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PubMed2006

Ageing of the baby boomer generation: how demographic change will impact on city and rural GP and nursing workforce.

INTRODUCTION OBJECTIVE: To compare the impact of ageing on the GP and nursing rural and city workforce. METHOD: Cohort analysis of Australian Bureau of Statistics census data. The data was used to examine the age distribution of the city and rural GP and nursing workforce; patterns of attrition for those 50 years and over; and the impact of changes in working hours. RESULTS: The rural GP and nursing workforce is significantly older than their city counterparts (p<0.001) with the 'baby boomer' generation making up 52% of city GPs but 59% of rural GPs in 2001. While a large proportion of city and rural GPs continued to work past the age of 65 years, rural GPs left the workforce at a significantly younger age than city doctors (p<0.001). Rural nurses are older than their city peers (p<0.001) but retire at an older age than city nurses (p<0.001). In 1986, a significantly higher proportion of rural GPs in all age cohorts worked more than 41 hours per week compared with their city counterparts (p<0.001). By 2001, rural 'generation X' GPs were no more likely to work long hours than those in the city (p<0.001). However, significantly more rural than city 'baby boomers' continued to work long hours. CONCLUSIONS: Rural GPs are retiring faster than city GPs and strategies to attract rural GPs and nurses will be critical to ensure adequate rural health care and that current rural workforce shortage do not worsen.

Adult↗
PubMed1989

[Cicatricial uteri. Vaginal delivery under peridural analgesia].

The results of 108 attempts to deliver women who had previously had caesarean sections vaginally under epidural analgesia are studied. 94 patients (87%) delivered vaginally taking the usual length of time for dilatation and delivery. These confirm that epidural analgesia does not alter the prognosis for this type of delivery. However, one uterus unfortunately ruptured with the rapid death of the baby. This study makes it possible to define certain rules that should be carried out to lessen or even get rid completely of the risk of these accidents. As far as the anaesthetic is concerned, epidural analgesia should be carried out and watched very carefully. Small doses of anesthetics should be used and those in low concentrations. Symmetry analgesia should be good. Medics should be aware of the cumulative effect of adding dose on dose. Finally, morphine or morphine-like substances should either be used carefully or forbidden altogether. These precautions will limit the quantities of epidural analgesics that are delivered and assure that there is symmetry so that it is easier to recognize the signs before rupture of the uterus. As far as the obstetrical side is concerned, although we did not use oxytocics very often (37%) we did not find that there was any risk attached to it. We recommend, however, that internal monitoring should be carried out very often whether oxytocics are used or not. Routinely, instruments should be used for the delivery to lessen the efforts required to expel the baby. Exploring the cavity of the uterus after the delivery does not seem to us to be necessary unless there are the usual obstetric indications for doing this.

Adult↗
PubMedDate not supplied

Deafness in childhood: 1. Diagnosis and treatment of deaf babies and children.

Recent technological advances make it possible to detect hearing impairments in very young babies. Babies as young as a few weeks old can now be helped with hearing aids and early language therapy. The earlier the diagnosis and start of treatment, the better the later performance in speech. Nurses and midwives, together with the parents, are often the first to suspect a baby has a hearing loss. Bear in mind the risk factors--low birth weight, neonatal jaundice, family history of deafness etc-and if in doubt, always refer. There are different degrees of hearing loss and it is possible to be misled into thinking a child with partial hearing can hear normally. Again, if in doubt, refer. Hearing aids are essential for almost all children with sensori-neural hearing loss and can also be helpful for moderate conductive hearing loss. Remember that while some parents are the first to suspect deafness and seek treatment, others may deny their suspicions and even refuse to accept a diagnosis of hearing loss. They want to be able to believe that their child is normal.

Child, Preschool↗
PubMedDate not supplied

Bathing or washing babies after birth?

One group of healthy full-term newborn babies was washed after birth and another was bathed to remove vernix caseosa and clean the skin. Few infections, none of them serious, occurred in either group. Bacterial colonisation of the umbilical cord on the third day of life was similar in both groups. The rectal temperature fell further and more infants cried during washing than during bathing. Thus bathing the baby after birth makes it calmer, quieter, and more comfortable than washing and causes less heat-loss. Clinical signs of infection and bacterial colonisation rates are no higher after bathing than after washing.

Baths↗
PubMedDate not supplied

Learning to live with our children. 1949.

As the title suggests, being perplexed by one's children is not unique to the 21st century. In her paper, published in the original Public Health Nursing, Henrietta Fleck (1949), chair of Home Economics at New York University, addressed this persistent problem by providing advice on parent education methods for public health nurses. The materials-films, newspapers, cartoons, posters-are all within the nurse's arsenal today, supplemented by television, and the Internet. More interesting was Fleck's philosophy about parenting and family life. The excerpt omits the dated description of resources, focusing instead on her point of view. It reflects post-World War II optimism about the meaning and power of democracy in shaping familial behavior. The United States was readjusting to civilian life following World War II, fathers were returning home from military fields of action overseas, women were gradually being displaced from the industrial workplace-the country was expanding into suburbia and baby boomers were making their first appearances in the world. Fleck's assumptions include belief in the value of individualism, the importance of sharing both privilege and obligation, and the nature of maturity evidenced in an ability to make reasoned and reasonable choices and to hold oneself accountable for them. The limitations of her view are left to us to ponder.

Child↗
PubMed1981

Relationship between apnoea and bradycardia in preterm infants.

Nine studies were carried out on seven babies who were having repeated episodes of bradycardia without any clinically obvious apnoea. Their mean gestational age was 31.7 weeks (range 29 to 36 weeks) and the mean birth weight was 1.56 kg (range 1.08 kg to 2.16 kg). Investigations were carried out in a total body plethysmograph. Face mask with a pneumotachograph attached to it measured flow. Tidal volume was obtained by integrating these signals. An oesophageal balloon measured intrathoracic pressure changes and the heart rate was measured from ECG chest electrodes. A total of 172 episodes of apnoea were observed. In 50% of these apnoeas, the airway was closed as determined by the absence of cardiac artefact on the flow signals. Apnoea was associated with bradycardia in just over 25% of all apnoea. It tended to occur early (11 to 14 sec). Whether the apnoea was central or obstructive had no effect on the pattern provided the baby did not make any inspiratory efforts. Inspiration against a closed airway produced bradycardia in over 50% of obstructive apnoea, the heart rate falling precipitously within 1 to 2 sec. These findings indicate that often bradycardias occur too early in apnoea to be due to central hypoxia and must be due to a peripheral mechanism.

Apnea↗
PubMed1991

Field trials of the Baby Check score card: mothers scoring their babies at home.

The Baby Check score card has been developed to help parents and health professionals grade the severity of acute illness in babies. This paper reports the results of two field trials in which mothers used Baby Check at home, 104 mothers scoring their babies daily for a week and 56 using it for six months. They all found Baby Check easy to use, between 68% and 81% found it useful, and 96% would recommended it to others. Over 70% of those using it daily used it very competently. Those using it infrequently did less well, suggesting that familiarity with the assessment is important. The scores obtained show that Baby Check's use would not increase the number of mothers seeking medical advice. With introduction and practice most mothers should be able to use Baby Check effectively. It should help them assess their babies' illnesses and make appropriate decisions about seeking medical advice.

Attitude↗
PubMedDate not supplied

Helping parents to grieve after second trimester termination of pregnancy for fetopathic reasons.

The main interest in our study was to find out if advice given to facilitate mourning after perinatal child loss (looking at the dead child, picture, burial) could be used to help parents terminating pregnancies for fetopathic reasons. To evaluate the acceptance and to compare the outcome in grief reactions we interviewed women undergoing termination of pregnancy for fetopathic reasons 1-2 days after the loss of the child and they answered a mailed questionnaire 8 weeks later. For comparison we assessed data from women with spontaneous child losses within the 12th to 24th week of pregnancy in a similar way. No difference in the extent of creating memories between the two groups of child losses could be assessed (44% of women after termination and 55% after spontaneous loss looked at their dead child). Making the dead baby a tangible person led to stronger grief reactions immediately after the loss without significant difference due to the kind of loss. But 8 weeks later women after spontaneous child losses reported significantly more mourning than those after termination. It could be shown that women do mourn after termination of pregnancy, that creating memories leads to more intense grief reactions shortly after the loss and that grief diminishes over time. The advice given to facilitate mourning after perinatal child loss can be transferred to parents dealing with termination of pregnancy for fetopathic reasons although coping seems to be more complicated in the latter situation.

Abortion, Induced↗
PubMed2000

[Prematurity as an interplay between psychological and biological risk factors leading to infant psychopathology].

Concepts such as risk factor, vulnerability, protective factor and resiliency have become central in the field of developmental psychopathology. The birth of a very-low-birth weight premature baby can be used as a paradigm of the interplay between these factors. Indeed, prematurity implies for both infant and parents, biological as well as psychological risk factors. They may interact in such a way that the child's emotional, cognitive and social development will deviate from normal. Understanding the psychological impact of premature birth includes reference to both the normal psychological processes that characterize pregnancy that are jeopardized by a premature, often traumatic delivery, and to the special significance of being a parent in the Special Care Nursery. The contrast between the expected appearance of the baby and that of the sick-looking, tiny premature, together with uncertainty about its medical status, often affect the parents' bonding process. In addition, parents must learn quickly to cope with issues such as total dependence on a very busy team, loss of control of the care of their baby, and their unclear roles as parents. Added to these risk factors are the specific neurobehavioral characteristics of premature babies, which often make it hard for parents to read their cues and respond to them properly. A clinical vignette illustrates the chain of psychological and biological events that lead to severe disturbance of the early parent-child relationship. It also brings up the question of psychosocial intervention in the Special Care Nursery, both in terms of early detection of families at risk and the types of intervention.

Adaptation, Psychological↗
PubMed2001

[A study of the relation between providing healthcare information and behavior changes of people in Japan. Parental behavior changes after receiving information about the sudden infant death syndrome].

OBJECTIVE: Considering the lack of evidence concerning the relationship between providing healthcare information and behavior of people in Japan, we utilized a questionnaire to survey the parents of infants to evaluate behavior change after receiving information about the Sudden Infant Death Syndrome (SIDS). METHODS: A questionnaire about SIDS information was administered in 234 municipalities in Niigata, Gifu, Shizuoka, and Hiroshima Prefectures and in Yokohama City in November and December of 1999 to 14,879 parents who visited for the 18-month health examination of their children. The questionnaire did not ask for the participants' names. Logistic regression analysis was used to study the connection between behavior change and SIDS information sources. RESULTS: 10,900 parents returned the questionnaire to give a 73.3% response rate, 19.0% of these receiving information about SIDS risk factors from hospitals or clinics, 3.7% from public health centers, and 9.2% from their friends. More received information from the mass media such as TV programs, which provided the main source for 71.1% of the parents. The degree of behavior change was evaluated after adjustment for variables concerning a variety of information sources and other appropriate factors such as the age and sex of parents and the number of their children. We found that receiving information from hospitals or clinics significantly influences behavior changes for all kinds of risk factors. Information from public health centers, baby-care groups, and friends influenced behavior changes relevant to the risk factors for feeding methods, sleeping position, and parents' smoking. There was no relation between receiving information from the mass media and behavior change of parents. CONCLUSIONS: The mass media provide far more information than do medical facilities, public health centers, baby-care groups and personal contacts but the latter played much more effective roles in making parents change their baby care behavior. These results point to an obvious discrepancy between efficiency in providing information and the degree of behavior change elicited. We should thus take the source of information and the target population into consideration when we examine the best way to provide healthcare information for people in the future.

Adult↗
PubMed1996

Teaching baby massage to new parents.

In this paper the author reviews six years of running an on-going baby massage group in a health clinic and makes observations, based on experience, on the importance of offering these classes in health centres where they are accessible to all parents with young babies. As baby massage classes are becoming increasingly popular, private individuals are offering classes and, in some cases, there is doubt as to the qualifications of the instructors, their understanding, and their ability to give sufficient support to young mothers at a vulnerable stage in their lives. The quality of training given by the International Association of Infant Massage Instructors based in the USA is appraised and some thoughts are given as to the way ahead in making more baby massage classes available to all parents within the Primary Preventive Health setting.

Adult↗
PubMed1990

How do parents of babies interpret qualitative expressions of probability?

One hundred mothers and 50 medical students and doctors were interviewed to examine their understanding of eight common probability expressions as they are used in statements of the kind that doctors regularly make to mothers of babies. Respondents were asked to translate each term into a number on a scale from 0 to 10. There was a wide range of interpretation of the expressions, and significant differences were found between the mothers and medical group for seven of the expressions. Most mothers expressed a preference for receiving information in numerical terms. We advise that verbal probability expressions should be restricted, and more information presented in numerical terms.

Communication↗
PubMed1995

Audit of the support for breastfeeding mothers in Fife maternity hospitals using adapted 'Baby Friendly Hospital' materials.

BACKGROUND: The objective of this study was to assess the level of support given to breastfeeding mothers during their stay in maternity hospitals. The audit was carried out in maternity hospitals in Fife with the co-ordination of the Fife Joint Breastfeeding initiative. METHODS: The subjects consisted of ten maternity hospital staff (medical and midwifery), and 12 antenatal and 21 postnatal women. The design of the study consisted of an audit of hospital policies and practices in comparison with ten internationally recognized standards. This was carried out by adapting the external evaluation instruments from the WHO-UNICEF "Baby Friendly Hospital" materials. Methods relied not only on reported practices but also on direct observation and enquiry. RESULTS: Action was taken to address areas of practice which fell below the WHO-UNICEF standards: supplementary feeding of breastfed babies, particularly overnight, was reduced; discharge "bounty packs" advertising baby milk manufacturer products were discontinued; a hospital breastfeeding support group was established; the hypoglycaemia policy was revised; and the need for an orientation session on breastfeeding policies for medical staff was recognized. CONCLUSIONS: This audit approach using "Baby Friendly Hospital' materials has helped to define policy, measure performance against recognized standards, identify quality specifications for maternity service agreements and has improved hospital support for breastfeeding mothers. This approach is suitable for maternity hospitals whose breastfeeding rates make them ineligible for "Baby Friendly Hospital" accreditation, and has the potential to be extended to encompass wider "health-promoting hospital" issues such as promotion of infant car seats.

Adult↗
PubMed2003

Neonatology in Singapore: the way we were, the way forward.

Singapore has a maternity hospital since 1924, but for many decades the newborns could only receive basic care. Neonatal and perinatal mortality rates were high. Marked improvement in neonatal care began from the 1980s when many neonatal departments were set up to provide intensive care. Improved socioeconomic status, better healthcare facilities, effective infection control, immunisation programmes and availability of potent antibiotics contributed to the decline of perinatal and neonatal mortality. Following the implementation of the glucose-6-phosphate dehydrogenase (G6PD) deficiency screening programme, severe neonatal jaundice and kernicterus were largely reduced. Exchange blood transfusions initiated in the 1960s and phototherapy in the 1970s had saved many babies. Kernicterus is almost not seen now. With more neonatal-trained staff, organised resuscitation teams, advances in respiratory management and better monitoring equipment, more babies have survived. Closer cooperation between obstetricians and neonatologists was a great leap forward towards perinatal medicine. Physicians should endeavour to reduce the incidence and prevalence of birth defects and metabolic errors. Perinatal asphyxia should be promptly detected and managed effectively, including neuroprotective strategies. There should be markers to predict the outcome of asphyxiated babies for decision-making. Neonatologists should be mindful of safe introduction of new technologies and rapid diagnostic techniques for infections, including group B streptococcal screening and chemoprophylaxis when required. Other current issues include prevention of major morbidities, preservation of brain function, improved neurodevelopmental outcome of premature babies, use of blood substitutes, optimal nutrition, fetal surgery, evidence-based medicine, better information systems, avoidance of medication errors, adequate sedation and pain relief of the baby, and the use of nitric oxide. One should bear in mind the need to enhance the neonatal intensive care environment, improve non-invasive monitoring and minimise invasive procedures. Physicians should prioritise neonatal care for their country and utilise less costly neonatal care. Ethical issues in neonatology that arise following advancement in neonatal care deserve attention. Advances in life sciences, such as the completion of the human genome project, cloning of tissues and organs, human stem cell research and technology, gene therapy, deoxyribonucleic acid vaccines and nanomedicine, should benefit neonatology.

History, 20th Century↗
PubMed2005

Parents' experiences of sharing neonatal information and decisions: consent, cost and risk.

This paper is about the care of babies with confirmed or potential neurological problems in neonatal intensive care units. Drawing on recent ethnographic research, the paper considers parents' experiences of sharing information and decisions with neonatal staff, and approaches that support or restrict parents' involvement. There are growing medico-legal pressures on practitioners to inform parents and involve them in their babies' care. Data are drawn from observations in four neonatal units in southern England, and interviews with the parents of 80 babies and with 40 senior staff. The paper compares standards set by recent guidance, with parents' views about their share in decision-making, their first meetings with their babies, 'minor' decision-making, the different neonatal units, being a helpless observer and missed opportunities. Parents' standards for informed decisions are summarised, with their reported views about two-way decision-making, and their practical need to know. Whereas doctors emphasise distancing aspects of the consent process, parents tend to value 'drawing together' aspects.

Anthropology, Cultural↗