As manifestações do comportamento da criança e a capacidade de amamentar são fatores reconhecidos, pela mulher, como determinantes do bem estar do filho. A decisão adotada pelas mulheres diante do curso da amamentação, particularmente sobre sua capacidade de amamentar, se baliza em percepções próprias relacionadas aos atributos do leite produzido e às respostas de satisfação do filho. Este estudo teve como objetivos: caracterizar a prática da amamentação realizada pelas mulheres com base nos indicadores da OMS; caracterizar a prática do aleitamento materno exclusivo (AME) com base nos parâmetros: freqüência e duração das mamadas, intervalo entre as mamadas, término da mamada, alternância e esvaziamento das mamas; identificar a percepção materna sobre o leite produzido e sua relação com a duração, condução do AME e percepção sobre a saciedade da criança; identificar os problemas percebidos pelas mulheres durante a amamentação e sua relação com a duração do AME. Trata-se de um estudo epidemiológico, transversal, descritivo exploratório, que foi desenvolvido na UBDS Vila Virgínia, em Ribeirão Preto-SP. A amostra constituiu-se de 231 mulheres que acompanharam seus filhos de 0 a 4 meses, na consulta de puericultura ou para realização das vacinas, de fevereiro a agosto de 2008. Os dados foram coletados utilizando-se um questionário sobre a alimentação oferecida à criança, contendo 52 questões. Os dados foram processados e analisados no programa Statistical Analysis System (SAS), versão 9.0. Na análise realizou-se distribuição de freqüências, médias, desviospadrões, medianas, comparação entre médias, teste exato de Fisher e regressão logística. No momento da coleta de dados, 58,9% das crianças estavam recebendo AME e, para as outras crianças esta prática durou em média 47 dias (desvio-padrão = 35,4 dias). A média de mamadas foi de 9,4 por dia, 27 minutos cada mamada e intervalo de 1 hora e 54 minutos entre as mamadas. 88,3% das participantes ofereciam as mamas em livre demanda e o término da mamada era realizado pela criança em 87,0% dos casos. Após a mamada, 71,4% das mulheres sentiam a mama vazia. A percepção materna sobre o leite produzido apresentou resultado estatisticamente significativo quando associado com a saciedade da criança, indicando que as mulheres que perceberam a criança insatisfeita após a mamada têm 32 vezes a chance de apresentar uma percepção ruim sobre seu leite (p<0,01; OR ajustado = 32,70 e IC 95% [14,73 72,59]). Foi verificada diferença estatística significativa entre os intervalos de mamadas feitos pelas mulheres que tinham uma boa percepção sobre o seu leite e aquelas que tinham uma percepção ruim. (p<0,01, IC 95% [0,10 0,39]). Além disso, as mulheres que não apresentaram problemas durante a amamentação tem 2,53 vezes a chance de manterem o AME até os 4 meses de vida da criança (p<0,01; OR = 2,53 e IC 95% [1,48 4,34]). Concluise que, para as participantes deste estudo, o indicador mais utilizado para avaliar o seu leite produzido foi a satisfação da criança, mostrando que as ações pró-amamentação devem ser revistas, no sentido de contemplar as necessidades das mulheres e incentivar a sua confiança na capacidade de boa produção láctea. / Childrens behavior and the capacity to breastfeeding are factors recognized by woman, as determinants of her childs well being. The womens decision to breastfeeding, particularly concerned about their capacity to breastfeed, is based on their own perceptions about the attributions given to the human milk and the signs of childs satisfaction. This study aimed: to characterize the breastfeeding practice by women based on World Health Organizations indicators; to characterize exclusive breastfeeding (EBF) practice based on the following parameters: frequency and length of time, interval between breastfeed, how breastfeed ends, breasts interchange and breast emptying; to identify womens perception about the milk produced and its relation with the breastfeeding maintenance, exclusive breastfeeding behave and the perception of child satiation; to identify problems perceived by women during breastfeeding and their relation with the exclusive breastfeeding lastingness. This is a crosssectional descriptive study, developed in one Basic and District Health Unit in Ribeirão Preto SP, Brazil. The sample was composed by 231 women that were previously schedule in the child care service or immunization for the children with ages from 0 to 4 months, from February to August 2008. Data collection was performed using a specific questionnaire, with 52 items related to nutrition offered to the children. Data were analyzed using Statistical Analysis System (SAS), vs. 9.0. In the data analysis, frequency distribution, mean, standard deviation, median, means comparison, Exact Fisher Test and logistic regression were used. When data were collected, 58,9% of children were receiving EBF and, for other children this practice lengthen 47 days (standard deviation = 35,4 days). Daily breastfeeding mean was 9,4, 27 minutes each breastfeed and interval of 1,54 hours. 88,3% of participants offered ondemand breastfeeding and the breastfeeding end was lead by child in 87,0% of occurrences. After breastfeeding, 71,4% of women felt the breast empty. Maternal perception about produced milk showed statistically significant result when associated with childs satiation, indicating that women who perceived the child insatiate after breastfeeding had 32 times the chance to have a bad perception about their own milk (p<0,01; adjusted OR=32,70 and CI 95% [14,73-72,59]. Statistically significant difference was verified between the breastfeeding interval adopted by women who had good perception about their milk and by those who had a bad perception (p<0,01, CI 95% [0,10 0,39]). Besides, women who do not presented problems during breastfeeding have 2,53 times chance to keep EBF until 4 months of childs life (p<0,01; OR = 2,53 e CI 95% [1,48 4,34]). In conclusion, for the participants, the most used indicator to evaluate their own milk was child satisfaction, pointing that, actions probreastfeeding must be reviewed, in order to observe womens need and improve their confidence in their capacity to produce good milk.

O puerpério é a fase final do ciclo gravídico-puerperal, sendo permeado por intensas modificações físicas e psíquicas. Essas modificações podem ser influenciadas pelas orientações recebidas durante a gestação nas consultas de pré-natal, cursos de gestante e pelo meio sociocultural em que a puérpera está inserida, podendo resultar em alterações patológicas específicas do ciclo. Nesta perspectiva, a consulta puerperal de enfermagem tem o papel de prevenir essas alterações por meio de orientações e esclarecimentos das dúvidas apresentadas pelas puérperas, sendo importante atrelar o saber social/familiar com o saber científico e encaminhar para outros profissionais sempre que necessário. Assim, esta pesquisa objetivou identificar as principais queixas e problemas apresentados pelas puérperas durante a consulta e elaborar um fluxograma que se adapte às necessidades das puérperas atendidas na instituição. Trata-se de um estudo descritivo, exploratório e transversal com tratamento quantitativo dos dados. A estratégia utilizada para obtenção dos dados foi a entrevista semiestruturada, sendo composta por dados referentes à situação sociodemográfica, pré-natal, parto, puerpério e exame físico do binômio mãe-filho. As mães de recém-nascidos que permaneceram hospitalizados após a alta materna foram excluídas do estudo. O estudo foi realizado na maternidade de um hospital privado do interior paulista, entre os meses de outubro e dezembro de 2016, com uma população de 114 puérperas que tiveram o seu parto no respectivo período. Das puérperas avaliadas, 55,9% eram primíparas, e a faixa etária variou entre 19 e 43 anos de idade. No que se refere ao pré-natal, 97,3% realizaram mais que 06 consultas e 66,7% referiram não terem recebido nenhuma orientação sobre o período puerperal nas consultas de pré-natal. O parto cesáreo ocorreu em 89,5% dos casos. Todas as puérperas estavam praticando o aleitamento materno, e 42,1% destas relataram dificuldades em amamentar. No geral, essas dificuldades foram referentes a realizar a \"pega correta\" do recém-nascido ao seio materno. Dentre as complicações mamárias, verificou-se que 36,8% foram relativas a traumas mamilares, sendo as fissuras mamárias responsáveis por 30,7% dos casos. Das pacientes atendidas, 80,7% das puérperas necessitaram de orientações sobre autocuidado e/ou para os cuidados dispensados ao recém-nascido. Dos recém-nascidos avaliados, 90,4% apresentaram bom estado geral e foram liberados para a casa e 9,6% foram encaminhados para avaliação com pediatra. Conclui-se que, apesar da consulta puerperal ter indicado melhorias na assistência oferecida ao binômio mãe-filho, evidenciou-se o número reduzido de puérperas que retornaram ao serviço para realização da consulta puerperal, seja pela cultura de medicalização ou pela predileção das mulheres em realizar a consulta de puerpério com o médico. Com base nesses achados, faz-se necessário realizar ações educativas com as grávidas a fim de esclarecer a importância da consulta puerperal de enfermagem na prevenção e identificação precoce de complicações no binômio mãe-filho. / Puerperium is the ultimate stage of the pregnancy-puerperium cycle and is permeated by intense physical and psychological changes. These changes may be influenced by the guidelines received during pregnancy in the prenatal consultations, courses for pregnant women, and by the sociocultural environment in which the puerperal woman is inserted, which may entail pathological specific changes of this cycle. From this perspective, the puerperal nursing consultation has the role of preventing these changes by means of guidelines and clarifications of the doubts presented by puerperal women, and it is important to associate social/family knowledge with scientific knowledge and refer them to other professionals whenever required. Accordingly, this research was intended to identify the main complaints and problems presented by puerperal women during the consultation and to draw up a flowchart adapted to the needs of the puerperal women served at the institution. This is a descriptive, exploratory and cross-sectional study, where the data were processed quantitatively. The strategy used to obtain the data was the semi-structured interview, which was composed of data relating to sociodemographic situation, prenatal, delivery, puerperium and physical examination of the mother-child binomial. Mothers of newborns who remained hospitalized after maternal discharge were discarded from the study. The study was performed in the maternity ward of a private hospital in the countryside of São Paulo, between the months of October and December 2016, with a population of 114 puerperal women who had their delivery in the respective period. Of the surveyed puerperal women, 55.9% were primiparous, and the age range varied between 19 and 43 years. Regarding prenatal care, 97.3% underwent more than 06 consultations and 66.7% claimed that they did not receive any guideline about the puerperal period in the prenatal consultations. Cesarean delivery occurred in 89.5% of the cases. All the puerperal women were breastfeeding, and 42.1% of them reported difficulties in breastfeeding. In general, these difficulties were related to performing the \"right handling\" of the newborn on the maternal breast. Among the breast-related complications, we found that 36.8% were related to nipple traumas, where breast fissures were responsible for 30.7% of the cases. Of the treated patients, 80.7% of the puerperal women required guidelines on self-care and/or for the care provided to the newborn. Of the evaluated newborns, 90.4% presented good general condition and were released to the home and 9.6% were referred for evaluation with a pediatrician. We can conclude that, although the puerperal consultation has indicated improvements in the care offered to the mother-child binomial, we perceived a decreased number of puerperal women who returned to the service to undergo the puerperal consultation, either by the culture of medicalization or the preference of women in terms of undergoing the puerperium consultation with the physician. Based on these findings, there is a need to perform educational actions with pregnant women in order to clarify the importance of the puerperal nursing consultation in preventing and identifying as early as possible complications in the mother-child binomial.

Group B Streptococcus, or GBS, is a gram positive bacteria commonly found in the gastrointestinal, genital and urinary tract of healthy adults. Between 10% and 30% of all pregnant women are colonized with GBS in the vagina or rectum. While GBS colonized mothers typically show no symptoms or adverse health effects, the bacteria can be passed to their child during labor and delivery. Although significant progress has been made in the identification and treatment of GBS, it remains the leading infectious cause of Page 14 2014 Appalachian Student Research Forum morbidity and mortality among newborns in the United States. The current guidelines recommended by the Center for Disease Control and Prevention (CDC) and endorsed by the American College of Obstetrics and Gynecology (ACOG) is to test pregnant women for GBS colonization between 34-37 weeks of gestation. The current gold standard for identification of GBS colonization is the use of selective enrichment broth (SEB) followed by culture and biochemical testing. Identified concerns with the culture procedure are: 1) the length of time it takes to get the results, 2) the lower sensitivity if the SEB step is left out to improve turn-around-time (TAT) and 3) the limited number of qualified technicians available to perform the complex test. Recently, several semi-automated molecular assays have been developed for identification of GBS which are marketed as having equivalent sensitivity and specificity to SEB followed by culture. The goals of this study were to: 1) validate the sensitivity and specificity of an FDA approved GBS molecular assay (Illumigene, Meridian Bioscience) and 2) evaluate a new testing strategy utilizing SEB followed by the Illumigene GBS assay to see if it offers an improvement in TAT when compared to SEB culture in our in-house microbiology lab and to those sent out to a national reference lab for GBS DNA assay. During the validation process, 20 consecutive samples were submitted to SEB followed by simultaneous in-house culture and Illumigene assay for GBS. The method validation experiments were analyzed using the EP Evaluator version 11 statistical software (Data Innovations). Comparison of TAT was evaluated utilizing a blinded report generated from our Laboratory Information System (Harvest, Orchard Software) for a 2 month period for the GBS tests performed using the SEB followed by Illumigene molecular assay (n=73), in-house SEB followed by culture (n=50) and send-out reference lab GBS DNA assay (n=43) procedures. The TAT (hrs) for each method (Mean±SEM) were determined from the time of collection until result approval. The Illumigene assay had a high sensitivity (100%) and specificity (100%) when compared to SEB followed by culture for identification of GBS. Utilization of the Illumigene assay following SEB significantly (p

To examine the association between maternal depressive symptoms during early childhood of their offspring and later overweight in the children. Only children (n = 1,090) whose weights and heights were measured at least once for three time points (grades one, three and six) from the National Institute of Child Health and Human Development Study were included. Maternal depressive symptoms, defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or greater, were assessed using CES-D when the child was 1, 24, and 36 months. Childhood overweight was based on standardized height and weight measures taken during the interviews, and was defined according to appropriate CDC age- and sex-specific BMI percentiles. Generalized estimating equation was used to examine the impact of maternal depressive symptoms on the childhood overweight after adjusting for covariates. Compared to children of mothers without depression at any of the three time points, when children were one, 24 and 36 months of age, children of mothers with depression at all three time points were 1.695 times more likely to be overweight after adjusting for other child characteristics (95 % CI = 1.001–2.869). When further adjusted for maternal characteristics, children of mothers with depression at all three time points were 2.13 times more likely to be overweight (95 % CI = 1.05–4.31). Persistent maternal depressive symptoms may be associated with an increased risk of childhood overweight in their offspring. Children of mothers with depression may benefit from special attention in terms of obesity prevention.

Abstract available in The FASEB Journal.

No description available.

Obesity, elevated blood pressure and dyslipidemia are highly prevalent in Hispanic children. Compared to their non-Hispanic White peers, Hispanic children experience higher prevalence of obesity and hypertension. The Hispanic population in Tennessee has been growing, with about a tenth of newborn babies being Hispanic. This study aimed to: 1. Examine the influence of sociodemographic factors on Hispanic children’s cardiometabolic risk; 2. Assess the relationship between food group intake and cardiometabolic risk in Hispanic children; and 3. Evaluate the efficacy of non-traditional biomarkers for detecting cardiometabolic risk in Hispanic children. Data for the study came from a larger cross-sectional pilot study of metabolic syndrome in Hispanic children attending a community health center in Johnson City, TN. Descriptive and multiple logistic regression analyses were used. The prevalence of overweight and elevated blood pressure were 40.7% and 31.0% respectively. Children of obese mothers were more likely than children of mothers with normal body mass index to engage in less than three days of at least 60 minutes of vigorous physical activity (PA) per week (OR: 6.47: 95% CI: 1.61-26.0). Children whose mothers did not engage in moderate PA were more likely to have elevated blood pressure (OR: 2.50, 95%CI: 1.02-4.53); and to engage in less than three days of at least 60 minutes of vigorous PA per week (OR: 2.92, 95% CI: 1.18-7.24), than children whose mothers engaged in moderate PA. Children generally exceeded fruit and legume intake recommendations, but did not meet vegetable, wholegrain, dairy and fiber recommendations. Higher legume (OR: 0.052, 95% CI: 0.04-0.64), dairy (OR: 0.61, 95% CI: 0.37-0.99) and fiber intake (OR: 0.88, 95% CI: 0.81-0.96) were protective against elevated blood pressure, but only fruit intake was protective against overweight (OR: 0.93, 95% CI: 0.87-0.99). Leptin, C-peptide and TNF-α showed significant positive correlations with cardiometabolic risk factors. The optimal cut-offs for detecting three or more cardiometabolic risk factors were: leptin, 5.95 ng/ml, C-peptide, 0.73 ng/; and TNF-alpha, 4.28 pg/ml. Helping mothers to achieve and maintain a healthy BMI and promoting children’s consumption of more vegetables, fruits, dairy and fiber could help reduce cardiometabolic risk in Hispanic children.

The UpliftU® program is a long-term residential program for women and families who are homeless or at risk for homelessness. This program is one part of a larger, community-based non-profit organization serving low-income and homeless families in Hillsborough County, Florida for over 35 years. This program is not an emergency shelter program, but rather offers up to 18 months of participation in a self-sufficiency program to single women and families. The goal of the program is to prevent future homelessness for residents by helping them to reach their highest level of self-sufficiency. After volunteering at this organization for nine months, I completed an internship as the Health Specialist Case Manager for the UpliftU® program during the summer of 2008. The internship was conducted using ethnographic research methods to understand counseling team members' and resident mothers' perceptions of access to health care resources and their experiences in utilizing area health care services. This thesis compares the perspectives of the counseling team members with the resident mothers' perspectives, and examines barriers to and gaps in service provision, as reported by both groups. Findings from qualitative data analysis suggest that counseling team members conceptualize the barriers to health care as originating at the individual level with resident mothers' behaviors and actions, while resident mothers' expressed that they experience barriers to health care services at interpersonal and institutional levels. Resident mothers described how health professionals and staff treating them poorly leads to barriers to health care at an interpersonal level, and that at an institutional level the bureaucratic hassles associated with public insurance and public clinics also acted as barriers to care. Such differences in perception of causality of barriers to health care services between counseling team members and resident mothers have significant ramifications for resident mothers' health and ability to access health care services.

Introduction: The Center for Disease Control (CDC) reports that the maternal mortality ratio (MMR) in 1987 was 7.2 deaths per 100,000 live births compared to 18.0 deaths in 2015. This increase in MMR has occurred disproportionately. The same report demonstrates that black women are more than 3 times as likely to die of pregnancy-related causes than non-Hispanic white women. The present study explores how structural differences in the economy, education system, and public policy affect the health of black, pregnant women in the U.S. Methods: This research examined epidemiological studies of maternal mortality in the U.S. Data from previous studies was used to investigate the relationship between the racial disparity in MMR and societal, economic, and political factors that contribute to said relationship. Data from the Center for Disease Control (CDC), the U.S. Census Bureau, the United Nations (UN), and the Claremont Colleges Library network was examined. Results: Studies show that between 2008-2012, black women were found to have the greatest prevalence of preexisting conditions prior to pregnancy. Furthermore, white women are more likely to have their labor induced than black, Asian, and Hispanic women. The increased prevalence of preexisting conditions among black women can be greatly attributed to factors stemming from institutional racism. These factors include less access to health care, education, and equal economic opportunities. Conclusion: Implicit bias among practicing health professionals must be addressed via multiethnic education. It is necessary to create an equally safe environment for women of all races. Additionally, health care providers should take on the responsibility of educating pregnant women about any possible preexisting chronic conditions to properly care for themselves. Prenatal health education must be made readily available and accessible to all demographics. Reports demonstrate that the creation of standardized, disease-specific procedures that target chronic conditions may reduce the U.S. MMR. For black women to overcome the current rates of comorbidity, U.S. public policy must change in a way that decreases the disparity in the socioeconomic status of all Americans.

Background: The United States has one of the lowest rates of breastfeeding in the world. Studies hypothesize that inadequate social support from healthcare providers, family members, and employers may have contributed to the low breastfeeding rate. This study aims to: 1) examine the importance of each individual (father, maternal grandmother, paternal grandmother, obstetrician, and pediatrician) within the social support network on breastfeeding initiation and duration, 2) determine the relationship between type of prenatal care provider and time to breastfeeding cessation, and 3) examine the role of breastfeeding intention and confidence as mediators in the association between workplace support and breastfeeding duration Methods: This study analyzed data from the Infant Feeding Practices Survey II. Breastfeeding duration was reported as number of weeks. Breastfeeding initiation was dichotomized (yes; no). Logistic regression was used to investigate breastfeeding initiation. Cox proportional hazards models was utilized to assess the relationship between social support and breastfeeding duration. Structural equation modeling was used to determine the role of mediators in the association between workplace support and breastfeeding duration. Results: Mothers whose prenatal care was provided by a midwife were more likely to initiate breastfeeding and breastfeed for a longer duration. The relationship between workplace support and breastfeeding duration is mediated by a mother’s confidence in attaining breastfeeding goals. Lastly, this study found that multiple individuals within a mother’s social support network are important for breastfeeding initiation and duration. Conclusion: This project shed light into various components of social support that are integral to mother’s breastfeeding behaviors.