Kari Glavin

Redesigned community postpartum care to prevent and treat postpartum depression in women – a one‐year follow‐up study

AIM To investigate the effect of a redesigned follow-up care programme on prevention and treatment of postpartum depression. BACKGROUND Postpartum depression may have negative consequences on child development, maternal health and the relationship between parents. Early identification and treatment might prevent longer-term depression. DESIGN A quasi-experimental post-test design with non-equivalent groups. METHOD The study population was postpartum women with a live-born child, residing in one of two municipalities in Norway. A total of 2247 women were enrolled: 1806 in the experimental municipality and 441 in the comparison municipality. Public health nurses (26) in the experimental municipality were trained to identify postpartum depression using the Edinburgh Postnatal Depression Scale and clinical assessment and to provide supportive counselling. MEASUREMENTS The Edinburgh Postnatal Depression Scale at six weeks, three, six and 12 months postpartum and the Parenting Stress Index at 12 months postpartum. RESULTS The redesigned postpartum care programme yielded a significant group difference in the Edinburgh Postnatal Depression Scale score at six weeks (p < 0.01), odds ratio (OR) 0.6, three months (p < 0.01), OR 0.4, six months (p < 0.01), OR 0.5 and 12 months postpartum (p < 0.01), OR 0.6. Women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months. CONCLUSION The findings of this study suggest that redesigned postpartum care comprising training of health professionals, increased focus on mental health problems and support for the parents is a useful approach to managing postpartum depression in the community. RELEVANCE TO CLINICAL PRACTICE Public health nurses are well positioned to identify and treat depressed mothers and provide referrals when needed. A small investment in training nurses to identify and treat postpartum depression can be cost-effective in the longer term. These findings have implications for service delivery in public health.

Important periods of weight development in childhood: a population-based longitudinal study

BackgroundIdentifying important ages for the development of overweight is essential for optimizing preventive efforts. The purpose of the study was to explore early growth characteristics in children who become overweight or obese at the age of 8 years to identify important ages for the onset of overweight and obesity.MethodsData from the Norwegian Child Growth Study in 2010 (N = 3172) were linked with repeated measurements from health records beginning at birth. Weight and height were used to derive the body mass index (BMI) in kg/m2. The BMI standard deviation score (SDS) for each participant was estimated at specific target ages, using a piecewise linear mixed effect model.ResultsAt 8 years of age, 20.4% of the children were overweight or obese. Already at birth, overweight children had a significantly higher mean BMI SDS than normal weight 8-year-olds (p < .001) and this difference increased in consecutive age groups in infancy and childhood. A relatively large increase in BMI during the first 9 months was identified as important for being overweight at 8 years. BMI SDS at birth was associated with overweight at 8 years of age (OR, 1.8; 1.6–2.0), and with obesity (OR, 1.8; 1.4–2.3). The Odds Ratios for the BMI SDS and change in BMI SDS further increased up to 1 year of age became very high from 2 years of age onwards.ConclusionsA high birth weight and an increasing BMI SDS during the first 9 months and high BMI from 2 years of age proved important landmarks for the onset of being overweight at 8 years of age. The risks of being overweight at 8 years appear to start very early. Interventions to prevent children becoming overweight should not only start at a very early age but also include the prenatal stage.

Prevalence and risk factors for postpartum depressive symptoms in Argentina: a cross-sectional study

Introduction Postpartum depression is a prevalent disorder with negative consequences for women, infants, and the family as a whole. Most studies of this disorder have been conducted in Western countries, and studies from developing countries are few. In this paper, we report the first – as far as we are aware – study of the prevalence and risk factors associated with postpartum depressive symptoms in Argentina. Materials and methods The study participants were 86 women attending 6 week checkups, (range 4–12 weeks) postpartum at a private health care center in the metropolitan area of Buenos Aires. The women completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire collecting demographic and obstetric data. Data were described as proportions (percentages). Differences between proportions were assessed with chi-squared tests. To control for possible confounders, we fitted bivariate logistic regression models in which the dependent variable was an EPDS sum score of <10 versus a score of ≥10. Results We found a high prevalence of depressive symptoms. A total of 32 women (37.2%) had an EPDS score of ≥10, 16 (18.6%) had a score between 10 and 12, and 16 (18.6%) had a score of ≥13. In our sample, an EPDS score of ≥10 was significantly associated with multiparity (odds ratio [OR] =3.58; 95% confidence interval [CI]: 1.13–11.30; P=0.030), pregnancy complications (OR =3.40; 95% CI: 1.03–11.26; P=0.045), labor complications (OR =11.43; 95% CI: 1.71–76.61; P=0.012), cesarean section (OR =4.19; 95% CI: 1.10–16.01; P=0.036), and incomplete breast-feeding (OR =5.00; 95% CI: 1.42–17.54; P=0.012). Conclusion Our results indicate that postpartum depression may be prevalent in Argentina, and may be associated with incomplete breast-feeding, cesarean section, perinatal complications and multiparity. The prevalence and risk factors for postpartum depression has not been described previously and is a considerable health-related problem among women. Argentinian health professionals should be aware of the high prevalence rate and possible risk factors so that these women and families can be identified and receive adequate support and treatment.

Development of family and dietary habits questionnaires: the assessment of family processes , dietary habits and adolescents' impulsiveness in Norwegian adolescents and their parents

BackgroundThere is a need for valid and comprehensive measures of parental influence on children’s energy balance-related behaviours (EBRB). Such measures should be based on a theoretical framework, acknowledging the dynamic and complex nature of interactions occurring within a family. The aim of the Family & Dietary habits (F&D) project was to develop a conceptual framework identifying important and changeable family processes influencing dietary behaviours of 13-15 year olds. A second aim was to develop valid and reliable questionnaires for adolescents and their parents (both mothers and fathers) measuring these processes.MethodsA stepwise approach was used; (1) preparation of scope and structure, (2) development of the F&D questionnaires, (3) the conducting of pilot studies and (4) the conducting of validation studies (assessing internal reliability, test-retest reliability and confirmatory factor analysis) using data from a cross-sectional study.ResultsThe conceptual framework includes psychosocial concepts such as family functioning, cohesion, conflicts, communication, work-family stress, parental practices and parental style. The physical characteristics of the home environment include accessibility and availability of different food items, while family meals are the sociocultural setting included. Individual characteristics measured are dietary intake (vegetables and sugar-sweetened beverages) and adolescents’ impulsivity. The F&D questionnaires developed were tested in a test-retest (54 adolescents and 44 of their parents) and in a cross-sectional survey including 440 adolescents (13-15 year olds), 242 mothers and 155 fathers. The samples appear to be relatively representative for Norwegian adolescents and parents. For adolescents, mothers and fathers, the test-retest reliability of the dietary intake, frequencies of (family) meals, work-family stress and communication variables was satisfactory (ICC: 0.53-0.99). Barratt Impulsiveness Scale-Brief (BIS-Brief) was included, assessing adolescent’s impulsivity. The internal reliability (Cronbach’s alphas: 0.77/0.82) and test-retest reliability values (ICC: 0.74/0.77) of BIS-Brief were good.ConclusionsThe conceptual framework developed may be a useful tool in guiding measurement and assessment of the home food environment and family processes related to adolescents’ dietary habits, in particular and for EBRBs more generally. The results support the use of the F&D questionnaires as psychometrically sound tools to assess family characteristics and adolescent’s impulsivity.

A comparison of the Well Child Clinic services in Norway and the Nurse Family Partnership programme in the United States

AIM AND OBJECTIVES To present a comparison and a discussion of the Well Child Clinic model in Norway and the Nurse-Family Partnership model in the United States. BACKGROUND The Nurse Family Partnership programme in the United States is voluntary and not universal. The Well Child Clinic programme in Norway is voluntary but universally available for Norwegian families. As the Well Child Clinics are used by the vast majority of the families in Norway, it is difficult to determine the benefits and outcomes for the families who receive universal services. DESIGN Qualitative design. METHODS Authors reviewed the literature on the Norwegian Well Child Clinics and the Nurse Family Partnership programme in the United States and interviewed public health nurses experts on evidence-based home visiting programmes in Minnesota. RESULTS The similarities between goals and content of the Nurse Family Partnership programme in the United States and the Well Child Clinic services in Norway are emphases on (1) intensive services, (2) a focus on behaviour, (3) the inclusion of both parents and children and (4) programme fidelity. The major difference in the programmes is the focus on a targeted population for the Nurse Family Partnership programme vs. the universal offer of Well Child Clinics in Norway. CONCLUSION Norway should continue with universal approach to support new families. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families. RELEVANCE TO CLINICAL PRACTICE Public health nursing leaders in Norway need to advocate for public health nurse ratios that make it possible for public health nurses to follow government guidelines. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families.

Postnatal depression among Sudanese women: prevalence and validation of the Edinburgh Postnatal Depression Scale at 3 months postpartum

Purpose Postnatal depression (PND) rates in low-resource countries have reached levels between 4.9% and 59%. Maternal mental health has not been researched in Sudan, and there are no existing statistics on prevalence or significant risk factors for PND. Consequently, no screening test has been validated to screen for PND at the primary health care level. This study investigates the 3 months prevalence of PND and validates the Edinburgh Postnatal Depression Scale (EPDS) against the Mini-International Neuropsychiatric Interview (MINI). Methodology Pregnant Sudanese women in the second and third trimesters were recruited to the study during routine antenatal care visits in two major maternity hospitals in Khartoum state. They were screened for PND at 3 months postpartum using the EPDS. Test positive women were matched with test negative women according to nearest date of birth. A clinical psychologist verified their depression status using the MINI. Results The follow-up rate was 79%. At a cutoff point of ≥12, the 3 months prevalence of PND was 9.2%. The sensitivity and specificity of the EPDS were 89% and 82%, respectively. The EPDS and MINI showed a strong positive relationship (odds ratio =36). The positive predictive value and negative predictive value, using this study’s prevalence, were 33% and 98.7%, respectively. The receiver operator characteristic analysis showed an area under the curve of 0.89. The cut-off point ≥12 was the most acceptable point as it had the lowest number needed to diagnose (1.4) and a false-positive rate of 18%. Conclusion The EPDS is a valid tool for screening for PND on a Sudanese population. It was accepted, easily administered, and understood by postnatal women. Health care personnel, especially village midwives, should be trained on screening and referral of depressed women for clinical evaluation and management. Due to limited resources available in Sudan, shorter screening tests need to be validated in the future.

Determinants of postnatal depression in Sudanese women at 3 months postpartum: a cross-sectional study

Objectives Maternal mental health is a neglected issue in Sudanese healthcare. The aim of this study was to explore the factors associated with postnatal depression (PND) at 3 months postpartum in a sample of Sudanese women in Khartoum state. Setting Recruitment was from two major public antenatal care (ANC) clinics in two maternity teaching hospitals in Khartoum state. The study participants were recruited during their pregnancy and were followed up and screened for PND at 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Participants A sample of 300 pregnant Sudanese women in their second or third trimester was included in the study. The inclusion criteria were Sudanese nationality, pregnancy in the second or third trimester and satisfactory contact information. Outcome measures PND was assessed using the EPDS at a cut-off score of ≥12. Maternal and sociodemographic factors of interest were illustrated in a directed acyclic graph (DAG) to identify which variables to adjust for in multivariate analyses and to show their type of effect on PND. A forward logistic regression model was built to assess the factors that are independently associated with PND. Results History of violence increased the odds of PND sevenfold, OR=7.4 (95% CI 1.9 to 27.6). Older age of mothers decreased the odds of PND by almost 20%, OR=0.82 (95% CI 0.73 to 0.92). Exclusive breast feeding and regular prenatal vitamins during pregnancy are associated with an 80% decrease in odds of PND, OR=0.2 (95% CI 0.06 to 0.70) and 0.17 (95% CI 0.06 to 0.5), respectively. Conclusions Factors associated with PND in this study are comparable to factors from other developing countries, although findings should be judged with caution owing to the high number of women who refused recruitment into the study.

A falls case summary: Application of the public health nursing intervention wheel

BACKGROUND The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. CASE PRESENTATION A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. METHODS The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. CONCLUSIONS The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

From Man to Father: Norwegian First-Time Fathersâ Experience of the Transition to Fatherhood

Objective: To explore how men experience becoming a father for the first time and how they perceive their role during their partner’s pregnancy, childbirth and the early period with a newborn child. Methods: The study had a qualitative design. Nine individual interviews were conducted with first-time fathers. Qualitative content analysis was used to interpret the data material. Results: The men’s ages were from 25 to 45 years. They were all Norwegian, seven were cohabitants, and two were married. Four categories describing fathers’ experience of the transition to their role as fathers were identified: Expectations of fatherhood, delivery, barriers to the father’s role, and facilitators of the father’s role. Conclusion: Development of the fatherhood role is a process in which the man transitions from relating to the abstractness of pregnancy via concretization through birth to the realization phase after birth. Growth in the father’s positive engagement depends on a sense of mastery, meaningfulness, control and manageability in relation to his child, his partner and his new everyday life. Identified factors facilitate or inhibit the development of a positive fatherhood role. The sum of the factors determines how this role is experienced. Insight into the fatherhood role is important to enable health professionals to provide personalized follow-up of high quality in the health services. Better follow-up will enable public health nurses and midwives to strengthen the role of both the individual father and the family as a whole. This will in turn contribute to better health and development for the child.

Public Health Nursing in the 21st Century: Challenges and Opportunities for Women and Children’s Health

This special issue focuses upon public health nursing with women and children in the 21st century. There are 6 papers which address a range of topics illustrating some of the opportunities and challenges arising in this area of nursing work from Ireland, Norway, Finland, UK, Canada, and Brazil.