This study assessed losses of the linoleic, alpha-linolenic, arachidonic and docosahexaenoic fatty acids, vitamin B2 and total vitamin C during storage of human milk, pasteurized and unpasteurized. The volatile compounds’ pattern change was monitored. The storage conditions were 8 days at 4oC and 6 months at -20oC and at -80oC, with and without limitation of oxygen. Fatty acids were analyzed by GC-FID; vitamins - by HPLC; volatile compounds’ concentration patterns were obtained using the e-nose machine; ANOVA tests were applied, with the statistical significance assigned to P<0.05. The official recommendations for human milk storage of 5-8 days at 4oC and of 6 or more months at -20oC are appropriate in regard to the analyzed nutrients and can be extended for pasteurized human milk storage. Oxygen limitation and -80oC temperature have no clear benefit for nutrient preservation. The evaluation of the odour cannot be based exclusively on the e-nose analysis.

This study assessed losses of the linoleic, alpha-linolenic, arachidonic and docosahexaenoic fatty acids, vitamin B2 and total vitamin C during storage of human milk, pasteurized and unpasteurized. The volatile compounds’ pattern change was monitored. The storage conditions were 8 days at 4oC and 6 months at -20oC and at -80oC, with and without limitation of oxygen. Fatty acids were analyzed by GC-FID; vitamins - by HPLC; volatile compounds’ concentration patterns were obtained using the e-nose machine; ANOVA tests were applied, with the statistical significance assigned to P<0.05. The official recommendations for human milk storage of 5-8 days at 4oC and of 6 or more months at -20oC are appropriate in regard to the analyzed nutrients and can be extended for pasteurized human milk storage. Oxygen limitation and -80oC temperature have no clear benefit for nutrient preservation. The evaluation of the odour cannot be based exclusively on the e-nose analysis.

Objectives: There are three aims for this thesis: the first is to develop a field and laboratory protocol for the storage and analysis of transforming growth factor–beta 2 (TGF-β2) in human breastmilk; second, to validate this protocol and the immunoassay used to assess this new method; and lastly, to explore the ramifications of biosimilar TGF-β2 across multiple milks on human health, growth, and immunity through the review of laboratory findings and previous literature. Rational: Little anthropological research has been done on TGF-β2 in human milk. Anthropology as a discipline is well positioned to provide insight into TGF-β2, combining biocultural, evolutionary, and ecological approaches to holistically illustrate the effects this cytokine has on human immunity. This thesis provides an applied anthropological perspective and methodology on TGF-β2 in human milk. Methods: A protocol was developed for a new method of drying breastmilk on polystyrene microplates. Samples were then reconstituted using reagent diluent with 1% BSA and assayed using a Human TGF-beta 2 DuoSet enzyme-linked immunosorbent assay (ELIZA) assay kit from R&D Systems. Other mammalian milks and infant formula samples were also dried and tested for TGF-β2 concentrations. Validity of the assay and TGF-β2 concentrations were then statistically measured using linear regression analysis and Bland-Altman plots. Results: The results of the first objective in the development of a laboratory and field protocol for drying breastmilk on polystyrene plates for the extraction of TGF-β2 showed this method to hold promise for future application, but lacked statistical power in this study to confirm if this method is viable. The second objective of assay validation was unsuccessful, with the percent coefficient of variation for the intra-assay variation and inter-assay validation 38.28% and 17.70%, respectively indicating that this assay struggled to produce consistent and reliable results from the reconstituted samples. Results from the third objective suggest that biosimilar TGF-β2 in non-human milk can influence human growth and development, the extent of which, however, needs further study. Conclusions: Given these findings, more work with TGF-β2 in milk is required. TGF-β2 is a cytokine which could reveal a great deal about the developmental origins of human immunity and how it is maintained and altered across our life course and therefore an area of biology worth further research.

Globally, preterm birth (defined as birth at < 37 weeks of gestation) affects around 11% of deliveries and it is closely associated with cerebral palsy, cognitive impairments and neuropsychiatric diseases in later life. Magnetic Resonance Imaging (MRI) has utility for measuring different properties of the brain during the lifespan. Specially, diffusion MRI has been used in the neonatal period to quantify the effect of preterm birth on white matter structure, which enables inference about brain development and injury. By combining information from both structural and diffusion MRI, is it possible to calculate structural connectivity of the brain. This involves calculating a model of the brain as a network to extract features of interest. The process starts by defining a series of nodes (anatomical regions) and edges (connections between two anatomical regions). Once the network is created, different types of analysis can be performed to find features of interest, thereby allowing group wise comparisons. The main frameworks/tools designed to construct the brain connectome have been developed and tested in the adult human brain. There are several differences between the adult and the neonatal brain: marked variation in head size and shape, maturational processes leading to changes in signal intensity profiles, relatively lower spatial resolution, and lower contrast between tissue classes in the T1 weighted image. All of these issues make the standard processes to construct the brain connectome very challenging to apply in the neonatal population. Several groups have studied the neonatal structural connectivity proposing several alternatives to overcome these limitations. The aim of this thesis was to optimise the different steps involved in connectome analysis for neonatal data. First, to provide accurate parcellation of the cortex a new atlas was created based on a control population of term infants; this was achieved by propagating the atlas from an adult atlas through intermediate childhood spatio-temporal atlases using image registration. After this the advanced anatomically-constrained tractography framework was adapted for the neonatal population, refined using software tools for skull-stripping, tissue segmentation and parcellation specially designed and tested for the neonatal brain. Finally, the method was used to test the effect of early nutrition, specifically breast milk exposure, on structural connectivity in preterm infants. We found that infants with higher exposure to breastmilk in the weeks after preterm birth had improved structural connectivity of developing networks and greater fractional anisotropy in major white matter fasciculi. These data also show that the benefits are dose dependent with higher exposure correlating with increased white matter connectivity. In conclusion, structural connectivity is a robust method to investigate the developing human brain. We propose an optimised framework for the neonatal brain, designed for our data and using tools developed for the neonatal brain, and apply it to test the effect of breastmilk exposure on preterm infants.

Bakgrund Många mammor som fött barn prematurt önskar amning som uppfödning för sitt barn för bröstmjölkens immunologiska faktorer och som en kompensation för att graviditeten avslutats för tidigt. Amningens etablering kan vara komplicerad och kräva tålamod när barnet behöver vård. Beroende på barnets känslighet kan det ta olika lång tid tills barnet kan påbörja amningsträning. En av de viktigaste faktorerna för att amningen ska kunna etableras är att mamman får igång en tillräcklig mjölkproduktion motsvarande den mängd ett fullgånget barn skulle kräva. För att få igång en tillräcklig produktion är det bra att komma igång med urmjölkning så fort som möjligt efter barnets födelse. Mamman behöver stimulera mjölkproduktionen tills barnet ammar fullt. Syftet med studien var att belysa innebörden av urmjölkning för mammor vars barn fötts prematurt. Metod Det strategiska urvalet utgörs av sju mammor vars barn fötts före vecka 34 med erfarenhet av urmjölkning. Datainsamlingen består av öppna intervjuer och materialet har analyserades med en fenomenologisk hermeneutisk ansats. Resultatet visar att urmjölkning utförs i en oreflekterad ansträngning men att mammor är måna om de egna behoven samtidigt som behoven åsidosätts. Vårdkontexten kan kännas utlämnade och begränsande. Självtilliten får betydelse liksom strukturen. När utfallet inte blir som planerat kan sorgen innebära att förhålla sig till det som inte kan förändras. Känsla av hanterbarhet, begriplighet och meningsfullhet kan få betydelse för processen. Slutsats Ur ett vårdvetenskapligt perspektiv blir det betydelsefullt att utgå från den enskilda mammans upplevelser av urmjölkningen och stärka en god självtillit. / Background Many mothers who have given birth premature wish to breast feed their children for immunological reasons and as a compensation for a pregnancy that ended too early. The breast feeding may be complicated and in need of great patience as the child might need health care. Depending of the baby´s sensitivity it can vary in time for a child to start breast feeding. One of the important reasons for the mother to get her breast feeding started is to make milk production start, corresponding to the amount of milk that a fully mature baby would need. To get a sufficient production it is important to start emptying the breasts quick as possible after having given full extend. Aim with the study was to illuminate the meaning of emptying the breasts for mothers whos baby was born premature. Method Seven mothers who had given birth before week 34 and had experienced emptying breasts. The data collection come from interviews and the results have been analyzed by a fenomenological hermenutichal approach. Results shows that emptying the breasts is done without any effort but that mothers are eager to look at their own needs at the same time as their own needs are being put aside. The hospital care can make the women feel left out and controlled. Self-confidence gets important as well as the structure. When the result is not as you had planned sadness make you realize that things cannot be changed. The feeling of managing, understanding and meaningfulness fills you up. Conclusions looking at it from a scientific perspective it is very important to consider the individual mothers experience in how to empty the breasts from milk and how to strengthen her self-confidence.

abstract: In this study, I used critical, qualitative methods to explore how the material and symbolic dynamics of milk banking complicate expectations of organizing and (in)effective lactation. Guided by theories of alternative organizing, in/voluntary membership, the structuration of d/Discourse, and corporeal commodification, I conducted document analysis, fieldwork, and interviews with hospital and milk bank staff and maternal donors and recipients. Results trace the (her)story and protocols of the milk banking industry and examine the circumstances of donation and receipt; the d/Discourses of filth, suspicion, and inadequacy that circulate the lactating, maternal body; and the presence or resistance of commodification within each organization. Milk banking occurs when mothers provide excess breastmilk to parents with low supply or compromising medical conditions. “Milk banking” is used as an umbrella term for different ways of organizing donor milk; organizing evolved from wet-nursing to a continuum of in/formal markets. Formal markets include for-profit and non-profit milk banks that pasteurize and/or sterilize breastmilk for Neonatal Intensive Care Units. Informal markets involve self-organized exchanges online that are driven by monetary ads or donation. Both formal and informal markets elicit questions regarding flows of capital, labor, reproductive choice, and exploitation. However, current research resides in medicine, law, and popular press, so we know little about how milk banking happens in real time or how participation affects maternal identity. My analysis makes four contributions to organizational communication theory: (1) alternative organizing punctuates the construction of and conflicts between in/formal markets and shows why such theories should be represented as cyclical, rather than linear; (2) membership in milk banking is unintentional and distinct from in/voluntary membership; (3) the obscured organization is a necessary alternative to Scott’s (2013) hidden organizations; and (4) d/Discourses of “safety” are used to discipline and indict, not just represent operational differences. Social-rhetorical implications reveal how milk banking operates as an affective economy (Ahmed, 2004) and mark where privileges and inequalities are present in the absence of data; practical implications suggest consideration of policy changes. Methodologically, this study also offers insight into crystallization (Ellingson, 2009) and participant witnessing (Tracy, forthcoming) and challenges the hegemonic underpinnings of fieldwork. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2019

No description available.

Mothers are known to have an emotional attachment to their infant; however, some mothers also experience an emotional attachment to their own milk. Exclusive breastfeeding in the first six months of life, followed by continued breastfeeding with complementary solids are recommended by the American Academy of Pediatrics and the World Health Organization. Some mothers produce enough surplus milk to donate to a human milk bank. This thesis considers the emotional attachment to milk experienced by women who donate milk to a milk bank. This research is based on participant observation in a human milk bank in Florida and interviews collected from 14 milk bank donors. These methods were informed by the frameworks of moral motherhood and emotive value to foreground and enhance understanding of mothers' experiences. The results of this study show that mothers do not emotionally attach to breastmilk itself, but rather what the breastmilk represents. This study starts a conversation and brings awareness to women's emotional experiences at the beginning of motherhood, especially as they pertain to breastfeeding and human milk.

Between 1994 to 1998 the ANRS 049a DITRAME trial was conducted during which a short regimen of ZDV demonstrated for the first time acceptability, tolerance and efficacy on reduction of mother-to-child transmission (MTCT). Our major aim was to analyze certain virological characteristics of infected women in this cohort and their association to HIV-1 transmission. On the one hand, we analyzed the HIV-1 replication capacity in different physiological compartments : blood, vaginal fluids (VF) and breast milk (BM) related to MTCT were investigated by nested case control studies in the DITRAME cohort. We demonstrated the relationship between plasma viral load (VL), at 34 weeks of amenorrheae and at Day 8 post partum, and MTCT in Africa where the probability to be exclusively breastfed for an one year infant is 46.6%. We also analyzed relationship between plasma VL and ZDV treatment. Additionally, we demonstrated that MTCT is essentially the consequence of a high proviral load in VF in our context. Moreover, reduced levels of HIV-1 RNA in milk at Day 8 were observed in mothers receiving ZDV therapy rather than in mothers under placebo. For the first time, the association between BMVL and postnatal transmission has been studied. We observed a highly significative difference between BMVL of women who transmitted the virus and those who did not. Moreover, univariate and multivariate analyzes clearly indicated that early breastfeeding log10 HIV-RNA at Day8 is an independent factor significatively associated to MTCT. Decreased median BMVL from 1608 copies/mL (c/ml) at Day8 to 346 c/ml at Day45 were found for mothers who transmitted the virus during the postpartum and who received placebo. Nevertheless, for those who received ZDV, median BMVL increased from 56 c/ml at Day8 to 470.5 c/ml at Day45. This marked trend to a rebound effect of BMVL could be the consequence of the treatment withdrawal as observed for adults at HAART withdrawal. On the other hand, we studied the variability of HIV and its association with MTCT. First, we analyzed HIV-1 diversity in African women in France and Burkina Faso. In a second step, we demonstrated that HMA was an adapted tool for co and super-infections studies for adults. By this way, we identified two superinfections among 147 women within our commercial sex workers cohort. Additionally, we used this tool to analyze children of the DITRAME cohort who were infected in utero and who could be superinfected during the delivery or later by breastfeeding. We identified seven children, among 18 who were infected in utero, displaying HMA profiles suspicions for co-infections, and who had a more important mortality rate than normally. Their proviral env sequences are currently analyzed. Moreover, we confirmed the fact that the rate of vitamin A has no influence on MTCT. De 1994 à 1998, s’est déroulé l’essai clinique DITRAME ANRS 049a qui a démontré, pour la première fois, l’acceptabilité, la tolérance et l’efficacité d’un traitement court de zidovudine (ZDV) sur la diminution de la TME. Notre travail s’est inscrit dans le cadre de cet essai et a eu pour but d’en analyser certains des aspects virologiques et leur rapport avec la transmission de la mère à l’enfant du VIH (TME). D’une part, nous avons analysé les niveaux de réplication virale dans différents compartiments physiologiques : le sang, les sécrétions cervico-vaginales (SCV) et le lait maternel (LM) et leur rapport avec la transmission, par des études cas-témoins nichées dans la cohorte DITRAME. Nous avons démontré le rapport entre la charge virale libre (CV) dans le plasma à 34 semaines d’aménorrhée et à J8 postpartum et la TME dans le contexte africain où la probabilité d’avoir un allaitement exclusif à un an est de 46,6%, et analysé leur rapport avec le traitement ZDV. Nous avons également démontré que la TME est essentiellement due à une charge provirale plus élevée dans les SCV dans notre contexte. De plus, grâce à la mise au point d’une technique, nous avons démontré que la ZDV avait un effet global marqué sur la diminution de la CV libre dans le LM. Il s’agit de la première étude mettant en relation la CV dans le lait avec la transmission postnatale. De même, nous avons observé une différence très hautement significative entre les charges virales libres des femmes ayant transmis le VIH et les non transmettrices. De plus, nos analyses univariée et multivariée démontrent que la CVlm mesurée en log10 de la lactation précoce (J8) est un facteur indépendant très significativement associé à la TME. Chez les femmes ayant transmis le virus durant le post-partum et non traitées à la ZDV, la CVlm médiane a décru de 1608 copies/mL (c/ml) à J8 à 346 c/ml à J45. Par contre, chez les femmes ayant transmis le virus mais ayant reçu un traitement ZDV, la CVlm médiane évolue de 56 c/ml à J8 à 470,5 c/ml à J45. Cette tendance marquée à un effet rebond de la CVlm à J45 laisse penser que la TME qui a lieu chez les femmes traitées à la ZDV pourrait être une conséquence de l’arrêt de ce traitement, comme observé chez les adultes après arrêt du traitement HAART. D’autre part, nous avons étudié la variabilité du VIH en fonction de la TME. Dans un premier temps, nous avons analysé la diversité du VIH-1 chez des mères africaines vivant en France, et par après au Burkina Faso. Ensuite, grâce à l’élaboration d’une nouvelle technique, nous avons démontré que le HMA pouvait être un outil adapté à l’étude des co- et sur-infection chez l’adulte. Nous avons identifié de cette manière deux surinfections parmi 147 femmes analysées au sein d’une cohorte de femmes à haut risque de surinfection. Nous avons ensuite utilisé ce moyen pour étudier des enfants de la cohorte DITRAME infectés in utero qui auraient pu se surinfecter durant le peripartum ou ensuite par l’allaitement. Sept enfants parmi 18 analysés, présentant des profils HMA à suspicion de coinfection et qui présentaient un taux de mortalité plus élevé que la normale, ont été identifiés. Leurs séquences provirales env sont en cours d’analyse actuellement. Par ailleurs, nous avons confirmé le fait que le taux de vitamine A n’a pas d’influence sur la TME.

<p>Background: The Baby Friendly Hospital Initiative (BFHI) is considered one of the most successful international efforts to protect, promote and support breastfeeding. The initiative has proven impact, increasing the likelihood of babies being exclusively breastfed for six months. Official designation as Baby Friendly requires careful assessment completed by a trained external team to confirm that the institution is truly carrying out all Ten Steps of successful breastfeeding and conforming to the International Code of Marketing of Breastmilk Substitutes (BMS).The implementation of these principles are however challenging for facilities as it requires &ldquo / strategic planning, implementation and maintaining change&rdquo / within the facilities. Aim: To assess the factors influencing the implementation of BFHI principles in non accredited MOU` s in the Metropole region of the Western Cape.</p>