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PubMed2004

Regionalized perinatal education.

Despite changes in the organization and financing of healthcare delivery, and dramatic increases in the number and distribution of perinatal facilities and professionals over the past three decades, there remains a continuing need for effective and efficient regionalized perinatal outreach education programmes. Both the organizers and the participants should be multidisciplinary and include both inpatient and outpatient providers. Content should be restricted to issues relevant to participants' practice, and include topics ranging from preconception to postpartum and early infant care. There are various effective formats, but consideration should be given to reaching as many providers as possible simultaneously within a given facility, minimizing expense and economizing on participants' time. Evaluation strategies range from assessment of immediate outcomes, which generally examine programme process, to ultimate outcomes, which measure changes in patient care and patient health.

Education, Continuing↗
PubMed2003

Effects of pre-synchronization using combinations PGF(2alpha) and (or) GnRH on pregnancy rates of Ovsynch- and Cosynch-treated lactating Holstein cows.

In Experiment 1, the effects of two pre-synchronization treatments on synchronized AI pregnancy rates of lactating dairy cattle were compared. Lactating Holstein cows (n=159) received 100 microg of GnRH (im) on day -7 and 25mg of PGF(2alpha) (im) on day 0 and were observed once daily for signs of estrus from day -3 to day 3. Cows detected in standing estrus and those that had lost significant amounts of tail-chalk in the previous 24h were immediately inseminated in a once-daily observation/AI program. Cows not detected in estrus by 72 h after PGF(2alpha) received fixed-time AI (TAI) and a concurrent 100 microg injection of GnRH (im). Cows were randomly assigned by parity and calving date to receive one of the following pre-synchronization treatments: (1) 25mg of PGF(2alpha) (im) on day -35 and day -21 (PGF-PGF) or (2) 100 microg of GnRH (im) on day -14 (GnRH). Fewer (P<0.05) GnRH- (49%, 41/84) than PGF-PGF-pretreated cows (65%, 49/75) were detected in estrus, however, overall pregnancy rates were not affected by pre-synchronization treatment (30 versus 32%, respectively). In Experiment 2, lactating Holstein cows received 100 microg of GnRH (im) on day -7, 25mg of PGF(2alpha) (im) on day 0 and TAI at 60-64 h after PGF(2alpha). Cows were randomized by parity and postpartum interval into pre- and post-synchronization treatments in a 2 x 2 factorial design. Pre-synchronization treatments included: (1) 25mg of PGF(2alpha) (im) on day -35 and on day -21 (PGF-PGF; n=168) or (2) 25mg of PGF(2alpha) (im) on day -21 and 100 microg of GnRH (im) on day -14 (PGF-GnRH; n=180). Within each pre-synchronization treatment, cows were further allocated by parity and postpartum interval to receive as a post-synchronization treatment 100 microg of GnRH (im) at either 48 h (Ovsynch; n=175) or 60-64 h (Cosynch; n=173) after PGF(2alpha). Pregnancy rates at TAI were not affected by pre- (PGF-PGF=26%, 44/168 versus PGF-GnRH=24%, 44/180) or post-synchronization treatments (Ovsynch=29%, 50/175 versus Cosynch=22%, 38/173). However, the numeric shift towards reduced pregnancy rates in Cosynch-treated cows suggests the 12h interval between GnRH and AI may be important to optimize conception rates in GnRH-PGF(2alpha)-based TAI protocols in dairy cattle. In conclusion, each of the pre-synchronization protocols evaluated in present study performed with comparable efficacy. Although the Cosynch protocol facilitates more efficient labor utilization, numeric trends toward reduced conception warrants further investigation.

Animals↗
PubMedDate not supplied

Health promotion and risk reduction in Malawi, Africa, village women.

OBJECTIVE: A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. DESIGN: Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. SETTING: Surveys were completed by trained data gatherers in the village setting. PATIENTS/PARTICIPANTS: All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. INTERVENTION: Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. RESULTS: The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. CONCLUSIONS: A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

Adult↗
PubMed1998

Development of a progestin-based estrus synchronization program: I. Reproductive response of cows fed melengestrol acetate for 20 days with an injection of progesterone.

We designed two experiments to determine the efficacy of an estrus control system in cows that combined long-term progestin exposure (20 d) with an acute increase in progesterone concentration. In Exp. 1, cows (n = 30) were fed either melengestrol acetate (MGA; .5 mg x cow(-1) x d(-1)) or ground ear corn (MGA carrier) for 20 d. On d -15 (last day of MGA feeding = d 0), cows were administered 25 mg of PGF2alpha to regress the corpus luteum (CL) and establish an environment conducive to the development of persistent follicles. To synchronously regress persistent follicles, cows fed MGA (n = 15) were injected with 200 mg of progesterone on d -2 (MGA-P), and the cows fed the MGA carrier were not treated (CONT; n = 15). Cows in the CONT group were artificially inseminated 12 h after detection of spontaneous estrus from d -20 to d 8. Estrus was observed, and all cows in the MGA-P group were artificially inseminated during the period of estrus synchronization (SYNC; d 1 to 8). No difference in conception rate was observed between treatments. In Exp. 2, postpartum cows (n = 113) received either the MGA-P (n = 56) or CONT (n = 57) treatment. More (P < .05) cows were observed in estrus during SYNC in the MGA-P (50%) than in the CONT (28%) group. Of the cows in the MGA-P group that were not observed in estrus during SYNC, 50% were in estrus for the first time 23 to 29 d after MGA withdrawal (SYNC2), suggesting that these cows ovulated without observable estrus during SYNC. Estrus was observed for the first time during SYNC2 in more (P < .05) cows in the MGA-P (25%) than in the CONT (7%) group. Conception rate at the synchronized estrus, pregnancy rate, and interval to first service and pregnancy were similar between treatments. We conclude that administration of MGA-P results in the synchronization and(or) induction of a fertile estrus in cows.

Administration, Oral↗
PubMedDate not supplied

Level of prenatal cocaine exposure and 48-month IQ: importance of preschool enrichment.

OBJECTIVE: This analysis was designed to determine whether prenatal cocaine exposure is related to children's standardized cognitive test scores at age 4 years after control for relevant covariates. METHODS: Masked examiners using the WPPSI-R assessed ninety-one 4-year-old children with prenatal cocaine exposure and 79 children of comparable demographic background who were not exposed. Level of cocaine exposure was documented by postpartum interviews of mothers and assays of the infants' meconium. RESULTS: Prenatal cocaine exposure, analyzed as exposed/unexposed or as an ordinal dose variable, was not associated in bivariate or multivariate models with decrements in full-scale IQ, performance IQ, verbal IQ, or in any of the subtests. In bivariate analyses, we found significant differences between exposure groups defined as "unexposed", "lighter", and "heavier" in mean scores of the WPPSI-R subtests Object Assembly (P=0.04) and Picture Completion (P=0.03). For these scores, children with heavier exposure attained higher scaled scores. Birth mother's education and child's experience with preschool enrichment were both associated with higher verbal IQ scores. CONCLUSION: These findings suggest that prenatal cocaine exposure does not exert negative effects on the cognitive competence of preschool-aged children. Children with a history of prenatal cocaine exposure benefit from preschool programs that have been shown to enhance outcomes for other low-income children.

Adult↗
PubMed1995

Synchronization of ovarian follicular waves with a gonadotropin-releasing hormone agonist to increase the precision of estrus in cattle: a review.

Treatment with GnRH and PGF2 alpha is a practical method for controlling ovarian follicular and luteal functions and increasing the precision of estrus synchronization in cyclic and acyclic postpartum cows and heifers. This method reduces considerably the period of time needed for estrus detection; it synchronizes the estrous cycle of 70 to 80% of the cyclic cows to within a 4-d interval without any detrimental effect on the fertility rate (65 to 85%). Moreover, resumption of ovarian activity and normal fertility in acyclic cows in favored. Administration of GnRH eliminates the large follicles by ovulation or atresia and induces emergence of a new follicular wave within 3 to 4 d after treatment at any stage of the estrous cycle, but it limits further growth of these emerging follicles by increasing atresia. The precision of estrus and the unaltered fertility rate is due to the synchronized selection of a new larger growing follicle, which becomes the ovulatory follicle after PGF(2 alpha)-induced luteolysis 6 d after GnRH treatment. Also, fixed-time AI programs without the need for estrus detection may be possible using a second injection of GnRH in a GnRH-PGF(2 alpha)-GnRH protocol to ovulate the selected follicle at a precise time. We describe a physiological model to explain how the precision of estrus is improved following PGF(2 alpha)-induced luteolysis, via the effect of pretreatment with GnRH on follicular development and luteal functions in cattle. Application of this model to the development of reliable methods of fixed-time insemination is also explored.

Animals↗
PubMed2006

Folate and long-chain polyunsaturated fatty acids in psychiatric disease.

Schizophrenia, autism and depression do not inherit by Mendel's law, and the search for a genetic basis seems unsuccessful. Schizophrenia and autism relate to low birth weight and pregnancy complications, which are associated with developmental adaptations by "programming". Epigenetics might constitute the basis of programming and depend on folate status and one-carbon metabolism in general. Early folate status of patients with schizophrenia might be compromised as suggested by (i) coinciding incidences of schizophrenia and neural tube defects (NTDs) in the Dutch hunger winter, (ii) coinciding seasonal fluctuations in birth of patients with schizophrenia and NTDs, (iii) higher schizophrenia incidence in immigrants and (iv) higher incidence in methylene tetrahydrofolate reductase 677C-->T homozygotes. Recent studies in schizophrenia and autism point at epigenetic silencing of critical genes or chromosomal loci. The long-chain polyunsaturated fatty acids (LCPUFA), arachidonic acid (AA, from meat) and docosahexaenoic acid (fish) are components of brain phospholipids and modulators of signal transduction and gene expression. Patients with schizophrenia and, possibly, autism exhibit abnormal phospholipid metabolism that might cause local AA depletion and impaired eicosanoid-mediated signal transduction. National fish intakes relate inversely with major and postpartum depressions. Five out of six randomized controlled trials with eicosapentaenoic acid (fish) have shown positive effects in schizophrenia, and 4 of 6 were favorable in depression and bipolar disorders. We conclude that folate and LCPUFA might be important in both the etiology and severity of at least some psychiatric diseases.

Animals↗
PubMed1999

[Evaluation of an educational course for pregnant adolescents].

The pregnancy among adolescent women in Mexico is close than half million by year, this problem could be attended through health education in the Mexican medical care system. Since 1995 the Instituto Nacional de Perinatologia has a free training program only for adolescents designed to improve the health care medical procedures and reduces some perinatals health risks. This paper shows the structural design, functioning strategies and results of its application. Through a pre codificated 48 item list, were analyzed transversally the clinical records of 234 adolescents engraved themselves to the course. Two groups were formed: the "A" group with the patients attended at least to three sessions (106) and the group "B" with the ones who did not (128). The data analysis was made by contrasting each item between the groups using the appropriate statistical tests. The group "A" had greater average in scholarship, the moreover socioeconomic characteristics and gynecoobstetric background did not show significant differences. Group "B" had a higher proportion of adolescent with aggregated pathology to the pregnancy. We too observed significant differences in the proportions of complications during the pregnancy evolution and in the postpartum period. The acceptance on the pregnancy by the adolescent, her family and by her couple also showed significant differences. The average weight of the newborns were greater statistically in the "A" group. The proportions of family planning methods acceptance was higher in the same group, who has too shorter intra-hospitalary stay. This evaluation shows good fitness with the adolescents education expectatives and performance and favorable associations with some perinatals health risks.

Adolescent↗
PubMed2006

Traditional beliefs as forgotten influencing factors on breast-feeding performance in Turkey.

OBJECTIVE: The aim of this cross-sectional study was to identify the infant feeding practices and to evaluate the attitudes and beliefs of mothers on breast-feeding in Turkey. METHODS: This study was established in 10 provinces of Turkey between December 2000 and March 2001 and the study group was comprised of 1,767 women between the ages of 15-49 years (mean 27.6 +/- 6.4 years). Questionnaires were self-filled by mothers in the waiting rooms of the health centers. RESULTS: One hundred seventy-three women (9.9%) were illiterate, 829 (47.7%) had < or =5 years of schooling, and 83.4% were housewives. A significant number of women have traditional beliefs related to breast-feeding practices. According to 23.4% of the women at least 3 calls to prayer (average 12 hours) should be waited before the first breast-feeding postpartum and more than 30% of the mothers believe that colostrum should not be given to the newborn, some mothers breast milk could harm their babies, and an evil eye could harm their breast milk. The traditional belief status and educational status of the women differed significantly between provinces, lower educational status and higher rates of women with traditional beliefs were observed in less developed eastern provinces. Overall, 60.6% of the women were knowledgeable on breast-feeding practices, whereas only 13.5% were scored as good in attitudes. Among all women with breast-feed babies, 35.8% started supplementary feeding in the first 3 months of life. Mother's age, education, occupation and traditional beliefs did not have a significant effect on supplementation time. CONCLUSION: As a result, these findings suggest the importance of taking into account the customs, local beliefs and family influences in planning community health programs.

Adolescent↗
PubMedDate not supplied

[Perception of common symptomatology during pregnancy, puerperium and lactation].

The objective of this investigation was to identify women's perception on normal and abnormal symptoms of pregnancy, puerperium and breastfeeding; its purpose was to assess the varying educational needs in the geographical area where a reproductive health education program will be implemented. 405 fertile females living in non-residential areas were interviewed in their homes. A predominantly pre-coded questionnaire was used; items related to reproductive health, preventable and susceptible to education were included. Symptomatology perceived incorrectly as normal: a) In pregnancy: Dysuria: 24 percent, genital hemorrhage: 15 per cent, absence of fetal movement: 23 per cent, did not know how to recognize preterm birth symptoms: 70 per cent. b) In puerperium: Increased quantity in lochia rubra: 17 per cent, fever: 22 per cent, fetid lochia: 28 per cent, and c) In breastfeeding: Breasts red and warm: 48 per cent, fever: 30 per cent, nipple fissures: 70 per cent. Symptomatology perceived incorrectly as abnormal: a) In pregnancy: Frequent urination: 17 per cent, morning nausea in the 1st trimester: 9 per cent, emotional instability: 21 per cent, Braxton Hicks contractions: 41 per cent, and b) Postpartum period: Decreased quantity in lochia rubra: 9 per cent, non-fetid lochia alba: 43 per cent, calostrum: 20 per cent. The assessment educational needs showed an inaccurate identification of abnormal and normal obstetric events; its frequency varied. It is essential that a pregnant woman be well informed and educated in order to preserve her own health as well as that of her unborn child. She must be able to recognize warning signs, take action and demand appropriate medical care. Health care personnel and health educators must be responsible for the promoting of maternal and child health during pregnancy.

Adolescent↗
PubMed2006

Long-term effects of a diabetes and pregnancy program: does the education last?

OBJECTIVE: To determine whether women with pregestational diabetes obtained long-term benefits from an intensive diabetes management program during pregnancy. RESEARCH DESIGN AND METHODS: Women with pregestational diabetes who had attended an intensive diabetes management program in pregnancy between 1991 and 1999 were interviewed regarding diabetes self-management behaviors and current glycemic control. A retrospective chart review was done to obtain information on self-management behaviors at entry to the program and at delivery and compared with the present. RESULTS: Comparing entry to the program to delivery, all diabetes self-management behaviors improved significantly, including frequency of self-monitoring of blood glucose, frequency of insulin injections, and frequency and complexity of insulin dose adjustment (IDA). HbA(1c) (A1C) also improved significantly from entry to delivery (mean 0.073-0.060) (P < 0.0001). Comparing entry to the present, frequency of insulin injections improved significantly (P = 0.0004), frequency of IDA improved significantly (P = 0.004), and complexity of IDA improved significantly (P = 0.0032). However, there was no significant change in frequency of self-monitoring of blood glucose (P = 0.766) from before pregnancy to the present, and A1C significantly worsened by 0.015 (P < 0.0001, 95% CI 0.009-0.021) from entry to the program to the present. CONCLUSIONS: Women participating in an intensive diabetes management program during pregnancy improve significantly from entry to delivery in diabetes self-management behaviors and glycemic control and, in the long term, retain some of these behaviors and knowledge. However, this is not reflected in an improved A1C level. This may be explained by the loss of contact with the diabetes care team and/or the discontinuation of frequent self-monitoring of blood glucose-a critical behavior necessary for achieving optimal glycemic control.

Adult↗
PubMed1998

Effects of maternal caloric restriction and exercise during lactation.

In affluent populations, breast-feeding women often wish to return to their prepregnancy weight as soon as possible postpartum and may restrict energy intake or increase exercise to achieve this goal. Gradual weight loss (< or = 2 kg/mo) seems to have no adverse effect on milk volume or composition, provided that the mother is not undernourished and is breast-feeding her infant on demand. Aerobic exercise improves cardiovascular fitness and does not affect milk energy transfer to the infant, but exercise alone is not likely to increase the rate of weight loss unless dietary intake is controlled. Less information is available on the effect of rapid weight loss. Data from a recent randomized intervention trial indicate that a short-term (11 d) energy deficit of 35%, achieved by dieting or a combination of dieting and increased exercise, results in weight loss > 1 kg/wk and does not adversely affect lactation. Exercise enhances maintenance of lean body mass and is therefore a recommended component of any weight loss program. Maternal plasma prolactin concentration generally increases under conditions of negative energy balance, which may serve to protect lactation. Further research is required on the longer-term effect of energy restriction and on the effects of energy balance in lactating women with low fat reserves.

Diet, Reducing↗
PubMed2001

Influenza vaccination during pregnancy. Patients' and physicians' attitudes.

OBJECTIVE: To identify potentially remediable attitudinal factors among women and their physicians that may present barriers to influenza vaccination during pregnancy. STUDY DESIGN: We conducted a prospective survey study administered concurrently during influenza season (January-March 2000) to postpartum women in an urban, high-volume medical center and to practicing obstetricians in the metropolitan Los Angeles area. Analyses focused on individual questions' relation to the outcomes of: (1) patients' receipt of influenza vaccine during the recently completed pregnancy, and (2) physicians' discussion of influenza vaccine with their pregnant patients. RESULTS: Surveys were completed by 242 postpartum women and 113 physicians. Among the women, 22% had discussed influenza vaccine with their physicians during pregnancy, with only 8% of respondents having been vaccinated. Significantly more physicians stated that they discussed vaccination with their patients than did women (74% vs. 22%; P < .001). Physicians were more likely to recommend vaccine if they were aware of current Centers for Disease Prevention and Control guidelines (RR = 2.6, 1.1-5.9), gave vaccinations in their offices (RR = 1.2, 1.01-1.4) and had been vaccinated against influenza themselves (RR = 1.9, 1.3-2.8). CONCLUSION: Influenza vaccination during pregnancy occurred infrequently in this study cohort, and a significant discrepancy was seen between patients' and physicians' impressions of whether its use or recommendation had been discussed. Gaps existed in both groups' understanding of potential benefits of influenza vaccine for both pregnant women and their newborns. The survey results suggest potential strategies for targeting improved educational programs for physicians and patients to improve influenza vaccination rates for pregnant women.

Adult↗
PubMed1988

The problem of grandmultiparity in current obstetric practice.

A retrospective analysis of 646 Arab grandmultiparas who booked for hospital confinement between 1983 and 1985 was carried out. The results were compared with that of non-grandmultiparas during the same period. In the grandmultiparas, the incidences of gestational diabetes, hypertension rheumatic heart disease, antepartum, postpartum hemorrhage and macrosomic infants were increased. However, contrary to some previous reports the incidences of anemia, cesarean sections, induced labor, dysmaturity and perinatal deaths were decreased. This is thought to be due to the provision of modern specialist perinatal care and improved socioeconomic standards.

Diabetes Mellitus↗
PubMed2002

Private health insurance uptake and the impact on normal birth and costs: a hypothetical model.

Recent Australian government policy has encouraged large numbers of women of childbearing age to enter private health insurance. This paper describes how increased uptake of private health insurance may impact on the rate of normal birth, caesarean section and the costs of providing maternity care in low risk primiparous women in New South Wales. A hypothetical model was developed using data from the NSW Midwives Data Collection. Costs were calculated using data established from previous research in NSW (Homer et al 2001). It suggests that, as the proportion of low risk primiparous women with private health insurance increases, the rate of normal birth may decrease with a subsequent increase in rate of caesarean section. As the rate of caesarean section rises, the cost of providing intrapartum and postpartum care may also increase. I argue that increased rates of private health insurance membership have the potential to increase the rate of caesarean section and the cost of providing maternity care to low risk women. It is evident that government policy can impact on the outcome of maternity care in Australia in ways that might not have been predicted. Paradoxically, the care of healthy childbearing women may cost the Australian government more to provide in the future.

Cesarean Section↗
PubMed2003

Initiation of breastfeeding among mothers of very low birth weight infants.

OBJECTIVE: To examine factors that predict the initiation of expressed milk feedings and the transition to direct breastfeedings among mothers of very low birth weight (VLBW) infants. METHODS: The sample consists of 361 mother-infant pairs enrolled in a follow-up study of children aged 6 to 8 years who were born weighing <1501 g in 1 of 5 hospitals between 1991-1993. Chart review at birth provided data on neonatal characteristics and demographic factors at delivery were obtained by postpartum maternal interview. Information regarding infant feeding practices was obtained at follow-up. RESULTS: In this study, 60% of mothers initiated expressed milk feedings for their VLBW infants. However, the duration of these feedings was brief with 52% of infants receiving 1 to 3 months or less of human milk feedings. Greater educational attainment, private insurance, and breastfeeding experience were each independently associated with the decision to provide expressed milk feedings. Only 27% of mothers reported directly breastfeeding their VLBW infants. The transition from expressed milk feedings to direct breastfeedings was positively associated with sociodemographic factors including maternal age, insurance status, and breastfeeding experience as well as the length of hospitalization, an indicator of infant health. CONCLUSIONS: Sociodemographic factors were associated with both the decision to initiate expressed milk feedings and the transition to direct breastfeedings. However, factors relating to infant health only influenced the transition to direct breastfeedings. Intervention programs need to consider the sociodemographic factors that influence infant feeding decisions as well as specific challenges encountered by mothers of VLBW infants.

Adult↗
PubMed1988

Memories of labor and birth: reliability of post partum questionnaire reports.

The stability of reports of feelings during vaginal births was assessed in three studies. In Study I, post partum reports from 475 primiparous women who participated in a childbirth preparation program were compared to identify differences between reports completed from the day of the birth to more than six weeks after the birth. In Study II, the post partum reports of 46 primiparous and 95 multiparous women completed 1, 3, or 6 mo. after giving birth were compared. In Study III, test-retest reliabilities were calculated for post partum reports completed by 22 primiparous and 16 multiparous women during the 5th and 7th post partum weeks. In these studies, reports of pain during labor were stable.

Female↗
PubMed1999

Family suite: an innovative method to provide inexpensive postpartum care.

The postpartum hospital stay has been decreasing in the United States in recent decades. Early discharge to achieve cost savings has been criticized by many inside and outside the health care community as sometimes being detrimental to the mother and infant. This article describes the efforts of the administration, nursing staff, and medical staff of a large public urban hospital to develop an alternative to the forced early discharge of mothers and infants.

Cost-Benefit Analysis↗