Maternal and Child Health Journal最新文献

Objective: To assess effects of Healthy Change intervention on maternal perception of her child's body weight (MPCW), maternal feeding style, and obesogenic home environment.

Methods: A randomized control trial was conducted, consisting of two arms: the intervention group received the Healthy Change program, and the control group received the Hygiene and Accident Prevention program. A total of 356 mother-preschool child dyads participated, 182 in the intervention group and 174 in the control group, residing in Mexico and the United States. Data were collected at baseline and after the program through self-administered questionnaires completed by mothers and child anthropometric measurements.

Results: Although no significant between-group difference in pre- and post-intervention change of MPCW was found, sub-analyses revealed that a higher proportion of mothers in the intervention group accurately perceived their child's body weight at the study endpoint using categorical (67% vs. 57.1%, p < 0.005) and visual scales (48.9% vs. 41.8%, p < 0.015). Additionally, more mothers of overweight children in the intervention group accurately perceived their children's overweight and obese status compared to those in the control group (29.8% vs. 10.3%, X² = 4.26, df = 1, p < 0.039). The intervention group also displayed a higher proportion of mothers with authoritative feeding style (26.4% vs. 16.5%, p < 0.036) and significantly higher family nutrition and physical activity scores (29.1 vs. 28.0, p < 0.000) at the study endpoint.

Conclusions for practice: Healthy Change Intervention led to improved accuracy of MPCW, a shift toward maternal authoritative feeding styles, and positive changes in obesogenic home environments.

Objectives: Long-acting reversible contraceptives (LARCs) are the most effective forms of contraception available and therefore play a critical role in supporting patients to exercise bodily autonomy and achieve reproductive goals. A comprehensive set of quality improvement (QI) interventions were implemented between March and June 2019 to improve LARC access at a federally qualified health center (FQHC) in (US State).

Methods: An evaluation study was conducted to assess the impact of the QI initiative considering the number of LARCS delivered as a proxy for access. The Wilcoxon-rank test was applied to test for significance, given a non-parametric sample of LARCs delivered by 13 providers (matched to themselves) pre- and post-intervention. Reimbursement for LARC procedures pre- and post-intervention was also examined to determine economic impact and sustainability of incorporating a new device, the Liletta™, in the floor stock.

Results: There was a statistically significant increase in LARC delivery between July 2019-March 2020 compared to July 2018-March 2019. Approximately $1,000 per month increased reimbursement for LARC services occurred post-intervention. The evaluation study concluded success of the QI intervention, with need for further study needed to determine equitable delivery of contraceptive services between different subpopulations and by insurance status.

Conclusions for practice: The study provides a blueprint for QI initiatives to improve access to LARCs while also increasing revenue for LARC services in an FQHC setting.

Introduction: Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States.

Methods: This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability.

Results: Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5 μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed.

Discussion: We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

Objective: Existing research has shown that parental exposure to violence has negative consequences on health outcomes, but the effect of such exposure on unmet health care and social service need is unknown. This study aims to investigate the association between unmet health care and social services and parental violence exposure among parents with children.

Study design: This study used the data of 6289 parents aged 18-60 years who had at least one child under 18 years living in the same household. Parental violence exposure was measured. Unmet child and adult health care and social service need was operationalized through questions on the services needed, those that had not been received, and those that were considered inadequate.

Results: Parents who experienced any kind of violence had more unmet service need. There were more women among parents with violence experience (65.4%) than those with no violence experience (51.9%). Violence experience increased the odds of unmet need for general adult healthcare services (OR 2.02, CI 1.64-2.57), maternity and child health clinics (OR 2.52, CI 2.00-3.18), family guidance clinics and home help (OR 2.38, CI 1.60-3.54), mental health or child welfare services (OR 2.05, CI 1.52-2.75), and school health care (OR 1.99, 1.50-2.65). After adjusting for sociodemographic factors, the associations between exposure to violence experience and unmet needs for healthcare and social services remained statistically significant.

Conclusion: Violence in close relationships profoundly impacts health and well-being. By addressing unmet health care needs and supporting parents, we can break the cycle of violence and promote better mental health outcomes. Preventive policies and early interventions are essential to mitigate the consequences of violence in families.

Purpose: This article describes the experience of establishing a new parent and baby mental health unit, including challenges in the first year of operation. The article aims to narrate the experience for the purpose of informing other new mental health services and contributing to service development knowledge.

Description: The analogy of the early infancy period is used to highlight the parallel process of adjustment, confidence and identity formation occurring as part of the unit development and by the parents who are admitted.

Assessment: Key challenges are presented as "We had a baby and moved house at the same time", "We had a baby with someone we just met", "We had ghosts in our communal nursery" and "We were juggling the baby and the bathwater".

Conclusion: The establishment of a new unit provides an opportunity to reflect on the complexity of building workforce, service and clinical capacity within the constraints of public health services. The challenges along the way have helped to build empathy for the experiences of the admitted parents who equally find that things have not gone how they have planned, while finding emerging opportunities for growth, resilience and change.

Background: This study aimed to evaluate the construct validity and reliability of the newly adapted German version of the Parental Bonding Questionnaire (PBQ) in a group of mothers drawn from the general population, with children aged 12-24 weeks. This assessment followed a thorough linguistic validation, which was conducted through a systematic, multi-step translation process.

Methods: 363 women completed the PBQ online 12-24 weeks after delivery. Cronbach's alpha and exploratory factor analysis (EFA) were used to assess internal consistency reliability and construct validity.

Results: The original 4-factor model could not be confirmed. The new PBQ provides a single factor solution. Ten items were removed from the original 25-item PBQ to produce the abbreviated German PBQ-15, which showed strong internal consistency. The Cronbach's alpha for this version was 0.86.

Conclusion: While further research is needed to establish diagnostic thresholds and strengthen the construct validity of the shortened version, the German-language 15-item version of the PBQ holds promise as an accessible tool for recognizing bonding issues in a general population of German-speaking women 3-6 months postpartum.

Introduction: This paper reviews the scientific basis and reports initial implementation results of California's Black Infant Health Program, a statewide group-based program with complementary one-on-one life planning to improve maternal and infant health among Black mothers and birthing persons.

Methods: Descriptive analyses were conducted at the participant and group session level using program evaluation data from the initial three years of program implementation to examine participation rates, rates of service delivery, and participants perceptions of the program.

Results: From 2015 to 2018, 3332 Black birthing persons received group and/or life planning and 386 10-session prenatal group series were initiated with an average of 5.9 participants per series. Most sessions delivered all required activities (86.1%) and met requirements for providing food (84.5%), transportation support (72.2%), and childcare (55.4%). More than 90% of responding participants agreed or strongly agreed that BIH helped them manage stress (94.5%), set (97.4%) and achieve (92.9%) goals, and build stronger social connections (94.5%).

Conclusions for practice: The program was developed in response to evolving scientific knowledge regarding racism as the root cause of health disparities for Black birthing people. Focusing on six interwoven strategies for improving maternal and infant health outcomes, the program is supported by current scientific knowledge and can be feasibly implemented at a level consistent with similar evidence-based models.

Purpose: The purpose of this study was to investigate stakeholder willingness to share information among various social service providers, and to determine perceived barriers to accessing these services in our state.

Description: The Maryland Family Network and the Maryland Chapter, American Academy of Pediatrics partnered to collect information on family information sharing preferences and barriers to services. We received 22 Survey Monkey responses and had 41 focus group participants aged 25 to 44 years and all regions of the state were represented. Nearly half of participants were Black or African American and participants indicated a broad range of family income.

Assessment: Most participants were a part of multiple assistance programs and were comfortable with all their information being shared, except their social security number. One third of participants noted they did not face barriers to accessing services. The other two thirds noted confusing applications, technology limitations and the need for self-advocacy as significant barriers.

Conclusion: Families are very comfortable sharing information among early childhood service providers, and in fact favor having a single basic application that allows them to check off the agencies to which they would like to apply. Barriers to accessing services are logistical as well as cultural.

Objective: This systematic review and bibliometric analysis investigated the keywords appearing most in the pregnancy-related eye disease field to elucidate the current state and trends of pregnancy-related eye disease research.

Methods: A systematic literature analysis of pregnancy-related eye disease was performed using the Web of Science Core Collection (WOS) databases. We used the keywords "ocular" OR "eye*" and "pregnancy" OR "pregnant" OR "gestation" to search for articles published from 1999 to 2022. Study data were analyzed and visualized using VOSviewer and CiteSpace.

Results: We analyzed 929 articles published from 1999 to 2022. From 1999 to 2012, the article number increased slowly, with a marked acceleration in publication frequency after 2013, original papers accounted for 780 (84%) of the total number of articles published. David A. Mackey was the most prolific writer, and Margaret A. Honein contributed the most citations. The American Journal of Ophthalmology, PLOS One, and the European Journal of Ophthalmology published the most articles. The American Journal of Ophthalmology, Ophthalmology, British Journal of Ophthalmology, Investigative Ophthalmology and Visual Science were the four most commonly cited journals. The University of Western Australia, the University of Sao Paulo, and the University of Melbourne were highly prolific institutions. Five co-cited references had a citation burst up to 2022, analyzed by CiteSpace. Keyword analysis (VOSviewer) yielded recent key themes (pregnancy, women, eye, risks and diagnosis) and suggested future research directions.

Conclusions: The current results laid the foundation of bibliometrics for scholars and identified researchers, scientific journals, countries, keyword clustering, hot topics, and trends in the literature. High-impact-factor journals contain the most keyword-clustering research and open new horizons for research in the pregnancy-related eye disease nursing field, providing research inspiration for investigators in this field.

Purpose: The COVID-19 pandemic and subsequent mitigation efforts impacted communities in many ways and placed immense strain on the health care system, impacting access to services. The purpose of this study was to examine changes in prevalence of child health care, child health, and caregiver and household health within children with autism and children with special health care needs (CSHCN) pre-pandemic to early pandemic years.

Methods: We examined data from the National Survey of Children's Health to examine changes in child health care, child health, and caregiver and household health for autistic children and CSHCN from 2018 to 2021.

Results: About one-third of children with autism and CSHCN missed preventive checkups due to the COVID-19 pandemic and half had virtual care in 2021. Parents of children with autism had less help with care coordination in 2020 compared to previous years. In CSHCN prevalence of anxiety increased from 2018/2019 to 2021, with a concurrent increase in need for mental health care, this was not seen in children with autism. Finally, difficulty paying medical bills and for food was less common in 2020 and 2021 (compared to 2018/2019).

Conclusions: The COVID-19 pandemic changed the healthcare landscape for everyone, including children with autism and CSHCN as highlighted in this study. Understanding the disruptions and how they impacted populations differently can be helpful in informing plans long-term emergency preparedness. This planning should involve disability inclusive policies, to ensure the most vulnerable groups retain health care access as needed.