Deborah Winders Davis

Social and professional support for pregnant and parenting women

Purpose A literature review to contrast the role of social and professional support in improving maternal and infant outcomes in pregnant and parenting women. In addition, recommendations are made for future research and policy and program development concerning support needed by pregnant and parenting women. Data Sources Data were limited to published studies. Searches of computerized databases, hand searches of journals, and backward searches from reference lists of studies were conducted. Nursing, medicine, psychology, public health, sociology, and social work literatures were searched (CINAHL, Medline, PsychLit, Social Sciences Abstracts, Social Sciences Citation, and Social Work Abstracts). Study Selection The studies focused on outcomes of social support and professional support to pregnant and parenting women. The samples of the studies included pregnant women and parenting women up to 2 years postpartum. Studies reviewed were conducted in the United States or Canada and included maternal and/or infant outcomes. All ages and races of pregnant and parenting women were considered. Data Extraction Data were extracted from each study concerning the theoretical framework, variables, sample, design, measuring instruments, interventions, and outcomes. Data Synthesis Social support outcomes were summarized in paragraphs while a table was used to summarize professional support intervention outcomes. Conclusions Outcomes associated with specific support interventions should be clearly identified, informed by theory, and include assisting the pregnant and parenting woman to improve her social support.

Evaluation of Printed Health Education Materials for Use by Low‐Education Families

PURPOSE Millions of adults lack adequate reading skills and many written patient education materials do not reflect national guidelines for readability and suitability of materials, resulting in barriers to patients being partners in their own health care. The purpose of this study was to evaluate commonly used printed health materials for readability and suitability for patients with limited general or health literacy skills, while providing easy recommendations to health care providers for how to improve the materials. METHODS Materials (N = 97) from three clinical areas that represented excellence in nursing care in our organization (stroke, cancer, and maternal-child) were reviewed for a composite reading grade level and a Suitability Assessment of Materials (SAM) score. RESULTS Twenty-eight percent of the materials were at a 9th grade or higher reading level, and only 23% were 5th grade or below. The SAM ratings for not suitable, adequate, and superior were 11%, 58%, and 31%, respectively. Few materials were superior on both scales. The SAM scale was easy to use and required little training of reviewers to achieve interrater reliability. CONCLUSIONS Improving outcomes and reducing health disparities are increasingly important, and patients must be partners in their care for this to occur. One step to increasing patient understanding of written instructions is improving the quality of the materials in the instruction for all patients and their families, especially those with limited literacy skills. CLINICAL RELEVANCE Using materials that are written in a manner that facilitates the uptake and use of patient education content has great potential to improve the ability of patients and families to be partners in care and to improve outcomes, especially for those patients and families with limited general literacy or health literacy skills.

Types of Support Expected and Received by Mothers After their Infants’ Discharge from the Nicu

This descriptive study examined specific types of social support that mothers of preterm infants expected before, and received after, their infants hospital discharge. The convenience sample consisted of 37 mothers of hospitalized preterm infants. The Postpartum Support Questionnaire, developed as a measure of perceived support specific to the postpartum situation, was used. The women found that material, emotional, and comparison support were more important than they had expected prior to bringing their infants home from the hospital. In addition, the women received less than they had expected of all types of support except comparison. In view of the results, mothers of preterm infants should be assisted in identifying individuals in their environments who can best meet their specific needs. In addition, maternity and pediatric nurses need to be involved in the follow-up care of these women and their infants.

Identification and Management of Behavioral/Mental Health Problems in Primary Care Pediatrics: Perceived Strengths, Challenges, and New Delivery Models

This study describes the experiences of and barriers for pediatricians in Kentucky in providing behavioral/mental health (B-MH) services in primary care settings. These data will serve as a foundation for improving service delivery. An online survey was completed by 70 pediatricians. Descriptive data are presented. More than 90% of the respondents said that they saw at least one patient a month with 1 of 10 specific B-MH diagnoses. Physicians’ comfort with diagnosing and treating disorders varied widely by diagnosis, age-group, and drug classification. Major barriers to providing optimal care were inaccessibility of mental health professionals for consultation and referral, lack of communication, and lack of knowledge. Respondents were more likely to favor consultation and co-location models over an integration model of care delivery. Overall, the authors found that pediatricians are dealing with patients with B-MH problems for which they may not have been adequately trained. Communication and collaboration needs were identified.

Treadmill stepping in infants born prematurely

Premature infants stepped on a treadmill as early as 1-month corrected age and they performed more coordinated alternate steps than their full-term peers. Twelve low-risk premature infants were observed at 1-, 6- and 9-months corrected-age. The infants were supported on a treadmill for five 20-s trials at three speeds. The following data were analysed from the video records: (1) Leg postures in treadmill-moving and non-moving trials, (2) various parameters of limb position and movement during each step cycle, and (3) multiple anthropometric measures. Premature infants at all ages performed coordinated alternating steps which responded to changes in speed. The premature infants had more extended leg postures during non-stepping analysis than they did once the swing was initiated. Low-risk premature birth did not interfere with the neuromotor pathway. Experience out-of-utero may have facilitated stepping.

Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years.

Objective:Changes in nutritional strategies over the past decade have been shown to improve postnatal growth in extremely low birth weight (ELBW) infants. We showed 10 years ago that the majority of these ELBW infants with bronchopulmonary dysplasia (BPD) suffer postnatal growth failure. We theorized that recent changes in nutritional support strategies would positively affect growth outcomes in ELBW infants with BPD.Study Design:A retrospective study of 88 ELBW infants with BPD. Nutritional data, postnatal growth and BPD severity were compared across three cohorts: (1) weight gain ⩽14 g kg−1 per day, (2) 14.1 to 16 g kg−1 per day and (3) ⩾16 g kg−1 per day from return to birth weight through discharge. We also compared these to a historical cohort.Result:In all, 73% of current subjects grew at or above fetal rates. There was less extrauterine growth restriction (EUGR) by weight and head circumference for those ELBW infants with BPD receiving higher amounts of protein. Aggressive early TPN and receipt of caloric-dense milk seemed to be the ‘new’ nutritional strategies improving growth for current ELBW infants with BPD compared with those 10 years ago.Conclusion:Despite a diagnosis of BPD, improved nutritional strategies have enhanced postnatal growth in infants at high risk for EUGR.

Lead exposure and attention regulation in children living in poverty

This study examined the relationship between lead exposure and attention regulation in children from low-income families. Children with lead exposure were expected to have lower attention regulation abilities than children who were not exposed. The 57 participants (39% male, 61% female) were children aged 4 and 5 years (mean age 4y 7mo [SD 5mo]); 24 children were lead-exposed (10-29microg/dl) and 33 were non-exposed comparisons (1-6microg/dl). Both groups qualified to be enrolled in programs for low-income families. A puzzle-matching task was completed in parent-child and child-alone conditions. Attention allocation and puzzle-matching performance were assessed in the two conditions. Children who were lead-exposed demonstrated less self-regulated attention than comparisons and had poorer puzzle performance in the child-alone condition. Attention patterns did not differ in the parent-child condition. This study extends previous knowledge concerning effects of lead exposure on preschool children from disadvantaged environments and suggests that lead exposure affects specific attention regulation abilities.

Health Promotion in Pediatric Primary Care Importance of Health Literacy and Communication Practices

Health literacy has been shown to predict health behaviors and outcomes above the effects of education or socioeconomic status. Much remains unknown about the health literacy of parents and the role it plays in children’s health outcomes or in health disparities. The current study explored the health communication needs and health literacy indicators in a diverse sample of parents (n = 75) to identify potential areas for future interventions. The sample consisted of parents of children 18 to 36 months old who were visiting 3 different pediatric medical offices, 2 of which served low-income families and 1 located in an affluent suburb. When comparisons were made between 2 educational attainment groups, there were variations in indicators of health literacy and health communication needs. These data can be used to guide the development of interventions by primary care providers to improve parent education.

Psychotropic Medication Use in Children With Autism in the Kentucky Medicaid Population

This study reviewed Kentucky Medicaid claims data for children with autism spectrum disorders to determine psychotropic drug (PTD) use in this population. Children with autism spectrum disorders (ICD-9 code 299.XX) in 3 different age-groups from 2005 to 2008 were identified; PTD use was defined as at least 1 prescription per year. PTD use in all age ranges was higher than in previously reported studies. High PTD use in children between 1 and 5 years is particularly of concern and may reflect perceived inadequacies of comprehensive educational/behavioral services for these children.

Attention Deficit/Hyperactivity Disorder in Preschool-Age Children: Issues and Concerns

The diagnosis of attention deficit/hyperactivity disorder (ADHD) in children has been steadily increasing over the past 10 years. ADHD is associated with numerous health, behavioral, social, and academic outcomes. The use of medication is common for the treatment of ADHD. However, the evidence base for pharmacological and non-pharmacological treatments for children younger than 6 years of age is limited. Both short-term and long-term studies of efficacy and safety of all interventions are needed in this population, especially the use of psychotropic medications. Understanding the long-term effects of psychotropic medication on the developing brains of preschoolers has important implications for outcomes into adulthood. Nonpharmacologic evidence-based interventions are available and should serve as the first line of treatment in this population. Future research needs include further evidence regarding specific curricula, dose, duration, delivery methods, and staff training to ensure optimal intervention outcomes.