The Influence Of Breastfeeding On Postpartum Weight Retention

Background:your words Weight gained during pregnancy and not lost postpartum has been identified as a contributor to increased obesity risk among women of childbearing age. Objective: To determine the influence of any and exclusive breastfeeding duration on postpartum weight retention (PPWR). Design: Women were selected from the longitudinal Infant Feeding Practices Study II (IFPS II) . All women who reported both their pre-pregnancy weight and at least one postpartum weight were included in the analyses. Multivariate logistic and linear regression models were used to examine the association between any and exclusive breastfeeding duration and PPWR at 3 (n=2254), 6 (n=1966), 9 (n= 1824), and 12 (n=1693) months postpartum. Models were controlled for pre-pregnancy BMI, maternal age, parity, poverty level, education, and prenatal smoking status. Results: Results indicate that breastfeeding is associated with PPWR. Any breastfeeding for between 3-4 and 4-5 months was associated with an increased odds of retaining above median PPWR at 12 months postpartum (OR: 1.99, 95%, CI: 1.21, 3.24; OR: 1.83, 95% CI; 1.01-3.29). By contrast, exclusive breastfeeding was associated with decreased odds of retaining above median PPWR at 6 months (OR: 0.63, 95% CI: 0.41-0.98). Exclusive breastfeeding for at least 6 months was also associated with significantly decreased odds of retaining above median PPWR at 6, 9, and 12 months postpartum. Conclusion: Exclusive breastfeeding for at least 6 months was associated with decreased odds of retaining above median PPWR

The Dietary Intake, Food Security, and Quality of Life of HIV-Positive Individuals Receiving Home Delivered Meals

Background: Nutritional status has become an increasingly important aspect of quality of life for people living with HIV/AIDS (PLWA). Ensuring the best possible treatment of HIV/AIDS additionally requires a nutritionally balanced diet to maintain a healthy body. AIDS Project New Haven (APNH) is an organization that provides access to a variety of comprehensive support services to those affected by HIV/AIDS. In order to address the nutritional shortcomings of homebound PLWAs, APNH provides home delivered meals through a program called Caring Cuisine. Objective: To inform APNH of client characteristics of both Caring Cuisine and case management. Additionally, a comparison of dietary intake, food security, quality of life, mental health, and HIV risk behaviors between Caring Cuisine and case management clients is important. With these descriptive measures, we aimed to assess the influence of home delivered meals through Caring Cuisine on nutritional status, clinical indicators, and various quality of life measures. Design: There were two parts to this evaluation that included a medical chart review (n=164) of all active APNH clients and client surveys (n=21) that were used to assess demographic information, dietary intake and diversity, food security, and quality of life/ mental health. Of those that completed the questionnaire,11 individuals were Caring Cuisine clients while 10 were case management clients. Scores were developed for survey measurements that were analyzed by student t-test and chi-squared test. Results: Overall, Caring Cuisine clients were older, less able to work and live in smaller households. There was no significant difference in quality of life indicators, except for social functioning. Less social functioning was seen for Caring Cuisine clients (43.6±35.6) than for case management clients (78.0±22.0). Additionally, household size was significantly smaller in Caring Cuisine households (p-value = 0.0006). On average, Caring Cuisine clients had lower physical health(34.1±8.8) and mental health summary scores (43.5±9.8) compared with case management clients (41.5±8.7 and 49.2±9.3, respectively). Furthermore,Caring Cuisine clients reported higher food security (1.7±2.2) than case management clients (6.0±7.1) and consumed 3 more vegetables, fruits dairy, meat and grains. However, Caring Cuisine clients also consumed more saturated fats, cholesterol, and sodium. Conclusion: As a preliminary analysis assessing subject characteristics of APNH clients enrolled in Caring Cuisine compared with general clients, we saw differences in absolute values of dietary, behavioral, and clinical outcomes. However, at this time, there is not a large enough client base to suggest that clients of APNH are significantly different from one another by Caring Cuisine enrollment status.Trends indicate that Caring Cuisine clients have on average less healthy eating habits, higher foods security, more risk behavior activities, and decreased quality of life indicators as compared with case management clients. Larger studies are needed to confirm and validate these findings.https://elischolar.library.yale.edu/ysph_pbchrr/1036/thumbnail.jp

Effects of In Utero and Early Life PM2.5 Exposure on Disease Risk Among Infants and Young Children

Particulate matter with a diameter of 2.5 microns or less (PM2.5), a surrogate estimate of traffic-related air pollution, is widespread and a risk to public health. In-utero exposures to PM2.5 may increase risk of birth defects, the leading cause of infant death during the first year of life in the United States, while early life exposures may increase risk of morbidities, such as bronchiolitis, the leading cause of infant hospitalizations, or otitis media (OM), the most common childhood infection. Infants may be more susceptible to negative PM2.5 effects because they are more likely to be active, breathe more air per pound of body mass, and are still developing. The effects of in utero and early life PM2.5 exposure on the risk of birth defects and infant bronchiolitis and OM are assessed among all births from 2001-2009 using the Pregnancy Early Life Longitudinal Data System (PELL), a Massachusetts birth cohort that has been linked to all subsequent records of clinical encounter. PM2.5 exposure models were based on data from satellite remote sensing, which provide extensive spatial coverage throughout Massachusetts. Findings suggest in utero PM2.5 exposure during specific critical windows of exposure may be associated with risk of specific cardiac defects. Acute early life PM2.5 exposure was associated with risk of infant bronchiolitis and OM clinical encounters, especially among preterm infants. Investigations of chronic PM2.5 exposure indicate null associations with infant bronchiolitis and OM clinical encounters, even after rigorous control for confounding

Maternal exposure to traffic-related air pollution and birth defects in Massachusetts

Exposures to particulate matter with diameter of 2.5µm or less (PM2.5) may influence risk of birth defects. We estimated associations between maternal exposure to prenatal traffic-related air pollution and risk of cardiac, orofacial, and neural tube defects among Massachusetts births conceived 2001 through 2008. Our analyses included 2729 cardiac, 255 neural tube, and 729 orofacial defects. We used satellite remote sensing, meteorological and land use data to assess PM2.5 and traffic-related exposures (distance to roads and traffic density) at geocoded birth addresses. We calculated adjusted odds ratios (OR) and confidence intervals (CI) using logistic regression models. Generalized additive models were used to assess spatial patterns of birth defect risk. There were positive but non-significant associations for a 10µg/m(3) increase in PM2.5 and perimembranous ventricular septal defects (OR=1.34, 95% CI: 0.98, 1.83), patent foramen ovale (OR=1.19, 95% CI: 0.92, 1.54) and patent ductus arteriosus (OR=1.20, 95% CI: 0.95, 1.62). There was a non-significant inverse association between PM2.5 and cleft lip with or without palate (OR=0.76, 95% CI: 0.50, 1.10), cleft palate only (OR=0.89, 95% CI: 0.54, 1.46) and neural tube defects (OR=0.77, 95% CI: 0.46, 1.05). Results for traffic related exposure were similar. Only ostium secundum atrial septal defects displayed significant spatial variation after accounting for known risk factors

Exposure measurement error in air pollution studies: the impact of shared, multiplicative measurement error on epidemiological health risk estimates

Spatiotemporal air pollution models are increasingly being used to estimate health effects in epidemiological studies. Although such exposure prediction models typically result in improved spatial and temporal resolution of air pollution predictions, they remain subject to shared measurement error, a type of measurement error common in spatiotemporal exposure models which occurs when measurement error is not independent of exposures. A fundamental challenge of exposure measurement error in air pollution assessment is the strong correlation and sometimes identical (shared) error of exposure estimates across geographic space and time. When exposure estimates with shared measurement error are used to estimate health risk in epidemiological analyses, complex errors are potentially introduced, resulting in biased epidemiological conclusions. We demonstrate the influence of using a three-stage spatiotemporal exposure prediction model and introduce formal methods of shared, multiplicative measurement error (SMME) correction of epidemiological health risk estimates. Using our three-stage, ensemble learning based nitrogen oxides (NOx) exposure prediction model, we quantified SMME. We conducted an epidemiological analysis of wheeze risk in relation to NOx exposure among school-aged children. To demonstrate the incremental influence of exposure modeling stage, we iteratively estimated the health risk using assigned exposure predictions from each stage of the NOx model. We then determined the impact of SMME on the variance of the health risk estimates under various scenarios. Depending on the stage of the spatiotemporal exposure model used, we found that wheeze odds ratio ranged from 1.16 to 1.28 for an interquartile range increase in NOx. With each additional stage of exposure modeling, the health effect estimate moved further away from the null (OR=1). When corrected for observed SMME, the health effects confidence intervals slightly lengthened, but our epidemiological conclusions were not altered. When the variance estimate was corrected for the potential "worst case scenario" of SMME, the standard error further increased, having a meaningful influence on epidemiological conclusions. Our framework can be expanded and used to understand the implications of using exposure predictions subject to shared measurement error in future health investigations