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Aim: To analyse the relationship between the frequency of family meals and the body weight of 13-year-olds and its selected determinants., Material and Methods: The study was conducted in 2008 as the last stage in a prospective cohort study of 605 children. Questionnaires containing questions about the frequency of family meals, the general regularity of meals, fruit and vegetable consumption, physical activity and the number of hours spent watching television or at the computer were sent to 13-year-olds by mail. School nurses performed anthropometric measurements of the pupils' weight and height. Statistical analyses were performed, i.e. Pearson's correlations, the two-step cluster analysis and the logistic regression analysis., Results: Most of the young people (80-90%) eat each of the main meals in the company of their parents at least once a week, 21% have breakfast with their parents every day, 41% - dinner, and 45% - supper. The frequency of family meals correlated negatively with the girls' BMI and the number of hours they spent watching television or at the computer, while positively with physical activity, regular meals and vegetable consumption in adolescents of both genders. The lowest mean values of BMI were found in a group of adolescents often eating family meals, the highest - in the group of young people who rarely ate family meals (over 20% of young people in this group were overweight), but the differences were statistically significant only for girls (p=0.025). The probability of less than 2 hours of sedentary behaviour daily, physical activity of at least 60 minutes per day and everyday vegetable and fruit consumption is twice as high in adolescents often consuming meals with their parents, and with the daily consumption of all the meals in this way - more than fourfold higher than in other groups., Conclusions: Family meals treated as a predictor of a healthy lifestyle can indirectly protect adolescents from overweight and obesity. Promoting family meals should be an important method of preventing obesity, particularly among teenage girls.

Objectives: 1. To examine the prevalence of selected risk factors for atherosclerosis: overweight, tobacco smoking, low physical activity, psychological distress and type A personality (characterized by tenseness, impatience, competitiveness, and aggressiveness) in adolescents and to assess the frequency the coexistence of risk factors (≥3) in relation to gender, age and school type., Methods: A cross-sectional study was carried out in a representative sample of youth aged 16 and 18 years (N=2983) in 8 voivodeships in Poland. The frequency of five atherosclerosis risk factors and their coexistence (≥3) was examined using self-reported questionnaires, in relation to gender, age and school type. Logistic regression analyses were used to assess the influence of the variables (gender, age and school type) on odds ratios of risk factor coexistence., Results: Low physical activity was the most common risk factor, statistically more frequent in students from Basic Vocational Schools than in other school types (p<0.05). In Basic Vocational Schools there was also the highest percentage of cigarette smokers (p<0.001). Psychological distress and type A behaviour were observed most frequently in students from General Upper Secondary Schools. The highest risk factor accumulation (≥3) was observed among students from Basic Vocational Schools (40%), significantly more frequent in girls than boys (47.5% and 37.5% respectively). Multivariable analyses show that students from Basic Vocational Schools had twice the odds (OR=2.25, p<0.001) to have the coexistence of risk factors for atherosclerosis as compared with students from General Upper Secondary Schools, girls had almost twice as many occurrences (OR=1.83, p<0.001) as boys and 18-year-olds 1.5 more than 16-year-olds (OR=1.46, p<0.001)., Conclusion: 1. A significant difference in the prevalence of risk factors for atherosclerosis in youth from different school types requires precise definition of priority health promotion activities depending on school type. 2. Students from Basic Vocational Schools should be the target group for intervention aimed at reducing atherosclerosis risk factors.

Introduction: Previous studies on relationships between the current family structure, socioeconomic status and family members' body mass don't give unequivocal results. A life course perspective evaluates the contribution of early life factors jointly with later life factors to identify risk and protective processes., Objectives: The relationship between economic status, family structure in first and thirteenth year of life, their changes in this period and overweight among 13-year olds in Poland., Participants and Methods: A study sample was the prospective cohort of 11 937 children enrolled in the observation in neonatal period, examined in the third year of life (questionnaire survey of 1250 mothers) and at the age of thirteen (561 children and their parents fulfilled questionnaires, children's height and weight were measured). Overweight criteria was BMI >85 percentile using WHO 2007 growth reference., Results: Higher prevalence of overweight was found in adolescents living in single-parent families than in 2-parent families (30.2% vs. 19.5%; p=0.049). The highest prevalence of adolescents' overweight was observed in families, whose structure changed during 13 years (in ""broken"" families - 32.7%, in reconstructed - 36.4%, p=0.033); the risk of overweight in these children increased twice compared to intact families. Adolescents from families whose reported economic status worsened during 13 years, were twice more likely to be overweight than their peers from middle and high economic status families (p=0.057)., Conclusions: The prevalence of overweight among adolescents in 2-parent families is significantly lower than in other family types. Unfavorable changes in family economic status and structure are the strongest redictors of overweight in 13-year-olds.

Objective of the Study: To examine the prevalence of overweight and obesity among parents and their 13-year-old children in Poland, and relationships between parental and child obesity., Participants and Methods: The study was conducted in 2008 as a part of prospective cohort follow-up study from 1995. The sample included 579 children (289 girls, 290 boys), their parents (549 mothers, 487 fathers). Parental height and weight were self-reported. Height and weight of children were performed by school nurses. IOTF criteria was used to determine overweight and obesity in children. For adults overweight was defined as BMI > or = 25.0 and obesity BMI > or = 30.0. The relation of parental-child overweight was tested by the odds ratio (OR)., Results: The prevalence of overweight was 43.4% for mothers and 71% for fathers (p < 0.001), including obesity respectively 12.3% and 20.3%, more often among rural mothers (48.1%) than urban (38.5%) (p = 0.69). Prevalence of childhood overweight was 16.7% for boys and 13.5% for girls, obesity respectively 2.4% and 1.0%. Overweight was observed more often in urban than rural areas, respectively 17.1% and 13.3%. OR for child hood overweight was the highest when both parents were overweight OR = 3.90 (1.57-9.72), when the mother alone was overweight OR = 2.55 (1.56-4.16), when father alone--OR = 2.10 (1.09-4.05)., Conclusion: Overweight and obesity is a family problem. In the obesity prevention, interventions should be directed towards the entire family.

The Aim of the Study: 1. Current physical status and selected pubertal features were assessed in Polish 13-year old adolescents, in urban and rural areas. 2. Dynamics and secular trends of body height, mass and body mass index in 1980-2008 were analyzed., Material and Methods: The study was conducted in 2008 in prospective cohort of 605 children (305 girls and 300 boys), who had been observed in the neonatal period, later at age of 3 years and now at age of 13 years. 49% adolescents were from urban and 51% from rural area. For secular trend analyses comparisons of the age and sex-specific means of body height, mass and BMI from 2008 with previous data from 1980, 1999 and 2005 in 13-year old were carried out. Similar comparison was made concerning average age at menarche by using previous probit analysis to determine average age at menarche during the last 3 decades., Results: Mean values of anthropometric features in adolescents were a little higher in 13-yrs old living in urban than rural area, but were statistically insignificant. Two thirds of examined 13-year-old girls already had their first period (menarche), statistically more often urban living girls (p = 0,017). The median age at menarche for entire group of 13-year-old girls estimated by means of Kaplan-Meier analysis was 12.77 years. The girls from urban areas had their first menses earlier than their rural living peers (12.65 and 12.88 years, p = 0.01). There were no statistically significant differences in urban and rural boys concerning age of appearance of facial hair. There are increases of mean height and weight values during the period of 30 years in 13-year-olds (2.51 cm and 2.2 kg for girls and 5.51 cm and 5.08 kg for boys) and BMI 0.21 kg/m3 and 0.75 kg/m2 for girls and boys. The average age of menarche was almost the same as in Warsaw girls in 1986 and 1996., Conclusions: 1. The study confirmed a reduction of differences in somatic development between 13-years olds in rural and urban areas. 2. Difference in mean age at menarche is still observed, they show earlier maturation in urban girls (about 2 months earlier than in rural girls). 3. Positive secular trend in height in Polish 13-year-olds is observed during the last 3 decades. 4. The mean age at menarche in Polish girls stabilized at 12.77 years in the last decade.

Aim: To analyse the influence of selected family socioeconomic factors on the regularity of meals consumption among 13-years aged adolescents., Material and Method: Group of 605 13-years olds identified in the prospective cohort study in 2008 was analysed. Data was gathered with use of posted questionnaires. On the basis of information given by children the regularity (4-5 times a week) of meals consumption on school days and eating meals with parents were correlated with parents' educational level, occupational status and perceived family wealth. The study also recognised the distinction between urban and rural residents., Results: Most questionnaires were filled out by mothers (95%), only 5% by fathers. In urban area, the mother's occupation and the perceived family wealth, correlate with children meals consumption and eating meals with parents. Children whose mothers have a job eat breakfast 1.5 times and supper 3 times less regularly, than children whose mothers don't work. Children from poor families eat breakfast 14 times less regularly than children from rich families as well as eat supper 3 times less regularly than children from average wealthy families. In the rural area, the regularity of meals consumption significantly influence the mother's education. Children whose mothers have a secondary education, compared with children of mothers with basic education, are 4 times more likely to eat dinner and supper regularly., Conclusion: The family socioeconomic factors significantly correlate with regularity of 13-years olds meals consumption and regularity of family meals. The place of residence involve the different factors influencing meals consumption habits. It was shown that children and fathers were too little engaged in family life, including family meals preparation and consumption.

Aim: To compare the study results concerning the correct level of 13- and 15-year-old adolescents physical activity and impact of selected physical activity determinants (self-efficacy, BMI, gender, domicile) obtained from two nationwide studies out in Poland, using a similar questionnaire in 2006 and 2008., Material and Methods: The material comes from two studies. The first, the 2006 HBSC survey included 2287 15-year-old students (1092 boys and 1195 girls); the second, the 2008 third phase of a prospective, three-phase survey, included 605 13-year-olds (300 boys and 305 girls) born in Poland in January 1995. Questions on physical activity were analysed (MVPA), along with the following determinants: self-efficacy, domicile, gender, body weight and height. Cross-tabulation with chi2 analysis and multilevel modelling were applied., Results: Physical activity deficiency was found in both examined populations. In study I--84.8%, in study II--80.3%. Self-efficacy (p < 0.01), gender (p < 0.001) and BMI (p < 0.04) had an impact on the 15-year-olds physical activity. In 13-year-olds, only self-efficacy was close to significant relation with physical activity. The results of multilevel logistic regression in study I identified protective factors: male gender [OR = 0.41; CI (OR): 0.32-0.53] and strong self-efficacy [OR = 0.66; CI (OR): 0.51-0.85]; while being underweight was identified as a risk factor [OR = 2.77; CI (OR): 1.11-6.95]. In study II only strong self-efficacy was found as a protective factor [OR = 0.51; CI (OR): 0.30-0.89] against lack of physical activity., Conclusions: Most of the examined adolescents from study I as well as study II suffered from physical activity deficiency. The share of biological determinants (gender, BMI) in maintaining correct level of physical activity increased with age. A link between physical activity and self-efficacy was demonstrated in the 15-year-olds, while this tendency was identified in the 13-year-olds. The results point to a need for implementing programmes supporting self-efficacy in children under the age of 13 and to carry out assessment of self satisfaction concerning own bodyweight. In preparing these programmes sex differences should be taken into consideration.

Objective: To assess progress in the protection, promotion and support of breast-feeding in Europe., Design: Data for 2002 and 2007 were gathered with the same questionnaire. Of thirty countries, twenty-nine returned data for 2002, twenty-four for 2007., Results: The number of countries with national policies complying with WHO recommendations increased. In 2007, six countries lacked a national policy, three a national plan, four a national breast-feeding coordinator and committee. Little improvement was reported in pre-service training; however, the number of countries with good coverage in the provision of WHO/UNICEF courses for in-service training increased substantially, as reflected in a parallel increase in the number of Baby Friendly Hospitals and the proportion of births taking place in them. Little improvement was reported as far as implementation of the International Code on Marketing of Breastmilk Substitutes is concerned. Except for Ireland and the UK, where some improvement occurred, no changes were reported on maternity protection. Due to lack of standard methods, it was difficult to compare rates of breast-feeding among countries. With this in mind, slight improvements in the rates of initiation, exclusivity and duration were reported by countries where data at two points in time were available., Conclusions: Breast-feeding rates continue to fall short of global recommendations. National policies are improving slowly but are hampered by the lack of action on maternity protection and the International Code. Pre-service training and standard monitoring of breast-feeding rates are the areas where more efforts are needed to accelerate progress.

Aims: 1. Comparison of cut-off points for selected anthropometric parameters in children and adolescents between reference values for Polish Institute of Mother and Child (IMD) and WHO growth, Methods: The accepted reference system were IMD reference values and the differences for mean (50th) and 3rd and 97th percentile for height and weight were calculated for boys and girls. The differences between BMI units for overweight (85th) and obesity (95th) percentile were compared. Warsaw 1980 reference values were used to estimate secular trend influence on differences between IMD and WHO cut-off points in stunting adolescents., Results: Comparison of height-for-age showed the largest differences with positive values relative to 3rd percentile in the Polish population. Boys aged 16 years attain 4% (6.2 cm) of 3rd percentile height value and girls aged 14 years 2.3% (2.8 cm). Secular trend of the Polish population did not influence the differences between IMD and WHO values in stunting adolescents. The differences for 85th and 95th percentile of BMI were most pronounced in prepubescence and the largest values were for boys and girls aged 10 years., Conclusions: 1. National height-for-age references should be used for growth assessment in Polish school-aged children and adolescents especially in stunting adolescents identified in puberty. 2. WHO norms for BMI, can be used as a tool for identifying overweight and obesity in epidemiological studies in Poland and for international comparisons. 3. The usefulness of WHO norms for clinical evaluation of overweight and obesity should be discussed among experts.

Early identification of children with developmental delay is an important task for the primary care physicians. Different screening tests are used to detect developmental disorders in infants and young children. The authors describe screening tools currently available in Poland in the primary care setting. The review of the standardized developmental screening tests available in other countries is given: parent report instruments, such as Ages and Stages Questionnaires (ASQ), Parent's Evaluation of Developmental Status (PEDS) and instruments that require direct examination as the Denver-ll Developmental Screening Test (DDST) and Bayley Infant Neurodevelopmental Screener (BINS). The authors describe a proposed standardized developmental screening instrument of infants and young children for primary care pediatricians and family doctors in Poland.

Introduction: Growth and development assessment of infants and young children is a very important component of early prophylaxis in paediatric health care. In 2006 the World Health Organization published the new Child Growth Standards for children up to 5 years of age. They describe the optimal pattern of young children development., Aim of the Study: 1. To compare the cut-off points for selected anthropometric parameters in children up to 5 years between reference values for Polish children and WHO Child Growth Standards. 2. To attempt to answer the question whether the WHO Child Growth Standards can be implemented to assess health and development in children up to 5 years in Poland., Methods: The differences for mean (50th percentile) and extreme values (3rd and 97th percentile) for length/height for age and weight for age were calculated for boys and girls. The differences in BMI units for overweight (mean + 1 SD) and obesity (mean + 2 SD) were compared using the z-score method., Results: Comparisons of the WHO and Polish length/height and weight for age showed no differences in children aged 1-60 months. Small differences were seen in the 3rd percentile (less than 2%) in children aged 3 and 6 years. BMI values for overweight and obesity were slightly lower for Polish children in the first 6 months of life than in WHO standards. These differences have positive values for boys and girls starting at 9th month and increasing in toddlers., Conclusions: WHO standards reflect the optimal growth pattern for children from birth up to 5 years. Therefore these instruments should be adopted for Polish children to assessing their growth.

Aim of the Study: to examine the prevalence of nutritional status and growth disorders in 13-year-olds in Poland by sex and place of residence and changes during the period 2005 to 2008., Participants and Methods: The study was conducted in 2008 as a part of prospective cohort follow-up study of 605 children (305 girls and 300 boys), from birth to 13 years. Analyses of anthropometric measurements: height and weight were performed. Institute of Mother and Child growth references for height-for-age and BMI-for-age (1999) were used to assess physical disorders., Results: The prevalence of overweight (BMI > or = 85th percentile) was 14% and underweight (BMI < 5 percentile) was 4,1%. Short stature (< 10th percentile of height) was found in 6%, and 6,2% were above 97th percentile of height. We found no statistically significant difference in nutritional and growth status disorders by sex and place of residence. The overall prevalence of overweight (including obesity) did not change from 2005 to 2008. Prevalence of underweight decreased especially among boys (9% to 3,1%, p=0,010) and among adolescents from rural area (8,2% to 4%, p=0,058). We found some evidence for equalization of the percentages of short stature in boys and girls, rural and urban adolescents. The tall stature rate rose only among girls (3,8% to 8,3%, p=0,050)., Conclusions: Disappearance of the prevalence of physical disorders by sex and place of residence has been observed in the last few years in Poland. Overweight among 13-year-olds is not growing and acceleration of height is still observed.

Aims: To compare the body mass patterns of breastfed and formula fed Polish infants in the first 6 months of life and to compare the results with the current Polish data., Methods: Data was taken from the last country-wide survey conducted in 1997. The group of 14116 infants under 6 months were in the original cohort. The final sample consisted of: 4546 exclusively breastfed (2228 male, 2318 female) and 391 formula fed (214 male, 177 female) healthy infants, weighing > 2500 g at birth. The infants were weighed at birth and again on the day of the interview. The 24-hours recall period data for feeding practices was collected., Results: Mean body mass of exclusively breastfed boys was greater in the period from 2 to 5 months (in month 3 the difference was statistically significant) in comparison with formula fed boys. Mean body mass of exclusively breastfed girls was greater for each month from birth to 6 months (in month 3 and 6 the difference was statistically significant) in comparison with formula fed girls. Compared with current Warsaw data, the infants of the analysed groups grew less rapidly., Conclusion: Our analysis shows that exclusively breastfed Polish infants in the first 6 months of life gained weight better than formula fed infants. Independently of feeding mode, gender and age, the mean body mass was lower in the examined infants as compared with the current Warsaw data. A reference body mass data based on breastfed infants is needed in Poland.

Objective: To identify factors affecting exclusive breastfeeding in maternity hospital care and during the first six months after birth., Methods: Two cross-sectional surveys form the basis of this study: the first, conducted in 1995 on maternity wards (n = 11,422 newborns) and the second, conducted in 1997 in primary care centers (n = 10,156 infants under six months)., Results: The most meaningful factors in hospital care were: cesarean section, breastfeeding initiation after 2 h, lack of skin to skin contact, use of pacifiers, separation longer than 1h/24 h and health problems of infants. After hospital discharge the most significant factors were: use of pacifiers, mothers reluctance to exclusive breastfeeding longer then four months, low level of mother and father education., Conclusions: Most of identified factors can be modified so our results can help to introduce more effective target intervention.

The effect of parental smoking on feeding pattern, birth weight and weight gain were studied in 13503 randomly selected infants aged 11-180 days. Among them 53% were exposed to parental smoking. The infants of smoking mothers tend to have lower birth weight and higher frequency of birth weight below 2500 g. When mothers smoke the infants born with weight below 2500 g who were exclusively breastfed gained daily significantly less. Smoking mothers less frequently initiated breastfeeding. Maternal smoking was associated with shortened exclusive and total breastfeeding duration. When the father smoked also, the effect of maternal smoking on birth weight, daily weight gain and risk of earlier weaning was significantly increased.

A growing body of research suggest that infant feeding can influence the prevalence of several chronic diseases of childhood, adolescence and adult life. Artificial infant feeding and too early supplementation of breastfeeding have been identified as a risk factors for different multifactorial diseases. Breast milk feeding promotes better intellectual development from early childhood trough the later life. As a genetic predisposition and environmental factors are understood more completely, the evidences for the role of breastfeeding in health and development is becoming more important for programming health care and standards. Recommendations of the necessary changes in the infants and young children feeding practices in Poland are presented.

Using prospective cohort study design the influence of skin-to-skin contact after birth on breastfeeding was analyzed in a group of 1250 three years old Polish children. The implementation of this practice significantly increased the mean exclusive breastfeeding duration by 0.4 month and overall breastfeeding by 1.4 months. The effect of skin-to-skin contact duration after birth was also observed. The infants kept with the mothers at least 30 minutes were 1.2 month longer exclusively breastfed and 1.7 month later weaned than those who had the shorter contact. The skin-to-skin contact after birth significantly coexisted with the other hospital practices supportive for breastfeeding: early first feeding [(OR=9,73), 95%CI:6.87-13.80] exclusive breastfeeding in the maternity ward [(OR=4,30), 95%CI:3.15- 5.89], rooming-in [(OR=2,78), 95%CI:2.05-3.78] and elimination of bottle [(OR=3,70), 95%CI:2.69-5.09]. Multivariate linear regression analysis showed that mother-infant contact afterbirth was a significant and independent factor for exclusive breastfeeding continuation.

The benefits of breast-feeding for health and development pre-term and full-term infants changed the attitude towards nutrition of twins and higher-order multiples. Mothers of twins are often at risk of unsuccessful initiation of lactation while in hospital. The possibilities to provide appropriate intervention and support when a mother breastfeeds twins are presented.

Objectives: To study the effects of newborn status and hospital practices on exclusive breast-feeding in a maternity ward., Design: National survey conducted in January 1995 in 427 hospitals., Materials and Methods: Data on 11,422 newborns obtained from hospital staff. Statistical analysis was performed using odds ratios (OR), population attributable risks (PAR%) and logistic regression method., Results: The most important factors for supplementation were: caesarean section (OR = 5.3; PAR = 19.0%), first breastfeeding later than 2 h after birth (OR = 5.2; PAR = 41.3%), mother and newborn separation longer than 1 h/24 h (OR = 3.4; PAR = 44.9%). Logistic regression analysis showed that first feeding in 2 hours is the main prognostic factor for exclusive breastfeeding in a maternity ward., Conclusions: Changes in hospital practices increase the proportion of exclusively breastfeeding infants during stay in the maternity ward.

Data on 11784 newborns collected by staff in 427 maternity hospitals in 1995 were analysed. In all 97.2% of newborns were breastfed, but only 72.5% with birth weight less than 2500 g. Univariate logistic regression model with birth weight as a continuous variable was applied to calculate the probability of breastfeeding initiation. Using bivariate logistic regression models, different groups of newborns were compared to explain the additional influence of 4 dichotomous variable: type of delivery (normal birth and caesarean section), neonatal problems (jaundice, birth asphyxia, disorders of adaptation after birth, infections, congenital malformations) and two hospital practices: rooming-in and skin-to-skin contact. Multivariate conditional logistic regression model showed that the independent prognostic factors for breastfeeding initiation were: birth weight (continuous), rooming-in (OR=5.5; CI(OR)=3.9-7.9) skin-to-skin contact after birth (OR=3.4; CI(OR)=2.6-4.5) and lack of neonatal problems (OR=2.1; CI(OR)=1.6-2.7). Logistic regression curves showed that influence of skin-to-skin contact and rooming-in after birth on breastfeeding initiation was more evident for newborn with lower birth weight.

Extensive research, especially in the recent years documents the divers advantages of breastfeeding not only for infants but also for breastfeeding women and their reproductive health. The paper presents the results of epidemiological studies concerning protective effects of breastfeeding against large number of acute and chronic diseases of childhood and possible health benefits for mothers like fertility regulation, stimulation of parenting abilities and protection against breast and ovarian cancer, bone loss, nutritional depletion. The recommendations of hospital postpartum care supportive to physiological initiation of breastfeeding, based on the experience of Baby Friendly Hospital Initiative implementation in Poland is also presented.

Factors associated with cessation of exclusive breastfeeding in Poland were studied in 10156 randomly selected infants aged 1-6 months. They were breastfed at the time of data collection. Among them, 4929 (48.5%) infants were exclusively breastfed. In multiple logistic regression analysis, the factors associated with cessation of exclusive breastfeeding were: use of a pacifier, short duration of total breastfeeding and exclusive breastfeeding accepted by mothers, first child in the family, primary education of parents, mother working in farming and non-employed father, maternal smoking and maternal age over 34 years.

Mother's milk is the only adequate nutrition for infants. In the recent years the extensive research documents the numerous advantages of breastfeeding. Especially important is exclusive mothers' milk feeding for infants in the first six months of life. The results of biological and epidemiological studies concerning protective effects of breastfeeding against acute and chronic diseases of early and later childhood were presented. Further needs of breastfeeding promotion in Poland based on the research conducted in the last years, were stressed.

Recent years have seen increased emphasis on appropriate development of public health intervention programmes with attention to evaluation. With reference to the breastfeeding promotion programme in Poland, the conceptual framework of evaluation development and implementation is presented. The use of analysis per formed for programme sustainability and progress and in the decision making process is underlined.

The indicators of newborns' adaptation during 75 min after birth were compared in three randomised groups of full-term newborns: skin-to-skin contact (group I), swaddled newborns beside the mother (group II), swaddled and separated from the mother (group III). The changes in skin temperature, blood glucose, pH, heart rate, respiration rate and crying time were studied. All the above characteristics but pH were significantly the most favourable for infants in the skin-to-skin group. The analysis of individual trends of changes in skin temperature indicated that for all but two newborns not separated from the mother (skin-to-skin or lying besides) the temperature was growing during the observation period, whereas in the separated group, six newborns (27%) had unstable not growing temperature. The mean level of blood glucose was the highest in skin-to-skin group (60.1 mg/dl), lower in group of swaddled and lying beside mother (52.5 mg/dl) and the lowest (49.6 mg/dl) in the separated group. The mean duration of crying time in the skin-to-skin contact was a little shorter than in the group of newborns lying besides the mother and more than three times shorter than in the separated group. The observed number of episodes of crying were 7, 17 and 38 in the three groups respectively. All results indicated that skin-to-skin contact is optimal for newborns', adaptation after birth especially as a protection against hypothermia and hypoglycaemia.

The data on 11,750 newborns collected in 427 hospitals during the survey of maternity words practices in 1995 were used to analyse the factors related to breastfeeding initiation while in hospital. The statistical analyses were done using percentage of newborn breastfed as well as odds ratio (OR) and population attributable risk in percent (PAR%) of artificial feeding. The identified factors of artificial feeding were: newborn birth weight < 2500 g (OR = 28.2; PAR = 52%), complications in neonatal period (OR = 10.3; PAR = 64%), caesarean section (OR = 4.3; PAR = 32.2%), mother and newborn separation longer than 1h/24h (OR = 13%; PAR = 87.2%), lack of skin-to-skin contact after birth (OR = 8.5; PAR = 60.9%).

Breast-feeding is the important factor for mother and child health. Many reasons for stopping breast-feeding are not the real contraindications. The most frequent maternal and child contraindications are discussed.

The most important techniques and strategies of marketing breast-feeding substitutes with special consideration of Polish market are discussed. WHO/UNICEF Code recommendations are presented.

Hyperbilirubinemia is a very frequent reason for interrupting breastfeeding in Poland. The pathogenesis of the early and late jaundice related to breastfeeding is discussed. The lack of contraindication to breastfeeding is stressed.

Early use of artificial nipples and nipple shields results in nipple confusion. This was identified as one of the most important barriers in successful breast-feeding. Alternative method of feeding can prevent breastfeeding problems.

On the basis of the experience and data gained during breast-feeding situation assessment process (see Part II) the major activities of the breast-feeding promotion programme were identified as follows: 1. Training of health workers which aims the revision and change of practices in health services responsible for mother and child care. 2. Education of population about advantages of breast milk and breast-feeding management. The detailed project of the implementation of the programme on the national scale was presented.

Assessment of breast-feeding situation in Poland was based on three kinds of nation-wide surveys conducted in 1988: newborn feeding and breast feeding routines in maternity wards epidemiology of breast-feeding and other feeding methods in first six months of infant life KAP study among MCH professionals The major findings of the surveys were: conflicting with lactation maternity wards routines especially: very initiation of breast-feeding, administration of liquids and formulas, rigid feeding schedule, separation of newborns from the mothers too early supplantation of breast-feeding lack of current breast-feeding knowledge among MCH professionals.

A breast-feeding promotion programme for Poland was developed as a part of governmental programme to protect and improve health of the mother, child and family for the years 1986-2000 carried out by Institute of Mother and Child. It was presented as a document consisting of three major components which will go to press successively. Part I covers justification of the proposed programme activities and thirty five consistent paragraphs summarizing principal information on breast-feeding and its promotion.

The purpose of the study was a trial to find out in what degree the activities and suggestions of health service personnel with respect to pregnant women and lactating mothers might be an obstacle in beginning and maintaining of lactation. A high percent of studied personnel declared activities incompatible with a successful course of lactation and excessive extension of indications to artificial feeding of infants. A general direction was established for intervention within the framework of the programme of activities for breast-feeding.

The study was carried out for investigating the attitudes towards breast-feeding among doctors, nurses, and midwives working in primary health service units providing care for mother and child in certain areas. Generally the attitudes were found to be positive. However, a great part of the studied personnel did not identify themselves with the possibility of actual activity for breast-feeding in their professional role. The necessity was stressed of a more precise outlining of the duties of various groups of health service workers and incorporation of activating mechanisms into it.

The study is a part of a preliminary analysis of the situation before introducing the promotion program of breast-feeding. It concerns the assessment of the knowledge of lactation physiology and properties of human milk among health service workers employed in mother and child health care. Significant deficiencies of knowledge on this subject were found. The obtained information was used for outling the directions of indispensable training.

The procedures used in obstetric-neonatal wards may stimulate or disturb lactation. Changes of hospital routine are an important element of the more widespread use of breast feeding. In the paper procedures applied in the observed wards are presented showing that the organization of neonatal care in most wards was insufficient form normal beginning and maintenance of lactation. Suggestions are outlined of organizational changes in the wards and the possibilities of their monitoring are indicated.

An analysis of 141 families with children with neural-tube defects was performed. The families were consulted in the Department of Genetics, the Institute of Mother and in Child the period between 17.01.1978 and 29.02.1980. The family histories were obtained from the parents. The diagnosis was established on the basis of autopsy data and/or medical records. In cases of multiple congenital malformations coexisting with a neural-tube defect the precise diagnosis of the syndrome was established after a thorough search of the medical literature. Analysis of the material, showed that in 10 families (6,5%) neural-tube defect was associated with other malformations. There were 5 cases of sporadic syndromes (cloacal extrophy-2, aberrant tissue bands-2, sacrococageal teratoma-1), 3 families with Meckel's syndrome and 2 cases in which the nature of the syndrome was not determined. In 131 families the neural-tube defect was isolated and multifactorial inheritance was assumed (table VII). 113 families were given information about the cause of malformation, risk of recurrence, possibility of prenatal diagnosis and indications for amniocentesis (estimation of alpha-foetoprotein in amniotic fluid). After receiving genetic counseling and being fully informed about prenatal diagnosis the parents were asked about their procreative plans and their attitude to amniocentesis. Out of these families 74,3% planned next pregnancy (table IX), 57,6% wanted to have prenatal diagnosis (table VI). 131 family histories (probands with isolated neural-tube defect) were reviewed to determine recurrence risk for relatives. The recurrence risk for sibs was found to be: 4,9% (table III) and was higher than the expected risk (3,4%) from the population incidence of neural-tube defects in Poland (1, 15/1000 births including stillbirths). The recurrence risk for second and third degree relatives was found to be 0,1% (table IV) and 0,3% (table V) respectively.

Procreative attitudes and acceptance of prenatal diagnosis were analysed in 567 families which received information about prenatal diagnosis. This group was selected from 1914 families referred for genetic counseling. Obstetric data following birth of the index case, results of amniocenteses performed and changes of attitudes in these families are presented.