Florin Oprescu

Infant Feeding Attitudes and Knowledge among Socioeconomically Disadvantaged Women in Glasgow

AbstractObjectives This study: (1) investigated infant feeding attitudes and knowledge among socioeconomically disadvantaged mothers in an urban community with historically low breastfeeding rates, (2) examined the influence of women’s social networks on infant feeding attitudes and decisions, and (3) validated a measure of infant feeding attitudes and knowledge in this population (Iowa Infant Feeding Attitude Scale, IIFAS). Methods Women attending a prenatal clinic (nxa0=xa049) reported on: (1) demographics, (2) infant feeding attitudes and knowledge (IIFAS), (3) feeding intent, (4) opinions about breastfeeding in public, and (5) social networks. Feeding method at discharge was abstracted from hospital charts. Social network members (nxa0=xa047) identified by the prenatal sample completed interviews covering: (1) demographics, (2) infant feeding attitudes and knowledge (IIFAS), (3) prior infant feeding methods and recommendations, and (4) opinions about breastfeeding in public. Results Mean IIFAS scores were low in both groups, indicating neutral to negative breastfeeding attitudes; mothers’ scores were lower than social network members. Higher maternal IIFAS score was significantly associated with intended and actual breastfeeding. A social network positive towards breastfeeding was significantly associated with mothers’ positive attitude towards breastfeeding. Both mothers and social network members support breastfeeding in public. IIFAS internal consistency was robust for both mothers and social network members. Predictive validity was demonstrated by significant positive association between score and intended and actual feeding methods.nConclusions Knowledge and attitude predict breastfeeding initiation in this population. Social network members may influence mothers’ feeding choices. This research is important because attitudes and knowledge derived from the IIFAS can be used to develop and evaluate breastfeeding promotion programs.

Empowerment and Sense of Community: Clarifying Their Relationship in Community Organizations

The research reported here tested the factor structure of a measure for sense of community in community organizations, and it evaluated sense of communitys potential as an empowering organizational characteristic within an organizational empowerment framework. Randomly selected community organization participants (N = 561) were surveyed as part of a study of a substance abuse prevention initiative located in the northeastern United States. Confirmatory factor analysis verified the putative structure of the sense of community measure tailored to community organizations. Hierarchical regression analyses indicated that community organization sense of community significantly predicted intrapersonal empowerment after controlling for demographics, participation, alienation, and other empowering organizational characteristic. Findings imply that organizational sense of community should be considered as an empowering organizational characteristic in community-based health education.

Reliability and validity of the Romanian version of a scale to measure infant feeding attitudes and knowledge

Aim: To describe the development and testing of the Romanian version of the Iowa Infant Feeding Attitude Scale (IIFAS‐R). The original instrument has well‐established psychometrics for use in English‐speaking countries.

Online information exchanges for parents of children with a rare health condition: key findings from an online support community.

Background The Internet provides new opportunities for parents of children with difficult illnesses and disabilities to find information and support. The Internet is particularly important for caregivers of children with special needs due to numerous health-related decisions they face. For at-risk populations, online support communities can become key settings and channels for health promotion and communication. Objective This study is an initial exploration of the information-seeking and information-provision processes present in an online support community, which is an area of opportunity and interest for Internet-based medical research and practice. The aim of this study was to explore and describe information-related processes of uncertainty management in relationship to clubfoot. Specifically, the study explored interpersonal communication (information seeking and provision) in an online support community serving the needs of parents of children with clubfoot. Methods The study population consisted of messages posted to an online community by caregivers (parents) of children with clubfoot. The theoretical framework informing the study was the Uncertainty Management Theory (UMT). The study used content analysis to explore and categorize the content of 775 messages. Results Women authored 664 of 775 messages (86%) and men authored 47 messages (6%). Caregivers managed uncertainty through information seeking and provision behaviors that were dynamic and multilayered. The ratio of information-seeking messages to information-provision responses was 1 to 4. All five types of information-seeking behaviors proposed by Brashers’ schema were identified, most of them being correlated. Information seeking using direct questions was found to be positively correlated to self-disclosure (r=.538), offering of a candidate answer (r=.318), and passive information seeking (r=.253). Self-disclosure was found to be positively correlated to provision of a candidate answer (r=.324), second-guessing (r=.149), and passive information seeking (r=.366). Provision of a candidate answer was found to be positively correlated with second-guessing (r=.193) and passive information seeking (r=.223). Second-guessing was found to be positively correlated to passive information seeking (r=.311). All correlations reported above were statistically significant (P<0.01). Of the 775 messages analyzed, 255 (33%) identified a medical professional or institution by name. Detailed medical information was provided in 101 (13%) messages, with the main source of information identified being personal experience rather than medical sources. Conclusion Online communities can be an effective channel for caregivers, especially women, to seek and offer information required for managing clubfoot-related uncertainty. To enhance communication with parents, health care institutions may need to invest additional resources in user-friendly online information sources and online interactions with caregivers of children with special illnesses such as clubfoot. Furthermore, explorations of information-seeking and information-provision behaviors in online communities can provide valuable data for interdisciplinary health research and practice.

Emergency department visits for nonfatal childhood injuries in Romania.

Background Childhood injury rates are higher in low and middle-income countries than in high-income countries. Childhood injuries have not been widely studied in Romania, a middle-income country, because data sources are lacking. Objective This study presents the first surveillance data of nonfatal childhood injuries from a large childrens hospital in Cluj, a major city of Romania. Methods This retrospective study included review of medical records of injured children of 0–18 years of age treated in a major city pediatric emergency department from 1999 to 2003. Results In the 5-year study period, 1179 childhood injuries were treated in the emergency department, for an average of 236 patients per year. For the county of Cluj, this represents an annual average injury incidence of 197 per 100u2009000 children younger than 5 years, 140 per 100u2009000 children aged 5–14 years, and 135 per 100u2009000 for children aged 15–18 years. Unintentional injuries represented 77.8% of cases, 18% were self-harm and suicide attempts, and 4.3% were assaults. Conclusion These trends, among the first reported from Romania, can help identify priority prevention areas.

Pediatric poisonings and risk markers for hospital admission in a major emergency department in Romania.

To identify the prevalence, characteristics, and risk markers for childhood poisonings treated in the emergency department of a large Romanian hospital. Trauma registry data using ICD-10 codes and case summaries were studied to identify poisonings among children aged 0–18. Multivariate logistic regression identified factors associated with hospital admission. Between 1999 and 2003, 1,173 pediatric trauma cases were seen in the emergency department; 437 (37.3%) were treated for poisoning, including medication (35%), alcohol (26%), chemical products (19%), and carbon monoxide (14%). Half of all poisonings were unintentional, primarily affecting childrenxa0<xa010xa0years. Half were intentional, mainly affecting children 10–18. Females were three times more likely than males to have documented suicidal intent (Pxa0<xa0.0001). Over 30% of suicide attempts were among children ages 10–14 (Pxa0<xa0.0001). We report significantly increased adjusted odds ratios (Pxa0<xa0.05) of hospital admission for children 10–18, and for chemical substance poisoning, and suicidal intent. Pediatric poisoning is a serious public health issue in Romania, and we suggest these findings are relevant across other eastern European countries with limited resources. Poisonings result in morbidity and hospital admissions, yet there are few prevention resources available. Health education programs and consumer product safety policies are needed in Romania and eastern Europe.

Validation of a Romanian scale to detect antenatal depression

The aim of this study was to develop and validate a linguistically and culturally appropriate version of the Edinburgh Postnatal Depression Scale (EPDS) for use with women attending antenatal care in Romania. We translated and tested a Romanian version of the EPDS (EPDS-R) in four hospitals in three Romanian cities: Cluj-Napoca, Satu Mare, and Sighetu-Marmatiei. The study population included third-trimester women attending antenatal clinics (n=418); 364 subjects were included in the analytic sample. We used the Center for Epidemiologic Studies Depression Scale (CES-D) as a “gold standard”. We assessed reliability, validity, and conducted sensitivity analysis to establish an EPDS-R cutpoint. We found that reliability was robust (α=0.89) and there was a significant linear relationship between EPDS-R and CES-D scores (r=0.77; p<0.001). We established an EPDS-R cutpoint of >12 to balance sensitivity and specificity. Principal component analysis revealed a two-factor solution. We detected antenatal depressive symptoms prevalence rates of 32% (CES-D) and 38% (EPDS-R). This is the first study to report exclusively on antenatal depression and the use of the EPDS in Central and Eastern Europe. The EPDS-R is easy to administer, reliable, and valid for screening depression among antenatal women in Romania.

A Structured Public Health Approach to Increasing Rates and Duration of Breastfeeding in Romania

BACKGROUNDnStudies indicate that since 1990, rates of breastfeeding initiation and duration in Eastern Europe, including Romania, have decreased. Most breastfeeding promotion efforts in Romania have focused on in-hospital care, with an emphasis on training clinicians. Prior studies report that about 88% of Romanian mothers initiate breastfeeding in the hospital; however, these same studies report limited breastfeeding duration. We posit that an important problem is lack of support and education in the weeks and months following the birth. The nature of this problem suggests the need for an integrated and structured public health solution.nnnMETHODSnBased on our independent research, the results of an international maternal and child health (MCH) conference, and consultation with Romanian and American experts, we propose use of the public health problem-solving paradigm to support breastfeeding in Romania.nnnRESULTSnThis article presents a conceptual model showing the integration of input, output, and process components and a logic model explicating possible interventions (or needs) and barriers to breastfeeding. We propose a public health solution that begins with a new MCH within the public health training structure at a major Romanian university and a summer course bringing together Romanian and American students to study MCH, including breastfeeding.nnnCONCLUSIONSnWe believe that these two courses will promote enthusiasm and generate ideas to develop community-based interventions as well as policy recommendations to increase breastfeeding duration in Romania. We suggest that this public health problem-solving approach provides an integrated way of maintaining and increasing breastfeeding; furthermore, this approach could be broadly used in Eastern Europe.

Parents Managing Clubfoot

Using established categories of social support and the Uncertainty Management Theory, this interdisciplinary study situated at the intersection of social science, medicine, information technology and health communication explored the types of social support exchanged by caregivers in a virtual online support community for parents of children with clubfoot. A systematic content analysis of 775 messages indicated that the online environment allows participants to receive and provide a wide range of social support, particularly informational, emotional and esteem support. Results reveal what social support behaviors members of the online support community (OSC) exhibit as a result of requests from their peers, thus identifying what types of health communication may be effective in such settings. Furthermore, OSCs provide a great opportunity for scholars and practitioners to learn about the experiences of caregivers of children with health conditions and explore where gaps in health communication may exist. It is suggested that online support communities are key channels for future health research, communication and interdisciplinary practice.