Optimal maternal nutritional status is required for development of a healthy infant. Drinking during pregnancy puts mothers at risk for nutrient deficiencies, endangering the health of the fetus and increasing the risk of Fetal Alcohol Spectrum Disorder (FASD). The current body of research has focused on interventions using nutrients important to fetal brain development (choline, DHA, folate, vitamin A, zinc) to reduce FASD in animal models. Whether mothers at risk for having a baby with FASD are consuming adequate amounts of these nutrients during pregnancy is unknown, due to a lack of sufficient research data. Therefore, this study aims to identify intake of nutrients important to fetal brain development in pregnant mothers. Through community engagement and partnerships with Mount Carmel Clinic and other prenatal programs located in Point Douglas and Downtown Winnipeg, 56 pregnant women were recruited and interviewed. Findings show that intake of certain nutrients important to fetal brain development are not being consumed in recommended amounts. While most participants met the Dietary Reference Intakes for zinc and vitamin A, only 44.6% met recommendations for folate, 48.2% for choline, and 16.1% for DHA. Dietary intake was not significantly different between women with alcohol exposure during pregnancy and those without. These results are important due to the high rate (46%) of women with prenatal alcohol exposure. Study outcomes may provide future nutrition interventions to enhance the health of mothers consuming alcohol during pregnancy and their infants, potentially reducing the effects of FASD. / October 2016

The purpose of this study was to determine whether participation in a Family Resource\Youth Services Center New and Expectant Parenting Series had an impact on maternal and child health knowledge of parents and their future behavior choices. The study had two components. First, a telephone survey was conducted with 40 past program participants asking them nine questions concerning behavior and lifestyle choices in regards to child safety, breast or bottle feeding, immunizations, car seat use, etc. Secondly, thirty participants were given a pretest and posttest questionnaire. As a control group, there were 25 Lamaze class participants, who also completed the pre-test and posttest questionnaires. The questionnaire was a 20 item multiple choice instrument (Learning About Parenting Survey or LAPS) which measured maternal and child health knowledge in such areas as family planning; informed parenting; maternal health; basic baby care; breast-feeding; bottle-feeding; first aid; child's health including immunizations, child safety; nutrition; child development and discipline. Analysis of covariance was performed using the LAPS raw scores from the posttests as the dependent variable, the pretest scores as the covariate and the treatment as the independent variable. The results showed no significant difference in parenting knowledge between the individuals enrolled in the Family Resource\Youth Services Center's New and Expectant Parenting Series and the comparison group who did not take the course.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 6 uppsatser.

Introduction: The prevalence of opioid abuse has increased throughout Northeast Tennessee. Subsequently, more infants are born drug-exposed or with Neonatal Abstinence Syndrome (NAS). According to the Tennessee Department of Health, hospitalizations for deliveries with maternal substance abuse tripled in Tennessee between 1999 and 2011. During this period, the inpatient hospitalization rate for NAS increased 11-fold. In 2017, there were 163 NAS cases reported in Northeast Tennessee. Depending on intrauterine and environmental exposures, there may be differences in health, growth, behavior, and development in infants. Our goal was to assess and explore those differences to help update education and care recommendations for pediatric primary care clinics. Methods: This cross-sectional study was set in a Northeast Tennessee pediatric clinic. 120 patients seen for a newborn visit between June 30, 2013 and July 1, 2014 were randomly selected. An additional sample of all infants with suspected drug exposure was identified for this period based on diagnosis codes. In total, 99 infants had no drug exposure and 62 were drug-exposed. An 83-item chart abstraction template was developed. Data was analyzed by SPSS. The chi-squared test and Mann-Whitney U test were used, with a critical value of p<0.05 to determine significance. The Bonferroni correction was applied to account for multiple comparisons. The research protocol was reviewed and approved by the Institutional Review Board of East Tennessee State University. Results: Of the 120 charts initially selected, 3.33% of infants were exposed to buprenorphine, 1.67% to methadone, 0.83% to marijuana, 0.83% to cocaine, and 1.67% to tobacco, 8.33% to benzodiazepine, and 1.67% to barbiturates during gestation. In total, 18.33% of infants had any drug exposure, 10.00% to any opiate, and 3.33% had a documented diagnosis of NAS in their chart. Prenatal drug exposure was significantly associated with multiple demographic factors as well as pediatric respiratory, behavioral, gastrointestinal, infectious disease, and cardiac conditions. Conclusions: Prenatal drug exposure was significantly associated with multiple pediatric complications. This illustrates the significance of addressing the increased incidence of prenatal drug exposure in Northeast Tennessee. Future multivariate analyses will attempt to control for potential confounders. This analysis is retrospective and exploratory, and any associations should be confirmed with a prospective study. A weakness of this study includes potential under-diagnosis of drug exposure and NAS due to lack of documentation in the EHR. Additional research will include further comparison of maternal and infant complications in drug-exposed and non-exposed infants. This will allow for a better understanding of the risks associated with maternal drug exposure. Findings from these research projects will be used to inform clinical initiatives for NAS in Northeast Tennessee.

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. 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. 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.

This study is an assessment of the quality of sexually transmitted disease (STD) management and control in a rural district of South Africa. A semi-structured questionnaire was administered to 5 nurses from public sector primary health care clinics, 5 doctors from the public district hospital, 5 private general practitioners, 6 traditional healers and 7 STD patients. A patient simulation exercise involving 6 nurses and 6 general practitioners was also conducted. Using routine data collection forms, the spectrum of STD syndromes and the contact tracing rate were assessed. The private sector treated nearly a third of the STDs even though they charge about ten times the price of the public sector services. In general, the clinical skills of all providers were poor. While hypothetical patient histories produced reasonable responses on STD management during the interviews, the patient simulation results showed that health service providers provided STD management that was much poorer than the questionnaires indicated. The private general practitioners did not practice syndromic STD management and often did not use laboratory tests appropriately resulting in incorrect diagnosis and inappropriate treatment for STDs. All health service providers did not counsel, promote condoms or encourage contact notification adequately. All health service providers were keen to participate in continuing medical education that better equip them to manage STDs. Any attempts at improving the quality of care in the district must therefore include private general practitioners as an important and central component of STD policy and planning. Interviews with traditional healers and patients showed the importance of using non-biomedical constructs of health and illness in developing health promotion strategies. There is an urgent need to improve STD management at district level in an attempt to meet the first milestone of ensuring that a patient presenting with an STD to a health service is correctly managed. This can be done through the design of simple quality assurance methods as demonstrated in this paper.

Smoking during pregnancy remains a significant public health issue despite knowledge about the adverse maternal and fetal health effects. This research had six purposes: identifying effective smoking cessation strategies for low income pregnant women; identifying characteristics of Kentucky women who smoke during pregnancy; estimating the role of smoking on birth outcomes in Kentucky; exploring the impact of tobacco reduction on birth outcomes; identifying the characteristics of women participating in the Giving Infants and Families Tobacco-free Starts (GIFTS) pilot program; and evaluating the impact of GIFTS on smoking status and birth outcomes. Seven randomized controlled trials targeting low income women with smoking cessation interventions identified social support and incentives as promising strategies. Only one study focused on women living in rural settings. Live birth certificate data from 2004-2008 revealed that 26% of Kentucky women reported smoking during pregnancy. Continuing to smoke approximately doubled the odds for low birth weight (LBW) [Estimated Odds Ratio 1.95 (95% Confidence Interval 1.87-2.03)] and no breastfeeding initiation (NBI) [1.93 (1.87-1.98)] versus no pre-pregnancy smoking. Continuers also had higher odds for preterm birth (PTB) [1.25 (1.20-1.29)] and neonatal intensive care unit admissions (NICU) [1.20 (1.14-1.26)]. Reducers and quitters had increased odds of LBW and NBI. The probability of quitting relative to the probability of continuing was increased for women aged less than 25, non-White, Hispanic, graduate degree, obese and "other" payor source for the delivery. The GIFTS program targeted pregnant women receiving local health department services who reported recent or current tobacco use. Significantly increased odds of participation were identified for women reporting 1-5 [2.05 (1.06-3.94) ], 6-10 [2.06 (1.10-3.83)] and ≥11 [2.17 (1.12-4.20)] cigarettes per day compared to those reporting no cigarettes. Women with one [1.55 (1.07-2.24)] or two [1.83 (1.21-2.76)] previous quit attempts also had increased odds for participation compared to those with no quit attempts. GIFTS participants were significantly less likely to have preterm infants (p=.0369) than a matched comparison group. No significant differences were found on tobacco cessation, tobacco reduction or cessation, LBW, NICU, or NBI. This research has implications for future cessation efforts as well as policy development.

Participation in risky behaviors is a common threat to an adolescent's health. Youth engagement (YE), a youth's meaningful and sustained participation in an activity, is a way to help reduce that threat. The Medical Reserve Corps (MRC), a public health emergency preparedness and response organization, has opportunities for engaging youth. However, few adolescents participate in MRC activities, signaling network-wide variations in working with youth. Furthermore, there is a gap in the literature exploring YE in emergency preparedness organizations, including the MRC. The purpose of this dissertation was to better understand youth engagement and development within organizations like these. With the MRC as the example and youth development theories as the lens, YE was examined as well as challenges and benefits of YE, needs, and use of YE strategies within the MRC. An exploratory sequential mixed-methods approach was used to assess YE in the MRC: Phase I- key informant interviews of youth (ages 14-18) and adults in and out of MRC (N=17); and Phase II- a nationwide web-based survey of adult MRC unit leaders (N=215). Qualitative data was analyzed with Microsoft Word and Excel; quantitative data analyzed with Stata 12.0. Results revealed common challenges experienced by MRC units working with youth, including liability concerns. Benefits found include preparation of the youth for future careers and giving youth a focus beyond themselves. A Spearman's correlation found a statistically significant association (r=0.30, N=52, p=0.0288) between the use of the core YE principles and the level of youth participation among the MRC units with youth membership, meaning use of these principles may be helpful in better involving youth. Furthermore, "Building Youth and Adult Capacity" was the top YE principle used among the MRC units that allow youth membership to engage youth. Despite noted challenges, engaging adolescents in the MRC still has many benefits with long-term public health and maternal and child implications for youth in emergency preparedness organizations. These include development of a responsible youth that protects their peers, families, and local communities from public health challenges, positively impacting the community. Recommendations for building student MRC programs across the nation have been provided.

Objective The purpose of the mixed methods study was to compare barriers and facilitators encountered by low-income African American women who engaged in different infant feeding practices. Methods Using the positive deviance approach and modified Integrated Model as theoretical frameworks, the research began with a qualitative study that informed a survey examining intention, skills, and environmental factors differentiating women’s infant feeding practices. Results Twenty-eight and 190 low-income African American adult women participated in focus groups or interviews and a survey, respectively. In the qualitative study, positive deviants, who breastfed for at least four months, seemed to have stronger breastfeeding intentions, self-efficacy and breastfeeding support than other women. In the final multinomial multiple logistic regression, for a one unit increase in the PBC scale of the revised Breastfeeding Attrition Prediction Tool, there was a 50% (OR 1.5[1.3-1.7]) and an 18% (OR 1.18 [1.03-1.3]) increase in the odds of breastfeeding at least three months (positive deviance) compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who did not smoke postpartum were 4.3 [1.5-12.3] and 5.6 [2.1-15.1] times as likely to be positive deviants; women who had C-sections were 3.6 [1.3-9.6] and 2.9 [1.0-7.8] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Women who ranked WIC full breastfeeding packages as most valuable were 14.9 [4.8-45.5] and 16.1 [5.3-50.0] times as likely to be positive deviants compared to only formula-feeding and breastfeeding for less than three months, respectively. Discussion High breastfeeding self-efficacy was associated with positive deviance, although the qualitative study findings suggested that general self-efficacy may also influence breastfeeding success. The likelihood of not smoking being associated with longer duration of breastfeeding is consistent with previous research. The C-section results may reflect a longer length of hospital stay leading to increased mastery of breastfeeding prior to discharge. Analysis of participants’ valuation of WIC infant feeding incentives led to the suggestion that WIC incentives be re-examined. Further exploration of these findings and subsequent interventions may lead to improved breastfeeding rates among low-income African American women.

As práticas alimentares da criança menor de um ano trazem inúmeras particularidades que transcendem o biológico e, portanto requerem ser analisadas nas dimensões culturais, psicológicas, sociais e econômicas. Desta forma, buscou-se compreender quais as representações sociais das mulheres/mães sobre as práticas alimentares das crianças menores de um ano. Tratase de uma pesquisa qualitativa, desenvolvida com 15 mulheres/mães de crianças menores de um ano e usuárias de um serviço da rede básica de saúde de Ribeirão Preto-SP. A coleta de dados foi através de entrevistas semi-estruturadas gravadas e transcritas na íntegra e registros de imagens do contexto social da alimentação da criança, fotografadas pelas mães. A coleta se deu após o consentimento livre e esclarecido, no domicílio dos sujeitos. O conteúdo foi categorizado com base na técnica de análise de conteúdo, modalidade temática, e as fotografias possibilitaram uma análise complementar. À luz das representações sociais na perspectiva socioantropológica, analisou-se como as mulheres, enquanto agentes do cuidado infantil, em especial da alimentação do filho, atuam nas diversas dimensões do \"espaço social alimentar\". Depreenderam-se quatro categorias temáticas: 1) O contexto de construção das práticas da alimentação infantil: a alimentação da família; 2) A alimentação da criança no primeiro ano de vida; 3) Pessoas tidas como referência para as práticas alimentares infantis e 4) A alimentação e a saúde da criança. A alimentação é a primeira socialização dos indivíduos, e a família é tradicionalmente o lócus no qual a aprendizagem social se dá, tendo os pais, particularmente as mães, a função de primeiros educadores alimentares. As mães fornecem os sentidos e ideologias que sustentam e determinam as decisões alimentares, desde o primeiro alimento recebido, o leite materno, até a introdução à comida da família. O comportamento alimentar da criança está delimitado por condicionantes fisiológicos, como as alternâncias de sensação de fome e saciedade, parâmetros esses manifestados pelas crianças, que guiam as condutas maternas na oferta do peito ao filho e na avaliação de sua capacidade como nutriz, evidenciando a necessidade de introduzir outro leite. Na alimentação complementar, o aspecto socioeconômico tem peso determinante na seleção dos alimentos, assim como o valor do alimento que deve ter vitaminas e que sustente a criança. A aceitação da comida, avaliada com base na quantidade ingerida, é entendida como uma preferência da criança, a qual guiará as condutas maternas futuras. Relacionam ainda a aceitação da comida como um comportamento esperado de uma criança saudável. O preparo dos alimentos infantis segue princípios que acreditam ser compatíveis com a fase de desenvolvimento da criança, sendo a textura e consistência valorizadas para evitar engasgos, e ao mesmo tempo encorpadas para garantir a sustância da criança. As práticas alimentares infantis se orientam por saberes que perpassam pela legitimidade do discurso científico e alcançam as subjetividades do conhecimento das mulheres do meio relacional, predominantemente de domínio feminino. A introdução precoce da comida da família, \"a mesma comida que a gente come, ele come\", é uma prática comum. Assim, as práticas alimentares demonstram estabelecer-se em um universo próprio que vai além do acesso à informação e das condições socioeconômicas, mas perpassam pelos desacordos existentes entre a prática declarada e a prática real, sendo guiadas pelas representações da comida como fonte de saciedade, evitando a fome, dando sustância e deixando a criança com o corpo forte e saudável. / The feeding practices of children under one year of age take on innumerable particularities that transcend the biological aspect, and, therefore, should be analyzed according to the cultural, psychological, social, and economic dimensions. Hence, the aim of this study was to understand what social representations that women/mothers have toward the feeding practices of children under one year of age. This is a qualitative study, developed with 15 women/mothers of children under one year of age, users of a public health service in the city of Ribeirão Preto, São Paulo State. Data collection was performed using semi-structured interviews, which were recorded and fully transcribed, in addition to photographs of the child\'s social context in feeding, provided by the mothers. This process took place after receiving consent from the participants at their households. The content was categorized based on content analysis technique, thematic mode, and the photographs allowed for a complementary analysis. Considering the social representations from the social-anthropologic perspective, the authors analyzed how women, as child care agents, particularly regarding their child\'s feeding practices, act in the various dimensions of the \"social feeding environment\". Four thematic categories emerged: 1) The context of constructing child feeding practices: feeding the family; 2) Child feeding in the first year of life; 3) People considered as a reference for child feeding practices, and 4) Child feeding and health. Eating is a person\'s first socialization experience, and the family is traditionally the location where social learning takes place. Therefore, parents, particularly mothers, have the role of being the first eating educators. Mothers provide the senses and ideologies that support and determine feeding decisions, from the first food provided, breast milk, to the introduction of food in the family. The child\'s eating behavior is limited by physiological conditionings, such as alternations between feelings of hunger and satiation. Children demonstrate these parameters, and guide the mother\'s act of offering her breast to her child and of evaluating her capacity of nursing, which may raise the need of introducing another milk. In complementary feeding, the socioeconomic aspect determines the selection of foods and the value assigned to the food that has the vitamins needed to feed the child. The acceptance of food, evaluated based on the amount consumed, is understood as the being a child\'s preference, and will guide the mother\'s behaviors in the future. Furthermore, there is an assumption that accepting food is a behavior expected in healthy children. The preparation of child food follows principles that believe to be compatible with the child\'s stage of development, in which texture and consistency are considered to avoid chocking, but are also made thick to assure child nourishment. Child feeding practices are guided by knowledge that skims over the legitimacy of scientific discourse and reaches the subjectivity of the knowledge of women in the relational environment, one that is mainly of feminine domain. The early introduction to family food, \"he eats the same food we eat\" is a common practice. Thus, feeding practices are established in their own universe, which goes beyond access to information and socioeconomic condition. However, they are also subject to the disagreement existing between the declared practice and the real practice, and are guided by the representations of food as a source of satiation, avoiding hunger, providing nourishment, and making the child strong and healthy.