Biomedical subjects

Debbie Johnson

Publications and source records attributed to Debbie Johnson.

5 recordsLinked to original sources

PubMed2004

A feasibility study of an intervention to enhance family support for breast feeding in a deprived area in Bristol, UK.

OBJECTIVE: to assess fathers' and grandmothers' knowledge of breast feeding and their ability to support successful breast feeding. To design a suitable intervention for fathers and grandmothers to support breast-feeding mothers, to assess the acceptability and feasibility of the intervention and monitor its likely effects on breast-feeding rates. DESIGN: qualitative focus groups and interviews. Evaluation of the feasibility of an antenatal intervention. SETTING: Community Health Centre and family homes in an area of relative social and economic deprivation in South Bristol, UK, from November 2001 to May 2003. PARTICIPANTS: 10 grandmothers and five fathers in focus groups and interviews. Twenty-nine families in the intervention. INTERVENTION: an antenatal intervention for grandmothers or partners to support breast feeding, which combined the benefits and mechanics of breast feeding with ways of providing support for breast feeding. FINDINGS: using an antenatal session based around a leaflet, specifically written for grandmothers and partners, and including a demonstration of good breast-feeding positioning and attachment in addition to the discussion of specific issues around the health benefits and mechanics of breast feeding was found to be acceptable, useful and enjoyable by all participants, particularly for first-time parents. The importance of fathers and grandmothers in providing emotional and practical support for breast-feeding mothers is highlighted, since those who were still breast feeding at eight weeks all felt that they were receiving similar or better support postnatally than they were antenatally. Significantly more intervention mothers were breast feeding their babies at eight weeks than in the wider practice population of mothers outside the study who intended to breast feed. Fathers' attitudes to breast feeding postnatally were fairly similar to those before the baby was born with breast feeding in public and knowing how much milk the baby was getting having the most influence on whether they felt that their partner should continue to breast feed. IMPLICATIONS FOR PRACTICE: this type of intervention could be part of a multi-faceted approach towards improving breast-feeding initiation and continuation, particularly in areas of low prevalence. Health professionals should be opportunistic about involving other family members in discussions about breast feeding whenever possible, both antenatally and postnatally.

Adult↗

PubMed2003

South Asian grandmothers' influence on breast feeding in Bristol.

OBJECTIVES: To assess South Asian grandmothers' health beliefs and cultural practices around baby feeding, knowledge of breast feeding and their ability to support successful breast feeding. To design a suitable antenatal intervention for grandmothers to support their breast-feeding daughters/in-law in an area of low exclusive breast feeding and to assess the acceptability and feasibility of the initiative by means of structured interviews. DESIGN: Qualitative focus groups and interviews. Evaluation of an intervention. SETTING: Community health centre and family homes in Easton, Bristol, where 32% of women having babies are South Asian. PARTICIPANTS: 14 Pakistani, Bangladeshi or Indian grandmothers in focus groups or interviews. 16 South Asian families in the intervention. INTERVENTION: An intervention for grandmothers to support exclusive breast feeding was based around a leaflet, which covered the health benefits of breast feeding, good positioning and attachment, feed management, and how families can support breast feeding. The intervention was delivered to mother and grandmother pairs at around 36 weeks gestation, and was translated into three languages. FINDINGS AND CONCLUSIONS: South Asian women are not a homogeneous group and differences were seen in cultural and religious practices and in breast-feeding rates between the Pakistani, Bangladeshi and Indian communities. To ensure that the health education message of exclusive breast feeding, how to overcome problems and the importance of family support reaches all women, linkworkers with appropriate training should be available to speak the languages relevant to the ethnic groups in the area. An antenatal educational intervention for extended family members to promote good breast-feeding practice was appreciated by the South Asian families involved and seemed to be influencing behaviour, particularly in giving colostrum, water or artificial milk and the use of dummies/pacifiers. IMPLICATIONS FOR PRACTICE: Recording details of baby-feeding method at eight weeks systematically by ethnic group will enable local rates to be monitored, particular groups targeted with information and positive reinforcement provided. Linkworkers with appropriate training should be available to speak the languages relevant to the ethnic groups in the area. Involving influential local interpreters in an educational intervention will help to educate the wider population in practices to support exclusive breast feeding.

Adult↗

PubMed2002

Breastfeeding in Bristol: teaching good positioning, and support from fathers and families.

OBJECTIVES: to determine whether a specific 'hands-off' breastfeeding technique, based on the physiology of suckling and clinical experience, if taught to mothers in the immediate postnatal period, improves their chances of breastfeeding successfully and reduces the incidence of problems. To investigate the factors associated with breastfeeding at two and six weeks postpartum using logistic regression analysis. DESIGN: a non-randomised prospective cohort phased intervention study. SETTING: subjects recruited from one postnatal ward in St. Michael's Hospital, Bristol from October 1996 to November 1998. PARTICIPANTS: 1400 South Bristol mothers who were breastfeeding on discharge from hospital. Three hundred and ninety-five of these mothers were scored for efficiency of using the breastfeeding technique. INTERVENTION: a 'hands-off' breastfeeding technique was taught to midwives in hospital who subsequently taught mothers in their care. MEASUREMENTS: frequencies of exclusive and 'any breastfeeding' at two and six weeks from questionnaires sent to mothers at home, and incidence of breastfeeding problems. FINDINGS: significant increases were observed in the proportion of mothers exclusively breastfeeding at two weeks (P < 0.001) and six weeks (P=0.02) and in 'any breastfeeding' rates (P=0.005) at two weeks after the technique intervention. The incidence of mothers feeling that they did 'not have enough milk' (perceived milk insufficiency) decreased significantly after the breastfeeding technique had been taught (P=0.02). Logistic regression analysis produced a model which showed that mothers with high scores for the 'hands-off' technique were significantly more likely to be breastfeeding at six weeks compared with those who did not use all the elements of the technique (OR 2.4; CI 1.3, 4.3). Factors associated with continuing to breastfeed at two and six weeks postpartum were also investigated using logistic regression. At two weeks, the significant factors associated with breastfeeding included mothers feeling that they had a 'plentiful milk supply' (OR 3.3; CI 2.1, 5.3), not using a dummy (OR 2.6; CI 1.6, 4.0), not giving the baby any other fluid in hospital (OR 2.4; CI 1.5, 3.8) and receiving enough support for breastfeeding from hospital staff (OR 2.1; CI 1.3, 3.5). By six weeks, in addition to these factors, the encouragement from a supportive partner, other family members and health professionals in enabling women to continue to breastfeed was found to show the largest associations with the maintenance of breastfeeding [(OR 37.2; CI 17.3, 80.2) for all three encouraging (327/817; 40% of breastfeeders) compared with no encouragement (67/817; 8% of breastfeeders)]. CONCLUSIONS: in the immediate postnatal period, if mothers are taught good breastfeeding technique by midwives in a 'hands-off' style, which enables mothers to position and attach their babies for themselves, and which is based on a physiological approach, breastfeeding rates are increased and the incidence of perceived milk insufficiency decreases. Successful breastfeeding in the early weeks was associated both with practices and support in hospital and with factors at home including not using dummies and having a supportive partner, family and health professionals who are encouraging breastfeeding. IMPLICATIONS FOR PRACTICE: teaching mothers how to breastfeed in a 'hands-off' way is important in empowering mothers to 'do it for themselves' and in improving breastfeeding rates. Widespread adoption of consistent good practice is achievable following a brief workshop teaching session. Using the 'breastfeeding score checklist' may help midwives to assess a breastfeed more accurately and determine which aspects need improving. Health professionals should aim to educate all key family members, whenever an opportunity arises both during pregnancy and postnatally, in the benefits of breast milk for babies in the first few months of life and how to encourage and support a mother in the early weeks of breastfeeding.

Adolescent↗

PubMedDate not supplied

Resource planning for patient-centered, collaborative care.

In this article, we use self-reported information from 13,271 older adults and the results from several controlled trials to construct a planned-care management strategy that cuts across diseases and conditions and also addresses health disparities attributed to low socioeconomic status. Three strata result from the interaction of patients' financial status, the presence or absence of bothersome pain and psychosocial problems, and their confidence with self-care. A majority of ambulatory patients generally fall in the first stratum. More resources are required in the 2 remaining strata to attain patient-centered, collaborative care. Because the planned-care management strategy is behaviorally sophisticated, it is likely to be more efficient and effective than strategies based on concepts of disease management that focus on either a single disease or groupings of patients who are "high utilizers" of healthcare. We conclude that modern technologies and related approaches make resource planning for patient-centered, collaborative care feasible and desirable.

Aged↗

PubMedDate not supplied

Diabetes care credit system: a model for comprehensive and optimal diabetes care.

OBJECTIVE: To introduce a "credit system," which empowers patients with diabetes to share in the implementation of guidelines with the health-care provider and provides credits for achievement of health variables considered essential for optimal diabetes care. METHODS: We describe the credit system and the points offered for achievement of variables that assess lifestyle, glycohemoglobin, blood pressure, lipid values, measurement of urinary albumin, annual physical examination, dilated eye examination, foot examination, and electrocardiogram, use of antiplatelet therapy, and use of angiotensin receptor blocker (ARB) or angiotensin-converting enzyme (ACE) inhibitor therapy. The patient's knowledge of diabetes and nutrition was also assessed. Patients with diabetes mellitus were enrolled in the credit program during their scheduled office visits. Results were compared with those in a control group. RESULTS: The study enrolled 613 patients (303 male and 310 female patients), with a mean age of 59.91 +/- 13.57 years (range, 16 to 90). The control group consisted of 119 patients with diabetes (63 men and 56 women; mean age, 55.94 +/- 14.83 years) not participating in the credit system. One year after initiation of the program, analysis of the study group demonstrated high rates of implementation of guidelines: complete physical examination, 94%; foot examination, 89%; dilated eye examination, 77%; blood pressure less than 135/85 mm Hg, 78%; hemoglobin A1c less than 6%, 7%, and 8%, 26%, 58%, and 82%, respectively; serum triglycerides less than 200 mg/dL, 61%; low-density lipoprotein cholesterol less than 100 mg/dL, 49%; high-density lipoprotein cholesterol more than 35 mg/dL, 76%; use of antiplatelet therapy, 60%; quantitative urinary albumin screening, 74%; and use of ACE inhibitors or ARB, 44%. These rates of achievement of established variables for hemoglobin A1c, serum lipids, blood pressure, antiplatelet therapy, and measurement of urinary albumin were significantly higher than those in the control subjects. CONCLUSION: The described credit system demonstrates an effective and practical means to implement and achieve the necessary guidelines and target variables that are intended to lead to optimal diabetes and cardiovascular outcomes.

Adolescent↗