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Hwang SS, Tong S, Pyle L, Battaglia C, McManus B, Niermeyer S, Sauaia A. Impact of State Prioritization of Safe Infant Sleep Programs on Supine Sleep Positioning for Non-Hispanic White and Non-Hispanic Black Infants. Am J Perinatol 2023; 40:1279-1285. [PMID: 34544194 DOI: 10.1055/s-0041-1735262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Investigate whether safe infant sleep prioritization by states through the Title V Maternal and Child Block Grant in 2010 differentially impacted maternal report of supine sleep positioning (SSP) for Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) U.S.-born infants. STUDY DESIGN We analyzed retrospective cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2005 to 2015 from 4 states: WV and OK (Intervention) and AR and UT (Control). PRAMS is a population-based surveillance system of maternal perinatal experiences which is linked to infant birth certificates. Piece-wise survey linear regression models were used to estimate the difference in the change in slopes of SSP percents in the pre- (2005-2009) and post- (2011-2015) periods, controlling for maternal and infant characteristics. Models were also stratified by race/ethnicity. RESULTS From 2005 to 2015, for NHW infants, SSP improved from 61.5% and 70.2% to 82.8% and 82.3% for intervention and control states, respectively. For NHB infants, SSP improved from 30.6% and 26.5% to 64.5% and 53.1% for intervention and control states, respectively. After adjustment for maternal characteristics, there was no difference in the rate of SSP change from the pre- to post- intervention periods for either NHW or NHB infants in intervention or control groups. CONCLUSION Compared with control states that did not prioritize safe infant sleep in their 2010 Title V Block Grant needs assessment, intervention states experienced no difference in SSP improvement rates for NHW and NHB infants. While SSP increased for all infants during the study period, there was no causal relationship between states' prioritization of safe infant sleep and SSP improvement. More targeted approaches may be needed to reduce the racial/ethnic disparity in SSP and reduce the risk for sleep-associated infant death. KEY POINTS · Supine sleep positioning improved for Black and White infants in the U.S.. · State prioritization of safe infant sleep did not directly impact SSP for NHB or NHW infants.. · More targeted approaches may be needed to reduce racial/ethnic disparities in safe sleep practices.
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Affiliation(s)
- Sunah S Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Suhong Tong
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado
| | - Laura Pyle
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado
| | - Catherine Battaglia
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Beth McManus
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Susan Niermeyer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Angela Sauaia
- Department of Biostatistics, Colorado School of Public Health, Aurora, Colorado
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Aitken ME, Whiteside-Mansell L, Mullins SH, Bai S, Miller BK. Safety Baby Shower Intervention Improves Safe Sleep Knowledge and
Self-Efficacy among Expectant Teens. SAGE Open Nurs 2023; 9:23779608231164306. [PMID: 36969364 PMCID: PMC10031593 DOI: 10.1177/23779608231164306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/29/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
Introduction Young, minority women are less likely to follow recommendations to prevent
infant sleep-related deaths putting their children at risk. This study
extended the past pre/post study designs to an RCT design and included both
parent report and objective observation of the sleep environment. Objective This study focused on this population in a quantitative, randomized
controlled trial using a low-cost, brief educational intervention, a Safety
Baby Shower (SBS). Methods Pregnant teens aged 13–19 (N = 147) were recruited as a dyad with a senior
female caregiver and randomized to intervention or control groups. Results Comparing self-report, safe sleep knowledge, attitudes, beliefs, and intent
(KABI) to act scores across the two groups found intervention dyads to have
more positive views on all four constructs than controls. Specifically,
intervention dyad young mothers were significantly more likely to have
positive beliefs about safe sleep and were more likely to report intent to
practice infant safe sleep than control young mothers. Intervention dyad
young mothers also had higher self-efficacy related to infant safety and
more positive attitudes about safe sleep practices than control young
mothers. Observations at a home visit conducted after delivery found no
differences in the safe sleep practices by intervention status. Participant
report of behaviors at the home visit also showed no differences in the use
of safe position between the intervention and control groups. Conclusion It appears that even when young mothers gain knowledge and self-efficacy,
they have difficulty implementing this knowledge. In practice, this suggests
that exploring barriers prenatally with this population and offering
suggestions to overcome them may be indicated.
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Affiliation(s)
- Mary E. Aitken
- Department of Pediatrics, McGovern Medical School at UTHealth and
Children's Memorial Hermann Hospital, Houston, TX, USA
- Mary E. Aitken, Department of Pediatrics,
McGovern Medical School at UTHealth and Children’s Memorial Hermann Hospital,
Houston, TX 77030, USA.
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine,
University of
Arkansas for Medical Sciences, Little Rock,
AR, USA
| | - Samantha H. Mullins
- Center for Applied Research and Evaluation, Department of
Pediatrics, University of
Arkansas for Medical Sciences, Little Rock,
AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Injury Prevention Center, Arkansas Children's Hospital, Little Rock,
AR, USA
| | - Shasha Bai
- Center for Biostatistics, Department of Biomedical Informatics, The
Ohio State University Wexner Medical Center, Columbus, OH, USA
- Biostatistics Resources at Nationwide Children's Hospital, Columbus,
OH, USA
| | - Beverly K. Miller
- Center for Applied Research and Evaluation, Department of
Pediatrics, University of
Arkansas for Medical Sciences, Little Rock,
AR, USA
- Arkansas Children's Research Institute, Little Rock, AR, USA
- Injury Prevention Center, Arkansas Children's Hospital, Little Rock,
AR, USA
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Achaliwie F, Wakefield AB, Mackintosh-Franklin C. The impact of education on the knowledge and attitudes of Ghanaian nurse tutors towards the assessment and management of pain in children: A quantitative study. NURSE EDUCATION TODAY 2023; 121:105680. [PMID: 36495595 DOI: 10.1016/j.nedt.2022.105680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Undertreatment of pain in children is an international problem as many children reports unresolved moderate to severe pain. One key factor which may contribute to under treatment of pain in children by nurses is lack of knowledge. In Ghana opportunities for nurses to learn about pediatric pain have been limited due to gaps in the undergraduate curriculum and inadequate continuing professional education post qualification. OBJECTIVE To assess tutors' knowledge and attitudes to pediatric pain management before and after an educational workshop. DESIGN Single group pre-test-post-test design. SETTING One Ghanaian Nursing Training College. PARTICIPANTS All (37) nursing tutors in the college. METHOD Total population sampling was used to access 37 tutors, data were collected using the Knowledge and Attitude Survey Regarding Pain at 3 stages; pre-intervention, immediately after the train-the-trainer based Pediatric Pain Educational Workshop and at 3-months follow-up. Data from the survey were analyzed using descriptive and inferential statistics. RESULTS Results at pre-intervention showed low scores in the survey. However, post-intervention results at both the immediate and 3-months follow-up stages revealed a significant increase from pre-intervention: Mean (SD) of 20.35 (4.56), to immediate follow-up Mean (SD) 26.93 (5.02), and 3-months follow-up Mean (SD) 25.19 (5.80) and a p-value of <0.001. CONCLUSION The results suggest tutors' knowledge and attitudes regarding pediatric pain management can be directly improved through a nurse tutor focused educational program. However, knowledge declines with time and as such there is the need for regular update through Continuing Professional Development activities.
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Affiliation(s)
- Francisca Achaliwie
- Department of Nursing, School of Nursing and Midwifery, CK Tedam University of Technology and Applied Sciences, P. O. Box 24, Navrongo, Ghana.
| | - Ann B Wakefield
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Carolyn Mackintosh-Franklin
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Mery JN, Vladescu JC, Day-Watkins J, Sidener TM, Reeve KF, Schnell LK. Training medical students to teach safe infant sleep environments using pyramidal behavioral skills training. J Appl Behav Anal 2022; 55:1239-1257. [PMID: 35854197 DOI: 10.1002/jaba.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
Medical personnel play a critical role in caregiver safe infant sleep education. However, training outcomes in the safe infant sleep training literature have been mixed. Promising approaches that warrant further investigation are the use of behavioral skills training and pyramidal training. The current study consisted of two experiments. Experiment 1 extended Carrow et al. (2020) and Vladescu et al. (2020) by teaching medical students safe infant sleep practices using behavioral skills training. Discriminated responding was examined across trained and untrained environmental arrangements using a multiple-baseline design. All participants arranged safe sleep environments following behavioral skills training. In Experiment 2, we used pyramidal behavioral skills training to train medical students to teach others safe sleep practices. Results indicated high procedural integrity scores following training and generalization of skills.
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Neuharth-Pritchett S, Salm Ward T, McLaughlin KC, Jackson VM. A comparison of safe sleep violations in child care and family child care learning homes in Georgia. Child Care Health Dev 2021; 47:184-190. [PMID: 33125758 DOI: 10.1111/cch.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/04/2020] [Accepted: 10/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND High rates of infant death associated with sleeping practices continue to persist in the United States. Infants spend a large portion of their day with child care and family child care learning home providers. Safe sleeping practices continue to be an area of need for care providers of young children. METHOD The current study examines data drawn from a publicly available database of child care licensing reports in Georgia (n = 3,501), which contained data on child care centres and family child care learning homes. Information in the database included characteristics of the centres, year of data collection and the specific violations by child care provider type. RESULTS Results indicated clear differences in the prevalence of violations between child care centres and family child care learning homes. Within the overall sample, 13.3% of centres and family child care learning homes were cited for safe sleeping practice violations with higher prevalence in licensed child care centres and unaccredited centres. Violations were consistent with those commonly found in child care environments and inconsistent with the American Academy of Pediatrics safe sleep recommendations. CONCLUSIONS Data from the current study suggest a continued need for professional learning on safe sleep practices.
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Affiliation(s)
| | - Trina Salm Ward
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Cornwell B, Yan X, Carlin RF, Fu L, Wang J, Moon RY. Social network influences on new mothers' infant sleep adjustments. Soc Sci Med 2021; 269:113585. [PMID: 33333376 PMCID: PMC7794038 DOI: 10.1016/j.socscimed.2020.113585] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
Despite public awareness campaigns, some parents continue to engage in infant sleep practices that are considered risky by health experts, such as bedsharing or placing their infants on their stomachs. This study examines the role their social networks play in shaping parents' responsiveness to new information and/or suggestions about how they should place their infants for sleep, paying attention to the respective effects of health professionals and their close interpersonal ties. We collected data from a sample of 323 new mothers in Washington, D.C., who described their infant sleep practices and perceived personal social networks. We find evidence that mothers' social networks play a significant role in the likelihood that they adjust their infant sleep practices within the first few months of their infants' lives. Mothers are more likely to change sleep practices when health professionals and/or (lay) family members advise them to do so. The influence of network members is not always positive. For mothers who initially follow safe practices, their probability of change increases if their network members substantially espouse unsafe practices. Among mothers with initially unsafe practices, network members' level of support for safe sleep practices is not predictive of the likelihood of sleep practice change. Implications for potential interventions are discussed.
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Affiliation(s)
| | - Xuewen Yan
- Department of Sociology, Cornell University, Ithaca, NY, USA
| | - Rebecca F Carlin
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, D.C., USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Linda Fu
- Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, D.C., USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Jichuan Wang
- Center for Translational Science Children's National Health System, Washington, D.C., USA; Department of Epidemiology and Biostatistics George Washington University, Washington, D.C., USA
| | - Rachel Y Moon
- Department of Pediatrics University of Virginia, Charlottesville, VA, USA
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Canty EA, Fogel BN, Batra EK, Schaefer EW, Beiler JS, Paul IM. Improving infant sleep safety via electronic health record communication: a randomized controlled trial. BMC Pediatr 2020; 20:468. [PMID: 33032546 PMCID: PMC7542743 DOI: 10.1186/s12887-020-02369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND With increased use of telehealth, interventions to improve infant sleep environments have not been explored. This study sought to assess the feasibility and efficacy of using electronic health record patient portals to transmit photographs of infant sleep between mothers and healthcare professionals as part of an intervention to promote sleep environments consistent with AAP guidelines. METHODS One hundred eighty-four mother-newborn dyads consented to participate in a randomized trial requiring patient portal registration within 1 month of delivery. We first assessed feasibility as measured by a) the proportion of consented mothers enrolling in the portal and b) maternal adherence to prompts to submit photographs of their infant sleeping to the research team through the patient portal. Intervention group mothers were prompted at 1 and 2 months; controls were prompted only at 2 months. Efficacy was determined via research assistant review of submitted photographs. These assistants were trained to detect sudden unexplained infant death risk factors utilizing AAP guidelines. Standardized feedback was returned to mothers through the patient portal. We used Fisher's Exact test to assess group differences in guideline adherence at 2 months. RESULTS One hundred nine mothers (59%) enrolled in the patient portal and were randomized to intervention (N = 55) and control (N = 54) groups. 21 (38, 95% CI 25-52%) intervention group participants sent photographs at 1 month and received personalized feedback. Across both groups at 2 months, 40 (37, 95% CI 28-46%) sent photographs; 56% of intervention group participants who submitted photographs met all safe sleep criteria compared with 46% of controls (difference 0.10, 95% CI - 0.26 to 0.46, p = .75). Common reasons for guideline non-adherence were sleeping in a room without a caregiver (43%), loose bedding (15%) and objects (8%) on the sleep surface. CONCLUSIONS Utilizing the patient portal to individualize safe infant sleep is possible, however, we encountered numerous barriers in this trial to assess its effects on promoting safe infant sleep. Photographs of infants sleeping showed substantial non-adherence to AAP guidelines, suggesting further needs for improvement to promote safe infant sleep practices. TRIAL REGISTRATION Name: Improving Infant Sleep Safety With the Electronic Health Record; Clinicaltrials.gov: NCT03662048 ; Date of Registration: September 7, 2018; Data Sharing Statement: None.
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Affiliation(s)
- Ethan A Canty
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin N Fogel
- Department of Pediatrics, Penn State College of Medicine, HS83, 500 University Drive, Hershey, PA, 17033, USA
| | - Erich K Batra
- Department of Pediatrics, Penn State College of Medicine, HS83, 500 University Drive, Hershey, PA, 17033, USA
- Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Eric W Schaefer
- Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jessica S Beiler
- Department of Pediatrics, Penn State College of Medicine, HS83, 500 University Drive, Hershey, PA, 17033, USA
| | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, HS83, 500 University Drive, Hershey, PA, 17033, USA.
- Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Vladescu JC, Day-Watkins J, Schnell LK, Carrow JN. Safe to sleep: Community-based caregiver training. J Appl Behav Anal 2020; 53:1922-1934. [PMID: 32989789 DOI: 10.1002/jaba.777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/07/2022]
Abstract
Annually, thousands of infant deaths are classified as sudden unexpected infant deaths (SUIDs). In an effort to reduce the risk of SUIDs, the American Academy of Pediatrics has made a number of recommendations to educate caregivers, childcare providers, and healthcare professionals on safe infant sleep practices. The purpose of the current study was to extend the literature on safe infant sleep practices by teaching caregivers to arrange safe infant sleep environments using a mannequin and common infant items. We partnered with community-based agencies to evaluate the effectiveness of behavioral skills training delivered in a single training session as part of the ongoing pre- or postnatal care these agencies provided. Following training, all participants demonstrated a substantial change in responding and returned favorable social validity ratings. We discuss these outcomes in light of previous studies, limitations, and future directions.
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Staton S, Pattinson C, Smith S, Pease A, Blair P, Young J, Irvine S, Thorpe K. Observed compliance with safe sleeping guidelines in licensed childcare services. Arch Dis Child 2019; 104:1193-1197. [PMID: 31300411 DOI: 10.1136/archdischild-2019-317000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/15/2019] [Accepted: 05/26/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services. DESIGN Full-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016-2017. SETTING Australian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines. PARTICIPANTS The sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys. MAIN OUTCOMES AND MEASURES Standard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual's knowledge, beliefs and attitudes regarding safe sleeping practices. RESULTS 83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room. CONCLUSION Despite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies. TRIAL REGISTRATION NUMBER ANZCTR 12618001056280-pre-results.
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Affiliation(s)
- Sally Staton
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Cassandra Pattinson
- Division of Extramural Research (NINR), National Institutes of Health, Washington DC, Washington DC, USA
| | - Simon Smith
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Pease
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Peter Blair
- Centre for Child and Adolescent Health, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Susan Irvine
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karen Thorpe
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
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Cerqueira ACDR, Cardoso MVLML, Viana TRF, Lopes MMCO. Integrative literature review: sleep patterns in infants attending nurseries. Rev Bras Enferm 2018; 71:424-430. [PMID: 29412302 DOI: 10.1590/0034-7167-2016-0480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 04/19/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify evidence available in the literature about sleep patterns of infants attending nurseries. METHOD An integrative review of studies published in Portuguese, English or Spanish available in full text on LILACS, CINAHL, and PubMed databases. The following descriptors sono, lactente and creches or berçários (in Portuguese) and sleep, infant and childcare or nurseries were used for LILACS, CINAHL and Pubmed, respectively. Nine studies were selected and analyzed. RESULTS The main component explored in the studies about sleep pattern is the sleep position of the infants, due to its association with sudden infant death syndrome. The results pointed to the need to promote and develop written guidelines regarding behavioral practices to reduce the risk of this phenomenon. CONCLUSION Evidence has identified sleep issues, mainly regarding the sleep position of the infant and the environment where the infant sleeps, showing that it is critical to set routines and interventions to improve the quality of sleep care of infants attending nurseries.
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Affiliation(s)
| | | | - Tamires Rebeca Forte Viana
- Universidade Federal do Ceará, School of Phamacology, Dentistry and Nursing, Postgraduate Program in Nursing. Fortaleza, Ceará, Brazil
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Santoro SL, Bartman T, Cua CL, Lemle S, Skotko BG. Use of Electronic Health Record Integration for Down Syndrome Guidelines. Pediatrics 2018; 142:peds.2017-4119. [PMID: 30154119 DOI: 10.1542/peds.2017-4119] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Established guidelines from the American Academy of Pediatrics for the care of patients with Down syndrome are often not followed. Our goal was to integrate aspects of the guidelines into the electronic health record (EHR) to improve guideline adherence throughout a child's life span. METHODS Two methods of EHR integration with age-based logic were created and implemented in June 2016: (1) a best-practice advisory that prompts an order for referral to genetics; and (2) a health maintenance record that tracks completion of complete blood cell count and/or hemoglobin testing, thyrotropin testing, echocardiogram, and sleep study. Retrospective chart review of patients with Down syndrome and visits to locations with EHR integration (NICUs, primary care centers, and genetics clinics) assessed adherence to the components of EHR integration; the impact was analyzed through statistical process control charts. RESULTS From July 2015 to October 2017, 235 patients with Down syndrome (ages 0 to 32 years) had 466 visits to the EHR integration locations. Baseline adherence for individual components ranged from 51% (sleep study and hemoglobin testing) to 94% (echocardiogram). EHR integration was associated with a shift in adherence to all select recommendations from 61.6% to 77.3% (P < .001) including: genetic counseling, complete blood cell count and/or hemoglobin testing, thyrotropin testing, echocardiogram, and sleep study. CONCLUSIONS Integrating specific aspects of Down syndrome care into the EHR can improve adherence to guideline recommendations that span the life of a child. Future quality improvement should be focused on older children and adults with Down syndrome.
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Affiliation(s)
- Stephanie L Santoro
- Nationwide Children's Hospital, Columbus, Ohio; .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas Bartman
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Clifford L Cua
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; and.,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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12
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Kuhlmann S, Ahlers-Schmidt CR. The Use of the Child Fatality Review Committee to Contribute to a Longitudinal Quality Improvement Project on Safe Sleep. Hosp Pediatr 2018; 8:504-505. [PMID: 30026249 DOI: 10.1542/hpeds.2018-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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13
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Lagon E, Moon RY, Colvin JD. Characteristics of Infant Deaths during Sleep While Under Nonparental Supervision. J Pediatr 2018; 197:57-62.e36. [PMID: 29622341 DOI: 10.1016/j.jpeds.2018.01.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/18/2017] [Accepted: 01/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare risk factors for infant sleep-related deaths under the supervision of parents and nonparents. STUDY DESIGN We conducted a secondary analysis of sleep-related infant deaths from 2004 to 2014 in the National Center for Fatality Review and Prevention Child Death Review Case Reporting System. The main exposure was supervisor at time of death. Primary outcomes included sleep position, location, and objects in the environment. Risk factors for parental vs nonparental supervisor were compared using χ2 and multivariable logistic regression models. Risk factors associated with different nonparental supervisors were analyzed using χ2. RESULTS Of the 10 490 deaths, 1375 (13.1%) occurred under nonparental supervision. Infants who died under nonparental supervision had higher adjusted odds of dying outside the home (OR 12.87, 95% CI 11.31-14.65), being placed prone (OR 1.61, 95% CI 1.39-1.86) or on their side (OR 1.35, 95% CI 1.12-1.62), or being found prone (OR 1.74, 95% CI 1.50-2.02). Among infants who died under nonparental supervision, those supervised by relatives or friends were more often placed on an adult bed or couch for sleep and bed sharing (P < .0001), and to have objects in the sleep environment (P = .01). CONCLUSIONS Infants who died of sleep-related causes under nonparental supervision were more likely to have been placed nonsupine. Among nonparental supervisors, relatives and friends were more likely to use unsafe sleep environments, such as locations other than a crib or bassinet and bed sharing. Pediatricians should educate parents that all caregivers must always follow safe sleep practices.
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Affiliation(s)
- Elena Lagon
- University of Virginia School of Medicine, Charlottesville, VA
| | - Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
| | - Jeffrey D Colvin
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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Gollenberg A, Fendley K. Is it Time for a Sudden Infant Death Syndrome (SIDS) Awareness Campaign? Community Stakeholders' Perceptions of SIDS. ACTA ACUST UNITED AC 2017; 24:53-64. [PMID: 29249897 DOI: 10.1080/13575279.2016.1259155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Sudden infant death syndrome (SIDS) remains a leading cause of infant death in the United States and in Virginia, the SIDS rate is higher than the national average. We sought to gauge the perceptions among community-identified stakeholders as to community resource needs to reduce SIDS. Methods We used snowball sampling to identify important community stakeholders to be interviewed as key informants. A semi-structured interview lasting 45 min-2 hours was delivered to determine resource needs to reduce SIDS, and whether high-risk community members were aware of SIDS risk factors among stakeholders representing a variety of disciplines. Interviews were conducted in two geographic areas with higher than average rates of infant mortality, an urban district, Winchester City, VA and a rural district, Page County, VA. Results A total of 74 interviews were completed with stakeholders in healthcare, health departments, social services, law enforcement, education/childcare, faith-based institutions, non-profit agencies and non-affiliated community members. The majority of respondents perceive that high-risk community members are not aware of factors that can lead to SIDS (50%). Participants suggested that more "education" is needed to further reduce the rates of SIDS in their communities (73%). Respondents detailed that more pervasive, strategic, and multi-channeled education is necessary to reduce cases of SIDS. Conclusion Community leaders perceive that high-risk community members are not fully aware of risk factors that can lead to SIDS. Maternal/child health stakeholders in these Virginia locales suggested more community-based education as a potential solution to SIDS.
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Affiliation(s)
- Audra Gollenberg
- Associate Professor of Public Health, Shenandoah University, College of Arts & Sciences, Public Health Program, Winchester, VA 22601
| | - Kim Fendley
- Associate Professor of Sociology, Shenandoah University, College of Arts & Sciences, Sociology Program, Winchester, VA 22601
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Aitken ME, Rose A, Mullins SH, Miller BK, Nick T, Rettiganti M, Nabaweesi R, Whiteside-Mansell L. Grandmothers' Beliefs and Practices in Infant Safe Sleep. Matern Child Health J 2017; 20:1464-71. [PMID: 26987862 DOI: 10.1007/s10995-016-1945-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background Sudden infant death syndrome (SIDS) and suffocation are leading causes of infant mortality. Supine sleep position and use of appropriate sleep surfaces reduce SIDS risk but are not universally practiced. Mothers' decisions about sleep position and environment may be influenced by guidance provided by infants' grandmothers and other caregivers. Methods A survey was conducted of a convenience sample of grandmothers aged 30-70 years who provide care at least weekly for an infant grandchild <6 months old. The survey was distributed through community partners of a university-based research team. Respondents received home safety items as compensation. Analyses focused on the relationship of grandmother demographic characteristics and beliefs on their reported practices related to infant sleep. Results Among the 239 grandmothers, 45 % reported placing infants to sleep supine on an appropriate sleep surface at the grandmother's house, while 58 % reported doing so when the infant was sleeping in the mother's house. After adjusting for other factors, respondents were less likely to adhere to recommended guidelines when they believed supine position increased choking risk (OR 0.34, 95 % CI 0.18-0.62) or believed infants are more comfortable or sleep longer when on their stomachs (OR 0.51, 95 % CI 0.28-0.93). Discussion Grandmothers do not universally observe evidence-based safe sleep practices, particularly if the infant is not sleeping in the home of the parent. Interventions for senior caregivers focused on perceived choking risk, infant comfort in the supine position, and other recent changes in recommended safety practices are warranted.
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Affiliation(s)
- Mary E Aitken
- Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA. .,Injury Prevention Center, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA.
| | - Alison Rose
- Arkansas Children's Hospital, Little Rock, AR, USA
| | - S Hope Mullins
- Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Injury Prevention Center, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA
| | - Beverly K Miller
- Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Injury Prevention Center, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA
| | - Todd Nick
- Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mallikarjuna Rettiganti
- Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rosemary Nabaweesi
- Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Injury Prevention Center, Arkansas Children's Hospital Research Institute, Little Rock, AR, USA
| | - Leanne Whiteside-Mansell
- Department of Family and Community Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Moon RY, Hauck FR, Colson ER, Kellams AL, Geller NL, Heeren T, Kerr SM, Drake EE, Tanabe K, McClain M, Corwin MJ. The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial. JAMA 2017; 318:351-359. [PMID: 28742913 PMCID: PMC5593130 DOI: 10.1001/jama.2017.8982] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. OBJECTIVE To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. DESIGN, SETTING, AND PARTICIPANTS Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. INTERVENTIONS All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. MAIN OUTCOMES AND MEASURES The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. RESULTS Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. CONCLUSIONS AND RELEVANCE Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01713868.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Fern R Hauck
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Eve R Colson
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Ann L Kellams
- Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville
| | - Nicole L Geller
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Timothy Heeren
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts
| | - Stephen M Kerr
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Emily E Drake
- Department of Family, Community, and Mental Health Systems, School of Nursing, University of Virginia, Charlottesville
| | - Kawai Tanabe
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville
| | - Mary McClain
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
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de Luca F, Gómez-Durán EL, Arimany-Manso J. Paediatricians' Practice About SUDDEN Infant Death Syndrome in Catalonia, Spain. Matern Child Health J 2017; 21:1267-1276. [PMID: 28160232 PMCID: PMC5443848 DOI: 10.1007/s10995-016-2225-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background SIDS is the major cause of death among healthy born infants in developed countries. Its causes are still unclear, but its risk can be reduced by implementing some simple active interventions. In Spain, limited attention was given to SIDS by the national healthcare system, and actual data on healthcare professionals' practice on this topic was not available. This study explored for the first time paediatricians' knowledge and practice about SIDS. Methods A cross-sectional survey was carried out between November 2012 and April 2013 in Catalonia, and reached 1202 paediatricians. The response rate was 46%. Results 94% of respondents perceived themselves as qualified for giving advice and recommendations about SIDS to parents, but only 58% recognized the supine position as the safest position and recommended the supine position exclusively to parents. Seniority and 'having received a specific training about SIDS' were detrimental to paediatricians' knowledge. Discussion Efforts should be made in order to improve paediatricians' knowledge and practice about SIDS. Specific refresher trainings are highly recommended, and should especially target paediatricians with higher seniority. These trainings could be provided as optional modules, as we could see that the paediatricians who would most benefit from them are already aware of the need to refresh their knowledge.
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Affiliation(s)
- Federico de Luca
- Department of Social Statistics and Demography, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Esperanza L Gómez-Durán
- Professional Liability Service, Col·legi Oficial de Metges de Barcelona, Barcelona, Spain
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
- Psychiatric Unit, Hestia Alliance, Barcelona, Spain
| | - Josep Arimany-Manso
- Professional Liability Service, Col·legi Oficial de Metges de Barcelona, Barcelona, Spain
- Forensic and Legal Medicine Unit, Department of Public Health, Universitat de Barcelona, Barcelona, Spain
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18
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Moon RY. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics 2016; 138:peds.2016-2940. [PMID: 27940805 DOI: 10.1542/peds.2016-2940] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue.
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Kassa H, Moon RY, Colvin JD. Risk Factors for Sleep-Related Infant Deaths in In-Home and Out-of-Home Settings. Pediatrics 2016; 138:peds.2016-1124. [PMID: 27940776 DOI: 10.1542/peds.2016-1124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Multiple environmental risk factors are associated with sleep-related infant deaths. Little is known about differences in risk factors for deaths occurring in-home and out-of-home. We sought to compare risk factors for in-home and out-of-home infant deaths. METHODS We conducted a cross-sectional analysis of sleep-related infant deaths from 2004 to 2014 in the National Child Fatality Review and Prevention database. The main exposure was setting (in-home versus out-of-home) at time of death. Primary outcomes were known risk factors: sleep position, sleep location (eg, crib), objects in the environment, and bed sharing. Risk factors for in-home versus out-of-home deaths were compared using the χ2 test and multivariate logistic regressions. RESULTS A total of 11 717 deaths were analyzed. Infants who died out-of-home were more likely to be in a stroller/car seat (adjusted odds ratio, 2.6; 95% confidence interval, 2.1–3.4; P < .001) and other locations (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.3; P < .001), and placed prone (adjusted odds ratio, 1.18; 95% confidence interval, 1.05–1.32; P < .01. There were no differences in sleeping on a couch/chair or objects in the sleep environment. CONCLUSIONS Sleep-related infant deaths in the out-of-home setting have higher odds of having certain risk factors, such as prone placement for sleep and location in a stroller/car seat, rather than in a crib/bassinet. Caregivers should be educated on the importance of placing infants to sleep supine in cribs/bassinets to protect against sleep-related deaths, both in and out of the home.
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Affiliation(s)
- Hilina Kassa
- Emory University School of Medicine, Atlanta, Georgia
| | - Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jeffrey D Colvin
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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20
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Abstract
Sleep-related infant deaths remain a major public health issue. Multiple interventions have been implemented in efforts to increase adherence to safe sleep recommendations. We conducted a systematic review of the international research literature to synthesize research on interventions to reduce the risk of sleep-related deaths and their effectiveness in changing infant sleep practices. We searched PubMed, CINAHL, PsycINFO, and Google Scholar for peer-reviewed articles published between 1990 and 2015 which described an intervention and reported results. Twenty-nine articles were included for review. Studies focused on infant caregivers, health care professionals, peers, and child care professionals. Targeted behaviors included sleep position, location, removing items from the crib, breastfeeding, smoke exposure, clothing, pacifier use, and knowledge of Sudden Infant Death Syndrome. Most articles described multi-faceted interventions, including: one-on-one or group education, printed materials, visual displays, videos, and providing resources such as cribs, pacifiers, wearable blankets, and infant t-shirts. Two described public education campaigns, one used an educative questionnaire, and one encouraged maternal note taking. Health professional interventions included implementing safe sleep policies, in-service training, printed provider materials, eliciting agreement on a Declaration of Safe Sleep Practice, and sharing adherence data. Data collection methods included self-report via surveys and observational crib audits. Over half of the studies utilized comparison groups which helped determine effectiveness. Most articles reported some degree of success in changing some of the targeted behaviors; no studies reported complete adherence to recommendations. Future studies should incorporate rigorous evaluation plans, utilize comparison groups, and collect demographic and collect follow-up data.
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21
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Caraballo M, Shimasaki S, Johnston K, Tung G, Albright K, Halbower AC. Knowledge, Attitudes, and Risk for Sudden Unexpected Infant Death in Children of Adolescent Mothers: A Qualitative Study. J Pediatr 2016; 174:78-83.e2. [PMID: 27113377 DOI: 10.1016/j.jpeds.2016.03.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/29/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. STUDY DESIGN Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. RESULTS Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate sleep space. The most common justifications for blankets were infant comfort and concern that babies were cold. Participants' decision making was often influenced by their own mothers, with whom they often resided. Participants felt that their instincts trumped professional advice, even when in direct contradiction to safe sleep recommendations. CONCLUSIONS Among focus group participants, adherence with safe sleep practices was poor despite awareness of the American Academy of Pediatrics recommendations. Many mothers expressed beliefs and instincts that infants were safe in various unsafe sleep environments. Future study should investigate the efficacy of alternative educational strategies, including education of grandmothers, who have significant influence over adolescent mothers.
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Affiliation(s)
- Michelle Caraballo
- Pulmonary Section, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
| | - Suzuho Shimasaki
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO
| | | | - Gregory Tung
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Karen Albright
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Aurora, CO; The Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Ann C Halbower
- Pulmonary Section, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
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Moon RY, Hauck FR, Colson ER. Safe Infant Sleep Interventions: What is the Evidence for Successful Behavior Change? Curr Pediatr Rev 2016; 12:67-75. [PMID: 26496723 PMCID: PMC4997961 DOI: 10.2174/1573396311666151026110148] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/18/2015] [Accepted: 10/21/2015] [Indexed: 11/22/2022]
Abstract
Sudden infant death syndrome (SIDS) and other sleep-related infant deaths, such as accidental suffocation and strangulation in bed and ill-defined deaths, account for >4000 deaths annually in the USA. Evidence-based recommendations for reducing the risk of sleep-related deaths have been published, but some caregivers resist adoption of these recommendations. Multiple interventions to change infant sleep-related practices of parents and professionals have been implemented. In this review, we will discuss illustrative examples of safe infant sleep interventions and evidence of their effectiveness. Facilitators of and barriers to change, as well as the limitations of the data currently available for these interventions, will be considered.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA 22908 USA.
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Herschell AD, Kolko DJ, Scudder AT, Taber-Thomas S, Schaffner KF, Hiegel SA, Iyengar S, Chaffin M, Mrozowski S. Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment. Implement Sci 2015; 10:133. [PMID: 26416029 PMCID: PMC4586014 DOI: 10.1186/s13012-015-0324-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/10/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes. METHODS/DESIGN This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment). DISCUSSION This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective. TRIAL REGISTRATION ClinicalTrials.gov: NCT02543359.
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Affiliation(s)
- Amy D Herschell
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - David J Kolko
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley T Scudder
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | - Satish Iyengar
- University of Pittsburgh Department of Statistics, Pittsburgh, PA, USA
| | - Mark Chaffin
- Georgia State University School of Public Health, Atlanta, GA, USA
| | - Stanley Mrozowski
- Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg, PA, USA
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Currie J, Rossin-Slater M. Early-life origins of life-cycle well-being: research and policy implications. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2015; 34:208-42. [PMID: 25558491 PMCID: PMC4773906 DOI: 10.1002/pam.21805] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Mounting evidence across different disciplines suggests that early-life conditions can have consequences on individual outcomes throughout the life cycle. Relative to other developed countries, the United States fares poorly on standard indicators of early-life health, and this disadvantage may have profound consequences not only for population well-being, but also for economic growth and competitiveness in a global economy. In this paper, we first discuss the research on the strength of the link between early-life health and adult outcomes, and then provide an evidence-based review of the effectiveness of existing U.S. policies targeting the early-life environment. We conclude that there is a robust and economically meaningful relationship between early-life conditions and well-being throughout the life cycle, as measured by adult health, educational attainment, labor market attachment, and other indicators of socioeconomic status. However, there is some variation in the degree to which current policies in the United States are effective in improving early-life conditions. Among existing programs, some of the most effective are the Special Supplemental Program for Women, Infants, and Children (WIC), home visiting with nurse practitioners, and high-quality, center-based early-childhood care and education. In contrast, the evidence on other policies such as prenatal care and family leave is more mixed and limited.
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Affiliation(s)
- Janet Currie
- Center for Health and Well-Being for the Woodrow Wilson School of Public and Interantional Affairs at Princeton University, Princeton, NJ, USA.
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Salm Ward TC, Doering JJ. Application of a Socio-Ecological Model to Mother–Infant Bed-Sharing. HEALTH EDUCATION & BEHAVIOR 2014; 41:577-89. [DOI: 10.1177/1090198114543010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mother–infant bed-sharing has been associated with an increased risk of sleep-related infant deaths, and thus, health messaging has aimed to discourage this behavior. Despite this messaging, bed-sharing remains a common practice in the United States, especially among minority families. Moreover, rates of accidental suffocation and strangulation in bed (often related to bed-sharing) are on the rise, with Black infants at two to three times greater risk than Whites. Multiple studies have identified risk factors for bed-sharing, but a gap remains between findings and translation into interventions. The socio-ecological model (SEM) has been suggested as a way to study and design interventions addressing complex public health issues. This article reconceptualizes the literature on mother–infant bed-sharing using the SEM. PubMed, POPLINE, ERIC, and Psych Info were searched for articles that (a) included bed-sharing as the outcome variable, (b) were published between 2000 and 2013, (c) were conducted in the United States, and (d) included quantitative comparison of more than one factor. The following data were extracted: sample characteristics, bed-sharing definition, methods, factors examined, key findings, and conclusions. Data were summarized into five SEM levels—infant, maternal, family and household, and community and society, nested within the historical context of race. Sixteen studies met inclusion criteria. Significant factors associated with bed-sharing were present within each SEM level of influence. Educational interventions may increase efficacy by attending to multiple levels of the SEM, especially when implementing such interventions within minority subpopulations. Using a harm reduction approach to reducing the risk around bed-sharing may be one way to account for the multiple influences on bed-sharing. The science and practice of minimizing mother–infant bed-sharing may be advanced through use of the SEM.
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Ball HL, Volpe LE. Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location – Moving the discussion forward. Soc Sci Med 2013; 79:84-91. [DOI: 10.1016/j.socscimed.2012.03.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/13/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Pearce J, Mann MK, Jones C, van Buschbach S, Olff M, Bisson JI. The most effective way of delivering a train-the-trainers program: a systematic review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:215-226. [PMID: 23173243 DOI: 10.1002/chp.21148] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Previous literature has shown that multifaceted, interactive interventions may be the most effective way to train health and social care professionals. A Train-the-Trainer (TTT) model could incorporate all these components. We conducted a systematic review to determine the overall effectiveness and optimal delivery of TTT programs. METHODS We searched 15 databases. Reference lists and online resources were also screened. Studies with an objective follow-up measure collected over 1 week after the intervention were included. The intervention had to be based on a TTT model for health and social care professionals. RESULTS Eighteen studies met the inclusion criteria. TTT interventions varied greatly, ranging from didactic presentations to group discussions and role-plays. The heterogeneity of the studies and limited data prevented meta-analysis. A narrative review found that the TTT programs in 13 studies helped to increase knowledge, improve clinical behavior, or produce better patient outcomes. One study showed no effect. Three studies showed possible effect and one study showed that a CD-ROM training method was more effective than a TTT training method in improving participants' knowledge. Ratings of the studies' methodologies suggested moderate risk of bias, which limits interpretation of the results. DISCUSSION There is evidence that using a blended learning approach to deliver TTT programs--combining different techniques such as interactive, multifaceted methods and accompanying learning materials--can help to effectively disseminate and implement guidelines and curricula to health and social care professionals. However, further research is needed to determine the optimum "blend" of techniques.
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Affiliation(s)
- Jennifer Pearce
- Department of Psychological Medicine, Cardiff University, Wales
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Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128:e1341-67. [PMID: 22007003 DOI: 10.1542/peds.2011-2285] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).
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Martino S, Ball SA, Nich C, Canning-Ball M, Rounsaville BJ, Carroll KM. Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction 2011; 106:428-41. [PMID: 20925684 PMCID: PMC3017235 DOI: 10.1111/j.1360-0443.2010.03135.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The effectiveness of expert-led (EX) and train-the-trainer (TT) strategies was compared to a self-study approach (SS) for teaching clinicians motivational interviewing (MI). DESIGN Twelve community treatment programs were assigned randomly to the three conditions. EX and TT conditions used skill-building workshops and three monthly supervision sessions guided by treatment integrity ratings, performance feedback and coaching techniques. Trainers in TT were first trained and certified in MI and then prepared carefully to deliver the workshops and supervise MI at their programs. Clinicians in SS only received the training materials. SETTING Licensed out-patient and residential addiction and mental health treatment programs in the US state of Connecticut were involved in the study. PARTICIPANTS Ninety-two clinicians who provided addiction treatment within these programs and had limited experience with MI participated in the study. MEASUREMENTS Primary outcomes were the clinicians' MI adherence and competence and the percentage of clinicians meeting clinical trial standards of MI performance. Assessments occurred at baseline, post-workshop, post-supervision and at 12-week follow-up. FINDINGS The study found EX and TT, in comparison to SS, improved clinicians' adherence and competence significantly, with higher percentages of clinicians reaching clinical trial standards of MI performance and few differences between EX and TT. CONCLUSIONS This study supports the combined use of workshops and supervision to teach community program clinicians MI and suggests the train-the-trainer approach may be a feasible and effective strategy for disseminating empirically supported treatments.
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Affiliation(s)
- Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
OBJECTIVES To identify demographic predictors of caregivers who are more likely to position their infants prone for sleep; to determine caregivers' primary information sources regarding sleep position recommendations; and to determine the primary influence on choice of infant sleep position among caregivers who still place their infants in an at-risk sleep position when informed of the recommendations. METHODS Survey of caregivers of 205 infants from birth to 24 months at 2 rural and 2 urban private pediatric practices in Southwest Tennessee. RESULTS Income was a significant predictor (P < 0.05) of caregivers' awareness of sleep position recommendations. Awareness rates were 74% among respondents with an income of less than $20,000 and 98% among those earning above $80,000. The primary source of sleep position recommendations for lower income and African American respondents was hospital staff; higher income and European Americans reported printed materials as the primary source. Among respondents who were aware of the recommendations but noncompliant, 60% reported infant preference as the primary influence on choice of sleep position. CONCLUSIONS Based on this study, particular emphasis needs to be placed on reaching out to lower income groups to disseminate the American Academy of Pediatrics (AAP) sleep positioning recommendations. The importance of positioning infants supine for sleep must be stressed before mother and baby are discharged from the hospital. Caregivers need to understand that many infants prefer to sleep on their stomachs, but there are ways to help babies adapt to supine sleeping.
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Moon RY, Oden RP, Joyner BL, Ajao TI. Qualitative analysis of beliefs and perceptions about sudden infant death syndrome in African-American mothers: implications for safe sleep recommendations. J Pediatr 2010; 157:92-97.e2. [PMID: 20303505 DOI: 10.1016/j.jpeds.2010.01.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/23/2009] [Accepted: 01/15/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate, by using qualitative methods, perceptions about sudden infant death syndrome (SIDS) in African-American parents and how these influence decisions. STUDY DESIGN Eighty-three mothers participated in focus groups or individual interviews. Interviews probed reasons for decisions about infant sleep environment and influences affecting these decisions. Data were coded, and themes were developed and revised in an iterative manner as patterns became more apparent. RESULTS Themes included lack of plausibility, randomness, and vigilance. Many mothers believed that the link between SIDS and sleep position was implausible. Because the cause of SIDS was unknown, they did not understand how certain behaviors could be defined as risk factors. This confusion was reinforced by perceived inconsistency in the recommendations. Most mothers believed that SIDS occurred randomly ("God's will") and that the only way to prevent it was vigilance. CONCLUSIONS Many African-American mothers may not understand the connection between SIDS and sleep behaviors or believe that behavior (other than vigilance) cannot affect risk. These beliefs, if acted on, may affect rates of safe sleep practices. Efforts to explain a plausible link between SIDS and safe sleep recommendations and to improve consistency of the message may result in increased adherence to these recommendations.
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Affiliation(s)
- Rachel Y Moon
- Goldberg Center for Community Pediatric Health, Children's National Medical Center, Washington, DC 20010, USA.
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Crawford D. Sudden unexpected deaths in infancy part I: The phenomena of sudden and unexplained infant Death. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.jnn.2010.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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