bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Breastfeeding Problems Related to Incorrect Breastfeeding Technique and the Use of Pacifiers and Bottles?
Authors: Righard Lennart
Published: March 2003

Background:

In Western countries during the 1960s and 1970s, sore nipples and insufficient milk were common problems that made it hard for mothers to maintain breastfeeding for long. This study investigated the relationship of breastfeeding problems to nursing behavior and pacifier use.

Methods:

Fifty‐two healthy mother‐infant pairs with breastfeeding problems were referred for observation of nursing behavior to a breastfeeding clinic at the Department of Pediatrics of Malmö General Hospital, Malmö, Sweden, from August 1987 to July 1989. The infants ranged in age from 1 to 17 weeks. A faulty nursing pattern was corrected as necessary. Forty mother‐infant pairs with no breastfeeding problems provided a control group.

Results:

In most cases the nursing problems were related to incorrect sucking technique. The difference in technique of the study group compared with the control group was significant (p= 0.0001). The continuation of breastfeeding was poorer if the infant already had become used to bottle‐feeding. Pacifier use was more common in conjunction with breastfeeding problems and in cases with a faulty superficial nipple‐sucking technique.

Conclusion:

Breastfeeding problems may be prevented by the adoption of hospital routines that do not interfere with the start of breastfeeding and by the avoidance of extensive use of pacifiers. (BIRTH 25:1, March, 1998)
Smoking Relapse and Early Weaning Among Postpartum Women: Is There an Association?
Authors: Ratner Pamela A , Johnson Joy L , Bottorff Joan L
Published: March 2003

Background: Smoking in the postpartum period may contribute to early weaning, although the nature and temporal aspect of the relationship are poorly understood. The objective of this study was to examine the association between early weaning and smoking relapse among women who stopped smoking during pregnancy. Methods: A secondary analysis of data from a randomized controlled trial was conducted. The participants were 228 women who had stopped smoking for pregnancy, who participated in a smoking relapse prevention trial, and who breastfed. Women who relapsed to daily smoking postpartum were compared with those who remained abstinent or smoked occasionally. The dependent variable was breastfeeding for less than 26 weeks (early weaning). Potential covariates included intended duration of breastfeeding, parity, partner's smoking, nicotine dependence, emotional health, return to paid employment, and various sociodemographic variables. Results: Approximately two‐thirds (65.1%) of the women who relapsed to daily smoking weaned before 26 weeks compared with 33.8 percent of the women who remained abstinent or smoked occasionally. Controlling for intended duration of breastfeeding, education, and return to paid employment, women who resumed daily smoking were almost four times more likely to wean early than those who abstained or smoked occasionally. Conclusions: Early weaning may result from psychological or physiological changes associated with tobacco use. Smoking relapse prevention in the postpartum period may be one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breastfeed their babies for the recommended duration.
Depressive Symptoms in the Late Postpartum Among Low Socioeconomic Status Women
Authors: Séguin Louise , Potvin Louise , St‐Denis Michèle , Loiselle Jacinthe
Published: March 2003

Background:
Postpartum depression has been the focus of much research in the past 15 years, but little is known about factors associated with depression of longer duration or later onset. The purpose of this longitudinal study was to analyze the relationship between stressful life conditions and postnatal depression in a group of women of low socioeconomic status from the third week to the sixth month postpartum.
Methods:
Nulliparas who met criteria for low socioeconomic status were recruited from the prenatal care clinics of four Montreal hospitals. Questionnaires were verbally administered in the home at 30 weeks' gestation, at 3 and 9 weeks postpartum, and at 6 months postpartum. Blockwise multiple linear regression analyses were performed by entering predictor variables that included sociodemographic characteristics, chronic stressors, life events, and social support network.
Results:
Sixty‐eight women participated in the study. At 6 months postpartum, 38.2 percent of the mothers had a Beck Depression Inventory score of 10 or more. After accounting for previous depression, analyses indicated that chronic stressors (maternal health problems, infant difficulty, lack of money for basic needs, frequent conflicts with network members) and poor social support (informational and emotional) were associated with postnatal depressive symptoms.
Conclusions:
Health practitioners should recognize that high depressive symptomatology frequently occurs among low socioeconomic status first‐time mothers at six months postpartum. Chronic stressors and inadequate social support are the most important factors associated with this problem.
Mastitis in the First Year Postpartum
Authors: Vogel Alison , Hutchison B. Lynn , Mitchell Edward A.
Published: March 2003

Background:
Limited information is available about the frequency and risk factors for lactation mastitis. The purpose of this study was to investigate frequency, risk factors, and outcome for lactation mastitis.
Methods:
We analyzed data from a cohort study of 350 mothers with healthy term infants, who were followed up for one year postpartum.
Results:
Eighty‐three women (23.7% of the sample) reported one or more episodes of mastitis symptoms, and 61 (17.4%) women reported symptoms including fever. Fifty‐six women (16%) received one or more courses of antibiotics for mastitis. Thirty women (8.5%) of the total cohort had recurrent episodes of mastitis symptoms. A total of 123 episodes of mastitis symptoms were reported. No cases of abscess were reported. Using multiple logistic regression, the adjusted risk ratio for mastitis symptoms associated with sore nipples in the first month was 2.07 (95% CI = 1.17, 3.66). A reduced risk of mastitis was associated with maternal smoking during pregnancy, with supplementation with water in the first month, and with the use of a pacifier on a daily basis within the first month. A history of mastitis symptoms was associated with a longer overall duration of breastfeeding.
Conclusions:
Our results suggest that mastitis may be a marker for an ample milk supply. Mothers presenting with mastitis can be reassured that the outlook for continued successful lactation is good. Further research is needed to investigate the reasons for recurrence of mastitis and the etiology of episodes occurring late in lactation.
432 Somali Women's Birth Experiences in Canada after Earlier Female Genital Mutilation
Authors: Chalmers Beverley , Hashi Kowser Omer
Published: March 2003

Background:
Women with previous female genital mutilation (sometimes referred to as circumcision) are migrating, with increasing frequency, to countries where this practice is uncommon. Many health care professionals in these countries lack experience in assisting women with female genital mutilation during pregnancy and birth, and they are usually untrained in this aspect of care. Somali women who customarily practice the most extensive form of female mutilation, who were resident in Ontario and had recently given birth to a baby in Canada, were surveyed to explore their perceptions of perinatal care and their earlier genital mutilation experiences.
Method:
Interviews of 432 Somali women with previous female genital mutilation, who had given birth to a baby in Canada in the past five years, were conducted at their homes by a Somali woman interviewer.
Results:
Findings suggested that women's needs are not always adequately met during their pregnancy and birth care. Women reported unhappiness with both clinical practice and quality of care.
Conclusions:
Changes in clinical obstetric practice are necessary to incorporate women's perceptions and needs, to use fewer interventions, and to demonstrate greater sensitivity for cross‐cultural practices and more respectful treatment than is currently available in the present system of care.
Implementing Change: Becoming Baby‐Friendly in an Inner City Hospital
Authors: Merewood Anne , Philipp Barbara L
Published: March 2003

The Baby‐Friendly Hospital Initiative of the United Nations Children's Fund and the World Health Organization dramatically raises breastfeeding rates when implemented. To date, only 27 of the 16,000 Baby‐Friendly hospitals worldwide are located in the United States. Barriers to becoming Baby‐Friendly in the United States include the strength of the infant formula industry, suboptimal clinician knowledge, and the need to implement significant change throughout an institution. This paper describes how Boston Medical Center, an inner‐city teaching hospital in Boston with approximately 1800 births per year, overcame numerous obstacles and, in December 1999, became the first Baby‐Friendly hospital in Massachusetts.
Maternity Care Practices: Implications for Breastfeeding
Authors: DiGirolamo Ann M , Grummer‐Strawn Laurence M , Fein Sara
Published: March 2003

Background:
Many United States mothers never breastfeed their infants or do so for very short periods. The Baby‐Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby‐Friendly practices experienced on breastfeeding.
Methods:
A longitudinal mail survey (1993–1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby‐Friendly practices (late breastfeeding initiation, introduction of supplements, no rooming‐in, not breastfeeding on demand, use of pacifiers), and number of Baby‐Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks.
Results:
Only 7 percent of mothers experienced all five Baby‐Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby‐Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.
Conclusion:
Increased Baby‐Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices is illustrated by the small proportion of mothers who experienced all five practices measured in this study.
Women's Perceptions of Helpful and Unhelpful Nursing Behaviors During Labor: A Study in Taiwan
Authors: Chen Chung‐Hey , Wang Shing‐Yaw , Chang Mei‐Yueh
Published: March 2003

Background: The job of the nurse in labor and delivery is not only to ensure a safe delivery but also to create a positive and satisfying childbirth experience. Few studies have been conducted of women's perceptions about the ideal image of the obstetric nurse during labor, and most previous studies involved only North American or European women. The purpose of this study was to assess Taiwanese women's perspectives about their encounters with obstetric nurses during labor. Methods: Interviews of a convenience sample of 50 mothers experiencing normal childbirth in Taiwan were conducted. The interviews were tape recorded and transcribed, and the transcriptions were analyzed to develop coding categories and identify themes. Results: Sixty percent of the participants reported having received helpful nursing behaviors only; 38 percent reported having received both helpful and unhelpful nursing behaviors. Helpful labor‐coping measures that were valued by participants included performing roles of emotional support providers, comforters, information/advice providers, professional technical skills providers, and advocates. Forty percent of the participants reported that some nurses had hindered their labor‐coping ability by failing to provide emotional support, comfort measures, adequate or correct information/advice, or to perform technical duties. Conclusions: The ideal nursing image encompasses the roles of emotional supporter, comforter, information/advice provider, professional/technical skill provider, and advocate. The findings may help obstetric team members better understand patients' needs, and enable them to provide better support during labor and to prevent unhelpful nursing behaviors.
Maternal Satisfaction with Active Management of Labor: A Randomized Controlled Trial
Authors: Sadler Lynn C. , Davison Tracey , McCowan Lesley M.E.
Published: March 2003

Background:
Active management of labor reduces the length of labor and rate of prolonged labor, but its effect on satisfaction with care, within a randomized controlled trial, has not previously been reported. The study objectives were to establish if a policy of active management of labor affected any aspect of maternal satisfaction, and to determine the independent explanatory variables for satisfaction with labor care in a low‐risk nulliparous obstetric population.
Methods:
Nulliparous women at National Women's Hospital in Auckland, New Zealand, in spontaneous labor at term with singleton pregnancy, cephalic presentation, and without fetal distress were randomized after the onset of labor to active management (n= 320) or routine care (n= 331). Active management included early amniotomy, two‐hourly vaginal assessments, and early use of high dose oxytocin for slow progress in labor. Routine care was not prespecified. Maternal satisfaction with labor care was assessed by postal questionnaire at 6 weeks postpartum. Sensitivity analyses were performed, and logistic regression models were developed to determine independent explanatory variables for satisfaction.Results:Of the 651 women randomized in the trial, 482 (74%) returned the questionnaires. Satisfaction with labor care was high (77%) and did not significantly differ by treatment group. This finding was stable when sensitivity analysis was performed. The first logistic regression model found independent associations between satisfaction and adequate pain relief, one‐to‐one midwifery care, adequate information and explanations by staff, accurate expectation of length of labor, not having a postpartum hemorrhage, and fewer than three vaginal examinations during labor. The second model found fewer than three vaginal examinations and one‐to‐one midwifery care as significant explanatory variables for satisfaction with labor care.Conclusions:Active management did not adversely affect women's satisfaction with labor and delivery care in this trial. Future studies should concentrate on measurement of potential predictors before and during labor.
Assessing Women's Preferences for Intrapartum Care
Authors: Hundley Vanora , Ryan Mandy , Graham Wendy
Published: March 2003

Background:
Recent government reports have recommended involving consumers in the planning of health services. Although satisfaction surveys have traditionally been used, they have several limitations. This paper describes a relatively new method of eliciting consumer preferences that allows respondents (women) to indicate the importance that they attribute to specific aspects of a service. The aim was to explore the feasibility of using a discrete choice experiment to assess the importance to women of different aspects of intrapartum care.
Methods:
In this pilot study of 301 women at low obstetric risk, data were collected using an anonymous self‐complete questionnaire given to each participant by the midwife at the booking visit.
Results:
The results of the regression model suggest that respondents prefer maternity units that offer greater continuity of caregiver, more methods of pain relief, continuous fetal heart rate monitoring, a homely appearance, routine involvement of medical staff, and greater involvement for the woman in the decision‐making process. Although all attributes were important to women, they were not all of equal importance. For example, if continuity of caregiver were achieved at the expense of decreasing the availability of pain relief then women would be worse off.
Conclusions:
The discrete choice experiment appears to be a useful tool in assessing the strength of women's preferences for different aspects of maternity care. Future research should include a qualitative approach to explore in greater depth the processes involved in shaping women's preferences.
Does Maternal Smoking Have a Negative Physiological Effect on Breastfeeding? The Epidemiological Evidence
Authors: Amir Lisa Helen , Donath Susan M.
Published: March 2003

Background:Women who smoke are less likely to breastfeed their children than nonsmokers. It is thought that nicotine has a negative effect on breastmilk supply by suppressing prolactin levels. The aim of this review was to assess the epidemiological evidence that maternal smoking has a negative physiological effect on breastfeeding.Methods:The following data sources were searched: The Cochrane Library, Medline, CINAHL, Current Contents, Psychinfo, Sociological Abstracts and the Lactation Resource Centre (Australian Breastfeeding Association) using the key words “smoking” and “breastfeeding” or “infant feeding.” The Journal of Human Lactation and Birth were hand searched.Results:Women who smoke are less likely to intend to breastfeed, less likely to initiate breastfeeding, and likely to breastfeed for a shorter duration than nonsmokers. Several studies have found a dose‐response relationship between the number of cigarettes smoked each day and breastfeeding intention, initiation, and duration that persists after adjusting for confounding factors. In some population groups a high proportion of smokers breastfeed successfully.Conclusions:The association between maternal smoking and lack of breastfeeding is consistent across different study designs in a range of countries. Given that women who smoke are less likely to intend to breastfeed, however, it cannot be assumed that the relationship between smoking and duration of breastfeeding is a physiological one. If smoking had a consistent negative physiological effect on lactation, one would not expect to see such wide variations in breastfeeding rates among women who smoke. Therefore, it is likely that psychosocial factors are largely responsible for the lower rates of breastfeeding found in women who smoke compared with those who do not. (BIRTH 29:2 June 2002)
U.S. Trends in Obstetric Procedures, 1990–2000
Authors: Jean Kozak Lola , Dawson Weeks Julie
Published: March 2003

ABSTRACT: Background: During the 1980s the rate of obstetric procedures performed during delivery rose precipitously. This study follows the use of obstetric procedures through the 1990s to explore whether the patterns witnessed in the previous decade continued through the next.

Methods: Data on total obstetric procedures and eight specific procedures (cesarean section, medical and surgical induction of labor, other artificial rupture of membranes, episiotomy, repair of current obstetric laceration, vacuum extraction, forceps delivery) were obtained from the National Hospital Discharge Survey, a nationally representative survey of discharges from short‐stay non‐Federal hospitals. Approximately 32,000 records for women with deliveries were included in the survey each year.

Results: The total rate of all obstetric procedures did not change significantly from 1990 through 2000. However, as during the 1980s, rates increased for induction of labor, vacuum extraction, and repair of current obstetric laceration. Rates decreased for forceps delivery and episiotomy, also continuing 1980s trends. After a long period of increase, the rate of cesarean section declined from 1988 to 1995 but increased again from 1995 to 2000.

Conclusions: Unlike the 1980s, the overall rate of obstetric procedures did not increase from 1990 to 2000, but the mix of obstetric procedures performed continued to change during this period. (BIRTH 29:3 September2002)
Parent Visiting and Participation in Infant Caregiving Activities in a Neonatal Unit
Authors: Franck Linda S. , Spencer Caroline
Published: March 2003

ABSTRACT: Background: Active parent involvement in caring for their infants in the neonatal care unit is thought to improve parent‐infant attachment and to moderate the psychological stress for parents, but few recent studies have examined parent visiting patterns and participation in infant caregiving. The study purposes were to describe the frequency and duration of parent visiting and participation in infant caregiving activities, and to identify parent and infant factors associated with parental participation.

Methods: Parental visiting frequency, duration, and participation in social, cleaning, and feeding activities with their infant (n=110) were recorded on 12 days during a 3‐month period in a tertiary neonatal unit.

Results: Mothers visited more frequently (85% vs 45% of possible days) and for longer than fathers, and visited less frequently if the infant had other siblings, if the infant was over age 1 month, or if fathers made fewer visits. Fathers visited less frequently if the infant was over age 7 days and more frequently if the mothers visited more frequently. All mothers and most (96%) fathers carried out social activities, such as talking, stroking or holding, during their visits. Over 75 percent of mothers engaged in infant cleaning and feeding activities during visits in contrast with less than 20 percent of fathers. Mothers’ participation in infant feeding was best predicted by the duration of their visit and their participation in infant cleaning. Fathers’ participation in infant feeding was only related to their participation in infant cleaning.

Conclusions: Significant differences were found in this neonatal unit between mothers’ and fathers’ visiting patterns and infant caregiving activities. Neonatal unit staff should consider factors that may influence parental visiting and explore strategies to improve parental involvement in caregiving. (BIRTH 30:1 March 2003)
Performance of a Rapid Whole Blood Test for Helicobacter pylori in Primary Care: A German Multicenter Study
Authors: Hackelsberger Andreas , Schultze Viola , Peitz Ulrich , Günther Thomas , Nilius Manfred , Diete Ulf , Schumacher Michael , Roessner Albert , Malfertheiner Peter
Published: March 2003

Background.

Serological rapid whole‐blood tests for the detection of H. pylori are presently being promoted for use in primary care. We conducted a multi‐center study to investigate the diagnostic accuracy of the Boehringer Mannheim Helicobacter pylori® test (BM test), which is identical with the Cortecs Helisal® test.

Patients and Methods.

A previous diagnosis of H. pylori, a history of peptic ulcer diseases, or proton‐pump inhibitor, bismuth or antibiotic use during the preceding month were exclusion criteria. The BM test was performed prior to endoscopy by 7 primary care physicians, 5 practicing gastroenterologists, or a single physician in the university hospital outpatient service. During endoscopy, antral and corpus biopsies were obtained for histology and rapid urease testing (RUT). H. pylori positivity was defined by histology and/or RUT as reference methods. H. pylori IgG‐ELISA was performed additionally.

Results.

Of the 203 patients included, 151 were H. pylori‐positive by reference methods (74.4%). The overall accuracy of the BM test was 77.3%. Eight BM tests were indeterminate, and in the other 195 patients the test performed as follows: sensitivity 80.3%, specificity 81.3%, positive predictive value 92.9%, negative predictive value 57.4%. Using IgG‐ELISA as reference, the BM test performance was similar. It also did not differ substantially among the three groups of physicians involved.

Conclusions.

We found the performance of the BM test to be insufficiently accurate, as both over‐ and underdiagnosis of H. pylori infection were not infrequent. This test needs to be improved before its use in primary care can be recommended.
High Dose Omeprazole Plus Amoxicillin and Azithromycin in Eradication of Helicobacter pylori in Duodenal Ulcers
Authors: Vc˘ev~ Aleksandar , Štimac Davor , Vc˘eva Andrijana , Takac˘ Boris , Pezerovíc Davorin , Ivandíc Ante
Published: March 2003

Background.

The aim of our study was to establish whether one‐week triple therapy regimen (omeprazole, amoxicillin, azithromycin) with low dose (2 × 20 mg/day) or high dose omeprazole (2 × 40 mg/day) is more effective in curing H. pylori infection in patients with active duodenal ulcer disease.

Methods.

One hundred and twenty patients with duodenal ulcer and H. pylori infection were treated with amoxicillin 2 × 1000 mg/day for the first 7 days plus azithromycin 500 mg/day for the first 6 days. Patients were randomly assigned to receive either omeprazole 2 × 20 mg/day for the first 7 days (group A; n = 60) or omeprazole 2 × 40 mg/day for the first 7 days (group B; n = 60). After 7 days all patients in both groups continued treatment with omeprazole (40 mg/day (days 8–14) and 20 mg/day (days 15–28)). H. pylori status was determined by urease test and histology before the treatment and 4 weeks after cessation of any medication.

Results.

One hundred and thirteen patients completed the study. H. pylori infection was eradicated in 73.2%[41/56] of patients in group A (intention‐to‐treat [ITT] analysis: 68.3%; 95% CI: 58.6–80.4%) vs. 82.5%[47/57] of patients in group B (ITT analysis: 78.3%; 95% CI: 67.8–87.9%; NS). All ulcers had healed after 4 weeks of omeprazole treatment. Side effects, usually minor, were recorded in 12.5% (group A) and in 14% (group B) of patients (NS), but therapy was discontinued for only one patient in group B (NS).

Conclusion.

There was no statistically significant difference between one‐week triple therapy regimen (omeprazole, amoxicillin, azithromycin) with high dose omeprazole (2 × 40 mg/day) and regimen with low dose omeprazole (2 × 20 mg/day) in curing H. pylori infection in patients with active duodenal ulcer disease.
Discrepancy Between Polymerase Chain Reaction Assay and Western Blot Analysis in the Assessment of CagA Status in Dyspeptic Patients
Authors: Paoluzi Omero Alessandro , Rossi Pina , Montesano Carla , Bernardi Sabrina , Carnieri Emanuela , Marchione Orazio Paolo , Nardi Francesco , Iacopini Federico , Pica Roberta , Paoluzi Paolo
Published: March 2003

Background.

Infection with CagA‐positive Helicobacter pylori may be diagnosed by detecting cagA gene by polymerase chain reaction assay (PCR) or serum antibodies against CagA by Western blot analysis. The aim of this study is to evaluate whether results of PCR and Western blot analysis are in agreement in CagA status assessment.

Patients and methods.

Thirty‐six dyspeptic patients with unknown H. pylori status underwent upper gastrointestinal endoscopy to assess the presence of mucosal lesions and to collect six gastric biopsies (three from the antrum and three from the body) for evaluation of H. pylori infection (rapid urease test, histology and PCR for ureA gene) and gastritis. CagA status was assessed by PCR (cagA gene) on two biopsy specimens and by Western blot analysis of serum (CagA‐antibodies) in each patient.

Results.

At endoscopy, nine patients showed normal mucosa, 15 a duodenal ulcer and 12 antral erosions. Twenty‐eight patients were found to be H. pylori‐positive and eight H. pylori‐negative. Of the 28 H. pylori‐positive patients, 17 were CagA‐positive and five were CagA‐negative by both methods, five were CagA‐positive by Western blot analysis but not by PCR and one was CagA‐positive by PCR but not by Western blot analysis. Of the eight H. pylori‐negative patients, none was CagA‐positive by PCR, while six were CagA‐positive by Western blot analysis. Therefore, the two tests agreed in only 24 patients (67%). In those patients in whom the PCR and Western blot analysis were not in agreement, the histological features appear to suggest that the results of the Western blot analysis should be considered false positives or false negatives.

Conclusions.

PCR and Western blot analysis failed to provide comparable data in many cases. Western blot analysis seems to be more likely to give misleading results than PCR. Thus, PCR seems to be the method of choice to assess CagA status.
cag Pathogenicity Island of Helicobacter pylori in Korean Children
Authors: Ko Jae Sung , Seo Jeong Kee
Published: March 2003

Background. cag pathogenicity island is reported to be a major virulence factor of Helicobacter pylori. The aim of this study was to investigate the status of cag pathogenicity island genes and gastric histology in Korean children with H. pylori gastritis.

Methods. Helicobacter pylori DNA was extracted from antral biopsy specimens from 25 children with H. pylori gastritis. Specific polymerase chain reaction assays were used for four genes of cag pathogenicity island. The features of gastritis were scored in accordance with the updated Sydney System.

Results. cagA was present in 23 (92%) of 25 children, and cagE in 24 (96%). Twenty‐two (88%) children were cagT positive and 19 (76%) virD4 positive. All of the selected genes of the cag pathogenicity island were present in 17 (68%) children and completely deleted in one child. There were no differences in neutrophil activity and chronic inflammation between children infected with intact cag pathogenicity island strains and those with partially or totally deleted‐cag pathogenicity island strains.

Conclusion. cag pathogenicity island is not a uniform, conserved entity in Korea. Completeness of cag pathogenicity island may not be the major factor to determine the severity of H. pylori gastritis in children.
Impact of Helicobacter pylori on the Development of Vitamin B12 Deficiency in the Absence of Gastric Atrophy
Authors: Serin Ender , Gümürdülü Yüksel , Özer Birol , Kayaselçuk Fazilet , Yilmaz Ugur , Koçak Rikkat
Published: March 2003

Background. Cobalamin (vitamin B12) deficiency is associated with Helicobacter pylori infection. This study examined how serum vitamin B12 levels relate to gastric mucosa H. pylori density and histology, and to hematological findings in patients with minimal or no gastric atrophy. A second aim was to confirm that H. pylori eradication therapy increases serum B12.

Materials and Methods. Biopsies of the gastric mucosa from a population of dyspeptic patients were graded for level of chronic inflammation, neutrophil activity, atrophy, and H. pylori density. A total of 145 H. pylori‐infected patients with minimal or no atrophy were included in the study. Serum cobalamin level, hemoglobin level, and mean corpuscular volume were measured in the 145 patients before eradication therapy, and in 65 of the subjects after treatment. The hematologic findings before and after eradication therapy and correlations between serum vitamin B12 level and histologic parameters, hematologic findings, and patient age were statistically analyzed.

Results. There was no significant correlation between serum cobalamin level and patient age. Before treatment all the histopathological scores were inversely correlated with serum vitamin B12 level (p < .01) on univariate analysis. Only H. pylori density was significantly associated with B12 level on multivariate analysis. Serum hemoglobin and cobalamin levels were significantly increased after treatment, regardless of H. pylori eradication status (p < .001).

Conclusion. The findings provide strong evidence that H. pylori infection is associated with cobalamin deficiency, and show that this is true even in patients with nonulcer dyspepsia and minimal or no gastric atrophy.
Helicobacter pylori and nonmalignant disease
Authors: Moayyedi Paul , Malfertheiner Peter
Published: March 2003

Helicobacter pylori eradication has become the recognized standard and widely adopted therapy to cure peptic ulcer disease. Other H. pylori associated conditions with potential benefit from eradication therapy are still subject to clinical investigations. The current state of evidence for these indications is summarized in this article.

For NSAID associated peptic ulcer disease the current evidence needs to be grouped in three subsets of clinical conditions: a) H. pylori eradication for prevention of ulcers before starting NSAIDs therapy is advisable; b) eradication during PPI treatment for NSAID associated active ulcer shows no advantage on healing; and c) eradication alone is not sufficient for secondary prevention of ulcer complications induced by NSAID, however it appears to protect from further episodes of aspirin induced bleeding.

In nonulcer dyspepsia the latest Cochrane collaboration review supports a small benefit in favour of H. pylori eradication.

New insight in the relationship of H. pylori with GERD is provided from clinical trials which show that H. pylori eradication does not influence the clinical course of patients with reflux esophagitis.

Finally important new data are presented regarding the management of dyspepsia at the primary care level with the confirmation that the H. pylori‘test and treat’ strategy in the appropriate setting is more cost‐effective than endoscopy.
Influence of Culture on Cancer Pain Management in Hispanic Patients
Authors: Juarez Gloria , Ferrell Betty , Borneman Tami
Published: March 2003

PURPOSE: The purpose of this pilot study was to describe the influence of culture on cancer pain management in Hispanic (Mexican and Central American) patients.

DESCRIPTION OF STUDY: This qualitative study is guided by the conceptual framework of the Pain and Quality of Life model and the Biocultural Model of Pain. It was developed as a companion study to a National Cancer Institute (NCI)‐funded project to disseminate a pain education program for adult patients with cancer and their family care givers in community home‐care agencies. After completing the NCI study, Hispanic subjects were invited to participate in the qualitative companion study. A total of 17 subjects, the majority of whom were women, were interviewed. The Hispanic Pain Experience Questionnaire (HPEQ) was used to elicit answers to open‐ended questions regarding the perception and management of cancer pain.

RESULTS: Themes that emerged from the questionnaire were Influence of Culture, Expressions of Pain, Managing Pain/Medications, and Use of Nondrug Interventions. Responses suggest that culture, family beliefs, and religion contribute significantly to management and expression of pain by the patient and care giver. In addition, this group showed that pain may be approached with stoicism; therefore, lack of verbal or behavioral expression of pain does not indicate a lack of pain itself. These patients also demonstrated a reliance on folk beliefs and nondrug interventions. The most common reason cited for noncompliance with pharmacologic treatment was an inability to understand instructions.

CLINICAL IMPLICATIONS: When providing care to Hispanic patients, it is imperative to be nonjudgmental, sensitive, and respectful. To improve compliance, the multidisciplinary cancer team should 1) incorporate the patients' folk healthcare practices and beliefs into the plan of care when possible; 2) involve family members and friends in the patient's care, identifying one key family contact; and 3) ensure that instructions for medications are available in Spanish and understood by the patient and care giver. When patients' overall beliefs and values are respected, compliance with pharmacological and other interventions may increase accordingly.
A Multidimensional Measure of Fatigue for Use with Cancer Patients
Authors: Stein Kevin D. , Martin Staci C. , Hann Danette M. , Jacobsen Paul B.
Published: March 2003

purpose
: The purpose of this study was to develop and validate a multidimensional measure of fatigue for use with cancer patients.

description of study
: Items for the Multidimensional Fatigue Symptom Inventory (MFSI) were generated through literature review, discussion with healthcare providers,and a survey of currently available measures of fatigue. The 83‐item MFSI was designed to assess global, somatic, affective, cognitive, and behavioral symptoms of fatigue. The instrument was administered on three occasions to 275 women who had received or were undergoing treatment for breast cancer and 70 women with no history of cancer. Reliability, validity, and factorialstructure of the MFSI were analyzed.

results
: The factor analysis produced five empirically derived scales that correspond generally to the five rationally derived scales. Reliability of the rationally and empirically derived scales was excellent (alpha coefficients .87 to .96). Estimates of test‐retest reliability were also favorable. Other results support the validity of both the rationally and empirically derived scales. The MFSI appears to be sensitive to fatigue, accurately discriminating cancer patients from control subjects and between patients with varying levels of performance status.

clinical implications
: The MFSI may be useful in identifying patterns of fatigue within individual patients and across treatment modalities. Such specificity may allow the clinician to develop, implement, and evaluate interventions that are targeted for differing patterns of fatigue. Because the measure is keyed to a 1‐week time frame, it may be useful during the course of cancer treatment. The MFSI appears to be a valid and reliable tool to assess the full spectrum of symptoms that characterize the construct of fatigue.
Cross‐Cultural Issues in the Disclosure of Cancer
Authors: Mitchell Jill L.
Published: March 2003

purpose
: To increase awareness of cultural differences in the disclosure of a cancer diagnosis or prognosis, the author reviews several surveys of patients and physicians from around the world.

overview
: The Western medical community is increasingly emphasizing full truthful dislosure of cancer diagnoses or prognoses and respect for autonomy as necessary prerequisites to ethical practice. However, surveys of European, Japanese, Native American, and various ethnic American (including Korean, Chinese, Mexican, Hispanic, African, and European American) cancer patients and physicians reveal that many cultures consider complete and accurate disclosure of cancer undesirable. Cultural differences in the rates of disclosure of a cancer diagnosis or prognosis; the physician's use of euphemisms to give a true or false diagnosis; as well as considerations of how to disclose a cancer diagnosis are described.

clinical implications
: Developing an awareness about cross‐cultural practices regarding cancer disclosure issues allows the clinician to become more sensitive to the expectations of culturally and individually diverse cancer patients. To this end, all healthcare professionals should be informed about how the patient would like to be informed of a diagnosis and how involved he or she would like family members to be. In addition, an awareness of the use of nonverbal communication in some cultures and the psychosocial impact of certain terms, such as “cancer,” is essential. Often, phrases such as “ malignant tumor” or “growth” are less inflammatory and are more readily accepted. In ascertaining a knowledge of various cultural preferences and developing a sensitivity to these preferences, clinicians are better able to provide effective care to individuals from a variety of cultural and individual backgrounds.
Selecting and Implementing Support Groups for Bereaved Adults
Authors: Lorenz Lois
Published: March 2003

Purpose
: This paper offers a rationale for initiating bereavement support groups in sites providing cancer care and delineates models to implement them. Skills needed to lead a bereavement support group are identified, with emphasis on adding to staff members’ competency that has already been developed by facilitating groups for oncology patients and their families.

Overview
: Bereavement support groups are essential elements in the provision of comprehensive oncology care, though they are seldom offered by staff in the traditional hospital setting. It is important that the bereaved feel that there is a place in which they have the time and understanding required to work through the normal grieving process. Special requirements for facilitators include self‐awareness of the impact of loss in their own lives and ability to tolerate both the emotions expressed in the grieving process and the often extended time period required for members' personal healing. Several bereavement support models, including the time‐limited, ongoing, monthly, and self‐help groups, are documented.

Clinical Implications
: Bereavement support is an essential element in the provision of comprehensive oncology care. Predictive models to identify individuals who are at higher risk for psychological distress could be used in oncology clinics to facilitate early referral or greater psychological support for family members. Staff members wishing to introduce this service can build on skills already developed leading traditional oncology support groups, and can utilize cofacilitation with a mental health professional to ease the anxiety of assuming a new role and obtain mentoring. Recruitment for a group might be achieved by inviting family members of patients who have died within a specific time frame or by issuing press releases to local papers and church bulletins. Offering bereavement support in the oncology setting is especially helpful to family members who might otherwise be unaware of such a service and who now have the opportunity to attend.
Social support and cancer screening in African American, Hispanic, and Native American women.
Authors: Gotay CC , Wilson ME
Published: March 2003

PURPOSE: Minority women have higher rates of mortality from breast and cervical cancers and lower rates of utilization of screening tests than white women. Innovative ways to increase screening in these populations are needed urgently. This report examines the effectiveness of screening interventions based on social support for breast and cervical cancers in African American, Hispanic, and Native American women. OVERVIEW: Despite the availability of mammography, clinical breast examination, and Papanicolaou smears, many women do not follow recommendations to obtain these tests. Further, many of the traditional approaches to health education have not been effective in minority populations. Additional strategies to promote screening for breast and cervical cancers are needed, particularly for women who, by virtue of language and/or culture, are outside the mainstream. Nontraditional approaches, or social support interventions, may be particularly effective in promoting cancer screening and reducing cancer mortality in high‐risk minority women. CLINICAL IMPLICATIONS: Programs that use social support offer the potential to draw on the strengths of a population‐‐the ties between individuals, the importance of the family, and traditional cultural values‐‐to improve screening for breast and cervical cancers in minority groups. In developing a social support intervention, healthcare providers should consider the similarities and differences among populations; collaborate with representatives of the target community; incorporate social support within hospitals and clinics; and include social support as an essential component of the clinical encounter.
Increasing Mammography Practice by African American Women
Authors: Erwin Deborah O. , Spatz Thea S. , Stotts R. Craig , Hollenberg Jan A.
Published: March 2003

purpose
: This study examines the effectiveness of the Witness Project, a culturally competent cancer education program that trains cancer survivors to promote early detection and increased breast self‐examination and mammography in a population of rural, underserved, African American women.

description of study
: The primary setting for the Witness Project–an intensive, community‐based, culturally sensitive educational program that incorporates spirituality and faith–was the African American church. Baseline and 6‐month follow‐up surveys were obtained from 206 African American women in two intervention counties and from 204 African American women in two control counties in the rural Mississippi River Delta region of Arkansas.

results
: Witness Project participants significantly increased (P < .0001) their practice of breast self‐examination and mammography (P < .005) compared with the women in the control counties.

clinical implications
: These results demonstrate that intensive, community‐based, culturally sensitive educational programming incorporating the spiritual environment of the faith community, such as the Witness Project, can positively influence breast cancer screening behaviors among rural, underserved African American women. Through the use of community churches and cancer survivors, breast cancer screening activities can be improved in this population.
Gender and Cancer Support Group Participation
Authors: Krizek Claudette , Roberts Cleora , Ragan Robin , Ferrara Jeffrey J. , Lord Beth
Published: March 2003

purpose
: Although support groups are offered to many patients who have received a diagnosis of cancer, a majority of patients choose not to participate. This article reports the results of a study comparing the behavior of men diagnosed with prostate cancer and women diagnosed with breast cancer in their responses to invitations to participate in support groups.

description of study
: One hundred thirty women with breast cancer and 87 men with prostate cancer completed a structured telephone interview. The interview included questions about the patients' choices about support group participation.

results
: Interview findings showed that men are less likely to join a support group, but those men who do join attend meetings for about 1 year, as do the women who join. Men and women cite essentially the same reasons for participation: to learn more about their diagnosis, to share their, concerns to compare their physical and emotional progress with other individuals.

clinical implications
: These results indicate the need for further exploration of effective interventions for men and women who have been diagnosed with prostate and breast cancer, respectively, in an effort to offer support for the difficult psychological and emotional issues associated with their diagnoses. Although more women than men join support groups, the majority of both populations (67% for women, 87% for men) do not attend any support group meetings. Innovative approaches are needed to encourage participation in existing support groups or to design alternative interventions.