Objective: The goal of this study is to uncover sociocultural barriers to breastfeeding among African American women in the Atlanta metropolitan area and provide an educational intervention based on identified barriers to increase the willingness to breastfeed. Methods: Non-Hispanic African American women, 6 to 9 months pregnant, between the ages of 18 and 45, of varying socioeconomic status were recruited from multiple Obstetrics and Gynecology clinics throughout the Atlanta-metropolitan area. Participants completed a self-administered pre-test survey that questioned their intention to breastfeed and anticipated barriers associated with breastfeeding. Those who were unsure of breastfeeding or did not plan to breastfeed were asked to participate in an educational intervention that provided information about breastfeeding, the benefits to mother and baby and managing commonly perceived barriers. Immediately after the intervention a post-test was provided. A second post-test was conducted after all participants delivered their baby. Chi-square analysis was performed to examine the distribution of actual breastfeeding initiation rates by initial intention as well as by age, income and education. Results: Forty-nine women participated in the study. 18 of 20 women (90%) who intended to exclusively breastfeed initiated breastfeeding. Sixteen women reported that they did not intend to breastfeed. After receiving the intervention, 56.3% (n=9) initiated breastfeeding. Thirteen women reported they were unsure of their feeding plans in the pretest. Of these, 69.2% (n=9) initiated breastfeeding. Participants reported their primary barriers to breastfeeding were fear of pain, difficulty breastfeeding once they returned to work and lack of support from family, friends and their partner/spouse/father of the child. A significant association was observed between ages 25-29 years old and initiation of breastfeeding in women who were unsure of their breastfeeding plans (p=0.005). No association was found between income or education and initiation of breastfeeding. Conclusion: Education about breastfeeding was a significant barrier to breastfeeding in the African-American women in our study population. Women who participated in the intervention were more likely to initiate breastfeeding. Employment status, income, and education were not significant factors in a woman’s decision to initiate breastfeeding.

Background:Various amalgamation diseases which the ESRD patient of may suffer from have already had quite a lot of research to latter stage abroad .Recently, Abroad research find The ESRD patient in carry on extended dialysis can exert an influence or appear melancholy mood to psychological condition their treat .Extended dialysis may influence its medical resource to use or increase mortality.It gradually become to a topic. Objectives¡GThis study explores the prevelance of ESRD with melancholia and finds out if there are any significant difference upon demography status, comorbodities, dialysis therapy, utilization of health care between ESRD with melancholia and without melancholia.As well as we will discuss the risk factors of ESRD patient with melancholia. Methods¡GWe conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and melancholia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result¡GThe prevelance of ESRD with melancholia were 0.47%(2000), 0.73%(2002),1.27%(2004), 1.34%(2008)¡FESRD patients with and without melancholia was significant difference (p < 0.0001) between sex, dialysis therapy, dialysis duration, and the regions of hospital organizations, class of hospital organizations. ESRD patients with and without melancholia was significant difference (p < 0.0001) between age, comorbidities, dialysis duration, outpatient visits and expenditures. Conclusion¡GThe study was benefited by large sample of adminstative data, but there were some limitation of precision of diagnoses and payment issue of health care system, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

Background: According to 2010 U.S. Renal Data System 2010Annual Data Report, the incidence and prevalence of End-Stage Renal Disease is the worst of the world in Taiwan. Sleep complaints are common in dialysis patients, and impacts negatively on health. It has become highly important issue. Objectives: This study explored the prevalence of ESRD with sleep disorder. We focused on demography status, comorbidities, dialysis therapies and utilization of health care to define the risk factors of disease. Methods: We conducted secondary data analysis with admnstrative data of National Health Insurance between 2000, 2002, 2004 and 2006. We firstly seleced the patients diagnosed as ESRD and Dyssomnia, and merged the data set and other related variables.The data was analyzed by Chi-square test, t-test and logistic regression. Result: The prevalence of ESRD with sleep disorder for the four years were 2.1%¡B2.7%¡B6.4% and 7.3%, respectively. Female patient has higher risk than male .Higher comorbidity score also lead to higher risk, dialysis therapies in hemodialysis/peritoneal were 16.45¡B16.48¡B8.23 and 7.91 in OR. There were significant differences in regions of hospital organizations (northern compared with the eastern, OR were 3.47, 2.73, 1.94 and 2.29, class of hospital organizations (compared with Physician Clinics), there are more cases in Regional Hospitals, except 2006. Outpatient expenses and visits are both positive correlation in all years. Conclusion: The risk factors of suffering sleep disorder in ESRD patients are sex, comorbidities and dialysis therapies. It is a relatively common but frequently unrecognized, therefore, we strongly suggested further study could be conducted by research questionnaires to make up the weakness of adminstatrative data.

This thesis describes the West Nile virus (WNV) epidemic in horses by exploring all aspects: sub-clinical infection, development of clinical disease and case fatality. All of the collected data were then compiled to create predictive risk maps of WNV infection for the province of Saskatchewan. <p>During the 2003 season, 133 clinical cases were documented with laboratory testing. Week of onset of clinical signs, gender, and coat color were significant predictors of whether the horse died or was euthanized due to severity of clinical signs. Studies of the serological response to vaccination and natural infection were examined to interpret the lab results from over 1100 samples taken from approximately 875 horses in 2003. A serologic study involving 212 horses on 20 farms determined the prevalence of sub-clinical infection (55.7% (95%CI, 44.9% to 65.8%)) and identified risk factors for infection. The study found risk of infection was highest in the Grasslands ecoregions compared to the Boreal Transition ecoregion. A case control study looked at risk factors for development of clinical disease. The study followed 23 case farms and control farms with a total of 300 horses sampled. This was the first field study to show that vaccination was efficacious in preventing the development of clinical signs. <p>The inclusion of horse surveillance data in the Saskatchewan Health WNV Integrated Surveillance Initiative was useful; however, it was discontinued due to time constraints, logistics, and declining monetary resources. <p>Since West Nile Virus is a mosquito-borne disease it is highly influenced by environmental changes, spatially and temporally. Discriminant analyses were used to partition Saskatchewan rural municipalities (RM) into categories of risk of infection with WNV based on acquired horse data and different environmental and meteorological data derived from both satellites or climate stations. The result was the creation of yearly predictive risk maps defining low to high risk of infection with WNV for each RM. <p>The 2003 epidemic provided a novel opportunity to study an important zoonotic disease emerging in a new environment. The information gathered will further the knowledge base upon which decisions for prevention of infection and clinical disease are made.

This thesis describes the West Nile virus (WNV) epidemic in horses by exploring all aspects: sub-clinical infection, development of clinical disease and case fatality. All of the collected data were then compiled to create predictive risk maps of WNV infection for the province of Saskatchewan. <p>During the 2003 season, 133 clinical cases were documented with laboratory testing. Week of onset of clinical signs, gender, and coat color were significant predictors of whether the horse died or was euthanized due to severity of clinical signs. Studies of the serological response to vaccination and natural infection were examined to interpret the lab results from over 1100 samples taken from approximately 875 horses in 2003. A serologic study involving 212 horses on 20 farms determined the prevalence of sub-clinical infection (55.7% (95%CI, 44.9% to 65.8%)) and identified risk factors for infection. The study found risk of infection was highest in the Grasslands ecoregions compared to the Boreal Transition ecoregion. A case control study looked at risk factors for development of clinical disease. The study followed 23 case farms and control farms with a total of 300 horses sampled. This was the first field study to show that vaccination was efficacious in preventing the development of clinical signs. <p>The inclusion of horse surveillance data in the Saskatchewan Health WNV Integrated Surveillance Initiative was useful; however, it was discontinued due to time constraints, logistics, and declining monetary resources. <p>Since West Nile Virus is a mosquito-borne disease it is highly influenced by environmental changes, spatially and temporally. Discriminant analyses were used to partition Saskatchewan rural municipalities (RM) into categories of risk of infection with WNV based on acquired horse data and different environmental and meteorological data derived from both satellites or climate stations. The result was the creation of yearly predictive risk maps defining low to high risk of infection with WNV for each RM. <p>The 2003 epidemic provided a novel opportunity to study an important zoonotic disease emerging in a new environment. The information gathered will further the knowledge base upon which decisions for prevention of infection and clinical disease are made.

Despite increases in HIV awareness, prevention and treatment, little is known about the contributing factors to medication adherence among adherent Black women with HIV. Understanding the protective factors that improve medication adherence and CD4 cell count for Black HIV+ women is essential and necessary to improve the treatment outcomes for this understudied population. The purpose of this study was to examine the relationship between spirituality, social support, trust in physician, and medication adherence among HIV+ Black women. While this study was not designed to test the influence on medication adherence, it was hypothesized that increased levels of spirituality, social support and trust in physician would positively relate to adherence. In this study, medication adherence was measured by 1) self-report on The AIDS Clinical Trial Group (ACTG) Adherence Questionnaire and 2) CD4 T-cell count. Baseline data was collected from 82 Black women in the Miami-Dade community and participants were administered the Spiritual Well-Being Scale (SWB), the Social Support Questionnaire (SSQ), and the Trust in Physician Scale (TPS). The results of this study indicate that medication adherence is not related to spiritual well-being, social support, or trust in physician. However, a significant positive correlation between spiritual well-being and trust in physician was found. Findings suggest that additional research is needed to explore the multifarious nature of the factors that enhance medication adherence for this population. Implications for research and practice are discussed with respect to the inclusion of spirituality, social support and trust in physician components within prevention and intervention programs designed to increase adherent behaviors among Black HIV+ women.