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Conocimientos de los residentes de medicina de familia de Tenerife sobre la lactancia materna
Resumen
Introducción
Los médicos de familia juegan un papel fundamental en la promoción de las prácticas adecuadas de la lactancia materna (LM), por lo que deben tener un conocimiento adecuado sobre el tema.
Objetivo
Evaluar el conocimiento sobre la LM y los factores asociados en los médicos de familia en una unidad de primer nivel de atención de Cuernavaca, México.
Material y métodos
Se realizó un estudio transversal, en 93 médicos adscritos y residentes de medicina de familia. El conocimiento sobre la LM se evaluó mediante el cuestionario ECoLa de 20 ítems, considerando variables familiares y demográficas. Se realizó una estadística descriptiva de los datos y los factores asociados al nivel de conocimiento se evaluaron mediante un modelo de regresión logística.
Resultados
De la muestra, el 72% fueron mujeres; 41% estaban casados y 55% tenían al menos un hijo, el 23% había tomado al menos un curso de LM. Se obtuvo una media de 11,5 aciertos en el cuestionario ECoLa, 52% se clasificaron en un nivel de conocimiento bajo, 45% en regular y 3% en adecuado. Después del ajuste por edad, cursos de lactancia y estado civil, las principales variables asociadas a un conocimiento regular/bueno fueron tener al menos un hijo (OR 4,63 IC 95% 1,1-19,42) y el sexo (mujer OR 5,75 IC 95% 1,58-20,94).
Conclusiones
El 52% de los médicos de familia mostró un conocimiento bajo sobre la LM. La experiencia personal de la paternidad o maternidad de los médicos de familia se asocia al mejor conocimiento de la LM, superando a las capacitaciones y a los cursos.
To report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding.
Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed, breast and bottle feed, bottle feed, or uncertain) at 32 wk of pregnancy: intention in the first week, intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months.
Data were available on 10,548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth, only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum, the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3, 4.4), compared with 2.5 mo (95% CI 2.4, 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression, using intended duration as the only explanatory variable, correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months.
This large population-based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.
A study of 78 primiparas examined the role of prenatal intent and postnatal experiences in breastfeeding duration Those fully breastfeeding 3 months after the birth of the baby had a higher level of education, timed their decision to breastfeed earlier, intended to breastfeed longer and had a more negative attitude to formula feeding Commitment and confidence scores were not related to breastfeeding duration in first-tune mothers Breastfeeding duration was also related to the timing of the first breastfeed and extent of mother-infant contact in the 72 hours after birth but not to the number of feeding problems
In this study a questionnaire was used to survey the attitudes towards and knowledge of breastfeeding of 300 health professionals working in Gippsland, Victoria. All groups investigated showed a decrease in knowledge with advancing age and years since training. Female health professionals who reported a positive experience of breastfeeding had a higher average score than those who had never breastfed and those who reported a negative experience of breastfeeding.
Physician support has been shown to increase breast-feeding rates, but anecdotal reports suggest that physicians are ill prepared for their role in breast-feeding promotion. Inadequate breast-feeding education during residency training may be a contributing factor.
A self-administered questionnaire mailed to 1099 family medicine residents and 665 recently board-certified family physicians assessed knowledge, attitudes, education, and activity related to breast-feeding promotion. Response rates were 71% for residents and 58% for physicians.
Although residents and physicians were strongly convinced that family physicians should be involved in breast-feeding promotion, both groups demonstrated significant deficits in knowledge about breast-feeding benefits and clinical management strategies. Common errors included inappropriate recommendations for breast-feeding termination or formula supplementation, a proven cause of breast-feeding failure. Personal breast-feeding experience was the only factor consistently associated with more frequent breast-feeding promotion activity among residents and increased self-confidence for both groups. Respondents reported only limited opportunities for developing breast-feeding counseling skills during residency training.
Improved breast-feeding education is needed for family medicine residents and physicians. Residency training and continuing education programs should emphasize the benefits of breast-feeding, clinical management strategies, and development of practical counseling skills.
The family physician can significantly influence a mother's decision to breast-feed. Prenatal support, hospital management and subsequent pediatric and maternal visits are all-important components of breast-feeding promotion. Prenatal encouragement increases breast-feeding rates and identifies potential problem areas. Hospital practices should focus on rooming-in, early and frequent breast-feeding, skilled support and avoidance of artificial nipples, pacifiers and formula. Infant follow-up should be two to four days postdischarge, with liberal use of referral and support groups, including lactation consultants and peer counselors.
The study objective was to determine the initiation rate, duration and exclusiveness of breastfeeding, in women resident in the North Eastern Health Board (NEHB) region. An additional aim was to identify determinants that influence the initiation and duration of all types of breastfeeding. All eligible mothers completed a self-administered questionnaire. For breastfeeding mothers there was additional follow-up, by telephone, at six and fourteen weeks postnatal. In total, 127 (51.4%) mothers initiated breastfeeding. This gradually declined to 52 (21.1%) at 14 weeks postnatal. Mothers' attributes significantly associated with initiating breastfeeding included: having previously breastfed, completed third level education, decision to breastfeed made early in pregnancy, being a non-smoker, having a mother who also breastfed, belonging to higher social class and age 24 years or older. However, after controlling for all of these variables in a regression model, only the following factors remained significant: having previously breastfed, completed third level education and the decision to breastfeed made early in pregnancy. Therefore, as decisions on infant feeding method are made prior to or early in pregnancy, efforts to increase breastfeeding rates will have to occur at societal level. Health sector initiatives can only have limited effect. In addition, creative methods must be developed and employed to encourage women from lower socio-economic groups to breastfeed.
Medical school and residency training programs, in which practice patterns are established, frequently lack formal education in breastfeeding in the United States. This project, a curriculum based on the Wellstart Lactation Management Guide, was developed for resident physicians and medical students at the University of New Mexico to address the deficiency in formal education about breastfeeding. The curriculum, developed and implemented by faculty members from obstetrics/gynecology, pediatrics, and family medicine, includes formal interactive teaching sessions, discussion of breastfeeding issues on daily clinical rounds, and patient visits with lactation support personnel. Interns from the Departments of Pediatrics, Obstetrics/Gynecology, and Family Medicine participate. Surveys of participating residents and faculty demonstrate highly favorable attitudes. In conclusion, a multidisciplinary approach to breastfeeding education is feasible and well received by both teachers and residents.