Knowledge, Attitudes, and Practices Towards ECC Prevention in Thai Medical Personnel.

OBJECTIVE: This study aimed to identify the knowledge, attitudes, and practices related to the prevention of early childhood caries (ECC) amongst medical personnel in well-baby clinics (WBC). METHODS: Participants were 152 health care professionals, including public health officers, nurses, and physicians, working in WBC in Chonburi Province, Thailand. Participants completed a 6-part online questionnaire asking about demographic data, knowledge and attitudes related to ECC, ECC prevention practices, collaboration, referral systems, and suggestions for improving collaboration between dental and medical personnel in WBC. RESULTS: Whilst most participants had high levels of knowledge about oral care instructions, tooth brushing frequency, and cariogenic foods and beverages, they knew less about recommendations for timing of the first dental visit, fluoride concentration in toothpaste, and the time for exfoliation of primary teeth. There were significant differences in the proportions of correct answers to questions related to the first dental visit and bottle feeding and in total knowledge scores between physicians and other health care professionals. Most participants demonstrated a positive attitude towards ECC prevention. More than 70% of participants always advise parents on oral hygiene and nutrition related to ECC prevention, but only 29% always refer patients to see dental personnel. Attitudes, collaboration, and referral systems were significantly associated with ECC prevention practices, but not knowledge. CONCLUSIONS: This study demonstrates that attitudes, collaboration, and referral systems are key contributors to ECC prevention amongst Thai medical personnel. In addition to training programmes, consistent interprofessional policy and referral systems should be formulated, especially in primary care settings.

Awareness and Perception of Parents Regarding Well Baby Clinic in Primary Health Care Centres in Abha City, Southwestern Saudi Arabia.

BACKGROUND: Well-baby clinic (WBC) service is implemented in all primary health care centers and is provided based on international standards to all children under 5 years in Saudi Arabia. It is a comprehensive package of health promotion and curative care to improve and maintain the health status and well-being of this age group. AIM: The main aim is to assess parents' awareness and perception regarding WBC in primary health care centers in Abha sector, Kingdom of Saudi Arabia (KSA). METHODOLOGY: A descriptive cross-sectional approach was used in the current study. The study targeted all babies' caregivers attending WBCs in primary health care centers in Abha city. The children's parents were included using three stages cluster sample technique. The questionnaire included participants' demographic data such as age, gender, relation to the baby, educational level, work, and monthly income. Awareness regarding the WBC was assessed using two main items covering hearing about the clinic provided services. RESULTS: The study included 1593 participants whose ages ranged from 19 to 55 years old with a mean age of 34.6 ± 11.8 years. About 64% of the respondents knew about the WBC, which was significantly higher among the females than males (P = .003). Also, 71.2% of respondents aged 25-34 years knew about well-baby clinic (WBC) compared to 35% of parents aged less than 25 years (P = .001). Exact 57.1% of the respondents went to the nearest governmental health office at vaccination times. About 46% of the respondents reported that the clinic nurse was the main person who dealt with them. Regarding services provided by a nurse at the vaccination clinic, registering child vaccination was the most reported (66.2%), followed by helping the mother make the child calm (56.8%). CONCLUSIONS: In conclusion, the study revealed that proper care is vital for a child's survival as well as optimal physical and mental development. Adequately cared child has proper well-being and happiness. Mothers and children caregivers had adequate awareness and acceptable attitude towards WBCs and provided services. Some barriers were declared including lack of available WBCs within the residence range, not all WBCs usually working, and more information should be provided about WBCs.

Women's Intention to Consent to Universal Screening for Intimate Partner Violence (IPV) at Well Baby Clinics.

The Israeli Ministry of Health requires medical and nursing staff in both hospitals and community settings, screen all women for Intimate Partner Violence (IPV). This study explored factors associated with the intention of Israeli women to consent to universal IPV screening during their visits to well baby clinics, using the Theory of Planned Behavior (TPB). Two hundred Jewish women of childbearing age completed a questionnaire based on the TPB. Only 52% of the women reported that they had undergone IPV screening conducted by nurses at well baby clinics in the last year. The TPB was found to predict 44% of the variance in women's intention to consent to universal IPV screening, whereas control beliefs, perceived behavioral control, and normative beliefs with regard to universal screening, were found to be the most significant predictors. These findings may help design interventions aimed at raising women's intentions to consent to universal IPV screening.

Motor skills and later communication development in early childhood: Results from a population-based study.

BACKGROUND: Motor milestones in infancy are important developmental markers, not only for later motor skills but also for more widespread social, cognitive, and communication development. The aim of the current study was to investigate the relationships between fine and gross motor development in infants at 6 and 12 months of age and communication skills at 24 months of age. METHODS: The Ages & Stages Questionnaire (ASQ-II) was used to measure gross motor, fine motor, and communication skills in a large population-based sample of 1,555 infants, recruited from well-baby clinics in five municipalities in South-Eastern Norway. Of these, 557 children had valid values of gross and fine motor scores at 6 and 12 months and for communication score at 24 months. The relationships between motor skills at 6 and 12 months and communication skills at 24 months were analysed using a linear regression analysis. RESULTS: Gross motor skills at 6 months were positively associated with communication skills at 24 months (coefficients 0.09, p = 0.036) and fine motor skills at 12 months were positively associated with communication skills at 24 months (coefficient 0.23, p < 0.001). We did not find clear evidence for a relationship between gross motor skills at 12 months and communication skills at 24 months (coefficient 0.05, p = 0.126) or between fine motor skills at 6 months and communication skills at 24 months (coefficient 0.08, p = 0.098). CONCLUSION: The present study supports previous research showing associations between early motor development and later communication development in infancy. Targeted intervention should be considered with at-risk infants.

Parent satisfaction before and after implementing of a developmental screening tool in nine well-baby clinics in Norway.

AIM: The aim of the study was to compare parental satisfaction items before and after the implementation of The Ages & Stages Questionnaires (ASQ) as part of the health check-up. METHODS: ASQ was implemented in regular health check-ups of infants up to two years of age in 9 Norwegian well-baby clinics. After the infant's two years' health check-ups, a questionnaire-based survey among 652 families before and 562 families after intervention was conducted. Descriptive analyses and ordinal logistic regression were used to report and compare parental satisfaction items before and after the project. RESULTS: Parents reported high satisfaction with well-baby services both before and after the implementation of ASQ, and ninety-six per cent recommended other well-baby clinics to use ASQ. Some significant differences appeared, before the implementation of ASQ, parents were more satisfied with the support they received regarding parenting and child development in general and information about the child's physical health. After ASQ was implemented, parents were significantly more satisfied with the information they received about 'the child's mental health'. CONCLUSION: Developmental screening in well-baby clinics in Norway is acceptable among parents with young children. The use of standardised instruments must not come at the expense of listening to parents' concerns.

Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses' perceptions.

OBJECTIVE: To explore and describe how public health nurses (PHNs) perceive the implementation of national guidelines for the prevention and treatment of overweight and obesity among children and adolescents in well-baby clinics and school health services. DESIGN, SAMPLE, AND MEASUREMENTS: An explorative descriptive design was carried out through individual interviews with 18 PHNs and analysed according to the phenomenographic tradition. RESULTS: Four implementation strategies were described and assigned a metaphor: the structured PHN, pragmatic PHN, critical PHN, and the resigned PHN. Competence, patient receptiveness, internal consensus, interdisciplinary collaboration, resources, and organizational embedding were the determinants identified that most frequently affect implementation, and these determinants were distributed at different levels of the organization. The extent of facilitation seemed to determine which implementation strategy would be used. CONCLUSIONS: How PHNs implemented the guidelines for overweight and obesity were affected by determinants at different organizational levels. Contextual facilitation of implementation seemed better in larger organizations, but factors such as leadership, drive, and experience compensated in smaller municipalities. The implementation of guidelines was hindered when the barriers exceeded the benefits.

Early detection of parenting and developmental problems in young children: Non-randomized comparison of visits to the well-baby clinic with or without a validated interview.

OBJECTIVE: Determine whether the early detection of parenting problems and developmental problems in young children improves with the help of a validated structured interview. DESIGN: Non-randomized controlled trial held from December 2006 until January 2008. SETTING: Preventive child health care services in the Netherlands. PARTICIPANTS: 4438 eligible 18-month-old children and their parents. INTERVENTIONS: A visit to the well-baby clinic with and without (usual care) the use of a validated structured interview for the early detection of parenting problems and developmental problems in young children: the Structured Problem Analysis of Raising Kids. OUTCOME MEASURES: The primary outcome consists of the difference in the number of 18-month-old children with high or increased risk for parenting and developmental problems. Secondary outcomes are the differences in care needs as expressed by child health care nurses, the percentage of parents and other children of the family attending, follow-up actions, the scores of parent report questionnaires and the time needed for the consultation. Data were analyzed by means of ordinal regression with propensity score adjustment. RESULTS: Certain discrepancies were noticed: during usual care visits, nurses found fewer children with high (1.2 versus 2.6%) or increased risk (14.5 versus 20.7%) than during visits in which the Structured Problem Analysis of Raising Kids was used (p=0.002), but they also indicated that more help was needed. Conversely, no additional contacts were advised for 25% of the children whom the nurses in the care-as-usual group labelled as high risk, while all high-risk children visited with the Structured Problem Analysis of Raising Kids received additional contacts. CONCLUSIONS: The Structured Problem Analysis of Raising Kids, a validated structured interview, improves the early detection of parenting and child-developmental problems in young children, compared to regular visits without an instrument. Structuring the collection of information about parents' concerns and care needs gives nurses information beyond their professional viewpoint and results in joint decisions that better match parental care needs and risk levels determined. TRIAL REGISTRATION: www.trialregister.nl. Identifier: NTR1413.

Early detection of parenting and developmental problems in toddlers: A randomized trial of home visits versus well-baby clinic visits in the Netherlands.

OBJECTIVE: The early detection of parenting and developmental problems by preventive child health care (CHC) services in the Netherlands takes place almost exclusively at the well-baby clinic. This study assesses whether, compared to a visit to the well-baby clinic, a home visit improves early detection. METHODS: 4481 eligible 18-month-old children and their parents were randomized to either a visit to the well-baby clinic or a home visit in the period from December 2006 to January 2008. A CHC nurse held structured interviews using the validated Structured Problem Analysis of Raising Kids (SPARK). Differences in the percentage of children with high or increased risks of parenting and developmental problems as assessed by the SPARK were analyzed with ordinal regression. Secondary outcomes included the percentage of parents attending, parents' concerns, needs assessment by parents and CHC professionals and user experience. RESULTS: Response rates were 94.0% for the home visit group and 93.2% for the well-baby clinic group. Using the SPARK at home identified significantly more high-risk children compared to clinic visits (3.7 vs. 2.6%) and fewer children with increased risk (19.1 vs. 20.7%; overall p=0.028). Home visits more often involved both parents and other children. At home, parents reported more concerns. Both parents and CHC nurses more often expressed the need for support and reported significantly better experiences at home. CONCLUSIONS: Aided by a validated structured interview, CHC professionals detect more children with high risks of parenting and child-developmental problems during home visits than during clinic visits. CLINICAL TRIAL REGISTRATION: www.trialregister.nl Identifier: NTR1413.

A comparison of the Well Child Clinic services in Norway and the Nurse Family Partnership programme in the United States.

AIM AND OBJECTIVES: To present a comparison and a discussion of the Well Child Clinic model in Norway and the Nurse-Family Partnership model in the United States. BACKGROUND: The Nurse Family Partnership programme in the United States is voluntary and not universal. The Well Child Clinic programme in Norway is voluntary but universally available for Norwegian families. As the Well Child Clinics are used by the vast majority of the families in Norway, it is difficult to determine the benefits and outcomes for the families who receive universal services. DESIGN: Qualitative design. METHODS: Authors reviewed the literature on the Norwegian Well Child Clinics and the Nurse Family Partnership programme in the United States and interviewed public health nurses experts on evidence-based home visiting programmes in Minnesota. RESULTS: The similarities between goals and content of the Nurse Family Partnership programme in the United States and the Well Child Clinic services in Norway are emphases on (1) intensive services, (2) a focus on behaviour, (3) the inclusion of both parents and children and (4) programme fidelity. The major difference in the programmes is the focus on a targeted population for the Nurse Family Partnership programme vs. the universal offer of Well Child Clinics in Norway. CONCLUSION: Norway should continue with universal approach to support new families. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families. RELEVANCE TO CLINICAL PRACTICE: Public health nursing leaders in Norway need to advocate for public health nurse ratios that make it possible for public health nurses to follow government guidelines. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families.

A study of screening for anemia in 9 month old infants in well baby clinic

Iron deficiency remains the most common cause of anemia in infants and chidren despite increasing availability of iron-fortified foods. We screened out anemia in 9-month old infants in well baby clinic to know the prevalence of anemia and the weaning status. The results were as follows: 1) Among 345 infants screened, 24 infants (7%) were found to have anemia. 2) The kind of anemia was microcytosis and 7 infants (2.2%) revealed hypochromia. 3) Among the remaining 311 non-anemic infants, 6 infants (1.9%) revealed microcytosis and 7 infants (2.2%) revealed hypochromia. 4) In anemic group the mean hemoglobin concentration was 8.75+/-1.03gm/dl, hematocrit was 27. 73+/-3.11%, MCV was 65.84+/-8.21 fL, MCHwas 20.95+/-2.93 pg and MCHC was 31.34+/-1.89 gm/dl. 5) In 9 anemic infants, weaning was delayed until 9 months of age.

A Study on Maternal Knowledge and Attitude in Regard to Infant and Child Health

A study was carried out to see the knowledge, attitude and practice of mothers in regard to infant and child health through enquete. The questionnaires were filled up by 350 mothers who registered at Well Baby Clinic, National Medical Center, during two months period from March, 1980 to April, 1980. The survey intended to look into maternal knowledge and attitude toward pregnancy, prenatal care, nutritional care, vaccination and health care. The following conclusions were obtained. 1. Among the mothers enrolled in this study, the age group in 25~29 constituted the largest proportion(58.3%) and the mean age was 28.0 years. 2. High school graduates occupied the largest proportion(48.1%) of the respondents. 3. The most frequent age of the first delivery was in 25~29(63.7%) years. 4. Concerning the knowledge on pregnancy, delivery and child rearing, the majority of the primary school graduates learned from their parents in law, the middle & high school graduates acquired through reading books or magazines and the college graduates learned by school education. 5. Regular prenatal cares were taken in 70% of the respondents. 6. Regarding the knowledge about the influences on fetus of the diseases during pregnancy, there noted the difference among the respondents by education, and most of them notified ventral diseases and tuberculosis as the diseases most concerned. 7. Breast feeding only was done in 50% of the respondents until the 3 months of age of the infants, and bottle feedings supplemented by solid foods or other was the most common type of feeding after 3 months of age to 15 months of age followed by adult type diet afterwards. 8. Relation between the educational level of mothers and the method of infant feeding disclosed that the higher the education level, the higher the bottle feeding. 9. About 71% of the mothers replied that they know the significance or the necessity of the weaning. The ideal starting period of weaning was thought 4~6 months in 58.6% of the respondents. 10. The most common initial weaning food was fruits and vegetables(50.4%) followed by cereals(18.7%) and commercial weaning food products(17.4%) 11. Regarding the most important nutrient in infants and children, they notified vitamins most commonly(46.9%) and more than half of them supplied the vitamins to their infants. 12. About 42% of all mothers know the beginning period of primary vaccinations as 2 months of age, 69.7% of them recognized the next vaccinations and 77.1% of them immunized their infants as schedule. 13. Most of the mothers(96.6%) realized the necessity and importance of the vaccination. A few mothers, however, had knowledge on the side effects of DPT vaccination. 14. The most concerned problem with regard to health care was the illness(42.9%). In more than half, health care was provided only on well baby clinic visits.