Maternal and Child Health Journal最新文献

Background: Toilet training practices vary across cultures and time. Assisted Infant Toilet Training (AITT) is commonly used in low- and middle-income countries.

Objectives: To synthesise the literature on AITT, including timing of initiation and completion, infant elimination signalling, and associations with bladder and bowel dysfunction.

Methods: An integrative review methodology was employed. Comprehensive searches of Scopus, Medline, CINAHL, Web of Science, PsycINFO, and Google Scholar identified relevant studies. Two reviewers independently screened and appraised studies using GRADE and JBI tools.

Results: Of 2,069 studies identified, 21 met inclusion criteria. Six observational studies reported reduced rates of bladder and bowel dysfunction when AITT was practised.

Discussion: AITT is widely practised in low-income, non-English speaking countries. While observational studies suggest a potential protective effect on bladder and bowel health, the evidence is at serious risk of bias. Further prospective research in high-income contexts is warranted.

Introduction: Care coordination can be an essential source of support to families of children with special health care needs and should ideally lead to improvements in the organization of care.

Purpose: This publication aims to share the experience of one statewide Title V organization's work to develop and validate a care coordination satisfaction survey.

Description: UIC-DSCC engaged with the Family Advisory Council and a Family Survey Committee to revise existing surveys measuring different care coordination domains. The overall consensus was to apply a 13-item annual care coordination satisfaction survey. The survey was administered to families between January and April 2023. Psychometric reviews included exploratory Factor Analysis for the underlying structure of the items and Cronbach α for reliability. A top-box approach was used to represent item proportion.

Assessment: 899 families completed the 13-item measure. The Exploratory Factor Analysis determined a 2-factor solution: (1) Care Coordination Satisfaction and (2) Engagement and Impact on Quality of Life-none of the items required removal. Factor 1's top-box results show families' positive experience with care coordination, with 6.37 of the seven questions being answered with the most favorable answer. Similarly, in factor 2, 5.28 of the six questions were responded to with the top or most favorable answer.

Conclusion: Family partnership is a crucial part of the care coordination process, and UIC-DSCC has learned that this partnership is also critical when evaluating family satisfaction with care coordination services. The 13-item care coordination survey demonstrated adequacy and can assist with quality improvement in care coordination programs.

Introduction: Both emotional reaction to pregnancy and pregnancy intention have been independently found to predict postpartum depressive symptoms (PDS). However, while pregnancy intention has been widely studied, there is minimal research on emotional reaction to pregnancy, and even less research on how these two factors interact.

Methods: Data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) survey in the state of Maine were analyzed for this study. Weighted logistic regressions were performed to predict both PDS and negative emotional reactions to pregnancy, with Odds Ratios and 95% Confidence Intervals calculated.

Results: Of 4,520 respondents, 38.8% reported unplanned pregnancies, 5.7% reported negative initial emotional reactions to pregnancy, and 4.2% reported unplanned pregnancies and negative initial emotional reactions. Approximately 11% reported PDS, and 15.1% had unplanned pregnancies and PDS, while 9% had planned pregnancies and PDS. Individuals with unplanned pregnancies had higher PDS risk than individuals with planned pregnancies, individuals with negative or unsure reactions had higher PDS risk than those with positive reactions, and individuals with unplanned pregnancies and all emotional reactions had increased PDS risk compared to those with planned pregnancies and positive reactions. After adjusting for covariates, only those indicating negative initial emotional reactions (independently) and those indicating negative emotional reactions and unplanned pregnancy (interactively) were at greater risk for PDS. Predictors of negative emotional reactions to pregnancy included lower income, greater number of previous live births, depression diagnosis in the 3 months before pregnancy, intimate partner abuse, and unplanned pregnancy.

Discussion: Negative emotional reaction to pregnancy and unplanned pregnancy independently and interactively predicted PDS. Findings highlight the importance of considering emotional and sociodemographic factors when evaluating the relationship between unplanned pregnancy and PDS.

Objectives: Prior to the Affordable Care Act (ACA), over two-thirds of states mandated that children had to be uninsured for set periods of time before enrolling in the Children's Health Insurance Program (CHIP), referred to as waiting periods. The ACA required that waiting periods could not exceed 90 days, leading states to reduce and eliminate waiting periods in response. This study aimed to examine the association between state waiting period elimination under the ACA with children's enrollment in CHIP.

Methods: We used 2010-2019 annual state enrollment data from the Centers for Medicare & Medicaid Services to calculate the proportion of children enrolled in CHIP among 20 states that eliminated waiting periods compared to 14 who maintained them. We estimated difference-in-difference models to assess the association between waiting period elimination with children's CHIP enrollment.

Results: In states that eliminated waiting periods, there were significant increases from 10.86% (95% CI: 9.51-12.21) of children enrolled in CHIP in the pre-policy period to 13.43% (95% CI: 12.21-14.66) after the ACA policy change. In adjusted difference-in-difference models, state waiting period elimination was associated with a 1.75% point (95% CI: 0.43-3.11) increase in children's enrollment in CHIP relative to states that maintained waiting periods, representing a 16% enrollment increase from pre-policy baseline levels.

Conclusions: Waiting period elimination under the ACA led to modest but significant increases in CHIP enrollment among children. Our results suggest potential CHIP enrollment benefits from the elimination of waiting periods that were maintained in 9 states.

Introduction: Low birth weight (LBW) is one of the most important factors affecting neonatal mortality and is a determinant of post-neonatal mortality. This study aimed to assess the effectiveness of the Pathways Community HUB Institute^® Model (PCHI^® Model) in improving birth outcomes among high-risk pregnant women.

Methods: In this retrospective study, data were drawn from the Pathways Community HUB Program (Community Health Access Project - CHAP) in Richland, Ohio, and the Ohio Department of Health from 2014 to 2017. We employed a 1:1 nearest neighbor propensity score matching for 315 participating and 315 non-participating women and used conditional logistic regression to analyze our data. The pregnancy outcomes we assessed included preterm birth and birth weight.

Results: The incidence of LBW in the Community Health Access Program (CHAP) group was 8.6% compared to 12.4% in the non-CHAP group. CHAP participants had a 43% lower chance of low birth weight births (OR = 0.572, 95% CI = 0.335-0.979), while the program's effect on preterm delivery approached but did not achieve statistical significance (OR = 0.640, 95% CI = 0.407-1.007). We also found that those who entered the CHAP program and those who had their first prenatal care appointment in the first trimester of their pregnancies were less likely to deliver a LBW infant than those who entered the program and had their first prenatal care appointment later in their pregnancies.

Conclusions: Among high-risk pregnant women, the PCHI^® Model can significantly improve prenatal care utilization and reduce the incidence of LBW infants. In addition, pregnant women participating in the Pathways Community HUB program appeared to benefit more if they entered the program in their first trimester rather than later in their pregnancy, suggesting that longer durations of program participation are associated with better birth outcomes.

Objectives: Adenomyosis is a common gynecologic disease involving the uterus, with its effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes.

Methods: Using the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.03, with the remaining pregnancies being the reference group. Then, ICD-10 codes were used to identify obstetrical and neonatal outcomes and multivariable logistic regression models, adjusted for baseline maternal demographics, were used to determine the impact of adenomyosis on these outcomes. Also, in light of the potential detection bias inherent in births by cesarean delivery, adjustment for mode of delivery was included in all regression analyses.

Results: Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases/100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (adjusted OR 1.7, 95% CI 1.2-2.4), preterm delivery (1.4, 1.2-1.6), preterm premature rupture of membranes (1.3, 1.1-1.6), postpartum hemorrhage (2.7, 2.1-3.3), post-partum transfusion (2.2, 1.6-3.0), disseminated intravascular coagulation (9.3, 4.2-20.9), sepsis (2.7, 1.6-4.5), congenital anomalies (2.0, 1.3-2.8), and intrauterine fetal demise (2.0, 1.0-3.8). Also, these pregnancies had an elevated risk of delivering by cesarean (15.7, 12.7-19.3).

Conclusion: Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. As such, pregnancies in patients with adenomyosis should be considered high-risk and should be delivered in centers capable of managing the potential poor events associated with these pregnancies.

Objectives: ExPAND Mifepristone is a one-year learning collaborative providing support for mifepristone provision in primary care for early pregnancy loss (EPL) or abortion. This study measured change in prevalence of medical management of EPL at a federally qualified health center (FQHC) that participated in ExPAND Mifepristone's pilot year. Secondary objectives were to describe changes in referral patterns and medication choice for EPL.

Methods: To quantify changes in medical management of EPL, we conducted a retrospective data query using International Classification of Diseases-10 codes during two time periods: pre-implementation (January 1, 2019 - February 29, 2020) and post-implementation (August 1, 2021 - June 30, 2022). Manual chart review was used to assess change in referral patterns for EPL.

Results: There were 193 patients with EPL in the pre-implementation period and 115 post-implementation. Pre-implementation, 8.3% (n=16) of EPL patients received medical management versus 15.7% (n=18) post-implementation (p=0.046). The percentage of all patients with EPL who received misoprostol alone was 8.3% pre- and 8.7% (p=0.91) post-implementation. Treatment with mifepristone plus misoprostol increased to 44.4%. EPL referrals to Obstetrics/Gynecology (OB/GYN) decreased from 14.0% to 1.7% (p=0.001). The most frequent reason for referral was procedural management.

Conclusion: After participation in ExPAND Mifepristone, there was an increase in medical management for EPL by PCPs and referrals to OB/GYN declined. ExPAND Mifepristone can help facilitate PCP use of mifepristone plus misoprostol for medical management of EPL.

Key words: Primary Care, Early Pregnancy Loss, Mifepristone, Women's Health, Referral.

Objectives: To examine associations between food insecurity and parenting stress and assess the extent to which parent and child mental health explain these associations.

Methods: Cross-sectional data from the 2016-2019 National Survey of Children's Health (N = 72,763) were pooled to compare parenting stress between households experiencing different levels of food insecurity. Tests were then performed to determine whether parent and child mental health mediates the association between food insecurity and parenting stress.

Results: Parents in households experiencing mild food insecurity had parenting stress scores that were 0.23 standard deviations higher than parents in food secure households. These parents were also 1.23% points (161.84%) more likely to report handling the demands of parenting poorly compared to parents in food secure households. The association between parenting stress and food insecurity increased in magnitude with more severe household food insecurity; parents in households experiencing moderate-to-severe food insecurity had parenting stress scores that were 0.46 standard deviations higher than parents in food secure households, and these parents were 4.3% points (565.79%) more likely to report handling the demands of parenting poorly compared to parents in food secure households. Differences in child and parent mental health explained only some of the identified disparities in parenting stress.

Background: Infertility poses a significant emotional burden on couples, leading to increased stress levels. This study aimed to investigate the effectiveness of cognitive-behavioral stress management training in reducing infertility-related stress among infertile couples.

Methods: A randomized clinical trial was conducted involving 20 infertile couples (40 individuals) who sought treatment at the Saboohi Infertility Center of Mahdieh in Tehran, Iran, between May and June 2018. Participants were selected using convenience sampling and randomly assigned to either the control group, which received routine infertility counseling, or the intervention group, which received cognitive-behavioral stress management training in addition to routine counseling. Independent t-tests and analysis of covariance (ANCOVA) were used.

Results: In the post-time period, the intervention group demonstrated a significant decrease in total stress scores compared to the control group for both men (B =  - 15.07, p < 0.001) and women (B =  - 2.82, p = 0.003), controlling for pre-time values. Subscale analyses revealed that the intervention group had lower scores in social concern, sexual concern, communication concern, rejection of childfree lifestyle, and the need to be a parent compared to the control group, for both men and women (p < 0.001).

Conclusions: In conclusion, our study highlights the effectiveness of a behavioral-based stress management intervention alongside infertility counseling in controlling infertility-related stress. These findings support the inclusion of this comprehensive counseling approach in the care package for infertile couples, enabling healthcare professionals to reduce stress and improve overall well-being.