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PubMedDate not supplied

Determinants of breastfeeding in developing countries: overview and policy implications.

Breastfeeding can play a major role in fertility regulation in developing countries. The effect of breastfeeding is enhanced when the incidence of breastfeeding is high and the duration extended. These factors are more likely to occur when suckling at the breast is frequent. Sociological and behavioral factors can also influence a woman's decision to initiate and terminate breastfeeding. The effects of urbanization, maternal education, and socioeconomic status act through the intervening variables of sociocultural factors, health services, employment status of women, and availability of breastmilk substitutes. Strategies to alter these intervening variables include educational campaigns and support groups for lactating women, changes in health services, availability of child care facilities near employment centers, and enforcement of the international code of marketing of breastmilk substitutes.

Breast Feeding↗
PubMed1995

Reducing the frequency of episiotomies through a continuous quality improvement program.

OBJECTIVE: To determine the effectiveness of a continuous quality improvement (CQI) program in reducing episiotomy rates. DESIGN: Before-and-after study; CQI methods were used to examine the process of care during labour and birth. INTERVENTIONS: Identification of care factors that would increase the probability of episiotomy. Implementation of initiatives that would change the process of care to minimize the probability of episiotomy. Educational strategies included promotion of better understanding of what constitutes an appropriate episiotomy rate and ways to reduce maternal exhaustion and true fetal distress as well as manoeuvres to protect the perineum during birth. SETTING: Low-risk family practice obstetrics service in a tertiary care hospital in southwestern Ontario. PARTICIPANTS: All 102 family physicians at the study hospital who provided intrapartum care in the year before and the year during which the CQI program was implemented and the women for whom the care was provided (approximately 1,400 per year). OUTCOME MEASURES: Episiotomy rates (overall, among primiparous and multiparous women, and among individual family physicians) and rates of perineal tear, perineal infection and postpartum readmission. RESULTS: Although the planned reduction in the episiotomy rate was not achieved during the study period, the overall rate decreased significantly from 44.5% to 33.3% (p < 0.001). Among the primiparous women the rate decreased from 57.6% to 46.2% (p < 0.001) and among the multiparous women from 34.3% to 23.6% (p < 0.001). The reduced episiotomy rate among the primiparous women was associated with a significant decrease in the rate of third- and fourth-degree perineal tears and a significant increase in the number of women giving birth with an intact perineum or a minor (first-degree) tear. These benefits were not seen among the multiparous women, whose decreased episiotomy rate was associated with a significant increase in the number of women experiencing a second-degree perineal tear. During the intervention period, there was no increase in the rates of vaginal trauma or postpartum bleeding, infection or readmission because of complications related to perineal trauma. The episiotomy rates for most physicians decreased significantly during the intervention period. CONCLUSIONS: The CQI model may be useful in modifying clinical practices such as episiotomy because it focuses on understanding the process of care and the environment in which care is provided, both of which may have a major impact on physician behaviour. Further study is needed to ascertain the sustainability of the effects of this approach and which components of the model had the greatest effect.

Algorithms↗
PubMed1991

Nutrition and reproduction in dairy cows.

Diagnosis of nutritional effects on herd fertility requires a systematic analysis of reproductive records in addition to quantifying the feeding program on the farm. Corroborative laboratory tests for specific deficiencies may be useful.

Animal Nutritional Physiological Phenomena↗
PubMed2000

The effect of individualized professional support on duration of breastfeeding: a randomized controlled trial.

A trial was conducted with 51 women randomly assigned either to a conventional nursing care group or to an individualized professional support group to examine the effect of professional support on breastfeeding status at 4 weeks postpartum. All participants identified themselves as having no prior support. At 4 weeks postpartum, 17 out of 25 (68%) and 26 out of 26 (100%) women in the control and intervention groups, respectively, continued to breastfeed (P = .005). Results indicate that postpartum care augmented with individualized professional support commenced in the hospital and continued in the community significantly increases the duration of breastfeeding among women who identify themselves as being without support for the first month postpartum.

Adult↗
PubMedDate not supplied

The Newborn Behavioral Observations system as a nursing intervention to enhance engagement in first-time mothers: feasibility and desirability.

Engagement is the social process of maternal transition that enables growth and transformation and is linked to attachment and bonding. The feasibility and desirability of the Newborn Behavioral Observations (NBO) system as a nursing intervention to enhance engagement in first-time mothers were examined. The NBO is an exploration of the newborn conducted with parents to increase their understanding of their infant's behavioral cues as well as how to respond. Perceptions of the NBO were obtained from mothers who participated in NBO sessions in the postpartum period and from unit nurses who had been given information on the NBO. Mothers (n= 10) rated the NBO high for increasing their knowledge of what their infants can do (m=3.7/4.0, SD=0.48), and how to interact with them (m=3.8/4.0, SD=0.63). Two of the activities of engagement, experiencing the infant and active participation in care, emerged as themes from the mothers' qualitative responses. Nurses (n=20) believed the NBO would be an effective intervention. Participants believed the NBO to be an effective nursing intervention for enhancing maternal engagement in the early postpartum period.

Adult↗
PubMedDate not supplied

A comparison pilot study of public health field nursing home visitation program interventions for pregnant Hispanic adolescents.

OBJECTIVE: Improve pregnancy outcomes in first-time Hispanic adolescent mothers and their infants. SETTING: Urban communities in Orange County, California. DESIGN AND METHODS: A comparison of the Nurse-Family Partnership pilot study home visitation program with traditional Public Health Field Nursing (PHFN) home visitation. PARTICIPANTS: Two hundred twenty-five Hispanic adolescent mothers and their infants. INTERVENTIONS: Participants in the control group received the traditional PHFN services; the intervention group received interventions from advanced trained public health nurses The control group received a minimum of three home visits: one initial client assessment and family profile, one antepartum visit, and one postpartum visit, including newborn assessment. Participants in the intervention group received weekly home visits for the first 4 weeks, followed by visits every other week until delivery, weekly visits for the next 6 weeks, visits every other week until the child was 20 months, and monthly visits until the child was 24 months of age. RESULTS: Preliminary results indicate that home visitation by public health nurses (PHNs) positively affected the health of adolescents mothers and their infants. The incidence of premature births to adolescent mothers in the intervention group was lower than that found in the California population of adolescent mothers. CONCLUSION: Preliminary results from this program showed that PHN home visitation (control and intervention groups) positively affects the birth outcomes of adolescent mothers and their infants.

Adolescent↗
PubMed2003

Is fertility declining in dairy cattle? A retrospective study in northeastern Spain.

The past few decades have seen a dramatic increase in infertility and reproductive disorders associated with a rising milk yield. Herein, we present a 10-year (from 1991 to 2000) retrospective survey of these factors using data from a reproductive management program performed on high-yielding dairy herds in north-east Spain. The data series included 12,711 lactations. The year was divided into warm and cool periods. Data were obtained from cows first inseminated or examined 45-70 days postpartum. The reproductive tract of each animal was examined by palpation per rectum within 43-48 days postpartum. Cows were then weekly examined until insemination or until postpartum Day 70. Cows with a corpus luteum were synchronized for estrus and timed AI. Cows showing natural estrus in the same period were also inseminated. All inseminations were pooled as a single group and inseminated cows were considered cyclic. Inactive ovaries and ovarian cysts were recorded as ovarian disorders. Incomplete uterine involution, endometritis and pyometra were grouped as uterine disorders. Overall cyclicity and pregnancy rates of all AI cows, and cyclicity and pregnancy rates corresponding to the warm period significantly decreased over the 10-year period, yet remained practically constant during the cool period. The incidence of inactive ovaries in the entire population and that corresponding only to cows examined during the warm period significantly increased with time but was similar during the cool period. Ovarian cysts were more frequent during the warm (12.3%) than during the cool (2.4%) period, though these proportions were maintained throughout the study. The incidence of uterine disorders significantly decreased with time and did not differ between cool and warm periods. Milk yield per cow and year increased from 7800 kg in 1991 to 10,200 kg in 2000. Regression analysis revealed that, for all cows and those inseminated or examined in the warm period respectively, each 1000 kg increase in average milk yield was related to decreases of 3.2 and 6% in pregnancy rate, 4.4 and 7.6% in cyclicity, and to increase of 4.6 and 8% in the incidence of inactive ovaries. The rate of uterine disorders decreased 1.1% regardless of season. Our overall results clearly reflect the increased infertility and incidence of reproductive disorders over the study period. This occurred simultaneous to increasing average milk yield. Nevertheless, under our study conditions, a cool environment appears to preserve fertility and reduce the risk of reproductive disorders irrespective of the milk yield. These findings prompt the need to improve management practices by attempting to reduce the effects of factors provoking stress.

Animals↗
PubMed2001

Barriers to prenatal care in Europe.

BACKGROUND: In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades. METHODS: A case-control study was performed in ten European countries (Austria, Denmark, Germany, Greece, Hungary, Ireland, Italy, Portugal, Spain, and Sweden). Postpartum interviews were conducted between 1995 and 1996. A total of 1283 women with inadequate prenatal care (i.e., with 0, 1, or 2 prenatal care visits or a first prenatal care visit after 15 completed weeks of pregnancy) and 1280 controls with adequate prenatal care were included in the analysis combining data from the ten countries. RESULTS: Based on combined data of the ten countries, lack of health insurance was found to be an important risk factor for inadequate prenatal care (crude odds ratio [OR] at 95% confidence interval [CI]: 30.1 [20.1-47.1]). Women with inadequate prenatal care were more likely to be aged < 20 years (16.4% vs 4.8%) and with higher parity (number of children previously borne) than controls. They were more likely to be foreign nationals, unmarried, and with an unplanned pregnancy. Women with inadequate care were also more likely to have less education and no regular income. They had more difficulties dealing with health services organization and child care. Cultural and financial barriers were present, but after adjusting for confounders by logistic regression, perceived financial difficulty was not a significant factor for inadequate prenatal care (adjusted OR [95% CI]: 0.7 [0.4-1.3]). CONCLUSIONS: Personal, socioeconomic, organizational, and cultural barriers to prenatal care exist in Europe.

Adult↗
PubMed1995

Pediatric office-based smoking intervention: impact on maternal smoking and relapse.

OBJECTIVE: To determine the impact of a brief smoking intervention delivered by pediatricians in the context of usual well baby office visits on postnatal maternal smoking and relapse. SETTING: Forty-nine private pediatric practices including 128 practitioners. DESIGN: Randomization of pediatric practices into minimal and extended intervention sites with all enrolled mothers of newborns within a practice receiving the same level of intervention. INTERVENTION: Smoking mothers in minimal condition received a hospital packet containing written information about passive smoking and a letter advising them to quit. Those in extended condition received the hospital packet plus oral and written advice at usual well baby visits: 2 weeks, 2, 4, and 6 months. MEASUREMENTS: Smoking and relapse rates at 6 months postpartum, demographics associated with smoking status, attitudes, and knowledge in regard to passive smoking, and recall surveys of mothers in regard to receiving advice or written materials. RESULTS: Two-thousand nine-hundred-one mothers of newborns were enrolled in the study. Those in the extended condition had higher quit rates (5.9% vs 2.7%, P < .01) and lower relapse rates (45% vs 55%, P < .01) than those in the minimal condition. Mothers' educational status and the presence of a smoking partner in the home were the major demographic variables associated with smoking status at enrollment and at follow-up. Compared with smokers in the minimal condition, those in extended at 6 months postpartum had significantly better attitudes and knowledge regarding passive smoking and allowed less smoking in the home. Mothers attending extended practices reported much higher rates of receiving oral advice and written materials than those in the minimal condition. CONCLUSIONS: A brief program can lead to major increases in the willingness of pediatricians to deliver smoking advice. A 1- to 2-minute intervention delivered in the context of usual well baby care can have a positive impact on maternal smoking and especially upon relapse prevention. A recent smoking history should be obtained from all mothers of newborns so that interventions can be aimed at both cessation and relapse prevention.

Female↗
PubMed2004

Hormonal induction of estrous cycles in anestrous Bos taurus beef cows.

A significant proportion of postpartum beef cows are anestrus at the onset of the breeding season. Much progress has been made in understanding anestrus and the changes that lead to spontaneous resumption of reproductive function. Likewise, knowledge regarding the impact of hormonal interventions on the endocrine and ovarian changes normally associated with spontaneous resumption of estrous cycles continue to accumulate. A wide range of hormonal treatment programs designed to induce estrous cycles in anestrous cows to coincide with the start of the breeding season have been developed. Programs structured to provide for increased progesterone, estradiol and LH concentrations at the appropriate times during the period leading to the first ovulation, and an induced preovulatory gonadotropin surge when the dominant ovarian follicle is of appropriate maturity have been demonstrated to induce estrous cycles of normal duration and acceptable fertility in a majority of anestrous, Bos taurus beef cows.

Anestrus↗
PubMed1993

A preliminary report of Norplant implant insertions in a large urban family planning program.

During the 21-month period between August 1, 1991, and April 30, 1993, 2,358 women received Norplant system insertions in either Parkland Memorial Hospital or the Dallas Maternal Health and Family Planning clinics. Forty-three percent of these women were teenagers with 14% 16 years of age or less. Overall, 431 patients received Norplant implants insertions postpartum prior to discharge from the hospital. To date, 138 Norplant systems have been removed, with the proportion of contraceptive implant removals among teenagers being essentially the same as that in more mature women. Of the reasons given by women discontinuing the Norplant system, an unanticipated high incidence of pain in the arm containing the implants, hair loss, and mood changes were noted. We have found the Norplant system to be a highly effective and highly acceptable contraceptive method for a large number of indigent women.

Adolescent↗
PubMed1991

Greater participation by veterinarians in the reproductive management of dairy cattle.

A program involving greater veterinary participation in detection of estrus and artificial insemination of cattle was evaluated in a 700-cow dairy herd from January 1987 through August 1988. Previous reproductive performance was below normal. First-service pregnancy rate from artificial insemination was 42%, and mean number of nonpregnant days for the cows was 120. Between postpartum days 55 and 62, all cows with functional corpus luteum assessed by rectal palpation were administered prostaglandin each Monday morning. Return visits were made to the herd each Thursday and Friday to observe cows and to inseminate those in estrus. On the other 5 days of the week, the owner or his employees inseminated all cows in estrus. The first-service pregnancy rate for 842 cows observed in estrus and inseminated by the veterinarian was 59%. The pregnancy rate for cows inseminated by the owner and his employees increased from 42% to 50%. The mean number of nonpregnant days for all 700 cows decreased from 120 to 98 days, resulting in approximately $46,000 of increased income for the dairyman or approximately a 4 to 1 return on investment in veterinary service. Results indicate that veterinarians could improve herd reproductive performance and solve chronic herd breeding problems by more actively participating with their clients in estrus detection and artificial insemination programs in cattle. The program allows practicing veterinarians an opportunity to observe cows for estrous behavior, establish their own pregnancy rate data, demonstrate to owners the importance of observing primary signs of estrus, and teach expert artificial insemination techniques.

Animals↗
PubMed2006

Interventions with depressed mothers and their infants: modifying interactive behaviours.

BACKGROUND: Postpartum depression (PPD) has a prevalence ranging from 3% to 30% and is associated with serious infant growth and developmental problems. Interventions directed at improving maternal mood have been unsuccessful in producing changes in observed face-to-face interactions between mother and infant. The Keys to Caregiving (KTC) is an intervention program that helps parents to understand and respond to infant behaviours, with a goal of increasing positive affective expressions in infants. In this pilot study, KTC was used with mothers suffering from mild to moderate PPD and their infants. METHODS: PPD was confirmed by scores on the Edinburgh Postnatal Depression Scale and the Beck Depression Inventory. Eleven dyads completed the study. KTC was carried out in 5 weekly group sessions, beginning at infant age of 3 months. Dyads were videotaped prior to and after KTC, using the Face-to-Face Still-Face paradigm, which assesses infants' responses during normal play and the effects of the Still-Face perturbation. The tapes were scored for infant facial emotion expressions. RESULTS: After intervention, infants displayed a marked increase in Interest and Joy when interacting face-to-face with their mothers, even though mothers' depression ratings did not change. LIMITATIONS: This pilot study is limited by lack of control dyads, however, it provides the foundation necessary for a full trial. CONCLUSIONS: This study suggests that intervention that focuses on what mothers do with their infants instead of how they feel can be effective in increasing infants' positive responsiveness and improving infant outcomes. Such interventions can be an essential component of treatment when mothers present with postpartum depression.

Adult↗
PubMed1997

Higher milk intake during pregnancy is associated with lower maternal and umbilical cord lead levels in postpartum women.

Lead exposure and its deleterious effects continue to be a problem in many countries. The lack of effective and safe treatments for low-level intoxication has promoted environmental interventions to control different sources of lead. In this study we evaluated the effect of milk consumption in 1849 mother-and-child pairs participating in the lead surveillance program in Mexico City. The mean lead levels were 11.2 micrograms/dL for maternal blood lead (MBL) and 10.8 micrograms/dL in umbilical cord. The correlation between blood lead and umbilical cord lead was r = 0.74. Forty-eight percent of the MBL exceeded 10 micrograms/dL and 9.5% exceeded 20 micrograms/dL. Maternal blood lead was positively related to the use of lead-glazed ceramic were and to traffic exposure and was inversely related to the consumption of milk and orange juice. Women who reported the consumption of more than 7 glasses of milk per week had a blood lead level of 8.7 micrograms/dL; in comparison, those women who reported a consumption of less than 7 glasses per week had a blood lead level of 11.1 micrograms/dL. Similar findings were observed for lead measured in umbilical cord. The association between lead levels and milk intake remained unchanged after taking in consideration other predictors of blood lead. This study suggests that a simple intervention could reduce lead burden among women and their newborns.

Animals↗
PubMed1992

Peripheral and central target-derived trophic factor(s) effects on auditory neurons.

In the developing inner ear, a naturally occurring programmed cell death of cochleovestibular ganglion (CVG) neurons as well as peripheral and central target-derived trophic effects on survival of embryonic CVG neurons are known. To further analyze these target derived trophic interactions, spiral ganglion explants obtained from 5 day postpartum (P5) rat pups were cultured with an intact organ of Corti and in the absence of Corti's organ. Both neuronal survival and neurite extension were influenced by the presence of this peripheral target tissue. Local destruction of Corti's organ caused both neuritic retraction and neuronal cell death to occur in a corresponding portion of the spiral ganglion. This peripheral target-derived neurotrophic effect may be mediated by a diffusible factor(s) since organ of Corti conditioned medium also had a neurotrophic effect on the survival of auditory neurons in cell cultures of dissociated spiral ganglia from P5 rat pups. A component of central target tissue, i.e. astrocytes, was also shown to release a diffusible factor(s) that supported the survival of dissociated P5 rat spiral ganglion neurons. The neurotrophic effects on the in vitro survival of spiral ganglion neurons by both of these conditioned medium factors were concentration dependent.

Animals↗
PubMedDate not supplied

Postnatal depression in primary care populations in Nigeria.

OBJECTIVE: The purpose of this study is to determine the prevalence and associated factors for postnatal depression in primary health care (PHC) centers of a developing society. METHOD: A two-stage screening procedure involving the 10-item self-report Edinburgh Postnatal Depression Scale (EPDS) and the Present State Examination Schedule was employed. RESULTS: The prevalence of postnatal depression in the primary care populations studied was 18.6%. Postnatal depression was found on logistic regression to be independently predicted by younger age (OR, 5.42; 95% CI, 2.61-10.32; P<.05), by being primigravida (OR, 2.73; 95% CI, 1.44-4.24; P<.05), by not having the desired gender for their babies (OR, 2.86; 95% CI, 1.62-5.93; P<.05) and by in-law relationship problems (OR, 3.64; 95% CI, 1.84-7.22; P<.05). The EPDS was shown to be a feasible screening instrument for postnatal depression in the PHC centers (sensitivity, 88.1%; specificity, 84.3%; minimum misclassification rate, 15.0%). CONCLUSION: The EPDS should be incorporated into the maternal and child health care programs of PHC centers in developing countries in order to ensure early detection and appropriate therapeutic intervention in cases of postnatal depression.

Adolescent↗
PubMed2006

Reproduction in dairy cows following progesterone insert presynchronization and resynchronization protocols.

The objectives of this study were to evaluate the effects of an intravaginal insert containing progesterone (CIDR, controlled internal drug releasing) administered in presynchronization and resynchronization protocols on cyclicity, detection of estrus, pregnancy rate, and pregnancy loss to first AI; reinsemination patterns; and pregnancy rates to second postpartum AI before and after the time of first-service pregnancy diagnosis in dairy cows. Holstein cows (n = 1,052) were blocked by parity and BCS at 3 +/- 3 d in milk (study d 0 = day of calving) and assigned randomly to 1 of 3 presynchronization treatments. During the presynchronization programs, all cows received 2 injections of PGF2alpha, on study d 35 and 49. Cows enrolled in the control presynchronization treatment received AI after detected estrus from study d 49 to 62. Cows enrolled in the CIDR estrus-detection (CED) presynchronization treatment received a CIDR insert from study d 42 to 49 and AI on detection of estrus from d 49 to 62. Cows enrolled in the CIDR timed AI (CTAI) presynchronization treatment received the same treatment as CED, but were subjected to timed AI on study d 72 after the Ovsynch (GnRH, 7 d PGF2alpha, 2 d GnRH, 24 h timed AI) protocol. The control and CED cows not inseminated by study d 62 were enrolled in the Ovsynch protocol on the same day and received timed AI on study d 72. After first AI, cows were assigned to no resynchronization (RCON) or resynchronization with a CIDR insert (RCIDR) between 14 and 21 d after AI. Blood samples collected on study d 35, 49, and 62 were analyzed for concentrations of progesterone and cows were classified as anestrous when progesterone was < 1.0 ng/mL in the first 2 samples. On study d 62, anestrous cows with progesterone > or = 1.0 ng/mL were classified as having resumed cyclicity. Pregnancy was diagnosed at 31 and 60 d after first AI and at 42 d after second AI. A greater proportion of anestrous cows in CED and CTAI became cyclic by d 62 postpartum than control cows. Resynchronization with the CIDR insert increased the pregnancy rate at 31 d after first AI in CED and CTAI, and at 60 d after AI in all cows because of reduced pregnancy loss. These results indicate that presynchronization with the CIDR insert increased induction of cyclicity in anestrous cows and that resynchronization with the CIDR insert did not affect the reinsemination rate but did reduce pregnancy loss and increased the pregnancy rate at 60 d after first AI.

Administration, Intravaginal↗