Diet plans step by step 0-2,best diet meal delivery,lose weight fast on protein diet foods - Plans On 2016

10.04.2016
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Objectives: To evaluate impact of postnatal health education for mothers on infant care and postnatal family planning practices in Nepal. Design: Randomised controlled trial with community follow up at 3 and 6 months post partum by interview.
Main outcome measures: Duration of exclusive breast feeding, appropriate immunisation of infant, knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea, knowledge of infant signs suggesting pneumonia, uptake of postnatal family planning. Conclusions: Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding, care, or immunisation, although uptake of family planning may be slightly enhanced. The rational approach to health promotion—that information given by health workers during clinic based or community based contacts will bring about a change in health behaviour—is still an integral part of primary healthcare strategies. With increasing use of hospital maternity and immunisation services, especially in urban areas of the developing world,6 perinatal contact with mothers represents an opportunity for health education about infant care and family planning. In our study, the prospectively defined hypothesis was that one to one postnatal health education for mothers would positively affect their subsequent knowledge of and practices about infant care and family planning. All pregnant women admitted to Prasuti Griha hospital for delivery residing in these two communities were eligible for entry to the trial.
The health education intervention was developed with hospital staff in collaboration with consultants experienced in health education and women's development. The first education session was conducted in a quiet room before discharge from the hospital. Although the health education given at birth and three months covered broadly the same areas, more emphasis was placed on the importance of exclusive breast feeding in the first session and on the need for family planning in the second session. At the end of each session the health educator repeated the key messages covered and asked the mother if she had any other questions. Women were followed up at 3 and 6 months post partum in their homes, when data relating to our outcome measures were collected. To assess the baseline situation we reviewed recent national survey data and conducted a pilot survey at the hospital outpatient clinic of 200 postnatal mothers—100 at birth and 100 at up to 4 months post partum.
Duration of exclusive breast feeding —The pilot survey showed 34% mothers were exclusively breast feeding at 4 months post partum.
Infant nutritional status —If education helps to prolong the duration of exclusive breast feeding, nutritional outcome might be improved.
Immunisation uptake —In 1991 in Nepal 74% of children aged 12 months had received three doses of diphtheria and pertussis vaccine and oral polio vaccine, and 81% were vaccinated against tuberculosis.15 We hypothesised that 40% of control and 60% of intervention infants would be fully immunised by 6 months of age, requiring 107 mothers in each group (95% confidence interval, power 80%). Family planning —In our pilot survey 20% of postnatal mothers were using a method of contraception at 4 months. Using these figures, we enrolled 540 subjects in order to compare four subgroups: mothers receiving health education immediately after birth and at 3 months post partum (group A), health education at birth only (group B), health education at three months only (group C), or no health education at all (group D).
Clearly, the mothers recruited and the health educators were not blind to the assignment of mothers to different groups. To estimate the effect of the trial intervention between the groups we measured the mean differences, 95% confidence intervals, and P values for continuous data, and the odds ratios, 95% confidence intervals, and P values for categorical data.
Immunisation coverage was higher than we had hypothesised for both groups (85% in groups C and D, 87% in groups A and B): our sample size would have detected an increase to 93% coverage in groups A and B at 5% significance (one sided test) and 78% power.
Poststudy calculations of the power of our study to detect a significant, one sided difference in exclusive breast feeding between groups (based on our hypothesis of 25% in mothers given no health education and 40% in those given education) were 67% (comparing group A with group D) and 84% (comparing groups A, B, and C with group D).
This trial in Nepal has shown that a health education intervention (one to one counselling of mothers by health educators) given on two occasions, immediately after delivery and 3 months later, had no significant impact on the mothers' knowledge and practices of child care or infant health outcomes, but there was a slight improvement in uptake of family planning at 6 months after birth. The overall lack of impact on practices in infant care might also be explained by the length and frequency of the intervention. Recommendations for the design of health education interventions and the importance of including evaluation in health education programmes have been widely reported. Health education by health workers is still seen as an important part of primary health care despite this lack of evidence of efficacy. It might be argued that a postnatal health intervention would be more effective if it focuses on only one outcome. Our results indicate the need for further, well designed evaluations of health education interventions that are randomised and controlled, provide a clear definition of aims, and present pre-intervention and post-intervention data for carefully defined outcome measures. We thank Dr Kasturi Malla for helpful discussions and the staff of Prasuti Griha and MIRA, Nepal, for their support.
Contributors: AB coordinated the formulation of the trial design and protocol, supervised the trial implementation, and participated in data collection and analysis and writing of the paper. Working in conjunction with a doctor, we offer an easy online program that focuses on a customized approach for your lifestyle or particular chronic condition.
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Please download the latest version of the Google Chrome, Mozilla Firefox, Apple Safari, or Windows Internet Explorer browser. Initial household survey of study areas to identify all pregnant women to facilitate follow up.
There were no other significant differences between groups with regards to infant feeding, infant care, or immunisation. 1 2 In practice, opportunities for one to one health education are given low priority by busy health workers.
A recent review of over 500 articles about health education in developing countries found that only 11% described and evaluated actual attempts at health education. In developing countries 50-60% of infant deaths occur in the neonatal period,7 and mortality from acute respiratory infections is highest in the first two months of life, when a mother's response to warning signs is crucial for survival. Because an intervention should be feasible and sustainable on a large scale, education was restricted to a maximum of two contacts. As there are no formal addresses in Kathmandu, a house to house survey of two communities was conducted before the study. Two mothers entered into the trial whose deliveries resulted in a stillbirth were withdrawn from the trial and received neither the intervention nor follow up. Three female health educators, two midwives, and one community health worker were trained to give the health education.
On average, seven mothers were enrolled in the trial each week from 250-300 admissions to the postnatal wards, so the risks of contamination (mothers in different groups sharing information) were negligible given that mothers were seen individually for the education intervention. The topics covered were infant feeding, treatment of diarrhoea, recognition of and response to symptoms suggesting acute respiratory infection in young infants, the importance of immunisation, and the importance of contraception after the puerperium.
Infant weight was measured to the nearest 50 g with a Soenhle electric infant weighing scale. These were well motivated women attending the hospital postnatally for infant immunisation.
Assuming infants of mothers receiving the intervention grew on average along the 50th centile for British infants, a difference of 300 g in weight at 6 months (3.8%) between the group receiving no education with the two groups receiving health education at birth would be detected with 95% confidence limits and a power of 80% with sample sizes of 131 and 262. Use of contraceptives by currently married women nationally was estimated at 14%,15 but this can be assumed to be higher in urban areas. For outcomes at three months, we combined groups A and B as the intervention group and C and D as the control group. Restricted randomisation was used in blocks of 20, each block consisting of a random ordering of the numbers 0-19. The outcome assessors were always blind to the assignment at both the 3 and 6 month follow up visits. We used the Mantel-Haenszel test to check for heterogeneity of categorical data, giving ?2 and P values, and analysis of variance for continuous data, giving F values and P values.
We recruited 540 mothers, 135 to each of the four groups, and followed up 403 (75%) to 3 months post partum and 393 (73%) to 6 months. We compared mothers in groups A and B, who received health education at birth, with those in groups C and D, who received none. We made two broad comparisons: groups A and B (health education at birth) compared with groups C and D (no health education at birth), and groups A and C (health education at 3 months) compared with groups B and D (no health education at 3 months). Given the higher than expected level of immunisation in all groups, we cannot rule out the possibility that health education may have had an impact in situations where coverage is lower. Whether mothers who gave birth at home would benefit from health education more than those who gave birth at hospital is questionable, but it is difficult to target mothers delivering at home and to conduct a trial of intervention in the home. Our study deliberately involved a maximum of only two contacts with each mother in an attempt to evaluate a less intensive, more sustainable intervention. In this trial 88% of women had attended one or more antenatal clinic appointments, at which only 3% had received any health education. 4 17-20 For example, the American Public Health Association stated that “from the outset, a health promotion program should be organised, planned and implemented in such a way that its operation and effects can be evaluated.”17 In practice, however, evaluation is rare.
Training of health and field workers to convey messages, and the development of health education materials, consumes a substantial proportion of health budgets in resource poor countries. The small but significant increase in contraceptive use at 6 months post partum by the mothers receiving health education immediately after birth might have been even greater if this was the only subject discussed. Future evaluations of education interventions also need to explore, through qualitative research, the understanding of the recipients and their reaction to the messages. We are grateful to Diana Gibb, Ruth Gilbert, and Sally Kerry for advice on trial design and statistical analysis.
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To see how this program can help you, click here now to schedule a FREE Weight Loss Consultation or call 973-664-7891. Of these, four described randomised studies and only three fulfilled the author's criteria for a rigorously designed evaluation.4 In countries with few resources there is also a trade off between impact and sustainability. Failure to use postnatal contraception may also lead to an early repeat pregnancy, with attendant risks to maternal health. Clinical objectives were to evaluate the impact of the intervention on uptake of immunisation, knowledge about and care of acute respiratory infections and diarrhoea in infants, the duration of exclusive breast feeding, infant growth, and use of postnatal family planning services.
Kirtipur is a periurban area 5 km south west of the hospital that contains 3663 households with a total population of 21 368.


All were fluent in the two local languages, Nepali and Newari, and conducted the education intervention in the appropriate language.
For each topic, the mothers were initially asked questions (such as, “How are you planning to feed your baby?” and “How would you know if your baby had pneumonia?”) and given time to respond to encourage interaction. We hypothesised a 20% uptake of contraception in the control group by 6 months post partum and an improvement to 33% in the intervention group, requiring 195 mothers in each group (95% confidence interval, power 80%). Staff who were involved in data collection at the 3 month follow up were not involved in data collection at 6 months. We analysed data on an intention to treat basis in which we compared intervention and control groups irrespective of the quality of the education intervention. The main reason for loss to follow up was the mother moving back to her parental home as part of cultural tradition. All the infant deaths occurred in the neonatal period: two occurred in group A, two in group B, three in group C, and three in group D.
There is some evidence that health education at an individual level has an impact if messages are repeated frequently to patients,4 but multiple contact with patients in the community is difficult to sustain in a resource poor country such as Nepal. Follow up rates for the trial were less than ideal (75% at 3 months and 73% at 6 months) but reasonable for a trial conducted in difficult field conditions, where mothers often return to their parental home postnatally. In a review of health education in developing countries spanning 10 years, only 11% of published articles described and evaluated the health education programme.4 Most of the evaluations were methodologically unsound so firm conclusions could not be drawn about the overall efficacy of health education. This requires further evaluation because postnatal family planning and birth spacing have health benefits for both mothers and infants. It might be that behaviour can be changed in response to simple messages repeated frequently in many forums, but in developing countries there will a trade off between efficacy and cost: repeated home visits by friendly health workers may not be feasible on a large scale.
PS contributed to the study design, participated in data collection, and reviewed drafts of the paper. We don't offer only a few food plans like fad diets--you customize your plan with the help of your doctor or other healthcare professional. You can also print out a detailed description of how to perform an exercise with pictures to give you guidance.
During these videos, you'll not only receive tips on how to make your meal, but also learn why certain aspects of that meal are helpful to you. And since this is a physcians supervised program, I'm able to design it so that it’s right for you even if you have a medical conditon such as Diabetes, Arthritis, Hypertension or High Cholesterol. It's for these simple differences alone that we offer weight loss programs designed specifically for women. For a FREE copy of the medical report: The Real Weight Loss Solution, visit our Free Resources page. I had always wanted to try a detox, but did not like the thought of having only liquids or having to drink some crazy mixture that tasted like who knows what.I decided to sign up and give this "diet" a try. Interventions that are considered successful usually result from small scale, well resourced projects which cannot be reproduced on a large scale. The health education session lasted about 20 minutes and was designed to be interactive and supportive rather than prescriptive in style.
The details of allocation to groups for consecutively recruited mothers were in sealed envelopes. Seven of these infants were born prematurely and had a birth weight less than 2.5 kg, two had severe congenital abnormalities, and one died from acute respiratory infection at home at 4 weeks of age.
Also, 20% of mothers in groups A and B were using contraception compared with only 14% of those in groups C and D, but this difference was not significant.
To test for interactions, we compared outcomes by health education at birth stratified by whether health education was given at 3 months post partum using tests for heterogeneity: we found no significant interactions.
Social cognitive theory, by contrast, suggests that experience from interactions within family, peer groups, or communities, rather than information per se, is the key to successful health promotion. It might also be argued that mothers in Nepal do not perceive many health workers as purveyors of credible knowledge about motherhood.
It might also be the case that the desired changes in behaviour are not realistic for the individual or community because of economic, social, and cultural barriers.
ME contributed to formulation of the trial design and protocol, and participated in data analysis and writing of the paper. No exercise machines are required, although we do suggest that you have a small set of hand weights and an exercise ball.
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Kalimati is an urban area of central Kathmandu situated 2 km from Prasuti Griha and containing 2467 households with a total population of 13 875. It was tested beforehand with 20 mothers, and modifications were made in the light of this experience.
For each topic, the discussion led on to the health educator giving key messages (see box) illustrated with large pictures on a cloth flip chart developed by local artists from health materials supplied by Unicef.
Timing of assignment was when a mother was identified by the research team either in labour or shortly after delivery. In our study we deliberately selected health educators who were able to gain the respect of mothers through their experience as midwives or community health workers, but who were also able to put mothers at ease during the education session.
Interventions aimed at women must take into account their heavy workload in the home and field and their degree of influence within the household on decisions about child care, family planning, and health seeking behaviour. AMdeLC conceived of the study hypothesis, developed the trial design and protocol, and contributed to data analysis and writing of the paper. The health educators were monitored weekly during the trial by two principal investigators to check the quality of the intervention with regards to the content and the style of delivery, especially the level of interaction, and constructive critical feedback was given. A member of the research team checked the hospital admission register at least twice each day between 7 am and 8 pm. I started with the fruit detox in August and from the first day there was more to eat than I ever expected.
A national collaborative study of identification of high risk families, mothers and outcome of their offsprings with particular reference to the problem of maternal nutrition, low birth weight, perinatal and infant morbidity and mortality in rural and urban slum communities. I always assumed a diet would be about eating food you don't like and trying to forget about how hungry you are. I lost over 7 pounds during the detox eating fruits that I like and not feeling hungry at all. A study on breast feeding status in rural and urban areas of central development region, Nepal. Child care practices of mothers: implications for intervention in acute respiratory infections. Self-efficacy in health promotion research and practice: conceptualisation and measurement.



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