Associations between perceived value of exclusive breastfeeding among pregnant women in the United States and exclusive breastfeeding to three and six months postpartum: a prospective study.

BACKGROUND: Successful breastfeeding often starts with prenatally established intention. Yet, few mothers with the intention to exclusively breastfeed achieve their intended breastfeeding duration goal. This study examined the degree to which having a strong value of exclusive breastfeeding is associated with exclusive breastfeeding duration for at least 3 and 6 months postpartum among women who reported prenatal intention to exclusively breastfeed. METHODS: Data were from the Infant Feeding Practices Study II, a longitudinal US national survey that followed maternal-infant dyads from pregnancy to 1 year postpartum. Bivariate and multivariate regression examined the degree to which strong maternal value of exclusive breastfeeding predicted exclusive breastfeeding duration. RESULTS: Of the 1799 women who prenatally intended to exclusively breastfeed within the first few weeks postpartum, 34 and 9 % exclusively breastfed for at least 3 months and 6 months, respectively. Thirty-six percent of women reported strongly valuing exclusive breastfeeding out of which 46 % exclusively breastfeed to three months. In adjusted results, women who reported that they strongly value exclusive breastfeeding had more than twice the odds of exclusive breastfeeding for at least 3 months (Adjusted Odds Ratio [AOR] 2.29; 95 % confidence interval [CI] 1.84, 2.85) and for 6 months (AOR 2.49; 95 % CI 1.76, 3.53) compared to those who did not strongly value exclusive breastfeeding. CONCLUSION: Valuing the benefits of exclusive breastfeeding during pregnancy is a strong independent predictor of actual exclusive breastfeeding duration. A minority of pregnant women strongly value exclusive breastfeeding and are able to exclusively breastfeed to 3 months even among women with established prenatal intention to exclusively breastfeed. Prenatal maternal education and environmental lactation support that extends into the postnatal period can promote longer duration of exclusive breastfeeding.

Factors influencincing discharge against medical advice among paediatric patients in Abakaliki, Southeastern Nigeria.

Discharge against medical advice (DAMA) has become a major problem in health care delivery in Nigeria. Children are the victims because most of the times they are not the one taking the decision, and may not understand or contribute to it. This retrospective study was undertaken to identify the factors that influence DAMA among paediatric patients in Ebonyi State University Teaching Hospital, Abakaliki in southeastern Nigeria, with a view at curbing it. There were 97 cases of DAMA out of a total admission of 6505 giving a prevalence rate of 1.5%. Infants constituted 52.2% of them, of which 37.8% were neonates. Majority (96.7%) were from lower social classes residing in rural villages (61.1%).Neonatal conditions (36.7%) were the most common condition for which DAMA was sought, followed by severe malaria (22.2%) and road traffic accident with fractures (12.2%). The common reasons given for DAMA were financial constraint (33.3%), resort to native treatment (25%) and hopelessness of the disease condition (15%). DAMA at the study site is closely asssociated with parental poverty and ignorance. Neonates and older children with surgical conditions are the most vulnerable group. Policies should be targeted at protecting these groups.

Postmortem grading of cerebral contusions : A proposed modification of the adams' contusion index with re-definition of anatomic markers.

In the 1970s, J. H. Adams and other researchers at the Institute of Neurological Sciences, Glasgow, Scotland introduced a grading system for the quantification and analysis of contusions of the brain. They derived a brain contusion index based on regional surface distribution and parenchymal depth of contusions of the brain. Following a subsequent modification of this scheme in the 1980s, they recommended evolving modifications that will fit a variety of possible applications. Having tested the applicability of this grading system for the forensic/medico-legal autopsy, we have encountered some applied anatomic limitations and have derived a modification that addresses these limitations in reference to the forensic/medico-legal autopsy.We recommend a two-tier system based on the Adams' system, which quantifies contusions of the brain by the gyral spread of contusions and by the parenchymal depth of penetration of contusions with a re-definition of the lobar distinctions and classifications of the brain. Gyral spread is assigned a grading scheme of 0-3 and the parenchymal depth of contusions is assigned a grading scheme of 0-4. A lobar contusion score is derived by multiplying the two assigned grades. A total brain contusion index is derived by summating all the lobar contusion scores. This reproducible grading system can be applied to routine bench forensic neuropathology reporting, court room illustrations and in comparative research analysis of brain trauma subjects.

Forensic pathology and forensic epidemiology of suicides in allegheny county, pennsylvania : A 10-year retrospective review (1990-1999).

Suicide has assumed epidemic proportions and constitutes a major public health issue throughout the United States. Suicide remains one of the top eight leading causes of death, accounting for approximately 30,000 deaths annually. The understanding and prevention of suicide requires a multidisciplinary approach that involves psychosocial and medical specialties starting with a forensic analysis of the characteristics of suicide. The aim of this 10-year (1990-1999) retrospective study was threefold: first, to examine the forensic epidemiological characteristics of suicides examined by the Allegheny County Coroner's Office; second, to describe emerging epidemiological patterns of suicide; and finally, to make recommendations for preventive measures. A total of 1447 suicides were identified, with 1164 males (80%) and 283 females (20%) resulting in a male to female ratio of 4:1. The race distribution comprised 90% whites, 9% blacks, and 1% other races. The age of suicide victims ranged from 13 to 96 years old with a peak within the 31- to 40-year-old age group, which represented 24.5% of all suicides. Overall, 40% of the victims were single and more blacks than whites were single. The greatest number of suicides occurred in July, with the least in December. Suicides most frequently occurred between 9:01 AM and 3:00 PM. Suicide notes were present in 29% of all suicides. Firearm injuries, hanging, and drug overdose were the leading methods of suicide. Use of firearms was the leading method of suicide among both sexes. Female drug overdose deaths outnumbered male drug overdose deaths. The 10 most common overdose drugs were all central nervous system depressants, with amitriptyline being the most common prescription overdose drug. Based on reported antecedent trends in suicides, we make two recommendations regarding suicide prevention: (1) physicians should be educated to replace the prescription of older and more toxic antidepressants such as amitriptyline with newer and less toxic antidepressants such as serotonin reuptake inhibitors; and (2) firearms should be made inaccessible to individuals with risk factors for suicide, especially in the home.