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1.
BMC Public Health ; 20(1): 1240, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795294

RESUMO

BACKGROUND: Lifestyles habits such as eating unhealthy foodscommence at home and are associated with the development of obesity and comorbidities such as insulin resistance, metabolic syndrome, and chronic degenerative diseases, which are the main causes of death in adults. The present study compared changes in dietary habits, behaviors and metabolic profiles of obese children whose mothers attended at the hospital to group sessions, with those who received the usual nutritional consultation. METHODS: Randomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention group and 87 in the control group. The intervention group attended six group education sessions to promote healthy eating, being this an alternative of change of habits in children with obesity. The control group received the usual nutritional consultation; both groups were followed up for 3 months. Frequency of food consumption, behaviors during feeding in the house and metabolic profile was evaluated. Mixed effect linear regression models were used to evaluate the effect of the intervention on the variables of interest, especially in HOMA-IR. RESULTS: The intervention group reduced the filling of their dishes (p = 0.009), forcing the children to finish meals (p = 0.003) and food substitution (p <  0.001), moreover increased the consumption of roasted foods (p = 0.046), fruits (p = 0.002) and vegetables (p <  0.001). The children in the control group slightly increased HOMA-IR levels (0.51; 95% CI - 0.48 to 1.50), while the children in the intervention group significantly decreased (- 1.22; 95% CI - 2.28 to - 1.16). The difference in HOMA-IR between the control and intervention group at the end of the follow-up was - 1.67; 95% CI: - 3.11 to - 0.24. CONCLUSIONS: The educational intervention improved some eating habits at home, as well as HOMA-IR levels; why we consider that it can be an extra resource in the management of childhood obesity. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04374292 (Date assigned: May 5, 2020). Retrospectively registered.


Assuntos
Dieta Saudável , Comportamento Alimentar/psicologia , Educação em Saúde , Síndrome Metabólica/prevenção & controle , Mães/educação , Obesidade Pediátrica/prevenção & controle , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Obesidade Pediátrica/epidemiologia , Avaliação de Programas e Projetos de Saúde
3.
Matern Child Health J ; 24(Suppl 2): 141-151, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32748287

RESUMO

OBJECTIVES: With funding from the Pregnancy Assistance Fund, the Maternal, Child, and Adolescent Health Division (MCAH) of California redesigned its existing Adolescent Family Life Program (AFLP) for expectant and parenting young women into a more intensive and structured intervention, AFLP with positive youth development (PYD). This paper presents key findings from a federally funded, rigorous implementation study of the two programs. METHODS: This implementation study collected data from 13 agencies from January 2016 through December 2017, including interviews with 69 case managers and 18 supervisors; focus groups with 130 program participants; surveys of 66 case managers and 1330 young women; and observations of 42 visits with program participants. The study combined qualitative and quantitative analysis methods. RESULTS: As designed, PYD was a much more structured and intensive program than AFLP. Case managers and supervisors saw value in the PYD model and new approach but needed more support and guidance than expected in order to deliver it with fidelity. MCAH provided additional trainings and technical assistance to address challenges. In practice, although staff noted differences in approach and content, the youth experience with the two programs was similar. CONCLUSIONS FOR PRACTICE: Integrating the PYD framework into case management systems may foster youth self-sufficiency and resiliency. However, the rigid structure of the program was often challenging to implement in practice. Organizations interested in implementing prescribed case management approaches should consider allowing opportunities for flexibility in implementation and providing more detailed preservice training to prepare staff for real-world implementation.


Assuntos
Mães/educação , Poder Familiar , Gravidez na Adolescência , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , California , Administração de Caso , Feminino , Humanos , Mães/psicologia , Gravidez
4.
Artigo em Inglês | MEDLINE | ID: mdl-32325635

RESUMO

Social adversity can significantly influence the wellbeing of mothers and their children. Maternal health may be improved through strengthened support networks and better health literacy. Health improvement at the population level requires optimizing of the collaboration between statutory health services, civic organizations (e.g., churches, schools), as well as community groups and parents. Two key elements in improving community engagement are co-production and community control. This study evaluated a co-produced and community-led project, PACT (Parents and Communities Together), for mothers in a deprived south London borough. The project offered social support and health education. Intended effects were improvements in mental health, health literacy, and social support, assessed by standardized measures in a pre-post design. Sixty-one mothers consented to take part in the evaluation. Significant improvements were found in mental health measures, in health literacy, for those with low literacy at baseline, and in overall and some specific aspects of social support. Satisfaction with the project was high. We found that the project engaged local populations that access statutory health services relatively less. We conclude that community-organized and community-led interventions in collaboration with statutory health services can increase accessibility and can improve mothers' mental health and other health-related outcomes.


Assuntos
Serviços de Saúde Comunitária/métodos , Educação em Saúde/organização & administração , Letramento em Saúde , Saúde Materna , Mães/educação , Cuidado Pós-Natal/estatística & dados numéricos , Apoio Social , Adulto , Criança , Saúde da Família , Feminino , Humanos , Londres , Mães/psicologia , Pobreza , Fatores Socioeconômicos , Reino Unido
6.
Artigo em Inglês | MEDLINE | ID: mdl-32121288

RESUMO

BACKGROUND: Newborn mortality in Cambodia remains high, with sepsis and complications of delayed care-seeking important contributing factors. Intervention study objectives were to improve infection control behavior by staff in health centers; improve referral of sick newborns; increase recognition of danger signs, and prompt care-seeking at an appropriate health facility; and appropriate referral for sick newborns by mothers and families of newborn infants. METHODS: The stepped-wedge cluster-randomized controlled trial took place in rural Cambodia from February 2015 to November 2016. Sixteen clusters consisted of public health center catchment areas serving the community. The intervention included health center staff training and home visits to mothers by community health volunteers within 24 hours of birth and on days 3 and 7 after delivery, including assessment of newborns for danger signs and counselling mothers. The trial participants included women who had recently delivered a newborn who were visited in their homes in the first week, as well as health center staff and community volunteers who were trained in newborn care. Women in their last trimester of pregnancy greater than 18 years of age were recruited and were blinded to their group assignment. Mothers and caregivers (2494) received counseling on handwashing practices, breastfeeding, newborn danger signs, and prompt, appropriate referral to facilities. RESULTS: Health center staff in the intervention group had increased likelihood of hand washing at recommended key moments when compared with the control group, increased knowledge of danger signs, and higher recall of at least three hygiene messages. Of mother/caregiver participants at 14 days after delivery, women in the intervention group were much more likely to know at least three danger signs and to have received messages on care-seeking compared with controls. CONCLUSIONS: The intervention improved factors understood to be associated with newborn survival and health. Well-designed training, followed by regular supervision, enhanced the knowledge and self-reported behavior of health staff and health volunteers, as well as mothers' own knowledge of newborn danger signs. However, further improvement in newborn care, including care-seeking for illness and handwashing among mothers and families, will require additional involvement from broader stakeholders in the community.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Promoção da Saúde/métodos , Visita Domiciliar/estatística & dados numéricos , Cuidado do Lactente/métodos , Saúde do Lactente/estatística & dados numéricos , Mães/educação , População Rural/estatística & dados numéricos , Adolescente , Adulto , Camboja , Área Programática de Saúde/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
7.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32188643

RESUMO

BACKGROUND: Mexican-origin women breastfeed at similar rates as white women in the United States, yet they usually breastfeed for less time. In our study, we seek to identify differences in Mexican-origin women's breastfeeding intentions, initiation, continuation, and supplementation across nativity and country-of-education groups. METHODS: The data are from a prospective cohort study of postpartum women ages 18 to 44 recruited from 8 Texas hospitals. We included 1235 Mexican-origin women who were born and educated in either Texas or Mexico. Women were interviewed at delivery and at 3, 6, 12, 18, and 24 months post partum. Breastfeeding intentions and initiation were reported at baseline, continuation was collected at each interview, and weeks until supplementation was assessed for both solids and formula. Women were classified into 3 categories: born and educated in Mexico, born and educated in the United States, and born in Mexico and educated in the United States. RESULTS: Breastfeeding initiation and continuation varied by nativity and country of birth, although all women reported similar breastfeeding intentions. Women born and educated in Mexico initiated and continued breastfeeding in higher proportions than women born and educated in the United States. Mexican-born and US-educated women formed an intermediate group. Early supplementation with formula and solid foods was similar across groups, and early supplementation with formula negatively impacted duration across all groups. CONCLUSIONS: Nativity and country of education are important predictors of breastfeeding and should be assessed in pediatric and postpartum settings to tailor breastfeeding support. Support is especially warranted among US-born women, and additional educational interventions should be developed to forestall early supplementation with formula across all acculturation groups.


Assuntos
Aleitamento Materno/etnologia , Aculturação , Adulto , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Suplementos Nutricionais/estatística & dados numéricos , Escolaridade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Fórmulas Infantis/estatística & dados numéricos , Recém-Nascido , Intenção , México/etnologia , Mães/educação , Estudos Prospectivos , Texas , Fatores de Tempo , Estados Unidos
8.
BMC Pregnancy Childbirth ; 20(1): 19, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906881

RESUMO

BACKGROUND: A considerable amount of research demonstrates how breastfeeding self-efficacy significantly influences breastfeeding outcomes. The aim of this study was to evaluate the role of nursing intervention on mother's breastfeeding self-efficacy. METHODS: In this experimental investigation, 130 pregnant women who attended a primary health care centre were randomly assigned to the experimental (n = 65) or control (n = 65) groups. The experimental group received two 60-90 min group breastfeeding educational sessions based on the breastfeeding self-efficacy theory along with routine care. Mothers' knowledge, attitudes, prenatal and postnatal self-efficacy towards the breastfeeding were compared between both groups. The Iowa Infant Feeding Attitude Scale measured the attitudes. Prenatal Breastfeeding Self-Efficacy Scale measured the self-efficacy during pregnancy and Breastfeeding Self-Efficacy-Short Form measured the self-efficacy in postnatal period. RESULTS: Breastfeeding self-efficacy during pregnancy and following two months of delivery in the experimental group was significantly higher. The experimental group had a higher level of knowledge and attitude in comparison with subjects in the control group. In addition, the mothers who breastfed exclusively had higher levels of postnatal self-efficacy in both experimental and control groups compared to formula feeding women (52.00 vs. 39.45 in the control and 57.69 vs. 36.00 in the experimental subjects; P < 0.001). CONCLUSION: The present investigation suggests that antenatal breastfeeding education is an effective way to increase the level of breastfeeding self-efficacy, which increases exclusive breastfeeding practice.


Assuntos
Aleitamento Materno , Conhecimentos, Atitudes e Prática em Saúde , Mães/educação , Gestantes/educação , Educação Pré-Natal , Autoeficácia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Iraque , Cuidados de Enfermagem , Gravidez , Cuidado Pré-Natal , Inquéritos e Questionários
9.
J Autism Dev Disord ; 50(1): 250-262, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606887

RESUMO

This two-site randomized waitlist-control study (n = 96 mother-child dyads) examined the efficacy of a psychoeducation program as compared to usual care to empower Latina mothers and improve their confidence in and use of evidence-based practices (EBPs) for their children with ASD. A secondary aim was to improve child outcomes. Compared to control group, we found significant positive changes in the treatment group in maternal confidence of and frequency in use of EBPs, child social communication and the number of EB services the child received. We found no significant differences for the treatment group in family empowerment or in child challenging behaviors. This RCT presents evidence of an efficacious intervention for Latino children with ASD and their mothers in California and Illinois.


Assuntos
Transtorno do Espectro Autista/terapia , Hispano-Americanos/educação , Mães/educação , Educação de Pacientes como Assunto/métodos , Adulto , California , Criança , Pré-Escolar , Empoderamento , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Mães/psicologia
10.
BMC Public Health ; 19(1): 1626, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796028

RESUMO

BACKGROUND: Early childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years. METHODS: Two geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1-6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs. DISCUSSION: ECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1-3-year-old children for three consecutive years and cross-sectional follow up of all available 1-6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program. TRIAL REGISTRATION: This trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).


Assuntos
Cárie Dentária/prevenção & controle , Educação em Saúde Bucal/métodos , Mães/educação , Saúde Bucal/educação , Criança , Pré-Escolar , Estudos Transversais , Cárie Dentária/epidemiologia , Feminino , Humanos , Incidência , Índia/epidemiologia , Lactente , Masculino , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
BMC Public Health ; 19(1): 1603, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791295

RESUMO

BACKGROUND: An exclusive breastfeeding rate in the first 6 months of life of at least 50% is one of the six World Health Organization global nutrition targets for 2025. However, the exclusive breastfeeding rate in China is quite low and decreasing which makes it urgent to explore effective ways to reverse the current downward trend. As mobile technologies have rapidly developed, mobile communication apps such as WeChat (one of the largest social networking platforms in China) are well accepted and have the potential to improve health behaviors in a convenient way. The current paper describes the study protocol of a WeChat intervention that aims to promote breastfeeding in rural areas in China. METHODS: The study is designed as a randomized controlled trial in rural Qinghai Province, China. Women who are 14-36 weeks pregnant will be randomized to routine antenatal and postnatal care, or routine care plus the WeChat breastfeeding education. pregnant women with a severe disease and complications of pregnancy or HIV-1 will be excluded. Breastfeeding knowledge and promotion information will be delivered to the intervention group through a WeChat official account from 3 months pregnancy to 6 months postpartum. The outcome assessments are conducted at baseline through face-to-face interviews, and at one week, 1 month, 3 months and 6 months postpartum by telephone interviews. The primary outcome is difference in the exclusive breastfeeding rate at 1 month, 3 months, and 6 months postpartum between the intervention group and the control group. Secondary outcomes include the overall duration of any and exclusive breastfeeding across the first 6 months postpartum; mothers' knowledge of breastfeeding; the proportion of early initiation of breastfeeding; and the timing of the introduction of solid food to infants. Intention-to-treat-analysis will be used. Survival analysis will be used to compare the overall duration of any and exclusive breastfeeding between groups. DISCUSSION: This study is the first effort to promote exclusive breastfeeding through WeChat in China. Our results will provide scientific evidence for the effect of health education through WeChat on breastfeeding. Thereby this may offer a comprehensive intervention to promote exclusive breastfeeding in China and other settings. TRIAL REGISTRATION: Chinese Clinical Trial Registry -ChiCTR1800017364. Registered 26 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29325.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde/métodos , Intervenção Baseada em Internet , Mães/educação , Cuidado Pós-Natal/métodos , Adulto , Aleitamento Materno/psicologia , China , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Recém-Nascido , Aplicativos Móveis , Mães/psicologia , Período Pós-Parto/psicologia , Gravidez , Cuidado Pré-Natal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Artigo em Inglês | MEDLINE | ID: mdl-31817170

RESUMO

This study sought to estimate the prevalence of maternal smoking and its association with exclusive breastfeeding vs. formula feeding. A cross-sectional study was performed on postpartum women at a public hospital in Spain, between January and August 2018. The main variables studied were their age, level of study, smoking habits, and chosen mode of infant feeding. In total, 948 postpartum women were included. Of these, 12.45% were smokers who smoked a mean of 7.23 cigarettes/day. Among the group of smokers, the probability of feeding the newborns with formula milk was multiplied by 2.32 ([95%CI 1.50-3.58] p < 0.001). When stratifying tobacco use into mild, moderate and severe, we found a statistically significant dose-response pattern. These associations and their statistical significance were maintained when adjusting by age and level of study. In conclusion, in the group of postpartum mothers who smoked, the probability of feeding the newborns with formula milk doubled. Our data highlight the need to improve health education programs in women of childbearing age, especially during pregnancy.


Assuntos
Alimentação Artificial/psicologia , Aleitamento Materno/psicologia , Fórmulas Infantis , Comportamento Materno , Fumar/psicologia , Adulto , Alimentação Artificial/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães/educação , Período Pós-Parto , Prevalência , Fumar/epidemiologia , Espanha/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-31861441

RESUMO

We designed a pilot study to develop a family interaction model-integrated a care farming program with mother-child pairs as the participants. In this pilot study, we aimed to assess the effects of the care farming program on communication skills and psychological health in families. Sixteen mother-child pairs in Sejong, South Korea participated in this study. The families participated in a care farming program once a week for six weeks (90 min per session) between May and July 2018. The care farming program was developed based on parenting education skills, strengths-based cognitive behavioral therapy, and the emotional intelligence model; the result was a family interaction model intended to improve communication and psychological health among mothers and children. The program consisted of gardening activities such as making a garden plot, planting transplants, harvesting, and cooking the harvested crops. Upon completion of the six-session program, we evaluated communication with the Parent-Children Communication Inventory, depression with the Beck Depression Inventory, and resilience with the Connor-Davidson Resilience Scale among the mothers. We also evaluated emotional intelligence among the children with the Emotional Intelligence Scale. According to post-intervention results, mothers showed significantly increased resilience, improved communication skills with their child, and decreased depression, while children showed significantly improved emotional intelligence (p < 0.05). Despite the study's limitation in establishing causality between the care farming program and the observed effects on family health, the care farming program clearly contributed to the observed improvements of mother-child communication skills, mothers' psychological health, and children's emotional intelligence, which in turn improved overall family health.


Assuntos
Culinária , Saúde da Família , Jardinagem , Relações Mãe-Filho/psicologia , Poder Familiar/psicologia , Adulto , Criança , Pré-Escolar , Terapia Cognitivo-Comportamental , Comunicação , Depressão/diagnóstico , Depressão/prevenção & controle , Educação não Profissionalizante/métodos , Inteligência Emocional , Feminino , Humanos , Masculino , Mães/educação , Mães/psicologia , Projetos Piloto , Testes Psicológicos , República da Coreia , Resiliência Psicológica
14.
Cult. cuid ; 23(55): 155-170, sept.-dic. 2019. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-190667

RESUMO

OBJETIVO: Describir el significado para la madre de participar en el cuidado al recién nacido prematuro en un grupo de madres que tenían sus hijos hospitalizados en una unidad neonatal de la ciudad de Bogotá, Colombia. METODOLOGÍA: Estudio cualitativo, con método de Etnoenfermería de pequeño alcance y aplicación de la teoría: Universalidad y diversidad del cuidado cultural de Madeleine Leininger. Los datos fueron obtenidos durante los meses de marzo a octubre del 2012, mediante la realización de 24 entrevistas a profundidad, notas de campo y observación participante a nueve informantes claves y cuatro informantes generales. RESULTADOS: Surgieron 28 códigos, 5 patrones y 2 temas centrales. Los dos temas centrales que definió el significado para la madre de participar en el cuidado al recién nacido prematuro hospitalizado fueron: Enseñanza de la enfermera: un camino de participación materna del cuidado del prematuro hospitalizado y el contexto de hospitalización del prematuro: un escenario influyente. CONCLUSIÓN: participar en el cuidado del prematuro hospitalizado para la madre significa contar con enseñanza de enfermería para cuidar al prematuro mediante explicación, observación, demostración y ejecución; en un contexto de predominio de lo ético sobre lo émico


OBJECTIVE: To describe the meaning for the mother to participate in the care of preterm birth, a group of mothers who had their children hospitalized in the neonatal unit in the city of Bogotá, Colombia. METHODOLOGY: Qualitative study, with a method of ethno-nursing of small scope and application of the theory: Universality and diversity of the cultural care of Madeleine Leininger. The data were obtained during the months of March to October 2012, through 24 in-depth interviews, field notes and participant observation to nine key informants and four general informantsRESULTS: 28 codes emerged, 5 patterns and 2 central themes. The two central themes that defined the meaning for the mother to participate in the care of the hospitalized premature newborn were: Nurse Education: A Way of maternal care participation and context hospitalized preterm premature hospitalization: an influential stage. CONCLUSIONS: participate in the care of hospitalized preterm birth for mother means having to care nursing education by the premature explanation, observation, demonstration and implementation, in a context of dominance of the ethical over the émic


OBJETIVO: Descrever o significado para a mãe de participar do cuidado ao recém-nascido prematuro em um grupo de mães que tiveram seus filhos internados em uma unidade neonatal na cidade de Bogotá, Colômbia. METODOLOGÍA: Estudo qualitativo, com um método de etno-enfermagem de pequeno alcance e aplicação da teoria: Universalidade e diversidade do cuidado cultural de Madeleine Leininger. Os dados foram obtidos nos meses de março a outubro de 2012, por meio de 24 entrevistas em profundidade, notas de campo e observação participante a nove informantes-chave e quatro informantes gerais. RESULTADOS: 28 códigos emergiram, 5 padrões e 2 temas centrais. Os dois temas centrais que definiram o significado para a mãe participar do cuidado do recém-nascido prematuro hospitalizado foram: Ensinar o enfermeiro: um caminho de participação materna no cuidado do prematuro hospitalizado e o contexto de hospitalização do prematuro: um cenário influente. CONCLUSÃO: participar do cuidado do prematuro hospitalizado para a mãe significa ter formação de enfermagem para cuidar do filho prematuro por meio de explicação, observação, demonstração e execução; em um contexto de predominância do ético sobre o emic


Assuntos
Humanos , Gravidez , Recém-Nascido , Doenças do Prematuro/enfermagem , Educação em Enfermagem , Hospitalização , Mães/educação , Entrevistas como Assunto , 25783 , Colômbia
15.
Fam Med ; 51(10): 836-840, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31722101

RESUMO

BACKGROUND AND OBJECTIVES: Despite the importance of breastfeeding, most US women do not meet recommendations for length of any or exclusive breastfeeding. Support in primary care settings is recommended (US Preventive Services Task Force, 2016), but optimal implementation strategies are not established. We evaluated the effect on breastfeeding rates of on-site breastfeeding support within an academic family medicine center with a diverse patient population. METHODS: We conducted a retrospective chart review 10 months before and 10 months following the implementation of integrated breastfeeding support provided by an International Board Certified Lactation Consultant (IBCLC) or MD-IBCLC. Two hundred eighty-one infants were identified, 140 before implementation and 141 after. A research assistant extracted data from the electronic medical record. We performed bivariate and multiple logistic regression analyses using STATA. RESULTS: There were no significant demographic differences before and after the intervention. The proportion of infants with any breastfeeding at 2, 4, and 6 months was greater in the postimplementation group (71.7% vs 86.7% at 2 months, P=.05; 61.5% vs 77.1% at 4 months, P=.08; and 50.7% vs 64.4%, P=.09 at 6 months). The proportion of infants exclusively breastfed was also greater in the postimplementation group (58.7% vs 77.8% at 2 months, P=.04; 50.5% vs. 54.2% at 4 months, P=.06; and 44.0% vs 49.3% at 6 months, P=.12). CONCLUSIONS: Providing on-site IBCLC breastfeeding support services within an academic family medicine clinic is associated with significant increases in breastfeeding, supporting the provision of lactation services on-site where mothers and children receive primary care.


Assuntos
Aleitamento Materno/psicologia , Aconselhamento , Medicina de Família e Comunidade , Mães/educação , Centros Médicos Acadêmicos , Adulto , Feminino , Humanos , Lactente , Mães/psicologia , Estudos Retrospectivos , Fatores de Tempo
16.
BMC Health Serv Res ; 19(1): 817, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703681

RESUMO

BACKGROUND: This study evaluated the Health Works (HWs) nutritional counselling skills and information shared with caregivers. This was a cross-sectional study in which an observation checklist was used to examine Growth Monitoring and Promotion (GMP) activities and educational/counselling activities undertaken by health workers (HWs) to communicate nutrition information to caregivers, depending on the ages of the children. METHODS: A total number of 528 counselling interactions between health workers and caregivers in 16 Child welfare Clinics (CWCs) in two rural districts in Ghana were observed. Frequencies were presented for the information that was obtained from each caregiver and those that were provided by the HWs during the nutritional counselling sessions. RESULTS: About 95.1 and 61.8% of the caregiver-HW interactions involved mothers of children who were less than 6 months of age and those above 6 months respectively. HWs counselled the caregivers on appropriate nutrition for the child. Health talk messages that were shared with caregivers focused mainly on the importance of attending CWCs and vaccination of children and rarely included any teaching materials. In most of the interactions, HWs made of child's feeding practices the past 1 month; and also did not provide advice on specific issues of IYCF. Nutritional counselling information given for non-breastfeeding children was inadequate and in some cases absent. Little attention was given to the feeding of children with animal products during counselling. CONCLUSION: Generally nutritional information given to caregivers who had children above 6 months was inadequate.


Assuntos
Cuidadores/educação , Bem-Estar da Criança/estatística & dados numéricos , Aconselhamento/normas , Educação em Saúde/normas , Estado Nutricional , Criança , Pré-Escolar , Enfermagem em Saúde Comunitária/normas , Enfermagem em Saúde Comunitária/estatística & dados numéricos , Aconselhamento/estatística & dados numéricos , Estudos Transversais , Feminino , Gana , Educação em Saúde/estatística & dados numéricos , Pessoal de Saúde/educação , Humanos , Lactente , Masculino , Mães/educação , Relações Profissional-Paciente , Saúde da População Rural
17.
BMC Public Health ; 19(1): 1430, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675942

RESUMO

BACKGROUND: Early prevention is a promising strategy for reducing obesity in childhood, and Early Years settings are ideal venues for interventions. This work evaluated an educational intervention with the primary aim of preventing overweight and obesity in pre-school children. METHODS: A pragmatic, cluster randomised trial with a parallel, matched-pair design was undertaken. Interventions were targeted at both the cluster (Early Years' Centres, matched by geographical area) and individual participant level (families: mother and 2-year old child). At the cluster level, a staff training intervention used the educational resource Be Active, Eat Healthy. Policies and provision for healthy eating and physical activity were evaluated at baseline and 12-months. The intervention at participant level was the Healthy Heroes Activity Pack: delivered over 6 months by Centre staff to promote healthy eating and physical activity in a fun, interactive way. Child and parent height and weight were measured at four time-points over 2 years. The trial primary outcome was the change in BMI z-score of the child between ages 2 and 4 years. Secondary outcomes consisted of parent-reported measures administered at baseline and two-year follow-up. RESULTS: Five pairs of Early Years' Centres were recruited. Four pairs were analysed as one Centre withdrew (47 intervention families; 34 control families). At the cluster level, improvement in Centre policies and practices was similar for both groups (p = 0.830). At the participant level, the intervention group reduced their mean BMI z-score between age 2 and 4 years (p = 0.002; change difference 0.49; 95% CI 0.17 to 0.80) whereas the control group showed increasing BMI z-score throughout. Changes in parent-reported outcomes and parent BMI (p = 0.582) were similar in both groups. CONCLUSIONS: The Healthy Heroes educational resource deterred excess weight gain in pre-school children from poor socioeconomic areas. With training, Early Years' staff can implement the Healthy Heroes programme. TRIAL REGISTRATION: ISRCTN22620137 Registered 21st December 2016.


Assuntos
Educação em Saúde , Mães/educação , Obesidade Pediátrica/prevenção & controle , Pré-Escolar , Feminino , Humanos , Masculino , Áreas de Pobreza , Avaliação de Programas e Projetos de Saúde , Populações Vulneráveis
18.
Cochrane Database Syst Rev ; 2019(11)2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31686427

RESUMO

BACKGROUND: In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems. OBJECTIVES: To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables. MAIN RESULTS: We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33. AUTHORS' CONCLUSIONS: This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Aconselhamento/métodos , Mortalidade Infantil , Mães/educação , Mortalidade Perinatal , Países em Desenvolvimento , Feminino , Educação em Saúde , Humanos , Lactente , Saúde do Lactente , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
East Mediterr Health J ; 25(8): 575-582, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31612972

RESUMO

Background: The initial years of life, particularly the first two years, are considered the most important for brain development and timely interventions profoundly affect the health of the child and families. Aims: This study aimed to determine the effect of maternal health education on motor, social and cognitive development in infants less than two years old, and to identify the factors that could affect normal development. Methods: Two hundred and ten mothers and their infants (109 interventions, 101 controls) were recruited from maternal and child health centres in Assiut Governorate, Egypt, in 2017. The maternal training programme has been taught to mothers of infants in intervention groups twice per month and up to five months' duration; however, routine services are provided to control groups only. Bivariate and multivariable analyses were performed to identify the most important predictors of normal development. Results: There were significant improvements in early childhood developmental domains for the intervention groups after five months comparable to the base line assessment. Percent of normal development among intervention groups in communication subscale increased from 46.8% to 76% to 97.9% compared to 50.5% to 46.8% to 57.4% in the control groups (baseline, after two month and after five months assessment respectively). The intervention was a significant predictor in normal development. Conclusions: There was an improvement in early childhood developmental domains for the intervention groups after applying maternal training programme. Designing educational interventions for routine health care services that reach all children will provide mothers with the opportunity for improvement in early childhood developmental.


Assuntos
Desenvolvimento Infantil , Educação em Saúde/organização & administração , Mães/educação , Adulto , Aleitamento Materno/estatística & dados numéricos , Cognição , Comunicação , Egito , Feminino , Nível de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Destreza Motora , População Rural , Habilidades Sociais , Apoio Social , Fatores Socioeconômicos , População Urbana , Adulto Jovem
20.
Glob Health Action ; 12(1): 1670033, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573416

RESUMO

Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers' knowledge, attitude and practice (KAP) and their children's behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1-9-year-old children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal, during August-November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers' KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had 'good' KAP (>75% of maximum possible scores), and mothers with 'good' knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers' attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children's diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers' KAP scores and children's behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal's Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.


Assuntos
Saúde da Criança , Dieta Saudável , Exercício Físico , Promoção da Saúde , Mães/educação , Adulto , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Agentes Comunitários de Saúde , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Nepal , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Adulto Jovem
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