acase@tulane.edu / Community Based Nutrition (CBN) began implementation in Ethiopia in 2009 in four regions with the objective of improving maternal and child nutrition. Among other interven-tions, CBN scaled up behavior change communication (BCC) to promote household practices and behaviors known to be associated with improved child nutrition. Nutrition BCC was pri-marily delivered through a cadre of Voluntary Community Health Workers (VCHWs). Program exposure was measured using household reports of contact with VCHWs for nutrition BCC. This quasi-experimental study used data collected from two rounds of household surveys be-fore and after program implementation. The design of this study used the natural variation in CBN implementation to allow post hoc categorization of communities into high/low program intensity groups. This enabled an evaluation of the differences in nutrition outcomes associated with the different categories of program intensity that were observed in the sample. Community-level program intensity was measured using the percentage of households reporting VCHW exposure in each community, dichotomized into high or low at the sample mean. We found evidence of a scale up in CBN over the two survey rounds: Mean households reporting exposure to a VCHW in the previous six months increased significantly, as did the mean households in communities with high VCHW intensity. The association between selected nutrition behavior outcomes and the program was evaluated using three approaches: (i) an examination of the association between cluster change in the outcomes and community intensity of Volunteer Community Health Workers (VCHWs); (ii) examination of the association be-tween individual-level outcomes and community intensity of VCHWs; and (iii) examination of the association between the outcomes behaviors and household exposure to VCHWs. We found plausible evidence that CBN scale up was associated with greater dietary di-versity and more women eating the same or more in pregnancy. We also found that living in a higher VCHW intensity community or having exposure to VCHWs was associated with more women receiving IFA in pregnancy, but that this association was not modified by the survey round. We did not find consistent evidence that that the increases in VCHW intensity or expo-sure were associated with improvements in colostrum, hand washing, or minimum meal frequency. These results imply that community-based programs of this intensity can bring about change in nutrition behaviors linked to improved nutrition. / 1 / Lisa Saldanha

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Decision making could be defined as the ability to make a choice or a judgement before an individual takes action. How the individual works through the process of making a decision is influenced by a number of factors. It is acknowledged decision making is a complex process that involves cognitive and affective thought processing, together with interpretation, understanding, choosing between alternatives and taking action. The steps involved in this process are varied and range from a few to many depending on whose literature one is reading at the time. This descriptive cross sectional study aimed to determine what factors influenced a woman's decision when choosing the infant feeding method for her newborn. The information was gathered by means of a survey questionnaire and follow-up telephone interview. The factors identified as being important or influencing the decision were included on the survey. These factors were highlighted in previous studies and were considered part of the Theory of Reasoned Action (TRA) the framework on which this study was based. The one hundred and sixteen women who participated in this study had delivered term babies - that is babies over thirty-seven weeks gestation, in two hospitals in metropolitan Melbourne. A number of assumptions were tested. The descriptive statistics was generated using Statistical Package for Social Sciences (SPSS) Version 7. The qualitative data was analysed using thematic analysis. Eighty-five per cent (85%) of the women in this study made the decision to breastfeed and seventy-five per cent (75%) made this decision prior to their pregnancy being confirmed. Ninety-seven (83.6%) of the women stated their own values and beliefs had a major influence (i) on their infant feeding decision with just over twenty per cent (20.2%) of the women indicating the midwife had a major influence on their decision. Results of data supported or refuted the assumptions made at the beginning of the study and previous studies. These results also identified areas in midwifery practice that require change. This in itself will be a challenge for midwives. How they respond to this challenge may have an impact of the way women make the decision regarding their choice of infant feeding

Mothers of low socioeconomic status are less likely to breastfeed and more likely to formula feed. In addition, low socioeconomic status is associated with a premature introduction of cow’s milk, juice and solid foods. Negative outcomes such as asthma, diabetes and obesity later in life may result from improper child feeding practices. The aim of this study was to determine if WIC participants in Gwinnett County, Georgia are practicing child feeding recommendations set forth by the American Academy of Pediatrics (AAP) as well as following the Division of Responsibility in feeding developed by Ellyn Satter. Ninety-six WIC participants (92% mothers) primarily African American (39%) and Hispanic (35%) from Gwinnett County, Georgia were surveyed in March of 2011. Participants completed one of three surveys based on their method of feeding (breastfeeding, formula feeding or solid foods) after a nutrition education class. Compliance to feeding recommendations was determined among the entire survey population and by survey subgroups. Frequency distributions by method of feeding were calculated by age and race. Trends in feeding practices and the feeding environment were determined. Ten percent of participants surveyed reported breastfeeding, 22% reported formula feeding and 68% reported feeding solid foods. Participants who were not following AAP guidelines reported that they received advice primarily from health care professionals. Our results are consistent with previous research in that breastfeeding rates were low, the introduction of solids was early, and caregivers reported controlling feeding behaviors. Future research should focus on understanding the child feeding practices and beliefs of health care professionals.

BACKGROUND AND OBJECTIVES: Obesity is emerging as the most significant health concern of the twenty-first century. A wealth of neuroimaging data suggest that weight gain might be related to aberrant brain function, particularly in prefrontal cortical regions modulating mesolimbic addictive responses to food. Nevertheless, food addiction is currently a model hotly debated. Here, we conduct a meta-analysis of neuroimaging data, examining the most common functional differences between normal-weight and obese participants in response to food stimuli. DATA SOURCE: We conducted a search using several journal databases and adhered to the 'Preferred Reporting Items for Systematic Reviews and Meta-analyses' (PRISMA) method. To this aim, 10 studies were found with a total of 126 obese participants, 129 healthy controls, equaling 184 foci (146 increased, 38 decreased activation) using the Activation Likelihood Estimation (ALE) technique. Out of the 10 studies, 7 investigated neural responses to food versus non-food images. RESULTS: In response to food images, obese in comparison to healthy weight subjects had increased activation in the left dorsomedial prefrontal cortex, right parahippocampal gyrus, right precentral gyrus and right anterior cingulate cortex, and reduced activation in the left dorsolateral prefrontal cortex and left insular cortex. CONCLUSIONS: Prefrontal cortex areas linked to cognitive evaluation processes, such as evaluation of rewarding stimuli, as well as explicit memory regions, appear most consistently activated in response to images of food in those who are obese. Conversely, a reduced activation in brain regions associated with cognitive control and interoceptive awareness of sensations in the body might indicate a weakened control system, combined with hypo-sensitivity to satiety and discomfort signals after eating in those who are prone to overeat.