Mothers' Knowledge of Infants' Fever Management: A National Prospective Study.

OBJECTIVES: The aim of this study was to describe mothers' knowledge of infant fever management after birth and six months later and its association with sociodemographic characteristics, perceived support, sources of consultation and health education; and to assess determinants of change in mother's knowledge from birth to six months. METHODS: Mothers (n = 2804) answered a self-reporting questionnaire after giving birth in maternity wards in six hospitals in Israel; six months later follow- up interviews were conducted by telephone. RESULTS: The mothers' knowledge level of infant fever management was low after birth (mean = 50.5, range 0-100, SD = 16.1), and rose to a moderate level six months later (mean = 65.2, SD = 15.0). Mothers having their first born, with lower household income or education were less knowledgeable about infant fever management after birth. However, these mothers showed the largest improvement after six months. Mothers' perceived support or sources of consultation and health education (partner, family, friends, nurses, and physicians) were not associated with their knowledge at either time. Moreover, mothers stated self-learning from internet and other media as often as receiving health education by health professionals. CONCLUSIONS FOR PRACTICE: Public health policy for health professionals in hospitals and community clinics is essential to promote clinical interventions promoting mothers' knowledge of infant fever management. Efforts should focus at first time mothers, those with non-academic education, and those with a moderate or low household income. Public health policy enhancing communication with mothers regarding fever management in hospitals and community health settings, as well as accessible means of self-learning is warranted.

Human Papillomavirus Vaccination Trends, Barriers, and Promotion Methods Among American Indian/Alaska Native and Non-Hispanic White Adolescents in Michigan 2006-2015.

Human papillomavirus (HPV) infection, the most common sexually transmitted disease in the US, is a preventable cause of cancer. HPV vaccination has the potential to prevent 90% of HPV-related cancer cases but is underutilized, especially among American Indian/Alaska Native (AI/AN) adolescents. The objectives of this study were to (1) describe trends and identify predictors of HPV vaccination initiation and completion in Michigan's AI and Non-Hispanic White children age 9 through 18 years and (2) to identify barriers to HPV vaccination and promotion methods at the tribal, state, and local levels in Michigan. Data from Michigan's immunization information system from 2006 to 2015 were used for analysis. Additionally, semi-structured interviews were conducted with public health professionals across the state to identify barriers to and promoters of HPV vaccination. Predictors for vaccine initiation included being female, AI/AN, and living in high poverty zip code. Predictors of vaccine completion were female gender and younger age at vaccine initiation. Barriers to vaccination included misinformation and weak or inconsistent provider recommendations. Strategies used by health professionals to promote HPV vaccination included immunization summaries, vaccine information statements, the Vaccines for Children (VFC) program, and provider training. Findings suggested the need for education of parents to demystify HPV vaccine benefits and risks and provider training for more consistent recommendations.

Non-fatal agricultural injury surveillance in the United States: A review of national-level survey-based systems.

BACKGROUND: Currently, surveillance of non-fatal agricultural injuries in the U.S. mainly relies on national surveys, and to date, none of these surveys were formally reviewed. Our objective was to review and evaluate these survey-based systems, to identify critical gaps in them and provide recommendations to improve them. METHODS: We used the updated Center for Disease Control and Prevention guidelines to describe each system and evaluate each system's attributes like simplicity, flexibility, data quality, timeliness, representativeness, etc. RESULTS: Four adult and two youth national surveys collected data for non-fatal agricultural injuries in the U.S. The evaluation identified three major gaps: 1) insufficient data quality attributed to non-response, measurement errors, and underreporting; 2) untimeliness of data; and 3) lack of flexibility to integrate with other existing systems. CONCLUSION: Improving data quality, timeliness and flexibility will provide reliable and valid injury estimates, and increase the usefulness of these surveys for surveillance and prevention of farm injuries.

Traditional versus internet bullying in junior high school students.

To examine the prevalence of traditional and Internet bullying and the personal, family, and school environment characteristics of perpetrators and victims. Students (12-14 years old) in 35 junior high schools were randomly selected from the Jerusalem Hebrew (secular and religious) and Arab educational system (n = 2,610). Students answered an anonymous questionnaire, addressing personal, family, and school characteristics. Traditional bullying and Internet bullying for perpetrators and victims were categorized as either occurring at least sometimes during the school year or not occurring. Twenty-eight percent and 8.9 % of students were perpetrators of traditional and Internet bullying, respectively. The respective proportions of victims were 44.9 and 14.4 %. Traditional bullies presented higher Odds Ratios (ORs) for boys, for students with poor social skills (those who had difficulty in making friends, were influenced by peers in their behavior, or were bored), and for those who had poor communication with their parents. Boys and girls were equally likely to be Internet bullies and to use the Internet for communication and making friends. The OR for Internet bullying victims to be Internet bullying perpetrators was 3.70 (95 % confidence interval 2.47-5.55). Victims of traditional bullying felt helpless, and victims of traditional and Internet bullying find school to be a frightening place. There was a higher OR of Internet victimization with reports of loneliness. Traditional bully perpetrators present distinctive characteristics, while Internet perpetrators do not. Victims of traditional and Internet bullying feel fear in school. Tailored interventions are needed to address both types of bullying.

Media Health Literacy (MHL): development and measurement of the concept among adolescents.

Increasing media use among adolescents and its significant influence on health behavior warrants in-depth understanding of their response to media content. This study developed the concept and tested a model of Media Health Literacy (MHL), examined its association with personal/socio-demographic determinants and reported sources of health information, while analyzing its role in promoting empowerment and health behavior (cigarette/water-pipe smoking, nutritional/dieting habits, physical/sedentary activity, safety/injury behaviors and sexual behavior). The school-based study included a representative sample of 1316 Israeli adolescents, grades 7, 9 and 11, using qualitative and quantitative instruments to develop the new measure. The results showed that the MHL measure is highly scalable (0.80) includes four sequenced categories: identification/recognition, critical evaluation of health content in media, perceived influence on adolescents and intended action/reaction. Multivariate analysis showed that MHL was significantly higher among girls (ß = 1.25, P < 0.001), adolescents whose mothers had higher education (ß = 0.16, P = 0.04), who report more adult/interpersonal sources of health information (ß = 0.23, P < 0.01) and was positively associated with health empowerment (ß = 0.36, P < 0.0005) and health behavior (ß = 0.03, P = 0.05). The findings suggest that as a determinant of adolescent health behavior, MHL identifies groups at risk and may provide a basis for health promotion among youth.

A new measurement for optimal antenatal care: determinants and outcomes in Cameroon.

A combined measure of optimal antenatal care can provide more information on the role it plays in maternal health. Our objectives were to investigate the determinants of a measure of optimal antenatal care and the associated pregnancy outcomes. Data on 7,557 women taken from the 2004 Demographic and Health Survey in Cameroon were used to develop a new measurement of optimal antenatal care based on four indicators: at least four visits, first visit in first trimester, last visit in third trimester and a professional provider of antenatal care. We studied the relationship of this new variable with other related variables in a multivariate analysis, taking into account the complex study design. Almost sixty six percent of the women had optimal antenatal care. Secondary or higher education (OR 1.74; 95% CI 1.28-2.36), greater wealth (OR 2.31; 95% CI 1.73-3.1), urban residence (OR 1.42; 95% CI 1.12-1.82) and parity of 3-4 (OR 0.79; 95% CI 0.62-0.99) were independently associated with optimal antenatal care. Women with optimal antenatal care were more likely to deliver in a health unit (OR 2.91; 95% CI 2.42-3.49), to be assisted by a skilled health worker during delivery (OR 1.88; 95% CI 1.49-2.37) and to have a baby with a normal birthweight (OR 1.62; 95% CI 1.11-2.38). Obtaining and using a new measure for ANC is feasible. The association of optimal antenatal care to education, wealth and residence in this study, consistent with others, highlights the role of the country's development in maternal health.

Can recall of birth size be used as a measure of birthweight in Cameroon?

Birthweight is a key predictor of future life outcomes. When this information is not available we must rely on maternal recall of weight or size. We evaluated the use of maternal recall of size as an indicator for birthweight, using data from the 2004 Demographic and Health Survey in Cameroon. The overall agreement between recorded and recalled weight and subjective assessment of birth size was 90% (Kappa = 0.46). Concordant descriptions were associated with higher birthweights (P < 0.001), higher education (P = 0.008) and delivery in a health unit (P = 0.025). Specificity for low birthweight (92.9%) was much higher than sensitivity (59.9%) and the negative predictive value (96.1%) was much higher than the positive predictive value (44.4%). These results indicate that recall of size, in Cameroonian women and in other low resource settings, should be used only in the absence of other sources of data.

[School health services: parents' and teachers' opinions].

BACKGROUND: Although School Health Services (SHS) are an efficient way of providing health care to children and adolescents, in recent years they have been curtailed in Israel. OBJECTIVES: To study parents' and teachers' knowledge about the content of SHS, their use and importance, and their preferred way of delivering these services. METHODOLOGY: From December 2006 - January 2007, teachers (n=304) of 2nd-12th-grade pupils and the pupils' parents (n=808) in state schools of the Hebrew education system (both secular and religious) were interviewed by phone. Parents were located by random dialing (response rate 63%), and the teachers from a Ministry of Education list (response rate 70%). RESULTS: About 70% of parents and teachers knew that SHS provide immunizations; 70% and 80% respectively, reported they provided first aid. Only 8% of the parents and 13% of the teachers reported that a nurse came at least three days a week to the school and most of them preferred that the nurse should come every day. Most respondents said that the SHS did important work. About a third of parents and 40% of teachers preferred that all health care services be provided in the schools by doctor and nurse; 40% of parents and teachers wanted the nurse to provide counseling and that the rest of SHS content be provided by the regular primary health care providers; 20% of parents and 14% of teachers preferred other options. CONCLUSIONS: Parents and teachers rate SHS as important and are prepared to consider alternatives for their delivery. This should be considered when re-organizing the SHS.

Do parental decision-making patterns predict compliance with use of child booster seats?

Booster seat use for 4-9 year olds remains the lowest of all age groups in many countries. The objective of this study is to examine whether parents' decision-making patterns, as measured by the Melbourne Decision Making Questionnaire, relate to car booster seat use. Israeli parents of 4-7 years old children (n = 398) answered a questionnaire about car safety and decision-making habits. Ninety per cent of parents reported having a booster seat; 70.5% reported consistent booster seat use in general and on short drives during the last month (booster seat use compliance index). Greater compliance index was positively related to a vigilant decision-making pattern, passenger compliance with rear seat belts and families with fewer children. Lower booster seat use compliance index was associated with buck-passing decision-making pattern. Health professionals and policy-makers should take into account parents' habitual decision-making patterns when designing interventions for car booster seat compliance.

Outcome of head and other injuries among Israeli children: physical limitations and stress symptoms.

BACKGROUND: Head injuries, especially in young children, are frequent and may cause long-lasting impairments. OBJECTIVES: To investigate the outcome of head and other injuries caused by diverse mechanisms and of varied severity. METHODS: The study population consisted of Jews and Arabs (n=792), aged 0-17 years old, hospitalized for injuries in six hospitals in Israel. Caregivers were interviewed during hospitalization regarding circumstances of the injury and sociodemographic variables. Information on injury mechanism, profile and severity, and length of hospitalization was gathered from the medical files. Five months post-injury the caregivers were interviewed by phone regarding physical limitations and stress symptoms. RESULTS: Head injuries occurred in 60% of the children, and of these, 22.2% suffered traumatic brain injury with loss of consciousness (type 1). Among the rest, 22% of Jewish children and 28% of Arab children remained with at least one activity limitation, and no statistically significant differences were found among those with head or other injuries. The odds ratio for at least two stress symptoms was higher for children involved in transport-related injuries (OR 2.70, 95% confidence interval 1.38-5.28) than for other mechanisms, controlling for injury profile. No association was found between stress symptoms and injury severity. CONCLUSIONS: Most children had recovered by 5 months after the injury. Residual activity limitations were no different between those with head or with other injuries. Stress symptoms were related to transport-related injuries, but not to the presence of TBI or injury severity.

Use of pre-hospitalization services in two population groups of injured children and adolescents in Israel.

BACKGROUND: Trauma management includes the care provided both in hospital and by emergency medical systems in the community. In many cases it is the parents who decide where to take an injured child for care, depending on the circumstances and severity of the injury, the personal characteristics of the injured or the carer and the availability and accessibility of services. OBJECTIVES: To examine the use of pre-hospitalization services and reasons for their use by children and adolescents according to the injury and personal characteristics. METHODS: The study group comprised 924 Israeli citizens aged 0-17 years hospitalized for injuries in six hospitals across Israel. Carers were interviewed in the hospital regarding the circumstances of the injury event, the use of pre-hospitalization services, and sociodemographic characteristics. Data on the cause and nature of the injury were obtained from the hospital records. RESULTS: The proportion of severe injuries (Injury Severity Score 16+) was higher in Arab children than Jewish children (15% and 9% respectively). Sixty-three percent of the Arab children and 39% of the Jewish children used community services prior to hospitalization. The odds ratio of proceeding directly to the hospital was 0.44, 95% confidence interval 0.29-0.69, for the Arab compared to the Jewish children, controlling for severity, cause and nature of the injury, sociodemographic characteristics, and the reported availability of ambulance services. CONCLUSIONS: More Arab than Jewish carers tended to seek care in the community for an injured child, but the effect of personal characteristics on seeking care was similar in both population groups. Issues of availability and accessibility of services may explain the differences.

An ecological model to factors associated with booster seat use: A population based study.

Belt-positioning booster seat use (BPB) is an effective technology to prevent severe child injury in cases of car crash. However, in many countries, age-appropriate car restraint use for children aged 4-7 years old remains the lowest among all age groups. The aim of this study was to identify the main determinants of BPB use through a comprehensive approach. An ecological model was used to analyze individual, parent-child relationships, and neighborhood characteristics. Parents of children enrolled in the first and second grades completed a self-reported questionnaire (n=745). The data were subjected to multilevel modeling. The first level examined individual and parent-child relationship variables; in addition the second level tested between neighborhood variance. According to parental self- reports, 56.6% of their children had used a BPB on each car trip during the previous month. The results indicated that the determinants positively related to BPB use were individual and parental; namely, the number of children in the family, the parents' car seat belt use, parental knowledge of children's car safety principles, and a highly authoritative parenting style. Children's temperaments and parental supervision were not associated with BPB use. At the neighborhood level, a small difference was found between neighborhoods for BPB users compared to non-users.

Neonatal transport of very low birth weight infants in Jerusalem, revisited.

BACKGROUND: Maternal transport, rather than neonatal transport, to tertiary care centers is generally advocated. Since a substantial number of premature deliveries still occur in hospitals with level I and level II nurseries, it is imperative to find means to improve their outcome. OBJECTIVES: To compare the neonatal outcome (survival, intraventricular hemorrhage and bronchopulmonary dysplasia) of inborn and outborn very low birth weight infants, accounting for sociodemographic, obstetric and perinatal variables, with reference to earlier published data. METHODS: We compared 129 premature infants with birth weights of 750-1250 g delivered between 1996 and 2000 in a hospital providing neonatal intensive care to 99 premature babies delivered in a referring hospital. In the statistical analysis, variables with a statistical significant association with the outcome variables and dissimilar distribution in the two hospitals were identified and entered together with the hospital of birth as explanatory variables in a logistic regression. RESULTS: Accounting for the covariates, the odds ratios (outborns relative to inborns) were 0.31 (95% confidence interval = 0.11-0.86, P = 0.03) for mortality, 1.37 (95% CI = 0.64-2.96, P = 0.42) for severe intraventricular hemorrhage, and 0.86 (95% CI = 0.38-1.97, P = 0.78) for bronchopulmonary dysplasia. The odds ratio for survival without severe intraventricular hemorrhage was 1.10 (95% CI = 0.55-2.20, P = 0.78). Comparing the current results with earlier (1990-94) published data from the same institution showed that mortality decreased in both the outborn and inborn infants (OR = 0.23, 95% CI = 0.09-0.58, P = 0.002 and 0.46; 95% CI = 0.20-1.04, P = 0.06, respectively), but no significant change in the incidence of severe intraventricular hemorrhage or brochopulmonary dysplasia was observed. Increased survival was observed also in these infants receiving surfactant, more so among the outborn. The latter finding could be attributed to the early, pre-transport surfactant administration, implemented only in the current study. CONCLUSIONS: Our data suggest that very low birth weight outborn infants may share an outcome comparable with that of inborn babies, if adequate perinatal care including surfactant administration is provided prior to transportation to a tertiary center.

Community-oriented primary care (COPC) and the affordable care act: an opportunity to meet the demands of an evolving health care system.

Community-oriented primary care (COPC) is a model of health care delivery that tightly integrates primary care and public health. This model of care, applied around the globe, could be more widely adopted in the United States as clinical delivery systems respond to the growing demand for population health management, which has been driven largely by various provisions of the Affordable Care Act (ACA). For that purpose, there is need for changes in capacitating health professionals and changes in organizational structures that will address the needs and health priorities of the population, considering individual care management in the context of population health for a defined population. This article presents how the Affordable Care Act is an appropriate framework for COPC to succeed and the way forward to develop COPC through practical alternatives for the delivery of primary care within a population context.

Análisis del sistema de salud cubano y del modelo atención primaria orientada a la comunidad / Analysis of the Cuban Health System and the Model of Community-Oriented Primary Care

La integración del cuidado de la salud individual con el de la población a través de la salud pública se ha podido llevar a cabo de forma efectiva a partir del modelo de la atención primaria orientada a la comunidad. En Cuba, la atención primaria es la base del sistema nacional de salud, con acceso universal y cuidado de los individuos, sus familias y la comunidad. El sistema nacional de salud y la atención primaria orientada a la comunidad contribuyen a la mejora de la salud y a la disminución de desigualdades en salud e iniquidades en la provisión de servicios. Este artículo presenta su descripción y análisis(AU)

Individual healthcare integrated with population healthcare through public health has been effective and possible through the model of community-oriented primary care. In Cuba, primary healthcare is the supporting structure of the national health system, including universal coverage and the care for individuals, their families, and the community. The national health system and community-oriented primary care contribute with health improvement and the decrease in health inequalities and in inequities of provided care. This article presents their comprehensive description and analysis(AU)

Injury inequalities: morbidity and mortality of 0-17 year olds in Israel.

BACKGROUND: To determine whether there are inequalities in the incidence of fatal and non-fatal unintentional injuries among Jewish and Arab children in Israel. METHODS: A nationwide random sample of injured children aged 0-17 attending emergency rooms (ER) during one year was selected (n = 11 058). The number of cases was weighted to 365 days and rates and odds ratios (OR) were calculated. Logistic regression was performed to study the OR of hospitalization in the total population and among Jews and Arabs controlling for independent variables. RESULTS: The incidence of ER admissions among the Jews was 752.6/10 000 (95% CI: 738.1-767.1), 1.5 times higher than among the Arabs (492.8/10 000, 95% CI: 472.8-512.8). However, the rate of hospitalization was 1.1 times higher among Arabs than among Jews and the mortality rate was 3.2 times higher among Arabs than among Jews. CONCLUSIONS: The differences in injury rates for fatal and non-fatal injuries may be due to differences in the severity of injuries or in the use of services by the two populations. A study is underway to elucidate this point.

A multicasualty event: out-of-hospital and in-hospital organizational aspects.

UNLABELLED: In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. OBJECTIVES: To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. METHODS: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. RESULTS: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. CONCLUSIONS: During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions.

Birth weight and weight, stature, and body mass index at ages 6 and 14 years.

To analyze the effect of birth weight on weight, stature, and the Body Mass Index (BMI) at the ages of 6 and 14 years, 1,115 Jerusalem schoolchildren were studied. Correlations were low, but higher between birth and 6 years (range 0.10-0.31) than between birth and 14 years (range 0.04-0.20). The positive predictive values for the highest quartile of BMI at 6 and 14 years were 29.6 and 29.4% among boys, 31.4 and 33.0% among girls. They were highest for menstruating girls, 35.6 and 40.0%, respectively. These girls were already heavier at age 6 than other girls and bodys. Aanalysis of covariance showed that birth weight was consistently associated with weight, stature, and the BMI, while mother's origin, education and age, and the number of children in the family were not. Overall, the explained variance was low and decreased with age in both sexes. It was higher for stature than for weight, and was specially low for the BMI. © 1993 Wiley-Liss, Inc.

Motor ability: protective or risk for school injuries?

The study aims were to assess the independent contribution of motor ability to the incidence of school injuries. The study included 2057 pupils in grades 3-6 of primary schools in a city in the north of Israel. A surveillance system gathered information about injuries that occurred on school premises or during school related activities and required medical treatment or caused limitation of usual activities. Children provided information on sensation seeking, self-appraisal of health, academic performance, physical activity, and dominant hand; anthropometric measurements and motor ability tests were performed. The incidence of injury events was 4% (95% CI=3.2-5.0). Injuries increased with increased balance and agility, but there were no differences according to reaction time. No other study variables were associated with the incidence of injuries. Our findings of an increase in the incidence of injuries with better motor ability may express differences in exposure to risk situations between children with better and poorer motor abilities.

Screening tests in prenatal care: a national study in Israel.

BACKGROUND: Prenatal care in Israel is established as a universal service, but the degree of compliance with care recommendations may vary with the healthcare provider or the characteristics of the population. OBJECTIVES: To study referral to and compliance with the performance of ultrasound, alpha-fetoprotein and amniocentesis and the factors associated with them in a national sample. METHODS: The sampling frame consisted of women who gave birth during March 2000. The sample included 1,100 Israeli Jewish and Arab women who resided in localities with over 50,000 and 20,000 inhabitants respectively. They were interviewed by phone 3 months after delivery. RESULTS: In both population groups 30% reported having seven or more ultrasounds during pregnancy. The performance of fetal body scans was relatively low. Factors associated with non-performance among Jewish women were: lower education, religiousness, and attending Mother and Child Health services as compared to all other services. Seventy-seven percent of Jewish women and 84% of Arab women reported that they had been referred for alpha-protein tests. For women aged 35 and over, 55% of Jewish women were referred for amniocentesis and 63% complied, whereas 39% of Arab women were referred but none complied. CONCLUSIONS: Ultrasound is almost universally performed among Jewish and Arab women, however fetal body scans, alpha-fetoprotein and amniocentesis (for women over the age of 35) are not. The reasons for the lower coverage may be due to under-referral and/or lack of compliance of the women, perhaps due to sociocultural barriers. In both population groups considerable out-of-pocket money is paid for the tests.