Hemoglobin concentration, breastfeeding and complementary feeding in the first year of life

OBJECTIVE: To assess the relationship between hemoglobin concentration and breastfeeding and complementary feeding during the first years of life. METHODS: Cross-sectional study with 553 children under age 12 months, who attended public healthcare facilities. Hemoglobin concentration was measured by the cyanmethaemoglobin method, using the HemoCue system. Associations of interest were analyzed through multiple linear regression. RESULTS: Hemoglobin concentrations compatible with anemia were identified in 62.8% of the children studied, with greater occurrence among the 6-12 months age group (72.6%). Exclusive breastfeeding during the first six months of life was associated with the highest levels of hemoglobin. The remaining feeding regimes were associated with different levels of reduction in hemoglobin levels, which became compatible with anemia in children fed with formula (p=0.009). Tea and/or water consumption was associated with a reduction in hemoglobin concentration of 0.76 g/dl (p<0.001) among children under age 6 months. For children aged 6-12 months, hemoglobin concentrations increased significantly with the consumption of sugar (p=0.017) and beans (p=0.018), and decreased significantly with the consumption of fruit (p<0.001). CONCLUSIONS: Exclusive breastfeeding until age 6 months and continuation of breastfeeding after this age, combined with qualitatively and quantitatively appropriate feeding may contribute towards an increase in hemoglobin concentration in the first year of life.     

Complementary feeding practices to children during their first year of life

This study aimed to investigate complementary feeding practices during children's first year of life in Botucatu, SP, Brazil. Practices were described according to the age range and the breastfeeding (BF) practice. Data were collected during a multi-vaccination campaign through the interview of 1,238 individuals who accompanied children younger than one year old being vaccinated. Differences associated with the BF situation were identified by the chi-square test and Fisher's exact test. The early introduction of complementary food was observed, which led to the low frequency of exclusive breastfeeding (36.9% <4 months). Children younger than 4 months old consumed tea (30.7%); children between 4 and 6 months old consumed fruits (54.1%), soups (39.9%) and home-made food (19.2%). Juice was offered only to 15.2% of children younger than 4 months old who were completed weaned, 60% of the children was offered water. Data show that the consistence of the food consumed was inappropriate: children between 6 and 8 months old were offered the family's regular food (48.8%) and children older than 8 months (71.6%) were offered soup. Therefore, interventions focused on complementary feeding are justified on the city.     

A longitudinal study of night waking in the first year

A longitudinal study of the development of sleep patterns addressed the issue of continuity and change in night waking in the course of the first year. Mothers of 118 infants, who took part in a follow-up study of normal babies, completed a sleep questionnaire at 3, 6, 9 and 12 months. Regular night waking was a common characteristic throughout the first year (46% at 3 months, 39%, 58% and 55% respectively at 6, 9 and 12 months). The number of awakenings per night was a function of age. Following a decline in the number of interruptions from 3 to 6 months, an increase in night waking at age 9 months was recorded. Although the methodology does not lend itself to an objective validation of the changes in sleep-wake states, nor is it suitable for causal explanations, it is, nevertheless, important to note this profile. The increase in night waking towards the end of the first year coincides with significant socio-emotional advances which characterize this developmental stage.     

母乳喂养困难、离乳原因及影响因素的系统综述

目的 对母乳喂养困难、离乳原因、影响因素进行系统综述,以总结母乳喂养困难、提前离乳的原因。方法 计算机检索护理学及医疗相关文献累计索引(CINAHL)、PubMed、Embase、维普、中国生物医学文献数据库,收集母乳喂养困难、离乳原因、影响因素的相关研究,根据纳入和排除标准筛选文献、提取资料及质量评价,并对文献进行定性分析。结果 共纳入35篇文献,分析纳入研究结果显示,母亲在母乳喂养过程中尤其是产后最初的几周会遇到很多困难,导致母亲停止(纯)母乳喂养的原因多种多样,影响母乳喂养的可能因素很多,但有些因素仍存在争议。结论 现有研究结果对母乳喂养行为的改变机制阐述仍不明确,还需进一步探索。     

The geography of mental health in Dunedin, New Zealand

The process of deinstitutionalization of people with chronic mental disabilities in Western countries has often produced a spatial concentration of ex-psychiatric patients, and of mental health services, in inner city urban neighbourhoods. In this paper, the geography of mental health services and patients in Dunedin is examined, and it is shown that a concentration does exist in one neighbourhood. The history and characteristics of this neighbourhood are described. The key factors in contemporary New Zealand that have generated this spatial pattern are then considered, and Dunedin's centralized mental health geography is contrasted with the North American "zone of dependence" phenomenon. The paper concludes by considering to what extent Dunedin's emergent geography of mental health provides a supportive environment for people with mental illnesses, and exploring the policy implications for health care planners and service providers.     

Protein requirements during the first year of life

The composition of human milk provides the model for estimated total protein and essential amino acid requirements during infancy. However, both the total protein content and the concentrations of individual proteins in human milk change throughout the first year of lactation. Recent reassessments of estimated requirements have resulted in lower total protein recommendations and have emphasized the provision of alpha-amino nitrogen because most nonprotein nitrogen is not used for maintenance or tissue deposition. In clinical studies, formulas containing various whey-to-casein ratios and having total protein concentrations in the range of 13-15 g/L were shown to promote adequate growth and to result in biochemical measures of protein nutritional status similar to those in breastfed infants. In the second half of infancy, human milk can provide most of the protein needed, provided a modest protein supply is obtained from weaning foods. In special situations in which greater protein intakes are desired, special preparations of protein might be needed.     

Antibiotic resistant staphylococci acquired during the first year of life

Nasal swabs were taken from 492 babies born consecutively to residents of two South Wales towns soon after their discharge from maternity hospitals. Staphylococcus aureus was isolated from 352 babies (72%) and in 79 (22%) of these it was resistant to at least one antibiotic. By the time these babies were a year old the prevalence of both sensitive and resistant strains had fallen, so that only 12% still carried nasal staphylococci, but 64% of these organisms were then resistant to penicillin. Administration of penicillin to the baby seemed to be a more important factor in selecting resistant organisms than other antibiotics given to the baby, any antibiotic treatment to other members of the household, or discharge from hospital.     

Young motherhood and infant hospitalization during the first year of life.

We studied the relationship of young maternal age with infant hospitalization using data from the National Longitudinal Survey of Youth for 3,130 infants born between 1979 and 1983 to mothers aged 14-25 years. Data on the mothers were first collected in 1979 and yearly thereafter. Data on their children were collected starting in 1982. Logistic regressions of infant hospitalization rates were estimated for first and second and higher births. The odds of infant hospitalization during the first year of life increased with decreasing maternal age, even with adjustment for sociodemographic characteristics, preventive health-care practices, and newborn health status, factors hypothesized to explain the maternal age effect. The maternal age relationship with hospitalization differed by birth order; among second and higher births, the odds of hospitalization was increased only for infants of mothers aged 20-22 years. Male infants, infants with a first well-baby visit after the first month of life, with birth weights between 1501 and 2500 g, and with nursery stays longer than 1 week also had increased odds of hospitalization. Ethnicity, grandmother's education, poverty status, mother's school enrollment, and family composition were not related to the odds of hospitalization, nor was smoking during pregnancy when adjustment was made for birth weight and length of nursery stay.     

Predicting stress in first year medical students: a longitudinal study

While there is ample documentation that medical training is stressful, less is known about predictive variables that might identify students who have the most difficulty in managing stress during medical training. Depression and anxiety in first year medical students were investigated in a longitudinal design. One-hundred and twenty-one medical students (81% of the class) were surveyed. The first survey took place immediately prior to the beginning of medical training (wave 1); the second survey was approximately 8 months after the beginning of classes (wave 2). Medical students who began their first year with relatively low ‘A'level grades, high ratings of state anxiety and depression, high trait anxiety and low dispositional optimism, and reliance on avoidant coping strategies were found to be at higher risk for developing depression and anxiety symptoms at wave 2. Students reported increased concern about curriculum and environment, personal competence and endurance, and time to have a life outside medical school at wave 2, compared to their reports at wave 1. Increase in concerns correlated with an increase in depression and anxiety. At both surveys, use of avoidant coping strategies resulted in increased depression and anxiety; at wave 2, active coping and positive reinterpretation resulted in decreased depression and anxiety. These findings suggest characteristics of vulnerable students who might be identified early in their first year and provided with additional support. Educating students to expect an increase in concerns about environment and personal ability to manage the academic load might make these concerns less overwhelming. In addition, information about effective coping strategies (i.e. active coping efforts) and ineffective means of dealing with stress (avoidant coping efforts) might be helpful in preventing distress.     

Antibiotic resistant staphylococci acquired during the first year of life.

Nasal swabs were taken from 492 babies born consecutively to residents of two South Wales towns soon after their discharge from maternity hospitals. Staphylococcus aureus was isolated from 352 babies (72%) and in 79 (22%) of these it was resistant to at least one antibiotic. By the time these babies were a year old the prevalence of both sensitive and resistant strains had fallen, so that only 12% still carried nasal staphylococci, but 64% of these organisms were then resistant to penicillin. Administration of penicillin to the baby seemed to be a more important factor in selecting resistant organisms than other antibiotics given to the baby, any antibiotic treatment to other members of the household, or discharge from hospital.     

Immune response to vaccine adjuvants during the first year of life

Subunit vaccine formulations often include adjuvants that primarily stimulate innate immune cells. While young infants represent the major target population for vaccination, effective immunization in this age group remains a challenge. Many parameters of innate immune responses differ quantitatively and qualitatively from newborns to infants and adults, revealing a highly regulated developmental program. Herein, we discuss the potential implications of innate immune ontogeny for the activity of adjuvants contained in licensed infant vaccines, as well as future directions for rational design of adjuvanted vaccines for this age group.