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Biomedical subjects

G L Freed

Publications and source records attributed to G L Freed.

50 records · Page 3Linked to original sources
PubMed1993

Effect of expectant mothers' feeding plan on prediction of fathers' attitudes regarding breast-feeding.

A mother's perception of the father's attitude toward breast-feeding may strongly influence her prenatal choice of infant feeding method; however, research has demonstrated that women do little better than chance in predicting these attitudes. this study sought to determine if differential perceptions of fathers' attitudes regarding breast-feeding existed between women who had made a prenatal decision to breast- or formula-feed their children. The 268 expectant mothers in prenatal classes completed a self-administered questionnaire. Chi-square analysis was performed to determine the significance of the association between maternal attitudes toward breast-feeding and intended feeding plan (breast or formula) and each predicted paternal attitudinal variable. The majority of subjects were white (80%) and married (95%). Seventy percent planned exclusive breast-feeding, and 68% felt the baby's father wanted them to breast-feed. Mothers who planned breast-feeding were more knowledgeable of its benefits, had more favorable perceptions, and were more likely to predict positive attitudes of fathers toward breast-feeding than those who planned formula feeding. Women who planned formula feeding predicted less positive paternal attitudes regarding breast-feeding; this perception (whether correct or incorrect) likely impacted on their choice of infant feeding method. More time should be devoted in prenatal classes and prenatal physician visits to breast-feeding education for mothers and fathers. Active encouragement of paternal participation in breast-feeding classes, usually directed toward women only, would foster understanding of the benefits of breast-feeding and the support fathers can provide.

Attitude↗
PubMed1993

Accuracy of expectant mothers' predictions of fathers' attitudes regarding breast-feeding.

BACKGROUND: Breast-feeding plays a well-recognized role in lowering infant morbidity and mortality during the first year of life. Previous research has demonstrated that fathers contribute to the decision of which infant feeding method will be used, and can be effective promoters of breast-feeding. A woman's decision to breast-feed her infant may rest on her assumptions of the father's attitude regarding this feeding method. As the perception of a negative paternal attitude toward breast-feeding may discourage some women from breast-feeding, this study was designed to determine whether a mother can accurately predict the father's attitude on this subject. METHODS: Subjects were 268 pairs of expectant mothers and fathers enrolled in childbirth preparation classes at five private hospitals in Houston, Texas. Participants individually completed pretested surveys assessing their attitudes regarding breast-feeding. Mothers' surveys additionally assessed their partner's attitudes toward breast-feeding. RESULTS: More mothers than fathers reported exclusive breast-feeding as their preferred feeding plan (69% vs 58%), whereas only 54% of partners both responded they preferred breast-feeding. Overall, fathers had more favorable attitudes toward breast-feeding than their partners predicted, but large numbers of fathers harbored misconceptions and negative attitudes toward breast-feeding. Mothers' predictions were little more accurate than random guessing in predicting their partner's response (range: 56% to 83%). CONCLUSIONS: A mother's perception of her partner's attitudes toward breast-feeding influences her choice of infant feeding method. If she perceives that the father has a negative attitude about breast-feeding, she will probably not choose this method. Additional efforts to dispel misconceptions about breast-feeding should be made during childbirth preparation classes and prenatal visits.

Attitude↗
PubMed1993

Reactions of pediatricians to a new Centers for Disease Control recommendation for universal immunization of infants with hepatitis B vaccine.

Despite immunization programs targeting high-risk groups, the incidence of hepatitis B has risen 37% over the last decade with 300,000 new infections and 5000 related deaths now occurring annually in the United States. As a new strategy to control the spread of hepatitis B, the Advisory Committee on Immunization Practices of the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. There was no other federal effort to disseminate this recommendation. On February 14, 1992, the American Academy of Pediatrics (AAP) issued a similar recommendation. The time between the CDC and AAP recommendations presented the opportunity to determine the singular effect on clinical practice of the CDC's dissemination effort. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. All 778 pediatricians in North Carolina were surveyed by mail 2 to 3 months after publication of the new CDC recommendation. Descriptive statistics, chi 2 analysis, and logistic regression were used to assess the relationship of variables hypothesized to predict physician awareness of and/or agreement with the new recommendation. The response rate was 78%. Although 82% of pediatricians who administer immunizations were aware of the new recommendation, only 32% believed it was warranted in their practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1993

Breast-feeding counseling practices of family practice residents.

BACKGROUND: Despite breast-feeding being the best newborn feeding method, the percentage of women in the United States who breast-feed has declined. Family physicians are in a unique position to counsel women about breast-feeding because their emphasis on continuity of care provides both prenatal and postnatal contact. Whether family physicians are trained sufficiently to offer such counseling is unknown. METHODS: A pretested questionnaire was distributed to all residents in 11 of 14 residency programs in North Carolina and Georgia. Data were analyzed with descriptive chi-square statistics and backward logistic regression to assess variables independently predictive of residents' counseling behaviors. RESULTS: One hundred fifty-five residents filled out usable surveys (response rate: 69%). The residents' primary teachers of breast-feeding were family physicians (34%) and nurses (33%). Most residents (93%) felt it was their personal responsibility to counsel women about breast-feeding; 67% believed their training was inadequate, and 48% stated they lacked necessary skills. Forty-one percent of residents counseled such women less than 50% of the time. Personal or spousal breast-feeding experiences gave residents more confidence in breast-feeding anticipatory guidance (P < .001), comfort in teaching techniques (P < .001), and effectiveness in counseling (P < .009) but did not lead to improved counseling rates. Multivariate analysis showed that female residents, those with high confidence in their breast-feeding counseling skills, and residents that had adequate training in breast-feeding counseling instructed women more often about breast-feeding. CONCLUSIONS: Breast-feeding counseling skills are an important but neglected aspect of family practice clinical training. Personal breast-feeding experience is an important indicator of breast-feeding counseling confidence and effectiveness, although it doesn't ensure that proper counseling skills are obtained. Family medicine training programs should incorporate breast-feeding educational programs into their residency curricula.

Breast Feeding↗
PubMed1993

Family physician acceptance of universal hepatitis B immunization of infants.

BACKGROUND: The incidence of hepatitis B infection has risen 37% over the last decade; 300,000 new infections and 5000 deaths occur annually in the United States. Because immunization programs that targeted high-risk groups failed to abate this increase, the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation to family physicians, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. METHODS: A random sample of 300 family physicians in North Carolina was surveyed by mail. Descriptive statistics and chi-square analysis were used to assess the relationship of variables hypothesized to predict physician awareness of, and agreement with, the new recommendation. RESULTS: The response rate was 78%. Overall, 48% of family physicians who administered immunizations to children were aware of the new hepatitis B vaccine recommendation. However, only 17% agreed that it was warranted for all newborns in their practice. Twenty-five percent expected more than one half of the parents to refuse three injections at a single well-child visit, a result of adding this vaccine to the current primary immunization schedule. Additionally, 42% expected nurses to resist giving three injections at one visit. CONCLUSIONS: The CDC does not have an effective mechanism for disseminating information to all physicians who care for children. Improved coordination of recommendations between the CDC and relevant specialty societies may help to increase physician adoption of new immunization recommendations in their clinical practice. Additionally, practical concerns of physicians and their patients regarding multiple injections and other practice-relevant issues must be considered when formulating new immunization recommendations, if their implementation is to be successful. Additional research is needed to determine effective methods to disseminate immunization information and to address practical concerns of clinicians.

Adult↗
PubMed1993

Childhood immunization programs: an analysis of policy issues.

Immunizations have been among the most successful of preventive interventions. However, concern exists in the United States that recent epidemics of vaccine-preventable diseases and low rates of childhood immunizations may signal the existence of major underlying problems in immunization policy. Additionally, the effectiveness of national, state, and local public health programs in administering these and other preventive services to children has been called into question. This article examines the current state of childhood immunizations in this country and offers a broad range of suggestions for policy modification.

Appointments and Schedules↗
PubMed1992

Attitudes and education of pediatric house staff concerning breast-feeding.

Pediatricians are expected to offer information and advice on breast-feeding to expectant and lactating mothers, but the educational experience for pediatric residents may not adequately prepare them for this responsibility. To examine knowledge and confidence regarding breast-feeding gained by pediatric house staff during their residency, a survey was administered to pediatric residents in a large, hospital-based training program. Of 108 program residents, 87 (81%) participated. Forty-one percent of the respondents were postgraduate level I (PL-I), 29% were PL-II, and 30% were PL-III. There was no evidence that PL-III residents were more competent or comfortable with routine breast-feeding counseling or intervention than their PL-I counterparts. Residents who had breast-fed, those with spouses who had breast-fed, and those with children of their own had the greatest knowledge and confidence base in several areas, such as their ability to teach breast-feeding techniques and to treat cracked nipples. They were also more familiar with different types of breastpumps. There were no significant differences among those who were or were not breast-fed as a child nor among men versus women. Residency programs must provide comprehensive education on breast-feeding to prepare future pediatricians to meet the needs of patients and their parents.

Attitude of Health Personnel↗
PubMed1992

Attitudes of expectant fathers regarding breast-feeding.

Fathers participate in choosing the feeding method for their newborns. However they traditionally have not been included in most breast-feeding education programs. To examine expectant fathers' attitudes and knowledge regarding breast-feeding, we surveyed 268 men during the first session of their childbirth education classes at five private hospitals in Houston, Texas. The study population was 81% white, 8% black, and 6% hispanic. Ninety-seven percent (n = 259) of the total were married. Fifty-eight percent (n = 156) reported that their spouses planned to breast-feed exclusively; several significant differences existed between these men and those who reported plans for exclusive formula feeding. The breast-feeding group was more likely to believe breast-feeding is better for the baby (96% vs 62%; P less than .0001), helps with infant bonding (92% vs 53%; P less than .0001), and protects the infant from disease (79% vs 47% P less than .001). The breast-feeding group was also more likely to want their partner to breast-feed (90% vs 13%; P less than .0001) and to have respect for breast-feeding women (57% vs 16%; P less than .0001). Conversely, those in the formula feeding group were more likely to think breast-feeding is bad for breasts (52% vs 22%; P less than .01), makes breasts ugly (44% vs 23%; P less than .05), and interferes with sex (72% vs 24%; P less than .0001). The majority of both groups indicated breast-feeding was not acceptable in public (breast-feeding = 71%, formula feeding = 78%, P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗
PubMed1992

Lack of agreement of tympanic membrane temperature assessments with conventional methods in a private practice setting.

An infrared tympanic membrane thermometer (FIRST temp) said to approximate core temperature accurately is being marketed as a noninvasive, quick, and easy-to-use clinical instrument. The determination of tympanic membrane temperatures by this device was compared with the determination of oral, rectal, or axillary temperatures by a conventional glass thermometer. Subjects were patients of a pediatric group practice in Houston, Texas. FIRST temp and conventional temperature determinations on individual patients were completed within 5 minutes of each other. The presence or absence of otitis media was noted by the examining physician. Agreement between the two methods of temperature determination was assessed by calculating limits of agreement within which 95% (+/- 2 standard deviations) of individual differences would fall. The location of conventional thermometer (oral, rectal, axillary), time interval between the two separate measures, and the presence or absence of otitis media were entered into a multiple regression analysis to determine whether these factors influenced the observed differences between the two methods. A total of 144 patients were enrolled in the study; oral comparisons were obtained in 92 (57%) patients, rectal in 35 (24%), and axillary in 29 (19%). The upper and lower limits of agreement between temperature methods were 1.12 degrees C and 0.89 degrees C and the mean difference was -0.12 degrees C. Regression analysis revealed that only the site of conventional thermometer location (oral, rectal, axillary) was a significant predictor of FIRST temp/conventional differences. Each site had a range of agreement greater than 1.65% degrees C; axillary temperatures had the greatest range (-0.94 degree C to +1.30 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

A practical guide to successful breast-feeding management.

It is often difficult for new mothers to know whom to approach for the necessary guidance and practical problem solving required for successful long-term lactation. Although obstetricians are familiar with the care of the breast, they may not maintain the degree of postpartum follow-up necessary to ensure its proper function nor is it their responsibility to ensure that the infant receives proper nourishment. Pediatricians are expected to offer advice and information regarding not only the advantages and disadvantages of breastfeeding but also practical management of this art. We provide a guide for practitioners who wish to assist breast-feeding mothers and their infants.

Bottle Feeding↗
PubMedDate not supplied

Prenatal determination of demographic and attitudinal factors regarding feeding practice in an indigent population.

Demographic and attitudinal factors influencing the decision to breast- or bottle-feed were evaluated early in pregnancy by survey of 307 women in a low-risk prenatal obstetric clinic at a publicly funded hospital in Houston, Texas. Subjects responded to 17 demographic and 24 attitudinal questions. Racial classification revealed blacks 36.4%, whites 29.2%, and hispanics 30.8%. Twenty-five percent of the completed surveys were in Spanish. Of the total sample, 26.7% planned to breast-feed, 48.2% planned to bottle-feed, and 25.1% planned to do both. Multiple logistic regression analysis revealed six prominent independent risk factors for bottle-feeding. The most significant variable was lack of support for breast-feeding from a significant other (husband, mother, other relative, or friend), which had a odds ratio (OR) of 456.3. Other attitudinal variables achieving independent significance were disagreement with the statements "breastfeeding protects against disease" (OR = 4.0), "breasts were made for breastfeeding" (OR = 8.0), and "I want to know more about breastfeeding" (OR = 120.0). Significant demographic variables identified were completion of less than 12th grade (OR = 32.1), and age less than 35 years (OR = 43.3). These findings indicate the influence of significant others in the decision to breast-feed and suggest that future educational programs should require their inclusion if the prevalence of breast-feeding in this population is to be increased.

Adolescent↗
PubMedDate not supplied

Physicians' early challenges related to the pneumococcal conjugate vaccine.

OBJECTIVE: To characterize the obstacles faced by physicians regarding administration of a 7-valent pneumococcal conjugate vaccine (Prevnar) to all children younger than 2 years and to high-risk children from 2--5 years of age during the months immediately following national recommendations. DESIGN: Semistructured telephone interviews. PARTICIPANTS: Convenience sample (n = 24) of pediatricians and family physicians. RESULTS: Eighteen physicians were recommending pneumococcal vaccine and 6 were not. Those who were recommending pneumococcal vaccine had encountered resistance from parents and variations in private and public insurance coverage. Physicians who were not recommending pneumococcal vaccine expressed concern about the cost of the vaccine and general caution in adopting new vaccine recommendations. Respondents offered several suggestions for improving the vaccine recommendation process. CONCLUSIONS: This analysis of physicians' early decision making regarding pneumococcal vaccine reflects obstacles to vaccine implementation that may arise with the introduction of other childhood vaccines.

Adult↗
PubMedDate not supplied

A new paradigm in academic health centers: productivity-based physician compensation.

This article describes the challenge of designing an incentive-based compensation program for a large group of academic pediatricians in the Division of General Pediatrics at the University of Michigan Health System. The program is based on an incentive system that measures performance in clinical care, education and research. Faculty members' salaries arise from five components: base, clinical incentive, academic supplement, administrative differential and teaching credit.

Academic Medical Centers↗