NURSE HOME VISITATION PROGRAM IN HAMILTON COUNTY, OH TO INCREASE MATERNAL AND CHILD HEALTH OUTCOMES

Hamilton County Ohio currently has poor outcomes related to maternal and infant health, specifically among African Americans. Compared to the Healthy People 2020 goals, Hamilton County has higher rates of infant mortality, preterm birth, neonatal infant mortality, and conception within 18 months of previous pregnancies. These rates are disproportionate among African Americans. For instance, African American babies born in Ohio have higher infant mortality rate (14.3 per 1,000) prematurity as a cause of death (4 per 1,000) and neonatal mortality rate (9.2 per 1,000). These are compared to White babies in Ohio with infant mortality rate (5.1 per 1,000), prematurity as a cause of death (1.4 per 1,000) and neonatal mortality rate (3.4 per 1,000). Similar disparities among maternal health is seen between Black and White women. In order to address these disparities in maternal and infant health, we are proposing a 3 year evidence-based nurse home visitation program that will decrease modifiable risk factors that pertain to poor birth outcomes, decrease modifiable risk factors that pertain to child abuse and neglect, and to help with the parental life course in ways of helping maternal life development in education and the workforce, and decreasing rapid successive pregnancies. This nurse home visitation program has shown great success across the country and we hope to bring it to Hamilton County. Women in the program must be enrolled at or before 28 weeks of pregnancy, and will spend 60-90 minutes with nurses in the homes focusing on the six domains of home visitation (personal health, environmental health, life course development, maternal role, family and friends, and health and human services). Recruitment of participants will occur at the Hamilton County Health Department, Planned Parenthood, and the OBGYN offices of UC Health, Mercy Health and TriHealth. Process evaluations will occur during recruitment and implementation of the program. Outcome evaluations will include questionnaires and biometric data to access our goals of the program. Short term outcomes include having mothers complete the program, mothers receive adequate prenatal care, they deliver full term and appropriate gestational weight babies, and they have knowledge of relaxation and stress relieving techniques. Our medium term outcomes include increasing knowledge of proper prenatal care, increase the knowledge of proper childcare, and mothers better care for their children. Finally, our long term goals for this program include lowering the rates of maternal and infant mortality, lowering the rates of child abuse and neglect, and bettering the lives of the mothers

At the Service of Community Development: The Professionalization of Volunteer Work in Kenya and Tanzania

This article explores the changing nature of the “volunteer” as an official role within health and development interventions in East Africa. Contemporary development interventions require the engagement of volunteers to act as links between project and community. This role is increasingly professionalized within development architectures with implications for the kinds of people who can engage in volunteering opportunities. Volunteers in development interventions are likely to be drawn from public sector staff and from educated youth seeking access to positions of paid employment. Volunteering as a formal status within the organization of development programs is recognized as a kind of professional work by those seeking to engage with development organizations. Volunteers perform important work in linking development programs with beneficiaries. At the same time, volunteering provides opportunities for personal transformation

Speech perception in noise for bilingual listeners with normal hearing

Objective: The purpose of this study was to determine if speech-in-noise ability, as measured by SNR-50 and SNR loss in bilingual Spanish listeners with normal hearing, was affected by test difficulty. Design: Quasi-experimental, non-randomized intervention study. Study sample: Two groups of adult listeners participated: monolingual English listeners with normal hearing (N = 12) and bilingual Spanish listeners with normal hearing who were proficient in English (N = 10). The quick speech-in-noise (QuickSIN), the Bamford-Kowal-Bench speech-in-noise (BKB-SIN), and the words-in-noise (WIN) tests were used to assess signal-to-noise ratio (SNR) loss and SNR-50 for both groups. Results: Despite the fact that the bilinguals had normal hearing and were proficient in English, each of the speech-in-noise tests evaluated indicated the Spanish listeners had measurable SNR loss and higher than normal SNR-50s. Performance on the BKB-SIN was best for both groups, indicating test difficulty had a significant impact on speech perception in noise. Conclusions: Bilingual Spanish listeners with normal hearing exhibited a mild SNR loss comparable to that observed for a person with hearing loss. This decreased performance in noise requires an improved SNR for this population to reach a comparable level of comprehension to their monolingual English counterparts

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (>59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P <.001). Overall motor and cognitive performance (P <.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P <.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P <.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P <.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients