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Spyridou A, Schauer M, Ruf-Leuschner M. Prenatal screening for psychosocial risks in a high risk-population in Peru using the KINDEX interview. BMC Pregnancy Childbirth 2016; 16:13. [PMID: 26801404 PMCID: PMC4722714 DOI: 10.1186/s12884-016-0799-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 01/06/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother's health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences. METHODS The study was conducted in cooperation with the gynecological department of a general hospital in a suburban area of Lima. Nine midwives conducted interviews using the KINDEX of ninety-five pregnant women attending the gynecological unit of the hospital. From these, forty pregnant women were re-interviewed by a clinical psychologist using established instruments in order to assess the feasibility of the prenatal assessment in public health settings and the relationship of the KINDEX with maternal perceived stress, psychopathology symptoms and trauma load during pregnancy. RESULTS We found high rates of risk factors in the examined pregnant women comparable with those found in the general population. Significant correlations were found between the KINDEX sum score and the three risks areas, stress, psychopathology and trauma load as assessed in the Clinical Expert interviews. The different risks assessed by the KINDEX are related to higher levels of stress, psychopathology and trauma load, depending on the risk. CONCLUSIONS The relationship between past adverse experience and current stressors with perceived maternal stress, psychopathology symptoms and traumatic experiences confirm the importance of prenatal assessment for psychosocial risks. The use of KINDEX by midwives providing obstetrical care to pregnant women in urban Peru is feasible and can be used to identify high-risk women and refer them to the adequate mental health or social services for necessary attention and support. Early interventions are essential to mitigating the adverse effects of maternal stress, trauma and psychopathology on the fetus and child.
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Affiliation(s)
- Andria Spyridou
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
| | - Maggie Schauer
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
| | - Martina Ruf-Leuschner
- />Center of Excellence for Psychotraumatology, Department of Psychology, Clinical Psychology & Behavioral Neuroscience Unit, University of Konstanz, Post Box D 23, D-78457 Konstanz, Germany
- />vivo international, http://www.vivo.org
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Joshua P, Zwi K, Moran P, White L. Prioritizing vulnerable children: why should we address inequity? Child Care Health Dev 2015; 41:818-26. [PMID: 26077027 DOI: 10.1111/cch.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and young people from vulnerable population groups, including Indigenous Australians, those in out of home care, those with disabilities and those from refugee families, have difficulties in accessing health services and are at high risk of adverse outcomes, driving population health inequity. Although heterogeneous, these groups face common disadvantage and shared challenges in health service utilization. AIM This study aims to analyse the demographics of vulnerable child populations in NSW, the rationale for focussing on their health needs and strategies for addressing population health inequity. METHODOLOGY A literature review was undertaken on vulnerable child populations and successful strategies for improving their health outcomes. NSW data on vulnerable children were collated. FINDINGS Vulnerable children in NSW are estimated to comprise 10-20% of the childhood population. Efforts to improve their health and well-being can be justified based on child rights, a focus on equity and effectiveness of care, public opinion and the evidence base supporting such interventions. Targeted (subpopulation specific) interventions and delivery of universally applied (population wide) strategies that disproportionately benefit vulnerable populations have been shown to be effective in reducing healthcare disparities. Most available information relates to specific vulnerable population groups. However, some effective strategies and key principles are broadly applicable to the vulnerable child population as a whole. CONCLUSION Vulnerable children should be a key focus of healthcare interventions if inequities are to be addressed.
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Affiliation(s)
- P Joshua
- Department of Paediatrics, Sydney South West Local Health District, Sydney, NSW, Australia
| | - K Zwi
- Sydney Children's Hospitals Network, Randwick Campus, Sydney, NSW, Australia, and.,University of New South Wales, Australia
| | - P Moran
- Sydney Children's Hospitals Network, Randwick Campus, Sydney, NSW, Australia, and
| | - L White
- Sydney Children's Hospitals Network, Randwick Campus, Sydney, NSW, Australia, and.,University of New South Wales, Australia
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Morinis J, Carson C, Quigley MA. Effect of teenage motherhood on cognitive outcomes in children: a population-based cohort study. Arch Dis Child 2013; 98:959-64. [PMID: 24126496 DOI: 10.1136/archdischild-2012-302525] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the association between teenage motherhood and cognitive development at 5 years. DESIGN Data from Millennium Cohort Study, a prospective, nationally representative UK cohort of 18 818 infants born between 2000 and 2001. PARTICIPANTS 12 021 (64%) mother-child pairs from white, English-speaking, singleton pregnancies were included. METHODS Cognitive ability at 5 years was measured by the British Ability Scales II. Difference in mean cognitive scores across maternal age groups was estimated using linear regression, with adjustment for potential confounders and mediators. RESULTS 617 (5%) children were born to mothers aged ≤18 years. Our analysis revealed that children of teenage mothers had significantly lower cognitive scores compared with children of mothers aged 25-34 years: difference in mean score for verbal ability -8.9 (-10.88 to -6.86, p<0.001); non-verbal ability -7.8 (-10.52 to -5.19, p<0.001); spatial ability -4.7 (-6.39 to -3.07, p<0.001), which is equivalent to an average delay of 11, 7 and 4 months, respectively. After adjustment for perinatal and sociodemographic factors, the effect of young maternal age on non-verbal and spatial ability mean scores was attenuated. A difference persisted in the mean verbal ability scores -3.8 (-6.34 to -1.34, p=0.003), equivalent to an average delay of 5 months. CONCLUSIONS Results suggest that the difference observed in the initial analyses for non-verbal and spatial skills are almost entirely explained by marked inequalities in sociodemographic circumstances and perinatal risk. However, there remains a significant adverse effect on verbal abilities in the children born to teenage mothers.
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Affiliation(s)
- Julia Morinis
- National Perinatal Epidemiology Unit, University of Oxford, , Oxford, UK
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Padilla CM, Deguen S, Lalloue B, Blanchard O, Beaugard C, Troude F, Navier DZ, Vieira VM. Cluster analysis of social and environment inequalities of infant mortality. A spatial study in small areas revealed by local disease mapping in France. THE SCIENCE OF THE TOTAL ENVIRONMENT 2013; 454-455:433-41. [PMID: 23563257 PMCID: PMC4097309 DOI: 10.1016/j.scitotenv.2013.03.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 01/07/2013] [Accepted: 03/08/2013] [Indexed: 05/13/2023]
Abstract
Mapping spatial distributions of disease occurrence can serve as a useful tool for identifying exposures of public health concern. Infant mortality is an important indicator of the health status of a population. Recent literature suggests that neighborhood deprivation status can modify the effect of air pollution on preterm delivery, a known risk factor for infant mortality. We investigated the effect of neighborhood social deprivation on the association between exposure to ambient air NO2 and infant mortality in the Lille and Lyon metropolitan areas, north and center of France, respectively, between 2002 and 2009. We conducted an ecological study using a neighborhood deprivation index estimated at the French census block from the 2006 census data. Infant mortality data were collected from local councils and geocoded using the address of residence. We generated maps using generalized additive models, smoothing on longitude and latitude while adjusting for covariates. We used permutation tests to examine the overall importance of location in the model and identify areas of increased and decreased risk. The average death rate was 4.2‰ and 4.6‰ live births for the Lille and Lyon metropolitan areas during the period. We found evidence of statistically significant precise clusters of elevated infant mortality for Lille and an east-west gradient of infant mortality risk for Lyon. Exposure to NO2 did not explain the spatial relationship. The Lille MA, socioeconomic deprivation index explained the spatial variation observed. These techniques provide evidence of clusters of significantly elevated infant mortality risk in relation with the neighborhood socioeconomic status. This method could be used for public policy management to determine priority areas for interventions. Moreover, taking into account the relationship between social and environmental exposure may help identify areas with cumulative inequalities.
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Affiliation(s)
- Cindy M. Padilla
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- French Environment and Energy Management Agency, Angers, France
| | - Severine Deguen
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
| | - Benoit Lalloue
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- Lorraine University Medical School–Institut Elie Cartan UMR 7502, Nancy University, CNRS, INRIA, Vandoeuvre-les-Nancy, France
| | - Olivier Blanchard
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
| | - Charles Beaugard
- Official Air Quality Monitoring Associations (AASQA), Atmo Nord Pas-de-Calais, Air Rhône-Alpes, France
| | - Florence Troude
- Official Air Quality Monitoring Associations (AASQA), Atmo Nord Pas-de-Calais, Air Rhône-Alpes, France
| | - Denis Zmirou Navier
- EHESP School of Public Health –Sorbonne Paris Cité – Rennes, France
- INSERM U1085-IRSET – Research Institute of Environmental and Occupational Health, Rennes, France
- Lorraine University Medical School–Institut Elie Cartan UMR 7502, Nancy University, CNRS, INRIA, Vandoeuvre-les-Nancy, France
| | - Verónica M. Vieira
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
- Program in Public Health, Chao Family Cancer Center, University of Irvine, CA 92697, USA
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Namiiro FB, Mugalu J, McAdams RM, Ndeezi G. Poor birth weight recovery among low birth weight/preterm infants following hospital discharge in Kampala, Uganda. BMC Pregnancy Childbirth 2012; 12:1. [PMID: 22230245 PMCID: PMC3282660 DOI: 10.1186/1471-2393-12-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 01/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthy infants typically regain their birth weight by 21 days of age; however, failure to do so may be due to medical, nutritional or environmental factors. Globally, the incidence of low birth weight deliveries is high, but few studies have assessed the postnatal weight changes in this category of infants, especially in Africa. The aim was to determine what proportion of LBW infants had not regained their birth weight by 21 days of age after discharge from the Special Care Unit of Mulago hospital, Kampala. METHODS A cross sectional study was conducted assessing weight recovery of 235 LBW infants attending the Kangaroo Clinic in the Special Care Unit of Mulago Hospital between January and April 2010. Infants aged 21 days with a documented birth weight and whose mothers gave consent to participate were included in the study. Baseline information was collected on demographic characteristics, history on pregnancy, delivery and postnatal outcome through interviews. Pertinent infant information like gestation age, diagnosis and management was obtained from the medical records and summarized in the case report forms. RESULTS Of the 235 LBW infants, 113 (48.1%) had not regained their birth weight by 21 days. Duration of hospitalization for more than 7 days (AOR: 4.2; 95% CI: 2.3 - 7.6; p value < 0.001) and initiation of the first feed after 48 hours (AOR: 1.9; 95% CI 1.1 - 3.4 p value 0.034) were independently associated with failure to regain birth weight. Maternal factors and the infant's physical examination findings were not significantly associated with failure to regain birth weight by 21 days of age. CONCLUSION Failure to regain birth weight among LBW infants by 21 days of age is a common problem in Mulago Hospital occurring in almost half of the neonates attending the Kangaroo clinic. Currently, the burden of morbidity in this group of high-risk infants is undetected and unaddressed in many developing countries. Measures for consideration to improve care of these infants would include; discharge after regaining birth weight and use of total parenteral nutrition. However, due to the pressure of space, keeping the baby and mother is not feasible at the moment hence the need for a strong community system to boost care of the infant. Close networking with support groups within the child's environment could help alleviate this problem.
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Affiliation(s)
- Flavia B Namiiro
- Department of Pediatrics, Mulago National Referral Hospital, Kampala, Uganda.
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Gungor I, Oskay U, Beji NK. Biopsychosocial risk factors for preterm birth and postpartum emotional well-being: a case-control study on Turkish women without chronic illnesses. J Clin Nurs 2011; 20:653-65. [PMID: 21320194 DOI: 10.1111/j.1365-2702.2010.03532.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES The study aimed to determine bio-psycho-social risk factors for preterm birth in a sample of Turkish women without chronic illnesses and evaluate their anxiety and depression in early postpartum period. BACKGROUND Preterm birth is a devastating event with long-term health and social implications. Studies have identified several risk factors; however, the contribution of these causes differs by ethnic groups. DESIGN This case-control study was conducted in a tertiary hospital in Istanbul over one year. In total, 149 preterm mothers were included in the case group and 150 term mothers who delivered in the same day with a case group woman were included in the control group. Chronic illnesses and anomalies were excluded. METHOD Data were gathered using a form that addressed risk factors for preterm birth. Multidimensional Scale of Perceived Social Support, Beck Depression Inventory and Spielberger's State-Trait Anxiety Inventory were administered within 24-72 hours after birth. RESULTS Logistic regression analysis revealed that partner's lower education (≤ 8 years), history of preterm birth, antenatal hospitalisation, genitourinary infection and irregular prenatal care were significant risk factors. Perceived social support from family and friends were significantly lower in preterm group. Preterm mothers experienced significantly more anxiety and depressive symptoms in early postpartum. CONCLUSION Many of the socio-economical and obstetric causes of preterm births were similar to other countries with higher preterm birth rates. Preterm births were associated with lower social support along with more anxiety and depressive symptoms in early postpartum. RELEVANCE TO CLINICAL PRACTICE Women who have established risk factors can be targeted for more intensive antenatal care for the prevention of preterm birth. Increased maternal anxiety and depression reveal the necessity of emotional support immediately after birth.
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Affiliation(s)
- Ilkay Gungor
- Department of Obstetric and Gynecologic Nursing, Istanbul University Florence Nightingale School of Nursing, Istanbul, Turkey.
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Barros AJD, Matijasevich A, Santos IS, Halpern R. Child development in a birth cohort: effect of child stimulation is stronger in less educated mothers. Int J Epidemiol 2009; 39:285-94. [PMID: 19717543 DOI: 10.1093/ije/dyp272] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Child health has improved in many developing countries, bringing new challenges, including realization of the children's full physical and intellectual potential. This study explored child development within a birth cohort, its psychosocial determinants and interactions with maternal schooling and economic position. METHODS All children born in Pelotas, Brazil, in 2004, were recruited to a birth cohort study. These children were assessed at birth and at 3, 12 and 24 months of age. In this last assessment involving 3869 children, detailed information on socio-economic and health characteristics was collected. Child development was assessed using the screening version of Battelle's Development Inventory. Five markers of cognitive stimulation and social interaction were recorded and summed to form a score ranging from 0-5. The outcomes studied were mean development score and low performance (less than 10th percentile of the sample). RESULTS Child development was strongly associated with socio-economic position, maternal schooling and stimulation. Having been told a story and owning a book were the least frequent markers among children with score 1. These children were 8.3 times more likely to present low performance than those who scored 5. The effect of stimulation was much stronger among children from mothers with a low level of schooling--one additional point added 1.7 on the child's development for children of low-schooling mothers, whereas only 0.6 was added for children of high-schooling mothers. CONCLUSIONS Our stimulation markers cannot be directly translated into intervention strategies, but strongly suggest that suitably designed cognitive stimulation can have an important effect on children, especially those from mothers with low schooling.
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Affiliation(s)
- Aluísio J D Barros
- Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas, Pelotas, Brazil.
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