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PubMedDate not supplied

In harm's way: recognizing and addressing alcohol risk for rural disadvantaged pregnant mothers.

The following article describes the efforts of a group of rural Vermont maternal child health (MCH) nurses who addressed alcohol risk for the pregnant mothers they served through the Women, Infants, and Children (WIC) Supplemental Nutrition program. As front-line providers, MCH nurses are in a position to both improve the detection of problem drinking during pregnancy and to strengthen maternal alcohol prevention and intervention initiatives. Results showed that a more refined screening for alcohol provided an opportunity to promote harm reduction.

Alcohol Drinking↗
PubMedDate not supplied

The effects of community health nurse monitoring on hypertension identification and control.

Identification and control of hypertension are important public health concerns. Lack of regular health care makes diagnosis and control difficult in some populations. Community health nursing services in settings where clients regularly congregate promote identification and control of hypertension. This study focused on the effects of community health nursing screening and monitoring services for hypertension provided to participants in a breadline, a senior nutrition program, an English as Second Language (ESL) class, and employees providing these services. Community health nurses (CHNs) provided 2,407 blood pressure-related service encounters. Blood pressures were elevated in 19% of encounters, and 10% of clients had elevations that warranted referral for medical assistance. At the end of the 18-month study period, 67% of all clients with elevations and 71% of those referred for medical assistance had achieved normal blood pressures. One-way analysis of variance indicated a significant relationship between the number of encounters with the nurses and a positive outcome for all clients with elevations. This relationship was not supported for those clients referred to medical assistance. The effectiveness of intervention appeared to vary somewhat among subgroups with some groups more likely than others to achieve a positive outcome. Group differences in outcome were not statistically significant.

Adult↗
PubMed2001

Complementary and alternative medicine use in the Amish.

OBJECTIVE: To examine the rate of utilization of complementary and alternative medicine (CAM) in Amish women, a population that traditionally uses non-mainstream medicine. METHODS & RESULTS: Sixty-six Amish women completed a survey concerning their use of CAM. Thirty-six percent of the Amish women used at least one form of CAM, primarily reporting a use of diet and nutrition programs, herbal therapies, and chiropractic medicine. In addition, ten pregnant Amish women reported using echinacea, St. John's Wort, red clover, garlic and ginseng. CONCLUSION: This survey highlights the need to address potential adverse effects of herbal therapies in young women who are a member of a group that may use non-mainstream medicine.

Adult↗
PubMed2001

High prevalence of postpartum anemia among low-income women in the United States.

OBJECTIVE: To determine the prevalence of anemia from 4 to 26 weeks post partum and to examine prenatal predictors of postpartum anemia. STUDY DESIGN: Retrospective cohort analysis of 59,428 participants in the Special Supplemental Nutrition Program for Women, Infants, and Children in 12 US states. RESULTS: The prevalence of postpartum anemia was 27%. Anemia rates were higher among minority women, reaching 48% among non-Hispanic black women. Of 9129 women who had normal hemoglobin in the third trimester, 21% had postpartum anemia. Prenatal anemia was the strongest predictor of postpartum anemia (adjusted odds ratio, 2.7; 95% confidence interval, 2.5-2.8). Maternal obesity, multiple birth, and not breast-feeding also predicted postpartum anemia. CONCLUSION: The high prevalence of post partum anemia among low-income women highlights the importance of anemia screening at 4 to 6 weeks post partum. These data suggest that screening should not be limited, as it is at present, to women considered at high risk.

Adolescent↗
PubMed2003

Who is breast-feeding? Recent trends from the pregnancy risk assessment and monitoring system.

OBJECTIVE: To examine breast-feeding initiation and continuation among women with recent live births in 10 states. STUDY DESIGN: By using Pregnancy Risk Assessment and Monitoring System surveillance data (n = 96,204), we assessed breast-feeding initiation and continuation for > or =10 weeks among women with recent deliveries from 1993 to 1998. We used 1993 as the base for comparing results by using univariate and multivariate analyses. RESULTS: Ten states showed a significant increase of 18% in initiation of breast-feeding from 1993 to 1998, from 57.0% (95% confidence interval [CI], 55.6-58.4) to 67.5% (95% CI, 66.1-68.9). Initiation increased among vulnerable groups such as low-income and black women, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children program, and mothers of infants admitted to the neonatal intensive care unit. The percentage of women predominantly breast-feeding at > or =10 weeks among women who initiated remained stable: 58.5% (95% CI, 56.5-60.5) in 1993 and 57.9% (95% CI, 56.0-59.8) in 1998. More women in vulnerable groups initiated breast-feeding, but those from higher socioeconomic groups continued breast-feeding. CONCLUSIONS: Breast-feeding initiation significantly increased, and several states exceeded the year 2010 objective. Breast-feeding continuation among women who initiated remained stable; however, gaps remained, indicating a continued need to implement breast-feeding promotion programs.

Adult↗
PubMed1992

Is cow's milk suitable for the dietary supplementation of rural Gambian children? 2. Patterns of cow's milk intake.

Cow's milk has been advocated as a source of supplementary diet for children in many parts of the developing world. The frequency and forms of cow's milk intake and the factors regulating its availability and consumption by 507 children aged up to 6 years in three Gambian villages were measured. Nineteen per cent of mothers did not give cow's milk to their children. Of 413 children taking cow's milk, 41% consumed it only once a week, 32% two to four times a week, 19% once a day and 8% more than once a day. Eighty per cent of children took both fresh and sour milk. Forty-one per cent of infants up to 1 year old received cow's milk at some time. There was a decrease with age in the proportion of children taking fresh milk and a rise with age in the proportion taking sour milk alone (p < 0.001) and both forms of milk. Only 2% of children were reported to have an adverse reaction to fresh cow's milk. The main factors affecting intake were the availability of money and milk. The consumption of cow's milk in early life is common and free of adverse effects. When it is available, it should be used to supplement the diet of the weaned child.

Animals↗
PubMed2005

Association of maternal smoking with overweight at age 3 y in American Indian children.

BACKGROUND: Prevalence rates of overweight are higher among American Indian children than among any other ethnic group, but little research has explored contributing influences. OBJECTIVE: The objective was to determine the prevalence and predictors of body mass index (BMI; in kg/m2) > or = 85th percentile in American Indian children in Wisconsin. DESIGN: A retrospective analysis was conducted with linked pediatric and pregnancy nutrition surveillance systems and birth records from 1997 through 2001. Participants were American Indian mothers and children (aged 0-3 y) who were participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in Wisconsin. Outcome measurements included indicators of BMI > or = 85th percentile identified by using binary logistic regression. RESULTS: Of the 3-y-olds, 22.2% were overweight and 18.7% were at risk of overweight. Of their mothers, 42.5% had smoked during pregnancy. Smoking at the initial prenatal visit significantly predicted overweight and risk of overweight in children at age 3 y (odds ratio: 2.16; 95% CI: 1.05, 4.47). Despite being smaller at birth, the children of smoking mothers had a significantly (P < 0.05) greater increase in weight-for-length z score between birth and age 3 y than did children of nonsmokers. This greater increase was due to a significantly (P < 0.02) greater increase in weight in children of smokers than in those of nonsmokers and not to a relatively slower increase in height. CONCLUSIONS: Our findings suggest the early influence of maternal smoking on the prevalence of overweight at age 3 y in a high-risk American Indian population and provide evidence that interventions to reduce smoking in pregnant women may be warranted.

Body Height↗
PubMed1975

Prevention of folate deficiency by food fortification. II. Absorption of folic acid from fortified staple foods.

The absorption of folic acid from maize, rice and bread fortified with pteroylglutamic acid was compared with that of an aqueous solution of pteroylglutamic acid in the same subjects. Feeding fortified maize and rice produced similar increments in folic acid concentration, which were approximately half those observed with the pteroylglutamic acid solution. Fortified bread produced a lower increment. Pteroylglutamic acid was found to resist destruction by boiling and baking at temperatures and times used for the conventional preparation of such foods. However, baking for longer periods resulted in a loss of folic acid activity. It is concluded that fortification of staple foods with folic acid may offer a practical adjunct to nutritional programs designed to improve the intake of essential nutrients.

Absorption↗
PubMed1984

Growth and hematological changes in the Eskimo children of Wainwright, Alaska: 1968 to 1977.

The growth and hematological status of all 152 Eskimo children of Wainwright, AK observed in 1977 are reported and compared with the respective status of the children living there in 1968. Fifty-two children (34%) in the 1977 study were also in the 1968 study. Comparison of height data observed in 1977 with those observed in 1968 reveals that male children less than 11 yr of age and female children ages 3 to 9 yr showed a significant improvement in stature (p less than 0.05). At the same time, an improvement in nutrition was observed among the children in 1977 as evidenced by the marked decrease in anemia for children under 6 yr (p less than 0.001). These changes in growth and hematological status have occurred during a time in which health services were improved, a supplemental nutrition program was instituted, and subsistence food gathering remained high. These changes underscore the contribution of environmental factors rather than of genetic variability to the growth potential of these children.

Adolescent↗
PubMed1990

Maternal and fetal responses to the stresses of lactation concurrent with pregnancy and of short recuperative intervals.

In many regions of the world, women breastfeed one child while pregnant with the next. Among rural Guatemalan women participating in a nutrition-supplementation trial, lactation overlapped with pregnancy in 253 of 504 (50.2%) of the pregnancies. For cases where overlap occurred, 41.4% continued to breast-feed into the second trimester and 3.2%, in the third trimester. The maternal and fetal responses to the energetic stresses of overlap and of the duration of the recuperative (nonpregnant, nonlactating) interval were assessed. Overlap resulted in increased supplement intake. Short recuperative periods (less than 6 mo) resulted in increased supplement intake and reduced maternal fat stores. The energetic stresses of overlap and short recuperative periods did not significantly affect fetal growth. The mother appears to buffer the energetic stress, protecting fetal growth. This research demonstrates that evidence of depletion of maternal nutrient stores caused by a demanding reproductive history is found when reproductive stress is characterized adequately.

Anthropometry↗
PubMed2005

Anemia, iron deficiency, and iron deficiency anemia in 12-36-mo-old children from low-income families.

BACKGROUND: Iron deficiency (ID) is the most common nutritional deficiency in the world and remains relatively common in at-risk groups in the United States. The actual prevalence of anemia, ID, and iron deficiency anemia (IDA) in California remains unclear. OBJECTIVE: The objective was to determine the prevalence of anemia, low iron stores, ID, and IDA in children participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) population, and to assess the value of using hemoglobin to predict ID. DESIGN: This was a cross-sectional study of a convenience sample of 12-36-mo-old children from WIC clinics in 2 California counties. RESULTS: The prevalence of anemia was 11.1% (hemoglobin <110 g/L at 12-24 mo or <111 g/L at 24-36 mo). Study- and literature-determined abnormal values for iron measures were as follows: serum ferritin or=8.4 or >10.0 microg/mL, and transferrin saturation or=2 abnormal iron measures) were 16.2% and 8.8%, and of IDA (ID with low hemoglobin) were 3.4% and 3.2% on the basis of study- and literature-determined cutoffs, respectively. Hemoglobin concentration was used to predict study- and literature-determined ID on the basis of receiver operating characteristic curves. The sensitivity of low hemoglobin in predicting study- and literature-determined ID was low (23.2% and 40.0%, respectively). CONCLUSIONS: Anemia and ID were prevalent in this WIC sample, but IDA was uncommon. Low hemoglobin is a poor predictor of ID.

Anemia↗
PubMed2002

Women's willingness to share information and participation in prenatal care systems.

With the expanded use of computerized databases to gather information, a concomitant interest in using databases for public health purposes has developed. The authors investigated correlates of consenting to participate in such databases. The Regional Perinatal Data System combines electronic birth certificate information with questions asked of all women delivering a livebirth. Each woman is asked to consent to share information with 1) her obstetric provider, 2) her infant's pediatric provider, and 3) an immunization registry. From 1996 to 1999, women who responded to the consent question and whose livebirth did not result in death or adoption were included. Odds ratios with 95% confidence intervals denoted the magnitude of association for refusing consent. Women who were "self-pay" (odds ratio = 2.0, 95% confidence interval: 1.7, 2.4), foreign born (odds ratio = 1.9, 95% confidence interval: 1.7, 2.1), and aged 40 or more years (odds ratio = 2.0, 95% confidence interval: 1.6, 2.3) were more likely to refuse to share data. Women eligible for but not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children were significantly more likely to not share their information with others (odds ratio = 1.5, 95% confidence interval: 1.3, 1.6), after controlling for confounders. Refusing to share information with other sources is not random, and women refusing consent often do not participate in publicly available programs.

Access to Information↗
PubMed1991

Establishment of research in primary health care in Greece. Experiences of Greek-Swedish collaboration.

The last few decades have seen great changes in health care and medical care in Greece, as well as in the Greek university system. A new law on health care and medical care has come into force, a new university hospital and new health centres have been built, and a faculty of medicine has been established at Heraklion in Crete. People are speaking of a change of paradigm. Simultaneous with the introduction of the new national health care system, the Department of Family and Social Medicine (DFSM) in Crete started a major project on public health, known as the Primary Health Care and Nutrition Programs (abbreviated as PPD). The purpose was to chart the state of health and living conditions of the Cretan population in the period 1986-1990. Cooperation in research and training began between DFSM and the Dalby Health Sciences Centre, Lund University in 1987. This was natural since there was a shared interest in research into family medicine and social medicine. In addition, a new Health Care Act had come into force in Sweden in 1982. The establishment phase of primary health care started in Sweden at the end of the 1960s. In the 1970s health centres were established, along with research and training in family medicine, in a way that is comparable in many respects to the situation in which Crete found itself a decade later. This paper concerns the organization and implementation of PPD and the research cooperation between Greek and Swedish institutions. This can be seen as an expression of the internationalization of research for which the two universities have striven.

Adolescent↗
PubMed1992

Impact of a clinic-based growth monitoring programme on maternal nutrition knowledge in Lesotho.

An evaluation of the impact of a nationwide clinic-based growth monitoring (GM) programme was done in Lesotho to determine if clinic attendance was associated with improved maternal knowledge of weaning practices and diarrhoea. A total of 907 mothers from eight clinics were included in the study. Our results showed that mothers who had attended the clinics knew more about the appropriate timing for introducing animal protein-rich foods in the child's diet and about the use of oral rehydration salts for diarrhoea, than those who had not. The difference in knowledge between previous clinic attendants and new attendants was particularly marked among mothers with less than secondary schooling and mothers with young babies (less than 6 months). From observation in the clinics, we believe that group nutrition education, although it was not integrated with growth monitoring, was probably responsible for the positive association between clinic attendance and maternal knowledge. Prior clinic attendance was not specifically associated with improved knowledge about feeding during diarrhoea or the need to stop breastfeeding gradually. These need to be better incorporated into present clinic nutrition education. Whether improvements in growth monitoring would further significantly improve nutrition education remains to be seen.

Adult↗
PubMed1998

Fortified foods contribute one half of recommended vitamin A intake in poor urban Guatemalan toddlers.

Vitamin A intake from food sources, not including breast milk, was determined from seven consecutive 24-h recalls for 55 children (mean age 20.8 mo, SD 8.9) from two poor communities of Guatemala City. Not including vitamin A derived from fortified sugar or breast milk, the median daily vitamin A intake was 194 retinol equivalents (RE). Including vitamin A derived from fortified sugar but not including that derived from breast milk, the median total vitamin A intake (25th and 75th percentiles) was 338 RE (146 and 617 RE) of which 78% was preformed retinol and 22% provitamin A. More than 90% of total vitamin A intake from non-breast milk food sources was derived from only 10 items; over half came from three fortified foods: fortified sugar, Incaparina and margarine. Sugar samples from 91 households in 1991 had a median of 3.3 RE/g (range, 0.0-29.9 RE/g), <25% of the target level (13-17 RE/g); nevertheless, fortified sugar provided 25% of these children's total vitamin A intake (81 RE/d) from non-breast milk food sources and their intake approached the level recommended by the FAO/WHO (400 RE/d). These results show that fortified foods make an important contribution towards vitamin A intake in this sample of poor urban Guatemalan toddlers.

Breast Feeding↗
PubMed2003

Iron bioavailability and utilization in rats are lower from lime-treated corn flour than from wheat flour when they are fortified with different sources of iron.

Although iron bioavailability from wheat flour fortified with iron has been widely studied, the bioavailability of lime-treated corn flour has not been evaluated sufficiently. We compared iron bioavailability and utilization of lime-treated corn flour and wheat flour supplemented with various iron sources. Bioavailability and utilization were determined in Sprague-Dawley rats using the iron balance and hemoglobin depletion-repletion methods. Rats were iron depleted by feeding them a low iron, casein diet for 10 d. During the repletion period, the rats were fed diets based on lime-treated corn flour or wheat flour, both supplemented with ferrous fumarate, ferrous sulfate, ferric citrate and reduced iron for 14 d. Hemoglobin was determined at the end of depletion and repletion periods. The phytate concentration was lower in wheat flour (114 mg/100g) than in lime-treated corn flour (501 mg/100g). Iron bioavailability and utilization by rats were higher from fortified and unfortified wheat flour than from the lime-treated corn flour counterparts. Iron utilization was greater in rats fed wheat flour supplemented with ferrous sulfate, followed by fumarate and citrate than in rats fed reduced iron. In lime-treated corn flour, iron utilization by rats fed unfortified flour and flour fortified with reduced iron did not differ, but utilization was higher in rats fed corn flour fortified with iron sulfate, fumarate and citrate than with reduced iron. We conclude that fortification of lime-treated corn flour with reduced iron has no effect on iron bioavailability or utilization, probably due to the high phytate content. Other iron compounds must be selected to fortify lime-treated corn flour when intended for public nutrition programs.

Animals↗