnaire the likelihood of having a dental visit was correlated with the caregiver's knowledge of when a child should have their first dental visit and having been told by a medical professional when their child should be going to the dentist. Conclusion: Children are more likely to have a dental visit when caregivers are aware of the age 1 dental visit, or when advised to seek care by a medical professional. With increased education of medical providers, starting in medical residency training, more children can be seen for preventive oral health care resulting in an earlier establishment of a dental home.

The food an infant is fed can reflect many things: a source of nutrition, the social and cultural circumstances into which an infant is born, or even a family’s beliefs about the body and breast milk as a source of nutrition. Exclusive breastfeeding, currently the gold standard for infant feeding in the United States (US), is often identified as an expectation in discourses on being a “good mother.” African American mothers in particular are the least likely group in the US to breastfeed in any capacity and many efforts are underway to increase the breastfeeding rates of this population. This dissertation presents findings of a three-part qualitative study whose purpose was to examine how African American mothers define being a good mother and to learn what factors they experience in early motherhood that may influence their decisions for infant feeding and infant care. Because most research in this area focuses on low income African American mothers, this research has a distinct focus on middle class African American mothers to allow for the consideration of factors besides low socioeconomic status that may contribute to breastfeeding behavior. By defining good motherhood in accordance with middle class African American mothers’ definition, this research argues against the standard that aligns “good motherhood” with breastfeeding and suggests instead that, in some instances, being a good mother means caring and providing for the family at the exclusion of breastfeeding. Included are suggestions for alternative strategies that extend beyond educating and encouraging African American mothers to conform to a standard that can appear to be in conflict with their primary values.

Understanding the transport of particulate and gaseous indoor air pollutants from source to exposure is paramount to improve our understanding of the complexities of the built environments in which we spend the majority of our time. This dissertation offers new insights on particle resuspension from indoor surfaces, infant exposure to organic contaminants released from crib mattresses, and the dynamics of pollutant transport and human exposure while sleeping. Particle resuspension is the physical process by which settled particles detach from a surface and become airborne through application of various aerodynamic and mechanical removal forces. Resuspension is an important indoor source of coarse mode particles (> 1 µm in diameter) and can be a source mechanism for biological matter and organic contaminants that accumulate in house dust. Settled dust deposits on indoor surfaces can vary considerably in their structure and mass loading, yet little is known as to how these parameters affect resuspension. Through wind tunnel experiments, this research demonstrates that the deposit structure (monolayer or multilayer) can have a significant impact on the number of particles that aerodynamically resuspend. Furthermore, this dissertation presents the first full-scale experimental chamber study to show that human body movements in bed can resuspend settled mattress dust particles. An indoor aerosol model was utilized to provide a mechanistic understanding of the impact of movement intensity, surface vibrations, bedroom ventilation rate, and dust loading on the resuspension flux and intake fraction of resuspended particles. Infants spend most of their time sleeping and are likely to be exposed to elevated concentrations of chemicals released from their crib mattresses. Through a combination of chamber experiments and solvent extractions, this research shows that infant crib mattresses can emit a variety of volatile organic compounds (VOCs) and contain numerous chemical additives, including phthalate and alternative plasticizers, flame retardants, and unreacted isocyanates. Additionally, this study discovered that infants are exposed to approximately twice the concentrations of VOCs in their breathing zones as compared to the bulk bedroom air, due to their close proximity to the source.

Thesis (M.S.P.H.)--University of Michigan, 1940.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.