Biomedical subjects
Nancy J Baker
Publications and source records attributed to Nancy J Baker.
Newborn tongue-tie: prevalence and effect on breast-feeding.
OBJECTIVE: The purposes of this study were: (1) to determine whether breast-fed infants with tongue-tie have decreased rates of breast-feeding at 1 week and 1 month of age, (2) to determine the prevalence of tongue-tie, and (3) to test the usefulness of the Assessment Tool for Lingual Frenulum Function (ATLFF) in assessing the severity of tongue-tie in breast-feeding newborns. METHODS: A case-control design was used. All infants in the Regions Hospital newborn nursery were examined for tongue-tie. Tongue-tied babies were examined using the ATLFF. Two breast-feeding babies with normal tongues were identified and matched for each case. Mothers were interviewed when the babies were 1 week and 1 month old. RESULTS: The prevalence of tongue-tie was 4.2%. Forty-nine tongue-tied and 98 control infants were enrolled. Tongue-tied babies were 3 times as likely as control babies to be bottle fed only at 1 week [risk ratio (RR), 3.11; 95% confidence interval (CI), 1.21, 8.03) By 1 month, tongue-tied babies were as likely as controls to be bottle fed only. (RR, 1.00; 95% CI, 0.55, 1.82) Twelve of the tongue-tied infants had ATLFF scores of "Perfect," none had scores of "Acceptable," and 6 had scores of "Function Impaired." The remaining 31 infants had scores that fell into none of these categories. CONCLUSIONS: Tongue-tie is a relatively common condition in newborns. Affected infants are significantly more likely to be exclusively bottle-fed by 1 week of age. The ATLFF was not a useful tool to identify which tongue-tied infants are at risk for breast-feeding problems.
Use of clinical indicators to evaluate COPC projects.
BACKGROUND: In 1989, Ramsey Family and Community Medicine Residency adopted a population-based focus for teaching and clinical activities based on the principles of community-oriented primary care (COPC). Evaluation and outcomes measurement proved problematic for each of the five COPC projects we implemented. METHODS: Surrogate measures, or key clinical indicators, were used to monitor the following COPC projects at Ramsey Family Physicians clinic: preschool immunization, family-centered birth, intimate interpersonal violence, teenage pregnancy-sexually transmitted disease prevention, and human immunodeficiency virus (HIV) screening. RESULTS: Between 1995 and 1998, we documented a decline in preschool immunization rates, an increase in preterm births and low-birth-weight infants, improved intimate interpersonal violence screening, a high but stable teenage pregnancy rate, a decrease in teenage chlamydia rate, and improved HIV prenatal screening. Our data collection and analysis were complicated by a lack of relevant indicators related to target goals, a shifting denominator, incomplete data and an unstable numerator, disconnected data sources, and missing comparison data. CONCLUSIONS: COPC project evaluation is an evolving process, and measurement deficiencies become recognized with time. Even so, outcomes measurement legitimizes COPC interventions and provides a value-added component to resident education and clinical activities.