Randomized Controlled Trial of a Paraprofessional-Delivered In-Home Intervention for Young Reservation-Based American Indian Mothers

ObjectiveTo evaluate the efficacy of a paraprofessional-delivered, home-visiting intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes.MethodFrom 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were randomized (1:1) to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit “Family Spirit” intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). The interventions began during pregnancy and continued to 6 months postpartum. Mothers and children were evaluated at baseline and 2, 6, and 12 months postpartum. Primary outcomes included changes in mothers' parenting knowledge and involvement. Secondary outcomes included infants' social and emotional behavior; the home environment; and mothers' stress, social support, depression, and substance use.ResultsParticipants were mostly teenaged, first-time, unmarried mothers living in reservation communities. At 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains, 13.5 (p < .0001) and 13.9 (p < .0001) points higher, respectively (100-point scale). At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain (β = ?.17, p < .05) and less separation distress in the internalizing domain (β = ?.17, p < .05). No between-group differences were found for maternal involvement, home environment, or mothers' stress, social support, depression, or substance use.ConclusionsThis study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):591-601.     

Reliable assessment of faecal loading in older adults by abdominal radiograph

Objective: To produce a measure of faecal loading using plain abdominal radiograph that has both face validity and reliability. This formed part of the Ballarat Constipation Study, which aimed to establish a suite of objective assessment tools for the identification of constipation in residential and extended care facilities. Methods: A 20‐point loading scale (five levels of loading × four segments of colon) was evaluated using 75 plain abdominal films of patients older than 65 years that were taken for various purposes. These were randomly ordered and five radiologists, following appropriate training, rated the films. Each was blinded to the others’ responses. To establish intra‐rater reliability, each radiologist rated 25 of the films for a second time. Results: Reliability was assessed using Q‐type correlations for raw scores and Cohen's kappa for dichotomised scores. Inter‐rater correlations ranged from 0.57 confidence interval (CI) (0.38, 0.72) to 0.83 CI (0.74, 0.90). Inter‐rater kappas ranged from 0.28 CI (0.06, 0.50) to 0.72 CI (0.50, 0.94). Intra‐rater correlations ranged from 0.68 CI (0.38, 0.84) to 0.92 CI (0.82, 0.96) and intra‐rater kappas ranged from 0.26 CI (?0.08, 0.60) to 0.90 CI (0.70, 0.99). Conclusion: This method of assessing and reporting faecal loading in older people has an acceptable level of reliability for four of the five radiologists. The scale was considered appropriate for use in the larger study, where its validity was tested.     

The trouble with family medicine

BACKGROUND: The trouble with family medicine is that the perceptual framework it uses to view the phenomena of health and illness is at variance with the frameworks traditionally used by medicine generally. This creates difficulties in communication between those in family medicine and those in other disciplines, and sometimes leads to misunderstanding of the nature of the discipline of family medicine and its place in the health care system. Those who practise family medicine need to be 'multilingual', able to understand and speak the language and use the metaphors of family medicine, yet equally able to use the language and metaphors of other disciplines. OBJECTIVES: This paper, which begins with a clinical scenario, reviews the contemporary biomedical paradigm, proposes an alternative, and examines the conceptual frameworks which underpin the discipline of family medicine.      

The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial

Observational studies suggest that including men in reproductive health interventions can enhance positive health outcomes. A randomized controlled trial was designed to test the impact of involving male partners in antenatal health education on maternal health care utilization and birth preparedness in urban Nepal. In total, 442 women seeking antenatal services during second trimester of pregnancy were randomized into three groups: women who received education with their husbands, women who received education alone and women who received no education. The education intervention consisted of two 35-min health education sessions. Women were followed until after delivery. Women who received education with husbands were more likely to attend a post-partum visit than women who received education alone [RR = 1.25, 95% CI = (1.01, 1.54)] or no education [RR = 1.29, 95% CI = (1.04, 1.60)]. Women who received education with their husbands were also nearly twice as likely as control group women to report making >3 birth preparations [RR = 1.99, 95% CI = (1.10, 3.59)]. Study groups were similar with respect to attending the recommended number of antenatal care checkups, delivering in a health institution or having a skilled provider at birth. These data provide evidence that educating pregnant women and their male partners yields a greater net impact on maternal health behaviors compared with educating women alone.     

The Respecting the Circle of Life trial for American Indian adolescents: rationale,design, methods,and baseline characteristics

This paper describes the rationale, design, methods, and baseline results of a randomized controlled trial to evaluate the impact of an adapted evidence-based intervention (EBI), “Respecting the Circle of Life” (RCL) to reduce behavioral risks for HIV/AIDS among American Indian (AI) adolescents. A participatory approach shaped intervention adaptation and study design. A total of 267 participants (aged 13–19) were randomized by peer groups of the same sex to receive the RCL intervention or a control condition. Self-report assessments were administered at four intervals. The sample was predominately female (57%), had low HIV knowledge prevention scores, early sexual initiation (mean 14.6 years), and 56% reported intention to use a condom at next sex. Baseline characteristics were evenly distributed between groups with the exception of age and extrinsic reward scores. This is the first rigorous evaluation of an adapted EBI for HIV/AIDS prevention among AI adolescents, an at-risk and understudied population.     

An evaluation and replication of miRNAs with disease stage and colorectal cancer‐specific mortality

MicroRNAs (miRNAs) have been implicated in colorectal cancer (CRC) development and associated with prognostic indicators such as disease stage and survival. Prognostic associations are often based on few individuals and imprecise. In this study, we utilize population‐based data from 1,141 CRC cases to replicate previously reported associations between 121 miRNAs and disease stage and survival. The Agilent Human miRNA Microarray V19.0 was used to generate miRNA data following a stringent quality control protocol. Assessment of survival was done using Cox Proportional Hazard models adjusting for age, disease stage and tumor molecular phenotype. Five miRNAs were associated with more advanced disease stage; hsa‐miR‐145‐5p and hsa‐miR‐31‐5p showed increased expression with more advanced tumor stage, while hsa‐miR‐200b‐3p, hsa‐miR‐215 and hsa‐miR‐451a had decreased expression with more advanced tumors. Thirteen miRNAs were associated with CRC mortality among individuals diagnosed with colon cancer while 14 were associated with CRC mortality after a diagnosis with rectal cancer. Strongest associations were observed for those miRNAs that were expressed in a small subset of tumors. Most notable associations were for hsa‐miR‐145‐3p [hazard ratio (HR) 2.94, 95% confidence interval (CI) 1.54, 5.61], and hsa‐miR‐9‐3p (HR 10.28, 95% CI 1.31, 80.84) with colon cancer and hsa‐miR‐335‐5p (HR 0.17, 95% CI 0.05, 0.54) for rectal cancer. hsa‐miR‐374a‐5p, hsa‐miR‐570‐3p and hsa‐miR‐18a‐5p significantly reduced the hazard of dying for all cases, regardless of tumor site. Our findings illustrate the need for a large sample to evaluate the association of miRNAs with survival and disease stage in order to determine associations by tumor site.