Improving Self-Regulation: Resiliency Skills in the Classroom.

PURPOSE: The impact of daily living often results in unimaginable stress for children, which can be exhibited as lack of self-control. Children with decreased self-regulation are often not successful in school. Many schools do not have the resources needed to employ professionals who could provide programs to improve self-regulation. Creative programs that can be implemented into the classroom without disrupting the school day are needed. The current article describes a resiliency program that was implemented in a school setting to increase self-regulation. METHOD: This pilot project used descriptive statistics to analyze the feasibility of incorporating resiliency skills into an elementary school curriculum and the resulting impact on self-regulation among school-aged children. RESULTS: Improvements were identified in self-esteem, compassion, and classroom behavior. CONCLUSION: Implementing resiliency skills into the curriculum can result in positive outcomes by improving self-regulation in school-aged children. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Self-Care Instruments to Measure Nutrition Practices in Children and Parents: Psychometric Analysis.

The purposes of this study were to evaluate the psychometric properties of English and Spanish instruments that measure the nutrition behavior and practices of children and their parents. Orem's self-care deficit nursing theory was used in this methodological study. A convenience sample of 333 children and 262 mothers participated from two schools in Washington, D.C. and two schools in Santiago, Chile. Principal component analysis indicated three component per instrument corresponding to Orem's Theory of operations demonstrating construct validity of the instrument. The study findings showed evidence for validity and reliability of the English and Spanish versions and indicated that the instruments appropriately represented Orem's operations. The results have implications for the development of health behavior measurement instruments that are valid, reliable, designed for children, culturally appropriate, and efficient. Measuring the nutrition behavior of children and parents is critical for determining the effectiveness of nutrition intervention programs. Furthermore, instruments are needed so that researchers can compare corresponding child and parent behaviors or compare behaviors across cultures.

The influence of maternal life stressors on breastfeeding outcomes: a US population-based study.

OBJECTIVE: The purpose of this study was to examine the contribution of maternal financial, emotional, traumatic, and partner-associated stressors on breastfeeding initiation and duration. METHODS: Data (216,756 records) from the Pregnancy Risk Assessment Monitoring System surveys were used in the analysis. Logistic regressions were conducted to estimate the magnitude and direction of associations between maternal stressors occurring in the 12 months prior to infant birth and both breastfeeding initiation and duration up to 4 weeks infant age. RESULTS: A substantial proportion of mothers (42%) reported having experienced one or two major stressors during the 12 months prior to the birth of their infant. Mothers who reported at least one major life stressor in the year before their baby was born were less likely to initiate breastfeeding and more likely to cease by 4 weeks infant age. Emotional and traumatic stressors were found to have the greatest impact on breastfeeding outcomes. CONCLUSIONS: Findings support the design and implementation of screening protocols for major maternal life stressors during regularly scheduled prenatal and newborn visits. Screening for at-risk mothers may lead to more targeted anticipatory guidance and referral with positive effects on breastfeeding outcomes and overall well-being of the mothers and their families.

Knowledge of intrapartum care among obstetric care providers in rural Kenya.

BACKGROUND: Kenya did not meet its maternal mortality ratio (MMR) target under the Millennium Development Goals. The aim of this study was to examine the gaps in knowledge of intrapartum care among obstetric care providers (OCPs) in rural Nandi County, Kenya. METHODS: This cross-sectional study in 2015 surveyed 326 nurses, midwives, clinical officers and physicians about their knowledge, attitudes and practices related to normal labor and childbirth, immediate newborn care and management of obstetric complications. RESULTS: Self-reported intrapartum knowledge among OCPs was insufficient according to accepted international standards. The mean total knowledge score for all OCPs based on a validated 30-question inventory was 62% (range 23-90%). Only 14 providers (4%) scored as 'competent' (a score ≥80%). Scores were higher for OCPs who had received pre- and postemployment emergency obstetric care training and those with higher levels of confidence in their skills. Survey respondents identified a lack of knowledge as one of the greatest barriers to high-quality patient care. CONCLUSIONS: Increasing training opportunities for OCPs may improve the quality of obstetric care provided to women in Kenya and other high-MMR locations in sub-Saharan Africa and enable progress toward achieving the ambitious Sustainable Development Goals target for maternal survival.

Early Life Factors for Overweight Risk Among Infants of Hispanic Immigrant Mothers.

INTRODUCTION: This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers. METHOD: Weight-for-length (WFL) measurements and face-to-face interviews were completed during well child visits. Regression models estimated the impact of early life factors (0-6 months) on overweight risk at 1 year. RESULTS: WFL ≥ 85th percentile was found among 2.4% at birth and 42.7% at 1 year. Most mothers (78.6%) experienced food insecurity, a factor that increased the likelihood of infant overweight risk by 2.29 times (1.03-5.09). Maternal underestimation of infant size increased the likelihood of overweight risk 5.07 times (2.57-9.99). Postpartum depression risk did not contribute to infant weight status. DISCUSSION: Assessment for maternal food insecurity and underestimation of infant weight status during early infancy may help reduce overweight risk and subsequent obesity for this vulnerable population.

Institute of Medicine Early Infant Feeding Recommendations for Childhood Obesity Prevention: Implementation by Immigrant Mothers From Central America.

PURPOSES: Describe implementation of Institute of Medicine (IOM) early infant feeding recommendations for child obesity prevention by immigrant mothers from Central America; examine potential relationships with food insecurity and postpartum depressive symptoms. DESIGN AND METHODS: Using a cross-sectional, descriptive design, face-to-face interviews were conducted with 318 mothers of 2month old infants at a large pediatric setting for low income families. Logistic regression models assessed feeding practices, food insecurity and postpartum depressive symptoms. RESULTS: Exclusive breastfeeding rates were low (9.4%); most mothers (62.7%) both breastfed and bottle fed their infants. Mothers who bottle fed at moderate and high intensity were twice as likely to affirm that if you give a baby a bottle, you should always make sure s/he finishes it (OR=2.30, 95% CI=1.13, 4.69; OR=2.29, 95% CI=1.26, 4.14). Food insecurity was experienced by 57% of mothers but postpartum depressive symptoms were low (Possible range=0-30; M=2.96, SD =3.6). However, for each increase in the postpartum depressive symptoms score, the likelihood of affirming a controlling feeding style increased by 11-13%. CONCLUSIONS: Immigrant mothers from Central America were more likely to both breastfeed and bottle feed (las dos cosas) than implement exclusive breastfeeding. Bottle feeding intensity was associated with a controlling feeding style. PRACTICE IMPLICATIONS: Infant well visits provide the ideal context for promoting IOM recommendations for the prevention of obesity among children of immigrant mothers from Central America.

Sensitive Timing for Risk of Overweight Among Infants of Low-Income Hispanic Immigrants.

INTRODUCTION: This study examined the association between early weight gain (0-6 months) and risk for overweight, as defined by the Institute of Medicine, at 1 year among infants of low-income Hispanic immigrant mothers. METHOD: Weight-for-age data were extracted from electronic medical records of 335 infants with gestations of 37 weeks or longer and birthweights appropriate for gestational age and without medical problems likely to interfere with growth or feeding. Logistic regression models were constructed to examine the impact of early weight changes on weight status at 1 year. RESULTS: By 12 months, 36.7% of infants had crossed weight-for-age of 84.1% or greater on World Health Organization growth charts. In adjusted models, infants had 20.8 (95% confidence interval = [19.8, 44.0]) times the odds of reaching this benchmark at 1 year for each z score increase at 0 to 6 months. DISCUSSION: The study highlights a time-sensitive opportunity for interventions to reduce risk for overweight for this vulnerable population.

Early Feeding Practices and Weight Status at One Year of Age: A Comparison of Hispanic Immigrant Mother-Infant Dyads with Participants of the Infant Feeding Practices Study II.

BACKGROUND: Hispanic preschoolers have higher rates of BMI ≥85th percentile than any other racial/ethnic group. To identify underpinnings of this disparity, we compared early feeding practices and subsequent weight status for a sample of infants of low-income, Hispanic immigrant mothers with participants from the Infant Feeding Practices Study II (IFPS II). METHODS: Proyecto de Bebés Hispanos Saludables (PBHS) collected medical record data for mother-infant dyads (n = 550) from a large pediatric clinic for low-income families and merged it with IFPS II data (n = 1502) to compare early feeding practices and late infancy weight status. RESULTS: Mode of milk delivery for PBHS mothers was less likely to be exclusive breastfeeding at 6 months (9.0% vs. 27.5%), but more likely to be both breast and bottle feeding (43.5% vs. 26.3%) compared to IFPS II mothers. No difference was found in age for solid food introduction. Weight for age of PBHS infants was more likely to be ≥85th percentile at 12 months than IFPS II infants (39.1% vs. 25.4%). Both PBHS and IFPS II infants were more likely to be ≥85th percentile at 1 year if mode of milk delivery was bottle only at 6 months compared to those who were breastfed only, even after adjusting for potential confounders. CONCLUSION: Differences in PBHS and IFPS II feeding practices and weight status suggest additional studies of modifiable, early life risk factors are needed to inform clinical and public health interventions that reduce childhood obesity for this growing sector of the US population.

Predictors of Depression Symptoms Among Low-Income Women Exposed to Perinatal Intimate Partner Violence (IPV).

Women experiencing perinatal intimate partner violence (IPV) may be at increased risk for depression. Baseline data was analyzed from 239 low-income pregnant women participating in an intervention study designed to reduce exposure to IPV. Depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and IPV factors were measured with the Conflict Tactics Scale-Revised (CTS-2). Stepwise regression was conducted to identify predictors of risk for depression. Race (p = 0.028), psychological IPV (p = 0.035) and sexual IPV (p = 0.031) were strongly associated with risk for depression. Regression results indicated that women experiencing severe psychological IPV were more likely to develop depression (OR 3.16, 95 % CI 1.246, 8.013) than those experiencing severe physical or sexual IPV. Experiencing severe psychological IPV during pregnancy is strongly linked to risk for depression. Routine screening for psychological IPV may increase identification and treatment of women at high risk for depression during pregnancy.

Posttraumatic stress disorder among low-income women exposed to perinatal intimate partner violence : Posttraumatic stress disorder among women exposed to partner violence.

Women exposed to intimate partner violence (IPV) and other forms of lifetime trauma may be at risk for negative mental health outcomes including posttraumatic stress disorder (PTSD). The purpose of this study was to examine potential predictors of PTSD among low-income women exposed to perinatal IPV. This study analyzed baseline cross-sectional data from 239 low-income pregnant women in the USA who participated in a nurse home visitation intervention between 2006 and 2012 after reporting recent IPV. PTSD was assessed with the Davidson Trauma Scale (DTS) in which participants answer questions about the most disturbing traumatic event (MDTE) in their lifetime that affected them the week before the interview. In total, 40 % of the women were identified as having PTSD (DTS ≥40). PTSD prevalence significantly increased with age to nearly 80 % of women ages 30 and older (n = 23). Age was also the strongest predictor of PTSD (p < 0.001). Most participants (65 %) identified non-IPV-related traumas as their MDTEs. Psychological (94 %), physical (82 %), and sexual (44 %) violence were not significantly associated with PTSD status. Despite recent exposure to IPV, most participants identified other traumatic events as more disturbing than IPV-related trauma. Further, the risk for PTSD increased with age, suggesting that the cumulative effect of trauma, which may include IPV, increases the risk for PTSD over a lifetime. Implementing comprehensive screening for trauma during prenatal care may lead to the early identification and treatment of PTSD during pregnancy in a community setting.

Nature and nurture in the development of childhood obesity: early infant feeding practices of overweight/obese mothers differ compared to mothers of normal body mass index.

OBJECTIVE: The purpose of this study was to describe early infant feeding practices among overweight/obese mothers using the Infant Feeding Practices Study II (IFPS II). METHODS: In this study, we used data pertaining to the first 2 months postpartum of IFPS II. The data set includes 2387 mothers who provided information about infant feeding habits at the 2-month postpartum period. RESULTS: Overweight/obese mothers were less likely to breastfeed exclusively at 2 months infant age and more likely to breastfeed at low intensity the first 2 months compared to mothers of normal body mass index (BMI). Logistic regression analysis revealed, that after controlling for potential confounders, obese mothers were 1.38 (95% CI: 1.11, 1.72) times more likely to introduce solids to their infants before 4 months of age, and 1.37 (95% CI: 1.10, 1.89) times more likely to add cereal to the infant formula than their normal BMI counterparts. CONCLUSIONS: In conclusion, overweight/obese mothers not only fall short of clinical practice guidelines in regards to breastfeeding, but also are more likely to initiate early introduction (<4 months infant age) to solid foods compared to their normal BMI counterparts. Interventions should be targeted to this group.

Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype.

Mantle cell lymphoma is an aggressive malignant B-cell disorder that often presents with a leukemic picture. Circulating lymphoma cell morphology may vary from small round mature-appearing lymphocytes resembling the lymphocytes of chronic lymphocytic leukemia to large prolymphocytoid or blastoid cells. Rare reports of hyperleukocytosis with leukostasis, treated with leukocytapheresis, are described in patients with prolymphocytoid or blastoid morphology. We report an 88 year old woman with mantle cell lymphoma, hyperleukocytosis (WBC > 400 × 10(3) /µL) with severe respiratory compromise but without interstitial or alveolar infiltrates on radiograph or computerized tomography of the chest. She was afebrile and had no central nervous system signs. Circulating lymphoma cell morphology was predominantly of the small lymphocyte type. A two-whole-blood-volume leukocytapheresis reduced her WBC from 465 to 221 × 10(3) /µL in 150 min. Her respiratory rate decreased from 28/min to 18/min and her arterial oxygen saturation (SpO2 ) rose from 91% to 97% on 6 L/min of oxygen by nasal cannula. Severe breathlessness before the procedure abated completely by the end of the procedure. Respiratory compromise may occur in mantle cell lymphoma with hyperleukocytosis with a mature lymphoma cell phenotype, even without a clear picture of leukostasis. Although the ultimate survival of the patient depends on treatment with chemotherapy, leukocytapheresis for alleviation of symptoms may be warranted and should be considered. Respiratory status and response to leukocytapheresis should be documented with physiological measurements. J. Clin. Apheresis 31:398-402, 2016. © 2015 Wiley Periodicals, Inc.

Self-Rated Mental Health: Screening for Depression and Posttraumatic Stress Disorder Among Women Exposed to Perinatal Intimate Partner Violence.

The purpose of the current study was to evaluate the validity of a single-item, self-rated mental health (SRMH) measure in the identification of women at risk for depression and posttraumatic stress disorder (PTSD). Baseline data of 239 low-income women participating in an intimate partner violence (IPV) intervention study were analyzed. PTSD was measured with the Davidson Trauma Scale. Risk for depression was determined using the Edinburgh Postnatal Depression Scale. SRMH was assessed with a single item asking participants to rate their mental health at the time of the baseline interview. Single-item measures can be an efficient way to increase the proportion of patients screened for mental health disorders. Although SRMH is not a strong indicator of PTSD, it may be useful in identifying pregnant women who are at increased risk for depression and need further comprehensive assessment in the clinical setting. Future research examining the use of SRMH among high-risk populations is needed.

Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women.

AIMS: Recent studies indicate that older women are more likely to consume alcohol during pregnancy, but subgroups at highest risk within the context of maternal age have not been identified. This study identifies subgroups at risk for alcohol use during pregnancy among three age categories using classification and regression trees (CART) analysis. METHODS: Using the 2002-2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records of U.S. women), logistic regression and classification trees were constructed separately for age groups, ≤24, 25-29, and ≥30 years. RESULTS: Overall, 6.5% of women reported drinking alcohol during the last trimester of pregnancy. Alcohol consumption by age group was: 3.7% for ≤24, 5.7% for 25-29, and 10.1% for ≥30 years of age. Women ≤24 years were at greater risk of consuming alcohol if they also smoked (5.8%). Among nonsmokers, higher levels of education and being Hispanic were associated with a 35% increase in alcohol use. Distinct high-risk subgroups emerged for the 25-29-year-old group. Specifically, 12.8% of non-obese women who reported having experienced abuse during pregnancy also reported drinking alcohol in the last trimester. About 16% of women ≥30 years with at least 16 years of education, White or Hispanic with normal or underweight BMI, drank alcohol during their last trimester. CONCLUSIONS: Given limited health care resources for prevention and treatment, the early identification of high-risk groups for prenatal alcohol use is critical. This study provides evidence that risk factors contributing to alcohol consumption during pregnancy may differ by maternal age.

Baby steps in the prevention of childhood obesity: IOM guidelines for pediatric practice.

The aim of this paper is to present an overview of the infancy-related guidelines from the Institute of Medicine (IOM, 2011) report "Early Childhood Obesity Prevention Policies" and highlight research studies that support their implementation in pediatric practice. Findings from recent studies of infant growth monitoring, feeding, sleep, and physical activity are presented. Research strategies that may be applied to today's clinical assessments and interventions are specified. Participation by pediatric nurses in the development of future multi-component interventions to prevent rapid infant weight gain is recommended.

Postpartum depression, infant feeding practices, and infant weight gain at six months of age.

INTRODUCTION: This study examined postpartum depression (PPD) as a potential risk factor for non-adherence to infant feeding guidelines and subsequent infant weight gain. METHODS: Participants were mother-infant dyads from the Infant Feeding Practices Study II (N = 1447). Main study variables were PPD, breastfeeding intensity, addition of cereal to infant formula, and age of introduction to solid foods. RESULTS: In logistic models adjusted for sociodemographic factors, mothers with PPD were 1.57 times (95% confidence interval [CI]: 1.16, 2.13) more likely to breastfeed at low intensity and 1.77 times (95% CI: 1.16, 2.68) more likely to add cereal to infant formula. Although PPD was associated with the early introduction to solid foods (odds ratio: 1.42; 95% CI: 1.07, 1.89), this relationship was not significant after adjusting for potential confounders. A small but significantly greater average weight gain at 6 months was observed among infants of mothers with PPD (10.15 lb, SD = 2.32 vs. 9.85 lb, SD = 2.32). DISCUSSION: Screening for PPD at well-child visits may lead to improved maternal health outcomes and the prevention of early life risk factors for childhood obesity.

Determinants of alcohol cessation, reduction and no reduction during pregnancy.

PURPOSE: Despite public health initiatives targeting the harmful effects of alcohol exposure on fetal growth, 12 % of pregnant women report current alcohol use. For women who reported drinking alcohol prior to pregnancy, we examined several factors as predictors of three alcohol use patterns during the third trimester of pregnancy: cessation, reduction and no reduction. METHODS: Using the 2002-2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records), a multinomial logistic regression model was constructed to compare alcohol risk by category: (1) cessation vs. reduction (2) no reduction vs. reduction. RESULTS: In this sample, 49.4 % drank alcohol before pregnancy. Among those who drank before pregnancy, ~87 % quit drinking during pregnancy, 6.6 % reduced, and about 6.4 % reported no reduction. Older women and those with higher education were more likely to reduce than quit their alcohol use. Conversely, women who were black or Hispanic, overweight, obese, or multiparas were more likely to quit than to reduce their prenatal alcohol consumption. Several stressors such as abuse during pregnancy increased their risk of not quitting or not reducing alcohol during the last trimester of pregnancy. CONCLUSIONS: Differentiating prenatal alcohol use patterns can inform the design of targeted interventions and public health policies to meet the Healthy People 2020 objective for achieving a national rate of 98.3 % alcohol abstinence during pregnancy.

Life stressors and barriers to timely prenatal care for women with high-risk pregnancies residing in rural and nonrural areas.

PURPOSE: To identify the contribution of life stressors and barriers to the untimely initiation of prenatal care for women with high-risk pregnancies living in rural and nonrural areas. METHODS: Data collected in 10 U.S. states by the 2006-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) were used (n = 34,161). Data were weighted to reflect the PRAMS complex survey design. Separate logistic regression models derived adjusted odds ratios for untimely prenatal care initiation based on several life stressors and barriers. RESULTS: Women with high-risk pregnancies living in rural areas were more likely to report late initiation of prenatal care (17.5% vs. 14.6%). The most frequently reported life stressors were the same for both cohorts: Moving, having a very sick family member, arguing more than usual with their partners, and having bills they could not pay. The most frequently cited barriers were also the same for both groups: Not having enough money or insurance for health care visits and not being able to get an appointment when they wanted one. Having two or more barriers increased the risk of late prenatal care initiation by 2.85-fold for rural women and 2.01-fold for nonrural women. CONCLUSION: To increase timely prenatal care initiation, preconception interventions are needed that address common life stressors and barriers shared by women living in rural and nonrural areas.

Clinical practice guidelines for feeding behaviors and weight-for-age at 12 months: a secondary analysis of the Infant Feeding Practices Study II.

BACKGROUND: The World Health Organization has identified childhood obesity as a major threat to global health. Accumulating evidence indicates that excess weight early in life is predictive of later childhood and adolescent obesity. Clinical practice guidelines for infant feeding behaviors have been developed by national and international health organizations. The relationship between these guidelines and infant weight status has not been established. AIM: To examine the relationship between weight-for-age at 1 year and adherence to four clinical practice guidelines for feeding behaviors: no bottle-to-bed, minimal juice consumption, breastfeeding throughout the first year of life, and introduction to solid food no earlier than age 4-6 months. METHODS: Data were obtained from the Infant Feeding Practices Study II, a longitudinal, national survey administered by the U.S. Food and Drug Administration and Centers for Disease Control and Prevention that followed mother-infant dyads from pregnancy through 1 year postpartum. The sample was comprised of 691 infants for whom 12-month survey data were available. RESULTS: Significant associations with weight-for-age were found for juice consumption (p= 0.003), breastfeeding during the second half of infancy (p < 0.001), and introduction to solid foods prior to age 4 months (p < 0.001). A regression model that controlled for infant and maternal characteristics demonstrated that these feeding behaviors remained significant predictors of weight-for-age at 12 months. CONCLUSIONS AND IMPLICATIONS: Modifiable infant feeding behaviors contributed to weight-for-age at 1 year. Replication studies with economically and culturally diverse samples are needed. Further, testing longitudinal interventions that address infant feeding practices is likely to yield the evidence needed for shaping future clinical practice guidelines that reduce the risk for childhood obesity and related pediatric comorbidities.

Maternal-child nutrition practices and pediatric overweight/obesity in the United States and Chile: a comparative study.

Childhood overweight/obesity is now epidemic in both developed countries and those undergoing economic transition. This study compared maternal and school-age child nutrition practices and body mass index in the United States and in Chile. Children (125 in the United States, 121 in Chile) and their mothers (116 in the United States, 101 in Chile) participated. Findings indicated that child nutrition practices were comparable, but mothers in the U.S. group demonstrated fewer healthy nutrition practices on behalf of their children. Significant associations were found between maternal and child nutrition practices. Substantially more children in the U.S. sample were overweight/obese. Implications for practice are presented.