Determining Clinically Relevant Cutoff Scores for the Iowa Infant Feeding Attitude Scales Among Prenatal Women in Canada.

BACKGROUND: The original 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been validated and widely used to assess attitudes toward breastfeeding. A reduced 13-item version of the IIFAS was recently validated in a Canadian setting. However, cutoff scores for categorization of infant feeding attitudes on both scales have not yet been established. Research Aim: The aim of this study was to determine optimal cut-ff scores predicting infant feeding attitudes and outcomes for the original and reduced IIFASs. METHODS: A population-based prospective cohort study was undertaken in the Canadian province of Newfoundland and Labrador. A sample of 658 pregnant women were followed up to 1 month postpartum. The receiver operating curve and Youden index were assessed to identify the sensitivity and specificity of cutoff scores. The magnitude at which these scores predicted postpartum feeding outcomes was evaluated using linear regression. RESULTS: Scores of ≤60 (sensitivity = 0.81, specificity = 0.87) and ≤45 (sensitivity = 0.84, specificity = 0.83) for the 17-item and 13-item IIFASs, respectively, were found to be optimal cutoff scores for predicting negative breastfeeding attitudes. The cutoff score for the reduced IIFAS version maintained its ability to predict women who formula-fed at 1 month postpartum (adjusted odds ratio = 6.32, 95% confidence interval = 1.84-11.61) compared with the original scale (adjusted odds ratio = 4.62, 95% confidence interval = 2.42-16.52). CONCLUSION: The proposed cutoff scores for the original and reduced IIFASs have excellent predictive ability to determine infant feeding attitudes and outcomes. The classification of scores enhances the use and applicability of the IIFAS.

The influence of different forms of early childcare on children's emotional and behavioural development at school entry.

BACKGROUND: Over the past few decades there has been a dramatic increase in maternal employment and, as a result, an increase in the use of non-maternal childcare in the early years. The purpose of this longitudinal study was to examine, in a large representative English sample, the influence of different forms of childcare on children's behavioural and emotional development around the age of school entry. METHODS: A sample of 991 families, originally recruited when the children were 3 months old, was assessed around school entry age at 51 months. The main outcome variable was the children's emotional and behavioural functioning, measured by questionnaire completed by both mothers and teachers. A range of repeated assessments were carried out at different time points, including direct observation of the quality of maternal caregiving and observations of the quality of non-parental care, and amount of time spent in different forms of care. RESULTS: The strongest and most consistent influences on behaviour and emotional problems were derived from the home, including lower socio-demographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (being a boy). Non-parental childcare had small effects on child outcome. One finding that did emerge was that children who spent more time in group care, mainly nursery care, were more likely to have behavioural problems, particularly hyperactivity. CONCLUSIONS: These findings suggest that interventions to enhance children's emotional and behavioural development might best focus on supporting families and augmenting the quality of care in the home.

SNOMED CT as the clinical terminology for the representation of the clinical care of the newborn infant.

Clinically relevant concepts of specialized clinical domains may not yet have been represented in SNOMED CT(R). The July 2006 release was examined with CliniClue browser to determine whether 881 terms for the clinical care of the newborn infant are represented in SNOMED CT. There was complete representation for 86.4% of terms drawn from the categories of diagnosis, intervention, drug or observation. There was partial representation for 10.2% and no representation for 3.4% of the terms.

Improving information prescription to parents of premature infants through an OWL-based knowledge mediator.

In the Baby CareLink system, information prescription plays an important role in preparing parents of premature infants for the eventual discharge to home of their children. However, the prescription process requires scarce clinician time in order to dispense information, and can become cumbersome as content bases grow in size. We describe the development of an OWL-based knowledge mediator to facilitate information prescription. We describe 1) the initial development of a clinical vocabulary for neonatology using OWL-DL; 2) the reuse of the vocabulary to represent prototypical premature infants and their typical clinical problems and treatments; 3) the software components used to integrate terminology and inferencing services with Baby CareLink. We demonstrate multifaceted uses for description logics in a clinical application, reuse of a base vocabulary for domain knowledge representation, and use of the OWL language in representing clinical vocabularies. We believe that semi-automated knowledge mediation will enhance the process of electronic information prescription using large clinical content collections.

Efecto de la suplementación nutricional sobre la grasa corporal en niños lactantes de 4 a 7 meses / Effect of nutritional supplementation on the body fat in lactanting niños from 4 to 7 months

El estado nutricional de los niños lactantes es muy importante de tomar en cuenta particularmente por ser una etapa de crecimiento acelerado. La alimentación es uno de los factores que tiene mucha influencia su crecimiento, por lo tanto la lactancia materna, así como la alimentación complementaria debe ser adecuada. A pesar de que esta comprobado de que lactancia materna exclusiva es adecuada para los niños y niñas hasta los seis meses de edad, con el objetivo de probar un suplemento nutricional se introdujo el mismo en un grupo de niños a partir de los cuatro meses de vida para establecer el efecto del suplemento alimentario "Nutriset", sobre el estado nutricional de grasa corporal. Se estudiaron 64 niños lactantes de ambos sexos que recibieron suplemento y otro grupo de 62 niños de ambos sexos que no recibieron suplemento. Se tomaron medidas de los pliegues cutáneos, el índice de masa corporal, el área grasa del brazo y el porcentaje de grasa del brazo. El suplemento nutriset fue distribuido dos veces al día, todos los dias durante tres meses a los niños de cuatro a cinco meses se les dio 25 g. de Nutriset en 75 ml. de agua y cuando cumplieron seis meses se les distribuyo 50 g. de suplemento en 135 ml. de agua. Las caracteristicas generales de los lactantes, entre el grupo suplementado y el no suplementado, eran similares. Todos los niños pertenecian a famialias de bajos recursos...

Early child care and self-control, compliance, and problem behavior at twenty-four and thirty-six months. The NICHD Early Child Care Research Network.

To evaluate child-care effects on young children's self-control, compliance, and problem behavior, children enrolled in the NICHD Study of Early Child Care were tested and observed in the laboratory and in child care at 24 and 36 months, and mothers and caregivers completed questionnaires. Indicators of child-care quantity, quality, stability, type, and age of entry, along with measures of family background, mothering, and child characteristics obtained through the first 3 years of life were used to predict 2 and 3 year child functioning. Results revealed (1) mothering to be a stronger and more consistent predictor of child outcomes than child care; (2) little evidence that early, extensive, and continuous care was related to problematic child behavior, in contrast to results from earlier work; (3) that among the child-care predictors, child-care quality was the most consistent predictor of child functioning, although limited variance could be explained by any (or all) child-care variables; and (4) that virtually none of the anticipated interactions among child-care factors or between them and family or child measures proved significant.

Limited comparability of classifications of levels of neonatal care in UK units. The ECSURF (Economic Evaluation of Surfactant) Collaborative Study Group.

AIM: To assess whether different classifications of neonatal care or dependency scales are comparable when used in multicentre studies of cost effectiveness. METHODS: A survey of classifications was used in a nationally representative group of 57 units in 1990-1, with a retrospective study of 10 354 cot days using patient records from a 5% random sample of 1042 admissions. Local and national classifications were correlated with medical and nursing procedures recorded for up to 26 days after each admission. RESULTS: Classifications varied substantially. Of the 57 units in our sample, 26 used one of two national classifications, sometimes modified; 17 used the Northern Neonatal Network dependency scale; and the other 14 did not record daily levels of care. In each classification, the highest level was having respiratory support by ventilation or continuous distending pressure through an endotracheal tube, nasal prongs, facemask or negative pressure device. This level of care was consistently comparable between classifications; lower levels were not. CONCLUSIONS: Retrospective comparisons between units with different classifications can only reliably differentiate between days with and without respiratory support. There is a pressing need to develop and validate more appropriate scales for prospective multicentre studies. These should relate activity to costs and outcome.