An educational intervention on promotion of breast feeding

This study was designed to search for an effective method to promote exclusive breast feeding among Turkish city women delivering in hospitals. Four hundred and forty-two primiparae with uncomplicated deliveries and with healthy infants with birthweights of greater than 2500 g were exposed to a group educational session on breast feeding after birth, followed by one repeat session at home. Four hundred and ninety-nine women served as controls. All homes were visited monthly for 6 months by independent observers and data relevant to the feeding of the infants were collected. Weight measurements of 176 infants were taken at age 4 months. The study and control mothers were similar in sociodemographic characteristics which reflected a low socio-economic/educational background but relatively good housing conditions. Although significant differences in frequency of exclusive breast feeding were found between the study and control groups, the impact of the intervention was much lower than our expectations and short-lived. Type of feeding was not related to sex or birthweight of the infant, nor to maternal variables. Weight at age 4 months was within normal limits and similar in the study and control groups. It was concluded that lack of up-to-date information on infant feeding was the main obstacle to breast feeding in urban groups in Turkey, and that the impact of an educational intervention limited to the first week after delivery was lost within the first 2 months.     

A breast feeding education and promotion program: Effects on knowledge,attitudes, and support for breast feeding

This study was undertaken to determine the effects of a partner-support, incentive-baed educational program on breast feeding knowledge, attitudes and support and to examine the relationship between feeding intentions and feeding behavior among low-income women. Women who expressed a willingness to participate in the intervention were randomly assigned to intervention and usual breast feeding (control) groups. Sixty-eight primipara women, with expected due dates between May and December, 1992, volunteered to participate in the study. Of these, 34 were randomly assigned to each of the two groups. Approximately 81 percent of the women completed the study, leaving n=29 in the control group and n-26 in the intervention group. The intervention consisted of special incentives (prizes) for women and their partners to participate in several breast feeding education and promotion activities. Intervention group women and their partners experienced positive changes in breast feeding knowledge and attitudes. Furthermore, the intervention seemed to have influenced more women in the treatment group to breast feed despite their prenatal feeding intentions. In addition, the partners of intervention group women were perceived to be more supportive of, breast feeding than control group partners. These findings suggest that incentives, such as donated prizes, can be used to attract lower socioeconomic group women and their partners to breast feeding promotion interventions. Participation in such interventions can produce positive changes in breast feeding knowledge, attitudes, and support, and can have a dramatic effect in promoting breast feeding.This study was supported through contract no. 59-3198-1-050 from the Food and Nutrition Service, U.S. Department of Agriculture.     

穴位按摩联合乳房护理对促进母乳喂养的前瞻性临床研究

目的:探讨在常规乳房护理的基础上进行穴位按摩对母乳喂养的影响。方法:选择160例产妇分为实验组(80例)和对照组(80例),对照组采用常规乳房护理,实验组在此基础上穴位按摩。记录两组产妇乳房硬度、疼痛及母乳喂养情况。结果:实验组乳房疼痛程度在产后第2天明显高于对照组(P0.01),在产后第3、4天较对照组轻(P0.05、P0.01);乳房硬度在第2天时实验组大于对照组,第4天实验组低于对照组(P0.01)。全部母乳喂养率实验组高于对照组,有统计学差异。结论:在常规乳房护理的基础上进行穴位按摩可促进乳汁分泌,减轻乳房胀痛,促进母乳喂养。     

健康促进对结核病控制工作的干预研究

目的分析健康促进对结核病控制工作的影响,为更好地开展结核病健康促进工作提供有益的启示.方法在规定时间内对目标县采取一系列健康促进活动后,采用直接和间接评价指标,全面分析健康促进对结核病控制工作的干预效果.结果健康促进活动开展前后人群结核病知识知晓率分别为19.93%和63.95%,可疑者年就诊率由0.83%上升到1.35%o.涂阳肺结核病人登记率由项目实施前的9.21/10万上升到项目实施后的20.63/10万;初治涂阳治愈率由90.42%上升到95.63%;复治涂阳病人治愈率由75.00%上升到85.29%.结论健康促进对结核病控制工作的影响是极为显著的,在结核病控制的进程中必须注重科学全面的健康促进.     

Recent developments in crisis intervention and the promotion of support service

A model of Primary Prevention is presented, based upon recent developments in the author's explorations, and upon the animal and human stress research literature. The main elements involve the multifactorial reverberation over time among past biopsychosocial hazards, individual competence, crisis reactions to current stress, and psychosocial supports. Methods of preventive intervention are described in detail. These include crisis methods: anticipatory guidance and preventive intervention; and support systems methods: providing and orchestrating professional support, convening a support group for a target individual, organizing a mutual-help couple, recruiting a panel of natural helpers, fostering development of mutual-help organizations, and supporting the supporters.This article is based on a chapter by Gerald Caplan inA Decade of Progress in Primary Prevention (1986), Marc Kessler and Stephen E. Goldston (Eds.).The research on which this article is based was supported by a grant from the Israel Cancer Association and by grants from the Shainberg Fellowship Funds of New York, which are gratefully acknowledged. The preventive work with children and their parents was conducted by the staff of the Hadassah Department of Child and Adolescent Psychiatry in collaboration with Professor Zvi Fuks, Professor Shoshanna Biran, and their colleagues of the Hadassah Department of Radiation and Clinical Oncology, and with Professor Israel Tamir and his colleagues of the Hadassah Department of Pediatrics, Ein Kerem, Israel.     

A breast cancer screening educational intervention targeting medical office staff

There is persistent evidence that breast cancer screening techniques remain under-utilized. While physicians cite lack of time as a barrier to the provision of preventive services, nurses and other medical office staff are in an ideal position to educate women and motivate adherence to screening recommendations. This paper describes the design, implementation and process evaluation of a breast cancer screening educational program targeting primary care medical office staff. This intervention was conducted in two Washington State counties as part of a larger community organization study. The PRECEDE model, educational outreach principles and focus groups were used to guide the program development. Consistent with 'academic detailing' concepts, the sessions were delivered at health care facilities. The program included a review of breast cancer-related data and screening methods, an overview of the nurse's role as a 'change agent' and breast self-examination instructor, and a discussion of women's barriers to mammography. Community-level penetration was relatively high, with sessions being completed by approximately 50% of the eligible staff. Overall, participants were positive about the value of the program. Medical office-based educational sessions have the potential of reaching a large proportion of primary health care workers and increasing disease prevention in communities.     

Impact of commercial support on continuing pharmacy education

INTRODUCTION: There is a serious debate over the involvement of the pharmaceutical industry in continuing education. Policies that govern the planning of continuing education for pharmacists center on the potential conflict of interest when there is commercial support for programs. The purpose of this study was to investigate the impact of commercial support on the provision and perceived outcomes of continuing pharmacy education. METHODS: A survey was administered online to a national sample of accredited providers of continuing pharmacy education, resulting in 134 responses. The 64-item survey was developed to measure the planning practices of these providers and their perceptions of the educational and noneducational consequences of commercial support for continuing education. RESULTS: One hundred thirty-four usable questionnaires (34%) were received from 386 leaders in pharmacy education. Approximately 86% of providers and 43% of programs received commercial support. Although the Accreditation Council for Pharmacy Education requires that providers review instructional content and materials for commercially supported programs before delivery, only 43% always did so. Commercial support was perceived to have consequences for provider organizations, pharmacists, and patients, such as increased cost and use of drugs and financial dependency of providers and participants on industry support. DISCUSSION: The results of our study lead to the conclusions that commercial support of continuing education is widespread, affects continuing education programs, and is perceived to have significant educational and noneducational consequences. The profession should ensure that continuing education guidelines are unambiguous related to specific practices that are allowable and unallowable when receiving commercial support. Future research should study the consequences of commercial support behaviorally by examining the effects on pharmacy professionals' practice and pharmaceutical care.     

Evaluation of an Australian intervention to encourage breast feeding in primiparous women

Breast feeding has nutritional, immunologic and antiallergicadvantages for the infant. Although it has been widely recommendedthat infants be exclusively breast fed until 4–6 monthsof age, only about half of all Australian babies currently receiveextended breast feeding. The present study evaluated an intensiveprogramme designed to increase the proportion ofprimi-parousmothers who breast fed for 4 months or longer. Women who registeredwith the hospital at least 20 weeks before delivery and whointended to breastfeed were eligible for the study. Two hundredand thirty-five women were allocated to receive either usualcare or an intensive breast feeding programme when they registeredwith the hospital. The intensive programme consisted of writtenmaterials, and group and individual sessions with a lactationcounsellor. It also included a visit from a breastfeeding consultantwhile in hospital after the birth and contact on return home.Women were followed up 6 weeks and 4 months after delivery.There were no significant differences in breastfeeding ratesbetween the control and intervention groups at either follow-uppoint. Breast feeding until 4 months was more likely among womenwhose baby did not receive a bottle feed while still in hospitaland who did not smoke, use the combined oral contraceptive pillor introduce solid food before 4 months. Those mothers who enjoyedand felt satisfied with breastfeeding were more likely to continueto 4 months. It seems likely that programmes designed to increasebreastfeeding will need to address underlying factors such ashospital policy rather than simply providing more health education.     

Quasi-experimental evaluation of a nutritional educational intervention among home support assistants for the elderly

BACKGROUND: The French National Program on Nutrition and Health has defined two specific objectives targeting older persons: (i) to improve their status in calcium and vitamin D and (ii) to prevent undernutrition. Home help provides support in activities of daily living, including meals, to dependent persons. The objective of our study was to evaluate the impact of a nutritional education intervention on knowledge and practices among home support assistants for the elderly. METHODS: Three facilities providing home support in Gironde (France) selected 132 home support assistants to follow an education program and 134 controls. Nutrition training was conducted in the intervention group by a dietician during two half-day sessions in May-June 2004. A non randomized controlled trial design was used for evaluation. Nutritional knowledge (20 questions) and practice (5 questions) of home support assistants were assessed by questionnaire before (April 2004) and after (September 2004) the training period in each group. Satisfaction of the intervention group was also assessed. RESULTS: The intervention group included 101 participants and the control group 106 persons who answered both questionnaires before and after the education program. The intervention group was significantly younger (p < 0.05), less educated (p = 0.01) and had less often participated to previous nutrition training (p < 0.001) than the control group. There was no significant difference between the two groups before intervention for their mean scores of knowledge or practices. The intervention group significantly improved its knowledge score (mean gain 2.5 points, p < 0.001) after the training period, whereas the score remained unchanged in the control group (mean gain 0.5 points, p = 0.06). The impact of the nutritional education was very significant (p < 0.0001) after adjustment for the characteristics which differed between the two groups. The practice scores did not differ significantly after intervention in multivariate analyses. Satisfaction of trained home support assistants was very high. Conclusion: An education program of home support assistants for elderly persons can improve their nutritional knowledge, but this study cannot conclude that the intervention was efficient to improve the nutritional status of older persons.     

Evaluation of a continuing educational intervention for primary health care professionals about nutritional care of patients at home

Objective

Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.

Design

Observational cohort study.

Setting

10 primary health care centers in Stockholm County, Sweden.

Participants

140 district nurses/registered nurses and general practitioners/physicians working with home care.

Intervention

87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.

Measurements

The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.

Results

In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.

Conclusion

The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.

     

Evaluation of the effects of a support campaign on exclusive breast feeding at 1 month

The aim of this study was to evaluate the effects of a support campaign on exclusive breast-feeding at one month postpartum among women having chosen breast-feeding. The study population consisted of all women (n = 657) having delivered in the Maternity Hospital in Pertuis (Area of Vaucluse-France) between January 1, 1987 and December 31, 1988. The first 151 women belonged to the control group not submitted to interventions while the following 506 composed the groups submitted to interventions. Interventions mainly aimed at providing information to women, supporting them after delivery, raising the awareness of their environment and educating Health professionals. Mothers were interviewed at the maternity and at their home one month later. Results showed that interventions significantly increased the number of women breast-feeding at one month (66% vs 52%-p less than 0.01) and reduced physical and medical problems related to breast-feeding (51% vs 60%-NS). To resolve these problems, Health professional education particularly appeared efficacious. The mothers' planned duration of breast-feeding was not significantly changed showing that actions were well conducted, as we wished, in the sense that the choice of mothers was respected. The greatest benefit was seen among the lowest social class (p less than 0.05), the less educated (p less than 0.01), and Maghrebin women (p less than 0.01).     

Equipping patients for a time of helplessness: An educational intervention

Objectives:  Quantify rates of awareness about, and ownership of, End-of-Life Planning (ELP) instruments. Examine whether this rate is increased by brief education during routine team care. Measure the time required by this exercise.
Design:  Quality Improvement Activity.
Setting:  General Practice on Mid-North Coast, New South Wales.
Participants:  Forty-two consecutive, consenting elderly patients undertaking a Home Health Assessment.
Main outcome measures:  This study assessed rates of ELP instruments at baseline, at 2 weeks, at 2 months and at 2 years following the provision and discussion of a fact sheet while measuring the clinicians' time required.
Results:  This education exercise increased the number of patients with ELP instruments from one to ten (24%). On average it took 5.6 min of nursing time and 3.9 min for the GP.
Conclusions:  Brief education during Home Health Assessments may empower patients to prepare for a scenario where they lost competency to make fully informed decisions. This may alleviate patient's fears about causing problems between those close to them and having treatments against their wishes.     

乳腺癌患者综合社会支持干预效果评价

目的探讨综合社会支持干预对提高乳腺癌患者术后应对能力和生命质量的效果。方法按病区将98例乳腺癌术后患者分为实验组和对照组各49例,实验组接受综合社会支持干预,对照组接受常规护理。分别在术后1~5天内及术后1个月、3个月进行社会支持、应对和生命质量各指标的测量。结果干预后,实验组和对照组的社会支持得分、应对量表8个方面得分和生命质量的生理维度、心理维度、和医务人员关系维度的得分及生命质量总分均的差异均存在统计学意义（P〈0.05）,社会支持得分、应对量表得分和生命质量得分均随干预时间推移而变化,干预方法与干预时间存在交互作用。结论综合社会支持干预可以提升患者对社会支持的感知度,增强正性应对,提高患者的生命质量。     

Does breast feeding protect against breast cancer? An epidemiological study]

The association between breastfeeding and the risk of breast cancer was studied as part of a Dutch population-based epidemiological study of the aetiology of female breast cancer. A total of 484 breast cancer patients and 484 controls (matched for age; age range: 20-54 years) were compared with regard to their breastfeeding habits. There was no clear association between breastfeeding and breast cancer risk. After adjustment for confounders women who had ever breastfed had no lower risk of breast cancer than women who never had given breastfeeding. Women who had breastfed for prolonged periods (total lifetime nursing of 44 weeks or more) had, after adjustment for confounders, a 29% lower risk of breast cancer compared to women who had never breastfed, but this risk reduction was not statistically significant. These results do not support the hypothesis that (short) periods of breastfeeding reduce the risk of breast cancer in young women. A possible protective effect of longer periods of breastfeeding, which is suggested more strongly in the literature, could not be investigated in this study because the women breastfed their children for relatively short periods.     

An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in rural Haryana, India

Complementary feeding practices are often inadequate in developing countries, resulting in a significant nutritional decline between 6 and 18 mo of age. We assessed the effectiveness of an educational intervention to promote adequate complementary feeding practices that would be feasible to sustain with existing resources. The study was a cluster randomized controlled trial in communities in the state of Haryana in India. We developed the intervention through formative research. Eight communities were pair matched on their baseline characteristics; one of each pair was randomly assigned to receive the intervention and the other to no specific feeding intervention. Health and nutrition workers in the intervention communities were trained to counsel on locally developed feeding recommendations. Newborns were enrolled in all of the communities (552 in the intervention and 473 in the control) and followed up every 3 mo to the age of 18 mo. The main outcome measures were weights and lengths at 6, 9, 12, and 18 mo and complementary feeding practices at 9 and 18 mo. All analyses were by intent to treat. In the overall analyses, there was a small but significant effect on length gain in the intervention group (difference in means 0.32 cm, 95% CI, 0.03, 0.61). The effect was greater in the subgroup of male infants (difference in mean length gain 0.51 cm, 95% CI 0.03, 0.98). Weight gain was not affected. Energy intakes from complementary foods overall were significantly higher in the intervention group children at 9 mo (mean +/- SD: 1556 +/- 1109 vs. 1025 +/- 866 kJ; P < 0.001) and 18 mo (3807 +/- 1527 vs. 2577 +/- 1058 kJ; P < 0.001). Improving complementary feeding practices through existing services is feasible but the effect on physical growth is limited. Factors that limit physical growth in such settings must be better understood to plan more effective nutrition programs.