A systematic review of measures assessing mothers' knowledge, attitudes, confidence and satisfaction towards breastfeeding.

In order to support breastfeeding interventions, there is a need for objective, reliable, valid and sensitive measures of factors related to breastfeeding. Publications on the development and testing of tools measuring mothers' knowledge, attitudes, confidence or self-efficiency and/or satisfaction towards breastfeeding were systematically reviewed. Twenty-two papers evaluating 13 self-report measures matched our selection criteria, and were critically appraised by two independent reviewers. All scales were tested with pregnant women or breastfeeding mothers. The 13 measures varied markedly in ease of completion and cultural appropriateness and none reached our highest level of evidence grading. Four of the measures had sufficient evidence to support their use, including the Breastfeeding Attrition Prediction Tool, the Modified Breastfeeding Evaluation Scale, the Breastfeeding Self-Efficiency Scale and the Iowa Infant Feeding Attitude Scale. There has been a tendency to develop new measures rather than evaluate the strengths and weaknesses of existing measures, particularly in different populations.

A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration.

OBJECTIVE: To determine whether postnatal 'hands off' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration. DESIGN: Mothers were randomised at the first postnatal feed to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care. SETTING: Eight wards in four English Midlands hospitals. PARTICIPANTS: 370 primiparous mothers with term babies who intended to breast feed, and could sit out of bed to do so. INTERVENTIONS: Experimental protocol of verbal-only advice on positioning and attachment, delivered at the first postnatal ward feed compared with routine care by a qualified midwife. MAIN OUTCOME MEASURES: Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife. The mothers' self-reported experience of care and support before, during and after delivery were assessed at 6 weeks, and feeding outcomes and employment status at 17 weeks. FINDINGS: Experimental group mothers more often held the baby across their lap and received 'hands off advice', but fewer babies in the experimental than control groups attached and fed: 59% (106/180) vs. 67% (118/175), p=0.1. No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups (stopped exclusive breast feeding: 76% (130/172) vs. 77% (126/163) at 6 weeks; 96% (167/174) vs. 96% (161/168) at 17 weeks; odds ratio 1.02, 95% CI 0.77 to 1.22; p=0.8; stopped any breast feeding: 35% (61/172) vs. 32% (53/167) at 6 weeks; 63% (109/173) vs. 60% (101/167) at 17 weeks; odds ratio 1.10, 0.84 to 1.45; p=0.5). There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation (other than at the first postnatal ward feed), nor after discharge home. CONCLUSIONS: No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment, perhaps because aspects of the intervention are already within routine UK practice. Other care practices at subsequent feeds may negate benefits of care at earlier feeds. 'Hands off' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward. IMPLICATIONS FOR PRACTICE: Midwives can be trained in a 4-hr workshop to achieve improved knowledge of 'hands off' positioning and attachment care, and these can be translated into clinical practice. Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds, and apply this advice consistently at successive feeds.

Policy and practice in the management of postnatal depression in Scotland.

To investigate current policy and practice in postnatal depression in Scotland and to consider how effectively guidelines were addressed. A questionnaire survey of all National Health Service Boards in Scotland between September 2003 and February 2004 to determine what written policies for postnatal depression were in place as at September 2003. This was followed by a questionnaire survey of a representative sample of general practices in Scotland to determine the routine procedures in use for managing postnatal depression in general practice primary care teams. NHS Boards and general practices in Scotland, UK. Forty-seven per cent of policies and 68% of General Practices had implemented the majority of the Scottish Intercollegiate Guidelines Network 60 evidence based recommendations. Practices were more likely than NHS Boards to have addressed a higher percentage of the recommendations (p < 0.05). Practices were more likely to implement antenatal screening for a history of puerperal psychosis if they were within NHS Boards that recommend this as routine practice. Practices within NHS Boards that had in-patient facilities for mother and baby admissions were more likely to identify these services as a treatment option than in the areas where the NHS Boards indicated the facilities were unavailable. Board guidance did not relate significantly to the likelihood of practices following the other evidence-based recommendations. Minimum standards represented by the SIGN 60 evidence-based recommendations were mostly followed in both policy and practice. If Board policy followed guidelines, the guidelines were more likely to be implemented at primary care level.

Randomized trial of essential oils to reduce perioperative patient anxiety: feasibility study.

AIM: This paper is a report of a feasibility study to examine the effectiveness of essential oils in reducing anxiety in thoracic patients awaiting the results of investigative and staging surgery. BACKGROUND: Patient anxiety is expected during the perioperative period. Anxiety places the patient at greater risk of adverse clinical outcomes. Nurses are limited in therapeutic options that can be used to address anxiety in the limited time available. Complementary therapies have been tested for therapeutic benefit but the evidence is weak. METHOD: Patients admitted to a thoracic unit for bronchoscopy/mediastinoscopy in 2005 and 2006 were invited to participate in this double-blind controlled trial and randomized to receive study oil (A), neutral oil (B) or no intervention (C). Intervention was controlled by the patient at home after the procedure. The State Trait Anxiety Inventory and the Hospital Anxiety and Depression Scale were used to measure baseline and periodic anxiety status (days 3, 21). FINDINGS: Of the 142 patients approached to participate, 71 (50%) agreed to take part. There were high and fluctuating levels of perioperative anxiety in the thoracic patient group, but no evidence that this was reduced by the absorption and inhalation of essential oils. CONCLUSION: The study did not provide evidence that the essential oils could reduce anxiety in this group of patients. Both recruitment rates and compliance rates were lower than anticipated. Logistic factors in the setting of diagnostic process for an acute condition may have contributed to these results. More stable settings would be better suited to evaluating such interventions.

What influences the timing of the introduction of solid food to infants?

The aim of the present study was to assess the factors which may influence the timing of the introduction of solid food to infants. The design was a prospective cohort study by interview and postal questionnaire. Primiparous women (n 541) aged between 16 and 40 years were approached in the Forth Park Maternity Hospital, Fife, Scotland. Of these, 526 women agreed to participate and seventy-eight were used as subjects in the pilot study. At 12 weeks we interviewed 338 women of the study sample. The postal questionnaire was returned by 286 of 448 volunteers. At 12 weeks 133 of 338 mothers said that they had introduced solids. Those that said that they had introduced solids early (<12 weeks) were compared with those who had introduced solids late (>12 weeks) by bivariate and multiple regression analysis. Psychosocial factors influencing the decision were measured with the main outcome measure being the time of introduction of solid food. The early introduction of solids was found to be associated with: the opinions of the infant's maternal grandmother; living in a deprived area; personal disagreement with the advice to wait until the baby was 4 months; lack of encouragement from friends to wait until the baby was 4 months; being in receipt of free samples of manufactured food. Answers to open-ended questions indicated that the early introduction appeared to be influenced by the mothers' perceptions of the baby's needs. Some of the factors influencing a woman's decision to introduce solids are amenable to change, and these could be targeted in educational interventions.

Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents.

BACKGROUND: Regular physical activity has been shown to have many health benefits. However, many older people are physically inactive. OBJECTIVE: To investigate why older people are reluctant to participate in leisure time physical activity and to identify strategies to encourage increased activity. DESIGN: Cross-sectional survey. SETTING: 16 general practices in Dundee, Scotland. METHODS: 409 randomly selected older people (65-84 years) who lived independently were interviewed at home. Forty-six percent of those invited to take part were recruited into the study. RESULTS: Levels of knowledge about the specific health benefits of physical activity were high. Almost all participants (95%) believed that physical activity was beneficial and 79% believed that they did enough to keep healthy. However, 36% did no leisure time physical activity and a further 17% did less than 2 hours per week. Regression modelling identified 11 factors that exerted significant independent effects on levels of leisure time physical activity. The most powerful deterrent was lack of interest (OR = 7.8). Other factors included lack of daily access to a car, shortness of breath, joint pain, dislike of going out alone or in the evening, perceived lack of fitness, lack of energy, doubting that exercise can lengthen life, not belonging to a group and doubting that meeting new people is beneficial. CONCLUSIONS: Increasing leisure time physical activities poses major challenges. Beliefs about desirable levels of activity in older people would need to be changed. Action would be needed to relieve physical symptoms and address fears about perceived ability to undertake physical activity. Finally, easily accessible facilities would be needed to encourage participation in physical activity.