Promoting breast-feeding in a deprived area: the influence of a peer support initiative

The present article describes a qualitative study designed to evaluate the effectiveness of a peer-support intervention to promote breast-feeding in a deprived area. The aims of the study were to: explore stakeholders' experiences of the intervention; explore the development of a 'culture' of breast-feeding; and consider the potential of the initiative for building community capacity. The methods used in the research were in-depth interviews, diaries and direct observation. The findings describe the social and cultural barriers to breast-feeding experienced by women, and the ways in which professional and lay participants in the peer-support project attempt to reduce them. The advantages of partnership working between health professionals and lay volunteers are then explored. These include: sharing the workload; providing an informal tier of support to mothers; and importantly, offering support and advice stemming from personal experience. For lay supporters, the benefits of taking part in the project range from personal satisfaction at being recognised as skilled, to gains in confidence which potentially open up further educational and training opportunities. In conclusion, it is suggested that the 'success' of such interventions is unlikely to be captured solely by monitoring breast-feeding rates, but needs to take into account the wider context of community development.     

State-specific prevalence of smoke-free home rules--United States, 1992-2003

Secondhand smoke (SHS) causes premature death and disease in children and nonsmoking adults. The home is the primary source of exposure to SHS for infants and children and a major source of SHS exposure for nonsmoking adults. To assess trends in national and state-specific prevalence of home "no smoking" rules (i.e., smoke-free home rules), CDC analyzed data from the Tobacco Use Supplement to the Current Population Survey for 1992-1993, 1998-1999, and 2003. This report summarizes the results of that analysis, which indicated that the national prevalence of households with smoke-free home rules in the United States increased significantly, from 43.2% during 1992-1993 to 72.2% in 2003. During this period, the national prevalence of such rules increased from 9.6% to 31.8% among households with at least one smoker and from 56.8% to 83.5% among households with no smoker. A regression analysis of the rate of change over time indicated that the increase in smoke-free homes during this period was not significantly different for households with at least one smoker compared with households with no smoker. Statistically significant increases in the prevalence of smoke-free home rules were also observed in all states, although variation was observed among states. Comprehensive tobacco-control measures, including 1) evidence-based interventions to help smokers quit, 2) policies making workplaces and public places smoke-free, 3) voluntary rules making homes smoke-free, and 4) initiatives to educate the public regarding the health effects of SHS, are needed to further reduce exposure of nonsmokers to SHS.     

State-specific estimates of complete smoke-free home rules among postpartum women, 2010

BackgroundSecondhand smoke exposure increases an infant's risk of morbidity and mortality. We provide state-specific estimates for and characterize postpartum women with complete smoke-free home rules.MethodsData were analyzed from 26 states and New York City (n = 37,698) from the 2010 Pregnancy Risk Assessment Monitoring System, a population-based survey of women who recently delivered live-born infants. We calculated state-specific estimates of complete rules and assessed associations between complete rules and selected characteristics.ResultsOverall, 93.6% (95% CI: 93.1–94.1) of women with recent live births had complete smoke-free home rules (86.8% [West Virginia] to 98.6% [Utah]). Demographic groups with the lowest percentage of rules were women who smoked during pregnancy/postpartum (77.6%), were non-Hispanic Black (86.8%), never initiated breastfeeding (86.8%), < 20 years of age (87.1%), < $15,000 annual income (87.6%), < 12 years of education (88.6%), unmarried (88.6%), initiated prenatal care late/had no prenatal care (88.8%), had Medicaid coverage (89.7%), had an unintended pregnancy (90.3%), and enrolled in WIC (90.6%).ConclusionsPrevalence of complete smoke-free home rules was high among women with recent live births; however, disparities exist by state and among certain sub-populations. Women, particularly smokers, should be educated during and after pregnancy about secondhand smoke and encouraged to maintain 100% smoke-free homes.     

Evaluation of the impact of a technology appraisal process in England: the South and West Development and Evaluation Committee

OBJECTIVES: To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process. METHODS: Two postal questionnaires examining issues of awareness, influence and quality of the DEC reports were sent to samples of clinical and managerial health service staff in S&W NHS region, the North West NHS region, and three other randomly selected health authorities elsewhere. Supplementary telephone interviews were undertaken with a subsample of staff. Trends in utilisation before and after the publication of four S&W DEC reports were examined using routine health service data. RESULTS: Survey response rates ranged between 73% and 85%. Within health authorities in the S&W, agreement about the impact of the DEC in informing policy and purchasing decisions was consistently high, although responses from clinicians were more equivocal. In the topic areas examined, the impact of the DEC reports could not be separated from wider influences on practice. The cost of each DEC report is estimated to have been pounds sterling 24659. CONCLUSIONS: Health service staff perceived that the S&W DEC process had had an impact on policy decisions and clinical practice locally; however, any actual impact on practice could not be identified with routine data. The approach used in this study would be valuable in evaluating the impact of the English NHS National Institute for Clinical Excellence.     

Physical activity and health: evidence from a study of deprived communities in England

This study aims to explore the relationship between physical activity levels and the self-reported health status of residents living in deprived communities in England. A cross-sectional interview survey was conducted in communities in receipt of funding from the New Deal for Communities (NDC) regeneration programme. A sample of 848 addresses was selected by random sampling from within each of the 39 NDC areas, and one adult from each household was selected for interview. A total of 19 574 residents were interviewed between July and October 2002. The main outcome measures were physical activity level and health status assessed using four self-reported health measures: health in the last 12 months, health change in the last 12 months, long-standing illness or disability and a mental health-related quality-of-life score. There are large regional and demographic variations in respect of NDC residents' physical activity levels. The areas with the lowest levels of physical activity are mainly located in northern industrial towns. Residents who did little or no physical activity were more than twice as likely to feel that their health was not good (adjusted OR 2.54, 95% CI 2.35-2.75).     

Seasonality of birth for cancer in Northern England, UK

Environmental factors operating around the time of birth may influence the subsequent development of childhood cancer, particularly leukaemia. Certain factors may vary with season (e.g. infections), and we therefore investigated whether there was any evidence of seasonality of month of birth, based on data from 4199 children diagnosed with cancer under the age of 15 years. We extracted details of (i) children born 1960-95 and diagnosed 1968-95 from two population-based registries, covering the Northern (n = 2053) and Yorkshire (n = 1977) Regional Health Authority and (ii) children born in Cumbria 1950-93 and diagnosed anywhere in the UK before 1994 from a birth cohort database (n = 397). The following diagnostic categories were analysed: 0-14 years--all cancers, leukaemias, acute lymphoblastic leukaemias, central nervous system tumours, all other solid tumours; 1-6 years--leukaemias, acute lymphoblastic leukaemias. Seasonal variation was tested using Walter and Elwood's test, and logistic regression analysis allowing for cyclical variation in month of birth. No evidence of seasonality was present for any group except acute lymphoblastic leukaemia diagnosed among 1- to 6-year-olds. Seasonal trends varied by region: in the Northern and Cumbrian datasets, seasonality patterns were significant and similar (P < 0.05) with a predicted peak in early spring, whereas in Yorkshire there was less strong evidence of seasonality (P = 0.08) with a peak predicted in late summer. These findings suggest that local seasonal environmental factors operating around the time of birth are not associated with the totality of childhood cancer, but possible links with acute lymphoblastic leukaemia are supportive of a hypothesis of an infectious aetiology.     

The impact of aerial application of organophosphates on the cholinesterase levels of rural residents in the Vaalharts district, Northern Cape Province, South Africa

A cluster of Guillaine-Barre syndrome cases in the Vaalharts region, South Africa prompted an investigation of the impact of aerial organophosphate spraying on cholinesterase levels of residents in the region. A prospective study of cholinesterase levels among residents and workers in the area and a control area was performed. Standardized red blood cell cholinesterase levels amongst participants were monitored before (round 1), during (round 2), and after (round 3) the 1996/1997 aerial spraying season. Participants were assigned environmental exposure categories based on the time since (within 10 or 30 days) and distance from (on farm, on neighboring farm, <10 km from farm) aerial pesticide application. There were 342 participants in round 1, of whom 78% participated in round 2, 62% in round 3, and 56% in all three rounds. There was an increase in cholinesterase levels in round 2 (mean increase = 5.96+/-6.25 IU/g hemoglobin) and then a decrease in round 3 (6.17+/-6.51), significantly associated with environmental exposure (participants living on farm or neighboring farm and <10 km from spraying area) controlling for age, gender, alcohol dependence, and usual and recent domestic and occupational pesticide use (e.g., for round 2-round 1 cholinesterase differences, beta; (exposed group relative to unexposed)=5.72+/-1.21 IU/g hemoglobin, P = 0.000, R2 = 0.27, n = 171). The results show a shift in cholinesterase levels associated with residence in the spraying area, but in the direction opposite to that expected from the spraying of pesticides. Seasonal fluctuations in ambient temperature during the study may have influenced the results.     

上海市某区家庭病床服务现状分析研究

目的：对上海市虹口区2009—2012年4年的家庭病床服务状况进行分析研究,为改善家庭病床服务状况提供依据。方法：对4年来收集的家庭病床工作报表数据进行统计,对撤床患者治疗结果、撤床结算患者费用支出等情况进行分析。结果：2012年与2009年相比,期内家庭病床撤床数增加1540张,增幅35．34％;治愈、好转和稳定率大于90％,医保人均费用减少95．44元。结论：家庭病床服务对完善社区医疗保障体系具有积极作用。     

Addressing children's oral health inequalities in Northern Ireland: a research-practice-community partnership initiative

OBJECTIVE: Northern Ireland has a high prevalence of childhood dental caries, reflecting heavy consumption of cariogenic snack foods. To develop a policy to promote and facilitate healthier eating, researchers, practitioners, and the school community formed a partnership, together creating the Boost Better Breaks (BBB) school-based policy. The policy was developed with and supported by dieticians, health promotion officers, teachers, school meal advisors, and local suppliers of school milk. Eighty percent of primary schools and preschool groups within the Southern Health and Social Services Board are involved in the program, which permits the consumption of only milk and fruit at break time. METHODS: The authors assessed the effectiveness of the partnership using data from its first two years. RESULTS: Results of the first two years of evaluation are positive. Initial findings indicate that the program had a positive effect in increasing the mean number of sound teeth in children attending schools in areas in which socioeconomic conditions are poor. CONCLUSION: This initiative suggests that collaboration can facilitate improvement in children's dental health and that careful targeting of the policy to schools in poor areas has the potential to narrow disparities.     

Clostridium difficile: a questionnaire survey of laboratory practice in England, Wales, and Northern Ireland

Since January 2004, the incidence of Clostridium difficile associated disease (CDAD) has been monitored by a systematic, national, laboratory surveillance system. This system incorporates the recommendations of a body of experts, the National Clostridium difficile Standards Group, which was convened in 2002 to advise the Department of Health (DoH). The recommendations of the group were informed by a questionnaire survey of current practice, and the results of that survey have been used to assess the implications of the recommendations on laboratory practice. Large variability was found as to the specimens selected, tested, and reported on for C. difficile. Standardisation of the diagnosis and reporting of CDAD is desirable and necessary to increase understanding of its epidemiology.     

The impact of evidence-based education on a perinatal capacity-building initiative in Macedonia

CONTEXT: The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital-based initiative to develop the capacity of health professionals to introduce evidence-based perinatal practice into 16 participating hospitals. A "train the teachers" approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje. OBJECTIVES: To describe the development, implementation and evaluation of the educational intervention. METHODS: A curriculum, based on specific Macedonian needs, was developed in order to integrate teaching in the knowledge, skills and attitudinal domains of learning, using small group, interactive techniques. Twenty-five Macedonian doctors and nurses participated in 4-month (phase 1a) and 6-month (phase 1b) teaching programmes at a tertiary perinatal unit in Sydney. Australian staff conducted 4 2-week modules for 36 trainees in Macedonia (phase 2). The phase 1 trainees conducted 8 modules for 57 colleagues in Skopje (phase 3). The intervention was evaluated by trainee questionnaires, assessments of competence, changes in hospital practice and pre- (1997-99) and post-intervention (2000-01) comparisons of PMR. RESULTS: A total of 115 doctors and nurses graduated from the programme. Positive responses to the education programme exceeded 80%. Evidence-based practice in 16 participating hospitals (covering 91% of all Macedonian births) was verified in 6 key areas of neonatology. The PMR fell significantly from 27.4 to 21.5 per 1000 births (RR 0.79, 95% CI 0.73, 0.85). The early neonatal death rate in babies weighing over 1000 g fell by 36%. CONCLUSIONS: The intervention has increased the capacity of Macedonians to practise best-evidence perinatal medicine and improve outcomes. Sustainability is predicted by the "train the teachers" approach, with concurrent strengthening of the infrastructure and organisational framework.     

Identifying adverse effects of area-based health policy: An ethnographic study of a deprived neighbourhood in England

Health interventions commonly have adverse effects. Addressing these could significantly improve health outcomes. This paper addresses an adverse effect common in the promotion of health behaviours: exacerbation of health inequalities between low- and high-socioeconomic groups. Health behaviours – particularly, physical activity - are positioned within the context of social inequality and the inequitable spatial distribution of resources. Area-based health policy that targets deprived areas is assessed for its capacity to promote health behaviours without exacerbating inequality. Data are derived from a 16-month ethnography in a deprived English neighbourhood that was the target of area-based intervention that prioritised the promotion of physical activity. Findings provide evidence of adverse intervention effects that further disadvantaged the low-socioeconomic population. Analysis demonstrates how this was ultimately the outcome of localised policy drifting away from initial commitments to equitable service access. These findings increase understanding of the processes through which adverse intervention effects arise and how they can be mitigated.