The purpose of this study was to evaluate the feasibility of a prenatal and postnatal nutrition and lactation consulting facility in either of two locations in the Tidewater region of Virginia, Virginia Beach or Williamsburg. Experts in nutrition and lactation, a registered dietitian and licensed lactation consultant, would be the ideal means of providing adequate nutritional and lactation advice for the mother and infant to foster healthy, optimal pregnancy outcomes and lactation success. A web-based search for adequate data on the demographic sketches of the two cities was done to develop an understanding of meeting the needs of the target population for this type of facility. Women of higher socioeconomic status, higher education level, and with emotional support from spouse/family were targeted. This study will act as the initial step in conducting further research in development of a business plan for a potential facility.

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Mammary gland (MG) is a dynamic organ that is essential for the production and secretion of breast milk. During pregnancy the MG undergoes a critical phase of remodeling, which is accompanied by the differentiation of mammary epithelial cells (MECs). During lactation, the MG requires high level of energy for proper folding of proteins in the secretory pathway, which takes place in the endoplasmic reticulum (ER). Limited evidence has been reported on the impact of cannabis or its components, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), on the differentiation of MECs. However, both THC and CBD have been reported to induce ER stress in various cell types, resulting in impacting cellular function. Furthermore, consequences of cannabis use in the perinatal period on breast milk composition have not been reported. Using the HC11 cell line, we investigated whether THC and CBD evoke ER stress in MECs resulting in the impaired cellular function. We also reported on the effects of cannabis use during pregnancy and lactation on the levels of macronutrients and bioactive factors in the breast milk of cannabis users. Relative to control, 10μM THC and 10μM CBD reduced mRNA levels of milk proteins (CSN2 and WAP) and lipid synthesizing enzymes (FASN, FABP4, PLIN2 and LPL), as well as whey acidic protein and lipid levels. In addition, 10μM THC, 10μM CBD, and the combination of 10μM THC + 10μM CBD significantly induced the expression of ER stress genes in HC11 cells. Furthermore, in the milk of women who used cannabis during pregnancy and lactation, the levels of secretory immunoglobulin A (SIgA) were decreased, relative to non-users. Altogether, our findings indicate that cannabis use in the perinatal period may have implications on breast milk composition and infant health. / Thesis / Doctor of Philosophy (Medical Science) / Breast milk is crucial to the nutrition and immunity of the newborn. It is produced by the mammary gland (MG), which is composed of mammary epithelial cells (MEC) that play a key role in producing and secreting proteins and factors into the milk. During pregnancy, the MG undergoes remodeling which is accompanied by differentiation of the MECs (change from unspecialized to a specialized stage that allows the MECs to produce milk proteins and other factors). The disruption in MEC differentiation can result in altered milk production and composition. Cannabis is used by women during pregnancy and breastfeeding. In this study, we investigated the impact of cannabinoids on the MEC differentiation and examined the effect of cannabis use in the perinatal period on the breast milk composition in humans. We reported that cannabinoids reduced the differentiation of MECs and maternal cannabis use during breastfeeding reduced levels of an essential immune factor.

<p>  </p> <p>In modern society, continuous light exposure and obesity are increasingly prevalent, especially in women of childbearing age. Circadian, metabolic, and reproductive systems have a complex, inter-regulated relationship. Thus, the disruption of one system likely impedes another. Excessive adiposity and circadian disruption alter normal behavior and physiology and disrupt the endocrine milieu. The overall goal of the studies described in this thesis was to develop and test a model system that could tease apart the influence of prepregnancy obesity and circadian disruption, as well as study the combined effects on female reproductive competence. </p> <p>The first study focuses on the prepregnancy period and aims to determine the effect of high fat diet feeding on diurnal eating pattern, body weight over the four-week period, the body composition at the end of the four-week period, hair corticosterone levels, and circadian fecal corticosterone patterns on female ICR mice. Five-week-old female ICR mice were randomly assigned to control (CON; 10% fat) or high fat (HF; 60%) diets and fed for four weeks to achieve adequate adiposity. During this four-week time period, mice had routine light exposure of 12h light and 12h dark. Feed was weighed at 0600 and 1745 Monday-Friday to determine diurnal feed intake. The mice were weighed on a weekly basis. After four weeks on respective diets, mice were anesthetized with isoflurane to measure crown-rump length to calculate BMI and hair was shaved for corticosterone extraction. Once mice recovered from anesthesia, body composition was measured with EchoMRI. After 1 week on diets, HF mice consumed more (P<0.05) during the day than CON mice, which is typically when mice are inactive. After two weeks on diets, HF mice weighed more (P<0.05) than CON, as well as had higher BMI and percent body fat (P<0.05) than CON after four weeks on diets. After four weeks on diets, HF mice had high hair corticosterone (P<0.05). Sampling feces over a 48h period at the end of the four weeks demonstrated that HF mice had elevated basal corticosterone, attenuated circadian rhythms, and a shift in corticosterone amplitude. The prepregnancy period demonstrated that high fat diets alone alter circadian eating pattern and corticosterone rhythms.</p> <p>The remainder of the study continued the dietary treatments assigned during the prepregnancy period, as well as implemented light conditions to create a 2Χ3 factorial study design. There were three light conditions: 12h light and 12h dark (LD), 24h dim light (L5), or 24h bright light (L100). Mice were moved into experimental light conditions after the observation of a vaginal plug or after 5 days with males. This portion of the study aimed to determine the effect of diet (CON or HF) and light exposure (LD, L5, or L100) on gestation length, number of pups born, milk composition, litter weight on postnatal day 12, as well as dam feed intake, hair corticosterone levels, and plasma prolactin. Continuous light exposure increased gestation length, with L5 (19.1 d ± 0.23) and L100 (18.9 d ± 0.21) having longer gestation lengths (P<0.05) than LD (18.1 d ± 0.25). Diet affected the number of pups born (P<0.05), with HF dams having fewer pups (9.99 ± 0.4) than CON (11.4 ± 0.4). Despite no difference in birth weight of standardized litters (n=8 pus/litter), litters of HF dams weighed more than CON by day 4 postnatal. The greater litter weight of HF dams continued until the end of the study on day 12 of lactation (P<0.05). Light had a tendency to increase litter weight (P=0.07). Diet, light, and stage of reproduction influenced dam feed intake (P<0.05). L100 dams had higher plasma prolactin, as well as final dam and mammary wet weights (P<0.05). Constant light exposure decreased ATP content in the mammary gland (P<0.05) and decreased milk lactose concentration (P<0.05). Pearson’s correlation analysis showed a positive relationship between mammary weight, fat pad weight, BMI, kcal of feed intake, and gestation length (P<0.05). In CON mice, hair corticosterone was negatively correlated with litter weight on lactation day 12. Liver weight was positively correlated with d 12 litter weight in HF mice. Together, these studies demonstrate that feeding high fat diets and continuous light alter maternal behavior and physiology, which may impact offspring health and development, however continuous light may not be the best approach to studying circadian disruption. Elevated maternal plasma prolactin and increased dam weight suggests a long day photoperiod was likely induced, thus potentially mitigating the circadian disruptive effects from constant light. Other model systems should be considered, such as using a chronic jet lag model that changes the light exposure every 3 d. </p>

Studien syftet är att undersöka om barn som har ammats längre än ett år har ökad risk för karies före sex års ålder. Metoden är en systematisk litteraturstudie där databaserna Cinahl, Cocharane och PubMed har sökts. Resultatet baserades på fyra kohortstudier och tio tvärsnittsstudier. Resultatet av dessa fjorton studier kan indelas i två riktningar, studier som visar att amning längre än ett år ökar kariesrisken och studier som indikerar att amning inte ökar risken för karies. Slutsatser: Utifrån resultatet av artiklarna får det anses att det vetenskapliga underlaget är otillräckligt för att hävda att amning ökar risken för kariesutveckling. / The purpose of this study is to investigate whether children who are breastfed longer than one year have increased risk of caries before the age of six. The method is a systematic literature review in which databases Cinahl, Cocharane and PubMED will be searched. The results were based on four cohort studies and ten cross-sectional studies. The findings of this fourteen studies can be divided in two directions, studies which indicates that breastfeeding increase the caries risk in children who are breastfed longer than one year and other studies indicates that there are no connection. Conclusions: Based on the results from the articles, it is considered inadequate to argue that breastfeeding increases the risk of caries development.

Breastfeeding rates in America are lower than other high-income countries, with Mississippi having one of the lowest rates. A survey using the Iowa Infant Feeding Attitude Scale (IIFAS) was distributed twice to Mississippi State University students to understand their breastfeeding attitudes. Attitudes were determined by calculating a composite score and conducting statistical tests for significance. Knowledge between health and non-health related majors were explored by using five statements, and attitudes towards the statement “Breastmilk is the ideal food for babies” were compared across demographics. Of 642 respondents, the composite score was 57.3 out of 85, and all demographics had a neutral score (between 49-69). All demographics agreed that “Breastmilk is the ideal food for babies” and health (46.1%) and non-health related majors (53%) had similar knowledge towards breastfeeding. College students may become parents, so understanding their attitudes can provide insight into their feeding methods and educational needs.

L’objectif du projet présenté dans ce mémoire de maitrise est d’évaluer l’effet du remplacement de la fléole des prés par la fétuque élevée, offertes en espèce pure ou en mélange avec la luzerne, et de vérifier l’impact de la méthode de conservation de la fétuque élevée, soit en ensilage préfané (35 % de matière sèche, MS) ou demi-sec (55 % de MS), sur les performances des vaches en lactation. Pour ce faire, cinq traitements ont été testés : 1) fléole des prés (70 % de la ration) en ensilage préfané ; 2) fléole des prés (42 % de la ration) + luzerne (28 % de la ration) en ensilages préfanés ; 3) fétuque élevée (70 % de la ration) en ensilage préfané ; 4) fétuque élevée (42 % de la ration) + luzerne (28 % de la ration) en ensilages préfanés ; 5) fétuque élevée (70 % de la ration) en ensilage demi-sec. Quinze vaches Holstein (128 +- 33 JEL) ont été distribuées dans un triple carré latin 5 × 5. Afin de comparer les traitements, les contrastes a priori suivants ont été réalisés : 1) fléole des prés-ensilage préfané vs fétuque élevée-ensilage préfané [(FP et FP + L) vs (FE et FE + L)]; 2) espèces pures-ensilage préfané vs mélanges-ensilage préfané [(FP et FE) vs (FP + L et FE + L)]; 3) interaction entre l’espèce de graminée fourragère et le mélange, pour les traitements à base d’ensilage préfané; et 4) ensilage préfané de fétuque élevée vs ensilage demi-sec de fétuque élevée [FE vs. FE (DS)]. Les contrastes ont été considérés comme significativement différents à des valeurs de P <= 0,05 et une tendance a été considérée quand 0,05 < P < 0,10. Les résultats ont démontré que l’espèce de graminée n’a pas influencé la consommation volontaire de matière sèche, la production laitière, et la teneur en gras du lait. La prise alimentaire et la production laitière ont été supérieures avec les mélanges fourragers, mais la teneur en gras du lait n’a pas été avantagée par ces derniers. La teneur en protéine du lait n’a pas été affectée par l’espèce de graminée pour les traitements à base de mélange fourrager, mais a été supérieure avec la fléole des prés pour les traitements de graminées seules. Les vaches ont consommé davantage de fétuque élevée sous forme d’ensilage préfané comparativement à l’ensilage demi-sec, mais la production laitière et la teneur en gras du lait n’ont pas été affectées par le mode de conservation. En somme, les résultats démontrent que la fétuque élevée est une bonne alternative à la fléole des prés pour les vaches en lactation et confirment les effets bénéfiques des mélanges fourragers dans leur ration.

Simulation is a critical component of nursing education. It provides a safe environment to practice and evaluate skills, supplements clinical hours, and removes barriers to a well-rounded education. Nurses are expected to be educators as part of our scope of practice, and simulation can facilitate this. One topic of nursing importance is lactation education, as breastfeeding has been shown to have multiple benefits for both mother and baby. National rates of exclusive breastfeeding for the first 6 months do not currently meet CDC recommendations. The pedagogy known as the Protégé Effect suggests that learning can be improved through teaching. Breastfeeding is a topic that inherently involves patient education but is currently given minimal attention in most nursing curricula. The purpose of this thesis is primarily to determine whether breastfeeding education within simulation improves student self-efficacy and secondarily, to explore the ramifications on clinical performance. A literature review was conducted across CINAHL, MEDLINE, Applied Science & Technology Source, ERIC, ScienceDirect, and Google Scholar to find studies comparing breastfeeding education to student self-efficacy within a simulated environment. Inclusion criteria included medical and nursing students at undergraduate- and graduate-level education, full text, written in English, and any student-led teaching opportunities about lactation and breastfeeding. After critical appraisal, 8 qualitative and quantitative articles were included in the study. Current literature strongly suggests breastfeeding simulations improve self-efficacy, but the findings are preliminary in nature. More research is needed. Including breastfeeding education in simulation can better prepare nursing students to assume their role as educators.

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