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INADEQUATE: A Metaphor for the Lives of Low-Income Women?
Chin, Nancy P.
Solomonik, Anna
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine
Exclusive breastfeeding of infants for the first six months of life with continued breastfeeding for at least six more months occurs only 11.9% of the time in the US. Efforts of the past 30 years to promote optimal breastfeeding practices have had little impact. In order to create significant change in the way we feed infants in this country, we need to change the way we look at this public health issue and examine the cultural logic that makes bottle feeding the preferred choice of most US women. This paper analyzes the term 'inadequate' not just as self-description of a woman's milk supply, but also as a metaphor for the lives of low-income women in the US, the group least likely to breastfeed. Low-income women in the US not only have inadequate incomes as compared to the general population, but inadequate child-care, education, preventive health services, and lives saturated with violence, leaving them inadequately safe even in their own homes. Here we outline a research agenda to explore the relationship between socially determined inadequacies and the cultural logic that makes bottle feeding a preferred form of infant feeding. (190 words)
Related Articles
High initiation and long duration of breastfeeding despite absence of early skin-to-skin contact in Karen refugees on the Thai-Myanmar border: a mixed methods study
White, Adrienne L
Carrara, Verena I
Paw, Moo Kho
Dahbu, ColleyPaw
Gross, Mechthild M
Stuetz, Wolfgang
Nosten, Francois H
McGready, Rose
International Breastfeeding Journal
Early skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children's Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling.
Data from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling.
Of 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months.
During FGD all primigravidae (n = 17) intended to breastfeed and all multigravidae (n = 33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is "good". Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss of the spirit of the newborn or attract malevolent spirits.
In a population with a strong culture of breastfeeding and robust breastfeeding practices, high rates of initiation and duration of breastfeeding were found despite a lack of early skin-to-skin contact. Local preferences, traditions and practices that protect, support and maintain high rates of breastfeeding should be promoted.
Breastfeeding initiation; Breastfeeding duration; Early skin-to-skin care; Midwifery; Refugee; Resource-poor; Swaddling
Related Articles
Factors affecting intention to breastfeed among Syrian and Jordanian mothers: a comparative cross-sectional study
Al-Akour, Nemeh Ahmad
Khassawneh, Mohammad Yousef
Khader, Yusuf S
Ababneh, Alla Ahmad
Haddad, Azeiza M
International Breastfeeding Journal
Breastfeeding is considered the ideal method of infant feeding for at least the first six months of life. This study aimed to compare breastfeeding intention between Syrian and Jordanian women and determine factors associated with breastfeeding intention among pregnant women in these two countries.
A cross-sectional design was used to collect data from1200 pregnant women aged 18 years and above (600 participants from each country). A self- administered questionnaire was used to collect data on socio-demographic characteristics and breastfeeding intention.
Intention to breastfeed was reported by 77.2% of Syrian and 76.2% of Jordanian pregnant women. There was no significant difference in intention to breastfeed between Syrian women and Jordanian women. In both countries, women with a more positive attitude to breastfeeding, women with previous breastfeeding experience and women with supportive partners were more likely to intend to breastfeed. Syrian women with a monthly family income of more than US$200, younger than 25 and primiparous or having one child were more likely to report an intention to breastfeed their infants. Jordanian women with an education level of less than high school and not living with their family-in-law were more likely to intend to breastfeed.
In Syria and Jordan, a more positive attitude to breastfeeding, previous breastfeeding experience and presence of supportive husbands are associated with intention to breastfeed. These factors should be considered when planning programs designed to promote breastfeeding in these two countries.
Related Articles
Breastfeeding and Smoking among Low-Income Women: Results of a Longitudinal Qualitative Study
Goldade, Kate
Nichter, Mimi
Nichter, Mark
Adrian, Shelly
Tesler, Laura
Muramoto, Myra
Birth (Berkeley, Calif.)
The benefits of breastfeeding for infants and mothers have been well established, yet rates of breastfeeding remain well below national recommendations in the United States and even lower for women who smoke during pregnancy. Primary goals of this study were to explore contextual factors that contribute to breastfeeding intentions and behavior and to examine how smoking status affected women's decision making about breastfeeding.
This paper is based on a longitudinal qualitative study of smoking, pregnancy, and breastfeeding among 44 low-income women in the southwest U.S. who smoked during pregnancy. Each woman was interviewed 9 times; 6 times during pregnancy and 3 times postpartum using semistructured questionnaires. Interviews lasted 1 to 3 hours and were tape-recorded, transcribed, and analyzed.
Despite 36 (82%) respondents stating that they intended to breastfeed for an average duration of 8 months, rates of breastfeeding initiation and duration were much lower than intentions. By 6 months postpartum, only two women were breastfeeding exclusively.
Women perceived that a strong risk of harming the baby was posed by smoking while breastfeeding and received little encouragement to continue breastfeeding despite an inability to stop smoking. The perceptions of the toxic, addictive, and harmful effects of smoking on breastmilk constitution and quantity factored into reasons why women weaned their infants from breastfeeding much earlier than the recommended 6 months. The results indicate a need for more consistency and routine in educating women on the relationship between smoking and breastfeeding and in promoting breastfeeding in spite of smoking postpartum. (BIRTH 35:3 September 2008)
smoking; breastfeeding; weaning; qualitative data; harm perceptions
Related Articles
Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study
Okanda, John O
Borkowf, Craig B
Girde, Sonali
Thomas, Timothy K
Lecher, Shirley Lee
BMC Pediatrics
One of the most effective ways to promote the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings is to encourage HIV-positive mothers to practice exclusive breastfeeding (EBF) for the first 6 months post-partum while they receive antiretroviral therapy (ARV). Although EBF reduces mortality in this context, its practice has been low. We studied the rate of adherence to EBF and assessed associated maternal and infant characteristics using data from a phase II PMTCT clinical trial conducted in Western Kenya which included a counseling intervention to encourage EBF by all participants.
We analyzed data from the Kisumu Breastfeeding Study (KiBS), conducted between July 2003 and February 2009. This study enrolled a total of 522 HIV-1 infected pregnant women. Data on breastfeeding were available for 480 mother-infant pairs. Infant feeding and general nutrition counseling began at 35 weeks gestation and continued throughout the 6 month post-partum intervention period, following World Health Organization (WHO) infant feeding guidelines. Data on infant feeding were collected during routine clinic visits and home visits using food frequency questionnaires and dietary recall methods. Participants were instructed to exclusively breastfeed until initiation of weaning at 5.5 months post-partum. We used Kaplan-Meier methods to estimate the rates of EBF at 5.25 months post-partum, stratified by maternal and infant characteristics measured at enrollment, delivery, and 2 weeks post-partum.
The estimated EBF rate at 5.25 months post-partum was 80.4%. Only 3% of women introduced other foods (most commonly water with or without glucose, cow's milk, formula, and fruit) by 2 months; this percentage increased to 5% of women by 4 months. Women who had ≥3 previous births (p < 0.01) and who were not living with the infant's father (p = 0.04) were more likely to exclusively breastfeed. Mixed feeding was more common for male infants than for female infants (p = 0.04).
Exclusive breastfeeding was common in this clinical trial, which emphasized EBF as a best practice until infants reached 5.5 months of age. Counseling initiated prior to delivery and continued during the post-partum period provided a consistent message reinforcing the benefits of EBF. The findings from this study suggest high adherence to EBF in resource limited settings can be achieved by a comprehensive counseling intervention that encourages EBF.
Related Articles
What Predicts Intent to Breastfeed Exclusively? Breastfeeding Knowledge, Attitudes, and Beliefs in a Diverse Urban Population
Stuebe, Alison M.
Bonuck, Karen
Breastfeeding Medicine
Maternal knowledge and comfort with breastfeeding affect prenatal feeding intentions, and these intentions are strong predictors of feeding outcomes. However, predictors of exclusive breastfeeding intention have not been well characterized.
We measured the association between intentions to exclusively breastfeed and knowledge of infant health benefits, feeding guidelines, and comfort related to breastfeeding in social settings. Participants were lower-income, ethnically diverse women in two randomized, controlled trials of breastfeeding support. We compared results with data from the national Infant Feeding Practices Study II.
Among 883 women in our trials, exclusive breastfeeding, mixed feeding, and exclusive formula feeding intentions were 45.9%, 46.1%, and 8.0%, respectively. In multivariate-adjusted models, women who disagreed that "Infant formula is as good as breastmilk" were more likely to intend exclusive breastfeeding versus exclusive formula feeding (odds ratio 3.44, 95% confidence interval 1.80–6.59) compared with women who agreed with this statement. Increasing levels of agreement that breastfed infants were less likely to develop ear infections, respiratory infections, diarrhea, and obesity were positively associated with intentions to exclusively breastfeed (p for trend < 0.001 for all). Compared with the national sample, our study participants were more likely to agree with all of these statements. Women who felt comfortable breastfeeding in public intended to exclusive breastfeed for 0.84 month longer (95% confidence interval 0.41–1.28) than those who felt uncomfortable.
Maternal knowledge about infant health benefits, as well as comfort with breastfeeding in social settings, was directly related to intention to exclusively breastfeed. Prenatal interventions that address these issues may increase exclusive breastfeeding intention and duration.
Related Articles
Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial
Thomas, Timothy K.
Masaba, Rose
Borkowf, Craig B.
Ndivo, Richard
Zeh, Clement
Misore, Ambrose
Otieno, Juliana
Jamieson, Denise
Thigpen, Michael C.
Bulterys, Marc
Slutsker, Laurence
De Cock, Kevin M.
Amornkul, Pauli N.
Greenberg, Alan E.
Fowler, Mary Glenn
PLoS Medicine
Timothy Thomas and colleagues report the results of the Kisumu breastfeeding study (Kenya), a single-arm trial that assessed the feasibility and safety of a triple-antiretroviral regimen to suppress maternal HIV load in late pregnancy.
Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and February 2009. The overall aim was to investigate whether a maternal triple-antiretroviral regimen that was designed to maximally suppress viral load in late pregnancy and the first 6 mo of lactation was a safe, well-tolerated, and effective PMTCT intervention.
Methods and Findings
HIV-infected pregnant women took zidovudine, lamivudine, and either nevirapine or nelfinavir from 34–36 weeks' gestation to 6 mo post partum. Infants received single-dose nevirapine at birth. Women were advised to breastfeed exclusively and wean rapidly just before 6 mo. Using Kaplan-Meier methods we estimated HIV-transmission and death rates from delivery to 24 mo. We compared HIV-transmission rates among subgroups defined by maternal risk factors, including baseline CD4 cell count and viral load.
Among 487 live-born, singleton, or first-born infants, cumulative HIV-transmission rates at birth, 6 weeks, and 6, 12, and 24 mo were 2.5%, 4.2%, 5.0%, 5.7%, and 7.0%, respectively. The 24-mo HIV-transmission rates stratified by baseline maternal CD4 cell count <500 and ≥500 cells/mm3 were 8.4% (95% confidence interval [CI] 5.8%–12.0%) and 4.1% (1.8%–8.8%), respectively (p = 0.06); the corresponding rates stratified by baseline maternal viral load <10,000 and ≥10,000 copies/ml were 3.0% (1.1%–7.8%) and 8.7% (6.1%–12.3%), respectively (p = 0.01). None of the 12 maternal and 51 infant deaths (including two second-born infants) were attributed to antiretrovirals. The cumulative HIV-transmission or death rate at 24 mo was 15.7% (95% CI 12.7%–19.4%).
This trial shows that a maternal triple-antiretroviral regimen from late pregnancy through 6 months of breastfeeding for PMTCT is safe and feasible in a resource-limited setting. These findings are consistent with those from other trials using maternal triple-antiretroviral regimens during breastfeeding in comparable settings.
Trial registration
ClinicalTrials.gov NCT00146380
Please see later in the article for the Editors' Summary
Editors' Summary
Every year, about half a million children become infected with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Nearly all these newly infected children live in resource-limited countries and most acquire HIV from their mother, so-called mother-to-child transmission (MTCT). Without intervention, 25%–50% of babies born to HIV-positive mothers become infected with HIV during pregnancy, delivery, or breastfeeding. This infection rate can be reduced by treating mother and child with antiretroviral (ARV) drugs. A single dose of nevirapine (a "non-nucleoside reverse transcriptase inhibitor" or NNRTI) given to the mother at the start of labor and to her baby soon after birth nearly halves the risk of MTCT. Further reductions in risk can be achieved by giving mother and baby three ARVs—an NNRTI and two nucleoside reverse transcriptase inhibitors (NRTIs such as zidovudine and lamivudine)—during pregnancy and perinatally (around the time of birth).
Why Was This Study Done?
Breastfeeding is crucial for child survival in poor countries but it is also responsible for up to half of MTCT. Consequently, many researchers are investigating how various ARV regimens given to mothers and/or their infants during the first few months of life as well as during pregnancy and perinatally affect MTCT. In this single-arm trial, the researchers assess the feasibility and safety of using a triple-ARV regimen to suppress the maternal HIV load (amount of virus in the blood) from late pregnancy though 6 months of breastfeeding among HIV-positive women in Kisumu, Kenya, and ask whether this approach achieves a lower HIV transmission rate than other ARV regimens that have been tested in resource-limited settings. In a single-arm trial, all the participants are given the same treatment. By contrast, in a "randomized controlled" trial, half the participants chosen at random are given the treatment under investigation and the rest are given a control treatment. A randomized controlled trial provides a better comparison of treatments than a single-arm trial but is more costly.
What Did the Researchers Do and Find?
In the Kisumu Breastfeeding Study (KiBS), HIV-infected pregnant women took a triple-ARV regimen containing zidovudine and lamivudine and either nevirapine or the protease inhibitor nelfinavir from 34–36 weeks of pregnancy to 6 months after delivery. They were advised to breastfeed their babies (who received single-dose nevirapine at birth), and to wean them rapidly just before 6 months. The researchers then used Kaplan-Meier statistical methods to estimate HIV transmission and death rates among 487 live-born infants from delivery to 24 months. The cumulative HIV transmission rate rose from 2.5% at birth to 7.0% at 24 months. The cumulative HIV transmission or death rate at 24 months was 15.7%; no infant deaths were attributed to ARVs. At 24 months, 3.0% of babies born to mothers with a low viral load were HIV positive compared to 8.7% of babies born to mothers with a high viral load, a statistically significant difference. Similarly, at 24 months, 8.4% of babies born to mothers with low baseline CD4 cell counts (CD4 cells are immune system cells that are killed by HIV; CD4 cell counts indicate the level of HIV-inflicted immune system damage) were HIV positive compared to 4.1% of babies born to mothers with high baseline CD4 cell counts, although this difference did not achieve statistical significance.
What Do These Findings Mean?
Although these findings are limited by the single-arm design, they support the idea that giving breastfeeding women a triple-ARV regimen from late pregnancy to 6 months is a safe, feasible way to reduce MTCT in resource-limited settings. The HIV transmission rates in this study are comparable to those recorded in similar trials in other resource-limited settings and are lower than MTCT rates observed previously in Kisumu in a study in which no ARVs were used. Importantly, the KiBS mothers took most of the ARVs they were prescribed and most stopped breastfeeding by 6 months as advised. The intense follow-up employed in KiBS may be partly responsible for this good adherence to the trial protocol and thus this study's findings may not be generalizable to all resource-limited settings. Nevertheless, they suggest that a simple triple-ARV regimen given to HIV-positive pregnant women regardless of their baseline CD4 cell count can reduce MTCT during pregnancy and breastfeeding in resource-limited setting.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001015.
The accompanying PLoS Medicine Research article by Zeh and colleagues describes the emergence of resistance to ARVs in KiBS
Information on HIV and AIDS is available from the US National Institute of Allergy and Infectious Diseases
HIV InSite has comprehensive information on all aspects of HIV/AIDS
Information is available from Avert, an international AIDS charity, on many aspects of HIV/AIDS, including information on children, HIV, and AIDS and on preventing mother-to-child transmission of HIV (in English and Spanish)
UNICEF also has information about children and HIV and AIDS (in several languages)
The World Health organization has information on mother-to-child transmission of HIV http://www.who.int/hiv/topics/mtct/en/index.html (in several languages)
Related Articles
Ringing Up about Breastfeeding: a randomised controlled trial exploring early telephone peer support for breastfeeding (RUBY) – trial protocol
Forster, Della A
McLachlan, Helen L
Davey, Mary-Ann
Amir, Lisa H
Gold, Lisa
Small, Rhonda
Mortensen, Kate
Moorhead, Anita M
Grimes, Heather A
McLardie-Hore, Fiona E
BMC Pregnancy and Childbirth
The risks of not breastfeeding for mother and infant are well established, yet in Australia, although most women initiate breastfeeding many discontinue breastfeeding altogether and few women exclusively breastfeed to six months as recommended by the World Health Organization and Australian health authorities. We aim to determine whether proactive telephone peer support during the postnatal period increases the proportion of infants who are breastfed at six months, replicating a trial previously found to be effective in Canada.
A two arm randomised controlled trial will be conducted, recruiting primiparous women who have recently given birth to a live baby, are proficient in English and are breastfeeding or intending to breastfeed. Women will be recruited in the postnatal wards of three hospitals in Melbourne, Australia and will be randomised to peer support or to 'usual' care. All women recruited to the trial will receive usual hospital postnatal care and infant feeding support. For the intervention group, peers will make two telephone calls within the first ten days postpartum, then weekly telephone calls until week twelve, with continued contact until six months postpartum. Primary aim: to determine whether postnatal telephone peer support increases the proportion of infants who are breastfed for at least six months. Hypothesis: that telephone peer support in the postnatal period will increase the proportion of infants receiving any breast milk at six months by 10% compared with usual care (from 46% to 56%).
Outcome data will be analysed by intention to treat. A supplementary multivariate analysis will be undertaken if there are any baseline differences in the characteristics of women in the two groups which might be associated with the primary outcomes.
The costs and health burdens of not breastfeeding fall disproportionately and increasingly on disadvantaged groups. We have therefore deliberately chosen trial sites which have a high proportion of women from disadvantaged backgrounds. This will be the first Australian randomised controlled trial to test the effectiveness and cost effectiveness of proactive peer telephone support for breastfeeding.
Trial registration
Australian and New Zealand Clinical Trials Registry ACTRN12612001024831.
Breastfeeding; Exclusive breastfeeding; Breastfeeding rates; Peer support; Telephone; Australia
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HIV: prevention of mother-to-child transmission
Teasdale, Chloe A
Marais, Ben J
Abrams, Elaine J
Clinical Evidence
Over 2 million children are thought to be living with HIV/AIDS worldwide, of whom over 80% live in sub-Saharan Africa. Without antiretroviral treatment, the risk of HIV transmission from infected mothers to their children is 15% to 30% during gestation or labour, with an additional transmission risk of 10% to 20% associated with prolonged breastfeeding. HIV-1 infection accounts for most infections; HIV-2 is rarely transmitted from mother to child. Transmission is more likely in mothers with high viral loads, advanced disease, or both, in the presence of other sexually transmitted diseases, and with increased exposure to maternal blood. Mixed feeding practices (breast milk plus other liquids or solids) and prolonged breastfeeding are also associated with increased risk of mother-to-child transmission of HIV.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of measures to reduce mother-to-child transmission of HIV? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We performed a GRADE evaluation of the quality of evidence for interventions.
We found 53 systematic reviews, RCTs, or observational studies that met our inclusion criteria.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: antiretroviral drugs, different methods of infant feeding, elective caesarean section, immunotherapy, micronutrient supplements, vaginal microbicides, and vitamin supplements.
Key Points
Without active intervention, the risk of mother-to-child transmission (MTCT) of HIV-1 is high, especially in populations where prolonged breastfeeding is the norm. Without antiviral treatment, the risk of transmission of HIV from infected mothers to their children is approximately 15% to 30% during pregnancy and labour, with an additional transmission risk of 10% to 20% associated with prolonged breastfeeding.HIV-2 is rarely transmitted from mother to child.Transmission is more likely in mothers with high viral loads, advanced HIV disease, or both.Without antiretroviral treatment (ART), 15% to 35% of vertically infected infants die within the first year of life.The long-term treatment of children with ART is complicated by multiple concerns regarding the complications associated with life-long treatment, including adverse effects of antiretroviral drugs, difficulties of adherence across the developmental trajectory of childhood and adolescence, and the development of resistance.From a paediatric perspective, successful prevention of MTCT and HIV-free survival for infants remain the most important focus.
Antiretroviral drugs given to the mother during pregnancy or labour, to the baby immediately after birth, or to the mother and baby reduce the risk of intrauterine and intrapartum MTCT of HIV-1 and when given to the infant after birth and to the mother or infant during breastfeeding reduce the risk of postpartum MTCT of HIV-1.
Reductions in MTCT are possible using multidrug ART regimens. Longer courses of ART are more effective, but the greatest benefit is derived from treatment during late pregnancy, labour, and early infancy.Suppression of the maternal viral load to undetectable levels (below 50 copies/mL) using highly active antiretroviral therapy (HAART) offers the greatest risk reduction, and is currently the standard of care offered in most resource-rich countries, where MTCT rates have been reduced to 1% to 2%. Alternative short-course regimens have been tested in resource-limited settings where HAART is not yet widely available. There is evidence that short courses of antiretroviral drugs have confirmed efficacy for reducing MTCT. Identifying optimal short-course regimens (drug combination, timing, and cost effectiveness) for various settings remains a focus for ongoing research.The development of viral resistance in mothers and infants after single-dose nevirapine and other short-course regimens that include single-dose nevirapine is of concern. An additional short-course of antiretrovirals with a different regimen during labour and early postpartum, and the use of HAART, may decrease the risk of viral resistance in mothers, and in infants who become HIV-infected despite prophylaxis.World Health Organization guidelines recommend starting prophylaxis with antiretroviral drugs from as early as 14 weeks' gestation, or as soon as possible if women present late in pregnancy, in labour, or at delivery.
Elective caesarean section at 38 weeks may reduce vertical transmission rates (apart from breast-milk transmission). The potential benefits of this intervention need to be balanced against the increased risk of surgery-associated complications, high cost, and feasibility issues. These reservations are particularly relevant in resource-limited settings.
Immunotherapy with HIV hyperimmune globulin seems no more effective than immunoglobulin without HIV antibody at reducing HIV-1 MTCT risk.
Vaginal microbicides have not been demonstrated to reduce HIV-1 MTCT risk.
There is no evidence that supplementation with vitamin A reduces the risk of HIV-1 MTCT, and there is concern that postnatal vitamin A supplementation for mother and infant may be associated with increased risk of mortality.
We don't know whether micronutrients are effective in prevention of MTCT of HIV as we found no RCT evidence on this outcome.
Avoidance of breastfeeding prevents postpartum transmission of HIV, but formula feeding requires access to clean water and health education. The risk of breastfeeding-related HIV transmission needs to be balanced against the multiple benefits that breastfeeding offers. In resource-poor countries, breastfeeding is strongly associated with reduced infant morbidity and improved child survival. Exclusive breastfeeding during the first 6 months may reduce the risk of HIV transmission compared with mixed feeding, while retaining most of its associated benefits.In a population where prolonged breastfeeding is usual, early, abrupt weaning may not reduce MTCT or HIV-free survival at 2 years compared with prolonged breastfeeding, and may be associated with a higher rate of infant mortality for those infants diagnosed as HIV-infected at <4 months of age. Antiretrovirals given to the mother or the infant during breastfeeding can reduce the risk of HIV transmission in the postpartum period. World Health Organization guidelines recommend that HIV-positive mothers should exclusively breastfeed for the first 6 months, after which time appropriate complementary foods can be introduced. Breastfeeding should be continued for the first 12 months of the infant's life, and stopped only when an adequate diet without breast milk can be provided. Heat- or microbicidal-treated expressed breast milk may offer value in particular settings.
Related Articles
Early breastfeeding experiences of adolescent mothers: a qualitative prospective study
Smith, Paige Hall
Coley, Sheryl L
Labbok, Miriam H
Cupito, Susan
Nwokah, Eva
International Breastfeeding Journal
Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers.
This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys.
Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems.
Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early breastfeeding experience, be able to identify and claim a reliable support system supportive of breastfeeding, and gain through their experience, a belief in their own agency and competency as mothers.
Breastfeeding; Adolescent health; Breastfeeding education; Preconception
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Breastfeeding Duration: A Survival Analysis—Data from a Regional Immunization Survey
Robert, E.
Coppieters, Y.
Swennen, B.
Dramaix, M.
BioMed Research International
Objective. To report the duration of and factors associated with exclusive and any breastfeeding among the French-speaking community of Belgium (Wallonia). Material and Methods. A two-stage cluster sample was drawn from the population of children aged 18–24 months living in the area in 2012. Anamnestic data on breastfeeding and sociodemographic information were collected from 525 mothers. Cox's proportional hazards model was used to identify factors associated with discontinuing breastfeeding. Results and Discussion. Only 35.1% of the women were satisfied with their duration of any breastfeeding. At 3 months, 54.1% of the infants were breastfed, of which 40.6% exclusively, with these percentages falling to 29.1% and 12.6% at 6 months. Exclusive and any breastfeeding durations were independently positively associated (P < 0.05) with foreign-born mothers, awareness of WHO recommendations, and maternity leave >3 months. Exclusive BF duration was associated with higher parental income and the prenatal decision to breastfeed. The duration of any breastfeeding was associated with the mothers' age of ≥30 years and whether they were exclusively breastfeeding at discharge from the maternity unit. Conclusions. Programs promoting and supporting BF should concentrate on training prenatal health-care professionals. Prenatal professional advice may promote adherence to WHO BF guidelines. The benefits of exclusive BF should be emphasized. Pregnant women should be discouraged from introducing supplementary feeding in the maternity ward.
Related Articles
HIV and infant feeding in Malawi: public health simplicity in complex social and cultural contexts
Chinkonde, Jacqueline R
Hem, Marit Helene
Sundby, Johanne
BMC Public Health
The question of when and how to best wean infants born to mothers with HIV requires complex answers. There are clinical guidelines on best approaches but limitations persist when applying them in diverse low-income settings. In such settings, infant-feeding practices are not only dependent on individual women's choices but are also subject to social and cultural pressures. However, when developing infant-feeding policies little attention has been paid to these pressures, even though they may yield useful empirical knowledge on the various forces that shape the infant-feeding dilemmas confronting women with HIV. This study aimed to a) identify the infant-feeding challenges that women with HIV faced when they were advised to wean their children at an early age of six months and b) explore how the women adhered to their infant-feeding options while facing and managing these challenges.
This study was conducted between February 2008 and April 2009 at two public health facilities where services to prevent mother-to-child transmission of HIV were implemented. Repeated in-depth interviews were conducted with 20 HIV-positive women. Two of the 20 women were also chosen for case studies which included home visits.
Several interdependent factors including the conflicting pressures of sexual morality and the demands of nurturing and motherhood, in conditions of abject poverty, impeded the participating women from following medical advice on infant feeding. If they adhered to the medical advice, the women would encounter difficulty maintaining their ascribed roles as respected wives, mothers and members of the society at large. The necessity of upholding their moral standing through continued breastfeeding, which signified HIV-negative status, put pressure on them to ignore the medical advice.
The infant-feeding dilemmas for women with HIV are complex. The integration of public health efforts with context-specific socio-cultural understanding is essential. The recent 2010 WHO guidelines offer a possible way of resolving these challenges. They recommend breastfeeding for one year with an adaptation to two years for Malawi. Efforts in the PMTCT programmes to supplement existing support systems, e.g. through the mothers-to-mothers (M2M) programme or consultation with expert mothers may also help women overcome these challenges.
Related Articles
Poor Adherence to National and International Breastfeeding Duration Targets in an Australian Longitudinal Cohort
Hure, Alexis J.
Powers, Jennifer R.
Chojenta, Catherine L.
Byles, Julie E.
Loxton, Deborah
PLoS ONE
To report on the proportion and characteristics of Australian infants who are fed, and mothers who feed, in accordance with the national and international breastfeeding duration targets of six, 12 and 24 months. Furthermore, to examine the longitudinal breastfeeding duration patterns for women with more than one child.
Breastfeeding duration data for 9773 children have been self-reported by a national sample of 5091 mothers aged 30–36 years in 2009, participating in the Australian Longitudinal Study on Women's Health.
Only 60% of infants received the minimum recommended 6 months of breast milk, irrespective of breastfeeding exclusivity. Less than 30% of infants received any breast milk at 12 months, and less than 3% were breastfed to the international target of 24 months. Young, less educated, unmarried or low-income women were at an increased risk of premature breastfeeding cessation. For women with three or more children, nearly 75% of women who breastfed their first child for at least six months reached this breastfeeding duration target for their next two children.
While national breastfeeding rates are typically evaluated in relation to the infant, a novel component of our study is that we have assessed maternal adherence to breastfeeding duration targets and the longitudinal feeding practices of women with more than one child. Separate evaluations of maternal and infant breastfeeding rates are important as they differ in their implications for public health policy and practice.
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Complementary feeding adequacy in relation to nutritional status among early weaned breastfed children who are born to HIV-infected mothers: ANRS 1201/1202 Ditrame Plus, Abidjan, Cote d'Ivoire
Becquet, Renaud
Leroy, Valériane
Ekouevi, Didier K.
Viho, Ida
Castetbon, Katia
Fassinou, Patricia
Dabis, François
Timite-Konan, Marguerite
In high HIV-prevalence resource constrained settings, exclusive breastfeeding with early cessation is one of the conceivable interventions aimed at the prevention of HIV through breastmilk. Nevertheless, this intervention has potential adverse effects such as the inappropriateness of complementary feeding taking over breastmilk.
Prospective cohort study in Abidjan, Côte d'Ivoire.
HIV-infected pregnant women willing to breastfeed who had received a perinatal antiretroviral prophylaxis were offered to practice exclusive breastfeeding and initiate early cessation of breastfeeding from the fourth month to reduce breastmilk HIV transmission. Nature and ages of introductory complementary feeding were described in infants up to their first birthday by longitudinal compilation of 24 hour and seven day recall histories. These recalls were done weekly until six weeks of age, monthly until nine months of age, and then quarterly. We created an index synthesizing the nutritional adequacy of infant feeding practices (in terms of quality of the source of milk, dietary diversity, food and meal frequencies) ranging from 0 to 12. The association of this feeding index with growth outcomes in children was investigated.
Among the 262 breastfed children included, complete cessation of breastfeeding occurred in 77% by their first birthday, with a median duration of four months. Most of the complementary foods were introduced within the seventh month of life, except for baby food and infant formula that were introduced at age four months. The feeding index was relatively low (5/12) at age six months, mainly due to insufficient dietary diversity, but was improved in the next six months (8.5/12 at age 12 months). Inadequate complementary feeding at age six months was associated with impaired growth during the next 12 months, with a 37% increased probability of stunting.
Adequate feeding practices around the weaning period are thus crucial to achieve optimal child growth. HIV-infected women should only turn to early cessation of breastfeeding when they are properly counselled to provide adequate complementary feeding taking over breastmilk. Our child feeding index could contribute to the assessment of the nutritional adequacy of complementary feeding around the weaning period and thus help detecting children at risk of malnutrition.
Breast Feeding; Child Development; Cote d'Ivoire; Developing Countries; Disease Transmission, Vertical; prevention & control; Female; Growth; HIV Infections; prevention & control; transmission; Humans; Infant; Infant Food; Infant Formula; Infant Nutrition Physiology; Infant, Newborn; Nutritional Status; Pregnancy; Pregnancy Complications, Infectious; Time Factors; Weaning; Africa; breast feeding; disease transmission, vertical; HIV infections; infant nutrition; nutritional status
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Breastfeeding Intentions Among Pregnant Adolescents and Young Adults and Their Partners
Sipsma, Heather L.
Divney, Anna A.
Magriples, Urania
Hansen, Nathan
Gordon, Derrick
Kershaw, Trace
Breastfeeding Medicine
Rates of breastfeeding remain disproportionately low among young mothers in the United States. Although breastfeeding behavior may be most directly related to breastfeeding intention, little is known about breastfeeding intentions among young women who are expecting a baby.
Subjects and Methods
Pregnant adolescents and young adults (14–21 years old) and their male partners were recruited for participation. Females were asked if they intended to breastfeed, and their partners were asked if they wanted their partners to breastfeed; participants indicated reasons for their responses. Logistic regression modeling was used to determine the associations between breastfeeding intentions and sociodemographic characteristics, relationship characteristics, and partner's intention to breastfeed.
Approximately 73% of females reported intending to breastfeed, and 80% of males reported wanting his partner to breastfeed, most commonly because it is "healthier for the baby" and "a more natural way to feed the baby." Sociodemographic and relationship characteristics explained a small amount of variance of breastfeeding intention (15% and 4% among females, respectively, and 8% and 4% among males, respectively). Partner intention explained an additional 23% and 24% of the variance in individual intention for females and males, respectively. Females who had experienced intimate partner violence (IPV) from their current partner had lower odds of intending to breastfeed (odds ratio=0.37; 95% confidence interval=0.16, 0.84). Race/ethnicity modified associations among both genders.
These findings emphasize the importance of dyadic approaches and suggest strategies for improving breastfeeding intentions and behavior among young couples expecting a baby. These results are also among the first to document the relationship between IPV and breastfeeding intentions among young women.
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Racial/Ethnic Differences in Breastfeeding Initiation and Duration Among Low-income, Inner-city Mothers
Lee, Helen J.
Elo, Irma T.
McCollum, Kelly F.
Culhane, Jennifer F.
Social science quarterly
Despite the promotion of breastfeeding as the "ideal" infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This paper investigates how maternal socio-demographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status.
Using data from a community-based, longitudinal study of women in Philadelphia, PA (N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration.
Both foreign-born black mothers and Hispanic mothers (most of whom were foreign-born) were significantly more likely to breastfeed their infants than non-Hispanic white women, findings that were partly explained by foreign-born and Hispanic mothers' prenatal intention to breastfeed. In contrast to previous studies, we also found that native-born black women were more likely to breastfeed than non-Hispanic white women.
Our findings suggest that when poor whites and African Americans are similarly situated in an inner-city context, the disparity in their behavior with respect to infant feeding is not as distinct as documented in national surveys. Breastfeeding was also more common among low-income immigrant black women than white or native-born black mothers.
Breastfeeding; Inner-city; Nativity; Race/Ethnicity; SES
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Infant feeding in the context of HIV: a qualitative study of health care workers' knowledge of recommended infant feeding options in Papua New Guinea
Vallely, Lisa M
Kelly, Angela
Kupul, Martha
Neo, Ruthy
Fiya, Voletta
Kaldor, John M
Mola, Glen DL
Worth, Heather
International Breastfeeding Journal
Interventions to prevent mother to child transmission of human immunodeficiency virus (HIV) during childbirth and breastfeeding can reduce HIV infections in infants to less than 5% in low and middle income countries. The World Health Organization (WHO) recommends all mothers, regardless of their HIV status, practice exclusive breastfeeding for the first six months of an infant's life. In line with these recommendations and to protect, promote and support breastfeeding, in 2009 the PNG National Department of Health revised their National HIV infant feeding guidelines, reinforcing the WHO recommendation of exclusive breastfeeding for the first six months followed by the introduction of other food and fluids, while continuing breastfeeding.
The overall aim of this paper is to explore health care workers' knowledge regarding infant feeding options in PNG, specifically as they relate to HIV exposed infants.
As part of a study investigating women's and men's experiences of prevention of mother to child transmission (PMTCT) services in two sites in PNG, 28 key informant interviews were undertaken. This paper addresses one theme that emerged from thematic data analysis: Health care workers' knowledge regarding infant feeding options, specifically how this knowledge reflects the Papua New Guinea National HIV Care and Treatment Guidelines on HIV and infant feeding (2009).
Most informants mentioned exclusive breastfeeding, the majority of whom reflected the most up-to-date National Guidelines of exclusive breastfeeding for six months. The importance of breastfeeding continuing beyond this time, along with the introduction of food and fluids was less well understood. The most senior people involved in PMTCT were the informants who most accurately reflected the national guidelines of continuing breastfeeding after six months.
Providing advice on optimal infant feeding in resource poor settings is problematic, especially in relation to HIV transmission. Findings from our study reflect those found elsewhere in identifying that key health care workers are not aware of up-to-date information relating to infant feeding, especially within the context of HIV. Greater emphasis needs to be placed on ensuring the most recent feeding guidelines are disseminated and implemented in clinical practice in PNG.
Prevention of mother to child transmission; Infant feeding practices; Exclusive breastfeeding; Health care worker knowledge
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Early cessation of breastfeeding amongst women in South Africa: an area needing urgent attention to improve child health
Doherty, Tanya
Sanders, David
Jackson, Debra
Swanevelder, Sonja
Lombard, Carl
Zembe, Wanga
Chopra, Mickey
Goga, Ameena
Colvin, Mark
Fadnes, Lars T
Engebretsen, Ingunn MS
Ekström, Eva-Charlotte
Tylleskär, Thorkild
BMC Pediatrics
Breastfeeding is a critical component of interventions to reduce child mortality. Exclusive breastfeeding practice is extremely low in South Africa and there has been no improvement in this over the past ten years largely due to fears of HIV transmission. Early cessation of breastfeeding has been found to have negative effects on child morbidity and survival in several studies in Africa. This paper reports on determinants of early breastfeeding cessation among women in South Africa.
This is a sub group analysis of a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008 (ClinicalTrials.gov no: NCT00397150). Infant feeding recall of 22 food and fluid items was collected at 3, 6, 12 and 24 weeks postpartum. Women's experiences of breast health problems were also collected at the same time points. 999 women who ever breastfed were included in the analysis. Univariable and multivariable logistic regression analysis adjusting for site, arm and cluster, was performed to determine predictors of stopping breastfeeding by 12 weeks postpartum.
By 12 weeks postpartum, 20% of HIV-negative women and 40% of HIV-positive women had stopped all breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first 3 days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks (Adjusted odds ratio, AOR 5.6, 95% CI 3.4 – 9.5 and AOR 4.1, 95% CI 1.6 – 10.8, respectively). Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding (AOR 3.1, 95%CI 1.7 – 5.7) and the mother having her own income doubled the risk of stopping breastfeeding (AOR 1.9, 95% CI 1.3 – 2.8).
Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.
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Effects of low income on infant health
Séguin, Louise
Xu, Qian
Potvin, Louise
Zunzunegui, Maria-Victoria
Frohlich, Katherine L.
CMAJ: Canadian Medical Association Journal
Few population-based studies have analyzed the link between poverty and infant morbidity. In this study, we wanted to determine whether inadequate income itself has an impact on infant health.
We interviewed 2223 mothers of 5-month-old children participating in the 1998 phase of the Quebec Longitudinal Study of Child Development to determine their infant's health and the sociodemographic characteristics of the household (including household income, breast-feeding and the smoking habits of the mother). Data on the health of the infants at birth were taken from medical records. We examined the effects of household income using Statistics Canada definitions of sufficient (above the low-income threshold), moderately inadequate (between 60% and 99% of the low-income threshold) and inadequate (below 60% of the low-income threshold) income on the mother's assessment of her child's overall health, her report of her infant's chronic health problems and her report of the number of times, if any, her child had been admitted to hospital since birth. In the analysis, we controlled for factors known to affect infant health: infant characteristics and neonatal health problems, the mother's level of education, the presence or absence of a partner, the duration of breast-feeding and the mother's smoking status.
Compared with infants in households with sufficient incomes, those in households with lower incomes were more likely to be judged by their mothers to be in less than excellent health (moderately inadequate incomes: adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1–2.1; very inadequate incomes: adjusted OR 1.8, 95% CI 1.3–2.6). Infants in households with moderately inadequate incomes were more likely to have been admitted to hospital (adjusted OR 1.8, 95% CI 1.2–2.6) than those in households with sufficient incomes, but the same was not true of infants in households with very inadequate incomes (adjusted OR 0.7, 95% CI 0.4–1.2). Household income did not significantly affect the likelihood of an infant having chronic health problems.
Less than sufficient household incomes are associated with poorer overall health and higher hospital admission rates among infants in the first 5 months of life, even after adjustment for factors known to affect infant health, including the mother's level of education.
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Prevalence of breastfeeding at four months in general practices in south London.
Sikorski, J
Boyd, F
Dezateux, C
Wade, A
Rowe, J
The British Journal of General Practice
BACKGROUND: Successive quinquennial National Infant Feeding Surveys have provided a valuable picture of national and regional variations in infant feeding practices within the United Kingdom. Social variation in breastfeeding has been recognised to be an important source of health inequalities in childhood by the Independent Inquiry into Inequalities in Health Report. AIM: To determine the prevalence of breastfeeding at birth and at four months in a sample of women from urban general practices, its variation between practices, and relation to practice population deprivation scores. To report the timing of introduction of solid feeds. DESIGN OF STUDY: Cross-sectional questionnaire survey based on a random cluster sample. SETTING: Women with infants aged four months in general practices in South London. METHOD: Mode of infant feeding at birth and four months, and time of introduction of solids. Jarman score as a measure of practice population deprivation. Housing tenure, maternal ethnic group, and maternal age at leaving full-time education. RESULTS: Twenty-five general practices were sampled. Median practice Jarman score was 15.0 (interquartile range [IQR] = 12.6-21.9). Responses were received from 1053 out of 1532 mothers approached (69%). Of these, 87% (897) had breastfed at birth, while 59% (609) were still breastfeeding their babies at four months. Mothers in rented accommodation were less likely to breastfeed than owner-occupiers (odds ratio [95% CI] = 0.52 [0.37-0.74]), as were women of white, compared with those of black, ethnic origin (odds ratio [95% CI] = 0.55 [0.36-0.82]). Those who completed up to two years and more than two years education after the age of 16 were 2.94 (95% CI = 1.85-4.66) and 9.25 (95% CI = 6.02-14.21) more likely to breastfeed at four months, respectively, than mothers whose formal education was completed at or before 16 years. Practice-specific rates of breastfeeding ranged from 71% to 100% at birth (median 87%; IQR = 79-93%) and 22% to 83% at four months (median 61%; interquartile range = 47-66%). The intra-practice correlation coefficient for breastfeeding at four months was 0.052 (within-cluster variance = 0.23, between-cluster variance = 0.013). There was no association between breastfeeding at four months and practice-specific Jarman score. Median age of starting solids was 16 weeks (IQR = 15-17 weeks). CONCLUSIONS: Housing tenure, maternal education, and ethnic group are significantly associated with breastfeeding prevalence at four months. Between-practice variation in breastfeeding prevalence is not associated with measures of practice population deprivation, as assessed by Jarman scores. Consideration should be given to including information on maternal ethnic group and housing tenure in future National Infant Feeding Surveys. Current weaning practices fall short of the recommendation of the World Health Assembly.
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Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial
Chapman, Donna J.
Morel, Katherine
Bermúdez-Millán, Angela
Young, Sara
Damio, Grace
Pérez-Escamilla, Rafael
To evaluate a specialized breastfeeding peer counseling (SBFPC) intervention promoting exclusive breastfeeding (EBF) among overweight/obese, low-income women.
We recruited 206 pregnant, overweight/obese, low-income women and randomly assigned them to receive SBFPC or standard care (controls) at a Baby-Friendly hospital. SBFPC included 3 prenatal visits, daily in-hospital support, and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers. Standard care involved routine access to breastfeeding support from hospital personnel, including staff peer counselors. Data collection included an in-hospital interview, medical record review, and monthly telephone calls through 6 months postpartum to assess infant feeding practices, demographics, and health outcomes. Bivariate and logistic regression analyses were conducted.
The intervention had no impact on EBF or breastfeeding continuation at 1, 3, or 6 months postpartum. In adjusted posthoc analyses, at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding (adjusted odds ratio [aOR]: 3.76 [95% confidence interval (CI): 1.07–13.22]), and giving at least 50% of feedings as breast milk (aOR: 4.47 [95% CI: 1.38–14.5]), compared with controls. Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth (aOR: 0.24 [95% CI: 0.07–0.86]).
In a Baby-Friendly hospital setting, SBFPC targeting overweight/obese women did not impact EBF practices but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth.
breastfeeding; peer counseling; obesity; overweight; exclusive breastfeeding; hospitalization; breastfeeding self efficacy
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Infant feeding practices and breastfeeding duration in Japan: A review
Inoue, Madoka
Binns, Colin W
Otsuka, Keiko
Jimba, Masamine
Matsubara, Manami
International Breastfeeding Journal
The Japanese health system places great emphasis on healthy development. However, the prevalence of Exclusive Breastfeeding at one month postpartum between 1980 and 2005 has remained unchanged, fluctuating between 42% and 49%. At the same time, the Any Breastfeeding prevalence has gradually increased from about 80% to 95%. In 2010, the latest national breastfeeding report showed that 'exclusive' and 'any' breastfeeding rates have improved. However, as the World Health Organization (WHO) definition of breastfeeding practices was not used in this study or in other national surveys, it is difficult to interpret these latest results. While the Japanese government has launched several promotion projects, there have been few studies and reviews of risk factors that influence breastfeeding duration. The objectives of this review were to summarise the factors that have influenced the duration of breastfeeding in Japan to provide information relevant to breastfeeding promotion programs. A search of electronic databases in Japanese and English was undertaken up to 2011. The inclusion criteria for this review were studies that focused on infant feeding practices and targeted Japanese mothers, fathers, or health professionals, but excluded mothers' friends and peer groups. In total, 12 articles were selected for the final analysis. Smoking status, low birth weight of infants and maternal perceptions of insufficient breast milk supply were negative influences on breastfeeding duration, while support from husbands/partners is associated with continued breastfeeding. Some factors that have been found to be associated with breastfeeding in other countries, including maternal age, family income, maternal educational levels, and living with grandparents of infants have not been confirmed in Japan. While the national breastfeeding rates were higher than other countries of similar health status, inconsistent knowledge of breastfeeding benefits and inappropriate hospital practices remain in Japan may be associated with increased the use of infant formula and reduced breastfeeding duration. Most of the studies reviewed were cross-sectional in design, with only a limited number of cohort studies. Also many published studies used small sample sizes. Cohort studies of infant feeding practices with larger sample sizes are required to monitor trends in rates and risk factors for breastfeeding outcomes.
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Pregnancy and Infant Outcomes among HIV-Infected Women Taking Long-Term ART with and without Tenofovir in the DART Trial
Gibb, Diana M.
Kizito, Hilda
Russell, Elizabeth C.
Chidziva, Ennie
Zalwango, Eva
Nalumenya, Ruth
Spyer, Moira
Tumukunde, Dinah
Nathoo, Kusum
Munderi, Paula
Kyomugisha, Hope
Hakim, James
Grosskurth, Heiner
Gilks, Charles F.
Walker, A. Sarah
Musoke, Phillipa
PLoS Medicine
Diana Gibb and colleagues investigate the effect of in utero tenofovir exposure by analyzing the pregnancy and infant outcomes of HIV-infected women enrolled in the DART trial.
Few data have described long-term outcomes for infants born to HIV-infected African women taking antiretroviral therapy (ART) in pregnancy. This is particularly true for World Health Organization (WHO)–recommended tenofovir-containing first-line regimens, which are increasingly used and known to cause renal and bone toxicities; concerns have been raised about potential toxicity in babies due to in utero tenofovir exposure.
Methods and Findings
Pregnancy outcome and maternal/infant ART were collected in Ugandan/Zimbabwean HIV-infected women initiating ART during The Development of AntiRetroviral Therapy in Africa (DART) trial, which compared routine laboratory monitoring (CD4; toxicity) versus clinically driven monitoring. Women were followed 15 January 2003 to 28 September 2009. Infant feeding, clinical status, and biochemistry/haematology results were collected in a separate infant study. Effect of in utero ART exposure on infant growth was analysed using random effects models.
382 pregnancies occurred in 302/1,867 (16%) women (4.4/100 woman-years [95% CI 4.0–4.9]). 226/390 (58%) outcomes were live-births, 27 (7%) stillbirths (≥22 wk), and 137 (35%) terminations/miscarriages (<22 wk). Of 226 live-births, seven (3%) infants died <2 wk from perinatal causes and there were seven (3%) congenital abnormalities, with no effect of in utero tenofovir exposure (p>0.4). Of 219 surviving infants, 182 (83%) enrolled in the follow-up study; median (interquartile range [IQR]) age at last visit was 25 (12–38) months. From mothers' ART, 62/9/111 infants had no/20%–89%/≥90% in utero tenofovir exposure; most were also zidovudine/lamivudine exposed. All 172 infants tested were HIV-negative (ten untested). Only 73/182(40%) infants were breast-fed for median 94 (IQR 75–212) days. Overall, 14 infants died at median (IQR) age 9 (3–23) months, giving 5% 12-month mortality; six of 14 were HIV-uninfected; eight untested infants died of respiratory infection (three), sepsis (two), burns (one), measles (one), unknown (one). During follow-up, no bone fractures were reported to have occurred; 12/368 creatinines and seven out of 305 phosphates were grade one (16) or two (three) in 14 children with no effect of in utero tenofovir (p>0.1). There was no evidence that in utero tenofovir affected growth after 2 years (p = 0.38). Attained height- and weight for age were similar to general (HIV-uninfected) Ugandan populations. Study limitations included relatively small size and lack of randomisation to maternal ART regimens.
Overall 1-year 5% infant mortality was similar to the 2%–4% post-neonatal mortality observed in this region. No increase in congenital, renal, or growth abnormalities was observed with in utero tenofovir exposure. Although some infants died untested, absence of recorded HIV infection with combination ART in pregnancy is encouraging. Detailed safety of tenofovir for pre-exposure prophylaxis will need confirmation from longer term follow-up of larger numbers of exposed children.
Trial registration
www.controlled-trials.com ISRCTN13968779
Please see later in the article for the Editors' Summary
Editors' Summary
Currently, about 34 million people (mostly in low- and middle-income countries) are infected with HIV, the virus that causes AIDS. At the beginning of the epidemic, more men than women were infected with HIV but now about half of all people living with HIV/AIDS are women, most of who became infected through unprotected sex with an infected partner. In sub-Saharan Africa alone, 12 million women are HIV-positive. Worldwide, HIV/AIDS is the leading cause of death among women of child-bearing age. Moreover, most of the 400,000 children who become infected with HIV every year acquire the virus from their mother during pregnancy or birth, or through breastfeeding, so-called mother-to-child transmission (MTCT). Combination antiretroviral therapy (ART)—treatment with cocktails of powerful antiretroviral drugs—reduces HIV-related illness and death among women, and ART given to HIV-positive mothers during pregnancy and delivery and to their newborn babies greatly reduces MTCT.
Why Was This Study Done?
Because of ongoing international efforts to increase ART coverage, more HIV-positive women in Africa have access to ART now than ever before. However, little is known about pregnancy outcomes among HIV-infected African women taking ART throughout pregnancy for their own health or about the long-term outcomes of their offspring. In particular, few studies have examined the effect of taking tenofovir (an antiretroviral drug that is now recommended as part of first-line ART) throughout pregnancy. Tenofovir readily crosses from mother to child during pregnancy and, in animal experiments, high doses of tenofovir given during pregnancy caused bone demineralization (which weakens bones), kidney problems, and impaired growth among offspring. In this study, the researchers analyze data collected on pregnancy and infant outcomes among Ugandan and Zimbabwean HIV-positive women who took ART throughout pregnancy in the Development of AntiRetroviral Therapy in Africa (DART) trial. This trial was designed to test whether ART could be safely and effectively delivered in Africa without access to the expensive laboratory tests that are routinely used to monitor ART toxicity and efficacy in developed countries.
What Did the Researchers Do and Find?
The pregnancy outcomes of 302 women who became pregnant during the DART trial and information on birth defects among their babies were collected as part of the DART protocol; information on the survival, growth, and development of the infants born to these women was collected in a separate infant study. Most of the women who became pregnant were taking tenofovir-containing ART before and throughout their pregnancies. 58% of the pregnancies resulted in a live birth, 7% resulted in a stillbirth (birth of a dead baby at any time from 22 weeks gestation to the end of pregnancy), and 35% resulted in a termination or miscarriage (before 22 weeks gestation). Of the 226 live births, seven infants died within 2 weeks and seven had birth defects. Similar proportions of the infants exposed and not exposed to tenofovir during pregnancy died soon after birth or had birth defects. Of the 182 surviving infants who were enrolled in the infant study, 14 subsequently died at an average age of 9 months, giving a 1-year mortality of 5%. None of the surviving children who were tested (172 infants) were HIV infected. No bone fractures or major kidney problems occurred during follow-up and prebirth exposure to tenofovir in utero had no effect on growth or weight gain at 2 years (in contrast to a previous US study).
What Do These Findings Mean?
By showing that prebirth tenofovir exposure does not affect pregnancy outcomes or increase birth defects, growth abnormalities, or kidney problems, these findings support the use of tenofovir-containing ART during pregnancy among HIV-positive African women, and suggest that it could also be used to prevent women of child-bearing age acquiring HIV-infection heterosexually. Notably, the observed 5% 1-year infant mortality is similar to the 2%–4% infant mortality normally seen in the region. The absence of HIV infection among the infants born to the DART participants is also encouraging. However, this is a small study (only 111 infants were exposed to tenofovir throughout pregnancy) and women were not randomly assigned to receive tenofovir-containing ART. Consequently, more studies are needed to confirm that tenofovir exposure during pregnancy does not affect pregnancy outcomes or have any long-term effects on infants. Such studies are essential because the use of tenofovir as a treatment for women who are HIV-positive is likely to increase and tenofovir may also be used in the future to prevent HIV acquisition in HIV-uninfected women.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001217.
Information is available from the US National Institute of Allergy and infectious diseases on all aspects of HIV infection and AIDS
NAM/aidsmap provides basic information about HIV/AIDS, and summaries of recent research findings on HIV care and treatment (in several languages)
Information is available from Avert, an international AIDS nonprofit on many aspects of HIV/AIDS, including detailed information on HIV/AIDS treatment and care, women, HIV and AIDS, children, HIV and AIDS, and on HIV/AIDS and pregnancy (some information in English and Spanish); personal stories of women living with HIV are available
More information about the DART trial is available
Additional patient stories about living with HIV/AIDS are available through the nonprofit website Healthtalkonline
Related Articles
Predictors of Breastfeeding Cessation among HIV Infected Mothers in Southern Ethiopia: A Survival Analysis
Haile, Demewoz
Belachew, Tefera
Birhanu, Getenesh
Setegn, Tesfaye
Biadgilign, Sibhatu
PLoS ONE
Mother-to-child transmission (MTCT) of Human immunodeficiency virus (HIV) through breastfeeding remains the most significant route infection among children. Although the current guideline is recommending continued breastfeeding for HIV exposed infants, significant proportion of infants have been subjected to early weaning to prevent HIV transmission. However the predictors of breastfeeding cessation among HIV positive mothers were not documented in Ethiopia. Therefore the objective of this study was to determine the predictors of breastfeeding cessation among HIV-infected women in Southern Ethiopia.
A facility based cross sectional study was conducted in Southern Ethiopia. The samples were selected by cluster sampling technique. The Kaplan-Meier curve was used to describe the survival time of breastfeeding and a step-wise multivariable Cox-proportional hazards regression model were used to identify the predictors of breastfeeding cessation. Both crude and adjusted hazard ratio were determined and p<0.05 was considered as statistically significant.
The mean duration of breastfeeding among HIV positive mothers was 13.79 [95% CI: (12.97–14.59)] months. The Kaplan-Meier estimate showed that proportions of women who were breastfeeding at 6, 9, 12 and 17 months were 89.3%, 75.3%, 66% and 17%, respectively. Those mothers having a monthly income of ≤500 ETB [AHR = 0.16, 95% CI :(0.03–0.76)], having a family size of three and below [AHR = 0.12, 95%CI: (0.02–0.68), four and above [AHR = 0.07, 95%CI: (0.01–0.35)] and bottle feeding [AHR = 3.95, 95%CI: (1.64–9.51)] were also independent factors associated with breastfeeding cessation.
Above one third of HIV positive mothers stopped breastfeeding before 12 months. Monthly income, bottle feeding and family size were the independent predictors of breastfeeding cessations. Strengthening the current counseling and promotion modality on avoidance of bottle feeding and continued breastfeeding is recommended for improved HIV free survival.
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Determinants of breastfeeding initiation among mothers in Kuwait
Dashti, Manal
Scott, Jane A
Edwards, Christine A
Al-Sughayer, Mona
International Breastfeeding Journal
Exclusive breastfeeding is recommended as the optimal way to feed infants for the first six months of life. While overall breastfeeding rates are high, exclusive breastfeeding is relatively uncommon among Middle Eastern women. The objective of this study was to identify the incidence of breastfeeding amongst women in the six governorates of Kuwait and the factors associated with the initiation of breastfeeding.
A sample of 373 women (aged 17-47 years), recruited shortly after delivery from four hospitals in Kuwait, completed a structured, interviewer-administered questionnaire. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.
In total, 92.5% of mothers initiated breastfeeding and at discharge from hospital the majority of mothers were partially breastfeeding (55%), with only 30% of mothers fully breastfeeding. Prelacteal feeding was the norm (81.8%) and less than 1 in 5 infants (18.2%) received colostrum as their first feed. Only 10.5% of infants had been exclusively breastfed since birth, the remainder of the breastfed infants having received either prelacteal or supplementary infant formula feeds at some time during their hospital stay. Of the mothers who attempted to breastfeed, the majority of women (55.4%) delayed their first attempt to breastfeed until 24 hours or more after delivery. Breastfeeding at discharge from hospital was positively associated with paternal support for breastfeeding and negatively associated with delivery by caesarean section and with the infant having spent time in the Special Care Nursery.
The reasons for the high use of prelacteal and supplementary formula feeding warrant investigation. Hospital policies and staff training are needed to promote the early initiation of breastfeeding and to discourage the unnecessary use of infant formula in hospital, in order to support the establishment of exclusive breastfeeding by mothers in Kuwait.
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text:
By Stephen Franklin
April 11, 2011
I have just received an email with an eye witness account from a resident living in Kibbutz Kfar Aza near the Gaza border.
What has been happening has been described in the Israeli press http://www.jpost.com/VideoArticles/Video/Article.aspx?id=215913 but I think that the following first hand report makes it clearer what it is like to be under such a bombardment.
"For the last few days we have been under almost contant bombardment, most people are living in their bomb shelters. The last 48 hours more than 100 missiles, rockets and mortars have hit our area. On Thursday a laser guide Kornet anti tank missile was fired at our yellow school bus with a direct hit. Fortunately the bus had just dropped off more than 30 children on the neighbouring kibbutz, and there was only one child on the bus, he was critically wounded.
There is a high level of stress, especially worrying about children and grandchildren. Even if they do not have to be in a bomb shelter, they cannot be more than 15 seconds from the shelter, so that they can take cover, when the alarm is given for an incoming missile.
Hoping this will soon be over, and we will have some respite, till the next round of hostlities."
A few years ago there was a report in Haaretz (http://www.haaretz.com/hasen/spages/945489.html)describing the effect of the bombardment from Gaza on the children of Sderot. Let's not forget them.

subset: commoncrawl


text:
Fantasyland maybe implementation
A fantasyland compliant implementation of the maybe monad.
var maybe = require'../'var log = console.logbindconsole '=>' var something = maybeof'Hello 'map return v + 'world!' logsomethingisSomething// => true logsomethingvalue// => 'Hello world!' var nothing = maybenothing'Hello 'map return v + 'world!' lognothingisSomething// => false lognothingvalue// => null (never use this, it not a value!)
Unlike many other "maybe" implementations this is not a currying function that checks for null inputs, but a value representation that can be Nothing.


text:
Orthopedic Care
At CHI Health Orthopedic Care, we specialize in all orthopedic and musculoskeletal problems including hip, knee and back pain or injury, arthritis, hand and wrist issues, foot and ankle problems and shoulder pain. Our experts provide the entire spectrum of treatment, from inpatient surgery to outpatient procedures and physical therapy.
CHI Health Creighton University Medical Center (CUMC) has been granted a two-year recertification for Orthopedic Trauma Disease Specific Care by the Joint Commission. CUMC was the second hospital in the country, and the only one in the region to be recognized by the Joint Commission for Orthopedic Trauma Disease Specific Care.


text:
Royalty Free Music Unique To Your Project - Every Time
Royalty Free Music » Emotions » Exuberant » Dramatic
Royalty Free Music — Exuberant & Dramatic
Browse Keywords:
(How To Use Search tutorial)
Track Search Results Switch to ALBUM VIEW
The following tracks match: Dramatic, Exuberant
March Of VictoryA proud orchestral fanfare to help those major announcements and intros.https://www.smartsound.com/strata/images/STRATEF_200.jpgSingle64605-ST$ 39.9564605-EX$ 59.9564605-W$ 149.95Emotions: Bold, Confident, Dramatic, Exuberant, Stately, Striving, Triumphant, Festive Genre: Processional, Orchestral, Olympic Production Types: Sports, Epic Instrument: Orchestra, Acoustic, Instrumental
March Of Victory from the album Epic & Fanfare
Global PulseThis powerful, yet tranquil cut combines aboriginal drum rhythms with soothing ethnic vocal tones to create a breezy cut with an international flair. It implies global expansion, with mankind working in concert with nature.https://www.smartsound.com/music/images/project.jpgSingle1306-ST$ 39.951306-EX$ 59.951306-W$ 149.95Emotions: Uplifting, Atmospheric, Dignified, Dramatic, Exuberant, Inspiring, Lively, Mystical, Spirited, Hopeful Genre: Earthy, Themes, World Production Types: Travel Instrument: Ethnic Ensemble, Percussion, Instrumental
Global Pulse from the album Project Millennium
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Extreme Mail makeover: Reimagined for the future of work
Every day, emails flood our inbox: tasks are left undone, messages go unanswered, and meetings overwhelm us. But new technology is anticipating user needs and improving productivity. Watch this vodcast to learn why email must evolve and how social analytics are being used to understand and cater for individual working ...Watch Now
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Cloud resilience has come of age and the benefits to the IT organization may be obvious. Understand how it may be time for your organization to jump on cloud too. This presentation helps you to make the case for cloud and achieve a higher level of business resilience.View this now
Meg Whitman presents Unlocking IT with Big Data
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Meg Whitman Presents Unlocking IT with Big Data
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Why Deploy Private Cloud in the Hybrid Cloud Era?
Whether deployed onsite or offsite, individually or as part of a hybrid, hosted or managed by a third party, private clouds have become a major catalyst for business growth and differentiation while providing a dynamic infrastructure for highly sensitiveFind out more
What the C-suite Needs to Know about the Economics of IT Risk and Reputation
View the presentation "Understanding the economics of IT risk and reputation"—based on a ground-breaking survey of 2,316 IT professionals conducted by Ponemon Institute and sponsored by IBM—to examine the costs behind this number and build a better business case for business continuity and IT security. Use it to demonstrate the ...Download Now
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The 2012 Gartner's Magic Quadrant for Data Warehouse Database Management Systems provides insight into the market for relational database management systems (DBMSs) used as platforms for data warehouses specifically. In this report, Gartner places IBM in the Leaders Quadrant. The Magic Quadrant compares 14 vendors and evaluates IBM's PureData System ...Find out more
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text:
Washington State University Vancouver will host the gubernatorial debate between candidates Jay Inslee and Rob McKenna on Aug. 29.
The debate will be from 8 to 9 p.m. at the WSU Vancouver auditorium. It will be broadcast live on KATU-TV and Brian Wood will be the host, the Greater Vancouver Chamber of Commerce announced Friday.
The auditorium can seat less than 200 people. Tickets are free and will be distributed to the community, the Vancouver chamber said. Forty tickets will be saved for the public and will be available starting Aug. 16. Details on how to get them will be available on Aug. 13.
CVTV and TVW will rebroadcast the debate on Comcast channels 21 and 23.
This story will be updated.


text:
Did you separate from a partner of 5 years or longer within the past 12 months? University of Michigan researchers need you for a study on separation and re-partnership. $100 compensation offered for two 2-hour online/telephone interviews. Ages 35-55 only. E-mail email@example.com !
Welcome, Guest ( Register | Login ) PLACE AN AD HERE or for assistance email: firstname.lastname@example.com!


text:
Carl Albert's Daytawion Lowe signs with OSU
MIDWEST CITY — Opportunity. That's what Carl Albert safety Daytawion Lowe saw when he visited Oklahoma State during the recruiting process. "I feel like there's an opportunity (to play early) there," Lowe said. "I'm going to go up there and play my heart out like I did at Carl Albert." Lowe became a Cowboy on Wednesday, signing with OSU over offers from Oklahoma, Pittsburgh, Stanford, Texas Tech, Missouri and Nebraska. "I'm happy and excited," Lowe said. "My heart was there. It's close to home, the program is growing and I like the coaching staff." With OSU in need of secondary help, Lowe will have the opportunity to play early in Stillwater. Lowe had 127 tackles and four interceptions as a senior.


text:
Cubis 2 masterfully delivers the next dimension of its
classic 3D matching game. New gameplay cubes
featuring the Bomb, Dual, and Ghost Cube, bring exciting
twists to every aspect of this addictive match-3 puzzler.
Fun Fact: Chosen by Apple to be one of the
first six games released for iPod 2.
- 3 Beautiful Themes
4 Play Modes Including
the new Morph-Fun Mode
- 300 Handcrafted Levels


text:
"A lot of good arguments are spoiled by some fool who knows what he is talking about."
Miguel de Unamuno
"I like to do all the talking myself. It saves time, and prevents arguments."
Oscar Wilde
"Ridicule is the first and last argument of a fool"
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"Marriage is a series of desperate arguments people feel passionately about."
Katharine Hepburn
"He who strikes the first blow admits he's lost the argument"
Chinese Proverbs
"Your always right, and I'm never wrong."
Babak Keissami
"In a family argument, if it turns out you are right -- apologize at once!"
Lazarus Long
Quotes Daddy offers a number of tools for developers and bloggers to integrate quotes into their site including customizable widgets, embeddable quotes and API.
Over 1,000,000 famous quotes and user quotes that you can save to your favorites, share with friends and add to your site, blog or social network.


text:
- BoliviaFoodFunding via IMPRO
La Amistad ...BoliviaFoodFunding via Emprender
RitaBoliviaFoodFunding via IMPRO
La Bolita - 26 Group
She makes a living selling breakfasts. She sells tea, coffee, yerba mate, sandwiches, and other things in one of the markets in the zone of Tembladerani.
This loan is her first loan cycle within the Institution. Karina is going to use the loan to buy ingredients, such as wholesale sugar, tea, and coffee, for the preparation of her breakfasts.
The reason she is requesting this loan is that she lacks capital for the purchase of ingredients. Karina faces challenges in her business such as the competition she has in the market of breakfast sales, and she is going to use her profits to continue increasing her working capital and improving her sales stand.
Her wish for her business is to try to purchase another stand and expand her business.
Additional Information
About EmprenderEmprender has been working in Bolivia since 1999. It is dedicated to becoming a key tool in the development of its clients and the improvement of their quality of life. Operating in three of Bolivia's major cities – La Paz, Cochabamba, and Santa Cruz – Emprender offers both urban and rural clients the opportunity to obtain financial products tailored to fit their needs and businesses. These products include housing loans, salary loans, "opportunity" (short-term) loans, and higher education loans. To better the quality of life for its clients and non-clients through non-financial services, Emprender offers free medical consultations and health classes given by trained doctors.
This is a Group Loan
In a group loan, each member of the group receives an individual loan but is part of a larger group of individuals. The group is there to provide support to the members and to provide a system of peer pressure, but groups may or may not be formally bound by a group guarantee. In cases where there is a group guarantee, members of the group are responsible for paying back the loans of their fellow group members in the case of delinquency or default.
Kiva's Field Partners typically feature one borrower from a group. The loan description, sector, and other attributes for a group loan profile are determined by the featured borrower's loan. The other members of the group are not required to use their loans for the same purpose.
About Bolivia
121View loans »
Success!! The loan was 100% repaid
- Repayment Term
- 8 months (Additional Information)
- Repayment Schedule
- Monthly
- Pre-Disbursed:
- Oct 26, 2012
- Listed
- Nov 19, 2012
- Currency Exchange Loss:
- Possible
- Ended:
- May 17, 2013


text:
| George Ostrouchov is a Senior Research Staff Member
and Analytics Task Lead
in the Scientific
Data Group of the
Computer Science and Mathematics
Division at the Oak Ridge National Laboratory,
Joint Faculty Professor in the Business Analytics and
Statistics Department at the University
of Tennessee, and a member of the Computational and Applied
Mathematics Group at the
Joint Institute for Computational
Sciences. He obtained his Ph.D. and M.Sc. in Statistics
from Iowa State University after undergraduate work in mathematics and
statistics at the University of Waterloo in Canada.
He is a
of the American Statistical Association.
George's interests are for many years focused on the interaction of High Performance Computing and Statistics, an area best described today as machine learning. He currently leads the pbdR project: r-pbd.org
| George Ostrouchov
Oak Ridge National Laboratory
1 Bethel Valley Road
P.O.Box 2008
Oak Ridge, TN 37831


text:
Somebody that is totally immature and/or a follower
av truth teller 28. desember 2003
of or pertaining to qualities of abrasive rudeness or hardened demeanor.
Man, that little shortie turned into one punk ass bitch!
av Merriam Webster 18. mai 2004
The kind of person who quits a game because they're losing. A total bum fucker.
Jonathan Warren is a punk ass bitch for kicking me out of the Psych game.
av The Landshark 1. april 2016


text:
We're usually more into Funko's big-headed Pop figurines around here, but they do make plenty of traditional action figures. They recently shrunk down their Game of Thrones figures to 3.75″, ...On April 18, 2016 / By Chance Kinney
With their March box, Nerd Block got us pumped for season six of Game of Thrones, which is set to return in a few weeks. We also saw some other current ...On April 3, 2016 / By Chloe Becquet
Which tattered, ruined banner are you going to be carrying coming into season six? It looks like that's what HBO was asking when they told fans last week ...On January 25, 2016 / By Chance Kinney
At first blush, "They have no idea what's going to happen" seems like pretty boilerplate teaser material. But, for the upcoming season of Game of Thrones, there's nothing ...On December 3, 2015 / By Chance Kinney
The ugly Christmas sweater is a holiday tradition that transcends denominations — if we can't all be unified in glorious tackiness, there really is no hope for us. ...On November 22, 2015 / By Chance Kinney
I don't see ThinkGeek carrying any lamps featuring other swords from Game of Thrones, so they either picked Longclaw at random or someone made a deep reference to ...On May 12, 2015 / By Chip Chick Staff
Sword and sorcery, myths and magic, dragons, and some things that aren't dragons. April's Loot Crate was all about Fantasy! To that effect, April's box included items from ...On May 6, 2015 / By Chloe Becquet
Well, high school in the '90s was kind of like Game of Thrones, in its own way. You had cliques fighting each other for control of the quad, ...On April 16, 2015 / By Chance Kinney
Good ol' Etsy. On an Internet full of sites tripping over themselves to be the best at being the same as everyone else, Etsy has remained a weird ...On March 26, 2015 / By Chip Chick Staff
It's a whole circle of inspiration, and it's a beautiful thing. Hadrian's Wall in northern England, the wall the Romans built in the early AD years to maybe ...On February 9, 2015 / By Chip Chick Staff
Actually, it depends on what kind of fan you are. Just like the show? Congrats! Only good news for you today. Prefer to read all the carnage instead? ...On February 2, 2015 / By Chance Kinney
Odds are spectacularly good that in any given Game of Thrones episode, a character you like is going to die. Death is a sure thing in Westeros (and ...On March 19, 2014 / By Chance Kinney
We're about three weeks out from the start of the fourth season of Game of Thrones, and you know there will be viewing parties. So, make sure you're ...On March 14, 2014 / By Chip Chick Staff
SXSW is literally a feast for your eyes – and liver, but one of the many highlights of this adrenaline rushing festival this year was Game of Thrones: ...On March 13, 2014 / By Ali Heriyanto
The rightful heir to the Iron Throne of the box-set world officially arrives in November. You can now pre-order the Game of Thrones Season One Blu-ray box set, ...On August 3, 2012 / By Chance Kinney
Game of Thrones Season 2 might have just come to an end, but that doesn't you mean you can't still claim the throne. If you are a fan ...On June 5, 2012 / By Ali Heriyanto
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text:
Journal of The American Society for Mass Spectrometry
, Volume 22, Issue 4, pp 718-730
First online:
Sequence Elucidation of an Unknown Cyclic Peptide of High Doping Potential by ETD and CID Tandem Mass Spectrometry
- Fuyu GuanAffiliated withSchool of Veterinary Medicine, University of Pennsylvania
- , Cornelius E. UbohAffiliated withSchool of Veterinary Medicine, University of PennsylvaniaPA Equine Toxicology and Research Center, West Chester University Email author
- , Lawrence R. SomaAffiliated withSchool of Veterinary Medicine, University of Pennsylvania
- , Jeffrey RudyAffiliated withPA Equine Toxicology and Research Center, West Chester University
Identification of an unknown substance without any information remains a daunting challenge despite advances in chemistry and mass spectrometry. However, an unknown cyclic peptide in a sample with very limited volume seized at a Pennsylvania racetrack has been successfully identified. The unknown sample was determined by accurate mass measurements to contain a small unknown peptide as the major component. Collision-induced dissociation (CID) of the unknown peptide revealed the presence of Lys (not Gln, by accurate mass), Phe, and Arg residues, and absence of any y-type product ion. The latter, together with the tryptic digestion results of the unusual deamidation and absence of any tryptic cleavage, suggests a cyclic structure for the peptide. Electron-transfer dissociation (ETD) of the unknown peptide indicated the presence of Gln (not Lys, by the unusual deamidation), Phe, and Arg residues and their connectivity. After all the results were pieced together, a cyclic tetrapeptide, cyclo[Arg-Lys-N(C6H9)Gln-Phe], is proposed for the unknown peptide. Observations of different amino acid residues from CID and ETD experiments for the peptide were interpreted by a fragmentation pathway proposed, as was preferential CID loss of a Lys residue from the peptide. ETD was used for the first time in sequencing of a cyclic peptide; product ions resulting from ETD of the peptide identified were categorized into two types and named pseudo-b and pseudo-z ions that are important for sequencing of cyclic peptides. The ETD product ions were interpreted by fragmentation pathways proposed. Additionally, multi-stage CID mass spectrometry cannot provide complete sequence information for cyclic peptides containing adjacent Arg and Lys residues. The identified cyclic peptide has not been documented in the literature, its pharmacological effects are unknown, but it might be a "designer" drug with athletic performance-enhancing effects.
Key wordsUnknown cyclic peptide Unknown sample Doping analysis Equine drug testing Electron transfer dissociation Collision-induced dissociatin Accurate mass Multiple stage CID
Reference tools
- Title
- Sequence Elucidation of an Unknown Cyclic Peptide of High Doping Potential by ETD and CID Tandem Mass Spectrometry
- Journal
Journal of The American Society for Mass Spectrometry
Volume 22, Issue 4 , pp 718-730
- Cover Date
- 2011-04
- 10.1007/s13361-011-0080-5
- Print ISSN
- 1044-0305
- Online ISSN
- 1879-1123
- Publisher
- Springer-Verlag
- Additional Links
- Topics
- Keywords
- Unknown cyclic peptide
- Unknown sample
- Doping analysis
- Equine drug testing
- Electron transfer dissociation
- Collision-induced dissociatin
- Accurate mass
- Multiple stage CID
- Industry Sectors
- Authors
- Fuyu Guan (1)
- Cornelius E. Uboh (1) (2)
- Lawrence R. Soma (1)
- Jeffrey Rudy (2)
- Author Affiliations
- 1. School of Veterinary Medicine, University of Pennsylvania, New Bolton Center Campus, 382 West Street Road, Kennett Square, PA, 19348, USA
- 2. PA Equine Toxicology and Research Center, West Chester University, 220 East Rosedale Ave., West Chester, PA, 19382, USA