[Controlled study of a regular telephone support program given by volunteers on the establishment of breastfeeding]. / Essai contrôlé d'un soutien téléphonique régulier donné par une bénévole sur le déroulement et l'issue de l'allaitement.

The goal of this controlled trial was to evaluate the impact of a volunteer telephone support program on the ability of the mothers to reach their breastfeeding objectives and to reduce the number of difficulties while nursing. Two hundred expectant women were randomly assigned to two groups. The first group received the usual services from the professionals and the second had the extra service from a trained volunteer. By comparing the proportions of women still breastfeeding at each month, the present study showed that this type of support was ineffective in meeting the objectives. The gap between the intended length of breastfeeding and the duration achieved was equally large in both groups. Only 30% breastfed for the length of time envisaged during pregnancy. Strategies to increase the effectiveness of this type of service are suggested.

Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal.

OBJECTIVES: To determine the prevalence of iron deficiency anemia among 1-year-old infants of disadvantaged families in Montreal as well as certain predictors of this condition. DESIGN: Cohort study. SETTING: Five poorest health districts in Montreal. PARTICIPANTS: Infants 10 to 14 months of age were identified from registration lists of births from May 1988 to August 1989. Those whose mother had less than 11 years of schooling and a family income below the government-defined low-income cutoff point were eligible. INTERVENTION: During a home visit capillary blood samples were obtained from the child, and the mother answered a questionnaire about infant-feeding practices. Infants with a serum ferritin level of 10 micrograms/L or less and either a hemoglobin level of 115 g/L or less or a mean corpuscular volume of 72 fL or less were considered as having iron deficiency anemia. RESULTS: Of the 299 mothers who were eligible and could be located 220 (74%) agreed to participate; 218 blood samples were available. Iron deficiency anemia was found in 25% of the infants (95% confidence interval [CI] 19% to 31%). The mean hemoglobin level was 115 (standard deviation 11) g/L. The serum ferritin level, assessed routinely in the last 62 infants, was 10 micrograms/L or less in 37% of the infants. The factors that were found to be predictors of iron deficiency anemia included the use of whole cow's milk before 6 months of age (odds ratio [OR] 3.56 [95% CI 1.07 to 11.26]) and the use of iron-fortified infant cereal for less than 6 months (OR 3.15 [95% CI 1.25 to 7.96]). A low birth weight and the use of iron-fortified formula for less than 6 months were associated with iron deficiency anemia. CONCLUSIONS: Despite a decrease in the prevalence of iron deficiency anemia among children of disadvantaged families in the United States socioeconomically disadvantaged infants in Montreal are at risk. Preventive measures must be taken to ensure adequate iron status in the first year of life.

[Promoting mental health : implications of an ecological model.]. / La promotion de la santé mentale : implication d'un modèle écologique.

Prevention is an approach more and more talked about in mental health. However, promotion is an aspect of mental health's prevention not often discussed. In this article, we present an inventory of strategies for promoting mental health and we describe the skills needed to achieve such a promotion. We then propose a few examples in the field of geriatrics to illustrate specifically what we mean by promoting mental health. Finally, we end this article with a critical reflection on the feasibilities of the strategies presented as well as on the importance of deve-lopping concrete actions for the purpose of promotion rather than giving short term prescriptions which will only modify our behavior.

[The issue of prevention in mental health within community mental health departments.]. / Point de vue sur la prévention en santé mentale dans les départements de santé communautaire (D.S.C.).

The three questions raised in this article express a point of view about prevention in mental health. They are : 1. how can the concepts used in the field of prevention in mental health become sufficiently operational to give rise to applicable strategies? 2. why must one refer himself to intercausal conceptual models when devising strategies for prevention in mental health? 3. is it useful to distinguish between a preventive intervention in mental health and a program of mental health? The principle obstacles to prevention are not uniquely society and the individuals who make it up; the profes-sionnals involved in mental health are also a source of obstacles who often have an ambiguous idea of what prevention in mental health is and of how it should be realized.

Increasing maternal participation in the hospitalization of young children.

In an attempt to reduce the harmful emotional effects of separation for young children, hospitals in recent years have liberalized visiting hours, but parents have not taken advantage of their new privileges. The study described here sought to increase mothers' participation in their children's hospitalization by overcoming some of the psychological barriers believed to exist. The mothers of 48 children aged 1 to 5, to be admitted for elective surgery to a large, metropolitan pediatric hospital, constituted the primary sample and were divided into experimental and control groups. Mothers in the experimental group had an extra half-hour session in a pre-admission interview focusing on visiting, and specific suggestions were made about frequency and timing of visits, as well as the role of the mother during her visits. During the experimental period weekly meetings were held with the nursing staff to enlist their support for this change in visiting patterns. Results indicate that duration of visits, timing of visits, and behavior during them were all significantly modified for the experimental group of mothers. In contrast, the nurses did not significantly change their relationship with the mothers or the children. Clinical possibilities and limitations of such a program are discussed.