Maternal and Child Health Journal最新文献

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: 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.

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.

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.

Introduction: Malnutrition in early childhood has long-term health consequences, including increased obesity risk due to catch-up growth in undernourished infants. While maternal perceptions and feeding practices affect infant malnutrition, limited evidence exists in middle-income countries like Mexico. This study examines the associations between maternal perceptions, feeding practices, and nutritional status in infants aged 6-12 months in northeastern Mexico.

Methods: A total of 192 mother-infant dyads were assed using questionnaires and anthropometric measurements. Maternal variables included perception of hunger and satiety, infant weight perception, feeding attitudes, self-efficacy, fatigue, and feeding practices. Infant nutritional status was determined using WHO Anthro, and multiple logistic regression identified associations between maternal and infant factors and nutritional status.

Results: 38% of infants were overweight/obese, and 7% were underweight. Low maternal self-efficacy, low perception of hunger and satiety signs, non-recommended feeding attitudes, and inaccurate perception of infant weight were identified. Maternal nocturnal sleep hours, type of feeding, and feeding frequency were associated to underweight. The maternal perception of infant weight was inaccurate for both underweight (mothers overestimate the weight) and overweight/obese (mothers underestimate the weight) infants.

Discussion: The main maternal perception influencing infant nutritional status was inaccurate weight perception. Mothers demonstrated limited knowledge and negative feeding practices with non-recommended feeding practices among Mexican mothers. Longer maternal sleep duration (> 8 h/night) was associated with underweight infants.

Introduction: Healthy Start is an initiative to reduce infant mortality and improve birth equity throughout the US, in large part by deploying community health workers (CHWs) to conduct home visits and provide educational and emotional support to new and expectant parents.

Methods: A mixed-methods assessment of the Bronx Healthy Start Partnership (BxHSP) was conducted as part of a quality improvement initiative to understand client perspectives regarding the impact of BxHSP on short- and intermediate-term outcomes that affect long-term well-being. Phone interviews (n = 16) and online surveys (n = 62) were conducted in English and Spanish with BxHSP participants in 2020 and 2022. The interview sample was selected purposefully; interview participants were eligible if they gave birth prior to mid-March 2020 and had received at least one CHW home visit. All individuals with open BxHSP cases (n = 379) were invited to complete the survey.

Results: Findings suggest that BxHSP CHWs can provide vital psychosocial, material, and educational resources that help engaged participants feel supported as new parents and develop knowledge and skills related to infant care. Results further suggest that these short-term outcomes contribute to lower stress, increased self-efficacy, and health-promoting infant care practices, enabling participants to feel more confident and capable as new parents.

Discussion: Findings underscore how programs like BxHSP can help address gaps in resources and improve health and well-being for pregnant and postpartum participants. Limitations include possible selection, recall, and/or social desirability biases as response rates were low and data were self-reported and retrospective. Limitations were addressed in part through triangulation of qualitative and quantitative data.

Introduction: Almost all parents seek online child-related information. This study focuses on parents' experience of using information from an easy-to-read parenting website, Naître et Grandir (N&G), specifically parents with low socioeconomic status (SES). SES is correlated with health literacy, a major determinant of child education and health. In January 2019, the Information Assessment Method (IAM) questionnaire was improved and implemented in a smartphone application (IAM + N&Gsmart) to reach more low SES parents.

Objectives: We measured the influence of IAM + N&Gsmart on the frequency with which low SES parents responded to the IAM survey of N&G webpages and the relative proportions of anticipated benefits of the N&G content. We also compared these benefits among fathers and mothers.

Methods: This was a 4-year prospective time series. For each N&G webpage, parents were invited to complete an IAM questionnaire and report anticipated outcomes. IAM data were collected before (2017-2018) and after (2019-2020) the intervention (IAM + N&Gsmart launch) from Quebec parents of 0-8-year-old children who completed at least one IAM questionnaire. Descriptive and inferential statistical analyses were applied.

Results: Participants completed 10,362 IAM questionnaires. Low SES participants anticipated more benefits than other participants, and particularly low SES fathers more than low SES mothers. The proportion of responses and reported benefits from low SES participants increased post-intervention.

Conclusions for practice: Results suggest that increasing literacy-oriented web content can lead to greater benefits among low SES parents, and that increasing father awareness and father-inclusive content can lead to even greater benefits among low SES fathers.

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.

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.