BACKGROUND: The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age.
METHODS: This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age..Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.
CONCLUSIONS: Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide\'s recommendations, clinical variability can be reduced and the care received by patients can be improved.
BACKGROUND: The trial was registered with ClinicalTrials.gov, number NCT01474096.

BACKGROUND: An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals.
METHODS: Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services.
METHODS: A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation.
RESULTS: A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups\' education and practice.
CONCLUSIONS: The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services.

We report results from an experimental study that tested the effectiveness of dissemination interventions to improve implementation of smoking cessation guidelines in maternal and child public health clinics. We additionally examine individual clinic results for contextual explanations not apparent from the experimental findings alone. Twelve clinics in Illinois were randomized to three dissemination strategies: (i) core dissemination (provision of the 2000 Public Health System Clinical Practice Guideline and a tested smoking cessation program, including program supplies and training), (ii) core dissemination and access to telephone counseling and (iii) core dissemination, telephone counseling access and outreach visits to clinics. Implementation outcomes were post-dissemination improvements over baseline in the percent of smokers reporting receipt/exposure to (i) provider advice, (ii) self-help booklet, (iii) videos, (iv) posters and (v) an adjunct intervention. Results showed significant increases in the percent of smokers receiving a booklet (overall) and an adjunct intervention (Groups 2 and 3). There were no increases in smoker-reported provider advice or videos and poster exposure. Examination of individual clinic findings showed that seven clinics accounted for all the experimental effectiveness. Smoker-reported provider advice to quit also increased in these clinics. Type of clinic and the absence of disruptive events distinguished clinics with and without effective dissemination outcomes.

OBJECTIVE: To assess the current practices of nutrition counselling given by nurses in well-women (WW) and well-baby (WB) clinics in Finland.
METHODS: A semi-structured questionnaire was distributed to nurses and their clients in clinics nationwide.
METHODS: The source and the quality of nutrition counselling and specific conditions including allergic diseases and vitamin D supplementation.
RESULTS: The clinics constituted the most important source of information for the clients. Personal counselling was highly appreciated. However, 83% of pregnant women reported having received dietary counselling, which deviates from the figure reported by nurses (99%, p=0.0003). Counselling concerning allergies was targeted to reduce the risk of infant allergy by means of elimination diets. In contrast to the report of the nurses (60% in WW and 18% in WB clinics), only 16% (p<0.0001) of the pregnant and 7% (p=0.022) of the breastfeeding women reported that they had been advised to use vitamin D supplements during the winter season.
CONCLUSIONS: This study calls for co-operation between scientists, governmental policy makers and healthcare professionals to ensure a continuous chain of information, applicable to nutrition counselling, from scientific data to everyday practice.

Information, education, and communication (IEC) guidelines for implementing the IEC component of the maternal and child health(MCH)/family planning(FP) project (MON/93/P01) of the Ministry of Health of Mongolia (the result of a mission by the CST for the East and South East Asia Adviser on Population Communication) target 3 groups: all women of reproductive age; adolescents and young adults aged 15-34 (36.7% of the total population); and children under 14 (41% of the total population). Government policy makers, legislators, administrators, school teachers, media practitioners, and health educators will receive IEC messages. Initial efforts will be in urban areas. The messages will cover reproductive health and hygiene, responsible sex, family life education, delaying marriage and first pregnancy, dangers of abortion, sexually transmitted disease (STD), safe motherhood, breastfeeding, child care, contraceptive methods, and misconceptions about family planning. Specific messages will be used for 5 high risk groups of women (those aged 20 or less; those older than 35; those with 4 or more children; those with children less than 2 years apart; and those 15-34 years of age). Messages will first be broadcast over radio and television and then confirmed, supported, and reinforced through use of print materials and face to face interactions with service providers. The proposed workplan includes activities on audience research; training on communication design; production of IEC materials, and planning and implementing IEC campaigns; IEC materials development and FP counseling workshops; newsletter production; and establishment of a Documentation Centre.

This paper examines the role of the Program for International Training in Health (INTRAH) in the development of national family planning service guidelines throughout sub-Saharan Africa. INTRAH noted that the service managers, trainers and service providers lacked a common set of references to guide family planning service development, provision, training and evaluation. This was evident from the great variations in family planning service delivery practices and procedures and working conditions, and considerable confusion about what constituted an acceptable level of family planning service coverage and quality. In response to this problem, INTRAH conducted a series of technical assistance program in Botswana, which resulted in two ministry-sanctioned service and training-directed guidance documents. These documents include a national family planning service policy and a set of standards to accompany the policy statements, and a set of family planning service guideline that operates the policy and standards. These documents are available at all government-sponsored family planning service sites, and service providers are expected to use them as references for service planning, provision and evaluation. In addition, INTRAH assists ministries of health to organize for and prepare drafts of country-appropriate service guides and guidelines with an emphasis on in-country working groups.

In these guidelines for improvement in the Indian Family Welfare Programme the Auxiliary Nurse Midwife (ANM) comes under scrutiny, especially in relation to other family planning personnel. The ANM is expected to provide maternal child care, family planning, recordkeeping, training and supervision of local midwives in maternal-child health services. Field observations show that the ANM has not been as effective as expected. Reasons offered include: lack of trust and understanding between the ANM and the villagers, location of subcenter, lack of supplies, and inadequate services. The author believes support and supervision by family planning personnel could improve the efficiency of the ANM. A 3 tier supervisional structure is proposed including; a) supervision by state headquarters, b) supervision by district level staff, c) supervision by primary health center staff. A sample of personnel involved and projected supervisional duties is described. The author feels that implementation of such needed improvements as undefined work areas and duties; poor followup; limited use of available literature; lack of scheduling; poor supplies and attitudes on part of the workers can succeed with the 3 tier system.

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