Human dental pulp stem cell adhesion and detachment in polycaprolactone electrospun scaffolds under direct perfusion.

Cell adhesion in three-dimensional scaffolds plays a key role in tissue development. However, stem cell behavior in electrospun scaffolds under perfusion is not fully understood. Thus, an investigation was made on the effect of flow rate and shear stress, adhesion time, and seeding density under direct perfusion in polycaprolactone electrospun scaffolds on human dental pulp stem cell detachment. Polycaprolactone scaffolds were electrospun using a solvent mixture of chloroform and methanol. The viable cell number was determined at each tested condition. Cell morphology was analyzed by confocal microscopy after various incubation times for static cell adhesion with a high seeding density. Scanning electron microscopy images were obtained before and after perfusion for the highest flow rate tested. The wall pore shear stress was calculated for all tested flow rates (0.005-3 mL/min). An inversely proportional relationship between adhesion time with cell detachment under perfusion was observed. Lower flow rates and lower seeding densities reduced the drag of cells by shear stress. However, there was an operational limit for the lowest flow rate that can be used without compromising cell viability, indicating that a flow rate of 0.05 mL/min might be more suitable for the tested cell culture in electrospun scaffolds under direct perfusion.

Animal models for cartilage repair.

Cartilage lesions still represent an unsolved problem: despite the efforts of the basic and translational research, the regeneration of this tissue is far from being reached (1-3). Articular cartilage lesions can be divided in two main groups: superficial or partial defects and full-thickness defects (4, 5). Partial lesions are not able to self-heal because multipotent cells from the bone marrow cannot reach the area leading to a progressive degeneration of the tissue (6). Conversely, full-thickness injuries possess greater chances to heal because subchondral bone involvement allows for the migration of mesenchymal cells, which fill the damaged area (7, 8). However, healing occurs through the formation of a fibrocartilaginous tissue, which has different biomechanical and biological properties (9). Native hyaline cartilage has indeed specific biomechanical properties, which confer resistance to compressive and shear stresses; the reparative fibrocartilaginous tissue lacks these abilities, therefore, the surrounding healthy cartilage progressively degenerates. In the past years, several therapeutic strategies have been developed to restore the damaged cartilage, bone marrow stimulation (chondroabrasion, drilling, micro- or nano-fractures) and more recently, tissue engineering approaches (10-14). Some of these latter procedures have already been applied in clinical practice such as matrix-induced autologous chondrocyte implantation (MACI) (15) or osteochondral scaffold implantation (16). Generally, tissue engineering approaches are based on the combination of three main elements: cells (i.e. primary chondrocytes or multipotent mesenchymal cells), biocompatible scaffolds (i.e. polymers, composites, ceramics) and signaling molecules (i.e. growth factors). Moreover, several culture conditions (i.e. static or dynamic cultures) and biomechanical stimuli can be applied during the in vitro culture to promote tissue maturation (17-19). However, an in vivo culture is mandatory to validate a new engineered construct as the in vitro phase lacks the essential in vivo environmental stimuli and because the in vivo culture allows for the testing of the biocompatibility and safety of a new material (18, 19). Moreover, preclinical animal models are crucial to understand the molecular mechanisms of cartilage lesions favoring the development of new regenerative strategies (20, 21). in vivo studies on animal models should focus on the analysis of the cellular component, analyzing the maintenance of the cellular phenotype and the tumorigenicity; on the evaluation of the biocompatibility, toxicity and degradation of the biomaterial and on the assessment of the engineered construct. In this manuscript, we will review the most common preclinical animal models, which are used to understand cartilage biology and therefore to develop new tissue engineering strategies. We will focus on both small and large animal models highlighting their peculiarities, advantages and drawbacks.

Characterization of different in vitro culture conditions to induce a fibro-chondrogenic differentiation of swine adipose-derived stem cells.

Meniscus repair is still a challenge for orthopaedic surgeons as this tissue has a scarce healing potential due to the limited vascularization and to the lack of progenitor cells. Lately, several tissue engineering strategies combining cells and scaffolds have been developed. Adipose-derived stem cells (ASCs) represent a novel cell source for meniscus repair as they are easy to harvest, and they possess an intrinsic chondrogenic potential. The aim of our study was to analyze and compare the chondrogenic differentiation of swine ASCs cultured in vitro with different supplemented media. We isolated ASCs from swine adipose tissue and we placed in pellet cultures supplemented with either Bone Morphogenetic Protein (BMP)-2 and Transforming Growth Factor (TGF)-ß3 or with Bone Morphogenetic Protein (BMP)-7 and Transforming Growth Factor (TGF)-ß1. Samples were analyzed after 7, 14 or 21 days of culture by biochemical, histological and gene expression analysis. Our preliminary results show that BMP-2 and TGF-ß3 are stronger inducers of chondrogenesis.

Histological changes of the meniscus following an osteochondral lesion.

In the last few years, different tissue engineering strategies have been developed for the repair of osteochondral lesions. When the osteochondral scaffold is implanted on the femoral condyle, the meniscus might be affected by the implant and might undergo a progressive degeneration. The aim of our study is to analyze the morphological changes of the meniscus following an osteochondral lesion and the implant of a biphasic scaffold. A critical osteochondral defect was generated in the medial femoral condyle of mature sheep. Three defects were left untreated, the remaining lesions were divided into three groups and treated with a biphasic substituted formed by collagen type I and Wollastonite or Wollastonite/Hydroxyapatite. Animals were sacrificed after 6 months and menisci were isolated and analyzed by arthro-CT, macroscopic evaluation and histology. The results demonstrated that the osteochondral lesion negatively affects meniscus morphology and that the osteochondral substitute only partially mitigates the meniscus degeneration.

The meniscus vascularization: the direct correlation with tissue composition for tissue engineering purposes.

Meniscal lesions still represent an unsolved problem in clinical practice. Like the articular cartilage, meniscus has a scarce healing potential. Thus, when this tissue is damaged, the joint biomechanics is completely altered, leading to the development and progression of premature osteoarthritis. Therefore, in the last years, several tissue-engineering strategies have been developed to regenerate the meniscus with debated results. The comprehension of complex processes underlying meniscus maturation and structure is essential for a correct approach for the generation of a biomimetic meniscal substitute. In this chapter, we will first review the morphology of the meniscus during growth, focusing on the unique pattern of vascularization, and then we will discuss the most common tissue engineering strategies for meniscus repair.

Comparison of three novel biphasic scaffolds for one-stage treatment of osteochondral defects in a sheep model.

In the last years, several tissue engineering techniques have been applied to develop different kinds of osteochondral substitutes to overcome the scarce reparative properties of this tissue. The aim of this study was to generate and compare three biphasic scaffolds in an osteochondral lesion in a large-animal model. A critical osteochondral defect was generated in the medial femoral condyle of 18 skeletally mature sheep. Three defects were left untreated, the remaining lesions were divided into three groups: 5 lesions were treated with a biphasic scaffold made of collagen type I and small cylinders of Magnesium Hydroxyapatite; 5 lesions were treated with a biphasic substituted formed by collagen type I and Wollastonite, 5 lesions were treated with a scaffold made of collagen type I and small cylinders of Wollastonite/Hydroxyapatite. Animals were sacrificed after 3 months and samples were analyzed by CT and MRI, macroscopic evaluation and histology. Our study demonstrated that one of these novel biphasic scaffolds possesses the potential for being applied for one-stage procedures for osteochondral defects.

PGRMC1 participates in late events of bovine granulosa cells mitosis and oocyte meiosis.

Progesterone Receptor Membrane Component 1 (PGRMC1) is expressed in both oocyte and ovarian somatic cells, where it is found in multiple cellular sub-compartments including the mitotic spindle apparatus. PGRMC1 localization in the maturing bovine oocytes mirrors its localization in mitotic cells, suggesting a possible common action in mitosis and meiosis. To test the hypothesis that altering PGRMC1 activity leads to similar defects in mitosis and meiosis, PGRMC1 function was perturbed in cultured bovine granulosa cells (bGC) and maturing oocytes and the effect on mitotic and meiotic progression assessed. RNA interference-mediated PGRMC1 silencing in bGC significantly reduced cell proliferation, with a concomitant increase in the percentage of cells arrested at G2/M phase, which is consistent with an arrested or prolonged M-phase. This observation was confirmed by time-lapse imaging that revealed defects in late karyokinesis. In agreement with a role during late mitotic events, a direct interaction between PGRMC1 and Aurora Kinase B (AURKB) was observed in the central spindle at of dividing cells. Similarly, treatment with the PGRMC1 inhibitor AG205 or PGRMC1 silencing in the oocyte impaired completion of meiosis I. Specifically the ability of the oocyte to extrude the first polar body was significantly impaired while meiotic figures aberration and chromatin scattering within the ooplasm increased. Finally, analysis of PGRMC1 and AURKB localization in AG205-treated oocytes confirmed an altered localization of both proteins when meiotic errors occur. The present findings demonstrate that PGRMC1 participates in late events of both mammalian mitosis and oocyte meiosis, consistent with PGRMC1's localization at the mid-zone and mid-body of the mitotic and meiotic spindle.

Chromatin remodelling and histone m RNA accumulation in bovine germinal vesicle oocytes.

Major remodelling of the chromatin enclosed within the germinal vesicle occurs towards the end of oocyte growth in mammals, but the mechanisms involved in this process are not completely understood. In bovine, four distinct stages of chromatin compaction-ranging from a diffused state (GV0) to a fully compacted configuration (GV3)-are linked to the gradual acquisition of developmental potential. To better understand the molecular events and to identify mRNA modulations occurring in the oocyte during the GV0-to-GV3 transition, transcriptomic analysis was performed with the EmbryoGENE microarray platform. The mRNA abundance of several genes decreased as chromatin compaction increased, which correlates with progressive transcriptional silencing that is characteristic of the end of oocyte growth. On the other hand, the abundance of some transcripts increased during the same period, particularly several histone gene transcripts from the H2A, H2B, H3, H4, and linker H1 family. In silico analysis predicted RNA-protein interactions between specific histone transcripts and the bovine stem-loop binding protein 2 (SLBP2), which helps regulate the translation of histone mRNA during oogenesis. These results suggest that some histone-encoding transcripts are actively stored, possibly to sustain the needs of the embryo before genome activation. This dataset offers a unique opportunity to survey which histone mRNAs are needed to complete chromatin compaction during oocyte maturation and which are stockpiled for the first three cell cycles following fertilization.

Large-scale chromatin morpho-functional changes during mammalian oocyte growth and differentiation.

Mammalian oocyte development is characterized by impressive changes in chromatin structure and function within the germinal vesicle (GV). These changes are crucial to confer the oocyte with meiotic and developmental competencies. In cow, oocytes collected from early and middle antral follicles present four patterns of chromatin configuration, from GV0 to GV3, and its progressive condensation has been related to the achievement of developmental potential. During oogenesis, follicular cells are essential for the acquisition of meiotic and developmental competencies and communicate with the oocyte by paracrine and gap junction mediated mechanisms. We recently analyzed the role of gap junction communications (GJC) on chromatin remodeling process during the specific phase of folliculogenesis that coincides with the transcriptional silencing and sequential acquisition of meiotic and developmental capabilities. Our studies demonstrated that GJC between germinal and somatic compartments plays a fundamental role in the regulation of chromatin remodeling and transcription activities during the final oocyte differentiation, throughout cAMP dependent mechanism(s).

Effect of vitrification of feline ovarian cortex on follicular and oocyte quality and competence.

Cryopreservation of ovarian cortex has important implications in the preservation of fertility and biodiversity in animal species. Slow freezing of cat ovarian tissue resulted in the preservation of follicular morphology and in the follicular development after xenografting. Vitrification has been recently applied to ovarian tissues of different species, but no information is available on the effect of this method on feline ovarian cortex. Moreover, meiotic competence of fully grown oocytes isolated from cryopreserved tissue has not been reported. The aim of this study was to evaluate the effect of vitrification of feline ovarian cortex on follicular morphology and oocyte integrity, as well as meiotic competence. A total of 352 fragments (1.5-2 mm(3) ) were obtained from ovarian cortical tissues: 176 were vitrified and 176 were used fresh as control. Histological evaluation of fresh and vitrified fragments showed intact follicles after cryopreservation procedures with no statistically significant destructive effect from primordial to antral follicles. After IVM, oocytes collected from vitrified ovarian fragment showed a higher proportion of gametes arrested at germinal vesicle (GV) stage compared to those isolated from fresh control tissue (33.8% vs 2.9%; p < 0.001). However, oocytes isolated from vitrified tissues were able to resume meiosis, albeit at lower rate than those collected from fresh tissues (39.8% vs 85.9%; p < 0.00001). Vitrification induced changes in the organization of cytoskeletal elements (actin microfilaments and microtubules) of oocytes, but significantly only for actin network (p < 0.001). Finally, chromatin configuration within the GV was not affected by the cryopreservation procedure. Our study demonstrated that vitrification preserves the integrity of ovarian follicles and that oocytes retrieved from cryopreserved tissue maintain the capability of resuming meiosis. To our knowledge, this has not previously been reported in the cat.

Expression of progesterone receptor membrane component-1 in bovine reproductive system during estrous cycle.

Several reports suggest the participation of progesterone receptor membrane component 1 (PGRMC1) in progesterone signaling in the reproductive system. This study aimed at investigating the presence and localization of PGRMC1 in bovine ovary, oviduct and uterus, during the follicular and luteal phases of the estrous cycle. In the ovary, PGRMC1 has been detected in surface germinal epithelium, granulosa cells, theca cells and in the germinal vesicle of the oocytes at all stages of folliculogenesis. In the corpus luteum the expression of PGRMC1 was influenced by the stage of the estrous cycle. In the oviducts and in the uterus horns, PGRMC1 was immunolocalized in the luminal epithelium, in the muscle layer cells and in the endothelial cells. In the uterus, PGRMC1 was intensely localized also in the glandular endometrium. However, in the oviducts and in the uterus horns, the localization of PGRMC1 was independent on the stage of the estrous cycle and on whether evaluating the ipsilateral or the contralateral organ. In conclusion, the present immunohistochemical study showed that PGRMC1 is located in various compartments of the bovine female reproductive organs. With the exception of the corpora lutea, PGRMC1 localization showed similar pattern during different stages of the estrous cycle.

The endothelial nitric oxide synthase/nitric oxide system is involved in the defective quality of bovine oocytes from low mid-antral follicle count ovaries.

In a previous survey concerning cows of reproductive age, we demonstrated that oocytes isolated from ovaries with <10 medium antral follicles of 2 to 6 mm in diameter (low ovaries; Lo) show less developmental competence than oocytes collected from ovaries with >10 medium antral follicles (high ovaries; Hi). The aim of the present study was to evaluate whether a defective endothelial nitric oxide synthase/nitric oxide (eNOS/NO) system and vasculature in healthy medium antral follicles is likely to reduce oocyte competence from Lo ovaries. Thus, experiments were conducted to 1) immunolocalize eNOS protein during folliculogenesis; 2) quantify eNOS protein/vasculature in the follicle wall; and 3) verify if NO donor, S-nitroso acetyl penicillamine (SNAP) administration during in vitro maturation affects developmental competence of oocytes isolated from Lo ovaries. Endothelial nitric oxide synthase protein was detected in granulosa and theca cells, as well as in blood vessels from primordial to antral follicles. Quantitative analysis indicated that in medium antral follicles from Lo ovaries, eNOS protein expression and vasculature were reduced (P < 0.05). The addition of SNAP improved blastocyst and hatching rates of oocytes from Lo ovaries, promoting a percentage similar to oocytes from Hi ovaries, and reduced the percentage of apoptotic nuclei in in vitro-produced blastocysts (P < 0.05). Results from our study suggest that in bovine ovaries with small mid antral follicle number, a defective eNOS/NO system is related to a reduced follicle vasculature and may affect oocyte quality, thus inducing a premature decline of fertility.

Short-term and long-term effects of embryo culture in the surrogate sheep oviduct versus in vitro culture for different domestic species.

The culture of early embryos in the surrogate xeno-oviduct was first developed in the early 1950s to allow transport of embryos at long distances. Later, it was applied to the study of culture requirements of the early embryo especially that of bovine origin. In this article, we review the data available on the culture of in vitro-matured and in vitro-fertilized embryos of Bos taurus, Sus scrofa, Equus caballus and Ovis aries in the surrogate sheep oviduct compared with data on in vitro culture in different media. Short-term and long-term cellular and molecular effects are described mainly for the bovine species where more extensive use of this technique has been made. A comparison with in vitro culture in various conditions and species indicate that embryos cultured in the sheep oviduct have close similarities to totally in vivo-derived embryos. The data provided demonstrate that the technique of in vivo culture in the surrogate sheep oviduct is versatile and allows a high rate of embryonic development in all species examined.

Localization of DNA methyltransferase-1 during oocyte differentiation, in vitro maturation and early embryonic development in cow.

DNA methyltransferase-1 (Dnmt1) is involved in the maintenance of DNA methylation patterns and is crucial for normal mammalian development. The aim of the present study was to assess the localization of Dnmt1 in cow, during the latest phases of oocyte differentiation and during the early stages of segmentation. Dnmt1 expression and localization were assessed in oocytes according to the chromatin configuration, which in turn provides an important epigenetic mechanism for the control of global gene expression and represents a morphological marker of oocyte differentiation. We found that the initial chromatin condensation was accompanied by a slight increase in the level of global DNA methylation, as assessed by 5-methyl-cytosine immunostaining followed by laser scanning confocal microscopy analysis (LSCM). RT-PCR confirmed the presence of Dnmt1 transcripts throughout this phase of oocyte differentiation. Analogously, Dnmt1 immunodetection and LSCM indicated that the protein was always present and localized in the cytoplasm, regardless the chromatin configuration and the level of global DNA methylation. Moreover, our data indicate that while Dnmt1 is retained in the cytoplasm in metaphase II stage oocytes and zygotes, it enters the nuclei of 8-16 cell stage embryos. As suggested in mouse, the functional meaning of the presence of Dnmt1 in the bovine embryo nuclei could be the maintainement of the methylation pattern of imprinted genes. In conclusion, the present work provides useful elements for the study of Dnmt1 function during the late stage of oocyte differentiation, maturation and early embryonic development in mammals.

Cardiovascular health interventions in women: What works?

Women's Cardiovascular Health Network members representing 10 Prevention Research Centers completed a literature review of approximately 65 population-based studies focused on improving women's cardiovascular health through behavior change for tobacco use, physical inactivity, or diet. A framework was developed for conducting the search. Databases (Medline, Psychlit, Smoking and Health, Cumulative Index to Nursing and Allied Health Literature) of studies published from 1980 to 1998 were searched. The review was presented at a meeting of experts held in Atlanta, Georgia. Output from the meeting included identification of what has worked to improve cardiovascular health in women and recommendations for future behavioral research. Additional information is available at www.hsc.wvu.edu/womens-cvh. Cardiovascular health interventions geared toward women are scant. Based on the available studies, program components that emerged as effective included personalized advice on diet and physical activity behaviors and tobacco cessation, multiple staff contacts with skill building, daily self-monitoring, and combinations of strategies. Recommendations for community-based tobacco, physical activity, and diet interventions are discussed. A few overarching recommendations were to (1) conduct qualitative research to determine the kinds of interventions women want, (2) examine relapse prevention, motivation, and maintenance of behavior change, (3) tailor programs to the stage of the life cycle, a woman's readiness to change, and subgroups, that is, minority, low socioeconomic, and obese women, and (4) evaluate policy and environmental interventions. The effects of cardiovascular interventions in women have been inappropriately understudied in women. Our review found that few studies on cardiovascular risk factor modification have actually targeted women. Hence, adoption and maintenance of behavior change in women are elusive. Intervention research to improve women's cardiovascular health is sorely needed.

Changes in public health nurses' knowledge and perception of counseling and clinical skills for breast and cervical cancer control.

This study discusses the findings from two surveys of 459 nurses working in public health about their knowledge and perception of counseling and clinical skills related to breast and cervical cancer control. The first survey was conducted in 1993 before professional education efforts with the Breast and Cervical Cancer Control Program (BCCCP) began in North Carolina. The second survey was carried out in 1996. The results show a significant increase from 1993 to 1996 in recognition of increasing age, nulliparity, late childbearing, and family history as risk factors for breast cancer, and for smoking and early age at first sexual intercourse as risk factors for cervical cancer. Nurses' skills were more likely to be rated as excellent or very good in 1996 as compared with ratings in 1993 for educating women about mammography, performing a clinical breast examination, teaching breast self-examination by demonstration, performing a Papanicolaou (Pap) smear and bimanual examination, and counseling women about abnormal Pap tests. Nurses who took a BCCCP-sponsored adult physical assessment course were more likely to know correct risk factors for breast and cervical cancer, and to show improvement in teaching breast self-examination, performing a Pap smear, and counseling women about abnormal Pap tests.

Tailoring and targeting a worksite health promotion program to address multiple health behaviors among blue-collar women.

PURPOSE: This study examined the relationship between health risks, health behaviors, stages-of-change, and behavior change priorities among blue-collar women participating in a worksite health promotion study. DESIGN: Cross-sectional. SETTING: Rural manufacturing worksites in North Carolina. SUBJECTS: Participants were 859 women aged 18 and over. MEASURES: The self-administered questionnaire assessed smoking, exercise, nutrition (fat, fruits, and vegetables), and breast and cervical cancer screening behaviors. In addition, demographics, body weight, perceived health, stages-of-change, and priority for behavior change were measured. Chi-square tests and regression analysis were used to assess statistical significance. RESULTS: Overall, 28% of women smoked, 37% were completely sedentary, 82% consumed less than five daily servings of fruits and vegetables, and the majority were overweight. The dominant stage of change for each of the lifestyle behaviors was contemplation, whereas most women were in the action stage for cancer screening. When asked to prioritize the behavior they most wanted to change, the majority of women chose healthy eating and/or exercise. CONCLUSIONS: The findings suggest that blue-collar women in this study had multiple health risks and were interested in changing multiple health behaviors. Allowing women to choose the behavior(s) on which they are ready to focus may be a promising approach to tailoring interventions for this population.

Social support and psychological functioning among high-risk mothers: the impact of the Baby Love Maternal Outreach Worker Program.

This study compared two groups of high-risk Medicaid-eligible mothers, 221 who participated in a maternal home visitation program and 198 who did not, to determine whether program participation was associated with improvements in the mothers' psychological functioning 1 year after delivery, and whether these improvements were associated with the type and intensity of support provided by home visitors. The results suggest that, compared to nonparticipants, participants provided with more intensive home visitor support had significantly higher self-esteem (p = 0.039) and were less depressed (p = 0.015). Participants with less intensive home visitor support, however, did not differ significantly from nonparticipants in their self-esteem or depression levels. No significant differences were observed in the perceived stress levels of participants as compared with nonparticipants, regardless of the intensity of home visitor support. Mothers who had support from the baby's father, however, had significantly lower perceived stress levels than mothers with no support from the baby's father (p = 0.046). Moreover, the type of support provided by home visitors (emotional, instrumental, informational) did not appear to be related to the mothers' psychological functioning. This study suggests that the intensity of support is an important component of maternal home visitation programs that aim to improve women's psychological functioning.

Georgia's breastfeeding promotion program for low-income women.

OBJECTIVE: Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. METHODS: Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. RESULTS: PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (

Factors predicting completion of a home visitation program by high-risk pregnant women: the North Carolina Maternal Outreach Worker Program.

OBJECTIVES: This study sought to identify characteristics of high-risk pregnant women that predicted long-term participation in a home visitation program. METHODS: Data regarding sociodemographic characteristics, perceived needs, psychological functioning, substance use, and informal social support were collected prospectively from 152 short-term and 221 long-term program participants. RESULTS: In comparison with short-term participants, long-term participants were more likely to have been African American, married, nonsmokers, and enrolled in the program during their second trimester of pregnancy, and they were more likely to have had emotional and instrumental support needs. CONCLUSIONS: Women with greater social support needs and healthier behaviors were more receptive to long-term home visitation than other women.