Maternal and Child Health Journal最新文献

Introduction: Variable selection is a common technique to identify the most predictive variables from a pool of candidate predictors. Low prevalence predictors (LPPs) are frequently found in clinical data, yet few studies have explored their impact on model performance during variable selection. This study compared the Random Forest (RF) algorithm and stepwise regression (SWR) for variable selection using data from a paediatric sepsis screening tool, where 18 out of 32 predictors had a prevalence < 10%.

Methods: Variable selection using RF was compared to forward and backward SWR. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), and the variables retained. Additionally, a simulation study assessed how increasing the prevalence of the predictors impacted the variable selection results.

Results: The best fitting RF and SWR models retained were 22, and 17 predictors, respectively, with 14 and 10 predictors having a prevalence < 10%. Both the RF and SWR models had similar predictive performance (RF: AUC [95% Confidence Interval] 0.79 [0.77, 0.81], LR: 0.80 [0.78, 0.82]). The simulation study revealed differences for both RF and SWR models in variable importance rankings and predictor selection with increasing prevalence thresholds, particularly for moderately and strongly associated predictors.

Discussion: The RF algorithm retained a number of very low prevalence predictors compared to SWR. However, the predictive performance of both models were comparable, demonstrating that when applied correctly and the number of candidate predictors is small, both methods are suitable for variable selection when using low prevalence predictors.

Objectives: This study aimed to estimate the prevalence of homelessness shortly before or during pregnancy and describe differences in maternal characteristics and adverse birth outcomes between people reporting homelessness and not reporting homelessness.

Methods: We used 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 31 sites to estimate the prevalence of self-reported homelessness during the 12 months before giving birth. We used logistic regression models to evaluate the association between homelessness and adverse birth outcomes, specifically small for gestational age (SGA), low birth weight (LBW), and preterm birth (PTB).

Results: Of 138,603 respondents, 4,045 reported homelessness, representing 2.4% of weighted respondents. Respondents reporting homelessness differed from respondents who did not report homelessness in maternal demographic characteristics, health conditions, behavioral and environmental risk factors, and adequacy of prenatal care. In unadjusted models, homelessness was associated with higher prevalences of SGA, LBW, and PTB (PR 1.38, 95% CI 1.21-1.57; PR 1.73, 95% CI 1.56-1.91; PR 1.42, 95% CI 1.25-1.61; respectively). After adjusting for maternal age, race and ethnicity, education, BMI, and cigarette smoking, prevalence ratios were attenuated and no longer significant.

Conclusions for practice: Although homelessness was not independently associated with adverse birth outcomes in adjusted models, people reporting homelessness before or during pregnancy represent a group at increased risk of inadequate health care utilization and adverse birth outcomes due to other underlying demographic and social factors. Health care providers can play a critical role in identifying if patients may be experiencing homelessness and facilitating connections to social support.

Introduction: Globally, the prevalence of undernutrition is highest in the sub-Saharan African region with over a third of the world's stunted children residing in this region. Many studies have explored child nutrition in sub-Saharan Africa, but they often overlook the intricate nuances of maternal knowledge. We examined the association between maternal nutritional knowledge and childhood nutritional outcomes.

Methods: This was a secondary analysis utilizing data from the Demographic and Health Survey of eight sub-Saharan African countries that were conducted between 2019 and 2022, focusing on children aged 6 to 23 months. The study used latent class analysis to identify discrete patterns of nutrition and health-related knowledge and mixed-effects logistic regression to assess their association with childhood nutritional outcomes namely, stunting and wasting. Statistical significance was determined at p < 0.05.

Results: Most participants knew the importance of colostrum (76.8%) and continued breastfeeding (76.7%), as well as immunization (60.0%) and diarrhoea prevention and treatment strategies (65.1%). However, only 24.49% knew about family planning. Children of high knowledge group/class had a 17% lower risk of childhood stunting (crude model; COR = 0.83; 95%CI: 0.77, 0.90, adjusted model; AOR = 0.89; 95%CI: 0.82, 0.97) and a 22% lower risk of wasting (COR = 0.78; 95%CI: 0.69, 0.89, adjusted model; AOR = 0.84; 95%CI: 0.73, 0.96) compared to those from the low knowledge group/class.

Conclusion: These results highlight the pivotal role of maternal knowledge in shaping children's health outcomes and emphasize the urgent need for targeted interventions and comprehensive maternal education programs to address the identified knowledge gaps and improve child health outcomes.

Objectives: To investigate differences in the prevalence of positive depression screens before and during the COVID-19 pandemic within primary care and assess patient characteristics based on depression screen results in both time periods.

Methods: This was a retrospective cohort study of patients ages 12-21 years-old from two urban primary care clinics seen for well-child visits and who had completed depression screens before and during the pandemic. Additional variables evaluated included demographics, substance use, and mental health (MH) conditions such as anxiety, depression, and suicidal ideation (SI). Paired analyses using McNemar's Chi-squared test and paired t-test evaluated differences in variables between time periods. Patients were also categorized into four groups determined by their depression screen result in each period and characteristics between the four groups were compared using the Fisher's exact test.

Results: Of 1621 patient charts reviewed with documented depression screens, there were 232 patients who had screens completed during both time periods. Twenty three (9.9%) patients screened positive for depressive symptoms before the pandemic and 38 (16.4%) screened positive during the pandemic. More patients had SI, depression, anxiety, and substance use during the pandemic. Patients who had at least one positive depression screen had more MH conditions than patients who had negative depression screens during both time periods.

Conclusions: Among a cohort of adolescents seen in primary care before and during the pandemic, more patients screened positive for depression and there were more MH conditions during the pandemic, demonstrating a need to prioritize MH resources for adolescents in the primary care setting.

Introduction: Labor and delivery (L&D) nurses are often responsible for initiating the critical first steps of the Neonatal Resuscitation Program (NRP). Identification of knowledge gaps and underlying reasons for NRP non-adherence is crucial for designing educational interventions.

Methods: A convenience sample of 37 L&D nurses from two delivery hospitals were enrolled. Participants completed a Likert scale survey capturing years of experience and comfort level in performing neonatal resuscitation followed by a video recorded standardized manikin-based simulation of a neonatal resuscitation. NRP adherence was assessed using an Observed Structured Clinical Examination (OSCE) assessment tool with prior validity evidence. Percentage of correctly completed OSCE items, median time to initiation of positive pressure ventilation (PPV), and achievement of effective PPV were analyzed using descriptive statistics.

Results: Participants reported a median of 2.5 years of L&D experience, and a 4/6 confidence level for performing NRP. Fifty-seven percent of items (12/21) items were correctly completed. Participants took 55 s to initiate PPV with 57% initiating PPV within the target of 60 s. The time to effective PPV was 109 s, with 32% of participants achieving this within 60 s. Years of L&D experience had a strong correlation with percentage of correctly completed OSCE items (r = 0.63).

Discussion: Despite high self-perceived confidence, initiating and achieving effective PPV within the 60 s time window mandated by NRP remains an area for significant improvement for L&D nurses. Next steps include the design and implementation of targeted training to address performance gaps and longer-term tracking for retention of knowledge.

Objective: To evaluate whether Covid-19 related workflow changes to a clinically-integrated breastfeeding peer counseling (ci-BPC) program were associated with poorer breastfeeding outcomes for Medicaid-enrolled patients.

Methods: This retrospective chart review included patients who received ci-BPC care during January 2017-March 2020 ("Pre-Pandemic," N = 318); March 2020-September 2020 ("During-Peak," N = 53); and September 2020-May 2021 ("Post-Peak," N = 97). ANOVA evaluated differences in encounter type frequencies for each time point, as well as differences in breastfeeding initiation, exclusivity during inpatient admission, and continuation of breastfeeding at least 6 weeks post-delivery.

Results: In-person prenatal counseling significantly decreased from Pre-Pandemic to During-Peak (43.9-8.2%, p < 0.05). Breastfeeding at 6 weeks postpartum significantly increased from the Pre-Pandemic cohort to the During-Peak cohort (67-85%, p < 0.05), and returned to baseline for the Post-Peak cohort (74%).

Conclusions for practice: Covid-19 related workflow changes for the peer counselor did not decrease breastfeeding outcomes as anticipated.

Objectives: The specific aims of the project are: (1) Examine the impact of COVID-19 on pregnancy experiences and outcomes; (2) Examine the mental health impact of COVID-19 in pregnant women and mothers of children 12 months or younger; (3) Identify risk and protective factors among this population in Puerto Rico.

Methods: Participants were recruited from the Puerto Rico Team for Exploring Contamination Threats (PROTECT) Superfund Program, which is composed of pregnant women and mothers from the northern karst region of Puerto Rico. The research had a mixed methods approach with a quantitative survey (n = 184) and qualitative interviews (n = 10); data collection was done in virtual mode.

Results: Findings from the qualitative interviews highlight the experiences regarding access to healthcare services, pregnancy and birth experiences, social support, and mental health during the pandemic among women with young children. These narratives serve to illustrate the particular challenges and opportunities that the participants faced during the year 2021 in regard to maternal health in Puerto Rico.

Conclusions for practice: COVID-19 restrictions impacted the experiences in receiving healthcare services, particularly regarding the birthing process and the participants' mental health. Social support, particularly from family, was found to be a protective factor for facing the challenges during pandemic times. We expect that the findings can lead to the development of interventions for community health centers, prenatal clinics, non-governmental organizations, and parents/caretakers in Puerto Rico.

Purpose: To demonstrate the process and results of an equity analysis of a reproductive health association.

Description: A series of quantitative surveys and qualitative interviews were conducted with employees of Planned Parenthood League of Massachusetts (PPLM), assessing different aspects of equity. Amaka Consulting and Evaluation Services, LLC, an external consulting agency, analyzed the results and provided recommendations for improvements.

Assessment: Between 25% and 33% of the employees identified as Black, Indigenous, and people of color (BIPOC). Staff expressed a high degree of satisfaction with the organization's alignment to its mission and commitment to equity. Turnover was higher among BIPOC employees, and employees of color were less likely to say they had confidence in senior management. Themes that arose frequently in surveys included the need for increased communication around equity action steps, greater accountability, and work environment issues. Qualitative interviews indicated acknowledgment of diversity, equity, and inclusion (DEI) efforts but feeling that they were not as legitimate as they could be and vocalized a need for more equitable hiring. Recommendations for improvements included tracking feedback around social movements; conducting equity impact assessments; supporting staff through salary, opportunities for advancement, and better supervision; requiring management to attend equity initiatives, and creating equity resources for staff.

Conclusion: This study provides a template for other evaluations of equity. Similar to other organizations in the field, this equity analysis suggests that PPLM had a stronger commitment to certain aspects of DEI than others, and that there was a need for improvement in several areas, particularly hiring and management.

Background and objectives: Families of children with special health care needs (CSHCN) have reported to benefit from social, emotional, and informational support from other families (peer support) with similarly affected children. Pediatric subspecialists often serve as the primary medical providers for CSHCN, as well as educators for these children's families. The extent to which subspecialists refer families to sources of peer support is unknown.

Methods: A statewide online survey of California pediatric subspecialists investigated opinions about the potential value and challenges of peer support. Data was obtained on the frequency with which families in their practices were referred to peer support, practice characteristics, and personal demographics. Weighted data, descriptive statistics, and regression models were used to characterize and predict factors affecting referral services.

Results: There were 388 respondents, a response rate of 14.5%. Subspecialists were generally unfamiliar with peer support resources in their communities, but many more knew of peer support programs in their institutions. Most (> 85%) held positive views about peer support, though only 40% of practices often referred families for such support. Individual opinions did not predict practice referral processes for peer support which were more influenced by knowledge of resources, and availability of time, staffing, and institutional peer support resources.

Conclusion: Offering referral to peer support services is compatible with pediatric subspecialty care. Educating physicians about available resources, assigning responsibility, providing staff time for referring families, and incorporating parent mentors into subspecialty practices can increase access. Future studies of families' referral experiences are needed.

Objective: Globally, obstetric hemorrhage and trauma are the leading causes of maternal and fetal morbidity and mortality during pregnancy. Delivering high-quality medical care to these patients is therefore imperative.This study aims to examine the relationship between month of referral and the severity of emergency admissions among pregnant women referred for obstetric hemorrhage and trauma.

Materials and methods: A retrospective cross-sectional analysis was conducted on hospital records of 1,684 pregnant women admitted to the case emergency center at Imam Reza Hospital in Mashhad, Iran for hemorrhage or trauma between January and December 2016. Secondary data extracted from the hospital information system (HIS) were used to calculate frequencies for patient demographics (age, insurance type), clinical characteristics (admission type, emergency severity, injury cause, referral reason) and external factors (month of referral). Logistic regression was used to assess the relationship between the month of referral and emergency severity (urgent/non-urgent) for hemorrhage and trauma.

Results: Hemorrhage during pregnancy (n = 1,636, 97.1%) was the most prevalent reason for referral throughout the year. The month of referral was significantly associated with emergency severity (P < 0.001). Compared to March, the odds of urgent referrals were notably higher in August (OR 3.822), October (OR 5.084), and November (OR 4.720).

Conclusion: A peak in emergency referrals were observed during the summer and fall months, with October having the highest number of referrals for obstetric hemorrhage and trauma.