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North Attleboro, MA, United States

Langellier B.A.,University of California at Los Angeles | Pia Chaparro M.,University of California at Los Angeles | Whaley S.E.,Health Enterprises
Maternal and Child Health Journal | Year: 2012

Hospital practices and early maternal return to work are associated with breastfeeding duration; however, research has not documented the long-term effects of many hospital policies or the effect of early return to work on breastfeeding outcomes of WIC participants. This study investigated the impact of in-hospital breastfeeding, receipt of a formula discharge pack, and maternal return to work on the long-term breastfeeding outcomes of 4,725 WIC participants in Los Angeles County, California. Multivariate logistic regression analyses were used to assess determinants of exclusive breastfeeding at 6 months and breastfeeding at 6, 12, and 24 months. In-hospital initiation of breastfeeding, exclusive breastfeeding in the hospital, receipt of a formula discharge pack, and maternal return to work before 3 months were all significantly associated with breastfeeding outcomes after controlling for known confounders. Mothers who exclusively breastfed in the hospital were eight times as likely as mothers who did not breastfeed in the hospital to reach the AAP recommendation of breastfeeding for 12 months or longer (P<.01). Only 6.9% of the sample reported exclusively breastfeeding for 6 months or more, and just one-third reported any breastfeeding at 12 months. Nine in ten respondents received a formula discharge pack in the hospital. Mothers who received a discharge pack were half as likely to exclusively breastfeed at 6 months as those who did not receive one (P<.01). Medical providers should educate, encourage, and support WIC mothers to breastfeed in the hospital and refrain from giving formula discharge packs. © Springer Science+Business Media, LLC 2011.

Derry G.N.,Loyola University Maryland | Derry P.S.,Health Enterprises
Nonlinear Biomedical Physics | Year: 2010

Background: The human menstrual cycle is known to exhibit a significant amount of unexplained variability. This variation is typically dismissed as random fluctuations in an otherwise periodic and predictable system. Given the many delayed nonlinear feedbacks in the multiple levels of the reproductive endocrine system, however, the menstrual cycle can properly be construed as the output of a nonlinear dynamical system, and such a system has the possibility of being in a chaotic trajectory. We hypothesize that this is in fact the case and that it accounts for the observed variability.Results: Here, we test this hypothesis by performing time series analyses on data for 7749 menstrual cycles from 40 women in the 20-40 year age range, using the database maintained by the Tremin Research Program on Women's Health. Both raw menstrual cycle length data and a formal time series constructed from this data are utilized in these analyses. Employing phase space reconstruction techniques with a maximum embedding dimension of 12, we find appropriate scaling behavior in the correlation sums for these data, indicating low dimensional deterministic dynamics. A correlation dimension of Dc≈ 5.2 is measured in the scaling regime. This result is confirmed by recalculation using the Takens estimator and by surrogate data tests. We interpret this result as an approximation to the fractal dimension of a strange attractor governing chaotic dynamics in the menstrual cycle. We also use the time series to calculate the correlation entropy (K2≈ 0.008/τ) and the maximal Lyapunov exponent (λ ≈ 0.005/τ) for the system, where τ is the sampling time of the series.Conclusions: Taken collectively, these results constitute significant evidence that the menstrual cycle is the result of chaos in a nonlinear dynamical system. This view of the menstrual cycle has potential implications for clinical practice, modelling of the endocrine system, and the interpretation of the perimenopausal transition. © 2010 Derry and Derry; licensee BioMed Central Ltd.

Backes G.,Safer Alternatives Through Networking and Education | Rose V.J.,Health Enterprises
Journal of Urban Health | Year: 2010

Under California law, local governments may authorize pharmacies within their jurisdictions to sell ten or fewer syringes to an adult without prescription, proof of identity, or proof of medical need. Local governments may simultaneously exempt adults from prosecution for violation of state drug paraphernalia codes for possession of ten or fewer syringes for personal use. Both of these provisions are temporary and sunset on December 31, 2010, unless subsequent state legislation amends that date. The objective of our study was to ascertain how and why local policymakers made their decisions regarding non-prescription syringe sale (NPSS). We examined influences on their decisions, including specific messengers and the arguments that were most salient to their decision making. We selected jurisdictions that were geographically representative of California counties; those with and without syringe exchange programs, and those that had passed or rejected NPSS. We conducted nine semi-structured interviews in five jurisdictions. To enrich primary data collection, we analyzed secondary data by reviewing audio, video, and written transcripts of public hearings and newspaper coverage in five jurisdictions, including three jurisdictions without primary interview data. Among proponents of NPSS, we identified common themes, including: (1) public health research provided conclusive evidence for reduction in HIV and hepatitis transmission without problems of crime, drug use, or unsafe discard of syringes; (2) the local health officer was the key to influencing local policymakers; (3) recall of prior debates over syringe exchange served to inform their decision making; and (4) a lack of local opposition or controversy. Common concerns among opponents of NPSS included: (1) that there would be an increase in unsafe discard of syringes; (2) loss of an important law enforcement tool; (3) that drug users were incapable of desired behavior change; and (4) that research was inconclusive, or proved that syringe access would not work in reducing rates of disease. Themes held in common by proponents and opponents of NPSS were identified as well. Syringe access through NPSS is in fact supported by a robust body of public health research and is considered an important component of a comprehensive strategy to reduce HIV and hepatitis transmission. Our study highlights the importance of understanding the perspectives of elected officials in order to ameliorate their concerns without undermining the public health goal of reducing death, disease, and suffering in at-risk communities. © 2010 The New York Academy of Medicine.

Chaparro M.P.,University of California at Los Angeles | Langellier B.A.,University of California at Los Angeles | Kim L.P.,University of California at Los Angeles | Whaley S.E.,Health Enterprises
Obesity | Year: 2011

Childhood obesity is a growing problem in the United States. Parental perception of their children's weight status is a key factor that needs to be considered when developing prevention programs for preschool children. Using a randomly selected sample of participants of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County, we assessed accuracy of maternal perceptions of their children's weight status by comparing children's weight classification to the mothers' response to the question Do you consider your child to be overweight, underweight or about right weight for (his) (her) height Additionally, we identified possible predictors of accurate maternal perception of their children's weight status by conducting a logistic regression model with child's gender, child's birth weight, maternal age, maternal BMI, maternal education, maternal acculturation level, and maternal language preference as potential predictors. Almost all mothers in the study classified their overweight or obese child as being about the right weight (93.6% and 77.5% of mothers, respectively). Maternal BMI and child's birth weight were the only predictors of maternal perception of their child's weight. Both were negatively associated with accuracy, with higher maternal BMI and higher infant birthweight associated with less accurate maternal perception of child weight. Parents need to be educated on the importance of childhood obesity and how to identify if their children are overweight or obese. If parents fail to recognize that their overweight child is overweight, then it is unlikely that they will recognize that interventions targeting obesity are relevant to their families. © 2011 The Obesity Society.

Feuchtbaum L.,Genetic Disease Screening Program | Dowray S.,Health Enterprises | Lorey F.,Genetic Disease Screening Program
Genetics in Medicine | Year: 2010

Purpose: State newborn screening programs are designed to prevent morbidity and mortality from hereditary disorders through early detection and ongoing disease management. These programs have traditionally focused on short-term follow-up. However, capturing data on the long-term follow-up process is emerging as a new priority. Long-term follow-up data can be used to assess the accessibility, continuity, and quality of care provided to these children. The California Newborn Screening Program uses a Web-based data collection system for short- and long-term follow-up. This article provides a description of the follow-up data collection system in addition to preliminary findings to demonstrate the efficacy of the California data collection approach. Methods: A preliminary analysis of short-term follow-up data collected from July 7, 2005, through April 30, 2009, and a preliminary analysis of long-term follow-up data collected from July 1, 2007, through April 30, 2009. Results: A majority of children are able to access ongoing care through age 5 years. The majority also have positive health outcomes at each year of follow-up. Conclusion: California's short- and long-term data collection system can serve as a model for other states interested in implementing a comprehensive Newborn Screening Program follow-up data system. © 2010 Lippincott Williams & Wilkins.

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