Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay

BackgroundLate-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.ObjectiveThe aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.MethodsThe intervention was designed to promote parents’ education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n = 212) and an intervention group (n = 161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.ResultsInfants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p = 0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p = 0.009).ConclusionThe intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.     

Comprehensive neighbourhood mapping: developing a powerful tool for child protection

This paper proposes ‘comprehensive neighbourhood mapping’ as a schema for gathering and interpreting information within a given geographical area which is informed by imaginative thinking about the safety of children and young people from sexual crime. It would build upon current forms of profiling by local authorities, health authorities and central Government. CNM would actively involve local people, in partnership with agencies, in ‘mapping’ danger points and support points. Eight components are discussed, including environmental issues, locations of sex offenders, sites where teenagers meet and share information, supportive individuals and organizations. Some issues for pilot projects are discussed, including the need to set up planning and implementation groups and to integrate CNM into wider child protection and community safety strategies. CNM is grounded in an ecological perspective which sees partnership approaches as essential and believes an overarching view of neighbourhood needs, based on detailed local information and understanding of how different forms of harm interconnect, is crucial in developing child protection strategies. At times of acute official anxiety about community ‘lynch‐mob’ reactions to known paedophiles, CNM aims to build communities which instead are informed and thoughtful about child protection. Copyright © 2002 John Wiley & Sons, Ltd.     

Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia

This report evaluates the extent of perceived and enacted HIV/AIDS-related stigma in a rural setting in Zambia. Stigmatisation is abundant, ranging from subtle actions to the most extreme degradation, rejection and abandonment. Women with HIV and pregnant women assumed to be HIV positive are repeatedly subjected to extensive forms of stigma, particularly once they become sick or if their child dies. Despite increasing access to prevention of mother to child transmission initiatives, including anti-retroviral drugs, the perceived disincentives of HIV testing, particularly for women, largely outweigh the potential gains from available treatments. HIV/AIDS related stigma drives the epidemic underground and is one of the main reasons that people do not wish to know their HIV status. Unless efforts to reduce stigma are, as one peer educator put it, “written in large letters in any HIV/AIDS campaign rather than small”, stigma will remain a major barrier to curbing the HIV/AIDS pandemic.     

Middle School Children's Perceptions on Welfare and Poverty: An Exploratory, Qualitative Study

This study was undertaken to determine how middle school children assess the effects of welfare reform on their daily lives. The study consisted of thirty interviews with children and their mothers recruited from a middle school in a large, metropolitan area. From the children's perspective, multiple jobs and evening/night hours interfered with the child-parent relationship. Other consequences included grades going down and not getting to school on time. All the children stated that mothers should work, but most children felt mothers should only work when their children are in school. Welfare and poverty were issues about which children were teased at school.     

Influences on registered nurses' decision‐making in cases of suspected child abuse

This paper reports on the factors influencing decision‐making for a group of 10 South Australian community nurses in cases of suspected child abuse. Each nurse participated in a structured interview. The data were organized into themes, using the computer program NUD*IST. Factors having an impact on the nurses' decisions to report included: the type of suspected abuse, making moral judgements and decision‐making, the consequences of reporting, and the impact versus the outcomes of reporting. Most significantly, the community nurses based many of their decisions on their estimation of the kind of intervention likely to be undertaken by children's protection services. Copyright © 2002 John Wiley & Sons, Ltd.     

A review of the epidentiological research on child sexual abuse. Community and college student samples

This article is the first of two consecutive reviews on the major empirical studies which have been carried out in an attempt to estimate the prevalence of child sexual abuse among females. The research is structured in terms of three sample categories: (a) probability and non-probability samples of the general population; (b) college student samples; and (c) clinical inpatient and outpatient samples. This part of the review deals with (a) and (b) and highlights a number of unresolved methodological issues which may contribute to the variance in reported prevalence rates. These include a myriad of definitions of child sexual abuse and different methods of eliciting information on possible histories of abuse. Despite these problems. taken as a whole the prevalence studies indicate the significant numbers of people who have experienced abuse and who are willing to disclose aspects of these abusive experiences.     

Dementia Problem Behavior and the Production of Informal Caregiving Services

Informal caregivers of individuals with Alzheimer's disease spend a considerable amount of time providing care. In this paper, we use Grossman's health production and Becker's time allocation models to develop a model of informal care provision to elderly dementia patients. In our model, time inputs produce caregiving services, which provides utility to the caregiver, but reduces leisure. We assume that time is less productive of services on the margin as the disease progresses. In this framework, an increase in patients' disease severity does not necessarily increase informal caregiver time input. The cost of formal care establishes a reservation price for informal caregiving. When the costs of informal caregiving rise above this reservation level, the patient is institutionalized. We test empirically the effect of deterioration in the patients' condition, proxied by both disease severity and dementia problem behavior, on informal caregiving time. We find that dementia-related problem behaviors and functional limitations significantly increase inputs of informal caregiving time. Patients' problem behavior exerts a modifying effect on functional limitations, and patients' comorbidities have no effect on informal caregiving time.     

Parent‐Adolescent Communication About Sex: Retrospective Reports by Latino College Students

Latina female (n= 97) and Latino male (n= 69) college students (M age = 21.4 years) completed self‐report surveys regarding family of origin experiences, including sexual communication with parents while growing up. Latino parents of this comparatively highly educated sample tended to use direct rather than indirect strategies for communicating about sexuality with their children. Young women reported higher levels of sexual communication with mothers while growing up than did young men, and respondents reported less communication with fathers than mothers. Among young women, sexual communication with mother was positively associated with non‐Mexican origin and negatively associated with having older brothers living at home. In contrast, maternal education was positively associated with mother‐son communication about sex. Paternal education and the absence of older brothers positively predicted communication with both sons and daughters. The analyses provide novel information regarding sexual communication in Latino families and suggest directions for future research.     

Efe fathers: one among many? A comparison of forager children's involvement with fathers and other males

The study reported describes Efe (pygmy) forager one-, two-, and three-year-olds' involvement with males. The Efe of northeastern Zaïre were chosen because their social organization allows us to examine hypotheses based on studies in Western, technologically complex societies about the distinctive role fathers play in the lives of their young children. Behavioral observations of Efe children's day-to-day activities with fathers, men and boys were recorded using a focal subject sampling technique (Altmann, 1974). Two behavioral measures were created to capture the extent to which males were involved with children: Social engagement describes males' involvement with children and social attention describes eavesdropping by children on males' everyday activities. Eight one-year-olds, 7 two-year-olds and 8 three-year-olds were each observed for six, one-hour observation sessions that were distributed evenly over the daylight hours. Data were analyzed using the traditional measure of involvement (e.g., adult males) and using a newly developed measure of the involvement of the average individual (e.g., average adult mate). Comparisons at each of the ages showed that fathers were consistently like other men in the extent to which children participated in social activities with them and watched their activities. Only fathers' level of social engagement declined significantly as children grew older. Boys' role relative to other males became increasingly distinctive as children aged. The findings suggest that Efe fathers may not be unique in the same sense assumed by Western study ideals, and raise questions about the special status given to fathers in Western theory and data. The patterning of mate involvement with children is discussed in terms of Efe community life, and in terms of Efe children's developing understanding of their relationship with fathers and other males.