Ambulatory Child Health最新文献

Objective To estimate the occurrence of prone sleep among a group of infants in two inner-city clinics and examine the factors associated with parents' choice of sleep position

Methods A convenience sample of 80 parents (76 mothers and 4 fathers) was interviewed between June and October 1997, during their healthy, term infant's 2-week health supervision visit. The interview included questions about sleep position practices, knowledge, and beliefs; knowledge about Sudden Infant Death Syndrome (SIDS); education about SIDS; and socio-demographic data. All participants received post-interview SIDS education.

Results Thirty-one percent of parents reported that they placed their infants to sleep in the prone position at least some of the time. Factors associated with prone sleeping included prior child-rearing experience (P = 0.005) and the opinion of other people that were regarded as important (P = 0.0001). Only 20% of parents usually had their child sleep on its back. The majority worried that the child would vomit and choke while lying on its back. Parents who chose to position their infant to sleep on its back were less likely to describe themselves as Hispanic (P = 0.025) and more likely to remember being told to have the infant sleep on its back by a health care provider (P = 0.001). Just over one-half of parents recall receiving sleep position instructions from a health care provider. More than 60% of these parents remember being told to place the infant on the side, 24% the back and none prone. Teen parents were more likely to remember being given sleep instructions (P = 0.033). Parents with older children were less likely to remember receiving sleep position instructions (P = 0.001).

Conclusions/implications for practice Many parents in our urban practice still put their children to sleep in the prone position at least some of the time. Family and friends, as well as prior child-rearing experience influence the choice. Parents are more likely to choose the supine position if they are instructed to do so by a health care provider. However, many parents do not recall such instruction being routinely given by their health care provider and have concerns for the safety of supine sleeping. Efforts to promote sleeping on the back should address parental concerns and health care provider practice.

Objective To determine whether training in emergent literacy-building techniques increases self-reported literacy-related knowledge, attitudes, and intervention with patients.

Design Quasi-experimental; prepost with intervention and comparison groups.

Subjects/setting Pediatric resident continuity clinics in three urban locations, serving primarily low-income patients. A total of 66 residents participated.

Intervention Residents in the intervention group (n = 48) were scheduled to receive a half-hour training session as part of their clinic didactic series. In addition, some intervention residents were exposed to other literacy-related training such as Grand Rounds, readings, and individual modelling by a supervising physician related to specific clinic families. Residents in the comparison group (n = 18) received no literacy training.

Measurement A demographic questionnaire was administered at pretesting. The Knowledge About Literacy Development and Attitudes Regarding Early Childhood Literacy Scales were administered prior to training and 6 months later. The Practice Activities questionnaire was administered at post-testing only.

Results Relative to 18 comparison subjects, 48 residents in the intervention group exhibited trends toward more frequent assessment of literacy milestones and more frequent literacy-related anticipatory guidance. Specifically, the observation of modelling by a supervising physician was significantly related to an increased frequency of literacy-related assessment and anticipatory guidance and to a trend toward more positive attitudes. Intervention and comparison residents did not significantly differ overall in knowledge or attitude gains. However, literacy-facilitative attitudes were significantly correlated with frequency of literacy-related anticipatory guidance.

Conclusions/implications for practice Residents had fairly high initial levels of general literacy-related knowledge

and positive attitudes about providing guidance in this area to parents.

Exposure to specific training in this area does appear to lead to an increased likelihood of addressing these issues in practice. Modeling by a supervising physician may be a particularly important component of training that can help residents learn how to integrate literacy assessment with overall developmental assessment and family guidance.