ABSTRACT
Reach out and Read program (ROR) prepares young children to succeed in school by partnering with physicians and training them in handing out age appropriate books and to counsel parents about the importance of reading aloud to their children. Children served by ROR enter kindergarten with stronger vocabulary and language skills. The aim of this project was to improve the rate of distribution of books and physician advice about reading, to the families at each well child visit in the age range of six months to five years. This Quality Improvement (QI) project was conducted in a large inner-city pediatric residency clinic serving a lower socio-economic status under-served population. After reviewing the data from the past two years, we noticed that there was a tremendous drop in the percentage of books handed out at well visits and advice given to parents about benefits of reading aloud and self-reporting of parents reading to their child for four or more days in a week. Two goals were established: 1. To increase the rate of distributing books at every well child visit (WCV) from six months to five years of age by at least 80%. 2. To improve the rate of counseling given by the resident physicians to the families by at least 75%. A workflow was created to efficiently distribute books at well visits. A presentation about the ROR program was attended by all the physicians and residents. Reading tips in each exam room were posted to serve as a reminder for all providers and for the parents. A three question survey was collected from the families at the end of their well visit. A total of 210 surveys were collected from parents over a six month period. The percentage of handing out books at all well child visits increased from 30% to 96%. The rate of providers giving advice about the benefits of reading increased from 26% to 87%. The percentage of parents reading to their child greater than four days per week increased from 56% to 80%. Reading aloud is widely recognized as the single most important activity leading to literacy acquisition. With the above interventions, families participating in the ROR model at our clinic were more likely to read to their children, more likely to report reading aloud at bedtime, and to read aloud four or more days per week.
ABSTRACT
Hormone-like substances are normal constituents of cow's and human milk. Progesterone has been quantified in cow's milk and dairy products with butter containing a high value of 300 ng/g. Estrogenic substances have been detected in cow's and human milk but literature values are sparse or tend to vary widely possibly because quanitative methods available lacked specificity and sensitivity. Pregnanediol is rather unique to human milk and its presence in elevated levels has been associated with prolonged neonatal jaundice of nursing infants. The concentration of this steroid in affected mother's milk appears to be in the range of 150-450 ng/ml. 17-Ketosteroids may be present in cow's and human milk but here again limited literature values vary widely. Corticoids have been reported in cow's milk at a concentration of 3.1-3.7 ng/ml. Thyroxine and triiodothyronine are present in human milk but practically undetectable in cow's milk. Prostaglandins (PGF2α) have been determined to be present in cow's milk at concentrations between 0.1 to 0.4 ng/ml.
