Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women.

This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p < 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p < 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.

Bridges to Elders: A Program to Improve Outcomes for Older Women Experiencing Homelessness.

Homelessness among older individuals is increasing and women experiencing homelessness have been previously shown to have poorer health outcomes than their male counterparts. To address these concerns, the Bridges to Elders (BTE) program was developed to improve health and social outcomes for older women experiencing or at risk for homelessness. BTE consisted of a nurse practitioner (NP) and community health worker (CHW) dyad who provided intensive case management services for women 55+ with housing instability. This evaluation used a pretest/posttest design to examine three main outcomes from BTE: change in housing status, enrollment with a primary care provider (PCP), and diagnosis of uncontrolled chronic condition. The sample included 96 BTE participants enrolled from January 2017 to December 2018. The average age of participants was 66 years and had a mean BTE enrollment time of 7.6 months. Statistically significant improvements were achieved in all three outcomes measured: 17% (p < .009) increase in stable housing, 35% (p < .001) increase in PCP enrollment, and 47% (p < .001) decrease in the diagnosis of an uncontrolled chronic condition. The results indicated an NP/CHW dyad improved housing status, primary care access, and targeted health outcomes for older women who are experiencing or at risk for homelessness. Future studies examining the impact of NP/CHW dyads on additional social determinants of health and their impact on health outcomes are recommended.

Heteroverticillium phytelephatis gen. et sp. nov. intercepted from nuts of Phytelephas macrocarpa, with an updated phylogenetic assessment of Nectriaceae.

An entry postal parcel with mature nuts of Phytelephas macrocarpa from Togo was inspected at Dalian Customs (China) in December 2021, and four strains were isolated from symptomatic tissues of the nuts. Based on morphological observations and molecular phylogenetic analyses, above strains were identified as a new species which is mainly characterised by the verticillately branching conidiophores. Based on multi-locus phylogenetic analyses, this new species forms a monophyletic clade closely related to Corallomycetella, Paracremonium and Xenoacremonium but could not be accommodated in any known genera of Nectriaceae. Thus, a new genus Heteroverticillium is established to accommodate this new species (H. phytelephatis). To our knowledge, this is the first time that Chinese customs have intercepted a new fungal genus. In addition, we provided an updated backbone tree for the generic relationships in Nectriaceae, which may largely assist future identification of nectriaceous fungi to genus level in quarantine inspections. Based on our analysis, Varicosporellopsis is likely a late synonym of Paracremonium.

Frontline healthcare workers' mental distress, top concerns, and assessment on hierarchy of controls in response to COVID-19: a cross-sectional survey study.

BACKGROUND: The existing studies showed that frontline healthcare workers during an epidemic experienced unusual stressors and mental distress which even lasted for years after the crisis. It is important to learn about their concerns early to mitigate the negative impact as well as to evaluate disease control from experiences on the front lines for improving responses to the outbreak. The study aimed to provide insights on how to strengthen public health responses to protect healthcare workers both physically and mentally, and effectively control the disease in light of hierarchy of controls. METHODS: A cross-sectional survey was distributed online via Qualtrics to frontline healthcare workers during the COVID-19 through a university's nursing program and received 267 valid responses from 103 certificated nursing assistants, 125 nurses, and 39 other health professionals. A descriptive data analysis with a Chi-square test at a two-sided 0.05 level of significance was performed on factors that potentially affected mental health of healthcare workers and effectiveness of disease control at workplace in five domains. The themes were summarized on open-ended questions. RESULTS: About 30% of the respondents showed the symptom of depression and needed a further investigation. The influencing factors in five domains were examined. Engineering and administrative controls, as well as PPE were widely used in response to COVID-19. The respondents assessed the state and workplace responses to COVID-19 better than the federal government responses. The workplace responses were considered most effective. Multiple factors with a statistically significant correlation with effectiveness of the disease control at workplace were identified. CONCLUSIONS: The study suggested that timely responses at policy level will be more effective than other measures in early prevention and control of the pandemic, mental distress should be addressed in addition to PPE, and nursing programs should consider providing a situation-specific career coaching or counseling for students. A longitudinal study at a larger scale is warranted to capture the variation of time change with the disease control evolvement and across geographic regions.

B-type natriuretic peptide levels and volume status in twice-weekly hemodialysis patients.

BACKGROUND: Twice-weekly hemodialysis (HD) could be regarded as an important part of incremental hemodialysis, volume status of this treatment model remains to be elucidated. METHODS: Patients undergoing regular twice-weekly or thrice-weekly hemodialysis in our unit on June 2015 were enrolled into the cohort study with an average of 2.02 years follow-up. Volume status of the subjects was evaluated by clinical characteristics, plasma B-type natriuretic peptide (BNP) levels and bioimpedance assessments with body composition monitor (BCM). Cox proportional hazards models and Kaplan-Meier analysis were used to compare patient survival between the two groups. RESULTS: Compared with patients on thrice-weekly HD, twice-weekly HD patients had significantly higher log-transformed BNP levels (2.54 ± 0.41 vs. 2.33 ± 0.49 pg/ml, p = 0.010). Overhydration (OH) and the ratio of overhydration to extracellular water (OH/ECW) in twice-weekly HD group were significantly higher than that of thrice-weekly HD (OH, 2.54 ± 1.42 vs. 1.88 ± 1.46, p = 0.033; OH/ECW, 0.17 ± 0.07 vs. 0.12 ± 0.08, p = 0.015). However, subgroup analysis of patients within 6 years HD vintage indicated that the two groups had similar hydration status. Multivariate Cox regression analysis showed that log-transformed BNP levels, serum albumin and diabetes status were predictors of mortality in hemodialysis patients. Kaplan-Meier survival analysis indicated that patients with BNP levels higher than 500 pg/ml had significantly worse survival compared with those with lower BNP levels (p = 0.014). CONCLUSIONS: Twice-weekly hemodialysis patients had worse volume status than that of thrice-weekly HD patients especially for those with long-term dialysis vintage, BNP level was a powerful predictor of mortality in HD patients.

Evaluation of body composition monitoring for assessment of nutritional status in hemodialysis patients.

BACKGROUND: Body composition monitoring is the only clinically available method for distinguishing among the three body components. This study aimed to determine the relationship between body composition and all-cause mortality in Chinese hemodialysis patients and examine whether the lean tissue index (LTI) derived from body composition monitoring can accurately diagnose malnourished patients. METHODS: Hemodialysis patients (n = 123) with nutritional and body composition assessment records in 2015 were examined. Body composition was assessed using a body composition monitor machine. RESULTS: Fifty-seven patients (46.3%) had low LTI (LTI less than the 10th percentile of the respective normal distribution). Significant differences in the fat tissue index (FTI) were observed, with the low LTI group having a higher FTI (10.8 kg/m2 vs. 9.0 kg/m2, p= .007). The kappa coefficient of agreement between LTI and subjective global assessment (SGA) was 0.26 for the presence of malnutrition. During the mean observation period of 26.7 months, 20 of 123 (16.3%) patients died. Low LTI remained highly predictive of survival in the Cox regression analysis (hazard ratio: 3.24, 95% confidence interval 1.06-9.91, p= .04). Malnourishment defined by SGA predicted survival in the Kaplan-Meier analysis (log-rank χ2=4.05; p= .04) but not in the multivariate analysis. CONCLUSIONS: LTI is a predictor of mortality, and its predictive power was not affected when FTI, SGA, and hydration status were included in the multivariate analysis. However, SGA may not be adequate to identify patients at a risk of death among Chinese hemodialysis patients.

Formation of nanoscale Te0 and its effect on TeO32- reduction in CH4-based membrane biofilm reactor.

Formation and recovery of elemental tellurium (Te0) from wastewaters are required by increasing demands and scarce resources. Membrane biofilm reactor (MBfR) using gaseous electron donor has been reported as a low-cost and benign technique to reduce and recover metal (loids). In this study, we demonstrate the feasibility of nanoscale Te0 formation by tellurite (TeO32-) reduction in a CH4-based MBfR. Biogenic Te0 intensively attached on cell surface, within diameters ranging from 10 nm to 30 nm and the hexagonal nanostructure. Along with the Te0 formation, the TeO32- reduction was inhibited. After flushing, biofilm resumed the TeO32- reduction ability, suggesting that the formed nanoscale Te0 might inhibit the reduction by hindering substrate transfer of TeO32- to microbes. The 16S rRNA gene amplicon sequencing revealed that Thermomonas and Hyphomicrobium were possibly responsible for TeO32- reduction since they increased consecutively along with the experiment operation. The PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) analysis showed that the sulfite reductases were positively correlated with the TeO32- flux, indicating they were potential enzymes involved in reduction process. This study confirms the capability of CH4-based MBfR in tellurium reduction and formation, and provides more techniques for resources recovery and recycles.

Using structural equation modelling to assess factors influencing children's growth and nutrition in rural China.

OBJECTIVE: Children's poor growth and nutrition status has serious consequences and therefore it is important to understand its contributing factors. DESIGN: A community-based interventional study focusing on child feeding was conducted in a rural community in China. Data from the intervention group at baseline (1-4 months of age) and follow-up visits (12 and 18 months of age) were used in the present study (n 236). A structural equation model was generated to explore the effects of family wealth, household food safety, dietary intake, diseases and other factors on the growth and nutrition of young children. RESULTS: Mother's knowledge and behaviours on household food safety had positive effects on children's weight-for-age Z-score (WAZ; ß direct=0·03 and 0·15, respectively, at 12 months of age; ß direct=0·02 and 0·08, respectively, at 18 months; P<0·05) and weight-for-length Z-score (WLZ; ß direct=0·04 and 0·21, respectively, at 12 months of age; ß direct=0·01 and 0·06, respectively, at 18 months; P<0·05). While mothers' feeding behaviours and children's dietary intake at 12 months of age were positively associated with WAZ and/or WLZ at current and later ages, children's diseases were negatively associated with WAZ and WLZ cross-sectionally. CONCLUSIONS: Caregiver's knowledge and feeding behaviours, and children's dietary intake and diseases, are factors influencing the WAZ and WLZ of children. Promoting feeding and health knowledge and behaviours at early stages of childhood can improve children's physical growth at later ages.

Assessment of metallic trace elements in the muscles and fins of four landed elasmobranchs from Kuala Terengganu Waters, Malaysia.

A study had been carried out to determine Cu, Zn, Cd, Hg and Pb concentrations in the muscle and fins of four elasmobranchs species namely spot-tail sharks, milk sharks, whitespotted bamboo sharks and whitespotted guitarfish from Pulau Kambing LKIM Fishery Complex, Kuala Terengganu, Malaysia. Zinc level was found to have the highest concentration whereas Cd had the lowest concentration in both organs. By comparing both organs, metals concentrations in fins of all elasmobranchs species were higher than muscle. Result obtained was compared with the guidelines set by Malaysian Food Regulation and the provisional tolerable weekly intake was also determined. Current study recommends that the muscle of whitespotted bamboo shark from Kuala Terengganu Waters is likely not to be consumed due to it exceeded the allowable consumption guideline. Finding of this paper is very useful as it provides the baseline data on the pollution status of elasmobranchs in Kuala Terengganu Waters.

Physical Activity Domains/Recommendations and Leukocyte Telomere Length in U.S. Adults.

PURPOSE: The purpose of this study was to examine the associations between different physical activity (PA) domains, PA recommendations, and leukocyte telomere length (LTL) using data from a nationally representative sample of U.S. adults in the National Health and Nutrition Examination Survey, 1999-2002. METHODS: A total of 6933 U.S. adults (3402 men, 3531 women; age range: 20-84 yr) who completed demographic, general health and PA questionnaires and provided a blood sample were included in the analyses. Multivariable-adjusted linear regression models were used to determine associations between PA (domain-specific PA [household/yard work PA, transportation PA, moderate leisure time PA (LTPA), and vigorous LTPA], total moderate PA and PA recommendation groups), and log-transformed LTL adjusting for age, gender, education, cigarette smoking, alcohol consumption, and body mass index. RESULTS: On average, an increase of 1 h·wk of vigorous LTPA was associated with a 0.31% (P < 0.001) longer LTL, and an increase of 1 h·wk of household/yard work PA was associated with a 0.21% (P = 0.03) shorter LTL while adjusted for sociodemographic and health behavior covariates. Neither transportation PA nor moderate LTPA was significantly associated with LTL. In addition, compared with not meeting the PA recommendation (<150 min·wk), exceeding the recommended PA levels (≥300 min·wk) was positively associated with longer LTL (P = 0.04), whereas there was no difference in telomere length between those not meeting versus those meeting the PA recommendation (150-299 min·wk). CONCLUSION: Greater engagement in vigorous LTPA and exceeding the PA recommendation may have a protective effect against telomere shortening. Future studies should examine the association between PA and LTL by exploring potential mediators such as sedentary behavior, genetics, nutrition, and chronic diseases.

Comparing Samples of Men Who Have Sex with Men Recruited Online and in Venues, Jiangsu Province, China, 2013.

PURPOSE: Two common methods to sample men who have sex with men (MSM) for HIV research are venue- and internet-based approaches. However, it is unclear which is best to sample Chinese MSM. METHODS: We conducted side-by-side comparisons of time-location sampling (TLS) and an online sample of MSM in Nanjing, China. RESULTS: TLS-recruited MSM tended to be older and of lower socio-economic status compared to online-recruited MSM, whereas online-recruited MSM reported higher risk behavior and lower frequency of HIV testing. CONCLUSION: Significant differences were observed between the two separate samples. Without a gold standard, the choice of sampling method or recruitment approach should be guided by the segment of the population targeted to be reached.

Experiences and correlates of HIV self-testing among men who have sex with men in Jiangsu province, China.

Substantial numbers of Chinese men who have sex with men (MSM) do not access facility-based HIV testing. Self-testing could promote testing uptake among this population. We describe experiences and identify correlates of self-testing among Chinese MSM. A cross-sectional survey was conducted among MSM in Jiangsu from November 2013 to January 2014. Participants were recruited through time-location sampling and from online. Participants were asked a series of questions about HIV self-testing uptake and associated experiences. Logistic regression was used to identify correlates of having ever self-tested for HIV. Of 522 participants, 26.2 % had ever self-tested. Finger stick was the most common self-testing modality (86.1 %). A majority of participants reported that it was "very easy" (43.1 %) or "somewhat easy" (34.3 %) to perform self-testing while lower proportions reported "very confident" (24.1 %) or "somewhat confident" (36.5 %) in the accuracy of their test results. Having ever self-tested was significantly associated with having had 2-5 and 6 or more male anal sex partners in the past 6 months (AOR 2.12, 95 % CI 1.00, 4.49; AOR 4.95, 95 % CI 1.90, 12.87), having ever tested for HIV (AOR 4.56, 95 % CI 1.66, 12.55), and having a friend or friends who self-tested (AOR 7.32, 95 % CI 3.57, 15.00). HIV self-testing can reach untested Chinese MSM and/or increase testing frequency. Peer- or social network-based interventions could futher help encourage self-testing. Monitoring systems should be strengthened to ensure the quality of self-testing kits and provision of essential support services, including post-test counseling and linkage-to-care.

A stiff price to pay: does joint stiffness predict disability in an older population?

OBJECTIVES: To describe the prevalence of joint stiffness and associated comorbidities in community-living older adults and to determine whether joint stiffness, independent of pain, contributes to new and worsening disability. DESIGN: Population-based cohort. SETTING: Urban and suburban communities in the Boston, Massachusetts, area. PARTICIPANTS: Adults aged 70 and older (N = 765) underwent a baseline home interview and clinic examination, 680 participants completed the 18-month follow-up. MEASUREMENTS: Morning joint stiffness on most days in the past month was assessed in the arms, back, hips, and knees. Mobility limitations were measured using self-reported difficulty and the Short Physical Performance Battery (SPPB). The home interview and clinic examination included extensive health measures. RESULTS: Four hundred one participants reported morning joint stiffness, half of these with one site of stiffness and the other half with multisite stiffness. Twenty percent of participants with multisite stiffness and 50% with single site stiffness did not have a major stiffness-associated condition. After adjustment for pain severity and other covariates, multisite stiffness was associated with a 64% greater risk of developing new or worsening mobility difficulty (relative risk = 1.64, 95% confidence interval = 1.05-2.79). Those with multisite stiffness had declined more quickly in physical performance over the 18-month follow up. CONCLUSION: Older adults with multisite stiffness are more likely to be at risk of disability than those without joint stiffness after accounting for pain severity and the presence of stiffness-associated conditions. Better assessment, along with strategies to prevent and treat multisite joint stiffness is needed to prevent or slow the progression of disability in elderly adults.

Meta-analysis assessment of GP210 and SP100 for the diagnosis of primary biliary cirrhosis.

PURPOSE: To conduct a systematic review of included studies assessing the association of GP210 and SP100 with the risk of primary biliary cirrhosis (PBC) using meta-analysis. METHODS: Five databases, the Cochrane Library, MEDLINE, VIP, CNKI, WANFANG were used to detect the role of GP210 and SP100 in diagnosis of PBC. Approximately 13,000 participants from several countries were included in this analysis. Meta-DiSc statistical software was used for analysis. RESULTS: 25 studies on GP210 and 21 studies on SP100 were included in the meta-analysis. The DOR, sensitivity, specificity of GP210 in diagnosis of PBC were 24.854 (11.957-51.660), 0.272 (0.257-0.288), 0.985 (0.982-0.988), respectively, and they were 9.133 (4.739-17.600), 0.231 (0.213-0.249), 0.977 (0.973-0.981) for SP100. CONCLUSION: Our meta-analysis indicated both GP210 and SP100 had high specificity but low sensitivity in diagnosis of PBC.

Blood safety and availability: continuing challenges in China's blood banking system.

Social and economic development, along with increased health care coverage, has caused a sharp increase in the clinical demand for blood in China. Whole blood collection has increased rapidly in the past decade but has failed to keep pace with the ever-increasing demand. Overall, the country's blood safety has been improved with 99% of whole blood donations collected from voluntary unpaid donors. However, the unmet clinical demand for blood and the increasing incidence of human immunodeficiency virus and syphilis in the general population pose new challenges to China's blood banking system. To ensure a safe and adequate blood supply, continued efforts are required to recruit and retain a sufficient number of low-risk voluntary blood donors, improve donor prescreening and blood testing process, ease donor restrictions, and strengthen patient blood management.

Zr61Ti2Cu25Al12 metallic glass for potential use in dental implants: biocompatibility assessment by in vitro cellular responses.

In comparison with titanium and its alloys, Zr61Ti2Cu25Al12 (ZT1) bulk metallic glass (BMG) manifests a good combination of high strength, high fracture toughness and lower Young's modulus. To examine its biocompatibility required for potential use in dental implants, this BMG was used as a cell growth subtract for three types of cell lines, L929 fibroblasts, human umbilical vein endothelial cells (HUVEC), and osteoblast-like MG63 cells. For a comparison, these cell lines were in parallel cultured and grown also on commercially pure titanium (CP-Ti) and Ti6-Al4-V alloy (Ti64). Cellular responses on the three metals, including adhesion, morphology and viability, were characterized using the SEM visualization and CCK-8 assay. Furthermore, real-time RT-PCR was used to measure the activity of integrin ß, alkaline phosphatase (ALP) and type I collagen (COL I) in adherent MG63 cells. As indicated, in all cases of three cell lines, no significant differences in the initial attachment and viability/proliferation were found between ZT1, CP-Ti, and Ti64 until 5d of incubation period. It means that the biocompatibility in cellular response for ZT1 BMG is comparable to Ti and its alloys. For gene expression of integrin ß, ALP and COL I, mRNA level from osteoblast cells grown on ZT1 substrates is significantly higher than that on the CP-Ti and Ti64. It suggests that the adhesion and differentiation of osteoblasts grown on ZT1 are even superior to those on the CP-Ti and Ti64 alloy, then promoting bone formation. The good biocompatibility of ZT1 BMG is associated with the formation of zirconium oxide layer on the surface and good corrosion-resistance in physiological environment.

Effectiveness of an educational intervention to improve child feeding practices and growth in rural China: updated results at 18 months of age.

Inappropriate complementary feeding practices have led to, in part, significant disparities in growth and nutritional status between rural and urban children in China. A cluster-randomised, controlled trial was implemented in Laishui, China to assess the effectiveness of an educational intervention on caregivers' feeding practices and children's growth. Eight townships were randomly assigned to the intervention or control. Five hundred ninety-nine healthy infants were enrolled at 2-4 months old, and were followed up at ages 6, 9, 12, 15 and 18 months. The intervention group received information on enhanced home-prepared recipes and food preparation and hygiene through group training, counselling and home visit. Key outcomes were children's physical growth, caregivers' knowledge and behaviours on complementary feeding, and the infant and child feeding index (ICFI). Analysis was by intention to treat. The intervention group achieved better knowledge and practices related to complementary feeding, and significantly higher ICFI scores at each follow-up point. Children in the intervention group achieved higher z-scores for weight-for-age (WAZ) and weight-for-height (WHZ) than the control (0.18 vs. 0.01 and 0.49 vs. 0.19, respectively) at 18 months old, and were less likely to have stunted growth (odds ratio = 0.71, 95% confidence interval: 0.53-0.94). Mixed model showed that the intervention group achieved significantly better linear growth over time, including WAZ (P = 0.016), WHZ (P = 0.030) and HAZ (P = 0.078). These results indicated that an educational intervention delivered through local health services can enhance caregivers' knowledge and practices of complementary feeding and ultimately improve children's growth.

Antidepressants and breast and ovarian cancer risk: a review of the literature and researchers' financial associations with industry.

BACKGROUND: Antidepressant (AD) use has been purported to increase the risk of breast and ovarian cancer, although both epidemiological and pre-clinical studies have reported mixed results. Previous studies in a variety of biomedical fields have found that financial ties to drug companies are associated with favorable study conclusions. METHODS AND FINDINGS: We searched English-language articles in MEDLINE, PsychINFO, the Science Citations Index and the Cochrane Central Register of Controlled Clinical Trials (through November 2010). A total of 61 articles that assessed the relationship between breast and ovarian cancer and AD use and articles that examined the effect of ADs on cell growth were included. Multi-modal screening techniques were used to investigate researchers' financial ties with industry. A random effects meta-analysis was used to pool the findings from the epidemiological literature. Thirty-three percent (20/61) of the studies reported a positive association between ADs and cancer. Sixty-seven percent (41/61) of the studies reported no association or antiproliferative effect. The pooled odds ratio for the association between AD use and breast/ovarian cancer in the epidemiologic studies was 1.11 (95% CI, 1.03-1.20). Researchers with industry affiliations were significantly less likely than researchers without those ties to conclude that ADs increase the risk of breast or ovarian cancer. (0/15 [0%] vs 20/46 [43.5%] (Fisher's Exact test P = 0.0012). CONCLUSIONS: Both the pre-clinical and clinical data are mixed in terms of showing an association between AD use and breast and ovarian cancer. The possibility that ADs may exhibit a bi-phasic effect, whereby short-term use and/or low dose antidepressants may increase the risk of breast and ovarian cancer, warrants further investigation. Industry affiliations were significantly associated with negative conclusions regarding cancer risk. The findings have implications in light of the 2009 USPSTF guidelines for breast cancer screening and for the informed consent process.

Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial.

OBJECTIVE: Inappropriate complementary feeding is one of the major causes of malnutrition in young children in developing countries. We developed an educational intervention, delivered by local health-care providers, aimed at improving complementary feeding practices and child nutrition. DESIGN: Eight townships in Laishui, a rural area in China, were randomly assigned to the educational intervention or control group. A total of 599 healthy infants were enrolled at age 2-4 months and followed up until 1 year of age. In the intervention group, educational messages and enhanced home-prepared recipes were disseminated to caregivers through group trainings and home visits. Questionnaire surveys and anthropometric measurements were taken at baseline and ages 6, 9 and 12 months. Analysis was by intention to treat. RESULTS: It was found that food diversity, meal frequency and hygiene practices were improved in the intervention group. Infants in the intervention group gained 0.22 kg more weight (95 % CI 0.003, 0.45 kg, P = 0.047) and gained 0.66 cm more length (95 % CI 0.03, 1.29 cm, P = 0.04) than did controls over the study period. CONCLUSIONS: Findings from the study suggest that an educational intervention delivered through local health-care providers can lead to substantial behavioural changes of caregivers and improve infant growth.

Breastfeeding in rural China: association between knowledge, attitudes, and practices.

Breastfeeding rates have decreased in the past decade in China. This study identifies psychosocial and sociodemographic factors associated with breastfeeding practices. A total of 599 mothers of infants 2 to 4 months old were interviewed using a structured questionnaire. Nearly all infants (95.5%) were breastfed, but only 4.2% were exclusively breastfed, and 48.7% were fully breastfed. Mothers' intention to breastfeed (odds ratio [OR] = 1.67, 95% CI: 1.39-2.01) and social support (OR = 1.22, 95% CI: 1.002-1.50) were associated with full breastfeeding. Full breastfeeding prevalence decreased with children's age (OR = 0.79, 95% CI: 0.63, 0.98). Girls were more likely to be fully breastfed than boys (OR = 1.46, 95% CI: 1.06, 2.02). This study found that optimal breastfeeding practices during the first 4 months of life are not universal in rural China. Health care providers should be more actively involved in educating and motivating mothers and their family members to adopt optimal breastfeeding practices.