Thesis (Ph. D.)--Columbia University, 1941. / Vita. "Bibliography and references": p. 141-143.

Thesis (Ph. D.)--UCLA, 2009. / Vita. Description based on print version record. Includes bibliographical references (leaves 184-232).

Thesis (Ph. D.)--University of Texas at Austin, 2000. / Vita. Includes bibliographical references (leaves 487-506). Available also in a digital version from Dissertation Abstracts.

The World Health Organization (WHO) recommends exclusive breast-feeding until 6 months of age, where exclusive breast-feeding is defined as giving human breast milk only with no other foods or fluids. This recommendation has since been adopted by many countries. A systematic review of studies in exclusively breast-fed infants by Reilly and colleagues found a mean milk intake at 6 months of age that seemed too low to cover infant energy requirements. However, the evidence was relatively scarce, only from cross-sectional studies and based on the method of test-weighing, which has been criticised for under-estimating milk intake. Furthermore, longitudinal studies indicated no marked increase in milk intake over time, but these studies did not include measurements at 6 months of age. Reilly and Wells proposed the hypothesis that for exclusive breast-feeding to adequately cover infant energy requirements to 6 months of age, either 1) infants had to be unusually small, or 2) breast milk energy content had to be unusually high, or 3) milk intake had to be unusually high. The Reilly-Wells hypothesis was backed up by evidence of a world-wide low prevalence of exclusive breast-feeding to 6 months, and by studies consistently reporting a maternally perceived insufficient milk supply as a major reason for mothers to cease exclusive breast-feeding and introduce either formula supplementation or complementary foods. Based on the Reilly-Wells hypothesis, the research question for the First-Feed study was: To explore how exclusive breast-feeding to 6 months of age is achievable – mainly from an energy balance point of view. The First-Feed study tested the hypothesis that successful exclusive breast-feeding to 6 months of age would include 1) infants that were small and/or growing slowly, 2) milk intakes and/or milk energy content that were higher than literature values and increasing over time, 3) infant energy requirements that were lower than reference values, and/or 4) infant feeding practices that were strained by very frequent and/or very time consuming breast-feeds. The study was designed as the first longitudinal observational study to use an isotopic method to measure milk intake and energy balance in exclusively breast-fed infants to 6 months of age, and it evaluated parts of the methodology employed in the study, in order to appreciate the results in light of the methodological strengths and limitations. The First-Feed study found that infants were overall of normal size and growing well relative to WHO Child Growth Standards. Metabolisable milk intakes were significantly higher than the values obtained by Reilly and colleagues at both 3½ and 6 months of age, and increased significantly over time. Infant energy requirements, determined as metabolisable energy intake, was significantly higher than references for mean energy requirements at 3½ months of age, while it was appropriate at 6 months of age. Breast-feeding practices showed no change over time in feeding frequency, but a significant decrease in time spent on breast-feeds. The First-Feed study had several limitations. Firstly, due to the inclusion criteria of exclusive breast-feeding, the participants were characterised as an affluent and well-supported sample of mother-infant pairs, who were highly motivated to breast-feed. Therefore, the generalisability of the present study to other populations should be accepted with caution. Secondly, the anthropometric measurements were prone to imprecision, as is often the case in field studies. Thirdly, the imprecision of the dose-to-infant procedure for administration of doubly-labelled water considerably reduced the precision of the doubly-labelled water method. This, in addition to the biological variation, increased the variation in some outcome variables. However, the First-Feed study is unique as it is the first to use a more objective method to measure milk intake in a longitudinal design, and on a sample of infants with a very high success rate of exclusive breast-feeding to 6 months of age. The WHO changed the recommendation on exclusive breast-feeding from 4 – 6 months to 6 months (exactly) in 2001. Since then, many resources have been invested in breast-feeding promotion, but rates of initiation, duration and exclusivity is only slowly improving. The present study supports that exclusive breast-feeding can adequately cover infant energy requirements to 6 months of age - even without undue strain on breast-feeding practices and even in mothers where initial breast-feeding problems were very common. However, the present study found a wide variation in both infant size, milk intake and energy requirements. It therefore begs the question if a recommendation based on one age-point (6 months exactly) is appropriate given the vast biological variation in variables that are important for the adequacy of exclusive breast-feeding, or if the recommendation should be adapted to include developmental milestones (e.g. oral motor skills) indicative of readiness for complementary foods.

The majority of children attending ophthalmology clinics require a visual acuity assessment. The optimal technique depends on age as well as the ability to cooperate with testing. Most acuity assessments are performed subjectively by an orthoptist. Objective acuity assessment by Visual Evoked Potential (VEP) provides a complementary assessment in those subjects who cannot complete subjective tests. The aim of this study was to develop and evaluate a rapid, objective visual acuity assessment. The technique was named the step_ VEP and is based on the real-time analysis of steady-state VEPs (ssVEP). It presents high contrast checkerboard stimuli of sizes 0.4 to 3.0 LogMAR with a successive approximation algorithm. Speed of response detection, specificity and sensitivity were optimised by investigation of recording montage and analysis techniques in a group of normal children and adults (N=102). The success, duration and outcome of step_ VEP acuity assessment was compared to transient VEP (t-VEP) acuity assessment and subjective acuity assessment in a group of paediatric patients (N=218). I-D Laplacian analysis of three occipital electrodes was significantly faster than conventional recording and analysis (Oz-Fz) at detecting ssVEP responses near visual acuity threshold (3' checks) from three years upwards, and at detecting responses to 6' and 9' checks in the 7-9 year age group. A lateral electrode site at 15% of the half-head circumference was fastest most often in adults. Step_ VEPs were 16% more successful than t-VEPs and 9% more successful than subjective tests in providing a complete acuity assessment. Subjective acuity scores were systematically higher than VEP acuity scores in subjects who successfully completed both assessments. A closer agreement with subjective acuity scores was found for step_ VEPs than t-VEPs. The disparity between step_ VEP acuity score and subjective acuity score was shown to reduce with age.

Objective: to examine the effects of work on health and pyschosocial status among boys aged 10-16 years in Jordan. Study design: This is a comparative cross-sectional study, comparing working and non-working with respect to health and psycho-social outcomes, taking account of confounding due socio-economical factors. Results. Bivariate analysis showed that child's work was a strong significant predictor for eight z score, height z score, PCV, morbidity, skinfold thickness percentile and PEFR. This significant effect persisted in the full regression models after controlling for socio-economic and smoking status. Working children had significant lower weight z score (B=-0.31), height z score (B=-0.51), PCV (B=-2.96), skinfold thickness percentile (B=-6.85) compared to non-working subjects. Pyschosocial score tended to be reduced by 13 points (better pyschosocial status) when the child was non-working (B=-12.7). The significant negative relationship between work and PEFR in the bivariate model disappeared in the full regression model. In multiple regression modelling work status explained 3% of the 6.5% of variance explained in the weight z-score model, 6.7% of 9.8% for height z-score, 12.5% of 14.9% for PCV, 15% of 21% for skinfold thickness, 115 of 24% for PEFR, 9.4% of 30.9% for morbidity and 46% of 50% for pyschosocial status. Mean height and weight z-scores and packed cell volume among working children were significantly lower than those of their siblings; 5% and 9.6% of working children respectively were wasted and stunted (z score<-2 SD) compared to none of the siblings. No statistically significant correlation was also found between weight z-scores, height z-scores, packed cell volume and skinfold thickness of siblings and the proportion of household income contributed by the working child. Duration of work, child's monthly income, household per capita income and maternal height, were significant predictors of the growth of working children expressed by weight and height z score.

Weight monitoring is an integral part of routine community child health care in the United Kingdom. An intensive focus on fluctuations in charted weight of young babies has been charged by some breastfeeding advocates with undermining continued breastfeeding. Concern has also been expressed by clinicians and women about the applicability of current growth charts to breastfed babies - a concern echoed by the World Health Organisation. This ethnographic study involved two phases. Six months' participant observation in a child health clinic in the Northwest of England was followed by longitudinal interviews with 14 breastfeeding women. Equal numbers of first and second-time mothers were included; they were interviewed two to three times in the first six months. Data were analysed using grounded theory, allowing an in-depth examination of the lived experiences of weighing and how these shaped on-going feeding decisions and the course of breastfeeding. Weighing babies was the major focus of clinic visits for women and for health visitors. Interactions centred on the concern that the baby's weight should 'follow the line' of the centiles on the chart. Mothers and health visitors also collaborated in efforts to achieve prescriptive routines of baby feeding and sleeping. Breastfeeding was treated as a milk production system, and required to measure up. If weight gain caused concern a variety of strategies were used, including formula supplements and 'worrying'. Techniques to improve the physical effectiveness of breastfeeding were not part of the routine approach to any feeding difficulty on the part of either mothers or health visitors. Using anthropological theory, the character of weighing as a ritual occasion is explored. Weighing sessions are shown to provide occasions to mark the rite of passage through the liminal time of early motherhood. Building on the observation of this ritual experience, it is suggested that the experience of breastfeeding is 'even more liminal', as our society treats formula feeding routines and growth as the implied norm for infants. Weight gain which conforms to chart centiles has become the measure and arbiter of breastfeeding adequacy. Minor fluctuations in weight were treated as potentially serious threats to infant health, while the maintenance of breastfeeding was considered secondary. Recommendations are offered for improving the practical conduct of routine weight monitoring to improve its ability to identify growth which should genuinely spark concern. At the same time, the need for rituals to ease women through their early months of motherhood and the experience of breastfeeding is highlighted. Currently breastfeeding as a method of feeding milk to babies is poorly supported with suggestions for improving physical effectiveness, while at the same time, breastfeeding as a social practice is pushed to the margins of normal everyday experience. This lived dilemma for women and the health visitors who support them deserves attention at national policy level and serious consideration in overall planning of services.

Thesis (Ph.D.)--University of Tasmania, 2003. / Library has additional copy on CD-ROM. Includes bibliographical references.

Thesis (M.A.)--University of Texas at El Paso, 2008. / Title from title screen. Vita. CD-ROM. Includes bibliographical references. Also available online.

Thesis (Ph.D.)--Virginia Commonwealth University, 2008. / Prepared for: Center for Public Policy. Title from title-page of electronic thesis. Bibliography: leaves 105-112.