Whom can I rely on? Mothers' approaches to support for feeding: an interview study in suburban Dar es Salaam, Tanzania

OBJECTIVE: to explore and describe mothers' perceptions of baby feeding and approaches to support for baby feeding. DESIGN: individual qualitative semi-structured interviews conducted with mothers. Method used for analysis was qualitative content analysis. SETTING: suburban Dar es Salaam, Tanzania. PARTICIPANTS: 8 mothers with babies under 6 months of age. FINDINGS: the study revealed four categories of mothers' perceptions of baby feeding: (1) baby feeding, housework and paid work have to adjust to each other; (2) breast feeding has many benefits; (3) water or breast milk can be given to quench baby's thirst; and (4) crying provides guidance for baby feeding. Four different themes describing approaches to support emerged from the data: (1) adhering to diverse sources; (2) relying wholeheartedly on a mother figure; (3) working as a parental team; and (4) making arrangements for absence from the child. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: knowledge of the different approaches to support for baby feeding described in this study can help define counselling and promotional strategies in order to reach mothers with more effective messages and support for optimal baby-feeding practices.     

Women's experiences and attitudes towards expectant management and induction of labor for post-term pregnancy

BACKGROUND: Clinical guidelines for post-term management differ, and studies on women's attitudes are lacking. We aimed to assess the experiences and attitudes among women managed with serial antenatal monitoring or induction of labor, and the effects of post-term pregnancy on self-reports of quality of life. METHODS: Women were randomized at 41 weeks to immediate induction of labor or antenatal fetal surveillance every third day. At inclusion women answered a questionnaire about their attitudes towards post-term pregnancy and health-related quality of life. This was repeated in a follow-up phone interview 6 months later, including questions about their experiences of labor and perspective on future deliveries. RESULTS: A total of 508 women entered the study. At 41 weeks 74% of all women preferred to be induced. Women reported good general and mental health, but physical health and vitality scores were low. In the induction group, 74% of women said they would prefer the same management in future pregnancies; only 38% of women who had serial antenatal monitoring would prefer this option again (p<0.001). In the induction group, contractions were reported as more intense (n=157 versus n=118, p<0.01) and frequent (n=116 versus n=87, p<0.01) compared to the monitored group. The majority (84%) reported a positive labor induction experience. CONCLUSION: Women preferred induction of labor to serial antenatal monitoring beyond 41 weeks. Labors were shorter and contractions were reported to be more frequent and intense in the induction group compared with the monitored group. However, their experience with labor induction was positive.     

Functional diagnosis of coronary stenosis using tissue tracking provides best sensitivity and specificity for left circumflex disease: experience from the MYDISE (myocardial Doppler in stress echocardiography) study.

AIMS: To evaluate the diagnostic capacity of quantitative analysis of segmental longitudinal myocardial displacement images (tissue tracking, TT) during dobutamine stress echocardiography for the detection of patients with coronary artery disease (CAD). METHODS AND RESULTS: TT-generated colour-coded maps of systolic segmental longitudinal displacement were obtained by post-processing of echocardiographic data from 105 patients with CAD and 90 low risk individuals selected from MYDISE database. Quantitative analysis of the distribution pattern of segmental displacement during dobutamine stress was most successful when a ratio of basal (high amplitude) to apical (low amplitude) colour-coded displacement bands (B/A ratio) was employed. Applied in four different left ventricular sectors, the B/A ratio provided a significant discrimination of patients with CAD (p<0.05 in the anterior and p<0.001 in the inferior wall) as assessed by receiver operating characteristic analysis. The procedure was most sensitive when applied in inferior wall for the detection of left circumflex coronary artery disease, the B/A ratio of 0.8 giving the best combination of sensitivity (77+/-8%) and specificity (77+/-5%) values. CONCLUSION: Quantification of dobutamine stress echocardiography using TT is an efficient diagnostic approach and a valuable additional modality in functional cardiac imaging for the initial identification of patients suspected for CAD.     

Tissue motion imaging of the left ventricle--quantification of myocardial strain, velocity, acceleration and displacement in a single image.

AIMS: Several methods of parametric imaging of left ventricular function including tissue velocity imaging (TVI) and strain rate imaging (SRI) have previously been presented, however, they have the limitation that they can, respectively, portray only one physiological myocardial parameter. The aims of this pilot study were to implement and validate tissue motion imaging (TMI) for the first time, a visualization technique which permits acceleration, velocity, displacement and strain to be interpreted quantitatively or semi-quantitatively in a single image. METHODS AND RESULTS: TMI is achieved by the color coding of temporal tissue velocity integrals. The principles behind this technique are validated, and case examples demonstrating its use in the clinical setting are provided. Limitations of the method as well as future applications and improvements are discussed. CONCLUSION: As this method allows representation of a multitude of variables and is visually attractive, it may facilitate more widespread use of myocardial quantitation in everyday practice.     

Improvement of cardiac function after haemodialysis. Quantitative evaluation by colour tissue velocity imaging.

BACKGROUND: Overhydration and accumulation of uraemic toxins may influence the myocardial function in haemodialysis (HD) patients. To evaluate cardiac function and the effects of fluid and solute removal during a single session of HD, colour tissue velocity imaging (TVI) was used. This new technique, which is less load dependent than conventional echocardiography, allows an objective quantitative assessment of myocardial contractility, contraction and relaxation. METHODS: Conventional echocardiographic and TVI images were recorded before and after a single HD session in 13 clinically stable HD patients (62+/-10 years, six males) and in 13 sex- and age-matched healthy controls. Myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E') and late (A') diastolic filling and strain rate (SR) were measured. RESULTS: Left ventricular hypertrophy (LVH) was present in 12 patients. TVI gave additional information in comparison with conventional echocardiography. Before HD, PS (5.0+/-0.8 vs 6.0+/-1.2 cm/s, P<0.05), E' (5.7+/-1.7 vs 7.3+/-2.0 cm/s, P<0.05) and A' (6.6+/-1.7 vs. 8.3+/-2.9 cm/s, P<0.05) velocities were lower in the patients than in the controls, indicating systolic and diastolic dysfunction. The HD session increased IVCv (4.0+/-1.7 to 5.5+/-1.9 cm/s; P<0.001), PSv (5.0+/-0.8 to 5.7+/-0.8 cm/s; P<0.05) and SR (0.7+/-0.2 to 0.9+/-0.2 1/s; P < 0.05) and decreased E/E' (16.7+/-7.7 to 12.2+/-4.0, P<0.05), indicating improved systolic function and decreased LV filling pressure, respectively. Linear regression analysis demonstrated a dependency of systolic contraction (PSv) and contractility (IVCv) upon plasma levels of phosphate (r(2) = 0.70, P<0.005, r(2) = 0.33, P<0.01). CONCLUSIONS: Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.     

Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling

BACKGROUND: The World Health Organization recommends exclusive breastfeeding until age 6 mo. Studies relying on mothers' self-reported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding. OBJECTIVE: We aimed to validate reported infant feeding practices in rural Bangladesh; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique. DESIGN: Subjects were drawn from the large-scale Maternal and Infant Nutrition Interventions, Matlab, study of combined interventions to improve maternal and infant health, in which women were randomly assigned to receive either exclusive breastfeeding counseling or standard health care messages. Data on infant feeding practices were collected by questionnaire at monthly visits. Intakes of breast milk and nonbreast-milk water were measured in a subsample of 98 mother-infant pairs (mean infant age: 14.3 wk) and compared with questionnaire data reporting feeding practices. RESULTS: Seventy-five of the 98 subjects reported exclusive breastfeeding. Mean (+/-SD) breast milk intake was 884 +/- 163 mL/d in that group and 791 +/- 180 mL/d in the group reported as nonexclusively breastfed (P = 0.0267). Intakes of nonbreast-milk water were 40 +/- 80.6 and 166 +/- 214 mL/d (P < 0.0001), respectively. Objective cross-validation using deuterium dilution data showed good accuracy in reporting of feeding practices, although apparent misreporting was widely present in both groups. CONCLUSIONS: The dose-given-to-the-mother deuterium dilution technique can be applied to validate reported feeding behaviors. Whereas this technique shows that the reports of feeding practices were accurate at the group level, it is not adequate to distinguish between feeding practices in individual infants.     

Analysis of the effect of temporal filtering in myocardial tissue velocity imaging.

Signal filtering to reduce random noise may compromise the reliability of tissue velocity measurements. This study evaluates the influence of temporal filters on time and velocity variables derived from myocardial tissue velocity images acquired in 15 healthy individuals at a high frame rate (142-184 Hz). Different time and velocity variables from the basal septum were analyzed offline before and after temporal filtering from 20 to 60 milliseconds in 10-millisecond steps using software enabling retrieval of myocardial Doppler velocity and 2-dimensional information from different cardiac locations during the same cardiac cycle. Filtering affected the results by increasing variability of time and by underestimation of velocity variables, the rapid isovolumic events being particularly filter sensitive. In addition, at a certain range of sampling rate, ambiguity of filtering effect was observed. This ought to be considered if an optimal, high-fidelity tissue Doppler velocity signal is to be obtained.     

Exercise electrocardiography for diagnosis of coronary artery disease: impact of sampling rate on the diagnostic performance of ST/HR-loop based on data from early recovery phase

Quantitative analysis of electrocardiographic ST-segment/heart rate relationship (ST/HR loop) during early recovery phase of exercise stress test provides a sensitive tool for the detection of coronary artery disease (CAD). This study evaluates the effect of data sampling frequency on the diagnostic performance of ST/HR loop in 1876 patients undergoing a routine exercise test on a bicycle ergometer. CAD was verified angiographically in 668 patients and excluded by coronary angiography (n = 119), myocardial scintigraphy (n = 250) and on clinical grounds (n = 839) in 1208 patients. The normalized ST/HR loop area was calculated in all cases by integration of ST-segment amplitude difference from the end of exercise to the end of the first 3 min of recovery period over HR and dividing the integral by the HR difference over the integration period. The effect of different sampling rates (one, two and five samples per minute) on the CAD discrimination ability of ST/HR loop area was subsequently evaluated using receiver operating characteristic (ROC) curves. Reduction in ST/HR data sampling frequency from two to one sample per minute resulted in a significantly decreased diagnostic performance of the ST/HR loop whereas no differences in CAD discrimination capacity were observed between sampling frequencies of two and five samples per minute. The choice of ST/HR data sampling frequency may have a significant impact on the CAD diagnostic ability of the ST/HR loop. The use of sampling frequency below two samples per minute results in a significantly diminished diagnostic performance, a fact that should be taken into consideration when employing ST/HR diagnostic procedures.     

Functional variants of the central bile acid sensor FXR identified in intrahepatic cholestasis of pregnancy

BACKGROUND AND AIMS: Intrahepatic cholestasis of pregnancy (ICP) is characterized by liver impairment, pruritus, and elevated maternal serum bile acids. It can cause premature delivery and intrauterine death. Bile acid synthesis, metabolism, and transport are regulated by the bile acid sensor FXR, and we hypothesized that genetic variation in FXR confers susceptibility to ICP. METHODS: The coding regions and intron/exon boundaries of FXR were sequenced in 92 British ICP cases of mixed ethnicity. Subsequently, a case-control study of allele frequencies of these variants in 2 independent cohorts of Caucasian ICP patients and controls was performed. Variants were cloned into an FXR expression plasmid and tested in functional assays. RESULTS: We identified 4 novel heterozygous FXR variants (-1g>t, M1V, W80R, M173T) in ICP. W80R was not present in Caucasians and M1V was detected uniquely in 1 British case. M173T and -1g>t occur both in Caucasian cases and controls, and we found a significant association of M173T with ICP (OR, 3.2; 95% confidence interval, 1.1-11.2; P = .02) when the allele frequencies of both Caucasian cohorts were analyzed together. We demonstrate functional defects in either translation efficiency or activity for 3 of the 4 variants (-1g>t, M1V, M173T). CONCLUSIONS: This is the first report of functional variants in FXR. We propose that these variants may predispose to ICP, and because FXR has a central role in regulating bile and lipid homeostasis they may be associated with other cholestatic and dyslipidemic disorders.