Signs Of Difficulties Research Articles

The Free Lunch Is Always an Effective Marketing Tool: Why WIC Must Change

Congratulations to Jensen and Labbok 1 and indeed to Breastfeeding Medicine for their article on the impact of the Special Supplemental Nutritional Program for Women, Infants and Children (WIC) on breastfeeding rates in the United States. It provides excellent evidence for the insidious impact of what is in effect a clever and effective formula company profit-making scheme. Who can resist a free lunch?! As Kent put it, ‘‘WIC’s breastfeeding promotion efforts are good, but not likely to be of the scale needed. It would take a much larger effort to counteract the strong incentive effect of offering free name-brand infant formula that appears to be endorsed by government.’’ Jensen and Labbok also suggest that allowing formula companies to use WIC’s name in their marketing serves as a form of endorsement, if unintentional. I saw the remarkable power of this phenomenon in a study in St. Vincent when I discovered that a group of mothers who passed a Catholic malnutrition rehabilitation facility on their way to work all used the same (unusual) brand that the nuns did. Spying it by looking into the windows, they actually told me they believed the nuns were using it to teach them what they should feed their babies. As an intern to a public health nutritionist in Silver Spring, MD, I helped design Montgomery County’s first WIC application in the summer of 1974. We heard that the program was saved from oblivion by infant formula company lobbying to Congress. Apparently the companies’ market research led them to despair of ever convincing the low-income groups, especially African Americans, to switch from evaporated milk to infant formula. This gave them the ingenious ‘‘health’’ argument that offering free formula was the only way to get low-income U.S. populations weaned off of such a relatively less appropriate means of feeding infants (with, for example, accompanying high levels of infant anemia). Thus warned of the risks involved, we tried reducing them by budgeting so that the value of the food a breastfeeding mother would receive was about double the value of infant formula at that time. Now, of course, the inflation-adjusted price of infant formula is much higher, no doubt linked to the WIC rebates, as Jensen and Labbok suggest. But neither we in 1974 nor Jensen and Labbok came upon the simplest and most powerful way of reducing WIC’s antibreastfeeding impact. Stop offering free formula. The only excuse for offering formula at all is that it is shifting lowincome mothers who may in any case not want to breastfeed from more harmful infant feeding regimens. But, formula does not need to be free to prevent women from raising babies on something inferior. It just needs to be the cheapest alternative available. In 1978–1981, I designed and evaluated a Rockefeller Foundation–funded breastfeeding promotion program in Yemen for my Ph.D. research. I spent one entire year obtaining baseline data and working with anthropologists and health workers to try understanding why breastfeeding had declined so rapidly during the previous few years. A wise Swedish midwife working in a Maternal Child Health center there helped me with one strand of the causal web. She said that Yemeni women had nothing against breastfeeding. They just saw the decision to switch to the bottle as unimportant—each feeding method had its advantages and disadvantages. Thus one goal of the later campaign (which set in motion processes that led gradually to a doubling of the duration of breastfeeding in both rural and urban areas of the country) was not so much to say that women ought to breastfeed as to help them realize that deciding to supplement in the early months or to stop it in the first couple years was a serious one—especially in a country where only 2% of couples practiced any form of modern contraception. (The qualitative ‘‘illuminative evaluation’’ found that most women who did practice exclusive breastfeeding were doing it because they were tired of having a baby every year.) As it stands now, many WIC mothers probably think similarly, if they think much about breastfeeding at all—or they abandon it at the first sign of difficulty—because accepting free formula is such an easy alternative into which to slide. If the WIC formula has a cost, even if low, then it is more likely that low-income women will go through some kind of weighing of the alternatives before making decisions so crucial to their own and their infants’ health.

OBSTRUÇÃO PARCIAL DA TRAQUÉIA EM CANINO

Partial tracheal obstruction caused by foreign bodies is a rare afliction in canines which can lead to tracheitis, bronchitis or pneumonia. The main clinical indications are dyspnea, coughing and cyanosis, which may lead to the death of the animal. One female Rottweiler dog of one year and seven months of age was treated at the Veterinary Hospital of the University of Cuiaba (UNIC/MT) for coughing and breathing difficulty. The radiology exam showed an opaque, circular object located in the cranial cervical trachea. The animal was therefore submitted to a surgical procedure for the removal of the foreign body which was subsequently identified as a child’s marble. The results were satisfactory, confirmed by the lack of respiratory difficulty signs after the surgical procedure. KEY WORDS: Canine, foreign body, trachea.

Czynniki społeczne w genezie nieprawidłowego rozwoju i zachowania

The paper deals with the impact of the social background for developmental disorders, searching for unfavorable factors in the three most important surroundings – family, school, contemporary group. Hence the analysis was made with signs of improper interpersonal relations and life conditions encroaching on mental balance that can be found in social agencies (school, family), responsible for personal development and behavior. Basing upon selected theoretical works and my diagnostic and therapeutic experience, various negative effects on personal development were illustrated, given the ill-adapted familial and educational systems, as well as informal roles played in contemporary groups. The paper got its material focused on the familial environment where personality traits and parental attitudes, ways of communication and pathological mechanisms permanently generate factors that appear unfavorable for personal social development (toxic messages, enforced loyalty, role delegation,collusion relationships). A particular emphasis was put on the role of social factors in the origins of both primary and secondary disorders, and on the fact that signs of difficulties and disorders a youngster meets may be an indirect reaction to factors infringing on his/her psychological balance or else – actualized belatedly when assuming new social roles.

O atendimento psicanalítico do bebê com risco de autismo e de outras graves psicopatologias. Uma clínica da antecipação do sujeito

The author proposed a theoretical and clinical articulation capable of providing support to an earlier psychoanalytical intervention to babies at risk of autism and other severe psychopathologies, as shown by signs of difficulty in establishing mother/child bonds, which could restrict the birth of the subjectivity in the infant. Interdisciplinary professionals that treat autistic children agree that the timing of the beginning of the treatment is essential for accomplishing the best results, which is explained by Medicine because of children’s greater cerebral neuroplasticity. How could psychoanalysis explain such fact, since psychoanalysis’ time is logical, not chronological?

Breast Feeding Initial Difficulties -descriptive study

This study aimed at identifying initial difficulties in breastfeeding in a rooming-in care. An assessment of ninety newly-born`sucking was carried out, using UNICEF standard protocol. Observation revealed that most mother-infant pairs presented favorable behaviours towards breastfeeding, and indicatory signs of difficulties were more evident in relation to sucking and to breast response. Care in collective wards should aim at overcoming these difficulties as to facilitale the beginning of breastfeeding, thus favoring its continuity.

Breast Feeding Initial Difficulties -descriptive study

This study aimed at identifying initial difficulties in breastfeeding in a rooming-in care. An assessment of ninety newly-born`sucking was carried out, using UNICEF standard protocol. Observation revealed that most mother-infant pairs presented favorable behaviours towards breastfeeding, and indicatory signs of difficulties were more evident in relation to sucking and to breast response. Care in collective wards should aim at overcoming these difficulties as to facilitale the beginning of breastfeeding, thus favoring its continuity.

Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home

Maternal mortality is highest in those countries whose health budgets are restricted. Practical strategies employed in the International Safe Motherhood Initiative, therefore, must be both effective and economical. Investing in emergency obstetric care resources has been touted as one such strategy. This investment aims to insure significant improvements are made in regional health centers, and a chain of referral is put into place so that only problem cases are attended by the most skilled health workers. This article examines how this model of referral functions in Sololá, Guatemala, where most Kaqchikel Mayan women give birth at home with a traditional midwife, and no skilled biomedical attendant is available at the birth to make a referral. Ethnographic data is used to explore reasons why women do not go to the hospital at the first sign of difficulty. I argue that the problem frequently is not that Mayan midwives, their clients and families fail to understand the biomedical information about dangers in birth, but rather that this information fails to fit into an already existing social system of understanding birth and birth-related knowledge.

Fragile X Syndrome and Speech and Language

Fragile X Syndrome and Speech and Language

Development of a totally implantable biventricular bypass centrifugal blood pump system

Background. During the past 2 years, the development of a totally implantable biventricular bypass rotary blood pump system has been made. Methods. An extracorporeal gyro centrifugal pump, the CIE3, was miniaturized and developed into the PI601, a totally implantable plastic pump. Two-day anatomic and hemodynamic feasibility studies demonstrated that these two pump systems were easily implantable inside a calf’s abdominal wall, directly under the diaphragm. The priming volume of the pump was 20 mL, with sufficient cardiac outputs at approximately 2,000 rpm and requiring less than 10 W of power. Two-week antithrombogenic screening tests also revealed these pump systems to be quite antithrombogenic. In addition, 1-month system reliability studies demonstrated fail-safe reliable performances. Results and Conclusions. Encouraged by these preliminary studies, the PI601 model was converted to the permanently implantable titanium gyro pump PI702 model. The long-term implantations were initiated approximately 3 months ago, and two such long-term LVAD studies are currently underway with no sign of difficulty (October 10, 1997). They were followed 283 days and 72 days, respectively. Both terminated due to functional inflow obstruction. There were no blood clots or emboli at autopsy.

Complication After Arterial Bypass Grafting

A 57-year-old man experienced sudden onset of pleuritic chest pain and respiratory distress 10 days after undergoing four-vessel coronary artery bypass grafting (CABG). The surgery was performed after cardiac catheterization had shown right coronary artery dominance and the presence of lesions occluding 40% of the mid right coronary artery, 20% of the left main coronary artery, and 99% of the lower left anterior descending artery and its first diagonal branch.The patient had initally presented with acute dyspnea following an episode of crushing, nonradiating pain in the left chest and was diagnosed as having a non-Q-wave myocardial infarction after cardiac enzyme testing. His hospital course before and immediately after CABG was uneventful. The first sign of difficulty was detected one week after surgery, on day 17. An echocardiogram showed a small pericardial effusion, moderate to severe concentric thickening of the left ventricle, a left ventricular ejection fraction of 0.60 (normal, 0.67±0.08), normal valves, and normal segmental wall motion. The pleural chest pains began two days later, on day 19.

Pragmatic Approach to Finance Infrastructure: Analysis of French Experience with Highway Concessions

Governments around the world are showing increasing interest in concessions or build-operate-transfer mechanisms in the highway sector. One or two decades ago, economic theory held that private funding was the most promising method for financing infrastructure development. Unfortunately, a significant number of privately financed projects are showing signs of difficulties (e.g., the Franco-British Channel Tunnel, the Dulles Greenway in Virginia, the second stage Bangkok Expressway in Thailand, the Guanzhour-Shenzen Highway in China, the delayed Birmingham Northern Relief Road in the United Kingdom, and the M1 and M3 Highways in Hungary). Emphasis has always been put on the financial aspect, leaving out the organizational one. A new basis for infrastructure finance is presented, analyzing the mistakes and successes of French experience in highway concession for more than 40 years. This experience is of interest since France has experimented with both toll and nontoll financing as well as with publicly and privately owned toll roads in building its system of highways. The main steps of the construction of the French highway network through concessions are traced and the lessons learned from this experience indicated, focusing on key elements, the advantages and drawbacks of a concession system, and the exact nature of the state’s role in concessioning. This information can serve as potential recommendations for other countries opting for concession systems.

Midwives and the care of ‘normal’ childbirth

The following extract, entitled ‘A hell of an assault course: Hepatticus is forced to go for a stint of management training’, is taken from a regular humorous column by a fictitious Professor Sir Hepatticus Oath, TS FRS, and appeared in the BMA News Review in May 1994: ‘… the coup de horreur was the discovery on the final day, that Hepatticus must do a three-legged assault course, tied by the ankle to a senior midwife. Can there be anything closer to a definition of hell? How is one meant to work with someone who refused to follow any simple instruction because she is a “practitioner in her own right” but who seemed incapable of doing anything practical at all? A woman who at the first sign of difficulty denied all responsibility and pleaded with Hepatticus to take over. Hepatticus thanks the Lord that, despite as a student being intrigued by William Hunter's 18th century classic, Gravid Uterus, I was never tempted into obstetrics.’

When It's Hard to Swallow: Feeding Techniques for Dysphagia Management

There are three phases of swallowing: oral, where the food is chewed; pharyngeal, where the bolus begins to move downward; and esophageal, where the bolus enters the esophagus. Signs of difficulty in swallowing may include difficulty initiating the swallow, packing food into cheeks, drooling, cough after a swallow or absent or weak cough, or fluid leaking from the nose after swallowing. Take your time when feeding patients and do not wash food down with liquids. Also, remember to position the patient properly and teach both the patient and his family effective feeding techniques.

Chronic physical illness in childhood: psychological and social effects in adolescence and adult life.

A national birth cohort followed for 36 years was used to compare the life chances of individuals with chronic physical illness in childhood with those of controls. The majority of those who had been chronically physically ill in childhood were found to differ very little in social and psychological circumstances by 36 years of age, but earlier in adult life there had been signs of difficulties. However, there was a disturbing tendency for those from lower social-group families to be in significantly worse social and psychological circumstances, and by 36 years they showed signs of relatively poor life chances and of basic social support, including the death of both parents.

Thrombosis of the digital vessels secondary to oral contraceptives

A 27-year-old woman who used oral contraceptives for 2 years and had 2 incidents of blurred vision followed by painful "blood-red" fingers is described. Contraceptive treatment was stopped. Most fingers of both hands were characterized by bluish, cyanotic, apparent pregangrenous discoloration. All laboratory tests were within normal range except; latex agglutination (weakly reactive), LE preparation (weakly positive twice, normal once), globulin immunoeletrophoresis (slightly elevated IgM), and blood volume determination (500 ml deficit of whole blood). 500 ml daily of low molecular weight dextran for 4 days was the only treatment. Gradually over 2 weeks cyanosis and pain ebbed. The hypothesis that this thromboembolic trouble is linked to the pill is circumstantial, but episodes of blurred vision are symptomatic of retinal vessel thrombosis. Erythema or pain in finger tips is the first sign of difficulty and should produce cessation of the pill.

The prediction of ego functioning in college.

This interdisciplinary study demonstrates a method for identifying signs of faulty ego functioning in adolescence from the routine written reports of secondary school teachers. These reports were coded systematically into categories which meaningfully described students and which had greater power to predict their future behavior and emotional stability in college than the usual demographic, ability, and performance parameters. The categories reflect well-known characterological types, styles of interpersonal relationships, and patterns of cognitive functioning. The results suggest that character is sufficiently well defined by mid-adolescence so that one can distinguish between normal adolescent turmoil and a pathological process. Adolescents whose egos fail in college have already manifested in high school signs of difficulty, specifically an intensification of aggression, increased narcissism, and deviant cognitive functioning.

ACUTE POLIOMYELITIS WITH AN ISOLATED PALATINE PARALYSIS

The occurrence of an isolated palatine paralysis as the only paralytic manifestation of an attack of acute poliomyelitis is rare. Literature contains only one reference to a similar instance, as observed by Ivan Wickman 1 and recorded in his classic monograph. The details of the symptomatology are not given. REPORT OF CASE History. —A girl, aged 3½ years, admitted to the Kingston Avenue Hospital, Oct. 4, 1921, had had influenza, measles and whooping cough in the past three years. The family history was irrelevant. A tonsillectomy had been performed, September 15, but she recovered well from the operation and was not observed to have any signs of difficulty in swallowing or of regurgitation through the nose until the onset of the present illness. September 29, five days before admission, the patient complained of headache. On the following day, she had difficulty in swallowing liquids and her