妇女营养与母乳喂养

妇女孕前的营养状况和妊娠期体重增重值,不仅影响婴儿出生体重,更重要的是影响母体的能量储备和产后哺乳。即便是营养不良的母亲,明智的选择仍然是产后实行母乳喂养,为母亲提供充足合理的食物,而不是为婴儿选用代乳品。     

Breastfeeding positions and techniques used by Canadians with physical disabilities

BackgroundBreastfeeding is recommended by both the World Health Organization and the Canadian Pediatric Society due to the numerous maternal and infant benefits. Current literature examining breastfeeding among people with physical disabilities is limited to the United States with limited information about the Canadian context.ObjectiveThe primary aim of this study was to identify breastfeeding positions and techniques used by people with physical disabilities and explore their perceptions of effectiveness in a Canadian context where individuals had universal access to a lactation consultant.MethodsA cross-sectional interview-based study was undertaken. Individuals were eligible for the study if they breastfed within the last 10 years and a) used a mobility device or b) experienced dysmobility, weakness or pain due to a medical condition while breastfeeding. Interviews were semi-structured to allow in-depth exploration of breastfeeding techniques and perceptions of effectiveness. The interviews were audiotaped, professionally transcribed, and assessed for content surrounding the use and effectiveness of breastfeeding positions and techniques.ResultsEleven people participated in our study. Participants in our sample mentioned a variety of techniques used to breastfeed including a) accessories, b) assistance from others, c) breastfeeding positions, and d) location of feeding.ConclusionsPeople with physical disabilities use a variety of breastfeeding techniques to overcome physical limitations. This practical advice may improve guidance for healthcare professionals, including lactation consultants, to better support people with physical disabilities meet their breastfeeding goals.     

Factors Associated with Very Early Weaning Among Primiparas Intending to Breastfeed

Objectives: The major objective of this study was to identify predictor variables that accurately differentiated breastfeeding women who weaned during the first 4 weeks, those who weaned between 5 and 26 weeks, and those who weaned after 26 weeks. Predictors were demographic variables, Theory of Planned Behavior (TPB) variables, breastfeeding knowledge, and difficulties experienced during the first month. Methods: Primiparas who delivered healthy infants in an urban midwestern hospital provided initial data prior to discharge. Follow-up occurred at 1,3,6,9, and 12 months. Following appropriate bivariate analyses, polychotomous logistic regression was used to determine predictors of weaning group. Linear multiple regression was used to predict intended duration. Results: Most of the 84 women who weaned very early had intended to breastfeed considerably longer. According to the multivariate analysis, women who weaned earlier were younger, had completed fewer years of education, had a more positive bottle-feeding attitude and a less positive breastfeeding attitude, intended to breastfeed less time, had lower knowledge scores, had higher perceived insufficient milk scores, and planned to work outside the home. Variables postulated by the TPB to be direct predictors of intention explained 36% of the variance in intended duration. Conclusions: Women at risk for early weaning can be identified with reasonable accuracy using a TPB-based conceptual framework expanded to include breastfeeding specific variables. Casefinding using empirically derived screening methods and careful postpartum follow-up, along with professional intervention, should be used to avert unintended early weaning.     

Moving Beyond Breastfeeding Initiation: A Qualitative Study Unpacking Factors That Influence Infant Feeding at Hospital Discharge Among Urban,Socioeconomically Disadvantaged Women

BackgroundFactors that influence breastfeeding initiation and duration have been well established; however, there is limited understanding of in-hospital exclusive breastfeeding (EBF), which is critical for establishing breastfeeding. Grady Memorial Hospital, which serves a high proportion of participants receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and racial/ethnic minorities, had an in-hospital EBF rate in 2018 by the Joint Commission’s definition of 29% and sought contextualized evidence on how to best support breastfeeding mothers.ObjectiveThe objectives were to (1) identify facilitators and barriers to in-hospital EBF and (2) explore breastfeeding support available from key stakeholders across the social-ecological model.DesignIn-depth, semistructured interviews were conducted and analyzed using thematic analysis.ParticipantsThe sample included a total of 38 purposively sampled participants from Grady Memorial Hospital (10 EBF mothers, 10 non-EBF, and 18 key stakeholders such as clinicians, community organizations’ staff, and administrators).ResultsKey themes included that maternal perception of inadequate milk supply was a barrier to in-hospital EBF at the intrapersonal level. At the interpersonal level, a personable and individualized approach to breastfeeding counseling may be most effective in supporting EBF. At the institutional level, key determinants of EBF were gaps in prenatal breastfeeding education, limited time to provide comprehensive prenatal education to high-risk patients, and practical help with latching and positioning. Community-level WIC services were perceived as a facilitator due to the additional benefits provided for EBF mothers; however, the distribution of WIC vouchers for formula to mothers while they are in the hospital undermines the promotion of EBF. Cultural norms and a diverse patient population were reported as barriers to providing support at the macrosystem level.ConclusionMultipronged approaches that span the social-ecological model may be required to support early EBF in hospital settings.     

Knowledge About Breastfeeding Among a Group of Primary Care Physicians and Residents in Puerto Rico

Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support.     

Association of Family and Health Care Provider Opinion on Infant Feeding with Mother's Breastfeeding Decision

In the United States, about 25% of women choose not to initiate breastfeeding, yet little is known about how opinions of individuals in a woman's support network influence her decision to breastfeed. In the 2005-2007 Infant Feeding Practices Study II, women completed questionnaires from the last trimester of pregnancy until 12 months postpartum. Mothers indicated prenatally their family members' and health care providers' opinion on how newborns should be fed: breastfed only, formula fed only, breast and formula fed, or no opinion/don't know. Breastfeeding initiation was determined by asking mothers around 4 weeks postpartum (n=2,041) whether they ever breastfed. Logistic regression was used to examine the association between mothers' perception of family members' and health care providers' opinion on how to feed the infant and the initiation of breastfeeding, adjusting for sociodemographic characteristics. Nearly 14% of mothers surveyed did not initiate breastfeeding. Mothers who believed their family members or health care providers preferred breastfeeding only were least likely not to initiate breastfeeding. Never breastfeeding was significantly associated with the following perceptions: the infant's father (odds ratio [OR]=110.4; 95% CI 52.0 to 234.4) or maternal grandmother (OR=15.9; 95% CI 7.0 to 36.0) preferred only formula feeding; the infant's father (OR=3.2; 95% CI 1.7 to 5.9) or doctor (OR=2.7; 95% CI 1.2 to 6.2) preferred both breast and formula feeding; and the infant's father (OR=7.6; 95% CI 4.5 to 12.7), maternal grandmother (OR=5.4; 95% CI 2.6 to 11.0), or doctor (OR=1.9; 95% CI 1.0 to 3.7) had no opinion/didn't know their feeding preference. The prenatal opinions of family members and health care providers play an important role in a woman's breastfeeding decisions after the infant's birth.     

Moving On? Predictors of Intent to Leave Among Rural and Remote RNs in Canada

Context: Examination of factors related to the retention or voluntary turnover of Registered Nurses (RNs) has mainly focused on urban, acute care settings. Purpose: This paper explored predictors of intent to leave (ITL) a nursing position in all rural and remote practice settings in Canada. Based on the conceptual framework developed for this project, potential predictors of ITL were related to the individual RN worker, the workplace, the community context, and satisfaction related to both the workplace and the community(s) within which the RN lived and worked. Methods: A national cross‐sectional mail survey of RNs in rural and remote Canada provided the data (n = 3,051) for the logistic regression analysis of predictors of ITL. Findings: We found that RNs were more likely to plan to leave their nursing position within the next 12 months if they: were male, reported higher perceived stress, did not have dependent children or relatives, had higher education, were employed by their primary agency for a shorter time, had lower community satisfaction, had greater dissatisfaction with job scheduling, had lower satisfaction with their autonomy in the workplace, were required to be on call, performed advanced decisions or practice, and worked in a remote setting. Conclusions: The statistical evidence for predictors of ITL supported our framework with determinants related to the individual, the workplace, the community, and satisfaction levels. The importance of community makes this framework uniquely relevant to the rural health context. Our findings should guide policy makers and employers in developing retention strategies.     

梅县客家产妇哺乳卫生状况及其对新生儿腹泻发病的影响调查

[目的]了解客家人新生儿哺乳卫生状况及其与新生儿腹泻发病的影响,为保护母婴健康提供参考依据。[方法32011年11月至2012年1月,在梅县随机抽取99名客家产妇及其哺乳的新生儿（婴儿）进行调查。[结果]检测99名产妇,手表面菌落总数和大肠菌群均检测的92人,2项指标均合格的占19．56％;新生儿使用的饮具菌落总数和大肠菌群均检测的95份,2项指标均合格的占14．53％;乳头乳晕大肠菌群检测82人,阳性率为40．24％;乳头部奶大肠菌群检测89份,阳性率为32．58％。调查的99名新生儿中,自出生至采样时发生新生儿腹泻的38名,发病率为38．38％。新生儿腹泻发生率,手卫生2项指标均合格的为16．66％,1项或2项不合格的为44．59％（P〈0．05）;乳汁过剩（溢出）的为87．50％,不过剩（溢出）的为5．97％（P〈0．01）。[结论]梅县客家产妇哺乳卫生状况较差,查复手被污染、乳汁过剩（溢出）是新生儿（婴儿）腹泻发病的原因之一。     

Secrets and lies: Breastfeeding and professional paid work

This paper explores the conflict between health advice and organisational practice regarding breastfeeding. It focuses on the group of mothers with the highest rates of both breastfeeding initiation and of continuous employment following maternity leave: specifically, educated mothers in managerial and/or professional occupations. In this context, the paper investigates, through in-depth interviews, the embodied experiences of 20 heterosexual UK mothers, qualified to degree level, who returned to professional employment within 1 year of childbirth. The paper observes that mothers who attempted to combine breastfeeding with paid work did so with difficulty because the material activity of breastfeeding was 'taboo' within the workplace. Thus, the requirement to conform to organisational expectations regarding 'suitable' embodied behaviour contradicted health advice about what was 'best' for infant children. In order to comply with workplace requirements, mothers in the study were obliged either to cease breastfeeding or to conceal breastfeeding activities. In the light of mothers' experiences, the paper suggests that breastfeeding duration rates among professionally employed mothers can only be improved if negative attitudes about maternal bodies and employment are challenged and if employers, as well as mothers, are the focus of health initiatives aimed at promoting breastfeeding.     

母乳喂养和辅食添加与儿童亚临床VitA缺乏的关系

目的:探讨母乳喂养和辅食添加与儿童亚临床Vit A缺乏的关系。方法:对于6~71个月儿童Vit A营养状况进行横断面研究,荧光法测定血清Vit A含量。半定量频率问卷收集调查前2周内儿童辅食情况,同时调查儿童的家庭经济、围生期保健及疾病情况等。结果:单因素分析表明母乳喂养为亚临床Vit A缺乏的危险因素(OR=3·52,95%CI为2·02~6·12);多因素Logistic回归在控制性别、月龄、儿童排行、母亲文化水平、母亲职业、Vit A增补剂、腹泻等因素后,仍然有显著意义(OR=2·39,95%CI为1·22~4·69)。单因素分析添加鲜奶或奶制品、蛋类、豆类及豆制品、蔬菜以及鱼虾等辅食对亚临床VitA缺乏有保护作用,OR均小于1;在控制已知协变量和混杂变量后,只有豆类及豆制品辅食添加有统计学意义(OR=0·41,95%CI为0·18~0·94)。结论:6个月以后母乳喂养不能成为亚临床Vit A缺乏的保护因素,辅食添加不足与亚临床Vit A缺乏关系有待进一步研究。     

丹东市高中生性观念和性行为调查

目的 了解高中生性观念、性态度及性行为的状况,分析其影响因素,为学校有针对性地开展性健康教育提供依据.方法 采用随机整群抽样的方法,抽取本市区重点高中、普通高中及职业高中各4所共12所2979名高中学生进行问卷调查.结果 80％的高中学生对恋爱持认同态度,约21％的高中生有恋爱经历,74％的学生对婚前性行为持包容态度;超过80％学生认为爱情是性的前提,性行为发生比例趋于升高（5.1％）;在发生性行为的学生中,近半数学生在性行为时未采取任何避孕措施,而在采取措施的学生中,2种以上（含2种）措施混用最多（26.3％）.职业高中学生性观念、性态度较重点和普通高中学生开放,早恋和性行为发生率也高于重点和普通高中学生.结论 重点高中、普通高中与职业高中学生性观念、性态度及性行为均有显著性差异,要对不同学校学生采取有针对性的教育方法,在高中学生中加强性健康教育非常重要.     

中医情志护理对阴道分娩初产妇产后宫缩痛及焦虑情绪的影响

目的 探讨中医情志护理对阴道分娩初产妇产后宫缩痛及焦虑情绪的影响.方法 选取0019年1月至0019年6月于我院行阴道分娩的70例初产妇,随机分为两组各35例.对照组给予常规护理,观察组在对照组基础上给予中医情志护理,比较两组的产后宫缩痛程度及焦虑情绪.结果 观察组的产后宫缩痛程度显著低于对照组(P<0.05).护理前...     

城市流动人口产后开奶时间及其影响因素分析

目的了解城市流动人口产妇开奶时间及其影响因素．促进母乳喂养的成功。方法采用统一的调查问卷收集资料，应用SPSS13．0统计软件对数据进行描述性和决策树分析。结果在被调查的3029例5岁以下流动儿童的看护人中，81．84％为流动儿童的母亲；89．00％在医院分娩；77．22％为初中及以下文化程度。开奶时间的影响因素有孩子出生地点、孩子出生城市、看护人对母乳喂养的认知以及看护人的文化程度。结论流动人口产后早开奶率低（24．38％）。建议卫生部门加大宣传初乳和早开奶的好处。加强医院对早开奶的产前宣教和产后指导，达到爱婴医院要求的标准。     

长沙市中学生性知识性观念及相关行为调查

目的了解长沙市中学生青春期性知识掌握水平以及性观念和性行为,为中学生性健康教育提供依据。方法采用整群分层抽样方法,对长沙市1 302名中学生进行性知识、性观念和性行为问卷调查。结果初中男生与高中男生对遗精的认识分别为15.5%和52.3%,差异有统计学意义(P<0.01),初中女生与高中女生对月经的认识分别为53.0%和68.2%,差异有统计学意义(P<0.05),在大多数性观念和性行为的项目中,男生和女生,初中生和高中生差异均有统计学意义(P<0.05)。结论大部分中学生已掌握一定的性知识。在中学生中适时开展性健康教育是非常必要的。     

徐州市小学生及其家长钙营养知识·态度·行为

目的 了解徐州市小学生及其家长钙营养知识与饮食习惯现状，为学生营养的干预性研究提供依据。方法采取整群抽样方法，对徐州市4所小学的三～五年级学生及其家长进行问卷调查。结果小学生对“奶是钙的最好来源”与“需补钙人群”2个问题回答正确率分别为75．2％和94．8％，其余均低于65．8％。79．7％的小学生和73．3％的家长为了补钙愿意改变以前的饮食习惯。10．3％的小学生和6．3％的家长经常不吃早餐。7．3％的小学生和31．4％的家长不喜欢食用乳及乳制品，32．2％的小学生和16．3％的家长不喜欢食用豆及豆制品。结论在钙营养知识与饮食行为方面，需要对小学生及其家长进行干预，让他们获得更多的钙营养知识，改变不良的饮食行为。     

COVID-19 Vaccination Coverage,Intent, Knowledge,Attitudes, and Beliefs among Essential Workers,United States

We assessed coronavirus disease vaccination and intent and knowledge, attitudes, and beliefs among essential workers during March–June 2021. Coverage was 67%; 18% reported no intent to get vaccinated. Primary concerns were potential side effects, safety, and lack of trust in vaccines, highlighting the importance of increasing vaccine confidence in this population.     

Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach

Objective To determine factors associated with breastfeeding in rural communities. Methods We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N = 1292) of infants born September 2003–2004 and (2) a parallel ethnographic study (N = 30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding. Results Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance. Conclusions Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.