A glass of milk

GRATITUDE AND UNCONDITIONAL LOVE IS ONE OF THE MOST MOST IMPARTANT VALUES'.ONE NEED TO SPREAD AND INCULCATE THIS VALUS UNTO ONE'S LIFE.
THIS IS MY DESIRE.


One day, a poor boy who was selling goods from door to door to pay his way through school, found he had only one thin dime left, and he was hungry.
He decided he would ask for a meal at the next house. However, he lost
his nerve when a lovely young woman opened the door.


Instead of a meal he asked for a drink of water. She thought he looked hungry
so brought him a large glass of milk. He drank it slowly, and then asked,
How much do I owe you?


"You don't owe me anything," she replied. "Mother has taught us
never toaccept pay for a kindness.
"He said..... "Then I thank you from my heart.


"As Howard Kelly left that house, he not only felt stronger physically, but his faith in God and man was strong also. He had been ready to give up and quit.


Many year's later that same young woman became critically ill. The local doctors were baffled. They finally sent her to the big city, where they called in
specialists to study her rare disease.


Dr. Howard Kelly was called in for the consultation. When he heard the name of the town she came from, a strange light filled his eyes. Immediately
he rose and went down the hall of the hospital to her room.
Dressed in his doctor's gown he went in to see her.
He recognized her at once.


He went back to the consultation room determined to do his best to save her life. From that day he gave special attention to her case.


After a long struggle, the battle was won.


Dr. Kelly requested the business office to pass the final bill to him for approval.
He looked at it, then wrote something on the edge and the bill was sent to her room. She feared to open it, for she was sure it would take the
rest of her life to pay for it all. Finally she looked,
and something caught her attention on the
side of the bill. She read these words.....
"Paid in full with one glass of milk" ........ (Signed) Dr. Howard Kelly.




Tears of joy flooded her eyes as her happy heart prayed: "Thank You, God, that
Your love has spread broad through human hearts and hands.


"There's a saying which goes something like this: Bread cast on the waters comes back to you. The good deed you do today may benefit you or
someone you love at the least expected time.


If you never see the deed again at least you will have made the
world a better place -And, after all, isn't that what life is all about?


Now you have two choices. You can send this page on and spread a positive message. Or ignore it and pretend it never touched your heart.


The hardest thing to learn in life is which bridge to cross and which to burn...
"If God brings you to it - He will bring you through it " - Denny

TOTEM

Mein Totem ist die Schlange Was ist Dein Totem?

Promotion and support of breastfeeding

MEDLINE
Counseling Interventions Recommended to Promote and Support Breast-Feeding
News Author: Laurie Barclay, MDCME Author: Charles Vega, MD
Release Date: October 23, 2008;
Authors and Disclosures
Laurie Barclay, MDDisclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Charles Vega, MDDisclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.

Laurie Scudder, MS, NP-CDisclosure: Laurie Scudder, MS, NP-C, has disclosed no relevant financial information.

Brande Nicole MartinDisclosure: Brande Nicole Martin has disclosed no relevant financial information.


October 23, 2008 — The US Preventive Services Task Force (USPSTF) has issued an updated statement recommending counseling interventions during pregnancy and after birth to promote and support breast-feeding. The updated guidelines and evidence review are published in the October 21 issue of the Annals of Internal Medicine.
"In children, breastfeeding has been associated with a reduction in the risk for acute otitis media, nonspecific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, childhood leukemia, and the sudden infant death syndrome," write Mei Chung, MPH, from Tufts-New England Medical Center Evidence-Based Practice Center in Boston, Massachusetts, and coauthors of the accompanying evidence review. "In mothers, a history of lactation has been associated with a reduced risk for type 2 diabetes and breast and ovarian cancer. According to the American Academy of Pediatrics, some of the obstacles to initiation and continuation of breastfeeding include insufficient prenatal education about breastfeeding, disruptive maternity care practices, and lack of family and broad societal support."
The goal of the evidence review was to evaluate the efficacy of primary care–based interventions to promote breast-feeding in breast-feeding rates and child and maternal health outcomes.
The reviewers performed electronic searches of MEDLINE, the Cochrane Central Register of Controlled Trials, and CINAHL from September 2001 to February 2008 as well as references of selected articles. Inclusion criteria for the review were English-language publications describing randomized controlled trials of interventions initiated in primary care to promote breast-feeding, primarily in developed countries.
Pertinent data reviewed by the authors included characteristics of interventions and comparators, study setting and design, clinical and demographic characteristics of the study sample, the proportion of infants continuing to be breast-fed for various durations, and health outcomes in infant and mother.
Of 38 randomized controlled trials identified that met inclusion criteria, 36 took place in developed countries. Breast-feeding promotion interventions in developed countries were associated with significantly increased rates of short-term (1 - 3 months) and long-term (6 - 8 months) exclusive breast-feeding, based on random-effects meta-analyses. Rate ratios were 1.28 for short-term rates (95% confidence interval [CI], 1.11 - 1.48) and 1.44 for long-term rates (95% CI, 1.13 - 1.84).
Compared with either prenatal or postnatal interventions alone, combining prenatal and postnatal breast-feeding interventions had a greater effect on increasing breast-feeding durations, according to the results of subgroup analyses. In increasing the short-term breast-feeding rate, interventions associated with a component of lay support, such as peer support or peer counseling, were more effective than usual care.
Limitations of this review included clinical and methodologic heterogeneity, precluding extensive meta-analyses; and inability to obtain reliable estimates for the isolated effects of each component of multicomponent interventions.
"Evidence suggests that breastfeeding interventions are more effective than usual care in increasing short- and long-term breastfeeding rates," the review authors write. "Combined pre- and postnatal interventions and inclusion of lay support in a multicomponent intervention may be beneficial."
On the basis of the above-described systematic evidence review, the USPSTF evaluated the efficacy of interventions to promote and support breast-feeding that were initiated in, conducted in, or referred to primary care. The resulting guidelines are an update of the 2003 USPSTF recommendation on counseling to promote breast-feeding.
Because the USPSTF concluded that there was moderate certainty that interventions to promote and support breast-feeding have a moderate net benefit, the updated statement recommends interventions during pregnancy and after birth to promote and support breast-feeding (grade B level recommendation).
"There is convincing evidence that breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for women," write Ned Calonge, MD, MPH, from the Colorado Department of Public Health and Environment in Denver, and colleagues. "Adequate evidence indicates that interventions to promote and support breastfeeding increase the rates of initiation, duration, and exclusivity of breastfeeding. No published studies focus on the potential direct harms from interventions to promote and support breastfeeding."
Although the review did not include a search for possible harms associated with breast-feeding itself, the USPSTF concluded that the potential harms of interventions to promote and support breast-feeding were no greater than small.
The task force noted that interventions including both prenatal and postnatal components may be most effective at increasing duration of breast-feeding, and they also recommended considering multiple intervention strategies. These may include formal breast-feeding education for mothers and their families, direct support of mothers during breast-feeding, training primary care staff regarding breast-feeding and various techniques for breast-feeding support, and peer support.
"Although the activities of individual clinicians to promote and support breastfeeding are likely to be positive, additional benefit may result from efforts that are integrated into systems of care," the statement authors conclude. "System-level interventions can incorporate clinician and team member training and policy development, and through senior leadership support and institutionalization, these initiatives may be more likely to be sustained over time. Although outside the scope of this recommendation and evidence review, community-based interventions to promote and support breastfeeding, such as direct peer-to-peer support, social marketing initiatives, workplace initiatives, and public policy actions, may offer additional sizeable benefits."
The Agency for Healthcare Research and Quality, US Department of Health and Human Services, supported this evidence review and statement. The authors of the statement have disclosed no relevant financial relationships.
Ann Intern Med. 2008;149:560-564, 565-582.
Clinical Context
The American Academy of Pediatrics recommends breast milk as the preferred choice for feeding infants, and the goals of the Healthy People 2010 initiative includes a target of 75% of mothers initiating breast-feeding their infants. In the United States, the rate of new mothers initiating breast-feeding was 73% in 2005, and 20% of mothers breast-fed their infants exclusively for 12 months. These rates in 2005 were higher vs 2002.
In its last recommendation in 2003, the USPSTF recommended counseling to promote higher rates of breast-feeding. The current recommendation uses the results of a systematic review of data available from January 2007 to update this recommendation. The results of this review and new recommendation are described in the "Study Highlights."
Study Highlights
Breast-feeding has been associated with numerous health benefits for both mother and infant. Breast-feeding during infancy has been associated with lower rates of otitis media, respiratory tract infection, and gastrointestinal tract infection. Later in childhood, breast-fed children have a lower risk for asthma, obesity, and type 2 diabetes vs children who were not breast-fed. Finally, breast-feeding is associated with lower risks for breast and ovarian cancer in the mother.
The systematic review included 38 randomized controlled trials of primary care–initiated interventions to promote breast-feeding. Study settings included primary care offices, hospital settings, and patient homes. The majority of these studies were located in developed countries.
Overall, breast-feeding promotion increased the odds ratio of breast-feeding during 1 to 3 months by a factor of 1.28. These programs increased the odds ratio of breast-feeding during 6 to 8 months by 1.44.
One study from Belarus, a developing country, demonstrated that a program to promote breast-feeding not only improved rates of breast-feeding but also reduced rates of gastrointestinal tract infection and atopic dermatitis in children.
Many interventions used multiple modalities to promote breast-feeding, so it was difficult to identify the most effective individual tool to increase the rate of breast-feeding. However, interventions built into health systems seemed to be the most effective, and combining prenatal and postnatal interventions was more effective than either type of intervention alone.
Interventions involving lay workers appeared more effective than usual care in promoting higher rates of breast-feeding.
No harms were reported in research studying interventions to support breast-feeding.
Overall, the USPSTF gives a grade B recommendation to interventions to promote and support breast-feeding. This level means that there is a high certainty of a moderate degree of benefit for these interventions or that a moderate certainty that the benefit is moderate to substantial.
The authors of the current recommendation call for further research into the individual components of breast-feeding promotion programs as well as cost-benefit analyses of these programs.
Pearls for Practice
Breast-feeding during infancy has been associated with lower rates of otitis media, respiratory tract infection, and gastrointestinal tract infection. Later in childhood, breast-fed children have a lower risk for asthma, obesity, and type 2 diabetes vs children who were not breast-fed. Finally, breast-feeding is associated with lower risks for breast and ovarian cancer in the mother.
The USPSTF recommends measures to promote and support breast-feeding in the prenatal and postnatal periods (a grade B recommendation).

Ultimi sprazzi d'estate.

Foto fatte nel mo giardinetto.

"I corbezzoli erano squisiti"

Pubblicità occulta

LONDON - SORTING OUT SUMMER PICS

Gardens

Hare Krishna Festival

Hooked to internet (internet point)

At the gate of British Musem

Havc you ever seen a real dog toilet ?

Dafne has just seen some swans

Red phone boot

A very sociable squirrel

Waterfalls in background

Notizie interessanti

Siamo troppo puliti?
Le insidiose trappole dell’igiene
Meno germi, più allergie. Ora questa ipotesi si estende al diabete e ai tumori
(da www.napscompany.com)L’«ipotesi igienica» non è più una curiosità come sembrava quando fu proposta, alla fine degli Anni Ottanta, dall’epidemiologo britannico David Strachan, che attribuiva alla minore esposizione ai germi durante l’infanzia l’aumento delle malattie allergiche nei Paesi più ricchi. A conferma della sua teoria diversi studi mostravano come la probabilità di soffrire di eczema, raffreddore da fieno, o asma era più bassa tra chi aveva molti fratelli, aveva frequentato l’asilo nido fin dai primi mesi di vita, o comunque, vivendo in contesti socioeconomici più sfavorevoli, aveva contratto l’epatite A, la salmonellosi o altre malattie che si trasmettono in condizioni igieniche inadeguate. «Oggi a queste prove indirette si sono aggiunti esperimenti di laboratorio e studi su modelli animali — spiega Paolo Maria Matricardi, che attualmente è senior scientist presso il Dipartimento di pneumologia e immunologia pediatrica dell’Università di medicina Charité di Berlino —. Esaminando l’incidenza di allergia nei militari, per esempio, abbiamo dimostrato che l’effetto protettivo, più che dalle infezioni respiratorie, che anzi possono innescare l’asma, viene da germi trasmessi da mani poco pulite e da cibi contaminati».
L’ipotesi igienica si è intanto estesa: le difese dell’organismo umano, non dovendosi cimentare con le molteplici infezioni cui è stato esposto per millenni, si rivolgerebbero non solo contro elementi di per sé innocui, come nelle malattie allergiche, ma anche verso tessuti e organi propri, scatenando malattie autoimmuni, come il diabete, la sclerosi multipla o il morbo di Crohn. Per studiare l’applicazione della teoria igienica al diabete di tipo 1 l’Unione europea ha stanziato 6 milioni di euro. Si è osservato, infatti, che in Finlandia il diabete è 6 volte più comune che in Russia e che in alcune regioni della Russia sono più frequenti le infezioni intestinali: il progetto Diabimmune, dovrà stabilire, indagando su 7 mila bambini, se c’è un legame tra queste due circostanze. La linea di ricerca più innovativa e di cui si è finora meno sentito parlare, però, è quella che riguarda i tumori, perché anche la loro genesi è tenuta sotto controllo dal sistema immunitario. Si è partiti dall’osservazione che i bambini inseriti al nido nei primi mesi di vita hanno un rischio ridotto di ammalarsi di leucemia infantile, o di sviluppare da grandi il linfoma di Hodgkin, tumore del sistema linfatico che è meno frequente anche nei giovani con più fratelli maggiori.
«Anche le difese immunitarie contro i tumori vengono attivate dal contatto con i germi, soprattutto dalle componenti di alcuni batteri, chiamate endotossine, — spiega il professor Giuseppe Mastrangelo, del Dipartimento di medicina ambientale e sanità pubblica dell’Università di Padova — con cui vengono particolarmente a contatto alcune categorie professionali, come gli allevatori e i lavoratori dei cotonifici». «Chi lavora nelle stalle, per esempio, ha cinque volte meno probabilità di avere un cancro al polmone rispetto ai contadini che non allevano animali — prosegue l’epidemiologo padovano — . Il rischio diminuisce quante più sono le mucche da accudire e torna ad aumentare col tempo se gli allevatori cambiano lavoro. In maniera analoga, le addette alla lavorazione del cotone sembrano protette, oltre che nei confronti del tumore al polmone, anche verso il tumore al seno, al fegato, allo stomaco, al pancreas. E pure in questo caso l’effetto protettivo è tanto maggiore quanto più intenso e lungo è stato il contatto con l’endotossina, presente nella polvere di cotone, così come nel letame».
Roberta Villa18 ottobre 2008(ultima modifica: 19 ottobre 2008)
Corriere della Sera on line