David E. Bee

Acculturation and the initiation of breastfeeding

Despite the fact that breastfeeding is the most appropriate form of nutrition for the healthy term infant, the rate of initiation in the U.S. is declining. One demographic factor associated with this low rate is ethnicity and so in this study we measured acculturation (one aspect of ethnicity) into the U.S. and its relationship to the successful initiation of breastfeeding in a sample of women recruited approximately 2 months prenatally in a U.S.-Mexico border city. Interviews were administered in English or Spanish by bilingual interviewers prenatally (n = 906), natally (n = 788), and postnatally (n = 715). Acculturation (measured with a 20 item instrument) was strongly related to the intent to (p < 0.001) or the successful initiation of breastfeeding (p < 0.001). Marital status (p = 0.014) and education (p = 0.002) were related to breastfeeding prenatally and natally. Initiation of breastfeeding was highest among those women least acculturated (52.9%) and lowest in those most acculturated (36.1%) indicating an inhibiting effect of acculturation. To improve the rate of initiation of breastfeeding in the U.S. (a national health goal) intervention programs must consider cultural factors.

Acculturation and Breastfeeding on the United States–Mexico Border

Previous studies have demonstrated a strong association between breastfeeding incidence and ethnic background, indicating the presence of strong cultural influences on infant-feeding patterns within ethnic groups. This study analyzed the relationship of acculturation into the United States, one aspect of ethnicity, to the initiation of breastfeeding among a sample of 213 women recruited approximately 2 months prenatally in the United States-Mexico border city of Brownsville, Texas. An in-depth, structured interview was conducted at that time (n = 213), at the time of birth (n = 207), and 2 to 3 weeks postnatally (n = 206). In addition, male partners of the mothers were interviewed prenatally when available (n = 119). Acculturation scores and demographic characteristics were tested relative to breastfeeding initiation. The degree of acculturation, age, and marital status were associated significantly with breastfeeding initiation (with breastfeeding continued at 2 to 3 weeks postnatally), but occupational status, education, and income were not. Breastfeeding incidence was highest among older, married, or low-acculturated, Anglo mothers. These data suggest that women being assimilated into the United States are inhibited in the initiation of breastfeeding. These findings suggest that to be successful, intervention programs to increase breastfeeding incidence must consider the cultural adaptation of different groups as they meld with the larger population.

Attitudes toward breastfeeding

ABSTRACT. To understand why some lower socioeconomic status mothers delivering at a state university hospital breastfeed, while others do not, 26 attitude items were administered in a survey of 358 mothers. A factor analysis of these items yielded four interpretable factors: benefits to infant, social inconvenience, personal inconvenience, and physical inconvenience-medical benefits to child. These factors were significantly related to breastfeeding within each level of ethnicity and marital status. The results imply that emphasizing the benefits for the infant, and providing strategies for minimizing personal inconveniences, should promote breastfeeding in these populations.

Effect of protein/energy ratio on growth and behavior of premature infants: Preliminary findings

Premature infants weighing less than 1550 gm at birth were randomly assigned to receive one of three formulas identical in composition except for protein content (2.2, 2.7, and 3.2 gm.100 kcal-1) to determine the effects on growth, protein nutritional status, and behavior. Data collected for 2 weeks from the time of achieving an enteral energy intake of 100 kcal.kg-1.day-1 included measurements of weight, length, head circumference, and skin-fold thickness, and concentrations of plasma amino acids, serum total protein, prealbumin, retinol-binding protein, and urea nitrogen. In a subset of infants, behavior was assessed at the end of the feeding study with the Neonatal Behavior Assessment Scale. Except for the concentrations of plasma amino acids, there were no significant differences in growth or in other biochemical measurements among the three groups, but there were significant differences in the orientation, habituation, and stability clusters of the behavior assessment. Further, there were significant correlations between the plasma amino acid values and the behavioral clusters. These preliminary data suggest a relationship between protein intake in the neonatal period and behavioral outcome at the end of the feeding period in the absence of differences in growth and gross markers of protein nutritional status. The behavioral items noted to differ among the groups may indicate later cognitive outcome; detailed studies about behavioral responses to neonatal dietary intakes and later outcome seem indicated.

Serum concentrations of vitamin D-binding protein (Group-specific component) in cystic fibrosis

SummaryVitamin D-binding protein (DBP) concentrations were determined in the sera of 90 cystic fibrosis homozygotes, 57 obligate heterozygotes, and 46 normal controls. Very significantly lower mean concentrations were found in the sera of CF homozygotes compared with both heterozygotes and controls (P<0.01, Wilcoxon Rank Sums Test). Subdivision of the samples by Gc phenotype showed that this relationship held true both in the Gc1 and Gc2-1 phenotypes. The small sample size of the Gc2 genotype makes the significance levels of limited usefulness, but the pattern of variation of DBP levels among CF homozygotes, heterozygotes, and controls was consistent with that observed for the Gc1 and Gc2-1 classes. Haptoglobin levels showed high coefficients of variation when compared among CF homozygotes, obligate heterozygotes, and controls, presumably because of nonspecific elevation in the acute-phase response. Alpha2-macroglobulin levels were, if anything, slightly elevated in CF homozygotes compared with controls, while albumin levels showed no significant mean differences between these groups. Since the DBP concentration does not vary with age nor with levels of vitamin D and its metabolites, we interpret our results to mean that DBP levels are specifically decreased in cystic fibrosis, perhaps as the result of impaired glycosylation of the protein.

Variations in the proportion of abnormal cells and required sample sizes for human cytogenetic studies

Abstract A study of cytogenetic aberration rates in human beings was conducted (1) to determine the magnitude of variation in one index of aberration, that of the proportion of abnormal cells, and (2) to estimate the number of subjects and the number of cells per subject needed to detect significant increases of predetermined size over a control value with a type I error of α = 0.05 and typeII errors of β = 0.20 or 0.10. The index of interest, the proportion of abnormal cells, was defined as the ratio of cells with at least one aberration to all cells scored. The study subjects were 239 persons seen for preemployment evaluation at a division of a large U.S. chemical company. 200 cells were scored on each subject. The proportion of abnormal cells for this groups was 0.022. The variance among subjects was found to be significantly larger than the variance with subjects ( p Several combinations of sample size requirements were calculated for the purpose of determining the most reasonable number of subjects per group and cells per subject. The detection of relatively small increases over a control value requires either more subjects or more cells per subject, and from the point of view of the costs associated with the scoring of cells, greater savings will be accomplished in most cases by increasing the number of subjects, rather than increasing only the number of cells per subject.

An In Vitro Evaluation of Ionized Calcium Levels and Clotting in Red Blood Cells Diluted With Lactated Ringer's Solution

The addition of lactated Ringers solution which contains calcium (RL) to citrated blood products poses a potential risk whenever the level of ionized calcium reaches a concentration capable of catalyzing the coagulation cascade. RL solution is used extensively as both a replacement and a maintenance fluid in the operating room. However, major surgical procedures often require replacement of blood components as well, during the operation. This study examines the in vitro propensity for coagulation when red blood cells (RBC) are diluted with RL. Seven mixtures with different ratios of RBC to RL were prepared from each of 23 units of RBC. These mixtures were analyzed for ionized calcium, total calcium, and pH, and were checked for any indication of coagulation. Nineteen additional RBC units were split into two parts which were mixed with equal volumes of normal saline (NS) or RL. These mixtures were filtered (40 micron) and the weight gain of the paired filters compared. From these studies, the authors identified a threshold value for ionized calcium (0.23 mM/L) below which the probability of clot formation is less than 0.01. This concentration is not reached if the RBC to RL volume ratio is 2:1 or greater. As much as 100 ml of RL can be added to a unit of RBC without exceeding the threshold value. Although not advocating the routine use of RL as a diluent for RBC, the authors conclude that, within the guidelines described, calcium containing salt solutions may be used to dilute blood products.

Comparability of the WISC and the WISC-R in Normal Children of Divergent Socioeconomic Backgrounds.

WISC and WISC-R IQs of two groups of normal ten-year-old children from divergent socioeconomic backgrounds (N = 36) were compared in a counterbalanced research design. Generally, all WISC mean IQs were higher than the WISC-R mean IQs for both groups of children. Significantly higher WISC IQs were obtained on the Verbal and Full Scales of the low socioeconomic group and on the Performance and Full Scales of the high socioeconomic group. Correlations between tests for Verbal, Performance, and Full Scale IQs were.95,.79, and.91 for the low socioeconomic group, and.84,.57, and.87 for the high socioeconomic group. Although practice effects did not appear to significantly affect IQs of the low socioeconomic group, various practice effects were observed in the high socioeconomic group. Negative effects were observed for both WISC and WISC-R on the Verbal Scale, whereas positive effects were observed on both Performance and Full Scales in this group. Analysis of simple effects reveals that WISC and WISC-R IQs did not differ significantly upon first administration, but were significantly different upon second administration. Conclusions were drawn that while WISC-R yields a lower IQ estimate than WISC for children of lower ability, results were not so clear for the children of higher ability, due to practice effects which disproportionately favor increases on WISC IQs upon second administration. The greater practice effects found on the WISC have implications for comparisons of the two tests in counterbalanced research designs. Simple randomized or treatment-by-levels design may be more useful in comparisons of the WISC and the WISC-R because of the bias introduced by counterbalanced designs.

Expectancies of infant-feeding methods among mothers in three ethnic groups

Abstract The psychometric characteristics and construct validity of an inventory of expectancy statements about breast- and formula-feeding were assessed to refine a measure of the predictors of breastfeeding initiation and maintenance. Respondents were a tri-ethnic sample of mostly lower income mothers within two days after delivery. Ninety-six expectancy items reflecting eight hypothesized domains in expectancies of breastfeeding (BF) and formula-feeding(FF) were submitted to maximum likelihood factor analysis. Four factors were determined: “Benefits of BF,” “Relative Advantages of FF,” “Inconveniences of FF,” and “Relative Inconveniences of BF.” All factors were significantly related to actual BF of the new infant in the expected directions using unweighted factor scores in a multiple logistic regression analysis. Predicted BF closely matched actual BF for all ethnicities combined with a total error rate for misclassification of only 14%. This match was high for Anglo- and Black-American mothers. Each ...

Photodeactivation of ethyl violet: a potential hazard of Sodasorb®

Breathing circuit cannisters containing functional CO2 absorbent are critical to prevent rebreathing CO2 during general anesthesia using closed or semiclosed breathing systems. Ethyl violet is the indicator dye added to Sodasorb to indicate impending exhaustion of the absorbent. A case of CO2 rebreathing due to failure of ethyl violet indicator in exhausted Sodasorb was encountered. Laboratory investigation demonstrated that dye failure could result from photodeactivation caused by fluorescent lights. Using a fixed intensity fluorescent light source and quantitative spectrophotometric analysis, a highly significant dose-response relationship was demonstrated between duration of light exposure and the decrease in ethyl violet concentration. After 24 h of fluorescent light exposure with a received flux density of 46 nwatts/cm2 at 254 nm, the concentration of functional ethyl violet remaining in pulverized Sodasorb was 16% of the baseline value. Furthermore, using multiple light sources of various intensities, the greater the intensity of light, the more rapid the rate of decline of the ethyl violet concentration. It is recommended to minimize the problem by using ultraviolet filters and incorporating additional ethyl violet in Sodasorb. Finally, ethyl violet undergoes temporal deactivation after a Sodasorb container is opened, even if it is stored in the dark.