Lois B. Dusdieker

Investigation of a model for the initiation of breastfeeding in primigravida women.

Primigravida women are faced with the decision about how they will feed their infants. Many will decide to breastfeed but the motivation for this choice is unclear. While certain beliefs and worries about breastfeeding appear to predict women who will choose to breastfeed, such concepts are influenced by a combination of other values, support resources and socioeconomic background. The main goal of this research was to demonstrate how multivariate analysis can be applied to the infant-feeding decision and how it can lend a theoretical interpretation to social issues such as the initiation of breastfeeding. One hundred completely breastfeeding and 57 bottle feeding primigravida women were enrolled in the study and completed a pretested Likert-type questionnaire. Three primary predictors for the initiation of breastfeeding were identified: positive maternal beliefs about breastfeeding; the absence of maternal worries about breastfeeding; and higher levels of maternal education. Secondary psychosocial predictors significantly associated with maternal breastfeeding beliefs included maternal beliefs in increased personal satisfaction from breastfeeding and maternal beliefs in preventive health measures. Secondary psychosocial predictors significantly related to maternal worries about breastfeeding before breastfeeding began. Over half of the strength of the direct psychosocial predictors for breastfeeding initiation could be attributed to their respective groups of indirect predictors. Thus, the main contribution of this research has been to shift the emphasis of past research away from differences between groups of bottle feeders and breastfeeders to focus more precisely on the decision-making process involved in the infant feeding choice.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of supplemental fluids on human milk production

The effect of supplemental fluid intake on milk production was evaluated in a randomized, crossover design study of breast-feeding mothers. Twenty-six women whose infants were growing well with breast-feeding alone were enrolled in the study when their infants were 90 to 120 days of age. Twenty-one women consumed at least a 25% increase in fluids (mean 59%, range 26% to 140%). Mean daily milk production was 814 +/- 163 ml/day in the baseline period and 797 +/- 157 ml/day during increased fluid intake. There was no significant change in milk production between study periods and no significant relationship between percent increase in fluid intake and change in milk production nor between volume of fluid intake and volume of milk produced.

Is Treatment of Acute Otitis Media With Once-a-Day Amoxicillin Feasible? Results of a Pilot Study

We report a study of the feasibility of once-a-day amoxicillin to treat acute otitis media (AOM). Seventy-seven children between ages 7 months and 12 years with AOM participated in a double-blind, placebo-controlled trial. Subjects received amoxicillin 40 mg/kg/day for 10 days. They were similar in age, sex, history of ear infections, and presenting symptoms. Group I received one total dose of amoxicillin and two doses of placebo daily. Group II received three divided doses of amoxicillin daily. Parents kept a daily diary of symptoms related to the childs illness and possible medication side effects. Ten children were lost to follow-up. In the remaining 67, pneumatic otoscopy and tympanometry after 10 to 14 days revealed that AOM had resolved in 82% of group I and 68% of group II. Groups showed no significant differences in persistence of middle ear effusion; 39% in group I and 24% in group II still had fluid. Diaries showed no significant differences between groups in medication side effects. Thus, reduced-frequency dosing for AOM seems feasible and more realistic than current regimens.

How much antibiotic suspension is enough

Objectives. Pilot data suggest that inadequate antibiotic volumes are often dispensed. Study goals were to determine the frequency of inadequate antibiotic volumes dispensed by local pharmacies, develop prescription-writing guidelines to ensure that adequate antibiotic suspension volumes are dispensed, and document the adequacy of verbal/written counseling pharmacists provide. Methods. Sixty-one local pharmacies filled prescriptions for penicillin potassium (PCN; 250 mg/5 mL [5 mL orally 3 times daily for 10 days]) and Bactrim (trimethoprim-sulfamethoxazole [TMP-SMX] 5 mL orally twice daily for 10 days). The prescriptions noted only to “dispense a 10-day supply.” Volumes were measured first as total amount dispensed and then into total doses dispensed. Written/verbal instructions were documented. Results. The volume of PCN dispensed was 195 ± 25 mL (range: 105–222 mL) for an average of 29.4 doses, where 30 doses were needed. TMP-SMX dispensed had a volume of 107 ± 5 mL (range: 98–120 mL) resulting in an average of 16.5 doses, where 20 doses were needed. Twenty pharmacies (33%) did not dispense a measuring device. Verbal counseling by the pharmacist and written instructions were not uniformly given. Conclusions. We suggest calculating the actual volume needed plus an additional 10% to 30% of volume (depending on the viscosity). The prescription should also request a medication-measuring/administering device. Patient counseling and instruction should be expanded.

Monitoring Health Care: Children with Bacteriuria

A program which used a nurse clinician to monitor the health care received by children with bacteriuria is described. We identified 152 patients with significant bacteriuria (≥ 105 organisms/ml) by urine culture from 351 patients who either had symptoms suggestive of urinary tract infections or routine urinalysis during health care visits. Adequate health care was provided to 116 (76 per cent) of the 152 patients and inadequate health care to 31 (24 per cent) of these patients. A significant number of patients who received inadequate therapy (12 of 36, or 37 per cent) compared to 8 (7 per cent) of 116 patients who received adequate therapy failed to clear their bacteriuria (Chi-square = 17, p < 0.001). Eight patients with recurrent bacteriuria despite adequate therapy were shown to have no urinary tract anomaly by radiography. The use of recurrence of UTI as a criterion for measuring adequacy of therapy and the uniqueness of the program are discussed.

Prognostic factors predicting control of chronic asthma symptoms in children receiving prophylactic bronchodilator therapy.

The factors predicting the control of asthma symptoms were studied in 312 consecutive children with chronic asthma who were receiving chronic prophylactic bronchodilator therapy. Asthma symptoms were controlled in 232 (74.4%) patients but not in 80 (25.6%) patients after 18 months of therapy. The cumulative percentage of patients in whom asthma symptoms were controlled increased with the duration of therapy. During the first 6 months of therapy, children who had a history of exacerbation of symptoms by fear stimulus or by dust had respectively an 83.3% (p = 0.0001) and a 35.4% (p = 0.003) lower rate of control of asthma symptoms than children without such a history. Similarly, children with a history of worsening asthma symptoms following ingestion of cold foods or drinks had a 71.4% (p = 0.002) lower rate of control of asthma symptoms after 6-12 months of therapy than children without such a history. Certain factors are important for predicting control of asthma symptoms at different times following the initiation of therapy and may relate to the lability of the airways to these stimuli.