Doing Better to Do Good: The Impact of Strategic Adaptation on Nursing Home Performance

Objective. To test the hypothesis that a greater commitment to strategic adaptation, as exhibited by more extensive implementation of a subacute/rehabilitation care strategy in nursing homes, will be associated with superior performance.
Data Sources. Online Survey, Certification, and Reporting (OSCAR) data from 1997 to 2004, and the area resource file (ARF).
Study Design. The extent of strategic adaptation was measured by an aggregate weighted implementation score. Nursing home performance was measured by occupancy rate and two measures of payer mix. We conducted multivariate regression analyses using a cross-sectional time series generalized estimating equation (GEE) model to examine the effect of nursing home strategic implementation on each of the three performance measures, controlling for market and organizational characteristics that could influence nursing home performance.
Data Collection/Abstraction Methods. OSCAR data was merged with relevant ARF data.
Principal Findings. The results of our analysis provide strong support for the hypothesis.
Conclusions. From a theoretical perspective, our findings confirm that organizations that adjust strategies and structures to better fit environmental demands achieve superior performance. From a managerial perspective, these results support the importance of proactive strategic leadership in the nursing home industry.     

做好新形势下高校附属医院思想政治工作

在新形势下,高校附属医院的思想政治工作不断面临新的问题、机遇与挑战。加强高校附属医院思想政治工作,必须适应形势发展,深入基层一线,把握思想动态,破除旧习歪风,努力改善医院思想政治工作的软环境;同时要创新工作理念,强调以人为本,大力整合资源,注重多管齐下,形成高校附属医院思政工作新机制。要弘扬医院文化,提升人文素养,树立医德医风,筑牢精神防线,加强医院思想政治工作文化建设。     

Life Course Factors Associated with Initiation and Continuation of Exclusive Breastfeeding

Introduction

Exclusive breastfeeding (EBF) benefits the life course health development of infants, families, and society. Professional health associations recommend EBF for 4 months, and many now recommend EBF for 6 months. Yet only 18.8 % of US infants born in 2011 were exclusively breastfed. Numerous studies on breastfeeding are published, but few describe EBF. This study describes characteristics of women who initiated EBF and examines the associations of those factors with EBF lasting ≥4 months. The Life Course Health Development (LCHD) framework was used to structure the analysis and interpret results.

Methods

Data collected through the Infant Feeding Practices Study II survey (2005–2007) were used to identify a cohort of women (n = 1226) practicing EBF at the time of hospital discharge and their sociodemographic, health, work, and childcare characteristics. Associations of these characteristics with EBF lasting ≥4 months were studied by bivariate and logistic regression analyses.

Results

College education [odds ratio (OR) 2.14, 95 % confidence interval (CI) 1.58–2.89] and marriage (OR 2.19, 95 % CI 1.43–3.37) were associated with greater odds of EBF lasting ≥4 months, whereas the plan to return to work after birth (OR 0.57, 95 % CI 0.43–0.74), living in the south (OR 0.67, 95 % CI 0.47–0.95), and postpartum depression risk (OR 0.43, 95 % CI 0.28–0.66) were associated with lower odds of EBF lasting ≥4 months.

Discussion

Several factors associated with disparities in continued EBF were identified. The application of the LCHD framework furthers understanding of the multiple and interacting risks associated with early discontinuation of EBF.

     

促进社区母乳喂养成功的对策研究

目的 为了将出生４个月内婴儿的母乳喂养率提高到２０００年的８０％。方法 在试点社区通过干预前调查,找出问题,进行干预,再通过终末调查评估干预措施的可行性。结果 试点社区内爱婴医院的服务质量提高,母亲接受母乳喂养知识和指导的效果得到最终纯母喂养纺和母乳喂养率均显著提高,出生后４个月内的母乳喂养充过８３．２％《     

The Impact of Community Health Professional Contact Postpartum on Breastfeeding at 3 Months: A Cross-Sectional Retrospective Study

This study investigated the effect of any health professional contact and the types of contact new mothers received in the first 10 days post-discharge on breastfeeding rates at 3 months. This cross-sectional retrospective self-report survey was distributed to women who birthed in Queensland, Australia between 1st February and 31st May 2010 at 4–5 months postpartum. Data were collected on pregnancy, birth, postpartum care and infant feeding. Logistic regression was used to assess the relationship between health professional contact and breastfeeding at 3 months. Data were analysed by birthing facility sector because of significant differences between sectors in health professional contact. The study cohort consisted of 6,852 women. Women in the public sector were more likely to be visited at home than women birthing in the private sector. Any health professional contact (AOR 1.65 99 % CI 0.98–2.76 public sector, AOR 0.78 99 % CI 0.59–1.03 private sector) and home visits (AOR 1.50 99 % CI 0.89–2.54 public sector, AOR 0.80 99 % CI 0.46–1.39 private sector) were not associated with breastfeeding at 3 months in either sector. A telephone call (AOR 2.07 99 % CI 1.06–4.03) or visit to a general practitioner (GP) (AOR 1.83 99 % CI 1.04–3.21) increased the odds of breastfeeding in public sector women. Health professional contact or home visiting in the first 10 days post-discharge did not have a significant impact on breastfeeding rates at 3 months. Post-discharge telephone contact for all women and opportunities for self-initiated clinic visits for women assessed to be at higher risk of ceasing breastfeeding may be the most effective care.     

Prolonged Exclusive Breastfeeding Through Peer Support: A Cohort Study From a Community Outreach Project in Swaziland

Swaziland faces great public health challenges, including suboptimal breastfeeding practices and the world’s highest prevalence of HIV. The objective of this study was to estimate neonatal and infant mortality rate and rate of exclusive breastfeeding for clients enrolled in a community-based peer support project in peri-urban areas of Swaziland. The intervention builds on the so called “Philani-model” with Mentor Mothers in the community under high level of supervision. Cohort data was collected from journals kept by the Mentor Mothers. Kaplan–Meier and Cox regression were used to analyse data. Neonatal and infant mortality were estimated to 15 respectively 57 per 1000 live births. High level of social vulnerability was associated with risk of neonatal mortality (HR 1.12, CI 95 % 1.01–1.24) while the mother’s positive HIV status was associated with infant mortality (HR 2.05, CI 95 % 1.15–3.65). More visits by a Mentor Mother could not be shown to result in lower mortality. The chance to practice exclusive breastfeeding for 6 months was estimated to 50 %. The risk of discontinuing exclusive breastfeeding before 6 months was lower for mothers being unemployed (HR 0.55, CI 95 % 0.44–0.69) or socially vulnerable (HR 0.95, CI 95 % 0.92–0.99) and higher for mothers being HIV positive (HR 1.22, CI 95 % 1.01–1.48). Receiving at least four visits by a Mentor Mother during pregnancy decreased the risk of discontinuing exclusive breastfeeding prematurely (HR 0.82, CI 95 % 0.67–0.99). Peer support with Mentor Mothers thus had a positive impact on exclusive breastfeeding rates in this disadvantaged population.     

Understanding Breastfeeding Initiation and Continuation in Rural Communities: A Combined Qualitative/Quantitative Approach

Objective To determine factors associated with breastfeeding in rural communities. Methods We combined qualitative and quantitative data from the Family Life Project, consisting of: (1) a longitudinal cohort study (N = 1292) of infants born September 2003–2004 and (2) a parallel ethnographic study (N = 30 families). Demographic characteristics, maternal and infant health factors, and health services were used to predict breastfeeding initiation and discontinuation using logistic and Cox regression models, respectively. Ethnographic interviews identified additional reasons for not initiating or continuing breastfeeding. Results Fifty-five percent of women initiated breastfeeding and 18% continued for at least 6 months. Maternal employment at 2 months and receiving WIC were associated with decreased breastfeeding initiation and continuation. Ethnographic data suggested that many women had never even considered breastfeeding and often discontinued breastfeeding due to discomfort, embarrassment, and lack of assistance. Conclusions Breastfeeding rates in these rural communities lag behind national averages. Opportunities for increasing breastfeeding in rural communities include enhancing workplace support, maximizing the role of WIC, increasing hospital breastfeeding assistance, and creating a social environment in which breastfeeding is normative.     

An Evaluation of a Perinatal Education and Support Program to Increase Breastfeeding in a Chinese American Community

Maternal and Child Health Journal - In 2015, a community health center implemented a multipronged, Chinese language, health education initiative to increase breastfeeding. Perinatal education,...     

Time Off Work After Childbirth and Breastfeeding Supportive Workplaces: Associations with Near-Exclusive Breastfeeding Trajectory Membership

ObjectiveWe aimed to determine whether the association between time off work and a near-exclusive breastfeeding trajectory is moderated by perceived employer support for breastfeeding.MethodsWe conducted a secondary analysis of working mothers (n = 1,468) from the Infant Feeding Practices Study II, a longitudinal observational (2005–2007) study of U.S. infant feeding behaviors. Previous studies have found four latent infant feeding subgroups in the Infant Feeding Practices Study II sample, each following a distinct breastfeeding intensity trajectory. Multivariate least-squares regression was conducted to estimate whether time off work after delivery predicted increased membership in the subgroup characterized by near-exclusive breastfeeding, and whether this association was moderated by perceived employer support for workplace breastfeeding.ResultsBoth time off work and perception of more breastfeeding support were independently, positively related to probability of membership in the near-exclusive breastfeeding trajectory (β = 0.16, p = .019, and β = 0.14, p = .004, respectively). The interaction of these two factors suggests an attenuation effect. The addition of paid leave to the model did not change the estimates.ConclusionThe positive relationship between time off and trajectory membership was significant only for mothers who perceived their workplaces to be unsupportive of breastfeeding.     

A Case Study on the Economic Impact of Optimal Breastfeeding

To develop a framework, using Louisiana as a case study, for estimating the potential cost savings to individual states if families were able to meet current recommendations for breastfeeding. Using cost-analyses methods, cost savings, as well as, case and death reductions of infant illnesses and deaths on four selected infant diseases (respiratory tract infections, gastroenteritis, necrotizing enterocolitis, and Sudden Infant Death Syndrome) were calculated utilizing the most recent data of breastfeeding and low/very low birth weight rates in Louisiana. To estimate the incidence of a disease in exclusive breastfed infants and formula fed infants respectively, we used the following formula: x = s/br + 1 ? b. Here “x” is the incidence rate of one disease in formula fed infants, “s” is the overall incidence of the disease, “b” is current breastfeeding rate and “r” is the odds ratios in favor of breastfeeding. A total of $216,103,368 could be saved and 18 infant deaths prevented, by these four conditions alone, if 90% of newborns in Louisiana were exclusive breastfed for the first 6 months of life ($186,371,125 in savings and 16 infant deaths prevented with 80% compliance). Increased rates of breastfeeding to the level of Healthy People 2020 goals and beyond would yield significant cost savings to Louisiana. Other US states can use the presented framework to demonstrate cost savings associated with breastfeeding promotion and support interventions in their respective states.     

Breastfeeding Promotion,Support and Protection: Review of Six Country Programmes

Reviews of programmes in Bangladesh, Benin, the Philippines, Sri Lanka, Uganda, and Uzbekistan sought to identify health policy and programmatic factors that influenced breastfeeding practices during a 10 to 15 year period. Exclusive breastfeeding rates and trends were analysed in six countries in general and from an equity perspective in two of them. Success factors and challenges were identified in countries with improved and stagnated rates respectively. The disaggregated data analysis showed that progress may be unequal in population subgroups, but if appropriately designed and implemented, a programme can become a “health equalizer” and eliminate discrepancies among different subgroups. Success requires commitment, supportive policies, and comprehensiveness of programmes for breastfeeding promotion, protection and support. Community-based promotion and support was identified as a particularly important component. Although health workers’ training on infant feeding support and counselling was prioritized, further improvement of interpersonal counselling and problem solving skills is needed. More attention is advised for pre-service education, including a stronger focus on clinical practice, to ensure knowledge and skills among all health workers. Large-scale communication activities played a significant role, but essential steps were often underemphasized, including identifying social norms and influencing factors, ensuring community participation, and testing of approaches and messages.     

Impact of a Feeding Log on Breastfeeding Duration and Exclusivity

Even with the gradual upward trends in breastfeeding initiation and duration, breastfeeding rates at 6 months continue to lag well behind the 50% target set for any breastfeeding and the 25% target set for exclusive breastfeeding by the Healthy People 2010 initiatives. Overall evidence is limited in identifying effective interventions that promote breastfeeding duration and more research needs to be focused on specific nursing strategies and their effect on breastfeeding outcomes. The aim of this study was to test the efficacy of a daily feeding log, guided by Bandura’s social cognitive learning theory, on breastfeeding duration and exclusivity in primiparous mothers. The study used a randomized, controlled, two-group experimental design with a sample of 86 primiparous mothers. The experimental group completed a daily breastfeeding log for a minimum of 3 weeks and breastfeeding outcomes were examined over 6 months. The breastfeeding outcome variable was analyzed using survival analysis and Cox proportional hazards regression procedures. Subjects in the experimental group did not breastfeed significantly longer than the control group, however, a larger proportion of subjects in the experimental group reported full breastfeeding at 6 months as compared with subjects in the control group. Additional predictor variables were WIC enrollment, planned duration of breastfeeding, feeding frequency and feeding length at 1 week. The findings from the study suggest that the breastfeeding log may be a valuable tool in self-regulating breastfeeding and promoting a longer duration of full breastfeeding, but its acceptability may be impacted by socio-demographic variables.     

An Integrated Model of Breastfeeding Peer Counseling Support is Feasible and Associated with Improved Exclusive Breastfeeding

Maternal and Child Health Journal - Background Though in-person contacts in the home have demonstrated efficacy in improving breastfeeding outcomes in peer counseling programs, home contacts are...     

An Evaluation of the Effects of a Breastfeeding Support Program on Health Outcomes

ObjectiveTo estimate the causal effect of a Michigan peer counselor (PC) breastfeeding support program for low-income women on infant health outcomes.ConclusionsThis Michigan PC breastfeeding support program resulted in improvements in breastfeeding and infant health outcomes as measured by the diagnosis of ailments while increasing health care utilization.