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Purpose While rates of breastfeeding have been increasing in the United States in recent decades, disparities exist among certain populations, including residents of the rural Southeast. Mothers’ perceptions of embarrassment, convenience, and social support related to breastfeeding may affect whether they choose to breastfeed and for how long. This study evaluated the effectiveness of a video intervention in improving perceptions of breastfeeding among pregnant women presenting for a prenatal clinic visit in rural Appalachia. Its effectiveness in increasing reported likelihood of breastfeeding was also assessed. Methods A multidisciplinary course team established a partnership with an OB/GYN clinic that serves a high volume of pregnant women. A 15 minute video addressing issues of embarrassment, convenience and social support related to breastfeeding was shown in the clinic waiting room. The video, Breastfeeding: Another Way of Saying I Love You, had been previously developed and evaluated by the Mississippi Department of Health. Pregnant women visiting the clinic during 8 days in 2009 were invited to complete an anonymous written survey immediately before and after viewing the video. The survey included items on demographics, perceptions of breastfeeding, and intention to breastfeed. Descriptive statistics were calculated. The proportion of women reporting improved perceptions of breastfeeding was compared between subgroups using chi-square testing. Mean breastfeeding perception scores were compared between subgroups and changes in women’s intention to breastfeed were evaluated. Results Before watching the video, of the 77 participants, 38.9% reported previously breastfeeding a child, 51.3% planned to breastfeed, and 25% were undecided. Consistent with demographics of the region, participants were predominantly white (91%). Twenty-six percent were teenagers and 71.5% reported having a high school education or less. After viewing the video, perceptions of embarrassment, convenience, and social support related to breastfeeding improved in a range of 39-44.2%, 37-40%, and 33.3-63% of women, respectively. Mothers who watched the video with a supportive other were more likely to report improved perceptions of embarrassment than mothers who watched the video alone (t=3.577, df=73, p=.001). Of the mothers who reported being undecided about breastfeeding prior to watching the video, 57.9% reported being more likely to breastfeed after watching the video (chi2=10.22, df=2, p=0.006). Conclusion The findings suggest this time-efficient video intervention was an effective means of improving perceptions of breastfeeding during the prenatal period among a sample of rural Appalachian women. Results indicate that its efficacy is significantly improved if pregnant women view it with a supportive other, and it is most useful in increasing likelihood of breastfeeding in women who are undecided about how they will feed their child.

Background: In recent years, the Accreditation Council for Graduate Medical Education (ACGME), and the Ambulatory Pediatric Association (APA) have developed detailed resident learning objectives and competencies. Maintaining adequate documentation that residents are fulfilling these objectives and competencies is a challenge. Objectives: To develop and evaluate use of an internet based curriculum, EPIC (East Tennessee Pediatric Internet Curriculum) to facilitate teaching and evaluation of the core competencies. Methods: Goals and content for the site were developed based on literature review and input from a pediatric internet committee. Resident internet-based learning is being evaluated using pre- and post- surveys over a six month period. Results: EPIC is a central location for residents to access information, including announcements, phone lists, and scheduling information. Educational content is organized around the six core competencies for resident education. For example, “Medical Knowledge”consists of a portfolio system developed for the ambulatory clinic. Portfolios include a checklist of pertinent information to be covered during a patient encounter and a related downloadable article to enhance resident knowledge. The section also includes links to other learning resources. An interactive discussion forum exists to facilitate discourse on medical and residency-related topics. Residents also complete online pre- and post- test questions during every clinical rotation and receive instant feedback on their responses. All 11 residents completed the pre-survey. Frequent or very frequent internet use was reported by 54% of residents to answer specific clinical questions and 45% of residents for general medical learning during the work day. Conclusion: Pediatric residents already utilize the internet to access medical information. EPIC accommodates residents’varying schedules and is a useful adjunct to other teaching and evaluation methods.

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Background: The process of level of care (LOC) determination has been traditionally fraught with unreliability and lack of objectivity. There is a similar need for reliable objective LOC determination tools for youth in the juvenile justice systems, which have high prevalence of psychiatric disorders and unmet mental health needs and are disproportionately from minority backgrounds. The CASII has already demonstrated significant interrater reliability and validity in studies with mental health and child welfare populations. Method: In 2004 and 2005, the Tennessee CPORT team reviewed 206 youth in the juvenile justice system ages 13 and older, 92.8% male, with 37.4% Caucasian, 55.8% African American. Instruments used included the CASII, CAFAS, CBCL, YSR, TRF, and the CPORT Child and Family Indicators. Results: There was a significant correlation between all of the CASII subscales and the CAFAS Total Scores (Pearson coefficients 0.210 to 0.618). The CASII Total Score and the CASII LOC were both highly correlated to CBCL, the YSR, and the TRF total scores and sub-scales. Significant correlations between the CASII LOC were found in 10 of the 13 CPORT Child and Family Indicators, while actual LOC placement was significantly correlated with only 4 of the 13 dimensions. The actual LOC placement was significantly different than recommended CASII LOC (p < 0.0000), with the majority of recommended LOCs being lower. Conclusions: This LOC tool is demonstrating high levels of reliability and validity in different systems of care settings, including juvenile justice, child welfare, and mental health contexts. Use of the CASII could result in significant savings in resources that could be used to provide services for adolescent offenders, and in reduction in unnecessary restrictiveness of placements.

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