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Breast-feeding contributes significantly toward the physical and psychological well-being of infants and health professionals should encourage mothers to breast-feed whenever possible. Nutritional advantages of breast milk include 1) a low sodium to potassium ratio; 2) an appropriate fat content; 3) optimal absorption rates for each compositional factor; and 4) high taurine levels which may promote nerve cell growth. Breast-fed infants are less likely to suffer from infant obesity than bottle fed infants. Most investigators agree that human milk affords the infant protection against infections; however, some diseases may be transmitted from the mother to the infant by breast feeding. Breast-feeding enhances the psychological well-being of both the mother and the child and strengthens the emotional bond between them. Breast feeding is contraindicated 1) for infants with phenylketonuria, rare amino acidurias, and galactosemia; 2) for infants whose mothers have diseases such as infectious tuberculosis and venereal disease; and 3) for infants whose mothers are taking medications which might be harmful to the infant. A history of breast cancer in the mother's family does not contraindicate breast-feeding. Hyperbilirubinemia in breast-fed infants can generally be prevented by the prompt initiation of breast-feeding following delivery and by providing the infant with frequent feedings throughout each 24 hour period. Infants with cleft palates can be breast-fed if they are fitted with a dental prosthesis. The threat of breast milk contamination by environmental pollutants is insignificant for most women in the U.S. Unless the mother has been exposed to an abnormally high level of chemical pollution, she need not worry about breast milk contamination.
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PMID:Breast-feeding and infant health. 52 12

A review of the risk of endometrial, ovarian, cervical and breast cancer in oral contraceptive users sets these neoplasms in perspective. Endometrial cancer is the 3rd most common cancer in U.S. women with 34,000 cases annually. The average women is 61 years old. Risk factors are obesity, nulliparity, late menopause and unopposed estrogens. Oral contraception for 1 year or more reduces the risk of endometrial cancer as much as 50%, more so for nulliparous women, and this protection lasts as long as 10 years. Ovarian cancer, with a 5-year survival of only 30%, kills 11,000 women a year. Risk factors are nulliparas, late 1st pregnancy and prior breast cancer. Orals decrease the risk as much as 50%, in proportion to duration of use. Cervical cancer, now only the 6th leading cause of cancer deaths for women because of screening, is probably a venereal disease. This complicates studies on the risk of pill use, which are controversial because of confounding factors such as sexual activity, surveillance, use of barrier contraceptives, and method of grading Pap test. Breast cancer has a long list of known risk factors, but studies linking the pill are controversial, especially regarding latency. The majority of studies report a relative risk around 1.0.
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PMID:Combination oral contraceptives and cancer risk. 220 49

There are currently numerous well-woman clinics in Britain which emphasize a specific aspect of health care, including cervical cancer screening (134 centers), family planning (142 centers), antenatal care (162 clinics), and venereal disease control (15 clinics). However, care provided in these clinics is fragmentary and excludes certain population groups from coverage. For example, cervical cancer smears are largely sought by upper class women under age 35, although this cancer has a higher incidence among older women from the lower social classes. Similarly, family planning clinics are not attracting women at highest risk of repeat abortion. Antenatal clinics, although effective in reducing perinatal and maternal mortality, exclude women beyond the childbearing years. At present, there are less than 10 comprehensive well-woman clinics in Britain. However, an estimated 17 million women could benefit from such a service, especially if cervical cytology screening was absorbed within it. A comprehensive clinic could focus on medical problems common to women, including menopause, frigidity, child abuse, obesity, thyroid disease, and depression. Omissions created by fragmented care, such as failure to test for conditions like anemia, could be avoided. The Manchester well-woman clinic, set up in 1981, provides an example of the role such clinics could play. The clinic is targeted at women who rarely see a general practitioner, e.g., poor, infertile, older women. Its emphasis is on the prevention and early detection of disease. Treatment is limited to self-help support groups and discussions with staff; however, new attendees are screened by a physician and nurse. 99% of attendees were found to have at least 1 medical problem. 2/3 of these problems, including breast problems, vaginal discharge, menopause problems, depression, and headache, were not already being treated. This experience suggests that there is an untapped need for such a facility, especially among women between menopause and old age.
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PMID:Evaluating well-woman clinics. 688 41

Intraamniotic infection is a common (2-4%) event in labor. The predictors of IAI include preterm labor or rupture of membranes, abnormal vaginal flora (e.g., GBS, sexually transmitted disease, bacterial vaginosis), obstetric manipulations (e.g., vaginal exams, internal fetal monitoring) in the presence of ruptured membranes, and diminished host response (due to smoking, drug abuse, obesity, immunodeficiency states, etc.). Group B Streptococcus and Enterobacteriaceae are the most important organisms associated with the polymicrobial infection. Anaerobes predict post-cesarean section complications. Neonatal pneumonia (2-5%) and early neonatal sepsis (1-4%) are the outcomes of the greatest concern and are caused by group B streptococcal or aerobic gram-negative rod infections. These outcomes are kept to a minimum if maternal antibiotic chemotherapy is started interpartum with agents that are safe, cross the placenta, and are active against GBS and Escherichia coli (e.g., ampicillin plus gentamicin). Anaerobic coverage should be added (clindamycin) if a cesarean section is performed. Antipyretics such as acetaminophen will reduce the hyperthermic stress on the fetus, and persistent fetal tachycardia after antipyretics may indicate fetal infection. Continuous electronic fetal monitoring is appropriate in cases of IAI, and providers should be prepared for neonatal resuscitation, early neonatal intravenous antibiotics, and respiratory support at delivery.
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PMID:Chorioamnionitis and intraamniotic infection. 829 82

China has been making progress in adolescence health care, carrying out directed investigations and academic exchanges, as well as training. Since 1949, both growth and development of Chinese children and adolescents have accelerated significantly. Menarche and the secondary sex characteristics of girls now appear earlier than before. The average age of menarche is 12.5 years (1991) and boys average first emission is 14.33 years (1991). In China, the commonly encountered adolescent health problems are menstruation hygiene, menstruation dysfunction, emission, masturbation, teenage pregnancy, acne, obesity, smoking, alcohol drinking, drug abuse, and suicide. Causes of death of adolescents in China has significantly changed, all deaths caused by infectious diseases have dropped significantly. Of all death causes today, accidental injury is the leading one. Sexually transmitted diseases and tuberculosis have shown a rebound recently. The rate of smoking among middle school students in Beijing increased from the 1980s to 1990s, with male students' smoking at significantly higher rates than female students. Adolescents is a transitional period from dependent childhood to independent adulthood. Good physical and mental health of children and adolescents makes for good health in adulthood, therefore adolescence is a very important period in one's life. We need to go a step further and develop more detailed data on adolescent health and provide more health care for adolescents.
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PMID:Health promotion of adolescents. 922 2

Today, there are significant risks to the health of teenagers. Drugs (tobacco, alcohol, steroids and others), sex (pregnancy, STDs, date rape), nutrition (obesity and eating disorders), and violence (abuse, fighting) are unfortunately a part of many teens' lives. These risks increase throughout the teen years. Since each risk has a strong behavioral component, we hope to modify the behavior and minimize the risk. Prevention and health promotion are an important part of health care for teens. Primary care providers, such as family physicians, are in an excellent position to provide teen preventative care that is comprehensive and specific to the needs of each teen.
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PMID:Adolescent preventive services. 946 14

Sucrose- and fructose-enriched diets produce hepatic insulin resistance in rats independently of obesity. In humans, fructose infusion results in impaired insulin regulation of glucose production. The aim of the present study was to identify intrahepatic mediators of sucrose- and fructose-induced hepatic insulin resistance. In study 1, male rats were fed a control diet (STD, 68% of energy from corn starch, 12% from corn oil) or a sucrose-enriched diet (HSD, 68% sucrose, 12% corn oil) for 1, 2, or 5 wk. HSD produced hepatic insulin resistance at all time points. Hepatic protein tyrosine phosphatase 1B protein levels and activity were increased at 5 wk only, whereas c-jun NH(2)-terminal kinase (JNK) activity was increased at all time points. Normalization of JNK activity in hepatocytes isolated from HSD rats improved insulin-stimulated tyrosine phosphorylation of insulin receptor substrate (IRS) proteins and insulin suppression of glucose release. In study 2, male rats were provided STD for 1 wk and then were either fasted or fasted and refed either STD or HSD for 3 or 6 h. Rats refed HSD were characterized by increased hepatic JNK activity and phosphorylation of IRS1 on Ser(307) after 6 h only. In study 3, hyperglycemic, hyperinsulinemic pancreatic clamps were performed for 3 or 6 h in the presence or absence of low or high intraportal fructose infusions. High intraportal fructose infusions, which increased portal vein fructose concentration to approximately 1 mM, increased hepatic JNK activity and phosphorylation of IRS1 on Ser(307) at 6 h only. These data suggest that sucrose- and fructose-induced hepatic insulin resistance are mediated, in part, via activation of JNK activity. Thus high rates of fructose metabolism in the liver appear to acutely activate stress pathways.
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PMID:Hepatospecific effects of fructose on c-jun NH2-terminal kinase: implications for hepatic insulin resistance. 1519 36

The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial-ethnic, age, and gender groups. Research has lead to the discovery of many risk factors for obesity, which may help practitioners target at-risk individuals. Insight concerning obesity prevention can come from examining other public health programs, which center on prevention; such as smoking, seat belt use, and sexually transmitted disease. Another guide when establishing obesity prevention is evaluation of currently successful programs. Prevention and treatment interventions for childhood obesity should promote the replacement of unhealthy eating and exercise practices with healthier behaviors. The goal of prevention should always be maintenance of normal growth patterns, rather than weight loss. In predisposed children, sedentary, non-nutritious environments challenge metabolic capacity and promote overweight conditions, further inactivity and increased sedentary behaviors. This results in clinically significant obesity, reduced insulin sensitivity and ultimately type 2 diabetes later in life. Prevention of future chronic disease in children and adults may depend on our ability to prevent the onset of obesity in young children. This should be a primary goal of pediatricians, family health care professionals, and public health professionals.
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PMID:Can obesity prevention work for our children? 1575 8

Human behaviour can be viewed as a collective phenomenon, determined partly by the group to which individuals belong. Collectivities of health behaviour have been found in alcohol consumption, hypertension, obesity, mental illness, and sodium intake in that the average level of risk is associated with the percentage of individuals at extremely high risk.The goal was to investigate whether sexual behaviour may be collectively determined. A cross-sectional US survey was conducted. Across 45 states, the mean number of lifetime sex partners excluding persons with >10, >20, and >40 lifetime partners was strongly associated with the proportion with >10, > 20 and > 40 lifetime sex partners, respectively, among men and women. Sexual activity may represent collectively determined behaviour. If so, interventions to reduce high-risk sexual behaviour to prevent HIV or sexually transmitted diseases (STDs) may be more effective if they address the entire population, rather than target only those at the extremes of risk.
Int J STD AIDS 2006 Mar
PMID:The collectivity of sexual behaviour. 1650 99

Normal postprandial insulin sensitivity depends on the action of the hepatic insulin sensitizing substance (HISS), which requires hepatic parasympathetic nerve activation. Since HISS action is impaired in several pathological models, including the genetically-modified obese Zucker rat (OZR), we compared the HISS-dependent and HISS-independent components of insulin action between the OZR model, and the high-fat diet (HFD)-fed rats. We hypothesize that both models present an impaired HISS action, accounting for the decrease in insulin sensitivity. Male Sprague-Dawley rats fed a HFD for 1 week (n = 5) and OZR (n = 5) were used as obese models. Standard diet-fed (STD, n = 5) and lean Zucker rats (LZR, n = 6) were the HFD and OZR non-obese controls, respectively. Rats were 9-weeks-old when tested. Insulin sensitivity was measured in the fed state, before and after atropine blockade of HISS release), using the Rapid Insulin Sensitivity Test (RIST, mg glucose/kg bw). HISS-dependent action was the difference between control and post-atropine RISTs. HISS action was impaired in both the obese groups (HFD vs STD: 40.1 +/- 5.0 vs 117.0 +/- 3.8 mg glucose/kg bw, p < 0.001; OZR vs LZR: 34.4 +/- 12.8 vs 115.9 +/- 19.4 mg glucose/kg bw, p < 0.01), whereas the HISS-independent component (post-atropine RIST), i.e., insulin action per se, was decreased only in the OZR (OZR vs LZR: 39.3 +/- 3.5 vs 173.3 +/- 20.5 mg glucose/kg bw, p < 0.001). According to our data, the insulin resistance mechanisms are different in the two obesity models studied: in the HFD-fed rats, only the HISS-dependent component is impaired, whereas in the OZR both components of nsulin action are equally impaired.
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PMID:Insulin resistance in two animal models of obesity: A comparison of HISS-dependent and HISS-independent insulin action in high-fat diet-fed and Zucker rats. 1860 45


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