PARENTAL BREASTFEEDING BEHAVIOR AND ATTITUDE QUESTIONNAIRE.

A validated questionnaire is required to evaluate scientifically community-based breastfeeding support and promotion. The aim of this study was to create a valid and reliable questionnaire to measure parents' behavior and attitudes about breastfeeding. The items in the questionnaire were selected by the authors according to regular data from the professional literature, and in consultation with three pediatric lecturers at higher and secondary health education, fellow pediatricians, and parents. A working version of the questionnaire was available on the website of the For a Healthy and Happy Childhood association from February 1, 2019 to May 31, 2019. The study was approved by the Ethics Committee of the Bjelovar General Hospital. After item analysis, 15 behavioral questions that showed good internal consistency were retained. Concerning the attitudes, principal component analysis showed a four-factor structure with 17 items explaining 46.11% of total variance. Cronbach's alpha (0.88) indicated acceptable internal consistency. To analyze the ability of the questionnaire to differentiate parents according to the desired outcome, the χ2-test, correlation and logistic regression were used. In the study, the desired outcome was defined as exclusive breastfeeding for 5 or 6 months, as well as breastfeeding for 12 months or more. In conclusion, the final instrument is reliable and valid for collecting breastfeeding data and evaluating changes in parents' behaviors and attitudes achieved through participation in breastfeeding promotion and support programs. The questionnaire may, in addition to the BIAKQ questionnaire, support professionals and activists involved in breastfeeding to create methodologically well-conceived programs.

EFFECTS OF A BREASTFEEDING EDUCATIONAL INTERVENTION ON SECONDARY SCHOOL STUDENTS AFTER 6 MONTHS.

Breastfeeding attitudes are already being formed in the years of preadolescence-adolescence, which means that the educational program should be focused on this age group. For this purpose, many authors suggest that school should be used as an established educational institution and therefore they are developing different education programs. The authors offered an educational program adapted to the cultural, sociological, legal, health, and other specificities of the community to which the students belong. A questionnaire on breastfeeding intentions and knowledge was used to measure the long-term effects of education (after 6 months) in 155 students. They were divided into two groups: experimental (n=101, Grammar School students) and control (n=54, Bjelovar High School students) groups. The experimental group underwent breastfeeding education program, while control group did not. The study was approved by the Ministry of Education and Science, and co-operation with schools was approved by the School Ethics Committees. Six months after educational intervention, students in the experimental group had significantly improved their breastfeeding intentions and knowledge compared to baseline measurement (before intervention). However, 6 months after the education, their knowledge and intentions were less positive than shortly after education, as described in a previous report. The authors suggest that a team of experts be gathered to design a structured educational program that would be interesting to secondary school students. This program should also be adapted to students' age and interest.

BREASTFEEDING INTENTION AND KNOWLEDGE IN SECONDARY-SCHOOL STUDENTS.

- Breast milk makes the world healthier and better. Deaths and suffering of thousands of children and mothers each year could be prevented through universal breastfeeding, along with enormous economic savings. The aim of this study was to examine the knowledge of breastfeeding and intention to breastfeed in third-year secondary school students from various high schools and to make a conclusion on the unique and structured education program on breastfeeding in secondary schools. A total of 252 third-year secondary school students from 4 high schools in Bjelovar, Kutina and Pakrac completed an online questionnaire on the knowledge and intention to breastfeed. The results were presented by descriptive statistics methods. Kruskal-Wallis test was conducted for intention scale and χ2-test for questions about knowledge. Logistic regression was used to predict probabilities of a response. The results showed the responses of students from individual schools to be statistically significantly different in some questions of knowledge and some items of intention of breastfeeding. Insufficient breastfeeding information in schools does not provide a basis to third-year secondary school students to make an informed decision about breastfeeding in adulthood. We propose development and use of a unique structured educational program on breastfeeding for secondary school students.

The Influence of Participation in Pregnancy Courses and Breastfeeding Support Groups on Attitudes and Knowledge of Health Professionals about Breastfeeding.

Numerous factors affect the behavior, attitudes, and knowledge of health professionals about breastfeeding. The aim of this paper is to determine the impact of participation in pregnancy courses and breastfeeding support groups on the attitudes and knowledge of health professionals about breastfeeding. The study compares two groups of health professionals according to the results they achieved on a validated questionnaire of behavior, attitudes, and knowledge about breastfeeding. The authors did not make personal contact with the respondents, as the questionnaires were filled out online. The two groups of respondents differed according to the frequency of participation in pregnancy courses, that is, groups for breastfeeding support. The results are presented tabularly and graphically (frequencies and percentages), while differences in the results between the infrequent and regular participants are shown with the Mann-Whitney U test (asymmetric distribution). Better results on the questionnaire were achieved by those who regularly attended breastfeeding support groups (Mdn = 149, IQR = 11) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The same is found for regular visitors of pregnancy courses (Mdn = 149, IQR = 15.75) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The differences are statistically significant (p < 0.00). Partial correlation confirms a more significant influence of breastfeeding support groups (<0.00) than pregnancy courses (p = 0.34). Working in breastfeeding support groups had a statistically significant positive effect on the attitudes and knowledge of health professionals about breastfeeding. The topic of breastfeeding should be given more space and importance during pregnancy courses as well. Personal experience working in breastfeeding support groups and pregnancy courses should be incorporated into the training of medical students.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding.

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

Diagnoses of suicidum and tentamen suicidi in the registers of patients of the Kingdom of Yugoslavia's Banovina Public General Hospital in Bjelovar from 1931-1940.

Suicide has been a subject of research of philosophy, ethics, religion and medicine for centuries. Attitudes towards it changed during the history, from condemnation of suicide as an unethical act to the theory of suicide as the utmost expression of a human as an individual. Croatia, with the annual suicide rate above 20 percent belongs to the high-risk countries. Suicide frequency varies from region to region, while the suicide rates for the County Bjelovarsko-bilogorska have been well above Croatia's average for decades. The aim of this retrospective study was to establish some epidemiological features of hospital patients with the diagnoses of "suicidum" and "tentamen suicidi" on the basis of records available in the registers of patients of General Hospital in Bjelovar in the period between 1931 and 1940. In the observed period, thirty-three people were treated in hospital for suicide attempt, seven of them dying. An equal number of men and women attempted suicide (13:13), while in the group of those who died, the ratio was more in favour of women (4:3). Suicide incidence was highest in November, followed by May and June, with the most common method for suicide being acetic acid.

Behaviour, Attitudes and Knowledge of Healthcare Workers on Breastfeeding.

The aim of this paper is to determine the current state of behavior, attitudes, and knowledge of health professionals about breastfeeding in Croatia. Data were collected via a breastfeeding behavior, attitudes, and knowledge questionnaire, which has already been validated and used in Croatia. The secondary aim is to identify differences in outcomes of respondents by occupation (nurses versus others health professionals). In the study, 374 health professionals participated (37 males and 337 females). Respondents completed the questionnaire online. Respondents were rarely involved in breastfeeding education. On the behavior scale, the worst answer was given to the question of advising mothers on breastfeeding after 24 months. On the attitude scale, the worst result was achieved in terms of public breastfeeding and the support of the child's father for the breastfeeding mother. Respondents demonstrated the worst knowledge of The International Code of Marketing of Breast-milk Substitutes and the use of medications while breastfeeding. There was no statistically significant difference between the results of respondents in relation to the occupation of the respondents. In the preparation of future breastfeeding education for health professionals in Croatia, particular attention should be given to these issues.

The application of autogenic training in counseling center for mother and child in order to promote breastfeeding.

The aim of this study was to investigate whether mothers with newborn children, the usage of autogenic training with advice on breastfeeding effect on: the decision and the duration of breastfeeding, increase maternal confidence and support. It was assumed that the above result in a higher percentage of mothers who exclusively breastfed baby during the first six months of child's life. The survey was conducted in the Association "For a healthy and happy childhood"-Counseling center for mother and child, in Bjelovar in 2010. The Counseling center was attended by 100 nursing mothers with children aged up to two months. They randomly went to the study or control group. Mothers of both groups were advised to successful breastfeeding. Study group has practiced autogenic training until the child's age of six months. In parallel, by using psychotherapeutic interview and specific questionnaires we collected data on the somatic, psychological and social situation of the mother, discovered mother's mental changes (anxiety, depression) that were treated. The results at the end of the study confirm the initial expected benefits from the application of autogenic training. Mothers of the study group were significantly more emotionally balanced with a higher self-esteem. Autogenous training with the advices for successful breastfeeding conducted in this counseling center contributed in significantly higher rate of breastfeeding children up to six months of life, improved mental and physical health of mother and child and their peculiar relationship.

Breastfeeding Promotion and the Results of the Maternity Ward - a Friend of Children Initiative Implementation in Bjelovar-Bilogora County in 2018.

BACKGROUND: Breastfeeding has a beneficial effect on the overall health system of the child and the mother. After six months of age, it is recommended to introduce complementary feeding in parallel and to continue breastfeeding for at least one year of the child's life. Maternal education is one of the key tasks of medical staff during pregnancy and especially during lactation. OBJECTIVE: The main objectives of the study is to determine the essential features of female respondents with regard to previous pregnancies, births and health visitors visits after birth; to determine the percentage of women whose lactation was started in hospital and who exclusively breastfed; to determine the differences in child's diet during a health visitor visit at two, four, six, nine and twelve months in regards to female respondents' age. METHODS: The study has been conducted as a cross-sectional study. 571 women who gave birth in General Hospital of Bjelovar took part in the survey and the reviewing was continued by Health Visiting Service of Bjelovar-Bilogora County in 2018. The tools for data collection were IT system of General Hospital of Bjelovar, case histories as well as Health Visiting Service IT system. RESULTS: Most of the female respondents are of the average age of 30 years. The study was conducted on a highly educated sample. 461 respondents have a certain form of education. Older respondents are considerably more educated (62 %). Single respondents and extramarital respondents are considerably of younger age. Older respondents predominantly live in the town, have more previous pregnancies and children compared to younger respondents. Lactation was started with 98.8 % respondents in hospital, and 96.7 % exclusively breastfed. The mothers of older ages breastfeed longer. CONCLUSION: Older, educated, employed, married, town residential female respondents decide upon breastfeeding and exclusively breastfeeding. Older respondents have more experience with previous pregnancies and lactation. The study has confirmed that older mothers breastfeed longer, while younger mothers more often reach for milk alternatives.

Development and Validation of a Questionnaire on Breastfeeding Intentions, Attitudes and Knowledge of a Sample of Croatian Secondary-School Students.

BACKGROUND: Validating a questionnaire/instrument before proceeding to the field for data collection is important. METHODS: An 18-item breastfeeding intention, 39-item attitude and 44-item knowledge questionnaire was validated in a Croatian sample of secondary-school students (N = 277). RESULTS: For the intentions, principal component analysis (PCA) yielded a four-factor solution with 8 items explaining 68.3% of the total variance. Cronbach’s alpha (0.71) indicated satisfactory internal consistency. For the attitudes, PCA showed a seven-factor structure with 33 items explaining 58.41% of total variance. Cronbach’s alpha (0.87) indicated good internal consistency. There were 13 knowledge questions that were retained after item analysis, showing good internal consistency (KR20 = 0.83). In terms of criterion validity, the questionnaire differentiated between students who received breastfeeding education compared to students who were not educated in breastfeeding. Correlations between intentions and attitudes (r = 0.49), intentions and knowledge (r = 0.29), and attitudes and knowledge (r = 0.38) confirmed concurrent validity. CONCLUSIONS: The final instrument is reliable and valid for data collection on breastfeeding. Therefore, the instrument is recommended for evaluation of breastfeeding education programs aimed at upper-grade elementary and secondary school students.

Adolescents' Knowledge of Breastfeeding and Their Intention to Breastfeed in the Future.

The aim of this paper is to analyze third-year secondary school students' knowledge of breastfeeding and intention to breastfeed their children, based on the results of a questionnaire. The respondents were 154 students (101 female/43 male) of two secondary schools in Bjelovar. The students completed a questionnaire which consisted of 23 questions regarding knowledge and intention to breastfeed. The answers were analyzed statistically and different results were compared by nonparametric tests. About half of the respondents think that both partners should decide on breastfeeding and recognize the role that fathers have in initiating and maintaining breastfeeding. Only 13.64% of the respondents know that breastfeeding is to be done only on demand. Exclusive breastfeeding for 6 months, as recommended by the medical profession, is recognized by 70.13% of the students. The question on how justified is the initiation of formula together with the mother's milk was answered correctly by 29.22% of the students. Secondary school students' knowledge of breastfeeding is insufficient, and schools, families, social communities and other sources of information should share the responsibility for improving this. We consider it necessary to pay more attention to improving students' knowledge of breastfeeding through school curricula.

Parental Perception, Prevalence and Primary Care Physicians' Knowledge on Childhood Food Allergy in Croatia.

Food allergy in children is increasing and the perception of food allergy among parents is even more common. In a questionnaire-based study of 702 children aged 6 to 48 months in four primary care settings, the aim was to determine the prevalence of perception vs. proven food allergy, parental anxiety and general pediatrician knowledge of food allergy. In 95/702 children (13.5%) parentally-reported food was associated reactions. IgE and/or skin prick test (SPT) and/or an open provocation test were performed in 48 (6.8%) and allergy was proven in 38 (5.4%) children. Discrepancy between parental perception and proven allergy is significant (p < 0.001), especially for food other than milk, egg and peanut (p < 0.001). Allergy to milk was the most common. Allergy to peanut was significantly more common in children ≥2 years (p < 0.05). Severe reactions occurred in 5/95 (5.2%) of all children and in 5/38 (13.1%) of allergic children, in 3/5 caused by peanut. Parents of children with proven allergy do not experience high degree of anxiety. The perception of food allergy among general pediatricians is limited, and in children with severe reactions precautionary measures and information to parents were insufficient. Parents and general pediatricians need additional education in food allergy.