What do you think of BREASTFEEDING in public places?

https://poutsch.com/question/1021874

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A Glimpse of Reality: David Jay’s SCAR Project

The SCAR Project is a series of large-scale portraits of young breast cancer survivors shot by fashion photographer David Jay. Primarily an awareness raising campaign, The SCAR Project puts a raw, unflinching face on early onset breast cancer while paying tribute to the courage and spirit of so many brave young women.
Dedicated to the more than 10,000 women under the age of 40 who will be diagnosed this year alone, The SCAR Project is an exercise in awareness, hope, reflection and healing. The mission is three-fold: raise public consciousness of early-onset breast cancer, raise funds for breast cancer research/outreach programs and help young survivors see their scars, faces, figures and experiences through a new, honest and ultimately empowering lens.

Breast cancer is the leading cause of cancer deaths in young women ages 15-40. The SCAR Project participants range from ages 18 to 35, and represent this often overlooked group of young women living with breast cancer. They journey from across America – and the world – to be photographed for The SCAR Project. Nearly 100 so far. The youngest being 18 years old.

 Although Jay began shooting The SCAR Project primarily as an awareness raising campaign, he was not prepared for something much more immediate . . . and beautiful: “For these young women, having their portrait taken seems to represent their personal victory over this terrifying disease. It helps them reclaim their femininity, their sexuality, identity and power after having been robbed of such an important part of it. Through these simple pictures, they seem to gain some acceptance of what has happened to them and the strength to move forward with pride."

Links:
http://www.thescarproject.org/

http://www.thedailymuse.com/health/a-glimpse-of-reality-david-jays-scar-project/
http://www.cbc.ca/passionateeye/episode/baring-it-all.html

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Studies Show that Nigeria Has The Highest Twinning Rate In The World

   A multiple pregnancy means that a woman has two or more babies in her uterus. These babies can come from the same egg or from different eggs. The occurrence and frequency of twinning, however, varies across human populations. The maternal age, socio-environmental factors, increase in the use of contraceptives, the race of human population, increase in the spontaneous abortion rate, and seasonal variations are among the factors that could influence twinning rate.

 
Information on twinning rates in southwest Nigeria is limited.

Delivery Rate   :
     A frequency of twin births of 46.5 per 1000 deliveries and 46.2 per 1000 deliveries was recorded for Ilesa and Ile-Ife respectively.
    The incidence of twinning among the races of the world has been extensively studied. Worldwide changes have occurred in the pattern of twinning rates in recent decades. The highest twinning rate is observed to occur among the Negroids, while the lowest occurred among the Mongoloid population. In Nigeria, the incidence of twinning was estimated to be 45‰.
Bulmer recorded 44.9‰ incidence of twinning in Ibadan, while 48.3‰ and 57.2‰ incidences of twin births were respectively obtained for Igbo-Ora and Ibadan between 1967 and 1969. On an average, the highest record of twinning is among the Yorubas of southwest Nigeria, with approximately 50-53 twin births per 1000 deliveries.These rates were suggested then as the highest in the world. Between 1985 and 1989, 68.1‰ twin births were recorded for Igbo-Ora, while 37.2‰ and 26.9‰ twin births were recorded for Ibadan and Lagos respectively.


Studies  determine  much of a particular trait is attributable to genetic predisposition. Apart from genetic predisposition, a factor that may have also been influencing high twinning rate in southwest Nigeria is diet. There is a general belief that the Yoruba's predisposition to high twinning rate is due to consumption of yam (Discorea sp.), which is believed to contain a natural hormone phytoestrogen, which may stimulate multiple ovulation. Indigene of the studied areas are known to have preference for food prepared in different forms from yam. Maternal history of twinning (though not considered in this study) might also have contributed to the high incidence of twinning observed in this study and previous studies from southwest Nigeria. This is because the probability of a subsequent twin pregnancy is increased fourfold in mothers of twins, and the risk of having dizygotic (DZ) twins is roughly double for a woman whose mother or sister has DZ twins.

Links:
http://www.webmd.boots.com/pregnancy/guide/twin-pregnancy

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150208/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840794/
http://www.drugs.com/mtm/wild-yam.html
http://www.bbc.co.uk/worldservice/people/highlights/010607_twins.shtml
http://www.randafricanart.com/Yoruba_Customs_and_Beliefs_Pertaining_to_Twins.html

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Warnings about the safety of Codeine, Oxycodone and Acetaminophen in breastfeeding mothers

          Doctors have been prescribing Codeine for postpartum pain management for many years, and, until recently, it was considered safe to breastfeed while taking the opioid. But the death of an infant exposed to Codeine through breast-milk has many health care providers questioning the safety of the drug when used by breastfeeding mothers. Because of the potential risks, some doctors have begun the practice of prescribing Oxycodone as an alternative to Codeine; however, a new study soon to be published in The Journal of Pediatrics finds that oxycodone is no safer for breastfed infants than codeine.The levels of Oxycodone in breast milk strongly correlated with plasma levels, suggesting that Oxycodone persisted in the breast milk of some mothers. Therefore, it is important to address the neonatal safety of Oxycodone during breastfeeding.

   
 In this study, were compared the maternal reports of CNS depression in breastfed infants exposed to Oxycodone with those in infants who were exposed to Codeine or Acetaminophen alone. The analysis reveals several important features of this potentially fatal adverse reaction: the maternal self-report of neonatal CNS depression is higher in neonates breastfed by mothers mediated with oxycodone than in infants breastfed by mothers medicated with acetaminophen.
   Symptomatic infants of mothers medicated with Oxycodone were sleeping longer than asymptomatic infants. In most cases of CNS depression in the oxycodone and codeine cohort, the parents reported dramatic neonatal improvement when exposure of the opioid ceased. There was a dose-response relationship with mothers of symptomatic infants having consumed on average 50% more oxycodone and codeine per kg of maternal body weight. However, some mothers reported neonatal CNS depression when they were consuming as little as 0.03 mg/kg of oxycodone daily. Furthermore, there was a trend for mothers of symptomatic infants of using oxycodone or codeine for longer periods than mothers of asymptomatic infants. Our findings suggest that maternal CNS depression is a strong predictor of neonatal CNS depression for both oxycodone and codeine. When clinicians observe maternal CNS depression, they need to monitor the child for it as well. Finally, mothers medicated with oxycodone were more likely to experience CNS depressive adverse effects in addition to other adverse effects known to be associated with opioid use compared with mothers taking codeine.

      Table . Maternal adverse event reported with oxycodone or codeine use during breastfeeding

	Oxycodone (n = 139)	Codeine (n = 139)
Sedation∗	92 (%)	21 (%)
Other concomitant adverse events
Nausea	19 (21)	4 (19)
Vomiting	8 (8.6)	2 (9.5)
Constipation	23 (25)	13 (62)
Dizziness	23 (25)	6 (29)
Weakness	8 (8.6)	6 (29)
Confusion	1 (1)	0 (0)
Rash	0 (0)	2 (9.5)

∗Of the proportion of mothers who reported experiencing adverse effects with oxycodone or codeine medication, all listed sedation as an adverse event. All other adverse effects with oxycodone or codeine medication occurred in conjunction with sedation. Mothers were significantly more likely to experience sedative adverse effects from oxycodone as compared with codeine (P < .0001; OR, 17.62; 95% CI, 9.95-31.21).

Several differences in the 3 cohorts in this study need to be highlighted:
1.First, maternal indications for receiving acetaminophen or opioids were different in the cohorts. This is reflective of the general practice of prescribing Opioids for pain relief after caesarian delivery or episiotomy in Canada. Therefore, questions related to comparative efficacy among Codeine, Oxycodone, and Acetaminophen cannot be addressed by this study.

2. Second, with sequential statistical analysis, mothers in the codeine group were found to be significantly more likely than mothers in the oxycodone group to be first-time mothers. Arguably, the inexperience of first-time mothers may lead to hypervigilance and increased anxiety, which could translate to increased reporting of CNS depressive symptoms. Although we observed a similar incidence of neonatal CNS depression between oxycodone and codeine, parity could have biased these results, causing over-reporting of CNS depression in the codeine group.

3. Third, infants who were exposed to oxycodone via breast milk were slightly younger in the oxycodone group as compared with the codeine and acetaminophen groups. Pharmacodynamic modeling has revealed that compromised neonatal opioid clearance capacity (which is closely related to age) may predispose infants to CNS depressive adverse effects when exposed to maternal opioids. However, within the oxycodone group, there was no difference in PMA between symptomatic infants and asymptomatic infants.
The major limitation of this study was its retrospective nature, and thus the potential for recall bias was introduced. Furthermore, the population of mothers interviewed were self-selected because they took the initiative to call the Motherisk Program and ask for safety advice. It is possible that these women may have exhibited increased vigilance in monitoring their infants for symptoms of adverse drug reaction than the general population, but this increased attention would also likely improve recall of the event. The control group or acetaminophen cohort was deemed critical to account for non-specific features that may resemble neonatal CNS depression especially when they are based on maternal reports. In accordance, there is only one maternal-positive report of infant CNS depression when a mother was breastfeeding and consuming acetaminophen alone.

In conclusion, maternal consumption of Oxycodone is associated with an increased risk of CNS depression in the breastfed infant, such that 1 in 5 breastfed infants with mothers medicated with oxycodone experienced symptoms of CNS depression. Therefore, replacement of codeine by oxycodone during breastfeeding cannot be assumed to be safe for the child and the mother. In the future, prospective and pharmacogenetic studies are needed to investigate other factors related to maternal oxycodone use and neonatal CNS depression.

Sources:

Use of Certain Opioid Analgesics During Breast-Feeding Not Safe http://www.medscape.org/viewarticle/749972?src=cmemp

Acetaminophen/Oxycodone Pregnancy and Breastfeeding Warnings http://www.drugs.com/pregnancy/acetaminophen-oxycodone.html

Central Nervous System Depression of Neonates Breastfed by Mothers Receiving Oxycodone for Postpartum Analgesia http://www.jpeds.com/article/S0022-3476%2811%2900678-0/fulltext#appsec1

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Breastfeeding . Why Human milk is irreplaceable?

World Breastfeeding Week  1–7 August 2011

      World Breastfeeding Week is celebrated every year from 1 to 7 August in more than 120 countries to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding.

      Breastfeeding is the best way to provide newborns with the nutrients they need. WHO recommends exclusive breastfeeding until a baby is six months old, and continued breastfeeding with the addition of nutritious complementary foods for up to two years or beyond.

Introduction to Breastfeeding

          Breast milk is thought to be the best form of nutrition for neonates and infants. The properties of human milk facilitate the transition of life from in utero to ex utero. This dynamic fluid provides a diverse array of bioactive substances to the developing infant during critical periods of brain, immune, and gut development. The clinician must be familiar with how the mammary gland produces human milk and how its properties nourish and protect the breastfeeding infant.

             Clinicians play a crucial role in a mother's decision to breastfeed and can facilitate her success in lactation. Although a mother may not be aware of the evidence indicating that breast milk contributes to her baby's short-term and long-term well-being, she has developed certain attitudes and cultural beliefs about breastfeeding. The issue of bonding between mother and newborn may be a strong factor; however, stronger cultural or societal barriers may result in the decision to formula feed. Such issues must be understood for successful counseling. The mother makes her decision regarding breastfeeding prior to delivery in more than 90% of cases; therefore, her choice of infant nutrition should be discussed starting in the second trimester and continue as part of an ongoing dialogue during each obstetric visit.

          Breastfeeding or bottle feeding your newborn baby is a personal decision. If you choose to breastfeed, it will be helpful if you are in a supportive environment and have resources to assist you with questions you may have or problems that may develop. 

• Consider attending a series of La Leche League meetings or reading La Leche League's book on breastfeeding (The Womanly Art of Breastfeeding) before the birth of your baby.
  
  
• Ask other breastfeeding mothers for advice.
  
  
• A supportive network including other like-minded mothers helps with the commitments of this style of feeding.
  
  
• If you are undecided at birth time, consider a one-month trial. It is easy to go from breastfeeding to bottle-feeding.
  
  
• The first month of breastfeeding is the most difficult, so if you get through that period, the rest will be easier.

Campaign Video : "Breastfeeding: First food for champions!"  

Comparison with Formula-Feeding

• The ideal food for human infants is human milk. Human milk contains all the right ingredients—protein, carbohydrates, fats, vitamins, minerals, and water—in just the right balance. No formula can make that claim. Infant formula manufacturers attempt to artificially duplicate human milk. Formula feeding is a practice that is relatively recent—about 60 years—compared to the beginning of humankind (not to mention all other mammals) relying on breast milk.
  
  
• Formula does not contain the disease-fighting factors or the digestive enzymes that breast milk has. The nutrients in formula are more difficult for a baby to digest and absorb than the nutrients in human milk, requiring the baby to handle excess waste. Some formulas may have a less than optimal composition by containing too much salt and/or not enough cholesterol, fats, lactose, zinc, and iron, among other nutrients.

• Some infants fed a cow's milk-based formula may develop allergies to the proteins in the cow's milk. Infants who are allergic to cow's milk often are also allergic to "hypoallergenic" (non-allergy-causing) soy formulas.
  
  
• During the early months, a formula-fed baby may develop signs of allergy to or intolerance of a particular formula. These signs may include the following:
  
  
  • Bouts of crying after feeding
    
    
  • Vomiting after most feedings
    
    
  • Persistent diarrhea or constipation
    
    
  • Colic with a distended tense painful abdomen after feeding
    
    
  • Generally irritable behavior
    
    
  • A red, rough sandpaper-like rash especially around the face or anus or in both places
    
    
  • Frequent colds and ear infections
    
    
  • Red itchy rash especially in the folds of the elbow and knee joints
    
    
• These signs, or the baby's preference, may lead you through a series of different formulas, often each more expensive than the last.
  
  
• Formula-fed infants may be exposed to a variety of environmental substances used during the preparation of the formula or carried as a minor contaminate from which breastfed infants are protected. 

Benefits of Breastfeeding

• With rare exceptions, breast milk is the preferred feeding for infants and confers unique benefits.
  
  Breastfed babies (for at least 6 months) may be at reduced risk for many acute and chronic diseases, including gastrointestinal tract infection (like diarrhea), lower respiratory tract infections (like a cold), urinary tract infections, otitis media (ear infections), and allergic reactions (like atopic dermatitis and asthma).
  The effect of breastfeeding in protecting against infection is well established. Infants who were fully breastfed for 6 months or more seem to have higher mental development when compared with infants who were never breastfed. Some studies show that the effects of breastfeeding may carry over and also protect young children and adolescents from becoming overweight.
  
  
• Milk has biologic specificity—meaning that every species of animal who breastfeeds their babies makes a milk that is unique for the young of that species.
  
  
• The amounts of nutrients change to match your baby's rapidly changing needs.
  
  
• The fat content increases during a feeding so that the baby gets the right amount of fat. Human milk contains the right kinds of fats along with an enzyme (lipase) that helps digest the fat.
  
  
• Cholesterol is high in human milk, lower in cow's milk, and very low in formulas. Cholesterol promotes brain growth and provides basic components of hormones, vitamin D, and intestinal bile.
  
  
• Milk (cow's, formula, and human) contains two main proteins: whey and casein. Whey is easier for humans to digest and is found in higher concentrations in human milk.
  
  
• Around 6 months of age, the baby's intestines mature and become less open to proteins that may harm the body as allergenic proteins (allergens). Giving only human milk until the intestines mature is the best way to keep potentially allergy-causing proteins out of baby's blood.
  
  
• Human milk includes helpful proteins not naturally found in milk made by cows or companies.
  
  
• Human milk is fresh and contains more lactose (sugar) than cow's milk. Formulas add sucrose or glucose (other types of sugars).
  
  
• Vitamins and minerals have a higher bioavailability in human milk. In other words, the body uses most of what is in the milk. There is very little waste.
  
  
• The germs in the baby's environment, to which the mother has been exposed, cause the mother to produce antibodies to that germ, which are passed on to the breastfeeding infant.
  
  
• Breastfeeding relaxes mother and baby.
  
  
• Women who breastfeed have a lower incidence of breast cancer.
  
  
• Breastfed babies tend to be healthier.
  
  
• Breastfeeding is less expensive.

Prepare for Breastfeeding

• There is really no physical preparation that is necessary for breastfeeding. Education about the benefits and practice of breastfeeding is the best preparation. Contrary to some popular beliefs, it is not necessary to "toughen up" or prepare the nipples in advance for breastfeeding. Some techniques of stimulating the nipples may actually be harmful.
  
  
• Sometimes women prepare for breastfeeding by exposing the nipples to air for a certain amount of time each day; while this has not been shown to be medically useful, it is likely not harmful either.
  
  
• Take a breastfeeding class. Your hospital may offer breastfeeding classes as part of the childbirth class. These classes can put you in touch with a lactation specialist who may later be your personal breastfeeding consultant.
  
  
• Join your local La Leche League or other breastfeeding support group. Call (800) LA LECHE to find your local leader.
  
  
• Talk with supportive friends who encourage your feeding choices.
  
  
• Learn proper positioning and latch-on techniques.

First Feedings

• Within a few minutes after birth, most babies can be introduced to breastfeeding. Relax. Most babies take a few licks, sucks, and pause. Sucking in frequent bursts and pauses is the usual pattern for the first few hours and sometimes even the first few days. The first milk the mother produces, colostrum, is the best food.
  
  
• Breastfeeding also helps the uterus contract, which helps stop uterine bleeding.
  
  
• Try to room-in with your baby. When you see your baby begin to open its eyes, look around, and put his or her fist into his or her mouth, then it is time to offer your breast.
  
  
  • Try to make the nurses understand that you wish to breastfeed and that your baby should not be given sugar water or formula without you and your health care provider being aware and consenting.
    
    
  • You may need to have the nurses actually put a sign on your baby's bed restricting bottle-feeding.
  
  
• Try latching the baby on at the first signs of hunger. Do not wait until the baby cries, or you will teach the baby to cry to get your attention. The baby will get upset more quickly the longer you take to respond.

  Conclusion :
 
          Human milk, in addition to its numerous nutrients that make it an ideal food source for the growing term infant, is a bioactive fluid that evolves from colostrum to mature milk as the infant matures. This bioactive fluid contains numerous factors and live cells that, in concert, promote the growth and well-being of the breastfeeding infant. Oliver Wendell Holmes said it best when he stated, "A pair of substantial mammary glands has the advantage over the two hemispheres of the most learned professor's brain, in the art of compounding a nutritious fluid for infants." With the ever-expanding knowledge resulting from current research, commercial formula clearly cannot replicate all of the valuable properties that are inherent in human milk.

Source:
world_breastfeeding_week
breastfeeding/article
http://emedicine.medscape.com/article/1835675-overview      
 http://www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Pages/CommonQuestions.aspx
http://www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Page  /EducationalMaterialsforBreastfeedingFamilies.aspx
http://www.webmd.com/parenting/baby/baby-food-nutrition-9/default.htm
http://www.happybabyfood.com/health-nutrition/47/210-happybaby-nutrition-guide
 Age by age guide to feeding your baby  http://www.babycenter.com/0_age-by-age-guide-to-feeding-your-baby_1400680.bc

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Causes of Amenorrhea

What is Amenorrhea?
Amenorrhea is the absence of menstrual bleeding. Amenorrhea is a normal feature in :

• prepubertal, 
• pregnant,
• postmenopausal females.

In females of reproductive age, diagnosing amenorrhea is a matter of first determining whether pregnancy is the etiology. In the absence of pregnancy, the challenge is to determine the exact cause of absent menses. This article reviews the physiologic aspects of menstruation and presents an approach for ascertaining the etiology of amenorrhea. Only the main components of amenorrhea are highlighted. Many minor components of physiology are important but are beyond the scope of this article.

Pathophysiology

The menstrual cycle is an orderly progression of hormonal events in the female body that results in the release of an egg. Menstruation occurs when an egg released by the ovary remains unfertilized; subsequently, the soggy decidua of the endometrium (which was primed to receive a fertilized egg) is sloughed in a flow of menses in preparation for another cycle.

The menstrual cycle can be divided into 3 physiologic phases: follicular, ovulatory, and luteal. Each phase has a distinct hormonal secretory milieu. When one diagnoses the disease processes responsible for amenorrhea, consideration of the target organs of these reproductive hormones (hypothalamus, pituitary, ovary, uterus) is helpful.

Primary and Secondary Amenorrhea

Primary amenorrhea is defined either as absence of menses by age 14 years with the absence of growth or development of secondary sexual characteristics (eg, breast development) or as absence of menses by age 16 years with normal development of secondary sexual characteristics.

Secondary amenorrhea is defined as the cessation of menstruation for at least 6 months or for at least 3 of the previous 3 cycle intervals. Because only 3 diagnoses are unique to primary amenorrhea and never cause secondary amenorrhea, differentiating primary from secondary amenorrhea does little to enhance the clinician's understanding of the etiology.

The causes of amenorrhea are listed below. Organize clinical evaluation on the basis of sexual development and basic developmental physiology. With such a vast differential diagnosis, one way to organize and memorize the causes of amenorrhea can be in its relationships with generalized pubertal delay, normal pubertal development, or abnormalities of the genital tract.

Causes of amenorrhea

Amenorrhea can be caused by any number of changes in the organs, glands, and hormones involved in menstruation.

Possible causes of primary amenorrhea (when a woman never gets her first period) include:

• Failure of the ovaries (female sex organs that hold eggs).
• Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes hormones involved in menstruation).
• Poorly formed reproductive organs.

In many cases, the cause of primary amenorrhea is not known.

Common causes of secondary amenorrhea (when a woman who has had normal periods stops getting them) include:

• Pregnancy
• Breast feeding
• Stopping the use of birth control
• Menopause
• Some birth control methods, such as Depo-Provera

Other causes of secondary amenorrhea include:

• Stress
• Poor nutrition
• Depression
• Certain drugs
• Extreme weight loss
• Over-exercising
• Ongoing illness
• Sudden weight gain or being very overweight (obesity)
• Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
• Thyroid gland disorders
• Tumors on the ovaries or brain (rare)

A woman who has had her uterus or ovaries removed will also stop menstruating.

 Sources:

http://www.mayoclinic.com/health/amenorrhea/DS00581/DSECTION=causes 

http://emedicine.medscape.com/article/953850-overview

http://www.medicinenet.com/amenorrhea/article.htm

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