Elinor A. Graham

Cultural Influences on Infant Feeding Practices

1. Suzinne Pak-Gorstein, MD, PhD, MPH* 2. Aliya Haq, MS, RD† 3. Elinor A. Graham, MD, MPH* 1. *Harborview Medical Center, Department of Pediatrics, University of Washington, Seattle, Wash 2. †Harborview Medical Center, Children and Teens Clinic, and Women, Infant, and Children Nutrition Program, Seattle, Wash After completing this article, readers should be able to: 1. Provide examples of specific cultural beliefs and traditions that affect infant feeding practices. 2. Describe the influence of acculturation in the United States (US) on infant feeding practices among immigrant mothers. 3. Recognize the problem of infant overfeeding among particular groups. 4. Outline a culturally sensitive approach to elicit personal and cultural beliefs regarding infant feeding and to provide effective infant feeding counseling for mothers from different cultural backgrounds. “… all different cultures, whether in a tropical village or in a highly urbanized and technologically sophisticated community, contain some practices and customs which are beneficial to the health and nutrition of the group, and some which are harmful. No culture has a monopoly on wisdom or absurdity.” Jellife D . Child Nutrition in Developing Countries: A Handbook for Fieldworkers. Washington, DC: United States Public Health Service; 1968 Healthy infant feeding practices, including exclusive breastfeeding and delayed introduction of complementary foods, are promoted by health clinicians as well as by numerous national and international organizations. However, mothers base their infant feeding decisions on an array of factors, including their experiences, family demands, socioeconomic circumstances, and cultural beliefs. As the number of children from immigrant families in the US increases, more pediatric clinicians are working not only with families of color who have a long heritage of living in the US spanning many generations, but also with families new to the US whose cultural backgrounds are markedly different from their own. Health professionals are faced with a growing challenge to appreciate the cultural beliefs influencing infant feeding practices for both recent immigrants as well as for resident US ethnic groups. Discussions regarding infant feeding often are the initial interaction between clinician and mother and, as such, are important in building a foundation of trust and rapport …

Elevated zinc protoporphyrin associated with thalassemia trait and hemoglobin E

OBJECTIVE Increased zinc protoporphyrin/heme (ZPP/H) ratio has been used in pediatrics to screen for iron deficiency and lead poisoning. This study was conducted to determine whether common hereditary hemoglobin disorders (alpha- and beta-thalassemia traits, hemoglobin E) found in U.S. minority groups are associated with an increase in the ZPP/H ratio in an iron-sufficient population. METHODS The database was compiled from hemoglobinopathy screens performed between 1987 and 1993 at a regional referral laboratory in Washington State. ZPP/H ratio and hemoglobin type were obtained for 326 subjects between the ages of 15 and 49 years of age who were iron sufficient (serum ferritin levels > or = 50 micrograms/L). RESULTS The mean ZPP/H ratio was significantly higher (p < 0.01) for subjects with beta-thalassemia trait (87 +/- 32 micromol/mol), (alpha-thalassemia trait (73 +/- 37 micromol/mol), and hemoglobin E disorders (73 +/- 24 micromol/mol) than for subjects with normal hemoglobin values (60 +/- 8 micromol/mol). Fifty-one percent of subjects with beta-thalassemia trait, 22% with hemoglobin E, and 20% with alpha-thalassemia trait had elevated ZPP/H ratios (> 80 micromol/mol), compared with only 1.5% with normal hemoglobin values. CONCLUSIONS The ZPP/H ratio is elevated in common hereditary hemoglobin disorders that mimic the microcytic anemia of iron deficiency, even in individuals without associated nutritional iron deficiency. For children who are treated for presumed iron deficiency, failure of the ZPP/H ratio to return to normal after adequate iron treatment, especially if microcytosis persists, indicates that a hereditary hemoglobin disorder may be present.

A Successful US Academic Collaborative Supporting Medical Education in a Postconflict Setting.

This article describes a model employed by the Academic Collaborative to Support Medical Education in Liberia to augment medical education in a postconflict setting where the health and educational structures and funding are very limited. We effectively utilized a cohort of visiting US pediatric faculty and trainees for short-term but recurrent clinical work and teaching. This model allows US academic medical centers, especially those with smaller residency programs, to provide global health experiences for faculty and trainees while contributing to the strengthening of medical education in the host country. Those involved can work toward a goal of sustainable training with a strengthened host country specialty education system. Partnerships such as ours evolve over time and succeed by meeting the needs of the host country, even during unanticipated challenges, such as the Ebola virus outbreak in West Africa.

Academic Medical Support to the Ebola Virus Disease Outbreak in Liberia

During the Ebola Virus Disease (EVD) epidemic in West Africa (2014-2016), many faculty, staff, and trainees from U.S. academic medical centers (i.e., teaching hospitals and their affiliated medical schools; AMCs) wished to contribute to the response to the outbreak, but many barriers prevented their participation. Here, the authors describe a successful long-term academic collaboration in Liberia that facilitated participation in the EVD response. This Perspective outlines the role the authors played in the response (providing equipment and training, supporting the return of medical education), the barriers they faced (logistical and financial), and elements that contributed to their success (partnering and coordinating their response with both U.S. and African institutions). There is a paucity of literature discussing the role of AMCs in disaster response, so the authors discuss the lessons learned and offer suggestions about the responsibilities that AMCs have and the roles they can play in responding to disaster situations.