Characteristics of Hospitalized Children With a Diagnosis of Malnutrition

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141004/1/jpen0623-sup-0001.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141004/2/jpen0623.pd

Symptoms of Depression and Preterm Birth Among Black Women.

OBJECTIVE: To investigate the relationship between depressive symptoms and preterm birth (PTB) while adjusting for social support, both general and from the father of the baby. DESIGN: Retrospective study design. SETTING: Participants of the Life-course Influences of Fetal Environments (LIFE) study were recruited from a suburban hospital in Metropolitan Detroit, Michigan. PARTICIPANTS: The LIFE data consisted of 1,410 self-identified Black women age 18 to 45 years; 1,207 women were included in this analysis. METHODS: Women were interviewed using a structured questionnaire administered 24 to 48 hours after birth during their postpartum hospitalization. Data on the newborns and their mothers health were collected through medical record abstraction. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure symptoms of depression. The CES-D scores ≥23 were considered severe symptoms of depression. Modified Poisson regression models were built using a stepwise approach to assess association between symptoms of depression and PTB. RESULTS: Approximately, 17% of women had a PTB and 20% of women in the sample had a CES-D scores ≥23. Women who had CES-D score ≥23 were about 70% more likely to have a PTB compared with women with CES-D scores <23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support. CONCLUSION: Women with CES-D scores ≥23 were almost twice more likely to have PTB compared with women with CES-D scores <23. Referrals for mental healthcare providers might benefit women with symptoms of depression and improve birth outcomes. Nurses should encourage women to seek support beyond the father of the baby

Inter-Relationships Between Objective and Subjective Measures of the Residential Environment Among Urban African American Women

Purpose:The inter-relationships between objective (census based) and subjective (resident reported) measures of the residential environment is understudied in African American (AA) populations. Methods: Using data from the Life Influences on Fetal Environments Study (2009–2011; n = 1387) of AA women, we quantified the area-level variation in subjective reports of residential healthy food availability, walkability, safety, and disorder that can be accounted for with an objective neighborhood disadvantage index (NDI). Two-level generalized linear models estimated associations between objective and subjective measures of the residential environment, accounting for individual-level covariates. Results: In unconditional models, intraclass correlation coefficients for block-group variance in subjective reports ranged from 11% (healthy food availability) to 30% (safety). Models accounting for the NDI (vs. both NDI and individual-level covariates) accounted for more variance in healthy food availability (23% vs. 8%) and social disorder (40% vs. 38%). The NDI and individual-level variables accounted for 39% and 51% of the area-level variation in walkability and safety, respectively. Associations between subjective and objective measures of the residential environment were significant and in the expected direction. Conclusions: Future studies on neighborhood effects on health, especially among AAs, should include a wide range of residential environment measures, including subjective, objective, and spatial contextual variables

Evaluating the Use of Music-assisted Caregiving Interventions by Certified Nursing Assistants Caring for Nursing Home Residents With Hiv-associated Neurocognitive Disorders and Depressive Symptoms: A Mixed-methods Study

In recent years, HIV-associated neurocognitive disorders (HAND) have become more common as people with HIV live longer due to advances in anti-retroviral medications. The symptoms of HAND are often associated with mild-to-severe cognitive impairment and depression, which may lead to burden and burnout among the certified nursing assistants (CNAs) of individuals with HAND. Music-based interventions provided by paid caregivers have been shown to have positive effects for people with cognitive impairments, depression, and HIV. However, little is known about the benefits of music-based interventions for people with HAND and depression. In this concurrent nested, mixed-methods experiment, 12 nursing home residents with HIV-associated neurocognitive disorders and depression participated in 4 weeks of music-assisted caregiving with 5 CNAs. The music-assisted caregiving intervention significantly decreased depressive symptoms among the residents and personal achievement improved among the CNAs. This study supports the effectiveness of the music-assisted caregiving intervention in reducing depressive symptoms among nursing home residents with HIV-associated neurocognitive disorders and provides directions for research to explore interdisciplinary approaches for people with HIV and related cognitive disorders further

Factors associated with HIV medication adherence in HIV-positive women enrolled in Option B plus in Zambia: a cross-sectional survey

Background: Every year about 1·4 million women living with HIV become pregnant, and these pregnancies lead to about 220 000 new HIV infections in infants and children. Furthermore, it is estimated that, worldwide, the cumulative total deaths caused by HIV will reach 75 million by 2030. In an effort to eliminate mother-to-child transmission of HIV, WHO has recommended Option B+, which gives HIV-positive pregnant women life-long antiretroviral therapy (ART), regardless of their CD4 cell count and viral load. The purpose of this study is to investigate factors associated with HIV medication adherence in HIV-positive women enrolled in Option B+ in Zambia. Methods: We recruited pregnant and breastfeeding HIV-positive women enrolled in Option B+ and residing in Lusaka (urban) and Sinazongwe (rural) districts of Zambia. Data were collected using a 122-item structured questionnaire prepared in English and then translated into two local languages (Nyanja and Tonga), which are commonly spoken in the Lusaka and Sinazongwe Districts. We used descriptive statistics to characterise ART adherence in the entire sample and by district. Four generalised modified-Poisson regression models were built using a step-wise approach to assess the association between the factors (age, education, marital status, occupation, income, counselling on side-effects, HIV transmission knowledge, and timing of first prenatal visit during pregnancy) and ART adherence. Findings: We included data from 150 participants, 81 (54%) from Lusaka district and 69 (46%) from Sinazongwe district. Mean age was 29 years (SD 6·2). Data were collected between July and September, 2017. A total of 119 respondents (79%) had counselling on the side-effects of ART: 72 (89%) in Lusaka district and 47 (68%) in Sinazongwe district. 36 women (24%) sought a prenatal visit in the first trimester of pregnancy, 93 (62%) in second trimester, and 16 (11%) in the third trimester; five (3%) did not know in which trimester they had first visited the antenatal clinic for care. In all, 37·8% of respondents missed taking their ART at least once in the week before data collection. There was an association between adherence and district of residence (p<0·0001). Also, counselling on the side-effects of ART was associated with adherence to treatment in the overall sample (p=0·01) and the rural district (p <0·0001), but not significantly in the urban sample (p=0·92). The timing of the first prenatal visit was significantly associated with adherence (p=0·02) in the overall sample but not in analyses stratified by district. Multivariate analyses showed a significant association between ART adherence and counselling on the side-effects of ART (prevalence ratio 3·80, 95% CI 1·10–13·12) after adjusting for socioeconomic variables and age. Interpretation: Counselling women on the side-effects of ART before commencing treatment could help promote adherence. Furthermore, encouraging women living with HIV to seek prenatal care early during pregnancy could offer them the opportunity to be educated on the importance of the ART and the need to adhere to treatment. Funding: None

Symptoms of Depression and Preterm Birth Among Black Women.

OBJECTIVE:To investigate the relationship between depressive symptoms and preterm birth (PTB) while adjusting for social support, both general and from the father of the baby. DESIGN:Retrospective study design. SETTING:Participants of the Life-course Influences of Fetal Environments (LIFE) study were recruited from a suburban hospital in Metropolitan Detroit, Michigan. PARTICIPANTS:The LIFE data consisted of 1,410 self-identified Black women age 18 to 45 years; 1,207 women were included in this analysis. METHODS:Women were interviewed using a structured questionnaire administered 24 to 48 hours after birth during their postpartum hospitalization. Data on the newborns and their mothers' health were collected through medical record abstraction. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure symptoms of depression. The CES-D scores ≥23 were considered severe symptoms of depression. Modified Poisson regression models were built using a stepwise approach to assess association between symptoms of depression and PTB. RESULTS:Approximately, 17% of women had a PTB and 20% of women in the sample had a CES-D scores ≥23. Women who had CES-D score ≥23 were about 70% more likely to have a PTB compared with women with CES-D scores &lt;23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support. CONCLUSION:Women with CES-D scores ≥23 were almost twice more likely to have PTB compared with women with CES-D scores &lt;23. Referrals for mental healthcare providers might benefit women with symptoms of depression and improve birth outcomes. Nurses should encourage women to seek support beyond the father of the baby

Neighborhood disadvantage and preterm delivery in Urban African Americans: The moderating role of religious coping

Evidence suggests that neighborhood disadvantage predicts preterm delivery (PTD). However, the design of most existing studies precludes within-group analyses, which would allow the identification segments of the population at highest risk, as well as preventive factors. African Americans (AA) are disproportionately affected by PTD, are disproportionately concentrated in disadvantaged neighborhoods, and frequently use religious coping in response to chronic stressors. Our objective was to examine the association between neighborhood disadvantage and PTD, and whether religious coping moderated the associations, among postpartum AA women. Addresses from participants of the Life Influences on Fetal Environments Study (n=1387) were geocoded and linked to data from the American Community Survey. An index of neighborhood disadvantage was derived from a principal components analysis of the following variables: % below poverty, % unemployed, % receiving public assistance income, % college educated, % AA, % female-headed households, % owner occupied homes, median income, and median home value. Three domains of religious coping were assessed: organizational (church attendance), non-organizational (praying for self and asking others for prayer), and personal or subjective (experiences, perceptions, and sentiments about religion), and all were dichotomized as frequent/infrequent or satisfied/not satisfied. Preterm delivery was defined as birth before 37 completed weeks of gestation. Prevalence ratios and 95% confidence intervals were estimated with log binomial regression models. Neighborhood disadvantage did not predict PTD rates in the overall sample. However, there was evidence of moderation by asking others for prayer (P for asking for prayer X disadvantage index interaction term: 0.01). Among women who infrequently asked others for prayer, neighborhood disadvantage was positively associated with PTD rates (adjusted Prevalence ratio: 1.28, 95% Confidence Interval: 1.01, 1.63), and a null association was found for those who frequently asked others for prayer. No evidence of moderation by the other religious coping variables was present. Non-organizational religious coping may buffer against the adverse effects of neighborhood disadvantage on PTD rates, among urban AA women. Future research should examine the mechanisms of the reported relationships. Keywords: Neighborhood context, Preterm delivery, Religious coping, African America