The Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form: reliability and validity assessment.

BACKGROUND: Only a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breastfeeding self-efficacy is a mother's confidence in her ability to breastfeed and is highly predictive of breastfeeding behaviors. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was developed among English-speaking mothers to measure breastfeeding self-efficacy. OBJECTIVES: To translate the BSES-SF into Spanish and assess its psychometric properties. DESIGN: Methodological study. SETTING: One public hospital in Orihuela, Spain. PARTICIPANTS: A convenience sample of 135 in-hospital breastfeeding women was recruited on their second day postpartum. METHODS: The BSES-SF was translated into Spanish using forward translation, back-translation and pilot testing. Internal consistency, construct validity and predictive validity were assessed. A battery of self-report questionnaires was administered on the second day postpartum including: a questionnaire on sociodemographic variables and breastfeeding status, the translated BSES-SF, the Spanish adaptation of the General Self-Efficacy Scale and the Stress Management Self-Efficacy Scale. Also, data on breastfeeding status at three weeks postpartum were collected by telephone interviews. RESULTS: The Cronbach's alpha coefficient for internal consistency was 0.92. The translated BSES-SF presented a unidimensional structure with factor loadings of >0.30. In addition, demographic response patterns and correlations with self-efficacy scales provided further evidence of construct validity. In-hospital BSES-SF scores significantly predicted exclusive breastfeeding at 3 weeks postpartum. CONCLUSIONS: The results of this study indicate that the Spanish translation of the BSES-SF can be considered a valid and reliable measure of maternal breastfeeding self-efficacy in Spain.

Becoming baby-friendly in Spain: a quality-improvement process.

AIM: To describe the implementation process and effect of a quality-improvement intervention aimed at achieving compliance with the Baby-friendly Hospital Initiative (BFHI). METHODS: We conducted a prospective study of the development and evaluation of a quality-improvement intervention at the Yecla Hospital, Spain. A random sample of 1273 infants born in the hospital was followed up in primary care centres between 1997 and 2005. The study interventions were process-oriented training, audit and feedback, quality-improvement cycles and provision of breastfeeding support resources. The main outcome measures were changes in compliance with the Global Criteria for the BFHI and breastfeeding rates before, during and after the intervention. RESULTS: Compliance with the Global Criteria increased progressively, and in 2004 all criteria were met. The median duration of breastfeeding went up gradually from the start of the intervention. The likelihood of being breastfed at different ages among infants born in 2005 was between 45% [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38-0.79] and 86% (OR 0.14; 95% CI 0.09-0.20) higher than among infants born in 1997. CONCLUSION: Quality-improvement interventions based on participation, training, audit and feedback of information, and provision of resources are useful for the implementation of the BFHI, which is associated with a significant increase in breastfeeding rates.

La duración de la lactancia materna se asocia a un menor riesgo de infarto de miocardio entre la mediana edad y finales de la edad adulta / Duration of lactation and incidence of myocardial infarction in middle to late adulthood

Objetivo: Se evaluó la relación entre la duración del amamantamiento y los episodios de infarto de miocardio en madres. Método: Estudio de cohortes prospectivo de 89.326 mujeres con hijos del Nurses’ Health Study. Resultados: Durante 1.350.965 personas-año de seguimiento, se diagnosticaron 2.540 casos de enfermedad coronaria. Comparado con mujeres con hijos que nunca habían amamantado, las mujeres que lo habían hecho un tiempo total de 2 años o más tenían un 37% menor riesgo de enfermedad coronaria (intervalo de confianza [IC] del 95%, 23-49%; p para la tendencia<0,001), ajustado por edad, paridad y antecedentes de muerte fetal. Con un ajuste adicional para adiposidad al principio de la edad adulta, antecedentes en los padres y estilo de vida, las mujeres que habían amamantado un tiempo total de 2 años o más tenían un 23% menor riesgo de enfermedad coronaria (IC del 95%, 6-38%; p para la tendencia=0,02) que las mujeres que nunca habían amamantado. Conclusiones: En una gran cohorte prospectiva, la lactancia de larga duración se asoció con un menor riesgo de enfermedad coronaria(AU)

[Critical moments for weaning in a 6-month follow-up study]. / Momentos críticos de abandono de la lactancia materna en un seguimiento de 6 meses.

OBJECTIVE: To identify critical moments for discontinuing full breast feeding (FBF) and any breast feeding (BF) in the first 6 months. METHOD: We performed an observational, 6-month follow-up study of an accidental sample of 270 mothers with healthy breastfed infants. Survival analyses and the incidence rates (IR) of discontinuance of FBF and ABF every fortnight were obtained. RESULTS: Loss to follow-up: 10% at 4 months and 17% at 6 months. The median length of FBF was 120 days (95% CI = 111.17-128.83) and the median length of BF was 171 days (95% CI =151.40-190.60). The median duration of partial breast feeding (PBF) was 30 days (95% CI=19.49-40.51). IR peaks of BF were found in the first and second weeks and after week 17. Increases of the IR of BF coincided with IR peaks of FBF and also included subsequent weeks. CONCLUSIONS: The highest IR for discontinuance of BF were found at hospital discharge and return to work. PBF was related to weaning. These results suggest the need to increase support after discharge, especially to mothers PBF and those returning to work.