Influence of H-HOPE intervention for premature infants on growth, feeding progression and length of stay during initial hospitalization.

OBJECTIVE: To examine whether premature infants receiving the maternally administered H-HOPE (Hospital to Home Transition-Optimizing Premature Infant's Environment) intervention had more rapid weight gain and growth, improved feeding progression and reduced length of hospital stay, compared with controls. STUDY DESIGN: Premature infants born at 29-34 weeks gestational age and their mothers with at least two social-environmental risk factors were randomly assigned to H-HOPE intervention (n=88) or an attention control (n=94) groups. H-HOPE consists of a 15-min multisensory intervention (Auditory, Tactile, Visual and Vestibular stimuli) performed twice daily prior to feeding plus maternal participatory guidance on preterm infant behavioral cues. RESULT: H-HOPE group infants gained weight more rapidly over time than infants in the control group and grew in length more rapidly than control infants, especially during the latter part of the hospital stay. CONCLUSION: For healthy preterm infants, the H-HOPE intervention appears to improve weight gain and length over time from birth to hospital discharge.

HIV-related symptoms and patient clusters among Chileans living with HIV.

Identifying both Human immunodeficiency virus (HIV)-related and co-morbid symptoms experienced by people living with HIV (PLWH) who are receiving antiretroviral therapy (ART) treatment is a major challenge for healthcare providers globally. Yet, little research to date has examined the symptoms of illness experienced by PLWH including patients living in Central and South American. To address this gap, this study was designed to identify symptoms of HIV by socio-demographic and/or clinical characteristics among Chilean patients living with the virus. A convenience sample of 209 Chilean PLWH was recruited from an outpatient clinic in Santiago, Chile. A structured interview was used to elicit socio-demographic information and HIV symptoms status. Additional clinical information was obtained through a review of the participants' medical records. Results show that patients' most commonly reported HIV-related symptoms were fear/worries (66%), anxiety (52%), gas/bloating (50%), and thirst (50%). Multivariate analysis revealed a positive association between the number of reported HIV-related symptoms and number of years living with HIV. Having completed college was negatively associated with number of symptoms. Latent class analysis indicated that PLWH in the sample who had completed college were two times more likely to experience a mild intensity of HIV-related symptoms than their lesser educated counterparts. Similarly, logistic regression revealed that college-educated PLWH were twice as likely to be classified in the subgroup reporting mild intensity of symptoms than those who lacked a college degree. Overall, the study's results reveal that many Chilean PLWH, even those with high CD4 counts and low or undetectable viral loads, are not symptom free. The findings point to the need for clinicians to tailor a plan of care for individuals living with HIV that is based on their symptomatology.

Rural Malawians' perceptions of HIV risk behaviors and their sociocultural context.

Prevention remains key in the fight against HIV/AIDS. However, prevention requires understanding the sociocultural and economic context in which HIV-risk behaviors occur. This qualitative, descriptive study was part of the initial phase of a larger project to adapt and test a community-based HIV-prevention intervention. We conducted individual interviews with rural Malawian community leaders and focus groups with adult community residents to elicit perceptions of both sexual and non-sexual HIV-risk behaviors and their sociocultural context. Interviews and focus groups were conducted in Chichewa, audio-taped, transcribed and translated into English by bilingual co-investigators. Content analysis of transcripts was done collaboratively by US-based and Malawian co-investigators to confirm culturally accurate interpretation of data. Participants identified sexual and non-sexual HIV-risk behaviors and contextual factors that influence these behaviors, including gender relations, cultural practices, economic conditions and religion. Community leaders and residents voiced similar perspectives on risk behaviors, except that community leaders were much less likely than residents to discuss sexual transmission through participation in traditional cultural practices. We incorporated these study results in adapting our HIV-prevention intervention to the sociocultural context of rural Malawi. Study participation enhanced the community leader's and resident's interest in the intervention phase of the project.

Emotional adjustment and concerns of Korean mothers of premature infants.

This study describes the emotional adjustment and concerns of 50 Korean mothers of premature infants from hospitalization through six weeks after discharge. Five themes emerged: self-blame, concern about the infant, reluctance to express negatives, fear of stigmatizing responses to the infant by others, and delayed joy in mothering. Three Korean cultural beliefs influenced mothers' responses to premature birth: maternal responsibility for infant outcomes, negative thoughts can lead to negative consequences, and stigmatization of prematurity. Results identify specific ways caregivers in Korea and other countries can provide culturally appropriate support for Korean mothers experiencing a premature birth.

Validating the safety of nurse-health advocate services.

Prior to promoting the use of community health care advocates for home visits, it is necessary to evaluate their ability to safely screen for health problems. This study examined trained maternal-child health advocates (MCHAs) who, supervised by professional nurses, conducted maternal-child home visits consisting of health promotion and problem identification. Problems identified by MCHAs were compared to problems identified by professional, validating nurses, who were not part of the service project, on hypothetical home visit situations and during 213 duplicate home visits. There were no significant differences between MCHAs and professional nurses in their identifications of infant health problems, infant health care deficits, other family members' health problems, prenatal care deficits, emotional problems, and substance abuse on either the hypothetical home visits or the duplicate home visits. The validating nurses identified significantly more women's health problems (p = 0.01) and women's health care deficits (p = 0.02) than the MCHAs on the duplicate home visits. These findings validate the safety of using the model of trained community health advocates teamed with registered nurses to screen for infant health problems during home visits.

Evaluation of an interagency home visiting program to reduce postneonatal mortality in disadvantaged communities.

This paper describes an interagency home visiting program, Resources, Education and Care in the Home (REACH), designed to reduce preventable causes of morbidity among normal, socioeconomically disadvantaged infants at risk for adverse outcomes due to social factors. Home nursing visits by a trained nurse-community worker team were made throughout the first year of life to 1,269 infants from predominantly African American families. Results demonstrate that repeated home visits with ongoing infant health monitoring plus individualized and culturally sensitive teaching helped mothers maintain good health practices and identify illnesses early. Infants' outcomes during the neonatal period and at 12 months showed consistent, though statistically nonsignificant, positive effects on physical health. The postneonatal mortality rate among REACH infants was 4.7 deaths per 1000 live births in communities where rates for nonparticipants ranged from 5.2 to 10.9 per 100. The evaluation demonstrates a need in this population for more intensive services with greater continuity of care. Specific areas where more education is needed include home safety, skin care, and early identification and treatment of upper respiratory infections. Infants from communities with high infant mortality rates present numerous preventable morbidities requiring interventions, even when they are not considered medically high-risk at birth.

AIDS awareness and knowledge among Botswana women: implications for prevention programs.

In-depth interviews with 56 urban women in Botswana revealed high levels of AIDS awareness and high reliance on mass media information. Many of the women expressed confusion about AIDS as an illness, that is, its symptoms and the latent period. Nearly all of the women were aware that the virus that leads to AIDS is sexually transmitted and believed that condoms are effective for prevention. However, one third had incorrect knowledge about transmission, lacking a full understanding of sexual transmission and believing that transmission can occur through casual contact. Two thirds believed they were at risk for getting AIDS, usually because they did not trust their partners and lacked control over their partners' behaviors. More than half of the women said they had changed their behaviours to prevent AIDS. Thirty-six said they had only one partner, but only 11 said they used condoms or would do so with a future partner. The women's responses provide important information on gaps in AIDS knowledge that need to be addressed in AIDS prevention.

AIDS prevention for women: a community-based approach.

PIP: There were approximately 3 million HIV-positive women in the world, most of them in reproductive age according to the WHO's 1991 estimates. One third of the world's HIV-positive individuals are women; by the year 2000, women will account for half of the HIV-positive population. There are at least 200,000 HIV-positive women in Asia, mainly in Thailand, India, and China. The community-based Botswana project approach to AIDS prevention for women was based on a community-based model project at the University of Illinois to promote health in 2 low-income communities in Chicago by teams of trained residents and a nurse. Program elements included: women as health promoters; acceptance of primary health care; and emphasis on self-care in basic health. In Botswana the fertility rate is 5%, and approximately 40% of the women use contraceptives. The overall mortality rate is 37 per 1000. The 1st case of AIDS in Botswana was identified in 1985. As of January 1991, there were 180 cases and 59 AIDS-related deaths. There are 20,000 to 47,000 HIV-positive individuals in Botswana. There have been more women than men among reported AIDS cases in Botswana. Most women in their childbearing years are at moderate risk of HIV infection because of weak partner ties and occasional multiple partners. A 2-stage study of the effectiveness of nurse-managed peer education and support groups for AIDS prevention for women has been in operation for the 2nd year. In the 1st phase, interviews with more than 50 urban women explored their current risk of HIV infection and the risk-reduction strategies. The strategy for change used peer education and support groups led by trained community women to achieve lasting behavioral changes that promote health. The target group approach will include all women in the community. Heterosexual transmission of HIV is the predominant route of infection for women, hence promotion of safer sex is central in the Botswana intervention. The same AIDS preventive practices also protect against other sexually transmitted diseases including gonorrhea, syphilis, and chlamydiosis, which have high prevalence rates in Botswana.^ieng

Infant feeding practices of low-income mothers.

This study describes infant feeding practices over the first year of life for 294 medically indigent, inner city mothers. These findings highlight the need for interventions to improve infant feeding knowledge and practices throughout the first year of life. Nutritional problems identified included low rates of breast-feeding; early introduction of solid food, especially cereal in the bottle; and excessive use of foods that are high in sugar.

Early maternal attachment behaviors of adolescent and adult mothers.

This comparison of observed attachment behaviors of 184 medically indigent, low-risk, inner-city adolescent and adult mothers addresses three critical questions unanswered by current research regarding the maternal attachments behaviors of adolescents. The 69 mothers aged 14 to 17 and the 36 mothers aged 18 to 19 exhibited significantly fewer maternal attachment behaviors during in-hospital infant feedings than a control group of 79 mothers aged 20 to 24. Verbal reports of adolescent and adult mothers were not reliable indicators of actual attachment behaviors. Two-way analyses of variance, statistically controlling for other background factors and amount of infant contact, did not diminish the impact of maternal age. However, rooming-in and educational levels appropriate for age both had additional independent impacts on maternal attachment scores.

Homeless shelter policies for women in an urban environment.

A survey of shelters serving women in Chicago (N = 43) identified admission criteria, policies and services, estimated the number of homeless women in childbearing years served by the shelters, the number who were pregnant or mothers with children, and identified unmet health needs and health services provided. The majority (64%) of the women using shelters were African American and there was great variability in shelter policies. Women with male children more than seven years old, pregnant women and substance abusers were less likely to be admitted.

A comparative study of plans for infant care made by adolescent and adult mothers.

This study evaluated the choices of primiparous adolescent and adult mothers about whom they believe will care for their infant after they go home from the hospital. The responses of 70 younger adolescents (age 14-17 years) and 37 older adolescents (age 18-19 years) were compared with 80 adult (age 20-25 years) primiparas regarding their plans for school or work, type of child care arrangements planned, and the father's anticipated involvement in the care of the baby. There were no statistical differences among our three age groups. The results show that first-time mothers in all three age groups more often expect themselves to be the primary care giver for their infant, all age groups expected their mother to help most when they lived with her, and about three quarters of each age group expect the husband/baby's father to help in some way.

PIP: This study evaluated the choices of primiparous adolescent and adult mothers about whom they believe will care for their infant after they go home from the hospital. The responses of 70 younger adolescents (age 14-17 years) and 37 older adolescents (age 18-19 years) were compared with 80 adult (age 20-25 years) primiparas regarding their plans for school or work, type of child care arrangements planned, and the father's anticipated involvement in the care of the baby. There were no statistical differences among our 3 age groups. The results show that 1st time mothers in all 3 age groups more often expect themselves to be the primary care giver for their infant, all age groups expected their mother to help most when they lived with her, and about 3/4 of each age group expect the husband/baby's father to help in some way. The sample was drawn from attendees at a large metropolitan US city hospital, almost entirely of low socioeconomic status and nearly all dependent on public assistance. 70% are black, native-born Americans, 25% are Spanish-speaking Mexican-Americans. All subjects had planned to keep their babies.

Early discharge with home follow-up: impacts on low-income mothers and infants.

Low-income mothers and infants discharged at 24 to 47 hours after birth were compared to two control groups: early discharge with infant separation and conventional discharge. No differences among the three groups in maternal or infant morbidity at seven to 15 days postdelivery were recorded. Simultaneous early discharge was associated with higher maternal attachment scores, fewer maternal concerns, and greater maternal satisfaction with discharge type than early discharge with infant separation. All three groups had substantial morbidity in the first two weeks of life. A shorter hospital stay and more health monitoring postdischarge may be a better use of health resources than a conventional hospital stay for low-income mothers and their infants.

Early postpartum rooming-in and maternal attachment behaviors in a group of medically indigent primiparas.

Introduction of rooming-in at the study site provided an opportunity to examine the impact of rooming-in on maternal attachment behaviors. Maternal attachment scores for 80 mothers who received rooming-in were compared to 72 mothers who delivered before rooming-in and 35 mothers who requested but did not receive rooming-in. All subjects were medically indigent primiparas with no intrapartum or postpartum complications and term healthy infants. The groups were not significantly different in maternal age, race, or ethnicity. Maternal attachment behaviors were recorded during an infant feeding. Rooming-in mothers had significantly higher maternal attachment scores than both control groups. Rooming-in had an independent effect on maternal attachment after the effects of maternal age, episiotomy or lacerations, epidural anesthesia, infant contact at delivery, and time of feeding observation had been accounted for. Of these prior factors, only maternal age had a significant impact on rooming-in. These results suggest that rooming-in helps primiparas to form early attachments to their babies, and that the impact of rooming-in cannot be explained by the mother's motivation for rooming-in. It is important to provide close contact with the infant during the early postpartum, especially for adolescents who may be at higher than average risk of mothering inadequacies.

Changing commitments of American women to work and family roles.

This article, based on a study of Chicago-area women aged 25--54, concentrates on six major dimensions of women's involvement in employment and family roles. First, it breaks new ground in exploring women's attitudes about social security and retirement expectations. Second, it documents cohort changes in overall life patterns, employment, and family role involvements from age 19 to the period studied. The article also focuses on four aspects of those life patterns especially relevant to the social security program: changing levels and patterns of education and job training, factors related to employment rates, differences between full-time homemakers and employees, and a detailed examination of the womens occupations. The study shows that neither social security policies nor retirement plans are matters of everyday concern to the women. Those who believe that social security policies are unfair hold widely differing and partially conflicting views on why and for whom they are unfair. Low-income women often emphasize that their benefits are too small; those involved in jobs or careers emphasize unfairness to different groups.