Preventing abusive head trauma: can educating parents reduce the incidence?

Abusive head trauma (AHT) is the most lethal form of child abuse; preventing AHT should be a national priority, but research into this area is woefully underfunded. Prevention programs have primarily focused on universal parent education during the neonatal period, a time when parents are a captive audience of the health care establishment whose focus is on the needs of their newborn infant, and who will soon be exposed to the frustration and anger of infant crying. Research has suggested a strong causal link between infant crying and AHT, and parents - particularly fathers and father figures - have been identified as the most common perpetrators of AHT. A number of studies have suggested that educating parents during the postnatal period about the normalcy of inconsolable infant crying and its evolution over the first several months of postnatal life improves parental knowledge about infant crying and a number of positive parenting behaviors, and decreases emergency room visits for crying. In 1998, we began a pilot program in Upstate New York near Buffalo that led to a 47% reduction in AHT incidence. Similar studies have demonstrated 35-75% reductions in incidence, which has led to enthusiasm for this approach to preventing AHT. We, as well as another group, have enacted statewide programs in Pennsylvania and North Carolina; unfortunately, these two large statewide replication trials failed to demonstrate any impact of such an intervention on AHT rates. Serial messages for parents, provided repeatedly over the period of greatest risk for AHT, might be another avenue of research.

Shaken baby syndrome education program: nurses making a difference.

This article describes the nursing role in the Upstate New York Shaken Baby Syndrome (SBS) Education Program, an effort to educate parents of all hospital-born infants in the eight-county region of Western New York about the dangers of violent infant shaking. This program has now been expanded to include hospitals in 17 counties in Upstate New York. The major intervention is an educational program administered by nurses. These nurses describe the challenges and opportunities they faced in implementing a large community health program.

Effect of substitution of high stearic low linolenic acid soybean oil for hydrogenated soybean oil on fatty acid intake.

High stearic, low alpha-linolenic acid soybean oil (HSLL) has been developed via traditional breeding to serve as a substitute for partially hydrogenated soybean oils used in food manufacturing. The purpose of this study was to estimate the impact on fatty acid intake in the United States if HSLL were substituted for partially hydrogenated soybean oils used in several food categories, including baked goods, shortenings, fried foods, and margarines. Using National Health and Nutrition Examination Survey (NHANES) data (1999-2002), baseline intakes of five fatty acids and trans fatty acids (TFA) were determined at the mean and 90th percentile of fat consumption. Then intakes of these fatty acids were determined after HSLL was substituted for 100% of the partially hydrogenated soybean oils used in these four food categories. The results show that baseline intake of stearic acid is 3.0% energy at the mean and 3.3% energy at the 90th percentile. Use of HSLL could increase stearic acid intake to about 4-5% energy. Mean intakes of TFA could decrease from 2.5 to 0.9% energy, and intake of palmitic acid would remain unchanged. Use of HSLL as a substitute for partially hydrogenated soybean oils would result in changes in the fatty acid composition of the US diet consistent with current dietary recommendations.

Effect of substitution of low linolenic acid soybean oil for hydrogenated soybean oil on fatty acid intake.

Low linolenic acid soybean oil (LLSO) has been developed as a substitute for hydrogenated soybean oil to reduce intake of trans FA while improving stability and functionality in processed foods. We assessed the dietary impact of substitution of LLSO for hydrogenated soybean oil (HSBO) used in several food categories. All substitutions were done using an assumption of 100% market penetration. The impact of this substitution on the intake of five FA and trans FA was assessed. Substitution of LLSO for current versions of HSBO resulted in a 45% decrease in intake of trans FA. Impacts on other FA intakes were within the realm of typical dietary intakes. No decrease in intake of alpha-linolenic acid was associated with the use of LLSO in place of HSBO because LLSO substitutes for HSBO that are already low in alpha-linolenic acid.