Dyadic care to improve postnatal outcomes of birthing people and their infants: A scoping review protocol.

INTRODUCTION: Dyadic care, which is the concurrent provision of care for a birthing person and their infant, is an approach that may improve disparities in postnatal health outcomes, but no synthesis of existing dyadic care studies has been conducted. This scoping review seeks to identify and summarize: 1) dyadic care studies globally, in which the birthing person-infant dyad are cared for together, 2) postnatal health outcomes that have been evaluated following dyadic care interventions, and 3) research and practice gaps in the implementation, dissemination, and effectiveness of dyadic care to reduce healthcare disparities. MATERIALS AND METHODS: Eligible studies will (1) include dyadic care instances for the birthing person and infant, and 2) report clinical outcomes for at least one member of the dyad or intervention outcomes. Studies will be excluded if they pertain to routine obstetric care, do not present original data, and/or are not available in English or Spanish. We will search CINAHL, Ovid (both Embase and Medline), Scopus, Cochrane Library, PubMed, Google Scholar, Global Health, Web of Science Core Collection, gray literature, and WHO regional databases. Screening will be conducted via Covidence and data will be extracted to capture the study design, dyad characteristics, clinical outcomes, and implementation outcomes. The risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Tool. A narrative synthesis of the study findings will be presented. DISCUSSION: This scoping review will summarize birthing person-infant dyadic care interventions that have been studied and the evidence for their effectiveness. This aggregation of existing data can be used by healthcare systems working to improve healthcare delivery to their patients with the aim of reducing postnatal morbidity and mortality. Areas for future research will also be highlighted. TRAIL REGISTRATION: This review has been registered at Open Science Framework (OSF, https://osf.io/5fs6e/).

Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study.

BACKGROUND: Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS: Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS: Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION: We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.

Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study.

Background: Globally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort. Methods: A cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses. Results: More than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women. Discussion: The prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort.

Parent and grandparent neonatal intensive care unit visitation for preterm infants.

OBJECTIVE: Characterize family NICU visitation and examine associations with maternal health and social factors and infant health outcomes. STUDY DESIGN: Retrospective cohort study of 167 infants born ≤32 weeks at two urban NICUs 01/2019-03/2020. Average nurse-documented family member visitation and associations of visitation with maternal and infant factors and outcomes were compared. RESULTS: Mothers visited 4.4 days/week, fathers 2.6 days/week, and grandparents 0.4 days/week. Older maternal age, nulliparity, and non-English primary language were associated with more frequent family visitation. Mothers with depression or anxiety history visited less. Maternal depression and public insurance were associated with fewer father visits. Low parental visitation was associated with lower odds of feeding any maternal milk at discharge and low maternal visitation with 11.5% fewer completed infant subspecialty appointments in the year following discharge (95% CI -20.0%, -3.0%). CONCLUSION: Families with social disadvantage visited less often. Parental visitation was associated with infant feeding and follow-up.

Classification of blood pressure during sleep impacts designation of nocturnal nondipping.

The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood pressure from awake to sleep periods), as captured by ambulatory blood pressure monitoring, is a valuable element of risk prediction for cardiovascular disease, independent of daytime or clinic blood pressure measurements. However, capturing measurements, including determination of wake/sleep periods, is challenging. Accordingly, we sought to evaluate the impact of different definitions and algorithms for defining sleep onset on the classification of nocturnal nondipping. Using approaches based upon participant self-reports, applied definition of a common sleep period (12 am -6 am), manual actigraphy, and automated actigraphy we identified changes to the classification of nocturnal nondipping, and conducted a secondary analysis on the potential impact of an ambulatory blood pressure monitor on sleep. Among 61 participants in the Eastern Caribbean Health Outcomes Research Network hypertension study with complete ambulatory blood pressure monitor and sleep data, the concordance for nocturnal nondipping across methods was 0.54 by Fleiss' Kappa (depending on the method, 36 to 51 participants classified as having nocturnal nondipping). Sleep quality for participants with dipping versus nondipping was significantly different for total sleep length when wearing the ambulatory blood pressure monitor (shorter sleep duration) versus not (longer sleep duration), although there were no differences in sleep efficiency or disturbances. These findings indicate that consideration of sleep time measurements is critical for interpreting ambulatory blood pressure. As technology advances to detect blood pressure and sleep patterns, further investigation is needed to determine which method should be used for diagnosis, treatment, and future cardiovascular risk.

The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study: Design, Methods, and Baseline Characteristics.

Noncommunicable diseases (NCDs) account for a higher proportion of mortality and morbidity in the Caribbean and US territories-majority-minority communities-than in the United States or Canada. Strategies to address this disparity include enhancing data collection efforts among racial/ethnic communities. The ECHORN Cohort Study (ECS), a regional adult cohort study, estimates prevalence and assesses risk factors for NCDs in two United States territories and two Caribbean islands. Here, we describe the cohort study approach, sampling methods, data components, and demographic makeup for wave one participants. We enrolled ECS participants from each participating island using random and probability sampling frames. Data components include a clinical examination, laboratory tests, a brief clinical questionnaire, and a self-administered health survey. A subset of ECS participants provided a blood sample to biobank for future studies. Approximately 2961 participants were enrolled in wave one of the ECS. On average, participants are 57 years of age, and the majority self-identify as female. Data from the ECS allow for comparisons of NCD outcomes among racial/ethnic populations in the US territories and the US and evaluations of the impact of COVID-19 on NCD management and will help highlight opportunities for new research.

Development of the Anthropometric Grouping Index for the Eastern Caribbean Population Using the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study Data.

Improving public health initiative requires an accurate anthropometric index that is better suited to a specific community. In this study, the anthropometric grouping index is proposed as a more efficient and discriminatory alternative to the popular BMI for the Eastern Caribbean population. A completely distribution-free cluster analysis was performed to obtain the 11 categories, leading to AGI-11. Further, we studied these groups using novel non-parametric clustering summaries. Finally, two generalized linear mixed models were fitted to assess the association between elevated blood sugar, AGI-11 and BMI. Our results showed that AGI-11 tends to be more sensitive in predicting levels of elevated blood sugar compared to BMI. For instance, individuals identified as obese III according to BMI are (POR: 2.57; 95% CI: (1.68, 3.74)) more likely to have elevated blood sugar levels, while, according to AGI, individuals with similar characteristics are (POR: 3.73; 95% CI: (2.02, 6.86)) more likely to have elevated blood sugar levels. In conclusion, the findings of the current study suggest that AGI-11 could be used as a predictor of high blood sugar levels in this population group. Overall, higher values of anthropometric measures correlated with a higher likelihood of high blood sugar levels after adjusting by sex, age, and family history of diabetes.

A qualitative analysis of text message conversations in a breastfeeding peer counselling intervention.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) breastfeeding peer counselling (BFPC) program supports optimal early life nutrition by providing evidenced-based breastfeeding protection, promotion, and support. The Lactation Advice Through Texting Can Help (LATCH) study was a randomized controlled trial that tested the effectiveness of a text messaging intervention designed to augment the BFPC program. The purpose of the present study was to understand the topics discussed during the text message exchanges between breastfeeding peer counsellors (PCs) and their clients in the intervention arm of the LATCH study, from the time of enrollment up to two-weeks postpartum. Text messaging data were first coded and analysed for one- and two-way text message exchanges. Text messages of participants with a high volume of two-way exchanges were then analysed qualitatively. Four domains were identified in both the prenatal and postpartum periods: the mechanics of breastfeeding, social support, baby's nutrition, and PCs maintaining contact with participants. Additional themes and subthemes identified in the postpartum period included the discussion of breastfeeding problems such as latching trouble engorgement, plugged ducts, pumping, other breastfeeding complications, and resuming breastfeeding if stopped. Two-way text messaging in the context of the WIC BFPC program provides an immediate and effective method of substantive communication between mothers and their PC.

Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Caribbean region. OBJECTIVE: This study explored the concept of a health network, relationships focused on health-related matters, and examined associations with CVD risk factors in the Eastern Caribbean. DESIGN: The Eastern Caribbean Health Outcomes Research Network Cohort Study is an ongoing longitudinal cohort being conducted in the US Virgin Islands, Puerto Rico, Trinidad and Tobago, and Barbados. PARTICIPANTS: Participants (n = 1989) were English or Spanish-speaking adults 40 years and older, who were residents of the island for at least 10 years, and who intended to live on-island for the next 5 years. MAIN MEASURES: Logistic regression was used to examine associations between health network characteristics and CVD risk factors: physical activity, hypertension, and smoking. A baseline survey asked questions about health networks using name generator questions that assessed who participants spoke to about health matters, whose opinions on healthcare mattered, and who they would trust to make healthcare decisions on their behalf. KEY RESULTS: Health networks were mainly comprised of family members and friends. Healthcare professionals comprised 7% of networks, mean network size was four, and 74% of health network contacts were perceived to be in "good" to "excellent" health. Persons with larger health networks had greater odds of being physically active compared with those with smaller networks (OR = 1.07, CI = 1.01-1.14). CONCLUSIONS: Health networks may be useful to intervention efforts for CVD risk factor reduction. More studies are needed to examine health networks in Caribbean contexts and explore associations with other CVD risk factors.

Phenotypes of Hypertensive Ambulatory Blood Pressure Patterns: Design and Rationale of the ECHORN Hypertension Study.

Objective: To describe the rationale and design of a prospective study of ambulatory blood pressure measurement (ABPM) combined with measurement of contextual factors to identify hypertensive phenotypes in a Caribbean population with high rates of HTN and cardiovascular disease. Design: Prospective, multi-center sub-study. Setting: Eastern Caribbean Health Outcomes Research Network Cohort (ECHORN) Study, with study sites in Puerto Rico, the US Virgin Islands, Trinidad and Tobago, and Barbados. Participants: Community-residing adults without a diagnosis of HTN and not taking antihypertensive medication. Intervention: Ambulatory BP patterns are assessed using 24-hour ABPM. Contextual factors are assessed with: ecological momentary assessment (7-item survey of experiences, exposures and responses associated with daytime BP measurements); actigraphy (capturing physical activity and sleep quality); and self-report surveys (assessing physical and social health, environmental and social stressors and supports). Main Outcome Measures: Phenotypes of contextual factors associated with hypertensive BP patterns (sustained HTN, masked HTN, and nocturnal non-dipping). Methods and Results: This study will enroll 500 participants; assessments of blood pressure and contextual factors will be conducted during Waves 2 and 3 of the ECHORN parent study, occurring 2 years apart. In Wave 2, we will assess the association between contextual factors and ABPM patterns. Using advanced analytic clustering methods, we will identify phenotypes of contextual factors associated with hypertensive ABPM patterns. We will then test the stability of these phenotypes and their ability to predict change in ABPM patterns between Waves 2 and 3. Conclusions: Assessment of ABPM, and the contextual factors influencing ABPM, can identify unique phenotypes of HTN, which can then be used to develop more precision-based approaches to the prevention, detection and treatment of HTN in high-risk populations.

Impact of the Lactation Advice Through Texting Can Help (LATCH) Trial on Time to First Contact and Exclusive Breastfeeding among WIC Participants.

OBJECTIVE: Determine the impact of a 2-way text messaging intervention on time to contact between participants and their breastfeeding peer counselors (BFPCs) and on exclusive breastfeeding (EBF) status at 2 weeks and 3 months postpartum. DESIGN: Multisite, single-blind, randomized, controlled trial. SETTING: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) BFPC program. PARTICIPANTS: Low-income women (n = 174) participating in the WIC BFPC program. INTERVENTION: The control group received the standard of care WIC Loving Support BFPC program. The intervention group received standard of care plus the text messaging intervention. MAIN OUTCOME MEASURES: Time to contact with BFPC and EBF status. ANALYSIS: The 2-sample t test or χ2 test assessed whether an association existed between study variables and each outcome. Multivariable ordinal and binary logistic regression assessed the impact of the intervention on time to contact and EBF status. RESULTS: Lactation Advice Through Texting Can Help had a significant impact on early contact between participants and BFPCs (odds ratio = 2.93; 95% confidence interval, 1.35-6.37) but did not have a significant impact on EBF (odds ratio = 1.26; 95% confidence interval, 0.54-2.66). CONCLUSIONS AND IMPLICATIONS: Lactation Advice Through Texting Can Help has the potential to facilitate the work of BFPCs by shortening the time-to-first-contact with clients after giving birth. Research is needed to identify the level of breastfeeding support staff coverage that WIC clinics must have to meet the demand for services created by Lactation Advice Through Texting Can Help.

Evaluation of Nutrition Interventions in Children in Conflict Zones: A Narrative Review.

Food and nutrition insecurity becomes increasingly worse in areas affected by armed conflict. Children affected by conflict, or in war-torn settings, face a disproportionate burden of malnutrition and poor health outcomes. As noted by humanitarian response reviews, there is a need for a stronger evidence-based response to humanitarian crises. To achieve this, we systematically searched and evaluated existing nutrition interventions carried out in conflict settings that assessed their impact on children's nutrition status. To evaluate the impact of nutrition interventions on children's nutrition and growth status, we identified published literature through EMBASE, PubMed, and Global Health by using a combination of relevant text words and Medical Subject Heading terms. Studies for this review must have included children (aged ≤18 y), been conducted in conflict or postconflict settings, and assessed a nutrition intervention that measured ≥1 outcome for nutrition status (i.e., stunting, wasting, or underweight). Eleven studies met the inclusion and exclusion criteria for this review. Five different nutrition interventions were identified and showed modest results in decreasing the prevalence of stunting, wasting, underweight, reduction in severe or moderate acute malnutrition or both, mortality, anemia, and diarrhea. Overall, nutrition interventions in conflict settings were associated with improved children's nutrition or growth status. Emergency nutrition programs should continue to follow recent recommendations to expand coverage and access (beyond refugee camps to rural areas) and ensure that aid and nutrition interventions are distributed equitably in all conflict-affected populations.