The SMART Moms Program: A Randomized Trial of the Impact of Stress Management on Perceived Stress and Cortisol in Low-Income Pregnant Women

Background: Antenatal period is a time of rapid change during which fetal organs are vulnerable to various stressors. Studies have suggested that psychosocial stressors during pregnancy could adversely influence physical and behavioral outcomes of the infant. Aim: This paper aimed to discusses the importance of antenatal stress assessment and management on both mothers' and infants' health status. Method: This review aggregated evidence from various studies that examined the impact of maternal stress management and its outcomes on pregnant women and their infants. Results: Maternal stress is generally associated with unpleasant fetal outcomes. The use of stress reduction techniques was approved to reduce psychological stress in pregnant women. Conclusion: Ongoing assessment of antenatal stress using a standardized process promotes proper stress handling strategy.

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The Southside Simple Suppers Scale-Up (S4): Effects of a Family Meals Program on Head Start Caregivers

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_130 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 279-279

Author(s):

Amy Sharn ◽

Leah May ◽

Miranda Westrick ◽

Ashley Walther ◽

Carolyn Gunther

Keyword(s):

Mental Health ◽

Blood Pressure ◽

Waist Circumference ◽

Data Collection ◽

Head Start ◽

Perceived Stress ◽

Low Income ◽

Family Meals ◽

Post Test ◽

The Impact

Abstract Objectives Assess the impact of an 8-week Head Start family meals intervention (Simple Suppers) on participating caregiver's weight status and health outcomes. Methods This is a single arm pre- to post-test study. The intervention is occurring during the 2019–20 school year (fall, winter, and spring sessions) at 3 Head Start sites. Caregiver outcomes include: BMI (kg/m2), waist circumference (cm), blood pressure (mm Hg), and mental health measures (depression (Patient Health Questionnaire-9 (PHQ-9)), perceived stress (Perceived Stress Scale (PSS)), and anxiety (Generalized Anxiety Disorder-7 (GAD-7))). Regression models factoring in attendance will be used to examine pre- to post-test changes. Results Nineteen caregivers completed data collection for the fall session. 55.6% of families were low-income and 21.1% had low/very low food security. Mean (SD) caregiver age was 37.6 (12.1) yr, 94.7% were female, and 84.2% were non-Hispanic Black. There were no significant changes in BMI, blood pressure, waist circumference, depression, or perceived stress from pre- to post-test according to attendance level, however anxiety significantly decreased with increasing attendance (P < 0.05). Data collection for the remaining sessions will be completed in spring 2020. Conclusions This study can be expected to have a positive impact by understanding the role of healthy family mealtime routines in caregiver's physical and mental health among racial minorities residing in low-income households. Funding Sources USDA NIFA.

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Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189546 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9546

Author(s):

Marta Caviglia ◽

Marcelo Dell’Aringa ◽

Giovanni Putoto ◽

Riccardo Buson ◽

Sara Pini ◽

...

Keyword(s):

Pregnant Women ◽

Emergency Medical Service ◽

Sierra Leone ◽

Low Income ◽

Medical Service ◽

Hospital Admissions ◽

Access To Healthcare ◽

Emergency Medical ◽

National Emergency ◽

The Impact

We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2–1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33–1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47–3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.

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Randomized Trial of Effect of Energy Dense Biscuits in Under Nourished Pregnant Women on Birth Weight of their Newborns in Low Income Peri-urban Settings of Karachi

International Journal of Clinical Nutrition & Dietetics ◽

10.15344/2456-8171/2017/119 ◽

2017 ◽

Vol 3 (1) ◽

Author(s):

Farah Qamar

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Randomized Trial ◽

Low Income ◽

Urban Settings

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The Impact of the COVID-19 Pandemic on Depression and Sexual Function: Are Pregnant Women Affected More Adversely?

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1736174 ◽

2021 ◽

Vol 43 (10) ◽

pp. 765-774

Author(s):

Ramazan Denizli ◽

Önder Sakin ◽

Kazibe Koyuncu ◽

Nayif Çiçekli ◽

Nihat Farisoğulları ◽

...

Keyword(s):

Sexual Dysfunction ◽

Sexual Function ◽

Pregnant Women ◽

Low Income ◽

Sexual Experience ◽

Economic Status ◽

Depression Score ◽

Income Loss ◽

Increased Risk ◽

The Impact

Abstract Objective To investigate depression and sexual function among pregnant and non-pregnant women throughout the COVID-19 pandemic. Methods A total of 188 women, 96 pregnant and 92 non-pregnant were included. The Beck Depression Inventory (BDI) and the Arizona Sexual Experience Scale (ASEX) were applied to the participants after obtaining sociodemographic data. Results The depression scores of pregnant and non-pregnant women were similar (p = 0.846). We found that the depression scores were significantly higher among the group of participants who have lower economic status (p = 0.046). Moreover, the depression score was significantly higher among women who lost their income during the pandemic (p = 0.027). The score on the ASEX was significantly higher, and sexual dysfunction was more prevalent among women who have lower levels of schooling and income (p < 0.05). Likewise, the ASEX scores were significantly higher (p = 0.019) among the group who experienced greater income loss throughout the pandemic. Upon comparing the pregnant and non-pregnant groups, we detected that sexual dysfunction had a significantly higher rate among pregnant women (p < 0.001). Conclusion In times of global crisis, such as the current pandemic, low-income families have an increased risk of experiencing depression and sexual dysfunction. When we compared pregnant women with non-pregnant women, depression scores were similar, but pregnant women were at a 6.2 times higher risk of developing sexual dysfunction.

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Design and rationale of the Longitudinal Evaluation of Norms and Networks Study (LENNS): A cluster-randomized trial assessing the impact of a norms-centric intervention on exclusive toilet use and maintenance in peri urban communities of Tamil Nadu

10.1101/2020.06.26.20140830 ◽

2020 ◽

Cited By ~ 1

Author(s):

Sania Ashraf ◽

Cristina Bicchieri ◽

Maryann G. Delea ◽

Upasak Das ◽

Kavita Chauhan ◽

...

Keyword(s):

Behavior Change ◽

Randomized Trial ◽

Low Income ◽

Tamil Nadu ◽

Cluster Randomized Trial ◽

List Type ◽

Behavior Change Intervention ◽

Ex Ante ◽

Cluster Randomized ◽

The Impact

AbstractIntroductionInconsistent toilet usage is a continuing challenge in India. Despite the impact of social expectations on toilet usage, few programs and studies have developed theoretically grounded norms-centric behavior change interventions to increase toilet use in low-income settings. This protocol details the rationale and design of an ex-ante, parallel cluster-randomized trial evaluating the impact of a demand-side, norms-centric behavior change intervention on exclusive toilet use and maintenance in peri-urban Tamil Nadu, India.Methods and AnalysisFollowing two years of formative research, we developed an evidence-based norm-centric behavior change intervention called Nam Nalavazhvu (Tamil for “Our wellbeing”). The multi-level intervention aims to shift collective beliefs by shifting empirical expectations or beliefs about other relevant people’s sanitation practices. It also provides action-oriented information to aid individuals to set goals and overcome barriers to build, consistently use and maintain their toilets. This trial includes 76 wards in Pudukkottai and Karur districts, where half were randomly assigned to receive the intervention and the remaining serve as counterfactuals. During baseline and endline (conducted one year after the initiation of intervention) assessments, we collect relevant data and compare results between study arms to determine the impacts of the Nam Nalavazhvu intervention on sanitation-related behavioral, health, wellbeing outcomes and potential moderators. This study is powered to detect differences in the prevalence of exclusive toilet use between study arms. We will also conduct a process evaluation to understand the extent to which the intervention was implemented, as designed.Ethics and DisseminationThe study protocol has been reviewed and approved by the ethics board at the University of Pennsylvania, USA and the Catalyst Foundation, India. Research findings will be disseminated through open access peer reviewed publications and presentations to stakeholders, government officials and conferences.Trial registrationNCT04269824.Strengths and limitations of this studyThis ex-ante, parallel cluster randomized trial assesses the impact of a norm-centric behavior change intervention strategy to improve sanitation practices. These behavior change techniques are novel to the sanitation sector but has been effective in changing a variety of behaviors, such as water use, drinking behavior, and energy consumption.The study outcomes include health, wellbeing outcomes, and a careful assessment of changes in social beliefs, expectations, and social determinants of collective sanitation behaviors.This study is being rolled out during the ongoing COVID-19 pandemic. This can potentially impact the effectiveness of this intervention package that uses community and network-based group activities. However, through a detailed process monitoring and evaluation we will be able to assess the impact on delivery, and subsequent behavior change in this unique setting.

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Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study

10.21203/rs.2.13895/v4 ◽

2020 ◽

Author(s):

Luísa M M Fernandes ◽

Sônia Lansky ◽

Bernardo J Oliveira ◽

Amélia A L Friche ◽

Christine T. Bozlak ◽

...

Keyword(s):

Pregnant Women ◽

Low Income ◽

Cross Sectional Study ◽

Low Income Countries ◽

Perceived Knowledge ◽

Cross Sectional ◽

Knowledge Domains ◽

Normal Birth ◽

The Mean ◽

The Impact

Abstract Background: Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This study evaluates the impact of the SoB intervention on pregnant women’s perceived knowledge about normal birth, cesarean, and use of EBP in childbirth. Method: 1,287 pregnant women answered a structured questionnaire, immediately after their visit to the exhibition, between March 2015 and March 2016, in four cities. To identify the impact of the intervention on women’s perceived knowledge and possible association with socioeconomic and demographic characteristics, statistical analyses were performed including paired T-tests, ANOVA, and logistic and linear regressions. Results: The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49- 4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59- 3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean). Conclusion: The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries targeting women.

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Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda

Journal of Global Oncology ◽

10.1200/jgo.19.00209 ◽

2019 ◽

pp. 1-13

Author(s):

Lydia E. Pace ◽

Jean Marie Vianney Dusengimana ◽

Lawrence N. Shulman ◽

Lauren E. Schleimer ◽

Cyprien Shyirambere ◽

...

Keyword(s):

Breast Cancer ◽

Randomized Trial ◽

Low Income ◽

Early Stage ◽

Cluster Randomized Trial ◽

Early Stage Disease ◽

Catchment Areas ◽

Hospital Visits ◽

Cluster Randomized ◽

The Impact

PURPOSE Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district. METHODS We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings’ impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs. RESULTS From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs ( P = .001) and 7.9 visits/month for phase 2 HCs ( P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas ( P = .048). CONCLUSION In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers.

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