Спонсорирано от:      Dreyfus Health Foundation

DHF, 205 East 64 Street, Suite 404

New York, NY 10021

E-mail: Postmaster@thf.org

http://www.thf.org

       Fax #  212-371-2776

 

Contents / Съдържание

 

FOREWORD: ON THE PROGRAMS OF DHF IN BULGARIA/ ЗА ПРОГРАМИТЕ НА ЗДРАВНА ФОНДАЦИЯ "ДРАЙФУС" В БЪЛГАРИЯ

MEDLINE INFORMATION / ИНФОРМАЦИЯ ОТ MEDLINE

 - Breast Cancer / Рак на млечната жлеза

 - The Truth about Breast Cancer / Истината за рака на гърдата

 - Infant Feeding (Continued) / Храненето на  кърмачето

ПРОЕКТИ, ПРЕДСТАВЕНИ НА 9 МАЙ, 1997 ГОДИНА В РИБАРИЦА

-  Avoiding Errors in Feeding Infants/ Избягване  на грешки при храненето на кърмачета

-  Air Pollution in Vratza and Asthma Control / Атмосферното замърсяване във Враца и заболяванията от астма

-  Weight Reduction in Obese Children / Нормализиране  теглото на затлъстели деца

-  Epidemiological Survey on Obesity in Diabetics /  Епидемиологично проучване на затлъстяване при диабетици

-  Poison Control in Children under 6 / Профилактика на отравянията при деца до 6 годишна възраст

-  Blood Pressure Control/ Контрол на артериалното  налягане

-  Health Education for Middle and High School Children / Здравно образование за средния и горния курс

-  Acupuncture for Asthma Patients Aged 15-18 / Акупунктура при болни от астма (15-18 годишни)

-  Prevention of Respiratory Infections in Asthma by Vaccination/ имунопрофилактика на  респираторните инфекции при астма

-  Improving Asthma and COPD Control in the Region of Vidin /  Подобряване на астма и ХОББ контрол във Видин и региона

-  Promotion of Blood Donation in Lovetch Region/ Увеличаване на броя на кръводарителите в Ловешки окръг

-  Breast Feeding Promotion / Промоция на кърменето

-  Screening 10 Villages Round Montana for Glaucoma / Скрининг на населението за глаукома в 10 села в регион Mонтана

-  Caries Prevention in Children Aged 3-6/ Профилактика на зъбния кариес при деца от 3 до 6 годишна възраст

-  Trauma Reduction in a Military Unit / Намаляване на травматизма във военно поделение

-  Care for Lonely Old People Not Covered by Social Services in the Region of Turnovo/ Помощ за самотноживеещи възрастни

-  First-aid  Training for Future Drivers / Обучение на кандидат-водачи на МПС

-  Standardization of Emergency Room Procedures / Изработване на стандартизиран  подход  при СМП

- Expert Software to Improve Emergency Treatment/ Eкспертен софтуер за СМП

 - Endemic Goiter  Prevention  in the Troyan Region /  Профилактика на ендемична струма в Троянско

 

 

Програмите на Здравна фондациЯ "Драйфус"

в БългариЯ

 

(Продължение от миналия брой)

 

Програмата “Решаване на проблеми за по-добро здраве” стартира през 1994 година като съвместна програма на Здравна фондация “Драйфус” и клуб “Отворено общество” - гр. Плевен. В организацията на първия семинар, проведен в гр. Плевен, изключително ценна е помощта на Фондация “Отворено общество".. В семинара участват около 35 лекари, учители, медицински сестри и др. Представителите на Здравна фондация “Драйфус” - д-р Бари Смит, г-н Дъглас Ейдс, г-жа Ан Сайкс (САЩ), д-р Ян Соботка, г-жа Дагмара Бараневска (Полша), д-р Силвия Сантош (Бразилия) и д-р С. Р. Соман (Индия) представят един нов подход в решаването на здравни проблеми: с използването на наличните финансови, кадрови и човешки ресурси и в сътрудничество с други, неправителствени организации.

Сравнително малко от представените от участниците протоколи прерастват в проекти - било поради неопитност на организаторите да ръководят работата по реализирането на намеренията, заявени в проектите, било от плахост на участниците да приложат нови подходи в решаването на здравните проблеми. От представените 25 протокола се реализират 7 проекта - “Превенция на забременяването на тийнейджърска възраст и предаване на болести по полов път”, “Обучение на пациенти с астма с цел по-добър контрол на заболяването”, “Превенция на злоупотреба с наркотици сред подрастващите”, “Превенция на злоупотреба с алкохол сред подрастващите”, “Епидемиология на остър инфаркт на миокарда”, “Борба с тютюнопушенето сред децата”, “Лечебна физкултура за предпазване от гръбначни изкривявания”.

Отчетените резултати от работата по тези проекти вдъхват повече увереност  на участниците в следващия семинар, който се провежда през юни 1995 година в Априлци. Броят на стартиралите проекти е вече 15.

През следващата година - 1996 в Орешак, Ловешко се провежда третият семинар “Решаване на проблеми за по-добро здраве". Тридесет и петте участници представят протоколи, на базата на които стартират вече 21  проекта.

Последният семинар се организира в Рибарица, Тетевенско. Макар че броят на участниците в него не е много по-голям от този на участвалите в предишните семинари, след него стартират 34 проекта.

В хода на работата по програмата “Решаване на проблеми за по-добро здраве” организаторите от клуб “Отворено общество” - Плевен набират опит: подобрява се организацията по проследяването на работата по проектите, документиране на дейността по програмата, организация на финансирането на проектите, подобряване на комуникациите между организаторите, Здравна фондация “Драйфус” и участниците в програмата. Ръководителите на проекти придобиват нови умения в организацията на дейностите си, в привличане на допълнителни средства. Все повече ръководители на заведения, където има действащи проекти, сътрудничат за успешното им реализиране.

Голям принос за макар и скромните засега успехи на програмата имат и контактите с другите страни, в които се работи по нея. Координатори от Бразилия, Гвиана, Ел Салвадор, Индия, Йордания, Словакия, Полша, САЩ са гости на семинарите и на срещи на ръководители на проекти. Споделянето на опит в решаването на възникналите трудности от най-различно естество определено помага в благородните усилия на работещите по проектите. Координаторите на програмата от Здравна фондация “Драйфус” често посещават и проектите по места.

Дейността по програмата се отразява в бюлетина на Здравна фондация “Драйфус” - CONNECTIONS, който излиза четири пъти в годината и достига до всички участници в програмата. В него могат да се намерят материали за семинари, срещи, инициативи, посещения на проекти по места, резултати от работата по проектите във всички страни, в които се работи по програмата.

От 1997 година в България  стартира програма “Комуникации за по-добро здраве”. Тя се субсидира от Здравна фондация “Драйфус” и Висш медицински институт - Плевен. Основната й цел е да се публикуват материали, които интересуват ръководителите на проектите, както и да отразява работата по тях. В този брой ще намерите кратки сведения за проектите, работата по които е обсъдена по време на семинара за ръководители на проекти през май 1997 година в Рибарица.

В следващите броеве на бюлетина ще бъдат публикувани материали, изпратени ни от участниците в програмата.

Очакваме вашите материали, въпроси, мнения и препоръки на следните адреси:

 

Програма      “Решаване на проблеми за по-добро здраве”:

                      5800 Плевен

                      ул.”Св. Климент Охридски”, No 1, ст.273

                      тел./факс: 064/33118

                      Е-mail: mailto:yapsbh@mbox.digsys.bg

         

Програма”    Комуникации за по-добро здраве”:

                      5800 Плевен

                      ВМИ - Плевен, Централна библиотека

                      тел./факс: 064/24765

                      E-mail:mailto:vmilibrpl@mbox.digsys.bg

 

                                                          От редакционната колегия

 

 

 Breast CANCER / РАК на млеЧната жлеза

 

TI:       Early cancer detection programmes for women at high risk for breast and ovarian cancer: A proposal of  practical guidelines

AU:     MW Beckmann, HG Schnurch, R Boddenheidrich, DS Mosny, G Crombach, U Nitz, M Achnoula, HG Bender

SO:      European Journal of Cancer Prevention 5: 6 (DEC 1996)

AD:     MW Beckmann, Univ Dusseldorf, Dept Obstet & Gynaecol, Moorenstr 5, D-40225 Dusseldorf, Germany

 

Women from families with multiple breast and/or ovarian cancers may be at increased risk to develop breast/ovarian cancer themselves, Due to personal experience with family members having these diseases they are anxious and ask for specific prophylactic measurements or treatment. The detection of two susceptibility genes, BRCA1 and BRCA2, has given insight into the genetic background of part of the familial breast/ovarian cancer syndromes. This has led to an increased demand in genetic counselling, testing, and early cancer detection programmes. Prospective data from early cancer defection programmes in this high risk population are yet not available, Based on data from epidemiological risk studies, breast and ovarian screening programmes and follow np data from breast cancer trials recommendations for an early cancer detection programme have been summarized, At the present these recommendations are tested in a prospective trial.

 

 

TI:       Non-dietary factors as risk factors for breast cancer, and as effect modifiers of the association of fat intake and risk of breast cancer

AU:     DJ Hunter, D Spiegelman, HO Adami, PA Vandenbrandt, AR Folsom, RA Goldbohm, S Graham, GR Howe, LH Kushi, JR Marshall, AB Miller, FE Speizer, W Willett, A Wolk, SS Yaun

SO:      Cancer Causes & Control 8: 1 (JAN 1997)

AD:     DJ Hunter, Channing Labs, 181 Longwood Ave, Boston, MA

 

To assess more precisely the relative risks associated with established risk factors for breast cancer, and whether the association between dietary fat and breast cancer risk varies according to levels of these risk factors, we pooled primary data from six prospective studies in North America and Western Europe in which individual estimates of dietary fat intake had been obtained by validated food-frequency questionnaires. Based on information from 322,647 women among whom 4,827 cases occurred during follow-up: the multivariate-adjusted risk of late menarche (age 15 years or more compared with under 12) was 0.72 (95 percent confidence interval [CI] = 0.62-0.82); of being postmenopausal was 0.82 (CI = 0.69-0.97); of high parity (three or more births compared with none) was 0.72 (CI = 0.61-0.86); of late age at first birth (over 30 years of age compared with 20 or under) was 1.46 (CI = 1.22-1.75); of benign breast disease was 1.53 (CI = 1.41-1.65); of maternal history of breast cancer was 1.38 (CI = 1.14-1.67); and history of a sister with breast cancer was 1.47 (CI = 1.27-1.70). Greater duration of schooling (more than high-school graduation compared with less than high-school graduation) was associated significantly with higher risk in age-adjusted analyses, but was attenuated after controlling for other risk factors. Total fat intake (adjusted for energy consumption) was not associated significantly with breast cancer risk in any strata of these non-dietary risk factors. We observed a marginally significant interaction between total fat intake and risk of breast cancer according to history of benign breast disease, with fat intake being associated non significantly positively with risk among women with a previous history of benign breast disease; no other significant interactions were observed. Risks for reproductive factors were similar to those observed in case-control studies; relative risks for family history of breast cancer were lower. We found no clear evidence in any subgroups of a major relation between total energy-adjusted fat intake and breast cancer risk.

 

 

TI:       The risk of breast cancer following spontaneous or induced abortion

AU:     PA Wingo, K Newsome, JS Marks, EE Calle, SL Parker

SO:      Cancer Causes & Control 8: 1 (JAN 1997)

AD:     PA Wingo, Amer Canc Soc, Epidemiol & Surveillance Res Dept, 1599 Clifton Rd      NE, Atlanta, GA 30329 USA

 

To evaluate the relationship between breast cancer risk and spontaneous and induced abortion, we conducted a detailed descriptive review of 32 epidemiologic studies that provided data by type of abortion and by various measures of exposure to abortion - number of abortions, timing of abortion in relation to first full-term pregnancy, length of gestation, and age at first abortion. Breast cancer risk did not appear to be associated with an increasing number of spontaneous or induced abortions. Our review also suggested that breast cancer risk probably was not related to the other measures of exposure to abortion, and probably did not differ by age or a family history of breast cancer. Finally, the data appeared to suggest a slightly increased risk among nulliparous women, but this tendency was based primarily on studies with a small number of nulliparous women who had had spontaneous or induced abortions. Definitive conclusions about an association between breast cancer risk and spontaneous or induced abortion are not possible at present because of inconsistent findings across studies. Future investigations should consider prospective designs, separate analyses of spontaneous and induced abortions, appropriate referent groups, and adequate adjustment for confounding and effect modification. Future investigations also should attempt to determine whether any increased risks reflect the transient increase in breast cancer risk hypothesized for full-term pregnancy or a causal relationship specific to spontaneous or induced abortion.

 

 

TI:       Cancers detected and induced in mammographic screening: New screening schedules and younger women with family history

AU:     J Law

SO:      British Journal of Radiology 70 (JAN 1997)

AD:     J Law, Univ Edinburgh, Western Gen Hosp, Dept Med Phys & Med Engn, Crewe Rd, Edinburgh EH4 2XU, Midlothian, Scotland

The numbers of cancers detected and induced in breast screening programmes are examined for two-view screening, and for a 2 year screening interval,in contrast to the single view screening at a 3 year interval of the UK Breast Screening Programme up until early 1995. Two-view screening is also considered for the 1 year interval and age range of the current UK age trial (40-47 years). The corresponding figures for screening of groups having a family history of breast cancer are calculated and discussed. Breast cancer induction data are taken from National Radiological Protection Board publications. Cancer detection rates are based on observed rates where available, and calculated rates otherwise. The results of calculations indicate cause for concern if screening is to be extended below the age of 30 years (or below 35 years in certain categories), or below 40 years of age if family history groups are shown in the future to have a generally increased susceptibility to ionizing radiation. The importance of restricting dose to 2 mGy per film (mean glandular dose for a standard breast thickness of 4.5 cm) is stressed, together with the need to maintain maximum image quality. This is especially true for the family history groups, who should only be screened in centres within established screening programmes, or in centres with equally strict quality control procedures.

 

 

TI:       BRCA1 mutations in women attending clinics that evaluate the risk of breast cancer

AU:     FJ Couch, ML Deshano, MA Blackwood, K Calzone, J Stopfer, L Campeau, A Ganguly, T Rebbeck, BL Weber, L Jablon, MA Cobleigh, K Hoskins, JE Garber

SO:      New England Journal of Medicine 336: 20 (MAY 15 1997)

AD:     BL Weber, Univ Penn, Dept Med, Stellar Chance Labs 1009, 422 Curie Blvd, Philadelphia, PA 19104 USA

 

Background To define the incidence of BRCA1 mutations among patients seen in clinics that evaluate the risk of breast cancer, we analyzed DNA samples from women seen in this setting and constructed probability tables to provide estimates of the likelihood of finding a BRCA1 mutation in individual families.

 Methods Clinical information, family histories, and blood for DNA analysis were obtained from 263 women with breast cancer. Conformation-sensitive gel electrophoresis and DNA sequencing were used to identify BRCA1 mutations.

 

Results BRCA1 mutations were identified in 16 percent of women with a family history of breast cancer. Only 7 percent of women from families with a history of breast cancer but not ovarian cancer had BRCA1 mutations. The rates were higher among women from families with a history of both breast and ovarian cancer. Among family members, an average age of less than 55 years at the diagnosis of breast cancer, the presence of ovarian cancer, the presence of breast and ovarian cancer in the same woman, and Ashkenazi Jewish ancestry were all associated with an increased risk of detecting a BRCA1 mutation. No association was found between the presence of bilateral breast cancer or the number of breast cancers in a family and the detection of a BRCA1 mutation, or between the position of the mutation in the BRCA1 gene and the presence of ovarian an cancer in a family.

Conclusions Among women with breast cancer and a family history of the disease, the percentage with BRCA1 coding-region mutations is less than the 45 percent predicted by genetic-linkage analysis. These results suggest that even in a referral clinic specializing in screening women from high-risk families, the majority of tests for BRCA1 mutations will be negative and therefore uninformative. (C) 1997, Massachusetts Medical Society.

 

 

TI:       Feasibility of obtaining breast epithelial cells from healthy women for studies of cellular proliferation

AU:     NA Miller, M Thomas, LJ Martin, DW Hedley, S Michal, NF Boyd

SO:      Breast Cancer Research and Treatment 43: 3 (MAY 1997)

AD:     NF Boyd, Ontario Canc Inst, Div Epidemiol & Stat, 610 Univ Ave, Toronto, on M5G 2M9, Canada

 

Increased dietary fat intake and rate of breast epithelial cell proliferation have each been associated with the development of breast cancer. The goal of this study was to measure the effect of a low fat, high carbohydrate diet on the rate of breast epithelial cell proliferation in women at high risk for breast cancer, Women were recruited from the intervention and control groups of a randomized;ow fat dietary intervention trial, breast epithelial cells were obtained by fine needle aspiration, and cell proliferation was assessed in these samples using immunofluorescent detection of Ki-67 and PCNA. The effects of needle size and study group on cell yield and cytologic features of the cells were also examined. Fifty three women (20 in the intervention group and 33 in the control group) underwent the biopsy procedure. Slides from 38 subjects were stained for Ki-67 and from 14 subjects for PCNA. No cell proliferation (fluorescence) was detected for either Ki-67 or PCNA in any of the slides. Epithelial cell yield and number of stromal fragments were greater with a larger needle size. Numbers of stromal fragments and bipolar naked nuclei were greater in the low fat as compared to the control group but no differences in epithelial cell yield were observed between the two groups. This study confirms that fine needle aspiration biopsy is a feasible method of obtaining epithelial cells from women without discrete breast masses, but suggests that cell proliferation cannot be assessed using Ki-67 and PCNA in such samples.

 

 

TI:       Prognostic significance of etiological risk factors in early breast cancer.

AU:     LJ Schouten, PSGJ Hupperets, JJ Jager, L Volovics, JA Wils, ALM Verbeek, GH Blijham

SO:      Breast Cancer Research and Treatment 43: 3 (MAY 1997)

AD:     LJ Schouten, Ikl, Ctr Comprehens Canc, Dept Canc Registrat, POB 2208, NL-6201 Ha Maastricht, Netherlands

 

Several risk factors for the etiology of breast cancer have also been correlated with the prognosis of breast cancer. However, the published studies have yielded conflicting results.

 Women under 71 years of age with stage I, II, or III breast cancer were eligible for inclusion in a clinical study. 866 patients with breast cancer entered the study, of whom 463 had positive lymph nodes.

Survival was analysed using Cox’s proportional hazards model. Age at menarche, parity, age at menopause and family history were not consistently related to survival. Young age at first full-term pregnancy was related to decreased survival (adjusted relative risk (RR): 1.69, 95% confidence intervals (95% CI):1.04-2.68),but it cannot be excluded that this result was due to chance alone. Use of oral contraceptives was not correlated with survival (RR: 1.10, 95% CI: 0.80-1.51) nor was family history (RR: 0.93, 95% CI: 0.66-1.30).

 

 

TI:         Side-effects of screening.

AU:        Garstin-IW; Kaufman-Z; Michell-MJ; Rodway-A; Ebbs-SR; Baum-M

SO:        Eur-J-Cancer. 1993; 29A(15): 2150-2

 

There has been a 42% increase in the number of mammograms performed outside the national screening programme (operating in Camberwell, southeast London) which was not anticipated in the Forrest Report, a document to the Health Ministers of the U.K. by a working group chaired by Sir Patrick Forrest. The report compiles recommendations on breast screening, using mammography and breast self-examination, to reduce the mortality in women aged 50-64 years. This 42% increase is attributable mainly to referrals from menopause clinics and general practitioners of patients mainly in the screening age group. When we looked at referrals from general practitioners, suspicious mammographic findings were reported in 20% of patients referred with a breast lump, in contrast to only 4% of patients referred with breast pain or nodularity. Better education of both the public and general practitioners, concerning the signs and symptoms of breast cancer, may reduce demands to perform mammo-graphies outside the current national screening programme.

 

 

TI:       Study of the role of breast self-examination in the reduction of mortality from breast cancer. The Russian Federation/World Health Organization Study.

AU:     Semiglazov-VF; Sagaidak-VN; Moiseyenko-VM; Mikhailov-EA

SO:      Eur-J-Cancer. 1993; 29A(14): 2039-46

 

Organization, of the role of breast self-examination (BSE) in reduction of mortality from breast cancer is presented. The major objective of the study is to determine the effect of a BSE programme on mortality from breast cancer. A population of of over 193,000 women aged 40 to 64 has been defined in Moscow and St Petersburg and randomised to study and control groups. In Moscow the education programme is based on a two-way communication principle allowing efficient person-to-person education in groups of up to 20 individuals and feedback information through specially designed personal calendars. In St Petersburg, class and individual instruction is carried out. After a 1-year feasibility study the project is planned to last for 15 years. It consists of an aggressive education programme, during and following which, all newly diagnosed breast cancers will be registered and treated, and followed up for 3 to 15 years. A key issue of the study is compliance of the population with BSE. The frequency and competence of BSE practice has been defined in subsamples of 400 randomly selected women by means of surveys at 6 months, 1, 2 and 3 years after the start of the project. The study is expected to result in the accrual of more than 1470 new breast cancer cases and 778 deaths from breast cancer. The power of the study is expected to permit detection of a 30% reduction in cumulative breast cancer mortality, assuming that 50-70% of the women in the study group practise BSE.

 

TI:         An evaluation of comparative strategies for teaching breast self-examination.

AU:        Agars-J; McMurray-A

SO:        J-Adv-Nurs. 1993 Oct; 18(10): 1595-603

 

This study compared the effects of three alternative methods of breast self-examination (BSE) instruction (booklet, film and group discussion, individual teaching) on nurses’ personal BSE practice. A pre-test and follow-up questionnaire were administered to a convenience sample of 166 nurses from Western Australian hospitals. The results demonstrated that each method of BSE instruction produced a significant improvement in the technique of BSE (P < 0.0001). However, the nurses involved in the film and discussion had the greatest improvement in BSE proficiency. Findings were analysed in terms of the Health Belief Model. The variables ‘barriers to action’ and ‘perceived susceptibility’ (in this case, to breast cancer) were found to be predictive of BSE practice; ‘perceived barriers’ at pre-test and ‘perceived susceptibility’ at follow-up. The incidence of BSE was significantly higher in the older nurses. A reminder to practise BSE was significantly associated with an effective BSE technique. Implications for nursing practice are discussed.

 

 

TI:         A statewide breast cancer screening project.

AU:        Coleman-EA; Lord-JE; Bowie-M; Worley-MJ

SO:        Cancer-Nurs. 1993 Oct; 16(5): 347-53

 

The cause of breast cancer remains unknown. Because prevention is not an option, early detection is the most viable alternative for

decreasing the mortality rates from breast cancer. To promote early detection, the Arkansas Division of the American Cancer Society implemented a project aimed at increasing public awareness. The project used a three-pronged approach: the life-saving benefits of mammography, regular breast examination by a health-care professional, and the importance of regular breast self-examination (BSE). This article focuses on the third prong, BSE. Project members recruited and trained 408 BSE instructors in the MammaCare method of BSE and contacted a total of 87,141 Arkansas women about breast cancer and the importance of early detection. In a follow-up survey of 1,300 women, of the 198 (15%) who returned the surveys, two women reported finding lumps that were diagnosed as cancer.

 

 

TI:         Breast cancer screening: should it be introduced and how?

AU:        Ackermann-Liebrich-U

SO:        Soz-Praventivmed. 1993; 38(5): 294-6

 

This brief discussion of the papers by Gastrin and Paccaud is looking at differences in the results of different study types. Introducing screening means changing unsystematic to systematic screening: only the latter has been shown to be effective. The comparison between randomized trials, and follow-up of acceptors only, suggests that the non-acceptors have much higher risks. Programmes should therefore concentrate on trying to reach non-acceptors. The combination of mammographic screening and self-examination in a randomized trial could add to the existing evidence.

 

 

TI:         BSE Rap: intergenerational ties to save lives.

AU:        Ehmann-JL

SO:        Oncol-Nurs-Forum. 1993 Sep; 20(8): 1255-9

 

This article presents an innovative public-education strategy that was created to promote breast health awareness and early breast cancer detection among minority and low-income adolescent females. Given the importance of teaching breast self-examination (BSE), program development focused on creation of the BSE Rap, a lively music-video presentation. Increasing adolescents’ knowledge and awareness of BSE is viewed as a springboard for disseminating information to their mothers and grandmothers. Funding was obtained for production of a video and a breast health diary, which are the program’s key components. Marketing strategies included contacts with community organizations and healthcare professionals. Program evaluations reveal that the BSE Rap serves as a positive motivator for participants to discuss BSE and mammography with their mothers and grandmothers. The BSE Rap offers oncology nurses the opportunity to save lives using a unique and creative tool that focuses on intergenerational ties.

 

 

TI:         A study on women’s practice of breast self-examination in Taiwan.

AU:        Chie-WC; Cheng-KW; Fu-CH; Yen-LL

SO:        Prev-Med. 1993 May; 22(3): 316-24

 

METHODS. A questionnaire interview was conducted on a sample of 3,040 women ages 30-59 years in the Taipei area through multistage sampling with probability proportional to size. Excluding mistakes in household registration, there were 2,311 qualified subjects, 1,749 of whom (75.7%) completed the interview. The study framework was set up according to Green’s PRECEDE model. RESULTS. In the results of this study only 8.4% of the subjects performed breast self-examinations monthly, and no single step of the breast self-examination procedure had a correct rate above 30%. The most remarkable associative factor for the correctness of breast self-examination was “source of instruction,” a variable of “enabling factors”; other variables with strong associations were “newspaper contact” (contact with health reports in newspapers), which also belongs to the enabling factors category and “knowledge of breast cancer,” a “predisposing factor.” Demographic factors such as “educational level” and “urbanizational level” were only indirectly related. CONCLUSION. The authors suggested using all possible routes of health education, such as mass media, hospitals and clinics, and distribution of information in the workplace, to instruct and encourage breast self-examination, especially among women from rural communities and those with less education.

 

 

TI:       Breast self-examination programmes in the trial of early detection of breast cancer: ten year findings.

AU:     Ellman-R; Moss-SM; Coleman-D; Chamberlain-J

SO:      Br-J-Cancer. 1993 Jul; 68(1): 208-12

 

Programmes of education in breast self-examination with specialist clinics for self-referral were introduced in two health districts around 1980. Combining the results from the two centres showed no reduction in mortality from breast cancer over the following 10 years but the mortality was low in one of the centres whilst in the other it was higher than in four geographically separate comparison centres in which there was similar careful monitoring of breast cancer incidence and mortality. Because this was not a randomised controlled trial and lacked a uniform treatment protocol, biases may be responsible for the differences observed, but it is also possible that BSE education with annual reinforcement contributed to the breast cancer mortality reduction seen in one district. The overall conclusion however is that the value of breast self-examination remains unproven.

 

 

TI:       Attitude and behavior regarding breast self examination among health professionals in Chile.

AU:     Schencke-M; Espinoza-S; Munoz-N; Messing-H

SO:      Bol-Oficina-Sanit-Panam. 1993 Apr; 114(4): 317-25

 

This study was carried out from April to December 1990 in the commune of Valdivia, Chile and involved 207 physicians, nurses, midwives, and nurse-midwives. The objective was to determine the relationship between subjective attitude and personal behavior on the part of these health professionals with regard to the practice of monthly breast self-examination (BSE). The data were collected by means of an instrument designed to measure attitudes, which was prepared by Victoria Lee Champion (1984) on the basis of the health beliefs model of Becker, et al. (1974). Also included were questions aimed at ascertaining the personal and sociodemographic background of the professionals surveyed and their knowledge of several aspects of breast cancer and BSE. The information collected was subjected to the following tests of validity and reliability: Person product-moment correlation coefficient r, split half method, Spearman-Brown R coefficient, Cronbach alpha coefficient, and the Chi-square test to determine the degree of association between the variables. The results showed that although 79% of the women studied had ample knowledge of many aspects of breast cancer and 82% were aware of the benefits of BSE, only 28% practiced it on a monthly basis. It is alarming that health professionals, who are responsible for teaching prevention measures to other people, have yet to assume responsibility for protecting their own health insofar as early detection of breast cancer is concerned.

 

 

TI:       A profile of Australian women practicing breast self-examination.

AU:     Yelland-MJ; Rice-DE; Ward-AE; Bain-C; Siskind-V; Schofield-F

SO:      Asia-Pac-J-Public-Health. 1991; 5(4): 307-12

 

Breast self-examination (BSE) and medical breast examination practices were studied in a group of 1,103 women without diagnosed breast cancer, randomly sampled to conform in age and social status with breast cancer cases from the population of Brisbane, Australia between 1981 and 1985. Relationships between these practices and sociodemographic factors, breast cancer risk indicators, health related behaviors and source of knowledge about BSE were analyzed. Overall, 63% of women reported performing BSE. BSE was practiced frequently (monthly or more). BSE frequency was only weakly associated with breast cancer risk indicators. It was more strongly linked with age, the 20-44 year group being more likely to examine their breasts occasionally and the women 65 years and over being less likely to examine their breasts. Married women were the most likely to practice BSE frequently and widowed or single women most likely never to practice. Women who underwent cervical smear testing were more likely to perform BSE than those who did not have smear tests. Women who learned BSE from their doctors as opposed to other sources practiced BSE more frequently and were more likely to practice BSE exactly as taught.

 

 

TI:         The practice of breast self-examination among older women.

AU:        Maddox-MA

SO:        Oncol-Nurs-Forum. 1991 Nov-Dec; 18(8): 1367-71

 

Mammography, professional breast examination (PBE), and breast self-examination (BSE) are viewed as very important screening techniques for the early detection of breast cancer. Mammography and PBE are performed on a routine basis at healthcare facilities, while BSE can be performed in the privacy of the home. The self-care practice of monthly BSE is important for women of all ages. Older women often feel unsure about their ability to perform BSE properly, and many know very little about this self-care practice. The purpose of this research study was to explore the validity of teaching older women the practice of BSE using the method of return demonstration. The inclusion of actual practice opportunities with models into teaching sessions resulted in the older women feeling more confident about their ability to perform BSE.

 

 

TI:         Training breast self-examination: a research review and critique.

AU:        Pinto-B; Fuqua-RW

SO:        Health-Educ-Q. 1991 Winter; 18(4): 495-516

 

Despite an increase in knowledge about breast cancer, a relatively low percentage of women practice breast self-examination (BSE) regularly and competently. This article reviews the BSE literature with a focus on training of BSE components, discrimination training, and the effectiveness of training procedures. Methodological issues such as the absence of control groups, lack of criteria for termination of training and reliance on self-reports of BSE frequency are identified weaknesses of BSE training studies. A theoretical analysis of BSE highlights potential difficulties in maintaining regular practice of BSE. Recommendations regarding training of proficient BSE skills and promoting regular practice of BSE are offered, and suggestions for further refinement of BSE training and directions for future research are discussed. Promising avenues of research in BSE training technology include discrimination training (on real or simulated breast tissue) together with computerized assessment of skill proficiency.

 

 

TI:       The Toronto Breast Self-Examination Instrument (TBSEI): its development and reliability and validity data.

AU:     Ferris-LE; Shamian-J; Tudiver-F

SO:      J-Clin-Epidemiol. 1991; 44(12): 1309-17

 

The Toronto Breast Self-Examination Instrument (TBSEI) was developed out of the need for a self-administered survey that is reliable and valid. This article describes the development of the TBSEI, its dimensions, and reliability and validity data to support its continued use. To analyze the reliability and validity properties of the three TBSEI scales, we surveyed 729 Toronto, Ontario women. The TBSEI was found to have good face and content validity, internal consistency reliability (0.91, 0.69, 0.85), and test-retest reliability (0.89). Age norms for each of the three scales are also provided. These results are consistent with previous research findings in breast cancer and breast self-examination research.

 

 

TI:         Breast self-examination.

AU:        Mant-D

SO:        Br-Med-Bull. 1991 Apr; 47(2): 455-61

 

Breast self-examination (BSE) continues to be widely promoted by Government agencies and medical practitioners in Europe and the United States. Point 10 of the European Code Against Cancer exhorts women to ‘examine their breasts regularly’. Breast lumps are common and most women will detect a breast abnormality at some time in their life, irrespective of the promotion of BSE by the medical profession. It should be possible to increase a woman’s ability to deal better with this anxiety-provoking situation, and to reduce the number of women presenting with locally advanced disease, by appropriate health education. But this does not mean that BSE should be promoted as a screening test for cancer, with the consequent emphasis on vigilance and early self-referral. The natural course of breast cancer is not completely understood. Although stage at diagnosis is related to survival, and mammographic screening trials suggest that early diagnosis (often before a lump is palpable) can lead to effective treatment which prolongs life, earlier treatment of a palpable lump detected by BSE is not guaranteed to improve survival.

 

 

TI:         Improving breast self-examination training by using the 4MAT instructional model.

AU:        Spatz-TS

SO:        J-Cancer-Educ. 1991; 6(3): 179-83

 

Women were taught breast self-examination (BSE) two different ways using the same material. The 4MAT presentation (N = 49) was directed to four learning styles and both brain hemispheres; the American Cancer Society (ACS) presentation (N = 45) used a traditional lecture/discussion format. A control group (N = 58) was untrained. The mean age of the Cooperative Extension Home Demonstration Club participants was 57 years. A questionnaire, which was given before training, immediately after training, and 3 months later, assessed knowledge of breast cancer and BSE, confidence in performing BSE, and frequency of BSE. ANCOVAs and t tests showed that, compared with the ACS presentation, the 4MAT presentation produced better immediate acquisition and better 3-month retention of both knowledge and confidence. Both 4MAT and ACS participants were statistically superior to the control group on all three dependent variables, both in acquisition and 3 months later. The 4MAT instructional model is recommended for BSE and other health education presentations.

 

 

The Truth About Breast Cancer by Mark Gittleman, M.D.

 

WHAT IS BREAST CANCER?

Quite simply breast cancer is an abnormal growth of tissue which enlarges and destroys normal tissue as it develops locally or spreads to other parts of the body.

 

SIGNIFICANCE:

It is true that in 1996, an estimated 182,000 woman in the United States will develop breast cancer and over 46,000 woman will die from this disease.  It is also true that breast cancer is the most common type of cancer among woman in this country today. Breast cancer, until recently was the most fatal cancer among women but now is the second most fatal cancer. First place now belongs to lung cancer. It is no surprise that lung cancer deaths parallel the increase in cigarette smoking by women that began in the 60’s and 70’s but that is another story.

What is not true, however, is the often quoted statement “one out of every eight women in the United States will develop breast cancer”. This statement was derived from the statistical data indicating the lifetime risk of a woman developing breast cancer was approximately 12% (or 1 out of 8)... if, she lives to be 110 years of age! This is not to say that breast cancer is not a major problem, but it does point out that the statement “1 out of 8” is a bit overstated.

Some have suggested that the “1 out of 8” is a tactic used to increase public awareness of breast cancer. Nonetheless women should be encouraged to perform frequent breast self examination, have annual breast physical examinations by a healthcare provider, and utilize mammography at recommended intervals. Perhaps this is a case of the ends justifying the means, since discovering breast cancer earlier in it’s course leads to greater disease free survival and greater overall life survival in most cases. Perhaps, more importantly, it allows a greater choice of more conservative treatment options than would be available if the disease is discovered later in its course.

 

ABOUT RISK FACTORS AND BREAST CANCER?

There are a number of reasons to identify factors associated with an increased risk for developing breast cancer. One reason is to decrease the risk of developing breast cancer if the risk factor can be modified in a positive way. Another reason to identify risk factors is to alert those individuals with the risk factor(s) to be more diligent in their surveillance for detection of breast cancer at an early stage or to consider taking preventive steps to avoid the disease entirely.

The three most significant risk factors associated with the development of breast cancer are: 1. A personal history of previous breast cancer. 2. Increasing age. 3. An immediate relative (mother, sister, daughter) with breast cancer. Other risk factors such as the age at time of menarche (first period), age at first pregnancy, age at menopause (last period), increased body weight, smoking, and alcohol consumption are all very weak risk factors. Breast  self examination should be done on a monthly basis starting at age 18. Instructions in the technique of breast self examination can be obtained from your physician or the local chapter of the American Cancer Society. A new finding on breast self examination persistent over a one month period should be reported to your physician. A breast examination by your physician or other healthcare provider should be done annually beginning at age 18.

Mammography should be performed at an accredited mammographic facility at regular intervals once the appropriate age is reached. Current recommendations are to begin mammography at age 40 and every 2 years thereafter. Yearly exams should begin at age 50. In women with known increased risk factors, mammography is recommended to start earlier, at age 35. It may be used even earlier depending upon individual clinical circumstances. Ultrasound examination of the breast is not a good screening method for detecting breast cancer. However, it is very useful in determining whether a palpable mass or an abnormality detected on a mammogram is solid or cystic (fluid containing mass). A solid mass may or may not be a breast cancer. A cystic mass is not a breast cancer.Why is it important to detect breast cancer earlier? Besides providing a better chance for surviving breast cancer, earlier detection allows for more conservative treatment options. Once a breast lump is removed and found to be cancerous, the entire remaining breast is prone to develop additional cancers at an alarming rate of 40% over the next 2 years. Therefore, the entire breast needs to be treated. This is accomplished in 1 of 2 ways; either the entire breast is removed (simple mastectomy) or the breast is not removed but is treated with radiation (Breast Conservation Treatment or BCT). The results in terms of local control of disease and overall survival are the same if the tumor is small. This conservative treatment of only removing the tumor mass but not the entire breast is loosely called “lumpectomy”.

Lumpectomy is usually reserved for tumors 2 cm (approximately1") or less [Stage I disease]. It is often combined with removal of lymph nodes under the arm on the affected side as well as the radiation treatment mentioned above. Some doctors will offer “lumpectomy” for tumors up to 5 cm (2") in size [Stage II] disease.Once the tumor becomes larger than 2 inches and /or the overlying skin is involved, survival is better with a mastectomy as compared to BCT or “lumpectomy”. Simple Mastectomy refers to removing the entire breast. “Modified Radical Mastectomy” is a term that means removal of the entire breast and the lymph nodes under the arm of the affected side. “Modified Mastectomy” (shortened term) is the treatment of choice for any invasive breast tumor larger than 2". Radical Mastectomy is an operation which removes the breast, the axillary (underarm) lymph nodes, and the muscle layer under the breast. This operation used to be the standard surgical procedure but is now only done with proven muscle invasion - which is very rare. Simple or Modified Mastectomy can often be combined with plastic surgical reconstruction of the breast using either a saline (safe) implant or a muscle flap brought up from the abdominal wall to create new breast. If the tumor is invasive, meaning that it has grown outside of the breast duct from where it started, the lymph nodes under the corresponding arm need to be removed to determine if the cancer has spread to those lymph nodes. This information is essential for staging the disease. Staging determines prognosis (long tern outlook), and determines what kind of additional treatment modalities, such as chemotherapy or hormone therapy  would be indicated. However, if the breast cancer is found at an even earlier stage prior to invasion outside of the breast ducts. lymph node removal is not necessary.

 

WHAT ABOUT PREVENTING BREAST CANCER?

Simply stated, we do not know how to prevent breast cancer since we do not know the cause or causes of this disease. However, a breast cancer gene has been identified. Therefore, a genetic basis for the development of breast cancer is likely. Unfortunately this may be only one of many factors involved in causing breast cancer. At this time only a small number of hereditary types of breast cancer have been identified.

Currently, there are trials and experiments being conducted to determine whether Tamoxifen, an anti-estrogen medication, can reduce the risk of developing breast cancer in women who are determined to be at increased risk for the disease.  At this time, since we can’t prevent breast cancer, our efforts must be directed at early detection. Hopefully, some day in the near future, we will have the means of preventing breast cancer and alleviating women of this dreaded disease.

 

Dr. Gittleman received his medical degree from the University ofPennsylvania Medical School. He completed residences in General Surgery at The Hospital of the University of Pennsylvania and TheHarrisburg Polyclinic Hospital. Dr. Gittleman is board certified byThe American Board of Surgery and is a Fellow of The American Collegeof Surgeons. He is a member of The American Society of Breast Surgeons. He is the director of Comprehensive Breast Services and associate chief of gegeral surgery at The Lehigh Valley Hospital. Heis a clinical assistant professor of surgery at The Pennsylvania StateMedical Center at Hershey. Due to his background and interest, Dr. Gittleman has limited his practice exclusively to patients with diseases of the breast and breast surgery.

The managing editors and publishers of Doctor’s Forum represent that all information presented in this magazine, while written by a medical/dental professional, is strictly an opinion or position held by an individual author. Readers should always consult with and follow the advice of their own personal healthcare professional.

 

 

INFANT FEEDING AND ITS INFLUENCE ON MOTHER AND CHILD HEALTH (CONTINUED FROM THE PREVIOUS ISSUE)/ ХРАНЕНЕ НА КЪРМАЧЕТО И ВЛИЯНИЕ НА КЪРМЕНЕТО ВЪРХУ ДЕТСКОТО И МАЙ-ЧИНОТО ЗДРАВЕ

 

(ПРОДЪЛЖЕНИЕ ОТ МИНАЛИЯ БРОЙ)

 

TI:         Breast-feeding and HIV: a balance of risks. [Review]

AU:        Cutting WA

SO:        Journal of Tropical Pediatrics 40:6-11, 1994.

 

HIV-1 infection may be transmitted by breast-feeding. The risk of vertical transmission varies with the stage of maternal infection, but is 29 per cent if a mother acquires infection during lactation. The risk of infant death by not breast-feeding in a poor and contaminated environment is greater than the risk of HIV-infection when an HIV-positive mother breast-feeds. Vertical transmission can be reduced if women avoid high risk activities during pregnancy and especially lactation. [References: 20].

 

 

TI:         Calcium kinetics in lactating women with low and high calcium intakes.

AU:        Specker BL, Vieira NE, O’Brien KO, Ho ML, Heubi JE, Abrams SA, Yergey AL

SO:        American Journal of Clinical Nutrition 59:593-599, 1994.

 

Absorption of calcium and its mobilization from bone during lactation are important for delivery of calcium to breast-feeding infants; whether calcium intake offsets bone resorption is not known. We hypothesized that calcium absorption is increased in lactation and greater in women on low calcium diets, resulting in similar rates of bone resorption and accretion. Calcium absorption and kinetic indexes were calculated by using two stable isotopic tracers in 8 women; 6 were studied both during lactation and nonlactation. Women consumed low calcium diets, with half receiving supplemental calcium. Intestinal absorption was related to serum 1,25-dihydroxyvitamin D and did not increase during lactation. Despite decreased urinary calcium excretion during lactation, especially in women with low calcium intake, net balance tended to be lower during lactation. Mean residence time decreased and bone resorption exceeded accretion in almost all lactating women. Calcium need for milk production appears to be met by decreased urinary excretion and increased bone resorption, and not by increased intestinal absorption.

 

 

TI:         Is milk production impaired by dieting during lactation?

AU:        Dusdieker LB, Hemingway DL, Stumbo PJ

SO:        American Journal of Clinical Nutrition 59:833-840, 1994.

 

To determine the feasibility of a weight-loss program during lactation, 33 healthy, well-nourished, breast-feeding women were enrolled. Twenty-two women completed the 10-wk study, losing a mean (+/- SD) of 4.8 +/- 1.2 kg. Mean energy intake during the study was nearly 2.25 MJ (538 kcal) below the mean daily baseline intake of 9.64 +/- 2.48 MJ (2303 +/- 592 kcal). The sum of three maternal skinfold thickness, waist, and hip measurements were significantly smaller (P = 0.0001) at study completion. Mean daily milk production was 759 +/- 142 mL/d at baseline and 802 +/- 189 mL/d at week 10. The infants gained an average of 21 g/d, or 1.48 +/- 0.40 kg overall. The mean percent fat of milk at baseline and 10 wk was 4.06 +/- 2.15 and 4.00 +/-2.56, respectively. The mean daily nitrogen content of milk at baseline and study completion was 1.82 +/- 0.32 and 1.62 +/- 27 g/L. These findings suggest that modest weight loss by healthy breast-feeding women does not adversely affect either quantity or quality of milk consumed by their infants.

 

 

TI:       Help me make it through the night: behavioral entrainment of breast-fed infants’ sleep patterns.

AU:     Pinilla T, Birch LL

SO:      Pediatrics 91:436-444, 1993.

 

The study objective was to investigate whether exclusively breast-fed infants could be taught to sleep through the night (defined from 12:00 AM to 5:00 AM) during the first 8 weeks of life. The design was short-term longitudinal, from the last trimester of pregnancy until the eighth week after birth. Twenty- six first-time parents and their newborn were randomly assigned to treatment and control groups (13 in each group). Treatment parents were instructed to offer a “focal feed” (between 10 PM and 12 AM) to their infants every night, to gradually lengthen intervals between middle-of-the-night feeds by carrying out alternative caretaking behaviors (eg, reswaddling, diapering, walking), and to maximize environmental differences between day and nighttime. All parents kept 72-hour diaries of their infants’ feeding and sleeping patterns every week from birth to 8 weeks of age and rated their infants’ temperament at birth and at 8 weeks. By 3 weeks, treatment infants showed significantly longer sleep episodes at night. By 8 weeks 100% of treatment infants were sleeping through the night compared to 23% of control infants. Treatment infants were feeding less frequently at night but compensated for the relatively long nighttime interval without a feed by consuming more milk in the early morning. Milk intake for 24-hour periods did not differ between groups. Treatment infants were rated as more predictable on Bates’ Infant Characteristics Questionnaire. It is concluded that parents can have a powerful influence on the development of their infants’ sleep patterns. Frequent night waking in breast-fed infants often results in early termination of lactation.

 

 

TI:       Changes in bone density with lactation.

AU:     Sowers M, Corton G, Shapiro B, Jannausch ML, Crutchfield M, Smith ML, Randolph JF, Hollis B

SO:      Journal of the American Medical Association 269:3130-3135, 1993.

 

OBJECTIVE: To test the a priori hypotheses that significant bone loss occurs in lactation of greater than 5 months’ duration and that bone mass returns to baseline levels when breast-feeding ceases. DESIGN: Prospective cohort study design of 12 months’ duration. SETTING: General community setting with recruitment occurring at birthing education classes. PARTICIPANTS: Volunteer sample of 98 healthy women of white (n = 95) and Asian (n = 3) origin, aged 20 to 40 years, and 0 to 1 parity prior to parturition, grouped according to lactation duration: 0 through 1, 2 through 5, and 6 or more months. MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the proximal femur was measured by dual- energy x-ray densitometry at 2 weeks (baseline), 2 months, 4 months, 6 months, and 12 months following parturition, and BMD of the lumbar spine was measured at baseline, 6 months, and 12 months after parturition. RESULTS: Women with lactation duration of 6 months or longer had mean BMD losses of 5.1% and 4.8% at the lumbar spine and femoral neck, respectively, comparing baseline values with those at 6 months post partum. Women who breast-fed 0 through 1 month lost no BMD at either bone site. Bone loss in women who breast-fed 6 months or longer was not explained by differences in age, diet, body size, or physical activity. Among women who breast-fed 6 months or longer, there was evidence of return to baseline levels of the lumbar spine at 12 months after parturition. The BMD of the lumbar spine of those women who continued to breast-feed more than 9 months had increased but was still significantly lower than baseline. CONCLUSION: Extended lactation (> or = 70% of energy intake is provided for > or = 6 months) is associated with bone loss; however, there is evidence of return to baseline BMD measurement at 12 months after parturition.

 

 

TI:         Breast-feeding and breast cancer in the offspring.

AU:        Ekbom A, Hsieh CC, Trichopoulos D, Yen YY, Petridou E, Adami HO

SO:        British Journal of Cancer 67:842-845, 1993.

 

The causation of breast cancer in certain strains of mice by a virus that can be transmitted vertically, through the milk produced during lactation, has led to the hypothesis that a similar phenomenon could exist in humans. There have been laboratory-based studies in humans suggesting that a virus may be involved in the etiology of female breast cancer although other investigations did not support this hypothesis. Descriptive data and epidemiologic evidence of ecologic nature do not indicate a role of lactation in the causation of human breast cancer, but the hypothesis has not been adequately assessed in analytic epidemiologic studies. A nested case-control study undertaken in Sweden to examine the role of renatal factors on breast cancer risk in the offspring, allowed the evaluation of the importance of breast-feeding in the causation of this disease. Standardised records concerning women born at the Uppsala University Hospital from 1874 to 1954 were linked with invasive breast cancer incident cases, identified through their unique national registration number in the Swedish Cancer Registry during 1958-1990. For each case with breast cancer, the females born to the first three mothers admitted after the case’s mother were selected as potential matching controls. Only controls living in Sweden and free from breast cancer until the time of diagnosis of breast cancer in the corresponding case were eventually included in the study. The analysis was based on 458 cases of breast cancer born in singleton pregnancies and 1,197 singleton age- and birth date-matched controls. Breast-feeding was not a significant or suggestive risk factor for breast cancer in the offspring; compared to women who at discharge were wholly or partly breastfed, women who as newborn were not breastfed had a relative risk of breast cancer of 0.97 with 95% confidence interval 0.44-2.17 (P = 0.95)

 

 

TI:       Perinatal lactation protocol and outcome in mothers with and without insulin-dependent diabetes mellitus.

AU:     Ferris AM, Neubauer SH, Bendel RB, Green KW, Ingardia CJ, Reece EA

SO:      American Journal of Clinical Nutrition 58:43-48, 1993.

 

This study compared the course of lactation from days 2 to 84 postpartum in 33 women with insulin-dependent diabetes mellitus (IDDM); 33 women without diabetes selected by using gestational age of the infant, method of delivery, sex of the infant, and prior lactation experience as a means of ensuring similar patterns in factors known to influence success (control subjects); and 11 healthy reference subjects who delivered vaginally. Nutritionists visited the mothers on days 2, 3, 7, 14, 42, and 84 postpartum; obtained prenatal and perinatal medical information; and questioned the mothers on their breast-feeding experience. Women with IDDM were able to establish lactation despite postpartum separation from their infants, delays in the start of breast-feeding, reduced frequency of feeding, increased use of supplemental feedings, and the high rate of cesarean section. Clinicians must recognize the need to provide appropriate counseling so that mothers with IDDM will not be discouraged by problems with breast-feeding.

 

 

TI:       Delayed lactogenesis in women with insulin-dependent diabetes mellitus.

AU:     Neubauer SH, Ferris AM, Chase CG, Fanelli J, Thompson CA, Lammi-Keefe CJ, Clark RM, Jensen RG, Bendel RB, Green KW

SO:      American Journal of Clinical Nutrition 58:54-60, 1993.

 

Breast milk lactose, total nitrogen, conductivity, osmolality, and intake by infants of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 control women without diabetes, and 11 reference women were determined in a 3-mo study of lactation. Milk of women with IDDM had significantly lower lactose and higher total nitrogen (2-3 d postpartum), and their infants had significantly less milk intake (7-14 d postpartum) than did control or reference women. Total nitrogen was negatively correlated with milk lactose for women with IDDM at all times and for control women through day 14 postpartum. The data indicate delayed lactogenesis for women with IDDM, which was more likely to occur with poor metabolic control. Differences in milk composition of women with IDDM do not preclude them from breast- feeding their infants.

 

 

TI:       Energy expenditure in lactating women: a comparison of doubly labeled water and heart-rate-monitoring methods.

AU:     Lovelady CA, Meredith CN, McCrory MA, Nommsen LA, Joseph LJ, Dewey KG

SO:      American Journal of Clinical Nutrition 57:512-518, 1993.

 

Estimates of total daily energy expenditure (TDEE) by heart-rate (HR) monitoring were compared with those made by the doubly labeled water (DLW) method in nine exclusively breast-feeding women. Subjects recorded HR and dietary intake daily during the 8- d, isotope-measurement period. Milk energy output was determined by 3-d test weighing and analysis of 24-h milk samples. Total energy output (milk energy and TDEE) averaged 12.36 +/- 1.03 MJ/d with DLW compared with 11.74 +/- 1.3 MJ/d with HR monitoring, a 5.8% difference (NS). Individual differences ranged from -27.1% to +17.6%. The high water turnover and relatively low level of activity during lactation made the slopes of deuterium and 18O disappearance more similar, resulting in increased error in estimates of TDEE by DLW. Therefore, the DLW method may not be appropriate for use in lactating women. There are considerable individual deviations in estimating TDEE by HR monitoring, but it is satisfactory for estimating TDEE of groups.

 

 

TI:       HIV, breast-feeding and under-5 mortality: modelling the impact of policy decisions for or against breast-feeding.

AU:     Del Fante P, Jenniskens F, Lush L, Morona D, Moeller B,Lanata CF, Hayes R

SO:      Journal of Tropical Medicine & Hygiene 96:203-211, 1993.

 

A computer model was developed to assess the impact on under-5 child mortality of breast-feeding practices in developing countries in the context of HIV infection. The model was used to estimate the effect on mortality of cessation of breast-feeding among mothers HIV-positive and mothers HIV-negative at birth, for both urban and rural settings. Using parameter values for a hypothetical East African country, cessation of breast-feeding in urban areas was predicted to result in increases in under-5 mortality of 10.8% for children of mothers HIV-negative at birth, and 27% for those HIV-positive at birth, with slightly larger increases in rural areas, suggesting that breast-feeding should continue to be promoted. A sensitivity analysis was conducted to identify critical values of key variables for which a review of olicies encouraging breast-feeding is indicated. This showed that, even under extreme assumptions, cessation of breast-feeding among mothers HIV-negative at birth (but at risk of acquiring HIV during the lactation period) would increase under-5 mortality. For mothers HIV-positive at birth, the key variables are the additional risk of vertical transmission attributable to breast- feeding, the under-5 mortality rate (U5MR) in breast-fed children, and the relative risk of mortality in non-breast-fed compared to breast-fed children. Depending on the values of these key variables, there may be some urban populations with low U5MR in which the positive and negative effects on under-5 mortality of a policy change are finely balanced. However, no change in policy should be made in these areas until more precise information is available on the key variables, and the many adverse consequences of such a change have been fully explored.

 

 

TI:       Breast feeding after aesthetic mammary operations and cardiac operations through horizontal submammary skin incision.

AU:     Deutinger M, Deutinger J

SO:      Surgery, Gynecology & Obstetrics 176:267-270, 1993.

 

In most aesthetic mammary operations, a certain amount of tissue remains connected with the areola complex. When performing horizontal submammary skin incision for median sternotomy, no mammary tissue is removed. Therefore, lactation should not be impaired after these operative procedures. We examined 107 patients after aesthetic mammary operation and 27 patients after horizontal submammary skin incision and asked for breast feeding attitudes. Only two of 22 patients with a delivery after operation could not breast feed their infants because of agalactia. In four patients, insufficient support might have been the main reason for primary ablactation. In 12 patients, we found reduced areola sensibility; however, asensibility was not observed. We did not find any correlation between areola sensibility and attitude of breast feeding. No patient reported severe complications because of breast feeding. From the current data, we can conclude that breast feeding is possible after aesthetic mammary operation or after a horizontal submammary skin incision for cardiac operation. Patients should be instructed before the mammary operation and encouraged during pregnancy to breast feed their infants. Scars in the region of the breast should not be a reason for primary ablactation.

 

 

TI:       Prolactin concentrations in serum and milk of mothers with and without insulin-dependent diabetes mellitus.

AU:     Ostrom KM, Ferris AM

SO:      American Journal of Clinical Nutrition 58:49-53, 1993.

 

Diabetes may affect the secretion of prolactin, the principal lactogenic hormone. Because adequate amounts are critical to the establishment of lactation, we assessed the prolactin status of 33 women with insulin-dependent diabetes mellitus (IDDM), 33 women without diabetes, and 11 reference women participating in a study of lactation from 2 to 84 d postpartum. Circulating concentrations of serum prolactin declined temporally for all women and did not differ significantly among any of the groups. During the first postnatal week, milk immunoreactive prolactin concentrations were lower for women with IDDM than for control and reference women and the inverse relationship between lactose and milk prolactin, which was significant at day 2 postpartum for reference women, was delayed until day 14 postpartum for women with IDDM. Early breast-feeding activity, increased breast-feeding frequency, and good glycemic control enhance prolactin secretion and should be promoted during lactation in women with IDDM.

 

 

TI:         Breast feeding and anaesthesia.

AU:        Lee JJ, Rubin AP

SO:        Anaesthesia 48:616-625, 1993.

 

Anaesthetists require a good knowledge of the excretion of drugs in breast milk and the potential hazards to suckling infants of drug ingestion via breast milk. A brief account of the physiology of lactation is given. The mechanisms of drug passage into breast milk are discussed followed by a review of the excretion in breast milk of drugs used in anaesthetic practice. Suggestions for the management of anaesthesia in breast feeding mothers are offered.

 

 

TI:       Growth  patterns of breast-fed infants in affluent (United States) and poor (Peru) communities: implications for timing of complementary feeding.

AU:     Dewey KG, Peerson JM, Heinig MJ, Nommsen LA, Lonnerdal B, Lopez de Romana G, de Kanashiro HC, Black RE, Brown KH

SO:      American Journal of Clinical Nutrition 56:1012-1018, 1992.

 

We compared growth, dietary intake, and morbidity of infants breast-fed for > or = 12 mo from two populations: Davis, CA (n = 46) and Huascar, Peru (n = 52). When compared against WHO reference data (based primarily on formula-fed infants), Huascar infants appeared to falter as early as 3-4 mo, but when compared with Davis breast-fed infants, the curves for weight and length were very similar in girls until 1 0-12 mo and in boys until 6-9** mo. Thereafter, Huascar infants grew less rapidly than did Davis infants. Breast milk intake was very similar between groups, but in Huascar the amount and nutrient density of complementary foods consumed after 6 mo were lower and morbidity rates were much higher than in Davis. These results indicate that growth faltering of Huascar infants, when judged against breast-fed infants in the United States, occurs primarily after the first 6 mo of life and is not due to poor lactation performance.

 

 

TI:       Pregnancy and lactation as determinants of bone mineral density in postmenopausal women.

AU:     Kritz-Silverstein D, Barrett-Connor E, Hollenbach KA

SO:      American Journal of Epidemiology 136:1052-1059, 1992.

 

The relation of pregnancy and breast feeding to bone mineral density of the wrist, radius, hip, and spine was examined in a white, upper middle-class, homogeneous sample of 741 postmenopausal women ranging in age from 60 to 89 years. Number of pregnancies ranged from 0 to 14, with a mean of 2.0 pregnancies and 1.5 live births. Almost two thirds of the women who had had a live birth reported breast feeding. Unadjusted comparisons indicated that bone mineral density of the wrist, radius, and hip increased with increasing numbers of pregnancies, and women who had breast-fed had higher bone mineral densities at these sites. However, after adjustment for age or age and body mass index, these associations were no longer significant. Multiple regression analyses adjusted for age, age at menopause, obesity, cigarette smoking, and estrogen and thiazide use also indicated that number of pregnancies and breast feeding were not significantly associated with bone mineral density at any of the four sites measured. Results of the present study suggest that reproductive history and breast feeding are not long-term determinants of bone mineral density.

 

 

TI:       Treatment with immunosuppressive and disease modifying drugs during pregnancy and lactation. [Review]

AU:     Ostensen M

SO:      American Journal of Reproductive Immunology 28:148-152, 1992.

 

Active rheumatic disease may necessitate the treatment of pregnant and lactating patients with disease modifying (DMARD) or immu-nosuppressive drugs. This review summarizes data from the literature, and attempts to give some recommendations. Possible teratogenic effects of gold, penicillamine, and chloroquine are still disputed. As long as the issue is not settled, it seems prudent to stop using these agents as soon as pregnancy is diagnosed. Hydroxychloroquine has been used by some rheumatologists for treating pregnant patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) without malformations detected in the neonates. Sulphasalazine does not increase the rate of congenital abnormalities. Selected case reports have not shown any teratogenicity of cyclosporine A so far. However, the drug may cause fetal retardation. The use of standard doses of azathioprine does not increase the risk of congenital anomalies. By contrast, the antitumor agents cyclophosphamide, chlorambucil, and methotrexate are possibly teratogenic when given during early pregnancy, but may be less harmful in late pregnancy. Data on the excretion of DMARD and the cytostatic drugs are sparse. Because of insufficient data, breast feeding is not recommended in patients on antimalarials, penicillamine, cyclosporine A, and cytostatic drugs. Intramuscular gold and sulphasalazine seem to impose no major risk on the nursing infant.

 

 

TI:       Studies in human lactation: milk composition and daily secretion rates of macronutrients in the first year of lactation.

AU:     Allen JC, Keller RP, Archer P, Neville MC

SO:      American Journal of Clinical Nutrition 54:69-80, 1991.

 

Time-dependent changes in milk composition and secretion from pregnancy through greater than or equal to 6 mo of exclusive breast-feeding were studied in 13 multiparous women. Concentrations and secretion rates of lipid, lactose, protein, sodium, chloride, potassium, total calcium, ionized calcium, magnesium, glucose, citrate, inorganic phosphate, creatinine, and urea and pH were analyzed longitudinally from day 6 until weaning commenced. The composition of the antepartum secretion was related to the permeability of the junctional complexes between mammary cells. Significant increases in lactose, glucose, pH, and ionized calcium and significant decreases in protein, sodium, potassium, chloride, and calcium concentrations were observed between 1 and 6 mo. Significant differences among individuals, which persisted through lactation, were observed for the concentrations of sodium, potassium, chloride, and inorganic phosphate. The amount of lactose, ionized calcium, and magnesium transferred to the infant was also characteristic of each mother-infant pair. Our data imply that lactation performance is determined in the first month postpartum.

 

 

TI:         A practical guide to successful breast-feeding management.

AU:        Freed GL, Landers S, Schanler RJ

SO:        American Journal of Diseases of Children 145:917-921, 1991.

 

It is often difficult for new mothers to know whom to approach for the necessary guidance and practical problem solving required for successful long-term lactation. Although obstetricians are familiar with the care of the breast, they may not maintain the degree of postpartum follow-up necessary to ensure its proper function nor is it their responsibility to ensure that the infant receives proper nourishment. Pediatricians are expected to offer advice and information regarding not only the advantages and disadvantages of breastfeeding but also practical management of this art. We provide a guide for practitioners who wish to assist breast-feeding mothers and their infants.

 

 

TI:       The effect of maternal supplementation with linoleic and gamma-linolenic acids on the fat composition and content of human milk: a placebo-controlled trial.

AU:     Cant A, Shay J, Horrobin DF

SO:      Journal of Nutritional Science & Vitaminology 37:573-579, 1991.

 

Total fat content and therefore total energy content and the content of essential fatty acids (EFAs) in milk are known to decline with prolonged breast feeding. In a placebo-controlled study a variety of evening primrose oil (Efamol) rich in linoleic and gamma-linolenic acids, or a matching placebo were given to 39 women for a period of 8 months starting between the 2nd and 6th months of lactation. Total fat and EFA contents of the milk declined in the placebo group but rose in the primrose oil supplemented group. A surprisingly high proportion of the supplemented dietary fatty acids could be accounted for by appearance in the milk. The milk composition can be readily manipulated by changing the fatty acid composition of the maternal diet.

 

 

TI:       The effect of maternal avoidance of eggs, cow’s milk, and fish during lactation on the development of IgE, IgG, and IgA antibodies in infants.

AU:     Hattevig G, Kjellman B, Sigurs N, Grodzinsky E, Hed J, Bjorksten B

SO:      Journal of Allergy & Clinical Immunology 85:108-115, 1990.

 

Serum levels of IgE, IgE antibodies to egg white (EW) and cow’s milk (CM), IgG, and IgA antibodies to ovalbumin (OA) and beta- lactoglobulin (BLG) were measured in a group of 115 infants with a family history of atopy/allergy at birth and at 3, 6, 9, 12, and 18 months of age. The mothers of 65 infants avoided eggs, CM, and fish during the first 3 months of lactation (maternal antigen avoidance diet, D group), whereas the remaining 50 mothers had no diet restrictions (no maternal antigen avoidance diet, ND group). CM was introduced after 6 months of age and EW after 9 months. The only statistically significant difference between the D and ND group infants was a lower rate of specimens with IgE antibodies to EW and/or CM in the infants at 3 months of age (p = 0.008). IgE antibodies to EW and/or CM appeared in 62 infants during the study period and often during complete breast-feeding. In 40 of the infants, IgE antibodies appeared before the introduction of EW and CM into the diet. The IgE concentrations of the D and the ND group infants were similar. Cord-blood IgE was a poor predictor of atopy/allergy; for example, only seven of 103 infants with double heredity for atopy/allergy had values above the 90th percentile of our normal reference. The concentrations of IgG antibodies to OA and BLG were similar in the two groups. The levels decreased significantly (p less than 0.001) from birth to 6 months of age, indicating a passive placental transfer.

 

 

TI:         Lactation in insulin-dependent diabetes. [Review]

AU:        Neubauer SH

SO:        Progress in Food & Nutrition Science 14:333-370, 1990.

 

The ability of insulin-dependent diabetic (IDDM) women to breast- feed has been documented, however, there is little information concerning milk composition or factors that influence successful breastfeeding. Placental lactogen and prolactin levels can be normalized during pregnancy with good metabolic control. These hormones affect the readiness of the mammary gland for lactation. Prolactin maintains mammary gland insulin receptors to ensure anabolism. Lactation in IDDM women may be influenced by hyper- or hypoglycemia as women balance their insulin needs. Milk from diabetic animals has decreased lactose, fat, protein and volume and these effects can be reversed with insulin administration. Mature breast milk of IDDM women has increased glucose and sodium and mammary gland lipid metabolism may be impaired. Milk lactose and citrate, markers of lactogenesis II, suggest delayed lactation occurs in diabetic women. Many factors may influence lactation success and breast milk composition of IDDM women. Some of these include: method of delivery, feeding frequency, fetal condition, gestational age, mastitis incidence, metabolic control and maternal dietary intake. Lactation management of the IDDM woman must address these factors.

 

 

TI:       Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning.

AU:     Kent GN, Price RI, Gutteridge DH, Smith M, Allen JR, Bhagat CI, Barnes MP, Hickling CJ, Retallack RW, Wilson SG, et al

SO:      Journal of Bone & Mineral Research 5:361-369, 1990.

 

The calcium (Ca) metabolism of established human lactation was studied in 40 adult women (mean age 32.4 years) who had been breast-feeding for 6 months (Lac) and in 40 age-matched controls (Con) using fasting urine and blood biochemistry and forearm single-photon bone mineral densitometry (BMD). Serial studies were performed up to 6 months after weaning in Lac women and repeated once in Con women. During lactation the significant findings were (1) a selective reduction (7.1%, P less than 0.03) in BMD at the ultradistal site containing 60% trabecular bone, but not at two more proximal, chiefly cortical bone sites; (2) increased bone turnover affecting bone resorption [fasting hydroxyproline excretion, Lac 2.22 +/- 0.12 mumol/liter GF (mean +/- SEM), Con 1.19 +/- 0.04, P less than 0.001] and affecting bone formation (plasma alkaline phosphatase, Lac 81.9 +/- 2.5 IU/liter, Con 53.5 +/- 2.7, P less than 0.001, and serum osteocalcin, Lac 14.0 +/- 0.7 microgram/liter, Con 7.3 +/- 0.4, P less than 0.001); and (3) renal conservation in the fasting state of both Ca and inorganic phosphate (Pi) with a resultant moderate increase in plasma Pi but not in plasma Ca (total or ionized). There were no differences between the groups in serum parathyroid hormone (PTH, intact and midmolecule assays), 25-hydroxy- and 1, 25-dihydroxyvitamin D, nephrogenous cyclic AMP production, or plasma creatinine.

 

 

TI:         The effects of lactation on bone mineral content in healthy postpartum women.

AU:        Hayslip CC, Klein TA, Wray HL, Duncan WE

SO:        Obstetrics & Gynecology 73:588-592, 1989.

 

Bone mineral contents were estimated by dual photon absorptiometry of the lumbar spine (L2-L4) and single photon absorptiometry of the mid- and distal radius in 19 healthy women on their second postpartum day and at 6 months postpartum. All bone mineral measurements were performed by one technician, and the single and dual photon absorptiometry results were read by one observer. Daily oral calcium intakes were estimated from dietary histories obtained by a dietitian. Twelve women who breast-fed exclusively throughout the first 6 months postpartum were compared with seven formula-feeding women who did not breast-feed or who breast-fed for less than 3 months postpartum. No differences were found in age, parity, height, weight, or daily calcium intake between the breast- and formula-feeding women. Breast-feeding women had a significant decrease (averaging 6.5%) in bone mineral of the lumbar spine at 6 months postpartum as compared with 2 days postpartum (1.14 +/- 0.03 versus 1.22 +/-0.03 g/cm2, mean +/- SEM; P less than .001), whereas no significant change occurred in the formula-feeding women at 6 months (1.24 +/- 0.03 versus 1.26 +/- 0.04 g/cm2). At 6 months postpartum, the breast-feeding women had a significantly lower mean bone mineral content of the lumbar spine than did formula-feeding women (P less than .05). No significant changes were noted in bone mineral content of the mid- or distal radius in either group of women during the period of evaluation. We conclude that during the first 6 months postpartum, breast-feeding is associated with bone mineral loss from the lumbar spine, but not from the mid- or distal radius.

 

 

TI:       Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women.

AU:     Brewer MM, Bates MR, Vannoy LP

SO:      American Journal of Clinical Nutrition 49:259-265, 1989.

 

Maternal weight and body fat changes were studied in 56 women from delivery to 6 mo postpartum. Six-month weight losses (p less than 0.01) in exclusively breast-feeding (BF), exclusively formula-feeding (FF), and combination breast- and formula-feeding mothers (CF) were 8.30 +/- 0.74, 8.19 +/- 0.96, and 7.22 +/- 0.74 kg respectively; however, only BF experienced a significant change between 3 and 6 mo. Suprailiac and subscapular skinfold thickness decreased over 6 mo (p less than 0.01) with the suprailiac region reflecting a significant feeding-method effect. Increases in triceps fatfold measurements at 3 mo suggest that a temporary redistribution of body fat occurs as the energy stores of pregnancy are mobilized. Lactating mothers consumed more (p less than 0.01) kilocalories (BF, 2055 +/- 435; CF, 2005 +/- 515) than did nonlactating mothers (FF, 1453 +/- 503). Age, parity, and prepregnancy weight exerted significant covariable effects. Results suggest that lactation does play a role in postpartum weight and body fat loss but that the current RDA may be too high to permit such losses.

 

 

TI:       Luteinizing hormone releasing hormone agonist for contraception in breast feeding women.

AU:     Fraser HM, Dewart PJ, Smith SK, Cowen GM, Sandow J, McNeilly AS

SO:      Journal of Clinical Endocrinology & Metabolism 69:996-1002, 1989.

 

During the period of lactation there is a need for a reliable method of contraception since the suppressive effects of lactation on ovulation decline as the duration of breastfeeding is decreased. The aim of this study was to establish that chronic treatment with a LHRH agonist would prevent ovulation throughout the period of lactation and to evaluate the effects of the treatment on estrogen production, bleeding patterns, and nursing practice. Starting 6 weeks postpartum, nine mothers took 300 micrograms LHRH agonist (buserelin), intranasally once daily for the remainder of the duration of breastfeeding [216 +/- 18 days (mean +/- SEM)]. Urinary excretion of LH, estrone, and pregnanediol was compared to that of nine control breastfeeding mothers. In the control subjects follicular development, as assessed by rises in estrone, was minimal during the first 90 days of the study. Thereafter, phases of estrogen secretion were observed. Ovulation occurred in seven of the nine mothers on one to six occasions; time to first ovulation varied from 90-296 days. In the women taking buserelin, LH and estrone were initially stimulated for 1 and 2 weeks, respectively, then declined to basal levels. No ovulations occurred in the treated group. In six treated mothers only minor fluctuations in estrone were observed during the remainder of agonist treatment. In three subjects more frequent and sustained episodes of estrogen secretion were observed, but in contrast to the controls the rises in estrone were not followed by a typical LH surge or a rise in pregnanediol. Bleeding occurred in eight of the nine of the control mothers on one to seven occasions during the study period. The first bleed in five of the mothers was anovular, while other menstrual bleeds occurred in response to falling levels of pregnanediol. Of the mothers taking buserelin, one was amenorrhoeic, and five had only one light bleeding associated with the initial stimulation of estrone. Of the three women with continued fluctuations of estrone, one had three light bleeds, one experienced frequent spotting, while one had regular bleeding. No other side-effects, such as hot flashes or changes in nursing practices, were reported. Our results indicate that LHRH agonist treatment has the potential to be developed as an acceptable method of contraception during the postpartum period. The duration of treatment may be long enough to have a significant effect on maternal-infant well-being without encountering significant problems associated with low estrogen output.

 

 

TI:         Feeding and urine cotinine values in babies whose mothers smoke.

AU:        Labrecque M, Marcoux S, Weber JP, Fabia J, Ferron L

SO:        Pediatrics 83:93-97, 1989.

 

In Canada, 8% to 20% of infants are breast-fed by mothers who smoke. To determine whether breast-feeding increases infants’ exposure to tobacco smoke products, urinary cotinine excretion was measured in 172 babies, 33 of whom were breast-fed. A milk sample was taken from the mothers who were breast-feeding, and cotinine was measured with gas chromatography. The breast-fed babies had a median cotinine to creatinine ratio of 433 ng/mg, whereas the bottle-fed babies’ median was 200 ng/mg (P less than 10(-4)). Similar differences were observed after adjustment for the number of cigarettes smoked by the mother and by other smokers in the home in the previous 24 hours. The correlation coefficient between the number of cigarettes smoked by the mother and the breast milk cotinine concentration was significant (r = .69, P = 2 X 10(-4) ). Moreover, urine cotinine values from the breast-fed babies increased with higher concentrations of cotinine in the mother’s milk (r = .56, P = .02). These results provide evidence that breast-feeding increases exposure to tobacco smoke components in infants whose mothers smoke. This is yet another argument for strongly encouraging women who smoke to stop smoking during pregnancy and lactation.

 

 

TI:         Lactation and cancer risk: is there a relation specific to breast cancer?

AU:        Kvale G, Heuch I

SO:        Journal of Epidemiology & Community Health 42:30-37, 1988.

 

Relations between previous lactation experience and risks of cancer of the breast and other sites were investigated after follow-up of 50,274 parous women from 1961 through 1980. Among women with complete information on lactation, 5102 developed cancer and, of these, 1136 were diagnosed with breast cancer. Analyses of associations with mean duration of lactation per birth and duration for each of the three first births suggested a nonlinear relation to breast cancer. The highest risk was observed for those with intermediate duration of breast feeding, whereas lower risks were found among those with very short or very long duration. For all nongenital cancers combined, decreased risks were observed among those with the longest duration of breast feeding. However, among cancers of specific sites, a significant inverse association was found for pancreatic cancer only. The overall impression given by our data is that breast feeding is not strongly related to risks of breast cancer or any other common cancer.

 

 

TI:         Malnutrition and gastroenteritis in The Gambia.

AU:        Rowland MG, McCollum JP

SO:        Transactions of the Royal Society of Tropical Medicine & Hygiene 71:199-203, 1977.

 

There is a strong association between failure to thrive and diarrhoeal disease in young Gambian children. The high prevalence of diarrhoeal disease seen is not due to frequent attacks of “acute infantile diarrhoea” of viral orgin. The picture of protracted diarrhoea is almost certainly due to colonization of the upper bowel and the high prevalence demonstrated to be at least partly due to the environment to which the children are exposed, particularly in terms of food and water hygiene. Until this cycle of upper bowel colonization and protracted diarrhoea is broken, a diet-based nutrition programme cannot be expected to function effectively.

 

.

TI:       Breast-feeding, nutritional status, and other prognostic factors for dehydration among young children with diarrhoea in Brazil.

AU:     Victora CG, Fuchs SC, Kirkwood BR, Lombardi C, Barros FC

SO:      Bulletin of the World Health Organization 70:467-475, 1992.

 

Early identification of children at high risk of diarrhoea- associated dehydration would be of great value to health care workers in developing countries. To identify prognostic factors for life-threatening dehydration, we carried out a case-control study among under-2-year-olds in Porto Alegre, Brazil. Cases were 192 children admitted to hospital with moderate or severe dehydration, while controls were children matched to controls by neighbourhood and age, who experienced nondehydrating diarrhoea in the week preceding the interview. The following variables were significantly associated with an increased risk of dehydration, after adjustment for age and other confounding variables: absence of the father from the home; low paternal education level; young age; maternal age 25-29 years or less than 20 years; mother of mixed race; high birth order; short birth interval; low birth weight; stunting, underweight and wasting; lack of breast-feeding; presence of other under-5-year-olds in the home; families with 4- 5 members; lack of antenatal care; less than three doses of diphtheria-pertussis-tetanus or poliomyelitis vaccine; previous admission to hospital; use of medicines during the fortnight prior to the episode; and living in an unclean home. The associations were particularly strong (P less than 0.001) for the child’s age, birth weight and other anthropometric indicators, birth interval, and feeding mode. In terms of their sensitivity and specificity, however, these prognostic factors were not as effective as early signs and symptoms for predicting the outcome of the episode.

 

 

TI:         Does breastfeeding influence mortality in children hospitalized with diarrhoea?

AU:        Sachdev HP, Kumar S, Singh KK, Puri RK

SO:        Journal of Tropical Pediatrics 37:275-279, 1991.

 

The association between breastfeeding and  mortality in children hospitalized for diarrhoea was investigated in a prospective manner in 309 subjects below 18 months of age. In multivariate logistic regression analysis, 36 cases who died were compared with 273 controls who were discharged in a satisfactory condition. Breastfeeding had a strong protective effect against mortality even after allowance was made for confounding variables (including nutritional status, chronicity of illness, associated non-enteral infections) and a possible bias of interruption of breastfeeding as an early consequence of the terminal illness. The adjusted odd’s ratio (OR) and 95 per cent confidence intervals (95 per cent CI) for the protective effect were 2.7 and 2.1-3.6, respectively. The adjusted OR’s (95 per cent CI’s) were 6.0 (3.6-10.2), 2.6 (2.0-3.4), and 1.8 (1.4-2.5) for the age intervals 0-6, 7-12, and 13-18 months, respectively (P less than 0.001, less than 0.01, and less than 0.05, respectively). Further stratified analyses suggested a greater benefit in children with severe wasting, severe stunting, protracted illness, and diarrhoea as the sole illness. It is concluded that in children up to 18 months of age, breastfeeding offers substantial protection against death in children hospitalized with diarrhoea.

 

 

TI:         Diarrhoea due to breast milk: case of fucose intolerance?

AU:        Barfoot RA, McEnery G, Ersser RS, Seakins JW

SO:        Archives of Disease in Childhood 63:311-311, 1988

 

An unusual form of diarrhoea is reported that was relieved when breast feeding was stopped. Chromatography to estimate sugars in the faeces should be performed for all infants with unexplained diarrhoea before changes are made in the diet.

 

 

Проекти, представени на семинара “Решаване на проблеми за по-добро здраве”, представени на семинара за проследЯване на работата по проектите, проведен на 9 май, 1997 година в Рибарица

 

Грешки при храненето на кърмаЧетата и неблагоприЯтните последици върху здравето им

Д-р Евгения Бързашка

Плевен

 

Проектът стартира след семинара, проведен през месец юни 1996 година в Орешак. В местната преса са отпечатани статии по проблемите на правилното хранене на кърмачетата. Съвместно с фирма “NESTLE” е проведен двудневен курс с медицински сестри от детските консултации в района, на който се обсъдиха естественото хранене и правилното захранване. Един месец по-късно -през ноември 1996 г. г-н Ленин Грос от Здравна фондация “Драйфус” посети детската консултация на III градска поликлиника. На срещата с педиатри и медицински сестри бяха разгледани случаи на неправилно хранени деца с хипотрофия, изоставане във физическото и нервно-психическото развитие и хронична диария, и с ръководителя на катедра “Детски болести” на ВМИ - Плевен проф. Мумджиев бяха обсъдени по-нататъшни мероприятия по проекта.

На 19 февруари 1997 във ВМИ - Плевен се проведе  дискусия по проблемите на храненето на новородените и ролята на персонала в женската консултация и АГ клиника. По проекта беше изнесен доклад на тема “Неблагоприятните последици от отбиването на новородените”. Участваха специалисти - завеждащи детски отделения, акушер-гинеколози, неонатолози, лекари от ДМД, педиатри. Направиха се конкретни предложения и се обсъди как да се стимулира естественото хранене и правилното захранване като най-рационално хранене на кърмачетата. През месец март във Велико Търново се преведе конференция на тема: “Естественото хранене на кърмачето- вчера, днес и утре”. По проекта бе изнесен доклад на тема: “Съвременни методи за стимулация на лактацията”. На конференцията присъстваха 100 души - акушер-гинеколози, педиатри, неонатолози, медицински сестри и студентки от региона на В. Търново. Конференцията бе заснета на видеофилм, който беше излъчен по двата канала на кабелната телевизия още същата вечер. Касетата с докладите от двете конференции се използва и за здравна просвета сред майките. На среща със завеждащите ДПО - Плевен и ДМД - Плевен бяха раздадени  200 анкетни карти, които ще бъдат прикрепени към личната амбулаторна карта на кърмачето и в тях ще се отбелязва начинът на хранене на кърмачетата, захранването и физическото развитие в продължение на 6 месеца. Видеофилм, съдържащ цикъл от лекции за предимствата на естественото хранене, стимулиране на лактацията и грешки при храненето и неблагоприятните им последици върху здравето на децата ще подпомага работата на детските консултации с майките.

В рамките на проекта бе проведено и диетично лечение при 16 деца, хранени изкуствено, неправилно, с непоносимост към протеините на кравето мляко, лактозен интолеранс и постентеритна малабсорбция.

 

 

ВлиЯние на атмосферното замърсЯване на териториЯта на гр. Враца с азотни съединениЯ (NO, NO2, NH3) върху тежестта на протиЧането на бронхиалната астма

 

Д-р Емил Миленков, д-р Ал. Семков

Враца

 

В гр. Враца се забелязва тенденция за увеличаване на броя на болните от бронхиална астма, както и промяна в хода на заболяването (преобладаване на умерено тежките и тежки форми на заболяването). ХЕИ - Враца в предварителни проучвания е доказал превишаване на ПДК (пределно допустими концентрации) за тези състояния на територията на гр. Враца от 4 до 10 пъти.

Основната цел на проекта е да проучи как се отразява върху тежестта в протичането на БА атмосферното замърсяване с NO, NO2, NH3 в надпределни концентрации и това повлиява ли финансовото натоварване на обществото (лични и обществени разходи).

Регистрирани са болните от БА на територията на града. Изработени са карти с адресно нанасяне върху тях на болните от БА. В ХЕИ се изработиха карти на най-замърсените с азотни съединения зони в града, съобразно розата на ветровете. Сформираха се 2 групи по 30 болни от БА (в зоната и извън нея), подбрани по еднаква възраст и форми, както и тежест на протичането на БА. Изготви се индивидуален план на лечение на болните от БА. Автономизирането на БА от болните се осъществява чрез индивидуални карти, в които се вписват данните от персонални пийк флоуметри (частично осигурени), вида и количеството на използваните медикаменти.

Резултати до момента показват, че в дните на пикова експозиция с азотни съединения се отбелязва повишаване на броя на болните от БА, които се обръщат за консултация към нас поради влошаване на състоянието си. Повишава се и броят на посещенията в БНМП. Нараства нуждата от обичайните медикаменти, както и включване на допълнителни.

Проектът ще се реализира за срок от 18 месеца.

 

                                                  

Нормализиране теглото на затлъстели деца Чрез промЯна стила на хранене в семейството (ново отношение към процеса хранене като фактор на здраве) -  I модул

 

Стефка Ченкова

Плевен

 

Поради важността на проблема като провокиращ сериозни заболявания и поради увеличената честота на случаите на затлъстяване в детската възраст се подбраха 30 семейства с деца в начална училищна възраст - преди пубертета, без хранителни смущения.

В началния етап  на проекта се проучи стилът на хранене в 100 български семейства чрез анкети, тестове, интервюта и др., и се подбраха 30 по-нататъшни изследвания и целенасочена работа. Проведоха се семинари и практикуми, свързани със здравословното хранене и правилните навици, в които участваха родители и деца. Темите бяха съобразени с възрастта, интересите и нуждите на конкретните групи. Наблегнато бе на опознаването на хранителните продукти, целесъобразен подбор, правилна подготовка и обработка на хранителните продукти, консервиране с цел запазване на ценните съставки; суровоядство, вегетарианство, екологични изисквания към продуктите, съдове за готвене; навици за хранене - бавно, без телевизия, книги, чисти ръце; предпазване от - гранясали мазнини, плесени, паразити по зеленчуците и т.н.

След 4 - 6 месеца ще се включи и проучване за двигателната активност в рамките на семейството (възможности, навици и пр.) и семейният психоклимат като фактор за здравето на затлъстелите деца, общи интереси и пр. Екипът на проекта включва педиатър, ендокринолог, педагог, агроном и сътрудници.

 

 

ЕпидемиологиЧно проуЧване на Честотата на затлъстЯване при диабетици с инсулинонезависим диабет в района на II поликлиника - град Бургас

 

Д-р Руслан Шейков

Бургас

 

Чрез този проект се започна изследване на честотата на затлъстяване и нарушенията в липидния профил и връзката между затлъстяването и други заболявания. Създаде се център за изследване и лечение на затлъстяването съвместно с ендокринологичното отделение към “Окръжна болница” - град Бургас.

 

 

Профилактика на отравЯниЯта сред децата в гр. Плевен

 

Д-р Бойко Шентов

Плевен

 

Отравянията са най-честите инциденти в детската възраст. Изискват квалифицирана, спешна, инвазивна, често скъпоструваща медицинска помощ. Причиняват временни, а понякога трайни функционални нарушения. През 1996 г. в “Детска клиника” - Плевен са лекувани 132 деца с екзогенна интоксикация, 6 от тях са починали. По принцип те са предотвратими, но родителите на децата да съхраняват правилно медикаментите и другите токсични субстанции.

Целта на проекта е да се намали честотата на инцидентите на отравяне сред децата от Плевен, ката се работи целенасочено с  родителите на деца до 6 годишна възраст. Здравно-просветната програма включва лични срещи, разпространяване на брошура със здравно-просветна насоченост, както и запознаване на обществеността с проблема чрез масмедиите: местни вестници, радио- и телевизионни станции. Оценката на ефективността на проекта ще бъде направена след ново отчитане на честотата на инцидентите.

Досега са проведени индивидуални срещи с участъковите педиатри от две от градските поликлиники. Отпечатани са две статии в два от местните вестници (седмичник и ежедневник). Направено бе и епидемиологично проучване върху отравянията на базата на хоспитализираните по този повод деца в детска клиника за 1996 г. В бъдеще се планира обособяване на център за контрол на отравянията, локализиран в катедра “Детски болести” на ВМИ - Плевен.

 

 

Контрол на артериалното налЯгане при хипертоници в диспансерни условиЯ

 

Д-р Диана Неделчева

Плевен

 

В България 64 % от населението боледува и умира от сърдечно-съдово заболяване. Страната е на първо място в Европа по темпове на покачване на исхемичната болест на сърцето (ИБС). 25 % от населението на региона страда от артериална хипертония (АХ). Тя е самостоятелен коронарен рисков фактор за ИБС и внезапната сърдечна смърт. Следователно, контролирайки АХ, намаляваме сърдечно-съдовия риск на болния и удължаваме неговия живот.

Целта на проекта бе да се осъществи контрол на артериалното налягане(АН) при хипертоници в диспансерни условия с цената на минимални лични и обществени  разходи в конкретен смисъл: намаляване на АН до 140/90 или до степен, която се понася добре или безопасно; намаляване на честотата на хипертоничните кризи, хоспитализациите, временната нетрудоспособност, пресорния ефект върху прицелните групи, предотвратяване на усложнения в еволюцията на АХ.

Чрез малка практическа програма, обхващаща 100  болни, сигурни хипертоници. набавянето на медицинска информация се осъществява от личните картони, епикризи от  хоспитализации, фиш за обслужен болен от ЦСМП. Програмата има терапевтично-образователен характер. Болните се обучават сами да измерват АН в дома си и да контролират проблема. Повярваха в нестандартния подход и така благоприятно повлияха върху заболяването си: някои обучават и свои приятели и роднини.

На всички болни се изготвиха дневни карти за нанасяне на измерените стойности, настъпилите хипертонични кризи и приетите лекарства. Всички имаха собствени апарати за кръвно налягане, а за работата с групата се достави прецизен живачен манометър. Бе оценен техният сърдечно-съдов риск чрез изследване на липидния им профил; издадоха се картони за частично облекчаване при заплащането на медикаментите. Изработиха се индивидуални комплекти с инструкции за рационално хранене, евентуални усложнения, алгоритми на поведение при хипертонични кризи и седем “златни” правила за лечение на АХ. Разяснен беше индивидуалният подход към проблема и се изискваше абсолютно съдействие от страна на пациента и неговото семейство. Работата започна с малки групи от 4 - 5 пациенти. Проведоха се 2 срещи с лекарите от първичната здравна мрежа и една с голяма част от групата. Осигури се телефонна линия за връзка между болните и кардиолога. Отчетоха се първите междинни резултати. Само 4 болни от групата бяха хоспитализирани за реализиран исхемичен мозъчен инсулт.

Контролът и работата с пациентите се осъществява от трима лекари - кардиолог, личен лекар и терапевт от БМП.

 

 

Образователен проект в средниЯ И горен курс на уЧилищата в град Стара Загора

 

Красимира Лазарова

Стара Загора

  

През последните няколко години се наблюдават се тревожни тенденции в разпространението на вируса на СПИН в България, както и  придвижване на заразеността по посока на по-младите групи от населението (най-голямата възрастова група са 19 -24 години). От “вносна” инфекция СПИН се превърна в инфекция, която се придобива в България основно по пътя на необезопасени полови контакти.

На фона на тази картина признаваме, че използването на единственото предпазно средство - презервативът - е крайно непопулярно.

Добре известен е фактът, че проблемът “СПИН” има огромна икономическа и психосоциална цена. Последните няколко години представиха убедителни факти, че епидемията от разпространението на вируса се съпровожда от десетократно по-голяма епидемия от напрежение, страх и репресивност (болестта е заразна, смъртоносна, безсимптомна, срамна, няма лечение и ваксина). Прилагането на ефективна програма има най-голям шанс за успех.

През последните седем години заболеваемостта от болести, предавани по полов път в Старозагорския регион се е увеличила над 20 пъти. Много голяма част от подрастващите разбраха погрешно демокрацията като разюздана свобода и осъществяваха безразборно полови контакти.

Целевата група на програмата са 14 - 19 години, а акцентите на образователната програма бяха: техники на безопасен секс, същност и ефект на HIV и AIDS, толерантно отношение към серопозитивните и болните. В програмата бяха включени и рискови  групи - промискуитиращи, етнически малцинства, проституиращи. Винаги е вземано съгласието за работа от подрастващите чрез среща - допитване.

Проучена бе СПИН - съзнателността преди  и след кампанията. Всички етапи на проекта са филмирани и се излъчи филм за него по ТВ Стара Загора”. Води се дневник за всички мероприятия по проекта. На всеки три месеца  обществеността се запознава с хода на проекта и резултатите от мероприятията.

 

 

Приложение на акупунктурата за леЧение на юноши (15 - 18 г.), страдащи от БА (бронхиална астма)

 

Д-р Стела Вулова - педиатър, Недка Алексиева - иглотерапевт

Плевен

 

БА е социалнозначимо заболяване в България, от което страдат 4 - 5 % от децата в страната. Групата от 15 - 18 год. бе избрана като най-слабо изследвана възрастова група в здравен аспект в България. Целта на програмата е съществено намаляване на броя и тежестта на пристъпите от БА.

В програмата са включени 4 деца на възраст 4-8 год. и 9 юноши, страдащи от средно тежка форма БА и лекувани до момента медикаментозно.

Процедурите се провеждат в период на пристъп и в извънпристъпния период.

Методиката включва до 15 процедури през 20 дни - 30 иглотерапевтични сеанса, след което се изработва индивидуална програма за лечение на всеки пациент с постепенно разреждане на процедурите в интервал на 1 година - година и половина и повече време непрекъснато клинично наблюдение.

Резултатите при 13-те наблюдавани деца са изчезване на пристъпите, спиране на медикаментозното лечение, подобряване качеството на живот на децата и родителите им.

От 6 месеца към програмата са присъединени трима астматици по възраст между 30 - 45 години и в това включване на възрастни болни и разширяване на работата с децата е развитието на проекта в бъдеще.

Проблем е снабдяването с индивидуални игли (всеки пациент трябва да разполага със 100 акупунктурни игли).

                                      

 

Профилактика на респираторните инфекции при  болни с бронхиална астма с Re-sPivax и противогрипна ваксина

 

Д-р Антоанета Кърчева, д-р Павлина Глоговска, д-р Стела Вулова

Плевен

 

Често наблюдаван факт в клиничната практика е изострянето на бронхиалната астма няколко дни след началото на вирусна или бактериална инфекция. Нашата цел бе да пренасочим средствата от квалифицираната медицинска помощ на обострянията на астмата към профилактични мероприятия, които да предотвратят възникването на такива обостряния, провокирани от инфекции (вирусни и бактериални).

Набрана бе група пациенти с бронхиална астма (БА) - лека и средно тежка форма, включваща 100 пациенти. Създадена бе база данни за тях. През октомври на 30 от тях бе приложен полимикробния имуностимулатор Respivax, а през април - на още 20. В края на м. октомври и началото на ноември 1996 г. при 50 болни беше приложена противогрипната ваксина Vaxigrip.

Respivax и Vaxigrip се прилагаха в момент на ремисия на БА след консултативен преглед в кабинет “Астма” на фондация “Белодробни заболявания” - Плевен. Основната група болни, с които работим, беше набрана от пациенти от кабинет “Астма”, а друга част - чрез участъковите лекари или насочени чрез отдел “Епидемиологичен” на ХЕИ.

Необходимо условие беше болните да притежават пийк флоуметри и дневни карти за обективно отразяване на състоянието. Ваксините бяха поставяни в кабинет “Астма”. Работата ни беше улеснена от възможността да ползваме материалната база, а също и информацията за пациентите на фондация “Белодробни заболявания”, сред които можахме да подберем подходяща група.

Затруднения: Отнася се до ваксиниране на болните със сериозно заболяване, които трябва да бъдат много внимателно преценявани. Необходими условия бяха:         

1.Астмата да е под контрол. 

2.Да няма анамнеза за алергия към яйца и АБ, съдържащи се във ваксината.

3.Да няма анамнеза за инцидент при предишни ваксинации.

4.Да е налице сътрудничество от страна на пациента.

Въпреки нашата предварителна работа имаше пациенти с предубеждения към ваксините въобще и други специално по отношение на противогрипната ваксина. Те не пожелаха да се ваксинират , въпреки че бяха подходящи. Поради високата цена на ваксините се постарахме да осигурим безплатни за социално слабите.

През 1997 г. същите препарати ще се приложат на същата група пациенти и данните да бъдат обобщени.

                     

 

ПодобрЯване обслужването на болни с БА и ХОББ в региона на гр. Видин

 

Д-р И. Илиев, д-р Т. Пешев

Видин

  

Цел на проекта е възстановяване и поддръжка на максимална работоспособност и физическа активност на болни с обструктивни белодробни състояния.

До момента е проведено обучение на болни с БА и ХОББ с цел резултатно лечение и самоконтрол. Обучени са лични лекари и лекари от ЦСМП за лечение и контрол на болни с обструктивни заболявания. Активно се издириха и нерегистрирани в специализираните кабинети пациенти във Видин и в региони, където няма специализирана помощ по проблема.

При реализацията на проекта срещнахме редица трудности - ограничени финансови възможности, непълноценно сътрудничество на болничната администрация и лекарите от специализираните кабинети, подценяване на проблемите от болните и липсата на постоянство в тяхното сътрудничество, финансова зависимост от пълноценната терапия и контрол от имущественото състояние на болния.

Наред с продължаване на работата на проекта с намаляване ефекта на горните трудности, смятаме да се ориентираме към превантивна насоченост на мероприятията и да го разширим, като включим болни с трайно нарушена работоспособност, нуждаещи се от надомна кислородотерапия.

 

 

УвелиЧаване  на броЯ на кръводарителите в Ловешки регион

 

Д-р Ивелина Иванова, д-р Цеца Кирова, м.лаб. София Цветкова Ловеч

 

През последните години броят на кръводарителите е намалял с около 50%, а нуждите от кръв за лечебните заведения са непроменени. Това налага нов подход към хората, които са обект на нашата дейност. Проектът включваше мероприятия, които да върнат старите и да привлекат нови кръводарители.

По местната радиостанция бяха излъчени поздравителни концерти за кръводарители по случай Коледа и Нова година, изпратени им бяха поздравителни картички за рождените им дни, Коледа и Великден. Изработени са рекламни материали и анкетни карти. Проведени са и срещи с кръводарителите, на които на всеки от тях  бе изказана благодарност за дарената кръв. Информация за целите и резултатите от проекта се публикува в местен вестник. На наши редовни кръводарители оказваме на съдействие при необходимост от преглед и лечение

За в бъдеще възнамеряваме да активизираме работата в училищата с оглед осигуряване на бъдещи кръводарители. По местната кабелна телевизия ще се излъчи видеозапис с информация по кръводаряването.

Планираме среща с колеги от останалите центрове по кръводаряване, на която ще представим и популяризираме проекта.

 

 

ПромоциЯ на кърменето в гр. Плевен

 

Д-р Ваня Недкова

Плевен

 

През последните години в развитите страни се увеличиха естествено хранените деца до 80 % през първите 4 месеца от живота им, а през 1995 година в гр. Плевен се кърмеха едва 45 % от децата.

Целта на проекта бе да се увеличи броят на естествено хранените деца до 60 %.

Организирахме и проведохме две конференции в Плевен и Велико Търново по проблемите на храненето. Участваха над 150  акушер-гинеколози,  акушерки, педиатри, участъкови медицински сестри. Раздадени бяха 150 листовки за десетте стъпки за успешно кърмене на УНИЦЕФ, направено бе предложение за създаване на колективи “Приятели на кърмачето. Отпечатани и въведени са 200 фиша към амбулаторната карта за отчитане начина на хранене на децата. Осигурени са и са безплатни консултации на майките по проблемите на хранене на децата. Публикувахме и статия за храненето на двумесечните деца.

До момента броят на кърмените двумесечни деца е увеличен - 80 % се кърмят. Резултатите ще се отчитат на 6 месеца и след 1 година.

 

 

Скрининг на населението на десет села в региона на Монтана за ранна диагностика на глаукома

 

д-р Милена Средкова

Монтана

 

Глаукомата е на първо място като причина за едноочна слепота. Боледуват 1.5 % от хората над 40 годишна възраст, а над 60 г. те са вече 6 %. Поради бедната симптоматика диагноза обикновено се поставя в напреднал стадий. Проучването има за цел чрез изследване на зрителната острота, очно налягане и офталмоскопия да се постави ранна диагноза на глаукомата сред тази група население.

Проучена бе възрастовата структура на населението на 10 села и се установи, че  в 5 от тях всички жители са над 40 години. От  преминалите през  очен кабинет за 1995 г. с диагноза “глаукома” са били 0.01 % от хората над 40 години в региона на Монтана и гр. Монтана.

Получихме съдействие от селските здравни служби за информиране на населението и прегледахме 550 пациенти от 5 села. От тях 27 бяха с повишено вътреочно налягане. След допълнителни изследвания диагноза “глаукома” беше поставена на 14 от тях. Трима от тях са оперирани.

При 102 пациенти бяха установени съдови заболявания на очите, 10 бяха с диабетна ретинопатия, 80 - с катаракта. Създадена бе  картотека на глаукомно болните в “Очен кабинет” и в момента активно наблюдаваме 200 пациенти с глаукома.

 

                                                                                 

Профилактика на зъбниЯ кариес в ранна детска възраст (3 г. - 6 г.)

 

Стоянка Александрова

Плевен

  

През последните години в България се наблюдава увеличаване на процента на зъбния кариес в ранна детски възраст (3 - 6 г.).

Целта на проекта е намаляване до минимум кариеса при децата.

През месец януари 1996 г. е проведен профилактичен преглед на 50 деца от две първи групи (3 г.). 19 деца са с кариес. Проведено е лечение от училищния зъболекар. От 19 деца 15 са излекувани.

Проведени са индивидуални разговори с родителите за създаване на здравни навици на децата В заниманията на децата е включено приучване към правилно миене на зъбите вкъщи и детската градина.

В края на учебната година през месец май 1997 г. се проведе профилактичен преглед на децата от двете първи групи. (3 г.).

Дори в началния стадий на проекта има по-добро разбиране за зъбната профилактика при децата.

                                                  

 

Дейности за намалЯване на травматизма и възникващите от него усложнениЯ във военно поделение”

 

Лазар Лазаров

Ст. Загора

  

Целта на проекта с образователно-профилактичен характер бе да се намалят  с 50 % травматизма и последващите го усложнения. Той бе реализиран на територията на военно поделение и войскови полигони в продължение на 6 месеца  с 60 човека - срочно- и свърхсрочнослужащи.

Проблемите, които констатирахме  в процеса на реализация са нарастването на алкохолизма и наркоманията в армията, които също довеждат до травматизъм и зачестили убийства с оръжие сред войниците, както и зачестяване на венерическите заболявания вследствие демократичните промени (публични домове, магистрални момичета и др.), а оттам и опасност от СПИН.

Затова успоредно с лекциите за травматизъм би следвало да се запознават и с изложените по-горе проблеми.

  

 

Помощ за самотноживеещите възрастни хора в региона на Велико Търново, невклюЧени в рамките на Домашен Социален Патронаж, осъществена от студенти със специалност “Социални дейности”

 

Стела Стоянова

Велико Търново

 

Застаряването на нацията и урбанизацията в страната превърнаха самотноживеещите възрастни в проблем за Велико Търново. ДСП не е в състояние да обгрижва всички нуждаещи се. Това са причините, обособили нуждата от студентска намеса.

Проектът цели да разшири обсега на самотноживеещите възрастни, за които се полагат грижи. В работата взеха участие 36 студенти от III и IV курс.

Първият етап беше теоретичен. Студентите анкетираха 86 възрастни от региона. След обобщаване на данните преминахме към практическа социална работа. 24 студенти започнаха да посещават по един възрастен един път през седмица. Срещите обсъждахме по време на упражнения.

Практическата част на проекта е в ход от март 1996 г. Предстои  да се анализира сегашното състояние на обгрижваните възрастни, като за целта те повторно ще бъдат анкетирани от студентите.

 

 

ОбуЧение на КандидатводаЧи на МПС за оказване на първа помощ при Пътнотранспортни произшествиЯ

 

д-р Папазова, д-р Велчев

Плевен

Раз­ра­бо­те­на бе план-про­г­ра­ма за обу­че­ние на кан­ди­дат-во­да­чи на МПС за ока­з­ва­не на пър­ва по­мощ. Из­не­се­ни бя­ха на ле­к­ции по про­ве­де­ния план сред кан­ди­дат-во­да­чи на МПС. По ос­но­в­ни­те те­ми има­ше пра­к­ти­че­с­ки за­ня­тия с ма­не­кен . Про­ве­до­ха се кур­со­ве за квалификация на полувисш и среден медицински персонал и шофьори. Инсталиран бе пряк телефон с пътна полиция.

Изработиха се табла за провеждане на образователната програма в съдействие с КАТ, СА, БЧК и средни училища. Разработиха се листовки и брошури за онагледяване и се разпространиха сред кандидат-водачи на МПС.

Изнасяне на лекции и практически занятия и пред сред служители на КАТ.

 

 

Изработване на стандартИЗИРАН подход при обслужване на спешноболни в ЦСМП - гр. Плевен с цел съкращаване времето за доболниЧно обслужване и избЯгване на пропуски и грешки (Алгоритми на поведение при спешни състоЯниЯ)

 

Д-р Мая Джунова

Плевен

 

Проектът се разработва на няколко етапа:

1.Разработване на алгоритми на поведение в помощ на дежурните лекари в спешно приемно отделение (СПО) и филиалите.

2.Изработване на табла, монтирани в СПО и филиалите.

3.Изготвяне на справочна програма в полза на работещите в СПО.

4.Обсъждане на програмата се обсъжда със специалисти от съответните профили. Коригиране, допълване и внедряване на програмата в сътрудничество с невролози, пулмолози, вътрешни болести, хирурзи и др.

5.Запознаване с идеята и нейното разпространяване в останалите центрове в страната.

 

 

Създаване и приложение на информационно-експертен софтуер в ЦСМП с цел повишаване ефективността на диагностиката и леЧението на спешноболните пациенти

 

Благовест Бечев

Плевен

  

Технологията на действие в момента в БП е след повикване по телефона диспечерът да подава случая към екипа на БП, който отива на местопроизшествието и оказва първа помощ. Ако е необходимо, пациентът се откарва в СПО или болничното отделение.

Ако след повикването диспечерът би могъл да даде предварителна информация за пациента, при който ще се отиде, то това би било от изключителна важност при някои случаи.   Например, при посещение на изпаднал в кома диабетно болен е от голямо значение предварителната информация за дозата инсулин, която е вземал до момента.

Получаването в реално време (за 20 - 30 сек.) на предварителната информация е възможно на базата на новите информационни технологии.

2.Направеното досега е в две направления:

а)Създаване на база данни и системата й за управление. Тя позволява на диспечера да потърси информация за пациента - обща и специфична за рисковата група, да я актуализира. Тази информация се подава на екипа, тръгващ за случая. Възможна е справка от лекаря по зададени критерии, помощ за алгоритъма на поведение и терапия.

б)Събиране на информация за рисковите контингенти в гр. Плевен - астма, диабет, епилепсия, хипертония, инсулт и ритъмни и проводни нарушения.

Общият брой - приблизително 7000 човека, като информацията е непълна и подлежи на актуализиране.

3.Перспективи:

След началото на 1998 г., когато се въведе компютъризирано диспечерно отделение, ще се създаде реална възможност да се внедри пълноценно тази система.

Бъдещото й развитие: Ще дава съвет, експертна помощ за конкретния случай при наличието на предварителна информация за пациента.

                          

 

ЕндемиЧна струма и профилактиката й в региона на ТроЯн и Априлци

 

Д-р Т. Русев, д-р В. Йотова, д-р А. Делчев

Плевен, Ловеч, Троян

 

Йоддефицитните заболявания (Iodine Deficiency Disorders) са група болестни състояния, обусловени от екзогенен йоден дефицит, имат ендемичен характер и могат да бъдат предотвратени чрез адекватен и системен йоден прием. Поради своята честота и разпространеност тези заболявания са световен медико-социален проблем. По данни на СЗО 29 % от населението в света (над 1.5 милиарда души) живеят в геоекологични области с йоден дефицит. От тях 655 млн. (12 %) имат гуша. В България 3.8 милиона от населението живее в йоддефицитни райони, заемащи 1/3 от територията на страната. През последните години се отбелязва увеличаване на честотата на ендемичната струма.

Един от ендемичните райони е Троянският. Прави впечатление значителният брой пациенти от този район, консултирани и лекувани в Ендокринологична клиника към ВМИ - Плевен. Много от болните са с напреднали форми на заболяването. Едно клинико-епидемиологично изследване може в значителна степен да помогне за ефективна профилактика и лечение на заболяването.

Целта на проучването е да се установи честотата и тежестта на ендемичната струма и се осъществи контрол върху профилактиката.

Осъществена е проверка в търговската мрежа за наличието на йодирана готварска сол.

Проведено е проспективно рандомизирано клинично проучване при 417 деца на възраст от 7 до 17 години и 296 възрастни (18 - 60 години) от гр. Троян. Увеличение на щитовидната жлеза се установява при 16.7 от децата. При 86 % от случаите струмата е от I-а степен, а 77 % от засегнатите са момичета. Заболявания на щитовидната жлеза се диагностицираха при 90 (30.4 %) от възрастните. За ехографско изследване са насочени 65 от пациентите, а за хормонално - 29.

От гр. Априлци бяха изследвани 168 лица на възраст от 19 до 65 г. Диагностицираха се и тиреоидни възли, а три от прегледаните жени бяха оперирани поради заболявания на щитовидната жлеза.

Предстои анализ на получените досега резултати, определяне на тежестта и преобладаващите форми на заболяването.