Search PubMed⌕ Search

Biomedical subjects

B Winikoff

Publications and source records attributed to B Winikoff.

At least 55 records · Page 3Linked to original sources
PubMed1990

Breastfeeding.

Explore the source record for details and available documents.

Breast Feeding↗
PubMed1989

Breast feeding and bottle feeding controversies in the developing world: evidence from a study in four countries.

This paper describes some of the findings from a comparative study to investigate infant feeding practices and their determinants in four Third World urban areas: Bangkok, Thailand; Bogota, Colombia; Nairobi, Kenya; and Semarang, Indonesia. The information about developing country urban woman provided by these data allows examination of the interaction of feeding practices with socio-economic and biomedical variables. Through the use of descriptive, bivariate, and multivariate analytic techniques, it is possible to explore some of the questions which have been debated regarding infant feeding practices. Data addressing five major questions are described in this paper: (1) Is breast feeding declining? (2) Is bottle feeding making women breast feed less? (3) Why do women use bottles? (4) How do mothers get the idea of using bottles? (5) How does paid employment affect infant feeding practices and the use of baby bottles? The study documents changes in infant feeding that can be expected to have detrimental effects for child health and for child spacing. Bottle use appears to interfere with breast feeding in all cultures, but more dramatically in more 'modernized' societies. Mothers resort to bottle use for a variety of reasons, but not usually as an attempt to wean. The health care system often provides the first contact between mothers and bottle use, and health care providers frequently encourage the use of artificial feeding. Women who work away from home early in their infants' lives must often use bottle feeding, but the percent of women affected is very small. Many more women use bottles and wean early than work away from home, and most artificially-fed babies do not have working mothers.

Attitude to Health↗
PubMed1987

Overcoming obstacles to breast-feeding in a large municipal hospital: applications of lessons learned.

A project to overcome institutional constraints to breast-feeding was implemented in a large municipal hospital. Interventions included staff education, intensive training of a team of physicians and nurses, development of user-tested educational materials, and day and evening staffing by a breast-feeding counselor. A nearby hospital served as a control. Project evaluation entailed chart reviews at the intervention site and a control hospital (n = 812); interviews with mothers during their postpartum hospital stay and at return clinic visits (n = 180); and field observations in all areas of the hospital that provided prenatal, intrapartum, postpartum, and pediatric care. Comparisons of the incidence and pattern of breast-feeding were made before, midway through, and after the project. At the intervention site, the incidence of breast-feeding increased from 15% to 56%, and exclusive breast-feeding for more than 3/4 of feedings increased from 0% to 15%. At the control site, the respective changes were from 28% to 41% and from 5% to 7%. Formula use by breast-feeding women decreased but was nonetheless extensive, and the usual reason given by breast-feeding women for supplementation was a perceived insufficiency of breast milk. This may be due, in part, to the fact that bedside assistance to breast-feeding mothers was not integrated into the routine care provided by staff nurses but was relegated to the lactation nurse/counselors who were not available at all times. It is concluded that the process to overcome institutional constraints to breast-feeding is difficult but feasible. Repeated and extensive professional education helps create the context whereby clinical and administrative staff can reassess routines and policies.

Adolescent↗
PubMed1986

Dynamics of infant feeding: mothers, professionals, and the institutional context in a large urban hospital.

A multidimensional approach was taken to understand the constraints to breast-feeding in a large municipal hospital. Data were collected through direct observation, chart review, and questionnaires to patients and staff. Breast-feeding had not yet begun within 24 hours postpartum in 37% of women who wanted to breast-feed. Chart review revealed that at hospital discharge no woman was breast-feeding exclusively: only 16% of infants had ever been breast-fed and all of these also had been formula fed. The most common reason for the use of supplementary formula and early weaning was the mother's perception or anticipation of insufficient milk. The existing procedures communicated the message to patients that the health care providers expected women to bottle-feed. Some practices that prevented successful breast-feeding were prolonged and/or unnecessary separation of mother and infant, routine provision of infant formula, confusion about drug contraindications for breast-feeding, and inconsistent identification of breast-feeding infants. Staff knowledge about breast-feeding management was inadequate, and staff underestimated mothers' interest in breast-feeding. Recommendations to facilitate breast-feeding include a revision of routines and procedures as well as provision of staff education and expansion of patient education.

Adolescent↗
PubMed1984

Trends in postpartum contraceptive choice.

Patterns of postpartum contraceptive choice are analyzed in a middle class private practice population between the years 1966 and 1981. The effect of age, parity, difficulty in conceiving, future pregnancy plans, and type of delivery are noted. A general decline in the use of oral contraceptives and intrauterine devices with a corresponding increase in the use of barrier methods is documented. Although very few changes among contraceptive techniques occurred between six weeks and six months post partum, an appreciable number of patients, more than half the sample, did change contraceptive techniques between pregnancies. Thus, women perceive different needs at different times during their reproductive lives. To serve patients effectively, a wide range of contraceptives must be available to accommodate changing demands.

Adolescent↗
PubMed1983

The effects of birth spacing on child and maternal health.

Child and maternal mortality and morbidity are examined in relation to the interval between pregnancies. Most data available pertain to child mortality. Very little reliable information links child morbidity or maternal health detriments to short birth spacing. The evidence on child mortality suggests that very short intervals (conceptions less than six months after a birth) are detrimental to survival of the second child, but these results must be viewed in light of the methodological difficulties of studies of this subject. Policy implications of the data are perhaps less clear than is sometimes assumed.

Adolescent↗
PubMed1981

Anthropometric determinants of birth weight.

The correlation of maternal and paternal physical characteristics to the weight of the newborn infant was investigated. It was found that a different anthropomorphic variable best explained the outcome in each group when mothers were divided by weight for height. In women of low weight for height, weight gain was most significantly associated with birth weight (P less than .01); and in women of intermediate weight for height, the significant variable was maternal prepregnancy weight (P less than .01); in women of high weight for height the outcome was best explained by maternal height (P less than .05). The model accounted for 17, 21, and 32% of the variance in birth weight in the 3 weight-for-height groups, respectively. It appears that the relative value of genetic and environmental factors may be different depending on the body type of the mother. It is postulated that other genetic and environmental factors, including smoking, alcohol ingestion, and exact gestation age, may be of significance. The conclusions of this study differ from those of previously reported studies. Possible explanations include variable population homogeneity and different socioeconomic groups studied as well as the obscuring of biologically significant variables if outcomes in subjects with different body types are not analyzed separately.

Adult↗
PubMed1980

The obstetrician's opportunity: translating "breast is best" from theory to practice.

The superiority of breast-feeding to artificial feeding of infants has been well established for nutritional, biochemical, antiinfective, psychological, economic, and contraceptive reasons. The promotion of breast-feeding should, therefore, be a high-priority concern of health workers. Both provision of information and support to expectant mothers and changes in hospital routines in the perinatal period have been shown capable of dramatically increasing the incidence and duration of breast-feeding in populations studied. Moreover, these interventions are interventions are quite specific, effective, manageable, and affordable. Obstetricians have a special responsibility and capacity to promote breast-feeding given their contact with women throughout pregnancy and their influence on hospital birth routines. A greater commitment on the part of obstetricians to promote breast-feeding could accelerate and extend the current shift back to breast-feeding, to the benefit of mothers and their babies in all socioeconomic groups.

Breast Feeding↗
PubMedDate not supplied

Acceptability and feasibility of early pregnancy termination by mifepristone-misoprostol. Results of a large multicenter trial in the United States. Mifepristone Clinical Trials Group.

OBJECTIVES: To evaluate whether the regimen of oral mifepristone and misoprostol for medical abortion is acceptable to women and providers, in the United States, including physicians, nurses, and counselors, and whether proposed modifications of this regimen appear feasible for clinical practice. DESIGN: A prospective study. SETTING: Seventeen clinics in 15 states. PARTICIPANTS: A total of 2121 women with pregnancies of 63 days or less in duration. INTERVENTIONS: The administration of mifepristone, 600 mg, orally, followed after 2 days by the administration of misoprostol, 400 micrograms, orally. Clinical observation for 4 hours followed misoprostol administration. Two weeks later, at a checkup, women were questioned about the abortion experience. Providers also answered questions about acceptability and feasibility. MAIN OUTCOME MEASURES: Patient reports of overall satisfaction with the abortion, the number of women who would choose medical abortion again if needed or recommend the method to others, the best and worst features of the method, and provider and patient assessments of home use. RESULTS: The regimen was highly acceptable. Nearly all women (95.7%) would recommend it to others, 91.2% would choose it again, and 87.6% found it very or moderately satisfactory. Even among women for whom the method failed, 69.6% would try it again, 84.9% would recommend it to others, and 51.9% found it very or moderately satisfactory. The chance to avoid a surgical procedure was reported as the method's best feature. The most commonly cited worst features were the uncertainty and fear of side effects. Providers and women considered home use feasible and safe. CONCLUSIONS: American women found abortion with the use of mifepristone and misoprostol acceptable. Even most with unsuccessful outcomes would select the regimen again and recommend it to others. Most providers and women thought that home use of misoprostol should be available for women who prefer it.

Abortifacient Agents, Steroidal↗
PubMedDate not supplied

Rethinking postpartum family planning.

This article examines the rationales for commonly advocated postpartum family planning services and challenges the behavioral and biological assumptions on which they are based. An alternative approach to service delivery is suggested. Services should be designed to incorporate breastfeeding and to increase their acceptability to postpartum women.

Attitude to Health↗
PubMedDate not supplied

Women's health: an alternative perspective for choosing interventions.

This paper outlines the health problems of mothers, discusses the links between maternal health and child health, and emphasizes the need to focus attention more clearly on the problems of women and the interventions that might help them as a way to improve both maternal and child health. The special problems of girls and women in the developing world--including maternity care, abortion, and maternal mortality and morbidity--and the ways in which these problems affect mothers and their children, are examined. Nutritional morbidity and infectious morbidity are described in terms of their effects on maternal and infant health, including low birth weight. It is shown how the cultural, social, and economic factors that affect women and children interact with their health problems. Recommendations are made to: reexamine well established interventions to determine if new program designs might improve long-term results; conduct research on the efficacy of retraining health personnel; broaden and improve service delivery; reassess the cost-effectiveness of highly targeted interventions; reexamine the locus of certain interventions; and emphasize long-term as well as short-term results. Attention should be given to women's health not only during pregnancy, but throughout the life cycle.

Adult↗