Effect of discharge samples on duration of breast-feeding.

The breast-feeding patterns of 146 women who initiated breast-feeding during their hospital stay were evaluated to determine whether those women who received a hospital discharge package containing a manual breast pump breast-fed their infants for a longer period of time than did women who received a discharge package containing an infant formula. Women were randomly assigned to receive either a specially prepared pack containing a manual breast pump but no infant formula or a commercially available infant formula package. The women were interviewed in the hospital and by computer-assisted telephone interviews at 2, 4, 6, and 8 weeks postdischarge. Information obtained included infant-feeding practices, sociodemographic characteristics, and attitudinal data. Follow-up interviews were completed for nearly 85% of eligible women at each time period. Women who received a discharge pack containing a breast pump but no infant formula continued exclusive breast-feeding for a greater number of weeks (mean = 4.18 weeks) than did women receiving infant formula in their discharge package (mean = 2.78 weeks) (P less than .05). Also, women who indicated that ease of nighttime feeding was an important consideration were more likely to breast-feed over the entire 8-week period if they received the breast pump rather than infant formula (P less than .05). The conclusion is that an easily implemented, low-cost intervention, the inclusion of a breast pump in discharge packages, may increase the duration of breast-feeding.

Assessment and evaluation of child health associates.

More than 20 studies have been carried out of child health associates to assess their knowledge, training, and practice; their ability to interpret and integrate data; their cognitive knowledge and psychomotor and interpersonal skills; and their competence and effectiveness as a primary health care providers. The results of the assessment and evaluation studies of child health associates indicate that they can determine the health status and manage the health care of patients in ambulatory settings and in the newborn nursery with a degree of skill and competence approaching that of pediatricians. Child health associates can provide comprehensive primary health care for more than 90% of children seen in these settings. The high degree of acceptance of child health associates by families and their demonstrated proficiency and cost-effectiveness document that they can be an important source of primary health care for most children.

Elevated environmental lead levels in a day care setting.

OBJECTIVE: To determine the risk of lead poisoning among children enrolled in day care centers with elevated environmental lead burdens. DESIGN: Survey. SETTING: Six day care centers on properties owned by a major state-supported university. PATIENTS AND OTHER PARTICIPANTS: One hundred fifty-five of 234 eligible children (mean age, 4.8 years) enrolled in these centers were screened by questionnaire for risk factors of lead exposures. Blood samples for lead levels were also obtained. Observations of day care activities relative to lead exposure risks were recorded. Analyses of lead levels in paint, dust, and/or soil samples at the six centers were obtained. MAIN OUTCOME MEASURES: Prevalence of elevated blood lead levels and associated behavioral risk factors for lead exposure in children attending day care centers. RESULTS: Elevated levels of lead in paint (2.4% to 40% lead) were present in all day care facilities. Three day care centers had elevated lead levels in windowsill dust (62,000 to 180,000 micrograms [corrected] of lead per square meter) or soil (530 to 1100 mg of lead per kilogram): Questionnaires documented low risk for lead exposure to children in the home environments. Direct observations in the day care setting revealed optimal supervision and hygiene of the children. Blood lead levels were less than 0.5 mumol/L (10 micrograms/dL) in all but one of the 155 children screened. CONCLUSIONS: Children attending day care centers with high environmental lead burdens need further documentation of blood lead levels, at-risk behaviors, and lead exposure risks in the home environments as an adjunct to the instigation of lead abatement procedures at the day care centers.

Does increased nitrate ingestion elevate nitrate levels in human milk?

OBJECTIVE: To determine whether the nitrate content of human milk is influenced by maternal ingestion of water containing elevated nitrate levels. DESIGN: Prospective, nonrandomized, volunteer study. SETTING: Clinical Research Center at the University of Iowa Hospitals and Clinics, Iowa City. PATIENTS: Twenty healthy lactating women with infants older than 6 months. INTERVENTIONS: The mothers were asked to consume a minimum of 1500 mL of water containing 0 mg of nitrate per liter on day 1, 45 mg on day 2, and 100 mg on day 3 in addition to consuming and recording their dietary intake. Breast-feeding was permitted during days 1 and 2, but milk was expressed on day 3 and the infants were given alternate food sources. After each 24-hour study day, maternal urine and milk samples were collected and frozen. A modified cadmium column reduction method was used to determine spot urinary and milk nitrate content. RESULTS: The meant total nitrate intake from diet and water on days 1,2, and 3, respectively, was 46.6, 168.1, and 272.0 mg. Spot urine nitrate content on days 1, 2, and 3, respectively, was 36.0, 66.0, and 84.0 mg. Nitrate concentration of human milk on days 1,2, and 3, respectively, was 4.4, 5.1 and 5.2 mg/L. CONCLUSION: Women who consume water with a nitrate concentration of 100 mg/L or less do not produce milk with elevated nitrate levels.

Nitrate in baby foods. Adding to the nitrate mosaic.

OBJECTIVE: To identify commercial baby food varieties high in nitrate content using ion chromatography and compare the health risk associated with the consumption of high-nitrate water and high-nitrate commercial baby food. DESIGN: Ion chromatographic determination of nitrate concentration in a variety of commercial baby foods. SETTING: University Hygienic Laboratory, University of Iowa College of Medicine, Iowa City. PATIENTS: None. RESULTS: Commercial baby foods with nitrate levels higher than 45 ppm include mixed vegetables, bananas, carrots, garden vegetables, spinach, green beans, and beets. The amount of nitrate in one 113-g (4 oz) jar of beets, for example, is equivalent to the amount of nitrate in nearly 5.5 L of water at 45 ppm nitrate. CONCLUSIONS: A controlled clinical trial is needed to clarify how consuming high-nitrate foods correlates with methemoglobin levels in infants younger than 6 months.

Hospital infant formula discharge packages. Do they affect the duration of breast-feeding?

OBJECTIVE: To determine whether the duration of breast-feeding is affected by the contents of the hospital discharge package. DESIGN: A randomized clinical trial with 2 experimental interventions (a discharge package containing a manual breast pump only and a discharge package containing a commercially prepared infant formula and a manual breast pump) and a control group who received a commercially prepared infant formula discharge package only. Sociodemographic characteristics and information concerning prior births (including feeding methods) were obtained from each mother within 48 hours of her infant's birth. Sources of influence on the mother's feeding decision, maternal attitudes concerning breast-feeding, and maternal feeding preferences were also assessed. PARTICIPANTS: The sample consisted of 763 women who had given birth who were admitted to the maternal-fetal unit of a midwestern community hospital. MAIN OUTCOME MEASURES: Information concerning current method of infant feeding was obtained from telephone interviews conducted at 2-week intervals until the infant was 16 weeks old. The data were analyzed using descriptive statistics, multivariate analysis of variance, logistic regression analysis, and survival analysis. RESULTS: The content of the hospital discharge package did not affect whether the mother engaged in exclusive or partial breast-feeding during the 16-week follow-up interval. However, there was some evidence that providing formula samples at discharge from the hospital increased the duration of exclusive breast-feeding compared with providing a manual breast pump. CONCLUSION: This study does not support the assumption that inclusion of infant formula in hospital discharge packages decreases the duration of breast-feeding.

Personal preferences and ethnic variations among Anglo and Hispanic breast and bottle feeders.

The preferences of Spanish-speaking Hispanics and English-speaking Anglos for breast and bottle feeding were evaluated using marketing research techniques. Preliminary interviews with 55 mothers conducted within the first 48 hr post-partum elicited a list of verbatim responses regarding the positive and negative aspects of both feeding methods. An additional 195 women rank-ordered the most frequently mentioned statements in terms of their preference for each. Socio-demographic data on the mothers were analyzed with chi-square analysis and discriminant analysis. Multidimensional scaling was used to assess the preferred characteristics of breast and bottle feeding. Results indicated that most mothers prefer a method of infant feeding that allows the mother to be 'closer to her baby' and allows the baby to 'grow up healthier.' Bottle feeders perceived bottle feeding to be superior because it insured that baby would be 'full and satisfied' and would 'get all the vitamins and nutrients it needed,' especially when 'mother was not eating right" or was 'on medications.' Analysis of cultural preference patterns revealed that there exists a strong culture pattern or preference for breast feeding and its characteristics among Anglos. In contrast, the Hispanics show no clear preference for either breast or bottle feeding.

Behavioral problems among twins.

Despite the frequency of multiple births, little information is available to assist parents and health professionals in the identification and management of behavior problems in multiple-birth siblings. Three case reports are presented that describe quarreling, aggression, and feeding problems among twins. To develop intervention strategies most appropriate for the problem behavior, it is important to determine whether (1) parents are able to effectively implement the intervention strategy, (2) behavior is isolated to one sibling, and (3) different reasons are responsible for similar behavior in siblings. Structured observations were used to determine whether the undesired behavior occurred to escape nonpreferred activities, gain access to preferred activities, or obtain parental attention. The cases provide a framework to facilitate the identification and management of common behavior problems occurring among multiple-birth siblings.

Basic Health Services in Nigeria: models for primary care in America.

The basic problems in delivery of health care in the United States and in Nigeria are similar; the major differences are in magnitude. Nigeria's Basic Health Services Scheme, now being implemented, is a bold effort to make quality health care accessible to the entire population. American health planners should look to such developing countries for concepts adaptable to our own health care delivery system. In developing primary care programs in particular, they should consider three basic components of the Nigerian scheme: (1) delegation of appropriate responsibilities to non-physician health providers in order to augment physician manpower in underserved areas; (2) location of training centers in environments similar to those where the trainees will serve; and (3) use of home-based care records to increase patient participation in health care.

Breast feeding preference of Hispanic and Anglo women. 1978-1985.

Hispanic women of Mexican origin are one of the fastest growing minority groups in the United States, but little information is available regarding the rate of breast feeding among this group of women. The breast feeding preferences of Hispanic women delivering at a southern California university hospital were determined by retrospective analysis of birth log records from 1978 to 1985. Approximately 95 percent of the Hispanic women delivering at this institution were of Mexican origin. Hispanic women had a preference for breast feeding similar to the national average for the same time period. The rate of breast feeding among Hispanic women of Mexican descent was consistently higher than previous reports from other regions of the United States.

Congenital hyperextension of the knees in twins.

Bilateral congenital hyperextension of the knees occurring in dizygotic twins is reported. Twin A had the mild form of the disease, genu recurvatum, while twin B had a more severe form of the disease, congenital subluxation. Hyperextension of the knee may occur as a sporadic abnormality, in conjunction with multiple dislocations or as a feature of a syndrome. Early detection and diagnosis are important, especially in the more severe forms of the condition, subluxation and dislocation, which require aggressive immediate intervention to prevent long-term sequelae. Conservative treatment consisting of manipulations and immobilization usually will correct the mild forms of the condition if instituted soon after birth. Prognosis is less favorable with delayed treatment, in the presence of other congenital anomalies, and with genetic syndromes.

Pediatrics in the Marshall Islands.

The delivery of health care to children living on isolated island communities presents unique challenges to health professionals. An evolved method of providing longitudinal services to infants and children residing on islands of the Marshall Island chain--a central Pacific portion of the Micronesian archipelago--is presented. The difficulties associated with provision of comprehensive health care in a vast ocean area are discussed.

Evaluation of a child health associate program.

The staff of the University of Colorado Child Health Associate Program critically reviewed the effectiveness of the program's structure and content during an intensive two-day seminar. The review was conducted through workshops involving participants representing students, graduates, faculty, employers, funding agencies, university administrators, and educational consultants. The agenda for the evaluation included workshops on specific topics such as basic and clinical sciences, psychosocial skills, and proficiency testing. Information obtained provided extremely valuable data which were used to improve the program.