Community management of lactational mastitis and/or breast abscess: a retrospective audit.

Lactational mastitis has an incidence of around 10 per cent in postpartum women, with breast abscess complicating some of these.The key principles of treatment include: supportive counselling, warm or cold compresses, effective milk removal, oral antibiotic therapy and symptomatic treatment. Patients can be managed in the community setting; however many present to hospital. The aim of this research was to establish which areas of clinical practice can be improved to reduce hospital admission rates. Sequential cases of lactation mastitis or breast abscess admitted to hospital over two years were reviewed, and it was found that the majority of patients attending the emergency department for management self-presented. There were low rates of utilisation of available community resources. There was poor patient knowledge of the natural history and simple management strategies for the condition. Midwives can play a vital role in educating new mothers and providing advice and support for non-pharmacological therapies.

A qualitative evaluation of the views of Child and Family Health Nurses on the early childhood oral health education materials in New South Wales, Australia.

ISSUE ADDRESSED: Health literacy is an important determinant of oral health. We explored the Child and Family Health Nurses' reflections on the usefulness of leaflets giving dental advice for parents of preschool children in New South Wales, Australia. METHODS: Child and Family Health Nurses (n=19) who recruited new mothers to an ongoing birth cohort study in South Western Sydney, Australia, were invited to take part in a qualitative study. A semi-structured, in-depth interview technique was used to explore their views on two leaflets designed by New South Wales Health, which gave dental advice to parents of preschool children. Interviews were audio-recorded, transcribed verbatim, and analysed using interview debriefing and a thematic coding. RESULTS: The nurses reported that the leaflets did not have clear consistent messages and had medical/dental jargon which could be confusing for parents from disadvantaged backgrounds. The advice on using a "pea-sized amount of toothpaste" was considered to be culturally irrelevant. Some early childhood oral health issues were inadequately addressed and the use of pictures was strongly recommended. CONCLUSIONS: Producers of paediatric oral health education materials in New South Wales, should reach a consensus on the key health promotion messages. Health authorities should consider re-designing dental leaflets and tailor them to the needs of the parents from disadvantaged backgrounds.

What is usual care for teenagers expecting their first child in England? A process evaluation using key informant mapping and participant survey as part of the Building Blocks randomised controlled trial of specialist home visiting.

OBJECTIVES: We compared the US-derived Family Nurse Partnership (FNP) home visiting programme when added to usually provided health and social care for first-time teenage mothers, to usual care alone. We aimed to: establish the nature of usual care, measure service usage and assess performance bias in core usual care services. DESIGN: Within trial process evaluation. Local professionals completed a survey mapping local health and social care services in seven domains. This focused on services available to young women, especially those relevant to pregnant teenagers. Descriptive data were assessed thematically to establish the range of services. Quantitative data collection with FNP supervisors enumerated service provision by site. Services identified were included in main participant trial follow-up interviews at four time points to quantify usage. Usage was described descriptively by domain. We explored predictors of health visitor visits. SETTING: 18 partnerships of local authority and healthcare organisations in England. OUTCOMES: Descriptive framework of services. Rates of service usage reported by trial participants. RESULTS: 161 separate services were identified, with multiple service models in each domain, broadly categorised as universal or specialist (eg, for teenage mothers). FNP supervisors identified 30-63 universal services per site and 22-67 specialist services. Use of core maternity care services was similar across trial arms and with only small differences in use of health visiting services. Participants accessed a wide range of services. Women who had ever been homeless, who had a higher subjectively defined social status, and poorer mental health received more visits from a health visitor. CONCLUSIONS: The large number of services available to teenage mothers in England may limit the incremental benefit achievable through enhanced home visiting. There was little evidence of compensatory practice, such as additional care for women in the usual care arm. Measuring usual care when trialling complex interventions is challenging and essential. TRIAL REGISTRATION NUMBER: ISRCTN23019866.