The Impact of Breastfeeding and Safe Sleep Mobile Health Messaging on Breastfeeding and Bedsharing.

OBJECTIVE: Mobile health (mHealth) safe sleep messaging increases rates of safe sleep. Bedsharing is more common among breastfeeders. Advice to not bedshare may negatively impact breastfeeding. We compared the impact of safe sleep or breastfeeding mHealth messaging on bedsharing and breastfeeding at 2 to 5 months. METHODS: This is a secondary analysis of mothers who initiated breastfeeding from a cluster randomized clinical trial of mHealth messaging for safe sleep or breastfeeding. A multi-ethnic sample of 1600 mothers was recruited from 16 US birth hospitals and surveyed at 2 to 5 months regarding the previous 2 weeks' breastfeeding and bedsharing practices. Data on 997 mothers who initiated breastfeeding were analyzed with multivariable generalized estimating logistic regression models to examine the association of mHealth messaging with infant care practices. RESULTS: Overall, exposure to breastfeeding versus safe sleep messaging was not associated with a difference in any breastfeeding at 2 to 5 months (69.3% vs 65.5%, respectively; adjusted odds ratio [aOR] = 1.33 [95% confidence interval, 0.91, 1.94]). Women with shorter planned duration of breastfeeding who received breastfeeding messaging had increased odds of breastfeeding at 2 to 5 months (50% vs 31%; aOR 3.13 [95% CI, 1.47, 6.65]). Mothers who received safe sleep messaging had lower rates of bedsharing overall when compared to breastfeeding messaging (24.8% vs 35.2%; aOR = 0.58 [95% CI, 0.44, 0.78]). CONCLUSIONS: In this large multi-ethnic US sample, receipt of safe sleep mHealth messaging was associated with lower rates of bedsharing without negatively impacting breastfeeding rates. Future research should focus on continued development of interventions to improve adherence to both safe sleep and breastfeeding recommendations.

Effectiveness of the Spirometry 360 Quality Improvement Program for Improving Asthma Care: A Cluster Randomized Trial.

OBJECTIVE: To determine the effectiveness of the Spirometry 360 distance learning quality improvement (QI) program for enhancing the processes and outcomes of care for children with asthma. METHODS: Cluster randomized controlled trial involving 25 matched pairs of pediatric primary care practices. Practices were recruited from 2 practice-based research networks: the Slone Center Office-based Research Network at Boston University, Boston, Mass, and the Puget Sound Pediatric Research Network, Seattle, Wash. Study participants included providers from one of the 50 enrolled pediatric practices and 626 of their patients with asthma. Process measures assessed included spirometry test quality and appropriate prescription of asthma controller medications. Outcome measures included asthma-specific health-related quality of life, and outpatient, emergency department, and inpatient utilization for asthma. RESULTS: At baseline, 25.4% of spirometry tests performed in control practices and 50.4% of tests performed in intervention practices were of high quality. During the 6-month postintervention period, 28.7% of spirometry tests performed in control practices and 49.9% of tests performed in intervention practices were of high quality. The adjusted difference-of-differences analysis revealed no intervention effect on spirometry test quality. Adjusted differences-of-differences analysis also revealed no intervention effect on appropriate use of controller medications or any of the parent- or patient-reported outcomes examined. CONCLUSIONS: In this study, the Spirometry 360 distance learning QI program was ineffective in improving spirometry test quality or parent- or patient-reported outcomes. QI programs like the one assessed here may need to focus on practices with lower baseline performance levels or may need to be tailored for those with higher baseline performance.

Influenza vaccine safety in pregnancy: can we identify exposures?

PURPOSE: To assess the feasibility of identifying influenza vaccine exposure in pregnancy. METHODS: Two study designs were used. (i) Women who contacted the Organization of Teratology Information Specialists (OTIS) network and were referred to their research center or contacted the center directly were invited to participate. (ii) Vaccine exposure information was gathered within an ongoing case-control surveillance program, the Slone Birth Defects Study (BDS). To confirm vaccine exposure and obtain details (e.g., brand name, presence of thimerosal), we requested medical records. If records were not available, we contacted the provider for information regarding the vaccine product used in that setting. If the provider used only one vaccine product during the reported exposure period, we assumed those vaccine details applied to the reported exposure. Otherwise, no details could be inferred. RESULTS: Between September 2006 and February 2008, OTIS enrolled 106 women who reported influenza vaccine exposure during pregnancy. Vaccine was confirmed for 100 (94.3%); brand was confirmed for 87 (82.1%). Among 2177 BDS interviews completed during the same period, 462 (20.8%) reported influenza vaccine exposure; brand and formulation were available for 314 (69.5%). Over one quarter of the BDS women (29%) received their vaccine in nontraditional settings, where influenza vaccine exposure would not likely be recorded in their medical record. CONCLUSIONS: We demonstrated the capacity both to identify influenza vaccine exposure in pregnancy and to obtain important details of the specific vaccine administered. Many women receive influenza vaccines outside of typical health care settings, which has important implications for influenza vaccine studies that rely on medical records.