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Download Pregnancy Books - PDF Drive Unit (Japanese: ??, Hepburn: Nana-san-ichi Butai), short for Manshu Detachment and also known as Kamo Detachment: Ishii Unit, was a covert biological and chemical warfare research and development unit of the Imperial Japanese Army that undertook lethal human experimentation during the Second Sino-Japanese War (�) of World War II. UNIT 2 MATERNAL NUTRITION IN PREGNANCY AND LACTATION Structure Objectives Introduction Nutrition during Pregnancy Nutritional Requirements During Pregnancy Dietary Intake, Nutritional Status and Outcome of Pregnancy Factors Associated with Deterioration in Maternal Nutritional Status Dietary Intake, Physical Work and Nutritional Status Nutrition . 10 best uplifting books to read during lockdown struggling actress Heidi has a life-changing accident in her early thirties she ends up in an amputee rehabilitation unit, unable to walk and.
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In their first update in two days, B. The statement puts the number of hospitalized patients at people, 96 of whom are in intensive care. Monday's update was the first since the province released incomplete data on Saturday, covering case numbers but not deaths, active cases or variants of concern.

Another cases caused by variants of concern have been confirmed since Thursday, for a total of 3, to date, Henry and Dix said. Of those, are currently active. In a media availability on Monday afternoon, Dix expressed concern about the spread of these more contagious variants of the virus.

We've seen that in other jurisdictions and we expect to see it here," he said. But he pushed back against public pressure to implement stronger measures to control the spread of these variants. There are currently 8, active cases of coronavirus in the province, and public health is monitoring 11, people across B. A total of 94, people who tested positive have recovered. On Tuesday morning, the province's online vaccine registration portal is set to go live.

People born in or earlier, and those whom the province has deemed clinically extremely vulnerable will be able to register online to book their appointment, as will Indigenous people who are 18 and older. Dix said the province has spent the past couple of weeks testing the system to be sure it's capable of handling a large volume of traffic when it goes live, and he's "hopeful" it won't crash. Monday's update follows concerning numbers released Saturday, when health officials announced back-to-back single-day records for new cases.

Recent weeks have seen a major surge in infections with the novel coronavirus, and rising numbers of people who've tested positive for more infectious variants of concern. Of the confirmed variant cases to date, 2, are of the variant first identified in the U. Challenged Monday about why the province isn't releasing more data on where the variants are spreading, Dix declined to provide specifics.

It's indoor spaces � indoor events, in some cases � indoor spread within households," he said. He said provincewide, intensive care units are about 77 per cent full, and there's more capacity available in surge beds as well.

On Sunday, Dix defended the measures that B. As of last week, officials have cancelled indoor dining, in-person worship and group fitness classes. He also acknowledged that a higher proportion of younger people are becoming ill from the disease. Health officials also urged British Columbians to stay home for the holiday weekend, but mayors in some tourist destinations said over the weekend that they were noticing an influx of visitors.

He was 54 and had been suffering from a brain tumour. We will miss him greatly. The argument is that competition today with China is more about economic and technological gains than arms � and its outcome will impact the United States' financial growth and influence, its ability to defend U.

They say his proposal has been loaded down with unnecessary spending projects and that raising taxes will ultimately hurt the U.

To varying degrees, addressing infrastructure has bipartisan support. Americans are experiencing outages, delays and irritations on transport and power systems designed in the s and earlier.

Meanwhile, China's latest five-year plan calls for hundreds more airports, coal-fired power plants and other standard infrastructure projects.

China spends more on infrastructure projects in other countries than the United States spends at home, said Jonathan Hillman, a China expert at the Center for Strategic and International Studies. That and China's long-running economic boom, fueled in part by its domestic infrastructure spending, are helping China become more influential internationally, and may give it more confidence as it makes claims over Taiwan and other contested territory or advances its interests, some argue.

Past American presidents pointed to the Soviet Union while building up the U. Pointing to her two decades living in the Boston area, Ye says she has seen no really big upgrades to tired local road networks, no bus route upgrades that would help her get into the city more easily, no rail upkeep that would make a train trip to New York to see friends more enticing.

Academic studies and economists claim the lost hours of delays in the air and on roads and rails cost billions of dollars in lost productivity.

And the federal government estimates 18 million Americans lack internet. What internet there is is expensive, compared to that of other big economies. It all led to scenes of U. There could be minor annoyances, like one day finding it tough to track down a USB cable with the right metal bit that fits their laptop, because design standards could start following those of China's booming market, not the United States', Hillman said.

China is facing its own problems with debt, an aging population, and slowing gains in worker productivity, Hass said. An international flight en route to Cuba was diverted to Halifax on Monday after a medical emergency on board.

Just before 6 p. AT, the aircraft alerted the Halifax International Airport's tower that they needed an emergency diversion, according to airport spokesperson Tiffany Chase. The aircraft, a Boeing , was dealing with a medical emergency, she said. The airport's emergency response team was on hand to help with the situation before paramedics arrived. While these diversions have been happening less frequently due to fewer international flights during the COVID pandemic, Chase said Halifax is still a designated site that can assist in these situations.

Chase could not comment on the details of the emergency, how many people were involved, or whether they were crew or passengers.

She also did not know when the airplane would be leaving Halifax. The flight had not taken off as of p. Its success offers four important lessons for organizations on how to return employees to the workplace during and after COVID An Edmonton police officer suffered minor injuries in a collision Monday while conducting a traffic stop on Whitemud Drive. The collision happened around a. The officer had pulled over a car and was walking in front of his police vehicle when a commercial truck struck the vehicle, "catapulting it forward and into the member," police said.

The police vehicle was pushed forward and collided with the vehicle the officer had pulled over. Paramedics took the officer to hospital, police said.

The truck driver remained on scene. Police said charges are pending. Any witnesses are asked to contact city police. Investigators blocked off the westbound lanes of the Whitemud while they investigated Monday's collision.

To release anyone, particularly Indigenous women, transgender and Two-Spirit individuals without a plan is irresponsible and dangerous and does not demonstrate a commitment to reconciliation. Less than a week after former Progressive Conservative Leader Ches Crosbie announced his resignation, the party's president is following suit, stepping down from the role while hinting he could make a bid for Crosbie's old job.

Eugene Manning said in a letter to executive party members Monday that he feared contravening the Tory constitution's neutrality condition that governs the president. Manning is the first to publicly suggest running for the position after Crosbie left the job Wednesday, following his second defeat in a general election. On Wednesday, Manning devoted a Twitter thread to Crosbie's accomplishments as elected Tory head, noting his success in growing the party's membership and representation across the province.

Manning has declined a request for comment. Chief medical officer of health, Dr. Deena Hinshaw, said it's believed it started with a traveller returning to Alberta from out of province. Hinshaw first posted Saturday about a "significant" outbreak of the P. She did not reveal who the employer is or to what industry the infected workers belong. So far, three of those infections are confirmed to be the Brazilian variant, but she added that was likely to increase as more results come in.

Anyone at risk is being directly contacted and supported. Nearly 40 per cent of active infections in the province are now variants. There were people in hospital, including 76 in intensive care. Four more deaths since Thursday were reported. Earlier Monday, the Opposition urged the United Conservative government to bring back stricter public-health measures.

NDP Leader Rachel Notley said Premier Jason Kenney has done nothing to change course, even though he has warned that variant spread could cause hospitalizations to spike by the hundreds within a matter of weeks. Notley wants a return to measures as they were in mid-January when there were tougher restrictions on indoor fitness, restaurants, bars and other businesses and activities.

The NDP also called for an urgent conversation on school safety with teachers and district boards, action on an Alberta learn-from-home fund and more support for families, businesses and workers. Kenney pleaded with Albertans ahead of the Easter long weekend to follow public-health measures, but his government announced no further action. Notley recalled that heading into the Thanksgiving weekend, cases were a fraction of what they are now and yet that holiday was a turning point that caused new daily cases to surge above 1, late last year.

He needs to take responsibility," Notley said. This report by The Canadian Press was first published on April 5, Chris Ashurst was out looking for a lost dog east of Masset on Haida Gwaii one evening in late March when a truck whizzed by and someone shouted out of the cab: "The cold chain is broken, get your vaccine now! As he headed home to pick up his wife and drive into Masset, his phone lit up with text messages saying the cold chain � the refrigeration system for COVID vaccines � had broken at the local clinic.

That meant a batch of vaccines in storage were warming to a temperature where they would soon be rendered useless, and needed to be used quickly. Staff at the Northern Haida Gwaii Hospital put out a call to the community in and around Masset, primarily via text message, asking them to come to the clinic as quickly as possible to receive a vaccine before they all spoiled.

Northern Health spokesperson Eryn Collins said people were vaccinated that night, and not a single dose of vaccine was wasted. People stood in line at the clinic into the early hours of the next morning.

Those vaccinated including Ashurst and his wife. Ashurst described the whole situation as a "vaccine flash mob," and said people in the lineup were jovial and excited to see friends � while staying two metres apart, of course. Ashurst was scheduled to receive his vaccine the following week, as Haida Gwaii had been scheduled for a whole community immunization. In February, 1. The break in the cold chain was due to "a simple matter of human error" when a fridge door at the clinic was not properly closed, Collins said.

To hear the interviews with Chris Ashurst and Northern Health, click here:. On Sunday, there were reports about hundreds of same-day appointments available at the clinic on Wellington St.

According to city stats, 1, doses were delivered at the HHS clinic from April 2 to the end of April 4, less than per day on average � a number which used to be more than 1, per day near the end of March. An HHS spokesperson could not comment on unused appointments at the clinic, deferring instead to public health. Public health also said only appointments out of were booked at the FirstOntario Centre on Monday. At council last week, Dr. Elizabeth Richardson said Hamilton takes direction from the province on when to allow younger age groups to receive the vaccine.

She said places like Halton, which are not under the provincial system, can make those decisions independently. But Skelly insisted public health units can make that decision locally.

On Friday, Toronto and Peel public health began offering appointments to residents 60 years and up. Previously, Hamilton was part of a pilot project where 4, residents aged 60 and up were contacted by their family doctors to receive the vaccine from March 13 to April 2.

The lower city has denser neighbourhoods and residents who are more vulnerable to the impacts of the virus, the statement said, also pointing to a large number of essential workers in the area.

Skelly noted that residents 55 years and older can register for a vaccine at a participating pharmacy in any part of the city � which Askwith did.

Authorities in several provinces expressed concern on Monday that the recent rise in COVID cases was putting renewed strain on the health-care system, as Quebec and Ontario brought in new restrictions to contain the spread of the virus.

Ontario on Monday reported nearly 6, new COVID cases over a two-day span, and the Peel region west of Toronto announced it was closing all schools for two weeks to slow transmission and protect students and staff. The province set a new all-time high for the number of patients in intensive care on Monday, with Many of those cases are in the Greater Toronto Area, prompting hospitals to transfer 88 patients to other regions to help address capacity issues.

The sobering numbers prompted the chief medical officers for Toronto, Ottawa and Peel to ask the Ontario government to implement stricter measures, including a provincewide stay-at-home order.

A letter dated Sunday and signed by Dr. Eileen de Villa, Dr. Vera Etches and Dr. Lawrence Loh cited variants of concern, the hospitalization of younger patients and high intensive care unit occupancy as reasons justifying more restrictions.

In the letter, which was published on Etches' Twitter account, they argued the order is necessary "to prevent and mitigate large scale morbidity and mortality and irreparable strain on the health-care system. He said the province needs to go further by working with the federal government to expand paid sick leave programs to help workers stay home and self-isolate. The Ontario government has said it will not duplicate the paid sick leave program run by Ottawa, but Tory said rising case counts and the resulting pressure on the province's hospitals show that approach needs to be reconsidered.

Quebec Health Minister Christian Dube also pointed to the situation in hospitals Monday as the province added five regional municipalities south of Quebec City to a list of cities that will have to abide by strict lockdown rules.

Quebec currently has people in intensive care for COVID, which is still well below the stated capacity of The province announced Sunday that non-essential businesses and many cultural venues must close, schools will move to virtual learning and the overnight curfew will be advanced to 8 p. Dube said officials are also worried about the Montreal area, which he described as "under pressure," although the province has not yet announced new measures for the metropolis.

New Brunswick's chief medical officer expressed concerns over hospital overcrowding in the hard-hit Edmundston area, in the northwest of the province, where cases have been linked to the variant of the novel coronavirus first identified in the U. Jennifer Russell said. Over the weekend the health network that includes the Edmundston hospital said some patients may have to be transferred if the situation doesn't improve.

Canada's chief public health officer said the jump in COVID cases in recent weeks and the rising proportion of cases involving more contagious variants were resulting in more hospitalizations.

While under nutrition is a major problem, there is a progressive increase in obesity especially among the urban middle and upper income group population. Infections are an indirect cause of under nutrition.

Maternal care providers continue to tackle the increased infections in undernourished and anaemic women. There is an association between urinary tract infection, chlamydial infection and low birth weight. With the advent of HIV epidemic in India in the eighties, it is inevitable that over the next decade there will be an increase in the severe undernutrition associated with HIV in pregnancy and adverse impact of maternal HIV infection on the infant.

Screening for these infections and their management will have to become a part of antenatal care. Micronutrient deficiencies are widespread and coexist with chronic energy deficiency in pregnant and lactating women. Anaemia is one such micronutrient and its adverse impact on mother child dyad has been very well recognized. The magnitude and health hazards associated with anaemia , iodine and vitamin A deficiency during pregnancy and lactation are well established.

National programmes to combat these micronutrient deficiencies are being implemented with varying degree of success. In recent years Vitamin D deficiency in pregnancy in the middle and upper income groups in some parts of the country has remerged. Defining the problems and evolving national programmes for tackling them with relatively inexpensive simple interventions with the goal that substantial improvement in health and nutrition will be achieved by the year AD was a powerful motivation for the nutritionists and health professionals to face and overcome the hardships in the earlier years.

The new century has brought greater challenges of increasing variety and complexity and even maintaining the current levels of health and nutritional status would require redoubled efforts.

In view of wide spectrum under and over nutrition due to variety of causes, you will have to assess each pregnant and lactating woman carefully and provide appropriate advice regarding diet, exercise, infection prevention and control and prevention detection and management of micronutrient deficiencies to improve health and nutritional status.

In our country, girls are married young and start their pregnancies during adolescence. You will also learn about nutrition and its effect on adolescent pregnancies. Energy requirement is defined as the amount that will balance energy expenditure of the individual as determined by body size, composition and physical activity consistent with long-term good health.

This amount will allow for maintenance of economically necessary and socially desirable physical activity. All estimates of requirement are based on habitual intakes; though these are expressed as daily intake, it is not implied that these amounts must be consumed on daily basis. Actual intakes and expenditure of people of same age, sex, similar body size and physical activity are used to compute average energy requirement for the groups.

The recommended intake of energy of a group is equal to the average energy requirement of individuals of the group. Both lower and higher energy intake are associated with health hazards. This is in contrast to other nutrients. Maternal Nutrition in Energy req.

Activity Heavy activity n 45 n 50 n 55 n 60 q 65 n 70 Fig 2. However, energy cost of work done computed in terms of basal energy cost or physical activity ratios are similar. Average weight of Indian men is 52 Kg and women 44 kg. In view of all these it is likely that energy requirement of Indians is likely to be substantially lower than the current ICMR recommendations Table 2. Table 2. This is shown in Table 2. You might have observed that obesity rates in all age groups are increasing. The dietary intake in different socio-economic group in India is mentioned below.

In this group pregnant women do not perform hard physical labour during pregnancy and work activity shows a reduction during pregnancy. The pre-pregnancy weight in this population group ranges between kg and the mean pregnancy weight gain is about 11 kg. The mean birth weight of infants is 3.

These findings are similar to those reported from women in developed countries Table 2. There is no increase in dietary intake during pregnancy. However, pregnant women continue to look after the household and other activities and remain moderately active throughout pregnancy.

These women weigh on average 43 kg prior to pregnancy and gain 6 kg during pregnancy. The mean birth weight of infants is 2. There is no obvious deterioration in the maternal nutritional status during pregnancy or following repeated pregnancies provided the inter birth interval is longer than 24 months Table 2.

However, rural women have to spend more energy in daily household chores. For instance, they have to fetch drinking water from sources which may be one to two kilometers from home, gather and bring firewood from the forest miles away.

Most rural women from the low income group also help their husbands in agricultural activities, especially during weeding, replanting and harvesting seasons. Therefore, these women weigh about 1 to 2 kg less than their urban counterparts and their fat-fold thickness is only half that of urban women.

These women gain about 5 kg during pregnancy and the mean birth weight of their infants is 2. In rural communities also there is no significant deterioration in the maternal nutritional status during pregnancy and after repeated pregnancies, provided the inter-birth interval is longer than 24 months. Data from several other developing countries indicate a similar trend. The mean birth weight of infants born to these women is 2.

Perinatal mortality in such communities varies between per thousand live births. It has been observed that women from these segments of population suffer from several pregnancy-associated problems such as anaemia and pregnancy-induced hypertension.

Combining adequate antenatal care with effective food supplementation programmes is likely to result in substantial improvement in outcome of pregnancy in undernourished communities. When the adaptive mechanism fail, the situations become associated with deterioration in maternal nutrition and reproductive performance. They are: 1 Reduction in the dietary intake below the habitual level. These situations can readily be identified by the community, family and the health care workers and appropriate remedial measures could be initiated.

In agricultural communities when dietary intakes are lowest and physical activity is highest, pregnancy weight gain is very poor, the mean birth weights are lower and prematurity rates are higher.

When food is available in abundance and work is less, the dietary intake improves and with this there is a marked increase in pregnancy weight gain, so that the earlier reduction in weight gain is more or less compensated.

The crucial factor that determines the maternal nutritional status and outcome of pregnancy is neither the dietary intake nor the physical work done during pregnancy, but the energy deficit due to the gap between energy intake and energy expenditure. The number of adolescents years will increase from 20 crore in to In adolescent girls, early marriage and pregnancy will perpetuate both maternal and child under-nutrition. Currently there is a need to combat both under-nutrition and over-nutrition.

The adolescents suffer from micronutrient deficiencies. With onset of menstruation, girls in this age group are vulnerable to anaemia and all its adverse consequences.

Gujarat Uttar Pr. It is hardly surprising that under-nutrition and anaemia are common in adolescent girls. If left undetected and untreated, anaemia will inevitably lead not only to increased morbidity in the mother but also to high low birth weight and perinatal mortality. In addition infants born to these girls have high morbidity and under-nutrition because of poor child rearing 26 practices. Appropriate nutrition and health education, for all adolescents, advocacy for delay in age at Maternal Nutrition in Pregnancy and Lactation marriage, optimum health and nutrition interventions during pregnancy in adolescents are some of the inter-sectoral initiatives to break this vicious cycle.

Pregnancy in the early teens before 16 years is associated with an adverse effect on maternal nutrition, birth weight and survival of the offspring. The extra nutritional requirements of pregnancy coming close after the nutritional requirements for adolescent growth spurt might be the major factor responsible for the observed poor nutritional status of girls who conceived before they are 16 years of age.

Both in urban and rural area, reasons for low mean birth weight, higher perinatal mortality PNM , neonatal mortality NNM and infant mortality rate IMR in teenage pregnancy are: l lower maternal body weight, l lower pregnancy weight gain, and l higher prevalence of anemia and l possibly pregnancy-induced hypertension among girls who conceived before they were 16 yrs.

High IMR may be due to : l the higher low-birth weight rates l obvious deficiencies in child-rearing practices of these young girls, and l poor availability and utilization of health care services, especially in rural areas, Undoubtedly, there is a very urgent need to: l create awareness regarding adverse consequences of early teenage conception l mobilize social support for strict implementation of laws regarding age at marriage.

You will read about the effect of food supplementation in this section. Since it would appear that among the poorer segments of populations in developing countries, physical work during pregnancy cannot be reduced without serious social, economic and domestic sequelae, attention has been focussed on investigating whether food supplements, given to pregnant women to reduce the energy gap, could mitigate some of the adverse obstetric consequences of undernutrition in these women.

Studies on the effect of food supplementation to undernourished women on the course and outcome of pregnancy show that: l food supplements during pregnancy result in improvement in birth weight and reduction in prematurity rate. During the nineties there has been a progressive increase in the economic constraints. In view of their high cost and limited impact it might not be possible to sustain the food supplementation programs for all pregnant women in the country.

Check Your Progress 1 1 Write the calorie requirements during pregnancy and lactation recommend by ICMR based on actual body weight for various activity category. Maternal Nutrition in Pregnancy and Lactation 4 List ways to tackle adolescent pregnancy and problems. The recognition that lactation may have profound effect on maternal nutrition and fertility is of more recent origin.

Maternal nutrition may affect lactational performance and lactation may have some effect on the maternal nutrition and return of fertility after delivery. The advent of the next pregnancy, or contraceptive measures used to avoid this, may have an effect on lactation and maternal nutritional status. Successful prolonged breast-feeding for months is the traditional practice among the poorer segments of the population in India.

The recognition of the importance of breast- feeding on infant survival, growth and nutrition in the poorer segments of the population in developing countries like India has resulted in sustained efforts to protect and strengthen the existing practice of prolonged lactation in these segments of the population.

Available information suggests that, unlike well-nourished women from developed countries, in undernourished women there is no deposition of body fat during pregnancy to meet the extra energy needs during lactation. Their dietary intakes provide no more than half of the recommended dietary allowances with respect to calories.

Under normal circumstances such a large energy deficit is likely to result in weight loss of about 1. Lactating 38 Nonpregnant non lactating women 34 However, with the introduction. The mean body weight of women whose infants were mainly on solid food but who received two or three breast-feeds a day was higher than that of women whose infants were mainly breastfed. If there was no intervening pregnancy these women regained their body weight once lactation waned.

Obviously, there are some exquisitely sensitive but ill-understood adaptive changes which bring about energy balance and ensure maintenance of maternal nutrition and satisfactory lactation in spite of widely varying habitual dietary intakes well below the RDA.

It has been suggested that efficiency of energy utilization increases under such circumstances. The fact that there are adaptive mechanisms to ensure that the mother and her infants are protected against deterioration in nutritional status is a measure of the importance of these mechanisms in the survival of mankind.

Specific efforts should be made to ensure that these made adaptive mechanisms are not compromised by further stress. Global studies have demonstrated that lactation prolongs postpartum amenorrhoea and provides some protection against pregnancy, especially during the first few months. However, with introduction of complementary feeds to the infant and increasing duration of lactation, the contraceptive effect of lactation wanes.

In India, among traditional urban and rural low-income group women, prolonged lactation for about two years is quite common. Contraceptive use is not widespread.

Available data indicate that under these circumstances, about one-third of all pregnancies occur in lactating women. Some women stop breast-feeding as soon as they realize that they are pregnant. This tradition might have been evolved to protect the women from the dual stress of pregnancy and lactation.

Many women continue to breastfeed their infants during pregnancy and face the nutritional and health consequences of the dual stress. Available data suggest that conception during the first year of lactation is relatively uncommon in India and occurs usually in working women and those who introduce supplements to the infant early, i.

Obviously the dual stress of pregnancy and lactation leads widening of the already existing gap between actual dietary intakes and nutrient requirements. Investigations undertaken by the National Institute of Nutrition, Hyderabad, indicate that irrespective of the duration of lactation, women who conceived during lactation weighed less in all the trimesters of pregnancy than those who conceived after lactation.

The difference in body weight was more marked in the third trimester especially in the small group of women who had conceived during the first six months of lactation. Birth weight of neonates born to women who conceived during lactation was also lower. It is obvious that conception during lactation does have an adverse effect on the maternal nutritional status during pregnancy.

Ensuring contraceptive care to lactating women would, therefore, constitute a non-nutritional intervention for reducing the magnitude of maternal under-nutrition during pregnancy.

Check Your Progress 2 1 How does maternal nutrition affect lactation? Women have long been working along with their menfolk in the fields in addition to carrying household work to support and sustain the family. Mankind has developed adaptive processes to ensure that this type of work, in or outside the home, has no adverse effect on the maternal nutritional status. Women work for the wellbeing of their family and hence they have borne the low monetary return with fortitude.

Increasing economic constraints have made employment outside home a necessity for women. Both in urban and rural areas women are seeking employment not only in the traditional occupations but also in newer avenues because of socioeconomic and other considerations.

It is estimated that in India working women constitute about 20 per cent of the total population and there is a trend towards increasing employment of women.

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