Factors associated with interruption of exclusive breastfeeding in low birth weight infants receiving primary care

This study aimed to identify factors associated with interruption of exclusive breastfeeding (EBF) in low birth weight infants receiving primary care. This was a cross-sectional study of 170 infants treated at primary care units on the urban periphery of S?o Paulo, Brazil. The sample included infants with birth weight ≤ 2,500g (including twins) and 5-minute Apgar ≥ 7, followed until the third month of life, and excluded infants/mothers with complications that would impede EBF, besides infant/maternal deaths. Data were collected from forms completed during consultations and patient records. Prevalence ratios were obtained by Poisson regression. The following factors were associated with interruption of EBF in the first three months of life: maternal age ≤ 18 years; informal employment (protective factor); alcohol intake during pregnancy; < 6 prenatal visits; multiple gestations; birth weight ≤ 2,000g; difficulty breastfeeding in the first month; complaints in breastfeeding during the first month; and use of pacifiers in the first two months. Prior knowledge of these factors can help plan measures and policies to increase EBF rates among low birth weight infants.     

Factors associated with exclusive breastfeeding in Accra, Ghana

OBJECTIVE: To assess factors associated with exclusive breast-feeding (EBF) in Accra, Ghana. DESIGN, SUBJECTS, SETTING: Data on current and past infant feeding patterns, sociodemographic, biomedical and biocultural factors were collected using a cross-sectional design, from a sample of 376 women with infants 0-6 months, attending maternal and child health (MCH) clinics in Accra. EBF was defined in two ways: (a) based on a 24-h recall, and (b) based on a recall of liquids or foods given since birth. RESULTS: Although 99.7% of mothers were currently breastfeeding (BF), only half (51.6%) of them EBF their infants. About 98% of participants had heard about EBF, and 85.6% of them planned to EBF on delivery. Based on 'since birth' EBF, planned EBF on delivery was associated with higher likelihood of EBF (OR=2.56; 95% CI, 1.06-6.17) and delivery at a hospital/polyclinic was associated with a two times higher likelihood of EBF (OR=1.96; 95% CI, 1.08-3.54). Women living in their own houses were more likely to EBF (OR=3.96; 95% CI, 1.02-15.49) than those living in rented accommodations and family houses. Those with a more positive attitude towards EBF were more likely to EBF (OR=2.0; 95% CI, 1.11-3.57) than their counterparts with more negative attitudes. The '24-h recall' EBF model yielded similar results. CONCLUSION: In this population, EBF was associated with delivery at hospital/polyclinic, having secondary school education, intention to EBF prior to delivery, owning a home and having a positive attitude to EBF.     

Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding

BACKGROUND: Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided, but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding durations in recipient infants. OBJECTIVE: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding. DESIGN: We conducted an observational cohort study nested within a large randomized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo (with continued mixed breastfeeding through >/= 6 mo) with 621 infants who were exclusively breastfed for >/= 6 mo. Regression to the mean, within-cluster correlation, and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses. RESULTS: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent. CONCLUSIONS: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life.     

Factors associated with the use of primary care services: the role of practice nurses

Rising demand for and costs of health care have led to an increasing role of practice nurses in primary care in many countries, including the United Kingdom. Previous research has explored how practice nurse care differs from that provided by general practitioners (GPs) in terms of costs and health outcomes, and has highlighted the importance of matching skills and experience with roles and responsibilities. However, there has been little research to compare the characteristics of patients seen by GPs and practice nurses in primary care. We aim to investigate the factors associated with the use of practice nurse visits, and to compare these with the factors associated with GP use. We jointly model the use of practice nurse and GP visits using a bivariate probit regression model with a large set of covariates taken from two rounds of the Health Survey for England (2001, 2002). We find that practice nurse use is associated with age and gender, health, socioeconomic and supply variables. There are differences in the factors associated with practice nurse and GP use. Chronically ill patients are more likely to see a practice nurse, while acute ill health has a stronger association with the probability of seeing the GP. Practice nurse use is also correlated with a narrower range of health conditions compared with GP use. We also found differences between practice nurse and GP visits with respect to the association with economic activity, ethnic group, number of children, degree of urbanisation, and distance to practice.     

Factors associated with exclusive breastfeeding in children under four months old in Botucatu-SP, Brazil

This study aimed to identify factors associated with exclusive breastfeeding (AME) and the reasons mothers presented to introduce complementary feeding in the first four months of life. A total of 380 mothers (92.2%) of children under four months old vaccinated in a Multi-vaccination Campaign were interviewed. To identify factors associated to AME, univariate and multiple logistic regressions analyses were performed. Thirty-eight percent of the children were on AME; 33.4% consumed cow milk; 29.2% tea; and 22.4% water. The mothers justified introduction of cow milk by factors related to quantity/quality of maternal milk and "necessity" of the child. The use of a pacifier (odds ratio=2.63; CI95%=1.7-4.06) and difficulty to breastfeed (odds ratio=1.57; CI95%=1.02-2.41) were associated with the absence of AME. The populational attributable risk percentage for the use of a pacifier was estimated at 46.8 %. Thus, modifiable risk factors were associated with AME interruption.     

我国中西部地区农村纯母乳喂养影响因素研究

【目的】调查我国中西部地区农村纯母乳喂养现状,并分析产后保健服务因素对纯母乳喂养的影响。【方法】采用描述流行病学方法探讨纯母乳喂养率、纯母乳喂养持续时间及其分布状况;采用混合效应模型探讨影响纯母乳喂养的因素。【结果】调查地区纯母乳喂养率为76.8%,4个月以上纯母乳喂养率为42.7%,6个月以上的喂养率为16.4%,母乳喂养的平均时间为3.1个月。控制了母亲年龄、文化程度、家庭经济、分娩方式等变量后,混合模型分析结果显示产后母乳喂养指导与纯母乳喂养持续时间存在关联。【结论】调查地区的纯母乳喂养率较低,产后母乳喂养指导可以提高纯母乳喂养时间,亟待采取产后保健相关的干预方法,有效提高农村的纯母乳喂养水平。     

Factors affecting exclusive breastfeeding in Poland: cross-sectional survey of population-based samples

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 = 10156 infants under six months).     

Factors affecting exclusive breastfeeding in Poland: cross-sectional survey of population-based samples

Summary. 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 = 10156 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.

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Zusammenfassung. Faktoren, die ausschliessliches Stillen in Polen beeinflussen: Querschnittsuntersuchungen auf der BevölkerungsebeneFragestellung: Es sollen Faktoren identifiziert werden, die das ausschliessliche Stillen in Geburtskrankenhäusern und während der ersten sechs Monate nach der Geburt beeinflussen.Methoden: Zwei landesweite Querschnittstudien dienen als Grundlage für diese Studie: die erste wurde 1995 in Entbindungsabteilungen durchgeführt (n = 11422 Neugeborene), die zweite, durchgeführt 1997 in Institutionen zur medizinischen Grundversorgung (n = 10156 Kinder unter sechs Monate).Resultate: Die wichtigsten Faktoren während der Krankenhausaufenthalt waren: Kaiserschnitt, erstes Stillen nach zwei Stunden, Mangel an Berührung, Gebrauch von Beruhigungsmitteln, Trennung für länger als 1 Std./24 Std. und Gesundheitsprobleme der Kinder. Die wichtigsten Faktoren nach der Krankenhausentlassung waren: Gebrauch von Beruhigungsmitteln, Widerwille der Mutter gegen ausschliessliches Stillen länger als vier Monate, niedriges Ausbildungsniveau von Mutter und Vater.Schlussfolgerung: Die meisten identifizierten Faktoren sind modifizierbar, so dass unsere Resultate dazu beitragen können, gezielte effektive Interventionsmassnahmen zu entwickeln.

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Résumé. Facteurs affectant lallaitement maternel exclusif en Pologne: étude populationnelle transversaleObjectifs: Identifier les facteurs qui affectent lallaitement maternel exclusif dans les maternités et durant les premiers six mois suivant la naissance.Méthodes: Deux enquêtes ont servi de base à cette étude: la première, conduite en 1995 dans des maternités (n = 11422 nouveau-nés), la seconde, conduite en 1997 dans des centres de santé (n = 10156 enfants âgés de moins de 6 mois).Resultats: Les facteurs ayant le plus dimportance dans les maternités sur lallaitement exclusif se sont révélés être: une césarienne, un allaitement débuté 2 h après la naissance, le manque de contact peau à peau, lusage dune sucette, la séparation durant plus de 1 h par 24 h et les problèmes de santé des nourrissons. Après avoir quitté lhôpital, les facteurs les plus significatifs étaient: lusage dune sucette, le manque denvie des mères de nourrir uniquement au sein au delà de quatre mois, le bas niveau déducation de la mère et du père.Conclusions: La plupart des facteurs identifiés peuvent être modifiés. Nos résultats pourraient aider à rendre les interventions plus ciblées et donc plus efficaces.

     

Factors associated with health care access and outcome

This study aims to (1) assess ethnic differences in health care access and health outcome between Asian Americans and whites and between Asian American subgroups, (2) examine effects of cultural factors, and (3) investigate moderating effects of health risk behaviors between cultural characteristics and health care access and outcome. Data were derived from the 2007 California Health Interview Survey. Asian Americans (n = 4,462) and whites (n = 4,470) were included. There were significant ethnic differences in health care access and health perception between Asian Americans and Whites and across Asian American subgroups. Health risk behaviors moderated relationships between cultural factors and health care access and outcome. Findings reveal that ethnicity affects an individual's health care access and health perception, and their health behaviors are an important factor that may improve or worsen outcomes. This study may increase our knowledge base of research and interventions to enhance ethnic minority populations' health care accessibility and perceptions.     

Factors associated with health care utilization by the elderly in a public health care system

OBJECTIVE: The objective was to determine the factors associated with the use of health care services by the elderly residing in the community. METHODS: A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status. RESULTS: The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41). CONCLUSIONS: Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.     

The role of health promotion in primary health care

A major transformation has been occurring in primary healthcare during the past 20 years. These changes are reviewed brieflyfor the benefit of those who do not work in the front-line ofcare and for those who have not had the opportunity to experiencethe changes. Two major components of the transformation arestressed:

1. the shift towards person (patient) centred methods;
2. a broadframework of reference which encourages horizontal integrationof skills in the nonspecialised way.

The opportunities for health promotion in primary health careare legion and evidence from worldwide experimental sourcesis reviewed to show how different levels of achievement canbe demonstrated and monitored. Responsibility, empowerment and participation were firmly declaredprinciples in the WHO Alma Ata Declaration on primary healthcare. The practical realisation of such principles in the fieldis occurring at an increasing rate, but their continuation willdepend on the further growth and development of appropriatecommunity-centred skills and practices. Evidence for the power of a "social sieve" to moderate professionalor official health recommendations is also discussed in thelight of current research. If recent research data is upheld,the relationship between primary health care personnel and thesocial network around them is likely to be shown to make a criticaldifference to health outcomes.     

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE

To assess the determinants of exclusive breastfeeding abandonment.

METHODS

Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period.

RESULTS

The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care.

CONCLUSIONS

Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.     

纯母乳喂养持续时间与婴儿体重的关系研究

目的 探讨我国城市地区婴儿体重相关指标与纯母乳喂养时间的关系。方法 以2011年在全国17所省市级妇幼保健院调查的465例9~13月龄正常足月儿童为研究对象。采用自拟调查问卷了解儿童6个月内喂养方式和1岁左右的体格发育情况。比较不同纯母乳喂养时间的儿童, 身长别体重Z值(weight for height Z-score, WLZ)、年龄别BMI Z值(BMIz)和年龄别体重Z值(weight for age Z-score, WAZ)中>+2s的发生情况。结果 纯母乳喂养0~6个月的婴儿在1岁左右肥胖的发生率(据WLZ>+2s)依次为12.35%、13.51%、15.79%、9.09%、6.84%、4.88%和4.05%;纯母乳喂养<4个月组婴儿1岁左右肥胖发生率(12.02%)高于纯母乳喂养4~6个月组 (5.60%), 差异有统计学意义(P<0.05)。BMIz、WAZ也表现为类似的趋势。Logistic回归分析显示纯母乳喂养时间对婴儿体重有显著影响。结论 婴儿1岁左右肥胖发生率随6个月内纯母乳喂养时间延长而降低, 纯母乳喂养时间长对于婴儿肥胖可能有预防保护作用。     

Factors associated with achievement of goals for home health care

With the introduction of Medicare's Prospective Payment System (PPS) and DRGs, the economic value of home health care services lies in its ability to reduce total patient care costs by the substitution of outpatient home care for inpatient hospital care. Analysis of service delivery patterns utilized by home health agencies in meeting goals for patient care will be an important ingredient in meeting these objectives. The purpose of this study was to determine if important patient characteristics known at the onset of home health care are predictive of utilization of home health services and/or the likelihood of meeting goals for home care established at the time of certification of care. Multivariate models were developed which predicted the odds of terminating with goals met based upon age, intensity of utilization, functional limitations, prognosis, presence of a caregiver, and type of patient condition. Results indicated that variability in likelihood of meeting goals for care is much better predicted by patient characteristics than by utilization of home care services.     

Factors associated with the duration of exclusive breast-feeding in asthmatic families

This study was part of a randomized controlled trial in which verbal and written advice about exclusive breast-feeding for 6 months was provided to Dutch women expecting a child with a high risk of developing asthmatic traits. Eighty-nine women completed a theory-based self-report questionnaire between the third and sixth months of pregnancy, which served as the baseline measurement. The aim of this study was to examine the factors that influence the duration of exclusive breast-feeding. Cox multiple regression analysis showed a positive significant association between the duration of exclusive breast-feeding and the mother's breast-feeding knowledge (P < 0.01), her intended hours of work per week after maternity leave (P < 0.01) and her age (P 相似文献   

The role of health promotion in primary health care.

A major transformation has been occurring in primary health care during the past 20 years. The changes are reviewed briefly for the benefit of those who do not work in the front-line of care and for those who have not had the opportunity to experience the changes. Two major components of the transformation are stressed: (i) the shift towards person (patient) centred methods; (ii) a broad framework of reference which encourages horizontal integration of skills in the nonspecialized way. The opportunities for health promotion in primary health care are legion and evidence from worldwide experimental sources is reviewed to show how different levels of achievement can be demonstrated and monitored. Responsibility, empowerment and participation were firmly declared principles in the WHO Alma Ata Declaration on primary health care. The practical realisation of such principles in the field is occurring at an increasing rate, but their continuation will depend on the further growth and development of appropriate community-centred skills and practices. Evidence for the power of a "social sieve" to moderate professional or official health recommendations is also discussed in the light of current research. If recent research data is upheld, the relationship between primary health care personnel and the social network around them is likely to be shown to make a critical difference to health outcomes.