Indicators of Differences in Immunization Rates of Mexican American and White Non-Hispanic Infants in a Medicaid Managed Care System

Abstract Immunization levels of Mexican American and white non-Hispanic infants enrolled in Arizona's Medicaid managed care demonstration project, a prototype of the model proposed for a reformed health care system, were compared and the influence of sociodemographic characteristics, acculturation levels, health beliefs of the mothers, and infant health status on immunization levels were assessed. The study used data collected from office records, birth certificates, and household interviews. The random sample included 292 white non-Hispanic and 274 Mexican American infants. White non-Hispanic infants received more immunizations by age 1 than the Mexican American infants. However, after controlling for a full set of explanatory variables in a multiple regression analysis, ethnicity was no longer a significant predictor of immunization levels. Significant predictors of a higher number of immunizations included fewer siblings, older maternal age, and higher maternal education. Health insurance and enrollment in a managed care plan were not sufficient to ensure adequate immunization of these Medicaid enrolled infants. Results are discussed in terms of previous research and the essential functions of public health as outlined in the Institute of Medicine's Report on the Future of Public Health.     

First-time mothers' and fathers' transition to parenthood: infant care self-efficacy, parenting satisfaction, and infant sex

The threefold purposes of our study were to determine differences between first-time mothers' and fathers' development of infant care self-efficacy and parenting satisfaction, relationships between mothers' and fathers' infant care self-efficacy and parenting satisfaction, and the effect of infant sex on the development of mothers' and fathers' infant care self-efficacy and parenting satisfaction during the first 4 months following the infant's birth. A convenience sample of 44 couples in a midwestern state completed the Demographic Questionnaire, the Infant Care Survey, and What Being the Parent of a New Baby is Like-Revised. Fathers' reports of infant care self-efficacy increased linearly during the first 4 months following the infant's birth while mothers' reports of infant care self-efficacy increased linearly during the first 3 months. At all data collection times, fathers reported significantly lower infant care self-efficacy than mothers. Reports of parenting satisfaction increased over time for mothers and fathers. At 8, 12, and 16 weeks following the infant's birth, mothers' infant care self-efficacy scores were significantly related to their parenting satisfaction scores. Fathers' infant care self-efficacy scores were significantly related to their parenting satisfaction scores at 12 and 16 weeks. Fathers of male infants had significantly higher parenting satisfaction scores than fathers of female infants at 12 and 16 weeks following the infant's birth. Nurses can develop individualized interventions to assist mothers and fathers during the transition to parenthood.     

Telephone triage. The rules are changing

The pressures of increasing clinical practice productivity as well as the limitations on parents' ability to make pediatric office visits has made it more difficult for children to be seen emergently in primary care clinics. For many children this translates into visiting an acute care center or emergency room to have urgent care needs quickly assessed and treated. Because of the gatekeeping now imposed on many organizations, it has become necessary for many primary care office settings to develop telephone management systems to triage the acuity of office visits or emergency room needs. This article reviews the issues inherent in developing an office-based telephone triage system, demonstrates some legal guidelines to follow for documentation, and describes the process of emergent management of parental concerns about child health.     

Dry chemistry: its expanded role in doctor's office testing

The physician's office laboratory is an important adjunct to quality patient care. Dry chemistry reagents and the instrumentation used with them provide an ideal mechanism to give the patient a timely, relatively inexpensive work-up. An office laboratory can save the physician and his or her staff many frustrations. But unless the physician's office laboratory director makes use of the assistance of laboratorians and manufacturers in setting up good quality assurance systems along with the choice of dry chemistry system, the director may merely replace his or her frustrations with new ones. The limitations of an office laboratory are far outweighed by the benefits in quality patient care.     

Resolution of suckling intolerance in a 6-month-old chiropractic patient

OBJECTIVE: To discuss the management and resolution of suckling intolerance in a 6-month-old infant. CLINICAL FEATURES: A 6-month-old boy with a 4(1/2)-month history of aversion to suckling was evaluated in a chiropractic office. Static and motion palpation and observation detected an abnormal inward dishing at the occipitoparietal junction, as well as upper cervical (C1-C2) asymmetry and fixation. These indicated the presence of cranial and upper cervical subluxations. INTERVENTION AND OUTCOME: The patient was treated 5 times through use of cranial adjusting; 4 of these visits included atlas (C1) adjustment. The suckling intolerance resolved immediately after the first office visit and did not return. CONCLUSION: It is possible that in the infant, a relationship between mechanical abnormalities of the cervicocranial junction and suckling dysfunction exists; further research in this area could be beneficial. Possible physiological etiologies of painful suckling are presented.     

Evaluation of Telehealth Use in Prenatal Care for Patient and Provider Satisfaction: A Step Toward Reducing Barriers to Care

Prenatal care in preparation for childbirth improves maternal-child outcomes. While prenatal care is essential for care of mother and baby, barriers exist to participation in the frequent face-to-face office visits with a provider for prenatal care. The costs associated with work disruptions, child care, and travel, and often long office waiting times, limit one’s ability to fully engage in a meaningful and productive in prenatal visit. This pilot study evaluated patient and provider satisfaction with participation in prenatal care that includes telehealth visits. The aim was to explore whether this model can help decrease barriers to accessing perinatal care.     

标准化工作流程在供应室的应用效果评价

目的：提高供应室质量,保证医疗护理安全。方法：将标准化工作流程实施6个月前后的临床科室对供应室服务满意度和供应室工作合格率进行自身对照。结果：标准化工作流程实施6个月后临床科室对供应室服务满意度显著增加（P〈0.05）,供应室工作合格率显著提高（P〈0.01）。结论：标准化工作流程实施后,提高了临床科室对供应室服务的满意度,保证了供应室质量,确保了医疗护理安全。     

Effect of early postpartum teaching on primiparas' knowledge of infant behavior and degree of confidence

The purpose of this experimental study was to determine the effectiveness of teaching primiparous mothers about infant behavior. Experimental mothers (n = 17) received a teaching intervention representative of the Brazelton Neonatal Behavioral Assessment Scale when their infants were 2 weeks old; contrast mothers (n = 16) completed a Newborn Information Checklist about infant behavior at home two weeks postnatally; control mothers (n = 13) received neither teaching nor a checklist. At a 4-week postnatal office visit, experimental mothers had more knowledge about infant behavior than either the contrast or control mothers. There was no difference among the groups regarding maternal confidence in interpreting behavioral cues of their own infant. Contrast mothers reported wanting information about topics included in the teaching intervention.     

福州市家庭母婴护理员工作现状及培训需求调查

目的 调查福州市家庭母婴护理员工作现状和培训需求。方法 采用自行编制问卷,于2018年8月—11月便利抽取福州市9所家政公司的130名家庭母婴护理员进行问卷调查。结果 116名（89.3%）家庭母婴护理员文化程度在初中及以下;就从业方式来看,68名（52.3%）私下接单,63名（48.5%）依托中介,36名（27.7%）为公司员工;总体培训需求率为61.3%,不同等级的家庭母婴护理员的总体培训需求得分差异具有统计学意义（P<0.05）,从业时间、年龄与总体培训需求得分呈负相关,r值分别为-0.266、-0.436（P<0.01）。结论 家庭母婴护理员的整体素质水平较低,从业流程有待进一步规范,主观培训意愿不强,建议应根据家庭母婴护理员等级定期开展分层培训,提高家庭母婴护理员的整体专业水平。     

Orthopedic trauma: office management of major joint injury

Orthopedic injuries are common reasons for visits to primary care physicians. Careful history and physical examination with intelligent use of imaging technology will arrive at the correct diagnosis in most patients. Many conditions may be definitively managed by the office internist. Others maybe initially stabilized and referred to orthopedic surgeons for definitive care. Nondisplaced fractures, tendon injuries, sprains, and overuse syndromes are entities within the purview of the primary care physician. Familiarity and confidence with diagnosis and management of these conditions in the office is optimal for the care of the adult patient.     

The pathologist's role in the diagnosis of cancer.

This brief overview of the activities of the pathologist for cancer patients has shown the primary care physician not only what is involved for the office patient, but also procedures that are out of the scope of office practice. It is intended that this review lead to better patient care through communication and cooperation.     

Infant handling in the NICU: does developmental care make a difference? An evaluative review of the literature

Infant handling and disruptions in the neonatal intensive care unit are environmental stressors over which nurses have the most control. Two of the major goals of developmental care are individualizing care by decreasing infant disruptions and handling by caregivers, and modulating or attenuating infant responses to the care they receive. However, it has yet to be established to what extent these goals have been achieved. This article will provide a comparative review of selected literature to ascertain what effect, if any, the introduction of developmental care has had on infant handling or disruption in the neonatal intensive care unit.     

A Pilot Study: Postpartum Mothers' Perception of the Information Received in the Hospital and Its Usefulness During the First Weeks at Home

The advent of prospective reimbursement provides hospitals with the incentive to decrease the length of the patient stay since hospitals are paid on the basis of patients' diagnoses instead of the traditional third party reimbursement based on length of stay. Communication of mothers' perceived needs to community health nurses for follow up care may prove to be more cost-effective and is essential for coordinating and maintaining quality care. This pilot study investigated: level of knowledge of self-care and infant care at hospital discharge; information found useful by mothers during first weeks at home; and other information that would have been helpful. The investigators developed two questionnaires with sections relating to: peri-care, breast care, food and fluids, elimination, activity, social interaction, infant physical care, infant feeding, and infant behavior. Data were gathered from consenting postpartum mothers by self-report on tools. The In-hospital sample consisted of 83 mothers (normal, full term, uncomplicated pregnancies and deliveries, discharged home with healthy infant within 5 postpartum days)t Mothers completed the first questionnaire on the day prior to discharge, usually the third postpartum day, and returned the second At Home questionnaire after 1 week at home. Seventy-eight mothers returned the second questionnaire: 47 multiparas, 29 primiparas, 51 breast-feeding, and 27 bottle feeding. Data analysis revealed physical care aspects related to self and infant care were reported by a majority of mothers as knowledge achieved. Knowledge attainment in the sections relating to activity, social interaction, and infant behavior were reported less frequently. Most of the mothers indicated all knowledge areas as useful at home. Mothers' written comments indicated a need for more guidance in the area of infant care, particularly infant behavior.     

Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians

BACKGROUND: The importance of office spirometry has been strongly advocated in the pulmonary community, but whether its importance is recognized and accepted by primary care physicians is less well established. METHODS: To assess primary care physicians' knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease, we conducted a brief mail survey on the local practice of office spirometry, barriers to performing office spirometry, and general knowledge about spirometry. We also provided 60-min educational workshops to assess whether such an approach would increase spirometry testing or perceptions about spirometry. RESULTS: Twenty-nine of 57 (51%) primary care offices responded to the survey. Of these, 66% owned their own spirometer. The most common reasons for not performing spirometry were uncertainty about the impact of the test (41%), physician and staff unfamiliarity (38%), and lack of training (34%). Twenty-one respondents participated in the workshops. In the 3 months following the workshops, the number of spirometry tests increased by 59% (p = 0.004). After the workshops, the proportion of clinics that reported reasons for not performing the test decreased by 13% (p = 0.01), but important barriers to performing office spirometry were still present, including physician and staff unfamiliarity (22%), uncertain interpretation of results (22%), time (22%), and reimbursement (22%). CONCLUSIONS: The general knowledge and use of office spirometry in the primary care community is poor, but can be improved, at least in the short-term, by a simple educational workshop.     

Words of thanks

Background: Many factors influence medical students’ career choice.

Purpose: Determining the influence of an office‐based component to the 3rd‐year internal medicine clerkship on selection of primary care.

Methods: A prospective study using surveys and internship match information.

Results: Thirty‐seven percent entered primary care; 44% completing the office‐based rotation vs. 36% of others: odds ratio (OR) = 1.6 (1.0, 2.7). Among those interested in family medicine or pediatrics, students completing the office‐based rotation were twice as likely to enter primary care as their peers: family medicine OR = 1.8 (1.1, 3.2); pediatrics OR = 2.2 (1.1, 4.4). Among those not interested in internal medicine, students completing the office‐based rotation were four times more likely to enter internal medicine than their peers: OR = 4.2 (1.6, 11.0).

Conclusions: This office‐based internal medicine clerkship is associated with primary care career choice for students expressing interest in family medicine or pediatrics, and students not identifying internal medicine as a choice.     

Help for Mothers with Infant Care and Household Tasks: Perceptions of Support and Stress

Abstract This study explored help with infant care and with household tasks from the infant's father and grandparents that mothers reported throughout their infant's first quarter-year, the extent to which help was perceived as a support and its lack as a stressor, and the difference that maternal experience made in holding this view. Participating mothers were interviewed biweekly concerning sources of help with infant care and household tasks (received help), and kept a daily log for the first 90 days after their healthy infant's birth that included supportive (e.g., help with infant care) and stressor (e.g., lack of help with household tasks) events. Received help varied by type (infant care or household help) and by source (father or grandparent). Help with infant care was more frequent than help with household tasks, and help from fathers was more frequent than help from grandparents for all six 15-day study periods. Lack of help was infrequently reported as a stressor, and only in the first 30 days. The discrepancy in number of mothers receiving help from fathers with infant care and household tasks and mothers perceiving help from them as supportive was significant in the last three study periods. Parity did not significantly affect either received or supportive help from fathers; however, with time fathers' supportive help with household tasks decreased. Study of mothers' expectations for help with infant care and household tasks from fathers and grandparents is needed to clarify these findings.     

Hypospadias—Complete Construction of Penis,With Establishment of Proper Sex Status

The obstetrician s responsibility in the diagnosis and management of erythroblastosis fetalis includes the detection of mothers likely to become sensitized or already sensitized by fetal-maternal blood-group incompatibility, evaluation of the seriousness of the problem in each sensitized mother under his care, formal consultation with the physician who will care for the newborn infant, selection of suitable blood donors prior to delivery, and delivery at a time most favorable for the infant. The obstetrician must be aware of his responsibility in the immediate care of the erythroblastotic infant.     

Marital and parenting satisfaction and infant care self-efficacy during the transition to parenthood: the effect of infant sex

The purpose of this follow-up study was to examine the effect of infant sex on changes in and differences between parents' reports of infant care self-efficacy and parenting and marital satisfaction from 4 months to 12 months after the birth of their first child. A convenience sample of 32 couples was selected from 44 couples who participated in a longitudinal study of the development of parenting satisfaction and infant care self-efficacy during the first 4 months after the birth of a first child (Brage Hudson, Elek, Fleck, 2001). Couples completed a demographic questionnaire, the Infant Care Survey (ICS, Froman Owen, 1989), the What Being the Parent of a New Baby is Like--Revised Questionnaire (WPBL-R, Pridham Chang, 1989), and the Dyadic Adjustment Scale (DAS, Spanier, 1976, 1989) 4 and 12 months postpartum. Infant care self-efficacy, but not parenting satisfaction, increased from 4 to 12 months; mothers reported higher infant care self-efficacy and parenting satisfaction than fathers at both times. Fathers of boys reported greater parenting satisfaction and infant care self-efficacy at 12 months than fathers of girls. Marital satisfaction decreased from 4 to 12 months for both mothers and fathers. Significant relationships existed among infant care self-efficacy, parenting satisfaction, and marital satisfaction at both 4 and 12 months postpartum. Implications for families and for nursing interventions are discussed.     

The relationship between sleep/awake rhythm development and caregiving activities

Ensuring proper central nerve system (CNS) development is the core issue in premature infant care. Because an infant's sleep pattern (or sleep state) manifests his or her CNS integration, recognizing infant sleep patterns is essential for caregivers involved with developmental care. This article aims to explore the development of biological rhythms and infant sleep/awake states, factors influencing sleep states, and the effectiveness of various interventions to promote infant sleep. Five major factors that influence infant sleep states include noise, light, environmental temperature, physical contact with caregivers, and body position. Accordingly, we propose interventions to improve infant sleep quality to facilitate the growth of premature infants.