Kenneth J. Gruber

Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants

Background:Necrotizing enterocolitis (NEC) is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. Human milk (HM) feeding has been associated with lower risk of NEC. However, mothers of VLBW infants often experience insufficient milk production, resulting in mixed feedings of HM and formula. Moreover, medical complications often limit the volume of feeding they can be given.Objective:To determine if high proportions of (50% or greater) HM enteral feeding within the first 14 days of life are protective against NEC.Method:This was a prospective cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days: <50% (low human milk, LHM, n=46) and ⩾50% (high human milk, HHM, n=156). The outcome of interest was development of NEC (Bell stage 2 or 3). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) and to assess potential confounding due to perinatal risk factors.Result:Two hundred and two infants were studied. Confirmed NEC occurred in 5/46 (10.6%) of the LHM group, as compared with 5/156 (3.2%) of the HHM. Gestational age was the only perinatal factor associated with risk of NEC. After adjustment for gestational age, HHM was associated with a lower risk of NEC ((OR=0.17, 95% CI: 0.04 to 0.68), P=0.01).Conclusion:Enteral feeding containing at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC.

Human Milk Consumption and Full Enteral Feeding Among Infants Who Weigh ≤1250 Grams

OBJECTIVE. Establishing enteral feeding is an important goal in the care of very low birth weight infants. In such infants, receipt of ≥50 mL/kg per day human milk during hospitalization has been associated with shorter time to full enteral feeding. The objective of this study was to determine whether high proportions (≥50%) of human milk during feeding advancement are associated with shorter time to full enteral feeding and improved feeding tolerance. METHODS. This was a prospective cohort study of very low birth weight infants (n = 127) who were grouped into low (<50%; n = 34) and high (≥50%; n = 93) human milk consumption groups according to their human milk proportion of enteral feeding during the time of feeding advancement. The primary outcomes of interest were ages at which 100 and 150 mL/kg per day enteral feedings were achieved. RESULTS. The high human milk group reached 100 mL/kg per day enteral feeding 4.5 days faster than the low human milk group. The high human milk group reached 150 mL/kg per day enteral feeding 5 days faster than the low human milk group. After adjustment for gestational age, gender, and respiratory distress syndrome, times to reach 100 and 150 mL/kg per day were significantly shorter for those in the high human milk group. Infants in the high human milk group had a greater number of stools per day; other indicators of feeding tolerance were not statistically different. CONCLUSION. In infants who weighed ≤1250 g, enteral feeding that contained at least 50% maternal human milk was associated with fewer days to full enteral feedings.

A family perspective for substance abuse: Implications from the literature.

SUMMARY This paper calls for researchers and treatment providers to increase their recognition of the role that family and family functioning has for understanding the incidence and impact of substance abuse. Substance abuse is identified as a family problem by exploring its occurrence within families as well as its impact on marital relationship, family violence, and child abuse and neglect. The impact of substance abuse on the roles of spouses and parents are examined, as is the impact of substance abuse on children at various developmental stages. The role of the family as participant in active substance abuse as well as a valuable treatment resource is also explored. Finally, the authors present recommendations for increasing the focus on family in substance abuse research.

Gender differences in the perceptions of self's and others' use of power strategies.

The utility of P. B. Johnsons [“Women and Interpersonal Power,” in D. N. Ruble & G. L. Zellman (Eds.), Women and Sex Roles, New York: W. W. Norton, 1978] framework for the sex typing of power strategies was examined. Female and male subjects rated the extent to which they used a number of power strategies in order to get their way with others. Subjects also rated their perceptions of the extent to which either men-in-general or women-in-general used the strategies. Partial support for Johnsons framework was found in that males reported greater use of “masculine”-typed strategies than did females, though they did not report using these strategies more than “feminine”-typed ones. Females did not report significantly greater use of feminine strategies than did males, though they reported using more feminine- than masculine-typed strategies. Data also indicated that both males and females held similar gender-consistent sex-stereotyped perceptions of the power strategies used by men-in-general and women-in-general. Comparison of self-report ratings with usage attributions for men-in-general and women-in-general revealed that both male and female subjects perceived themselves to use most of the strategies less often and to be more inclined to use socially desirable strategies involving reason and logic and compromise.

Positive and Negative Affect and Health Functioning Indicators among Older Adults with Chronic Illnesses

Emotional states have been linked with physical and mental health outcomes. In this study the role of positive and negative affect was investigated as determinants of health functioning for a community-dwelling sample of 153 older adults (age 60 or older) with chronic illnesses. High positive affect and low negative affect were found to be associated with lower levels of symptom distress, fewer depressive symptoms, higher daily activity scores, and higher perceived physical and mental health-related quality of life. These results have important clinical implications for the use of positive and negative affect as an indicator of life functioning among older adults. The relationship of positive and negative affect to reported health functioning found in this study suggests that measuring affect can provide a valuable means for understanding how individuals view their mental health as well as their symptoms of illness.

Maternal and infant characteristics associated with human milk feeding in very low birth weight infants.

This study identified maternal and infant characteristics predicting human milk (HM) feeding in very low birth weight (VLBW) infants whose mothers (n = 184) participated in a study of lactation counseling and initiated milk expression. Data were collected prospectively, by maternal interview and medical record review. During hospitalization, 159 (86%) infants received at least 50% HM proportion of feedings in the first 2 weeks of life, and 114 (62%) received some HM until the day of hospital discharge. Analysis showed plan to breastfeed was the strongest predictor of initiation and duration of HM feeding. Greater than 12 years of education, respiratory distress syndrome, Apgar score >6, and female gender were significant predictors, and no perinatal hypertensive disorder, white race, and mechanical ventilation were marginal predictors of HM feeding. Women with a high-risk pregnancy should be provided education about the benefits of breastfeeding for infants who are likely to be born prematurely. J Hum Lact. 25(4):412-419.

Sex differences in listening comprehension.

In order to examine the effect of sex of the speaker on listening comprehension in a public speaking situation, 60 male and 60 female subjects viewed either a male or female speaker presenting a talk on either a masculine (chess), feminine (interior decorating), or neutral (snow skiiing) topic. The results supported the hypotheses that when a male speaks he is listened to more carefully than a female speaker, even when she makes the identical presentation. No differences were found when the topic was biased towards one sex; males were still recalled better than females. The above relationships were also true for male and female subjects; both recalled information more accurately from male speakers than from female ones. Rating of informativeness of the presentation showed no difference for sex of the speaker; but effectiveness ratings of the speaker indicated that while both male and female subjects rated male speakers equally effective, the same was not true for the female speakers. Male subjects rated the female speakers significantly more effective than they did male speakers, whereas female subjects rated male and female speakers equally effective.

Impact of Doulas on Healthy Birth Outcomes

Birth outcomes of two groups of socially disadvantaged mothers at risk for adverse birth outcomes, one receiving prebirth assistance from a certified doula and the other representing a sample of birthing mothers who elected to not work with a doula, were compared. All of the mothers were participants in a prenatal health and childbirth education program. Expectant mothers matched with a doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.

Psychometric properties of the Chinese version of the SF-36 in older adults with diabetes in Beijing, China.

OBJECTIVE This study investigated the psychometric properties of the 36-item Short-Form Health Survey (SF-36) (China version) in older Chinese with diabetes living in Beijing, China. METHODS The SF-36 was administered to community-based sample of 182 older adults with diabetes living in Beijing. Data collection was conducted in face-to-face interviews. Reliability and validity were assessed using internal consistency, convergent and discriminant analyses. Exploratory principal components analyses (PCA) were conducted to compare the samples response patterns with the hypothesized scale constructs. RESULTS Item level validation of the scale supported the assumptions of the hypothesized structure. Internal consistency reliability (Cronbachs alpha >.70) of the subscales were acceptable except for the General Health subscale (.67). PCA confirmed general support of the two hypothesized dimensional factors and eight concepts (factors). The physical component summary (PCS) and the mental component summary (MCS) explained 62.26% of the variance and the eight factors components explained 67.39% of the variance. Known-group comparisons of scale scores indicated significantly higher levels of functionality for respondents with no blood pressure, heart, or depressive symptomatology problems. CONCLUSIONS The Chinese version of the SF-36 showed good reliability and validity and was culturally equivalent. The scale is appropriate for use with older Chinese adults with diabetes.

Diabetes knowledge among older adults with diabetes in Beijing, China.

AIMS AND OBJECTIVES To explore the relationships of demographic and clinical variables and attendance at diabetes educational programmes with diabetes knowledge among a community sample of older Chinese adults with type 2 diabetes residing in Beijing. BACKGROUND Knowledge of diabetes is an important component of diabetes self-management. Level of education, duration of diabetes, visits to a dietician and diabetes self-management are associated with diabetes knowledge. A few studies have examined these relationships in older Chinese with diabetes. DESIGN A descriptive correlational study. METHODS The study was conducted in face-to-face interviews with 108 older adults with type 2 diabetes and an average age of 68 (SD = 8·41) years residing in six residential apartment complexes in Beijing. Along with the assessment of diabetes knowledge and diabetes self-management, assessments of glucose, blood pressure, body mass index (BMI) and waist circumference were obtained. RESULTS Age and systolic blood pressure were negatively associated with diabetes knowledge. Diabetes knowledge was not related to diabetes self-care activities or glucose level. A regression model with age, education and clinical variables significantly predicted diabetes knowledge, explaining 29% of the variance in knowledge. Participants who had a family history of diabetes, visited traditional Chinese medicine (TCM) doctors and ophthalmologists and attended diabetes educational programmes were more likely to have high scores on diabetes knowledge. CONCLUSIONS Age, education, a family history of diabetes, visits to TCM providers and ophthalmologists and attending diabetes class are factors associated with increased levels of diabetes knowledge. RELEVANCE TO CLINICAL PRACTICE Healthcare providers need to provide age-specific, low literacy and family-focused diabetes education programmes and consider integrating principles and holistic perspectives of TCM in diabetes educational programmes for older Chinese with diabetes.