儿科医生在母乳喂养方面的实践和态度的国家趋势：1995 年至 2014 年。
National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014.
机构信息
Department of Pediatrics, Children's Regional Hospital, Cooper University Health Care, Cooper Medical School, Rowan University, Camden, New Jersey;
Private Practice, Indianapolis, Indiana.
出版信息
Pediatrics. 2017 Oct;140(4). doi: 10.1542/peds.2017-1229. Epub 2017 Sep 18.
BACKGROUND AND OBJECTIVES
The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014.
METHODS
Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; = 832), PS #57 (2004; response rate = 55%; = 675), and PS #89 (2014; response rate = 51%; = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs).
RESULTS
From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [ < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems ( < .01).
CONCLUSIONS
Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary.
背景与目的
美国儿科学会（AAP）已确认母乳喂养为婴儿喂养的首选方法；然而，对于儿科医生的建议、附属医院的政策、咨询实践以及对母乳喂养的态度在过去 20 年中如何变化，几乎没有进行系统的研究。本研究从 1995 年至 2014 年对这些趋势进行了调查。
方法
数据来自 AAP 成员的全国代表性调查——周期性调查（PS）。PS#30（1995 年；回复率=72%； = 832）、PS#57（2004 年；回复率=55%； = 675）和 PS#89（2014 年；回复率=51%； = 620）收集了人口统计学、患者和实践特征，以及儿科医生的建议、附属医院政策、咨询实践和对母乳喂养态度的详细信息。本研究使用了双变量统计和逻辑回归模型，通过预测值（PV）分析了随时间的变化。
结果
1995 年至 2014 年，越来越多的儿科医生报告称他们的附属医院申请了“婴儿友好”认证（1995 年的 PV=12%，2014 年的 PV=56%； <.05），且越来越多的儿科医生报告称他们建议纯母乳喂养（65%至 76%； <.05）。然而，报告认为母乳喂养能够成功的受访者比例减少（1995 年的 PV=70%，2014 年的 PV=57%； <.05），以及报告认为母乳喂养的益处超过困难的受访者比例减少（1995 年的 PV=70%，2014 年的 PV=50%； <.05）。年轻的儿科医生比年长的儿科医生在处理母乳喂养问题方面的信心更不足（ <.01）。
结论
1995 年至 2014 年，儿科医生的建议和实践与 AAP 政策更加一致；然而，他们对母乳喂养成功可能性的态度恶化了。这两个截然不同的趋势表明，即使母乳喂养率继续上升，仍需继续努力加强儿科医生对母乳喂养的培训和态度。
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