[Show abstract][Hide abstract]ABSTRACT: The calcium supplementation status during the postpartum period among Chinese lactating women is still unclear. The objective of this study is to utilize data from two population-based prospective cohort studies to examine the calcium supplementation status and to identify whether breastfeeding is associated with increased calcium supplementation among Chinese mothers after child birth. Information from 1540 mothers on breastfeeding and calcium supplementation measured at discharge, 1, 3, and 6 months postpartum were extracted to evaluate the association between breastfeeding and calcium supplementation postpartum. A generalized linear mixed model was applied to each study initially to account for the inherent correlation among repeated measurements, adjusting for socio-demographic, obstetric factors and calcium supplementation during pregnancy. In addition, breastfeeding status measured at different follow-up time points was treated as a time dependent variable in the longitudinal analysis. Furthermore, the effect sizes of the two cohort studies were pooled using fixed effect model. Based on the two cohort studies, the pooled likelihood of taking calcium supplementation postpartum among breastfeeding mothers was 4.02 times (95% confidence interval (2.30, 7.03)) higher than that of their non-breastfeeding counterparts. Dietary supplementation intervention programs targeting different subgroups should be promoted in Chinese women, given currently a wide shortage of dietary calcium intake and calcium supplementation postpartum.
Full-text available · Article · Oct 2016 · Nutrients
[Show abstract][Hide abstract]ABSTRACT: Issue addressed: The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes.Methods: The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants.Results: The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research.Conclusions: Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority.So what?: This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease.
Article · Jul 2016 · Health promotion journal of Australia: official journal of Australian Association of Health Promotion Professionals
[Show abstract][Hide abstract]ABSTRACT: Breastfeeding should be promoted widely to improve health across Asia. In the Western Pacific Region breastfeeding prevalence is considered suboptimal, however, there is no consensus on the actual level. This review compared breastfeeding rates as reported to the Western Pacific Region of WHO with the rates obtained from other research organizations. There was considerable variability observed between the different methods of data collection. For example, the WHO and UNICEF data from the Western Pacific Region which pools information mainly from national and regional survey that are cross-sectional in nature, reported the exclusive breastfeedingrate in infants less than six months of age to be 56% in China and 41% in Japan. Whereas, studies undertaken by the Curtin School of Public Health which have limited sample sizes but all use cohort methodology, reported the rate of exclusive breastfeeding at six months to be 6% in China and 15% in Japan. The large discrepancies among results indicate that representative, accurate and reproducible datais required. This implies the use of standard WHO definitions of categories of breastfeeding and a combination of routine surveillance and cohort studies in sentinel districts. Obtaining reliable data on infant feeding in the Asia-Pacific will highlight areas of focus, target interventions more appropriately and assist health professionals and parents to continue advocating for improved breastfeeding outcomes.
[Show abstract][Hide abstract]ABSTRACT: In the aftermath of many disasters the silence is punctuated by the crying of infants, hungry infants. The aim of this paper is to discuss ethical issues in feeding infants after disasters. The Asia Pacific region generates 25% of the world's GDP, but experiences 45% of natural disasters and 42% of the economic losses due to disasters. The region has 61% of the world's population, but 86% of the population affected by disasters. Breastfeeding, exclusive to six months and continuing thereafter, is important for growth and the health of the infant in the short term and later in life. In most natural disasters, mothers and infants will both suffer, but in some disasters, such as earthquakes and building collapses, infants can survive in small spaces. Infants separated from mothers require a wet nurse (rarely available) or feeding with infant formula and sterile water. Formula companies often donate supplies of infant formula but distribution should follow ethical principles. Mothers who are injured or short of food can still continue breastfeeding and don't need formula. Where formula must be used, health workers need to follow the highest ethical standards to avoid promoting infant formula to vulnerable communities in the post recovery phase.
Article · Jul 2012 · Asia-Pacific Journal of Public Health
[Show abstract][Hide abstract]ABSTRACT: Andy H Lee1, Naoko Hiramatsu21School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; 2Laboratory of Nutritional Science, School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, JapanAbstract: Cardiovascular disease is a major cause of morbidity and mortality worldwide. Its prevention through a healthy lifestyle and appropriate diet is important. Omega-3 polyunsaturated fatty acids (n-3 PUFA) therapy has shown promise in both primary and secondary prevention of cardiovascular disease. This commentary discusses the nutritional role of n-3 PUFA, including its metabolism and physiological role, comparison with n-6 series PUFA, as well as complications due to deficiency. Clinical use of n-3 PUFA for the prevention and treatment of cardiovascular disease, recommended intake, and potential adverse effects will also be examined. The available scientific evidence suggests that its supplementation and clinical use ranging from 0.4 to 1 g/day can provide tangible benefits. However, further studies are required to determine optimal dosing and the relative ratio of docosahexaenoic acid and eicosapentaenoic acid that provides maximal cardioprotection and treatment of cardiovascular disease.Keywords: alpha-linolenic acid, docosahexaenoic acid, eicosapentaenoic acid, cardiovascular disease, fish oil, polyunsaturated fatty acids
Article · Sep 2011 · Nutrition and Dietary Supplements
[Show abstract][Hide abstract]ABSTRACT: Along with reduced levels of physical activity, older Australian's mean energy consumption has increased. Now over 60% of older Australians are considered overweight or obese. This study aims to confirm if a low-cost, accessible physical activity and nutrition program can improve levels of physical activity and diet of insufficiently active 60-70 year-olds.
This 12-month home-based randomised controlled trial (RCT) will consist of a nutrition and physical activity intervention for insufficiently active people aged 60 to 70 years from low to medium socio-economic areas. Six-hundred participants will be recruited from the Australian Federal Electoral Role and randomly assigned to the intervention (n = 300) and control (n = 300) groups. The study is based on the Social Cognitive Theory and Precede-Proceed Model, incorporating voluntary cooperation and self-efficacy. The intervention includes a specially designed booklet that provides participants with information and encourages dietary and physical activity goal setting. The booklet will be supported by an exercise chart, calendar, bi-monthly newsletters, resistance bands and pedometers, along with phone and email contact. Data will be collected over three time points: pre-intervention, immediately post-intervention and 6-months post-study.
This trial will provide valuable information for community-based strategies to improve older adults' physical activity and dietary intake. The project will provide guidelines for appropriate sample recruitment, and the development, implementation and evaluation of a minimal intervention program, as well as information on minimising barriers to participation in similar programs.
Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.
Full-text available · Article · Dec 2010 · BMC Public Health
[Show abstract][Hide abstract]ABSTRACT: maternal mortality remains a major public health problem in many countries. The aim of this paper is to describe the progress made in maternal health care in Zhejiang Province, China over 20 years in reducing the maternal mortality ratio (MMR).
Zhejiang Province is located on the mid-east coast of China, approximately 180km south of Shanghai, and has a population of 49 million. Almost all mothers give birth in hospitals or maternal and infant health institutes.
the annual maternal death audit reports from 1988 to 2008 were analysed. These reports were prepared annually by the Zhejiang Prenatal Health Committee after auditing each individual case.
China has made considerable progress in reducing the MMR. Zhejiang has one of fastest developing economies in China, and since the 86 economic reforms of 1978, health care has improved rapidly and the MMR has declined. During the 1988-2008 period, 2258 maternal deaths were reported from 8,880,457 live births. During these two decades, the MMR decreased dramatically from 48.50 in 1988 to 6.57 per 100,000 in 2008. The MMR in migrant women dropped from 66.87 in 2003 to 21.67 per 100,000 in 2008. The rate of decline was more rapid in rural areas than in the city. There has been a decline in the proportion of deaths with direct obstetric causes and a corresponding increase in the proportion of indirect causes. The proportion of deaths classified as preventable has declined in the past two decades. Social factors are important in maternal safety, and on average 26.8% of maternal deaths were influenced by these factors.
as the economy was developing, maternal safety was made a priority health issue by the Government and health workers. The provincial MMR has dropped rapidly and is now similar to the rates in developed countries and lower than that in the USA. However, more work is still needed to ensure that all mothers, including migrant workers, continue to have these low rates.
[Show abstract][Hide abstract]ABSTRACT: Objective To identify issues and perceptions concerning physical activity in older adults. Design Qualitative study. Setting Perth, Western Australia. Methods Sixteen adults aged 65 to 74 years were interviewed in their own homes using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology. Results Participants believed that physical activity provided health benefits and reflected positively on physical activity experiences when they were younger, with many expressing a desire to engage in less age-appropriate activities. The major barrier to physical activity was pain. Participants described both positive and negative examples related to society's support of physical activity. Conclusions A number of issues were raised. These included: the need for more specific information on the benefits of physical activity; the role of pain management in physical activity; the concept that involvement in physical activity in younger years leads to involvement when older; and the expressed desire of older people to engage in less age-appropriate physical activities.
Full-text available · Article · Jan 2009 · Health education
[Show abstract][Hide abstract]ABSTRACT: This paper describes the influence of caesarean section on breastfeeding rates in Zhejiang Province, People's Republic of China. A longitudinal cohort study of infant feeding was conducted in Zhejiang Province, in city, suburban and rural areas. Mothers were recruited and interviewed while in hospital and then followed for six months. The sample size was 638 in the city, 347 in the suburban area and 532 in the remote mountainous rural area. In this study the highest caesarean section rate was in the city (76%), a similar rate in the suburbs (74%) and the lowest in the rural area (53%). The overall the breastfeeding initiation rate was 94%. Mothers who had a caesarean section were less likely to be exclusively breastfeeding on discharge (35.8% in city, 59.6% in the suburbs) compared to vaginal delivery where the rates were 45% and 74.4% respectively. The adjusted odds ratio for exclusive breastfeeding in caesarean section deliveries in the city and suburban mothers was 0.64 (95% CI 0.46, 0.88). Caesarean section is increasingly being used for routine deliveries in China and other countries in the region. Mothers who have an operative delivery have lower rates of exclusive breastfeeding on hospital discharge. These mothers will need extra support and encouragement to commence and maintain breastfeeding.
Article · Nov 2008 · Asia-Pacific Journal of Public Health
[Show abstract][Hide abstract]ABSTRACT: This study investigated attrition in a 6-month physical activity intervention for older adults. The program was based on the social-cognitive theory incorporating self-efficacy factors. Two hundred forty-eight insufficiently active 65- to 74-year-olds were recruited from the Australian federal electoral roll. The intervention comprised walking and strength and flexibility exercises and was conducted in 30 local neighborhoods where the participants resided. Characteristics of individuals lost to attrition (n = 86, 35%) were compared with those of program completers (n = 162, 65%). Logistic-regression analysis showed that those lost to attrition came from areas of lower socioeconomic status, were overweight and less physically active, and had lower walking self-efficacy scores and higher loneliness scores. The results suggest that early assessment of these characteristics should be undertaken to identify individuals at risk of attrition, to improve retention, and to avoid potential bias.
Full-text available · Article · May 2007 · Journal of aging and physical activity
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to document the introduction rates of complementary foods to infants in the Han, Uygur and other ethnic groups living in the Xinjiang Uygur Autonomous Region, PR China. A longitudinal study of infant feeding practices was undertaken using a random sample that included all of the ethnic groups in the region. Mothers were randomly recruited and interviewed in hospitals and maternal and child health institutes in the region. A total of 1219 mothers (578 Han, 360 Uygur and 281 from "other minority" groups), who delivered babies during 2003 and 2004, were recruited. After discharge they were contacted at approximately monthly intervals during the first six months of their infant's life to obtain details of feeding practices. The overall introduction rates of water, cow's milk and solid food in Xinjiang were, respectively, 23%, 2% and 6% before discharge and 76%, 39% and 78% at six months. The rates were different between ethnic groups. Uygur mothers were most likely to feed water to their babies, with introduction rates of 57% before discharge and 95% at six months, while the corresponding rates were 6% and 77% for Han and 12% and 52% for other minority groups. Mothers from Uygur and other minorities introduced cow's milk earlier than Han mothers. Uygur mothers also introduce solid foods earlier (10% pre discharge and 91% by six months) when compared to Han (3% pre discharge and 85% by six months) and other minorities (4% pre discharge and 48% by six months). The pattern of introduction of complementary foods in this region does not follow internationally recognized practices, suggesting the need for further education of health professionals and parents.
Full-text available · Article · Apr 2007 · Asia Pacific Journal of Clinical Nutrition
[Show abstract][Hide abstract]ABSTRACT: Breastfeeding is the foundation of good nutrition and provides the basis for health throughout the life span. The WHO and the Chinese Ministry of Public Health recommend exclusive breastfeeding to six months of age. The practice of giving prelacteal feeds may interfere with the establishment of good breastfeeding practices and is contrary to the principles of Baby Friendly Hospital accreditation. The objective of this study was to investigate the prevalence of prelacteal feeds in a hospital in Hangzhou and the influence of this practice on breastfeeding at discharge. A longitudinal study of infant feeding was conducted in Hangzhou, China and a total of 638 mothers were recruited and interviewed while in hospital. The questionnaire included full details of infant feeding methods and factors likely to influence the initiation and duration of breastfeeding. Binary logistic regression was used to analyse factors influencing breastfeeding on discharge. In Hangzhou almost all babies are born in hospital, the median length of stay was 5.6 days and 77% of births were by caesarian section. In 26% of births the infants were given formula, water or milk as their first feed. At the time of discharge from hospital 91% of infants were receiving some breastmilk, but only 36% of mothers were exclusively breastfeeding. Breastfeeding on discharge from hospital was inversely related to giving prelacteal feeds (OR 0.115, 95% CI 0.055-0.238). While in hospital just over one quarter of infants received prelacteal feeds and these infants had a lower rate of breastfeeding on discharge.
Full-text available · Article · Apr 2007 · Asia Pacific Journal of Clinical Nutrition
[Show abstract][Hide abstract]ABSTRACT: To document infant feeding methods in the first six months of life in Xinjiang Uygur Autonomous Region, People's Republic of China, 2003-2004. Some problems with breast-feeding in the area are explained.
A longitudinal study of infant feeding practices was undertaken. A total of 1219 mothers who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes, and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices. Multivariate logistic regression analysis was used to explore factors associated with breast-feeding initiation.
'Any breast-feeding' rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 92.2, 91.3, 89.9, 88.8, 87.7, 86.0 and 73.0%, respectively. 'Exclusive breast-feeding' rates at discharge and at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months were 66.2, 47.6, 30.1, 25.8, 22.1, 13.0 and 6.2%, respectively. The main problem of breast-feeding in Xinjiang was the early introduction of formula or water. The average duration of 'exclusive breast-feeding' was 1.8 months (95% confidence interval (CI) 1.7-2.0), of 'full breast-feeding' 2.8 months (95% CI 2.7-2.9) and of 'any breast-feeding' 5.3 months (95% CI 5.2-5.4).
Infant feeding methods in Xinjiang were documented in this study and the main problems with infant feeding in Xinjiang are discussed. Further studies are needed to identify factors associated with 'exclusive breast-feeding' and duration.
Full-text available · Article · Mar 2007 · Public Health Nutrition
[Show abstract][Hide abstract]ABSTRACT: To document 'exclusive breastfeeding' duration and factors associated with duration in Xinjiang, PR China.
A cohort of 1219 mothers in Xinjiang, PR China was recruited to study their infant feeding practices. The mothers who delivered babies during 2003 and 2004 were contacted in hospital and again at 0.5, 1.5, 2.5, 3.5, 4.5 and 6 months postpartum, or until they ceased to breastfeed. Interviews were conducted using a structured questionnaire. Survival analysis was used to calculate the mean of 'exclusive breastfeeding' and explore factors affecting 'exclusive breastfeeding' duration.
The average 'exclusive breastfeeding' duration in Xinjiang was 1.8 months. Factors negatively associated with 'exclusive breastfeeding' duration were mother's going to work and using pacifier. Factors positively associated with 'exclusive breastfeeding' duration were 'whether the maternal mother breastfed her children' and deciding 'exclusive breastfeeding' before delivery.
'Exclusive breastfeeding' duration in Xinjiang, PR China was short. The study identified some factors associated with 'exclusive breastfeeding' duration. The results suggested an education program aimed to correct traditional inappropriate breastfeeding perceptions and promote 'exclusive breastfeeding' in Xinjiang.
Full-text available · Article · Feb 2007 · Asia Pacific Journal of Clinical Nutrition
[Show abstract][Hide abstract]ABSTRACT: To develop strategies to recruit and retain inactive older adults into a physical activity program.
Names of 7378 older adults were obtained from 60 neighborhoods. Then, 6401 potential subjects were matched to telephone numbers and phoned. Subjects meeting the screening criteria were invited to join the program (n = 4209). Walk leaders and social support were used to enhance retention.
Five hundred seventy-three subjects were recruited (260 intervention and 313 control). The respective participation rate was 12.6% (260/2056) and 14.5% (313/2153), with low attrition of 31.9% (83/260) and 24.6% (77/313).
Effective recruitment and retention strategies were identified.
Full-text available · Article · Apr 2006 · American journal of health behavior
[Show abstract][Hide abstract]ABSTRACT: Breastfeeding is an important factor in infant health and there have been no previous studies of breastfeeding practices in the different ethnic groups of this region of China. We aimed to compare breastfeeding rates and duration between Han, Uygur and other ethnic groups living in Xinjiang, PR China.
A longitudinal study of infant feeding practices was undertaken using a sample that included different ethnic groups. Mothers were randomly recruited and interviewed in hospitals and after discharge were contacted in person or by telephone at approximately monthly intervals to obtain details of infant feeding practices. Setting: Xinjiang Uygur Autonomous Region, PR China. Subjects: A total of 1219 mothers (578 Han, 360 Uygur and 281 'other minority' mothers) who delivered babies during 2003 and 2004 were interviewed in five hospitals or institutes located in both urban and rural areas.
'Any breastfeeding' rates in Han, Uygur and 'other minority' groups at discharge were 88.5 %, 94.3 % and 97.1 % respectively, and at six months 76.7 %, 54.7 % and 87.6 % respectively. While 'exclusive breastfeeding' rates in the Han, Uygur and 'other minority' groups at discharge were 78.0 %, 34.5 % and 83.1 % respectively, at six months they had fallen to 4.8 %, 0.4 % and 16.8 % respectively. The median duration of 'Exclusive breastfeeding' of Han, Uygur and 'other minority' babies were 1.5, 0.1 and 2.5 months respectively. The Uygur babies were least likely to be 'exclusive breastfed'.
Uygur babies were least likely to be 'exclusive breastfed' and continued to 'any breastfeed' at six month. The 'any breastfeeding' rates in the Han group were lower in the first four months. An education program focused on breastfeeding continuation and exclusive breastfeeding is necessary in Xinjiang, especially for Uygur and Han ethnic groups.
Full-text available · Article · Feb 2006 · BMC Public Health
[Show abstract][Hide abstract]ABSTRACT: This study documented the prevalence (proportion) of mothers taking folic as supplements or as fortified foods and explored the factors that determined whether folic acid was taken. A cross sectional analysis of the baseline data of mothers who participated in the Perth Infant Feeding Study was performed. A total of 587 mothers who delivered at the two hospitals in the study completed baseline questionnaires. The factors associated with the decision to take folic acid supplements or fortified foods were investigated using multivariate logistic regression. Main outcome measures were the percentage of mothers taking folic acid or folic acid fortified foods. A total of 455 (78%) mothers stated that they took folic acid supplements before or during the first three months of their pregnancy. Of the 132 who did not take folate supplements only 35 (6% of all participating mothers) claimed to have taken folate fortified food or beverages. In the highest income group, 87% of mothers took folic acid supplements compared to 64% in the poorest group. The significant factors independently associated with not taking folic acid supplements or fortified food were " years of education " (OR ' 10 years or less' 0.45 (0.23-0.88)), " family income " (OR < $ 25000 0.40(0.20-0.80)), and for taking folic acid "the timing of the pregnancy. "(OR'actively trying'2.01 (0.1.04-0.3.87)). There was a significant proportion of mothers who did not take folic acid periconceptually. The mothers who were not taking folic were less educated, from lower socio-economic groups and were not actively trying to fall pregnant at the time they became pregnant. The results suggest that in order to reach all Australian mothers, mandatory fortification of foods with folic acid should be required.
Full-text available · Article · Jan 2006 · Asia Pacific Journal of Clinical Nutrition