Maternal depression and breastfeeding in home visitation.

BACKGROUND: Home visitation is a popular mechanism for supporting parents and their young children. Breastfeeding is often promoted by home visitors due to its health benefits. However, maternal depression may interfere with breastfeeding. Thus, home visitors may be attempting to encourage health-promoting behaviors like breastfeeding, but maternal depression may interfere with engagement in those behaviors. METHOD: The data for this study were provided by the Des Moines Healthy Start and the Empowerment Family Support Project (DMHSP). We analyzed the relation between depression and breastfeeding for 364 women. RESULTS: First, rates of elevated depression scores in this sample of women (8.7%-21.4% of women) were lower than rates of elevated depression scores reported in other studies of women enrolled in home visitation (30%-50% of women). Second, rates of breastfeeding at 3 months postpartum in this sample (56% of women) were higher than rates of breastfeeding reported in the general population (51% of women). Third, Non-Hispanic White women were significantly less likely to breastfeed compared to other racial groups. Fourth, average Edinburgh Postnatal Depression Scale (EPDS) scores during the first 3 months postpartum, but not during pregnancy, were predictive of likelihood to breastfeed at 3 months postpartum, even after accounting for demographic characteristics. CONCLUSION: Addressing maternal depression during the early postpartum period may increase the likelihood of engaging in breastfeeding.

Development and application of high-throughput screens for the discovery of compounds that disrupt ErbB4 signaling: Candidate cancer therapeutics.

Whereas recent clinical studies report metastatic melanoma survival rates high as 30-50%, many tumors remain nonresponsive or become resistant to current therapeutic strategies. Analyses of The Cancer Genome Atlas (TCGA) skin cutaneous melanoma (SKCM) data set suggests that a significant fraction of melanomas potentially harbor gain-of-function mutations in the gene that encodes for the ErbB4 receptor tyrosine kinase. In this work, a drug discovery strategy was developed that is based on the observation that the Q43L mutant of the naturally occurring ErbB4 agonist Neuregulin-2beta (NRG2ß) functions as a partial agonist at ErbB4. NRG2ß/Q43L stimulates tyrosine phosphorylation, fails to stimulate ErbB4-dependent cell proliferation, and inhibits agonist-induced ErbB4-dependent cell proliferation. Compounds that exhibit these characteristics likely function as ErbB4 partial agonists, and as such hold promise as therapies for ErbB4-dependent melanomas. Consequently, three highly sensitive and reproducible (Z' > 0.5) screening assays were developed and deployed for the identification of small-molecule ErbB4 partial agonists. Six compounds were identified that stimulate ErbB4 phosphorylation, fail to stimulate ErbB4-dependent cell proliferation, and appear to selectively inhibit ErbB4-dependent cell proliferation. Whereas further characterization is needed to evaluate the full therapeutic potential of these molecules, this drug discovery platform establishes reliable and scalable approaches for the discovery of ErbB4 inhibitors.

Depression screening of perinatal women by the Des Moines Healthy Start Project: program description and evaluation.

OBJECTIVE: Maternal depression is linked to poor infant and child outcome. In 2001, the U.S. Health Resources and Services Administration required all Healthy Start programs to incorporate maternal-depression screening as part of home visiting services. This article describes the implementation and results of depression screening by the Des Moines Healthy Start Project between 2002 and 2009. The study represents the first longitudinal assessment of the Healthy Start maternal-depression screening initiative. METHODS: The evaluation assessed staff compliance with a protocol for screening for depression among clients at regular intervals during the prenatal and postnatal periods until the client's child was two years old. Rates of acceptance of referral for treatment and treatment seeking as well as depression outcomes were measured. RESULTS: A total of 1,902 women were served by the Des Moines Healthy Start Project between 2002 and 2009. Compliance with the screening protocol was immediately high and increased significantly over the evaluation period, from 83% in 2002 to 98% in 2009. Of the 573 women who had elevated depression scores but who were not already in treatment, 64% accepted a referral, and 47% reported receiving treatment. Predictors of referral acceptance and treatment included higher depression scores and speaking English as a primary language. Depression severity significantly decreased for women who reported receiving treatment. CONCLUSIONS: A federal screening initiative identified a significant number of women who were at risk for maternal depression and connected them with treatment resources. Continuing work should assess the impact of this initiative on outcomes of women and children.