BackgroundIntegrative Medicine (IM) is an emerging field in paediatrics, especially in the USA. The purpose of the present study was to assess the attitudes and beliefs of Youth Health Care (YHC) physicians in the Netherlands toward IM in paediatrics.MethodsIn October 2010, a link to an anonymous, self-reporting, 30-item web-based questionnaire was mailed to all members of the Dutch Organisation of YHC physicians. The questionnaire included questions on familiarity with IM, attitudes towards Integrative Paediatrics (IP), use and knowledge of Complementary and Alternative Medicine (CAM), demographic and practice characteristics.ResultsA total of 276 YHC physicians (response rate of 27%) responded to the survey. Of the respondents, 52% was familiar with IM and 56% had used some kind of CAM therapy during the past 2 years, of which self-medicated herbal and/or homeopathic remedies (61%) and supplements (50%) were most frequently mentioned. Most of the YHC physicians (62%) seldom asked parents of clients about CAM use. One third of the YHC physicians recommended CAM to their clients. In general, about 50% or more of the respondents had little knowledge of CAM therapies. Predictors for a positive attitude towards IP were familiarity with IM, own CAM use, asking their clients about CAM use and practising one or more forms of CAM therapy. Logistic regression analysis showed that the following factors were associated with a higher recommendation to CAM therapies: own CAM use (odds ratio (OR) = 3.8; 95% confidence interval (CI) = 2.1-6.9, p = 0.001) and practising CAM (OR 4.4; 95% CI = 1.6-11.7, p = 0.003).ConclusionsIn general Dutch YHC physicians have a relative positive attitude towards IP; more than half of the respondents used one or more forms of CAM and one third recommended CAM therapies. However, the majority of YHC physicians did not ask their clients about CAM use and seemed to have a lack of knowledge regarding CAM.
BackgroundLow socio-economic status combined with other risk factors affects a person's physical and psychosocial health from childhood to adulthood. The societal impact of these problems is huge, and the consequences carry on into the next generation(s). Although several studies show these consequences, only a few actually intervene on these issues. In the United States, the Nurse Family Partnership focuses on high risk pregnant women and their children. The main goal of this program is primary prevention of child abuse. The Netherlands is the first country outside the United States allowed to translate and culturally adapt the Nurse Family Partnership into VoorZorg. The aim of the present study is to assess whether VoorZorg is as effective in the Netherland as in the United States.MethodsThe study consists of three partly overlapping phases. Phase 1 was the translation and cultural adaptation of Nurse Family Partnership and the design of a two-stage selection procedure. Phase 2 was a pilot study to examine the conditions for implementation. Phase 3 is the randomized controlled trial of VoorZorg compared to the care as usual. Primary outcome measures were smoking cessation during pregnancy and after birth, birth outcomes, child development, child abuse and domestic violence. The secondary outcome measure was the number of risk factors present.DiscussionThis study shows that the Nurse Family Partnership was successfully translated and culturally adapted into the Dutch health care system and that this program fulfills the needs of high-risk pregnant women. We hypothesize that this program will be effective in addressing risk factors that operate during pregnancy and childhood and compromise fetal and child development.Trial registrationCurrent Controlled Trials ISRCTN16131117
Background : The prevention of child abuse should starts as early as possible in the life of children living in families at risk for abuse. We describe a two-stage selection procedure to identify those pregnant women who are at risk for child abuse. The procedure was developed to guide these mothers to VoorZorg, the Dutch adaptation of the Nurse-Family Partnership program. Methods: In the first stage of the selection, professionals, most often midwives, apply five inclusion criteria: maximum age of 25 years, low educational level, maximum gestational age of 28 weeks, no previous live births and understanding of the Dutch language. In the second stage, trained nurses interview the selected pregnant women by applying a checklist with risk factors for child abuse. To identify the appropriateness of the two-stage selection procedure trained interviewers measured risk behaviour of the selected participants with validated questionnaires. Results: 460 high risk pregnant women were selected through the two-stage selection procedure. The prevalence of risk factors for child abuse in this sample is: single parent: 76%, drug or alcohol use: 25%, history of abuse: 50%, no current job and/or education: 74%. In total, 98% of the selected women had ≥ 4 risk factors for child abuse. Conclusions: The two-stage selection procedure adequately identifies pregnant women with multiple risk factors for child abuse.
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