Effectiveness of a Federal Healthy Start Program in Reducing Infant Mortality

Objective: Infant mortality is an important indicator of the health status of a community. In this analysis, we aimed to evaluate temporal changes in infant mortality rates (IMR) in the Central Hillsborough Healthy Start (CHHS) program service area in Tampa, Florida compared to rates in the rest of Hillsborough County and the state. Method: We conducted a five-year (2010-2014) trends analysis using birth and infant death data extracted from the Florida Community Health Assessment Resource Tool Set (CHARTS). The number of infant deaths and live births were used to calculate and compare IMRs in the CHHS catchment area to those in the rest of Hillsborough County, and the state of Florida. Three-year centered moving averages were directly adjusted to account for differences in the racial/ethnic distribution of mothers across geographic areas. Results: Between 2010 and 2014, the IMR decreased 42.8% in the CHHS service area (from 14.5 to 8.3 per 1,000 live births) compared to decreases of 10.1% and 7.7% in the rest of Hillsborough County and the state of Florida, respectively. Additionally, the infant mortality gap in the CHHS catchment area narrowed from 72% in 2010 to 14% in 2014 compared to the rest of the state, and was eliminated when compared to the rest of Hillsborough County. Discussion: The absolute and relative decreases in IMR in the CHHS catchment area reflect the program’s effectiveness in decreasing disparity in infant mortality. The quality services provided by the CHHS program have had a significant positive impact on the families served

Associations of prenatal maternal depressive symptoms with cord blood glucocorticoids and child hair cortisol levels in the project viva and the generation R cohorts:a prospective cohort study

Background: Prior studies have reported conflicting results regarding the association of prenatal maternal depression with offspring cortisol levels. We examined associations of high levels of prenatal depressive symptoms with child cortisol biomarkers. Methods:In Project Viva (n = 925, Massachusetts USA), mothers reported their depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, cord blood glucocorticoids were measured at delivery, and child hair cortisol levels were measured in mid-childhood (mean (SD) age: 7.8 (0.8) years) and early adolescence (mean (SD) age: 13.2 (0.9) years). In the Generation R Study (n = 1644, Rotterdam, The Netherlands), mothers reported depressive symptoms using the Brief Symptom Inventory (BSI) during pregnancy, and child hair cortisol was measured at a mean (SD) age of 6.0 (0.5) years. We used cutoffs of ≥ 13 for the EPDS and &gt; 0.75 for the BSI to indicate high levels of prenatal depressive symptoms. We used multivariable linear regression models adjusted for child sex and age (at outcome), and maternal pre-pregnancy BMI, education, social support from friends/family, pregnancy smoking status, marital status, and household income to assess associations separately in each cohort. We also meta-analyzed childhood hair cortisol results from both cohorts. Results: 8.0% and 5.1% of women respectively experienced high levels of prenatal depressive symptoms in Project Viva and the Generation R Study. We found no associations between high levels of maternal depressive symptoms during pregnancy and child cortisol biomarkers in either cohort. Conclusions: The present study does not find support for the direct link between high levels of maternal depressive symptoms and offspring cortisol levels.</p

Influence of Maternal Thyroid Dysfunction on Infant Growth and Development

Thyroid dysfunction is one of the most common endocrine disorders in women of childbearing age and the obstetric consequences of abnormal thyroid hormone levels during pregnancy have been established. Less understood is the implication of the presence of maternal thyroid autoantibodies on infant outcomes among women who are euthyroid during pregnancy. The objective of this study was two-fold: 1) to examine the influence of antenatal thyroperioxidase (TPO) status on fetal/infant brain and body growth measurements at delivery and 2) to explore the relationship of antenatal TPO status and maternal postpartum thyroid dysfunction (PPTD) on early infant growth and neurocognitive development. Six-hundred thirty-one (631) euthyroid pregnant women were recruited from prenatal clinics in Tampa Bay, Florida and the surrounding area between November 2007 and December 2010. TPO status was determined during pregnancy and fetal/infant brain and body growth variables were assessed at delivery. A subsample of forty-one (41) mother-infant dyads participated in a 6-month longitudinal supplemental study. Infant growth assessments were conducted at 3, 4, 5 and 6 months postpartum. Regression analysis revealed maternal TPO positivity was significantly associated with smaller head circumference, reduced brain weight and lower brain-body-ratio; however maternal race/ethnicity was identified as an effect modifier in the relationship. No significant differences were noted in birth weight, birth length, abdominal circumference or chest circumference measurements among infants born to TPO positive mothers of any racial/ethnic group as compared to their negative counterparts. Mixed model analysis of the smaller subset (n=41) revealed infants of TPO+ mothers were smaller at birth but experienced accelerated growth between birth to 3 months when compared to infants born to TPO- mothers. This acceleration led to their catch-up in growth to their TPO negative counterparts by 3 months of age. No significant differences were noted in neurocognitive outcomes between infants born to TPO+ mothers compared to those born to TPO- mothers. The findings in this dissertation indicate that maternal/race ethnicity modifies the relationship between TPO positivity and reduced fetal/infant brain growth. Additionally, the analyses suggest that maternal autoantibody status could lead to variations in early infant growth and development. The end-result of these variations is unclear. Further research is needed to determine the potential impact of reduced head circumference and accelerated growth as it relates to long-term neurocognitive consequences. Currently, TPO antibody status is not assessed as part of the standard prenatal care laboratory work-up, but findings from this study suggest that fetal brain growth may be impaired by TPO positivity among certain populations, therefore autoantibody screening among high-risk sub-groups may be useful for clinicians to determine whether prenatal thyroid treatment is warranted

Socio-ecological Model as a Framework for Overcoming Barriers and Challenges in Randomized Control Trials in Minority and Underserved Communities

Background:  Numerous barriers and challenges can hinder the successful enrollment and retention of study participants in clinical trials targeting minority populations. To conduct quality research, it is important to investigate these challenges, determine appropriate strategies that are evidence-based and continue seeking methods of improvement. Methods:  In this paper, we report such experiences in a registered clinical trial in an underserved minority population in the Southern part of United States. This research study is a randomized doubleblind controlled clinical trial that tests the efficacy of higher-strength as compared to low-strength/standard of care folic acid to prevent fetal body and brain size reduction in pregnant women who smoke.  A unique approach in this socio-behavioral, genetic-epigenetic clinical trial is that we have adopted the socio-ecological model as a functional platform to effectively achieve and maintain high participant recruitment and retention rates. Results:  We highlight the barriers we have encountered in our trial and describe how we have successfully applied the socio-ecological model to overcome these obstacles. Conclusions and Global Health Implications:  Our positive experience will be of utility to other researchers globally. Our findings have far-reaching implications as the socio-ecological model approach is adaptable to developed and developing regions and has the potential to increase recruitment and retention of hard-to-reach populations who are typically under-represented in clinical trials. Key words: Participant Enrollment • Recruitment • Genetic-Epigenetics • Socio-Ecological Model (SEM) • Clinical Trials • Retention • Challenges Copyright © 2015 Salihu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Evaluation of an Evidence-based and Community-responsive Fatherhood Training Program: Providers’ Perspective

Background And Objectives: Studies on male involvement and pregnancy outcomes have often not incorporated the providers’ perspectives, which are potentially critical to understanding program context, evolution, perceived impact, and sustainability. We sought to evaluate the 24/7 Dad® program from the viewpoint of the program providers. Methods: We conducted purposive sampling of 24/7 Dad program facilitators and administrators who were involved in recruitment, training, and follow up of program participants within a federal Healthy Start program (REACHUP) in Tampa, Florida, USA. Using a snowballing approach, we recruited six key informants who had administered the program for at least four years. We elicited and evaluated factors impacting the performance of the father involvement program using content analysis. Results: Under program participation and perceived impact, most providers thought that the program had created a safe space previously unavailable for men in the community. The most useful recruitment strategy was building partnerships with other organizations. The key informants noted an important evolutionary trend in the father involvement program over time as well as the nature of linkages to partner organizations within the area. Threats to program sustainability included the continued reluctance and scepticism to invest funds to address male issues, sub-optimal retention of participants who were living transient lives as well as geographical/transportation barriers. Conclusion and Global Health Implications: The involvement of fathers during pregnancy has significant implications for healthy babies. Our study results provide a clarion call to augment capacity and infuse more resources to improve paternal involvement in order to attain the United Nations Sustainable Goal (2015-2030) of ensuring healthy lives and the promotion of well-being for all at all ages. Key words: • Fatherhood involvement • Fatherhood training • REACHUP • Childhood development • 24/7 Dad program   Copyright © 2020 Obure et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Book of Abstracts: 2019 Health Equity Summer Research Summit Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on June 18th, 2019

Copyright © 2020 Harris. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited