Maternal and Infant Iron Status Are Related to Mother-Infant Interactions (P10-094-19)

Abstract Objectives To examine the association between iron status and mother-infant interactions in dyads from rural Bangladesh. Methods Maternal-infant interactions were assessed in dyads from a substudy nested within a randomized controlled trial in rural Bangladesh. Recorded interactions (10 minutes free-play; 2 minutes diapering) at baseline (BL) (infant age 6–18 mo; n = 116), midline (ML) (+ 3 mo; n = 324), and endline (EL) (+ 6 mo; n = 336) were coded per the Emotional Availability Scales (EAS; 4 maternal scales: sensitivity, structuring, non-intrusiveness, non-hostility; 2 child scales: responsiveness, involvement). Ferritin (Ft), transferrin receptor (TfR), and hemoglobin (Hb; in infants only) concentrations were measured at BL and EL. Group differences (categorized by iron status irrespective of intervention group) were assessed via ANCOVA (covariates: socioeconomic status, mean upper arm circumference, weight-for-age Z-score, child sex and age and maternal depressive symptoms (Center for Epidemiologic Studies Depression Scale) and reasoning abilities (Raven's Progressive Matrices)). Stepwise regressions were run to determine predictors of the EAS scores. Results Prevalence of iron deficiency (ID; Ft < 23.7 mg/L) in infants dropped from 55% to 38% and of ID anemia (IDA; Hb < 110 g/L) from 53% to 32%, respectively. Only 12% of mothers were ID (Ft < 15.0 µg/L). Dyads of iron sufficient (IS) infants had higher involvement scores at BL and ML (both P ≤ 0.04), and higher sensitivity and structuring but lower non-intrusiveness scores (all P < 0.01) at ML vs dyads of ID infants. In the regressions, iron status of the mother and/or child was significantly predictive of maternal behaviors for most of the EA scales at all time points with better iron status predicting better behavioral scores except for non-intrusiveness. At BL (but not EL), child BL TfR was negatively related to involvement and responsiveness. No other iron status variables were associated with child behavior at any time point. Conclusions An association exists between maternal and infant iron status and dyadic interaction. Adequate iron status appears to benefit the dyadic relationship. Funding Sources USAID through the Johns Hopkins Global Research Activity Cooperative Agreement.

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Effect of Communication Skills Training Program for Oncologists Based on Patient Preferences for Communication When Receiving Bad News: A Randomized Controlled Trial

Journal of Clinical Oncology ◽

10.1200/jco.2013.51.2756 ◽

2014 ◽

Vol 32 (20) ◽

pp. 2166-2172 ◽

Cited By ~ 91

Author(s):

Maiko Fujimori ◽

Yuki Shirai ◽

Mariko Asai ◽

Kaoru Kubota ◽

Noriyuki Katsumata ◽

...

Keyword(s):

Communication Skills ◽

Patient Preferences ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

Skills Training ◽

Control Group ◽

Communication Skills Training ◽

Communication Performance

Purpose The aim of this study was to identify the effects of a communication skills training (CST) program for oncologists, developed based on patient preferences regarding oncologists' communication. Participants and Methods Thirty oncologists were randomly assigned to either an intervention group (IG; 2-day CST workshop) or control group (CG). Participants were assessed on their communication performance during simulated consultation and their confidence in communicating with patients at baseline and follow-up. A total of 1,192 patients (response rate, 84.6%) who had consultations with the participating oncologists at baseline and/or follow-up were assessed regarding their distress using the Hospital Anxiety and Depression Scale, satisfaction with the consultation, and trust in their oncologist after the consultation. Results At the follow-up survey, the performance scores of the IG had improved significantly, in terms of their emotional support (P = .011), setting up a supportive environment (P = .002), and ability to deliver information (P = .001), compared with those of the CG. Oncologists in the IG were rated higher at follow-up than those in the CG in terms of their confidence in themselves (P = .001). Patients who met with oncologists after they had undergone the CST were significantly less depressed than those who met with oncologists in the CG (P = .027). However, the CST program did not affect patient satisfaction with oncologists' style of communication. Conclusion A CST program based on patient preferences is effective for both oncologists and patients with cancer. Oncologists should consider CST as an approach to enhancing their communication skills.

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Physical exercise programme during pregnancy decreases perinatal depression risk: a randomised controlled trial

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098926 ◽

2018 ◽

Vol 53 (6) ◽

pp. 348-353 ◽

Cited By ~ 17

Author(s):

Marina Vargas-Terrones ◽

Ruben Barakat ◽

Belen Santacruz ◽

Irene Fernandez-Buhigas ◽

Michelle F Mottola

Keyword(s):

Perinatal Depression ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

Late Pregnancy ◽

Perinatal Period ◽

Exercise Programme ◽

Epidemiological Studies ◽

Intention To Treat ◽

Pregnancy And Postpartum

IntroductionThe incidence of depression is high during the perinatal period. This mood disorder can have a significant impact on the mother, the child and the family.ObjectiveTo examine the effect of an exercise programme during pregnancy on the risk of perinatal depression.MethodsHealthy women who were <16 weeks pregnant were randomly assigned to two different groups. Women in the intervention group participated in a 60 min exercise programme throughout pregnancy, 3 days per week, which was conducted from October 2014 to December 2016. The Center for Epidemiological Studies-Depression Scale was used to measure the risk of depression at the beginning of the study (12–16 weeks), at gestational week 38 and at 6 weeks postpartum.ResultsOne hundred and twenty-four pregnant women were allocated to either the intervention (IG=70) or the control (CG=54) group. No differences were found in the percentage of depressed women at baseline (20% vs 18.5%) (χ2=0.043; p=0.836). A smaller percentage of depressed women were identified in the IG compared with the CG at 38 gestational weeks (18.6% vs 35.6%) (χ2=4.190; p=0.041) and at 6 weeks postpartum (14.5% vs 29.8%) (χ2=3.985; p=0.046) using the per-protocol analysis. No significant differences were found using the intention-to-treat analyses, except in the multiple imputation analysis at week 38 (18.6% vs 34.4%) (χ2=4.085; p=0.049).ConclusionAn exercise programme performed during pregnancy may reduce the prevalence of depression in late pregnancy and postpartum.Trial registration numberNCT02420288; Results.

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Feasibility and acceptability of a telephone and web-based stroke caregiver intervention: a pilot randomized controlled trial of the RESCUE intervention

Clinical Rehabilitation ◽

10.1177/0269215520957004 ◽

2020 ◽

pp. 026921552095700 ◽

Cited By ~ 1

Author(s):

Jennifer H LeLaurin ◽

I Magaly Freytes ◽

Kimberly E Findley ◽

Magda K Schmitzberger ◽

Nathaniel D Eliazar-Macke ◽

...

Keyword(s):

Problem Solving ◽

Controlled Trial ◽

Qualitative Interviews ◽

Pilot Trial ◽

Depression Scale ◽

Epidemiologic Studies ◽

Attention Control ◽

Active Listening ◽

Veterans Health ◽

Randomized Controlled

Objective: Assess the feasibility and acceptability of an Internet and telephone support and problem-solving intervention for stroke caregivers. Design: Randomized controlled pilot trial with four arms: four-week intervention ( n = 13), eight-week intervention ( n = 13), eight-week attention control ( n = 13), and standard care ( n = 14). Setting: Southeastern U.S. Veterans Health System. Participants: Informal caregivers of Veterans who suffered a stroke in the preceding 2.5 years were enrolled over an 18-month period. Interventions: Intervention participants received RESCUE, a support and problem-solving intervention delivered via telephone and Internet by registered nurses. Attention control participants received active listening with no advice delivered by nurses via telephone. Main Measures: Feasibility of a larger trial was assessed via recruitment and retention. Acceptability was assessed using an adapted enactment tool and qualitative interviews. Changes in caregiver depressive symptoms and burden were measured by the Center for Epidemiologic Studies Depression Scale and Zarit Burden Interview. The study was not powered for significance testing. Results: Of 340 eligible caregivers, 53 (16%) agreed to participate. Among those enrolled, 51 (96%) completed the study. Caregiver mean age was 60.3 (10.1), 49 (93%) were female and 36 (68%) were white. At baseline, 21 (39%) caregivers had high risk of depression and 18 (33%) had significant burden. Acceptability and enactment tool findings indicated positive participant responses to the intervention. Most rated the amount of sessions the “right amount”. Qualitative analysis revealed the intervention was valued by and acceptable to caregivers. Conclusions: Findings indicate the RESCUE intervention is feasible and acceptable to caregivers and warrants further testing.

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Malnutrition in an obese world: Can a dietary intervention improve iron status in pre-school children?

Proceedings of The Nutrition Society ◽

10.1017/s0029665120003316 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Ellen van der Gaag ◽

Kim Grootelaar ◽

Thalia Hummel

Keyword(s):

Iron Deficiency ◽

School Children ◽

Dietary Intervention ◽

Growth Parameters ◽

Iron Status ◽

Controlled Trial ◽

Intervention Group ◽

Dietary Advice ◽

Control Group ◽

National Guidelines

AbstractIntroduction:In previous studies iron deficiency was present in preschool children in the developed world1. The objective of this randomized controlled trial was to investigate whether iron deficiency was present in pre-school children and to what extend laboratory values could be improved with a nutrient rich diet.Material and Methods:A diet consisting of green vegetables, beef, full-fat milk and butter was developed. This diet comes close to the traditional Dutch diet from a century ago. All food products were in age appropriate portions, according to the national guidelines. Children aged one to four years, who were referred to the paediatrician due to recurrent URTI (without immunologic disorders) were allocated to the intervention or the control group. Both groups were given standard care. The intervention group was also given the dietary advise. All parents were asked to note of daily food intake.Results:No iron deficiency was present in our group of 1–4 years old. Mean Hb was 7.3 mmol/l in both groups. After following the dietary advice for 6 months,the hemoglobulin (Hb) concentration increased in both groups, but a little more in the intervention group :(0,280 mmol/l; p < 0,001 in the dietary intervention group and 0,214 mmol/l in the control group; p = 0,003). MCV values increased in the interventiongroup from 77.9 to 78.8 fl (p = 0.007) whereas a smaller increase was visible in the control group ;78.5 to 78.9 fl (p = 0.18). Ferritin, a marker for iron status but also a marker for inflammation, decreased non-significantly in both groups. There was a significantly correlation with decreasing CRP levels, therefore indicating a decrease in inflammation and not merely representing iron status. Growth parameters (weight, height or BMI) did not change significantly in both groups.Discussion and Conclusion:NoHb deficiency was present in our research population. However, a diet consisting of green vegetables, beef, full-fat milk and butter did improve the iron status in pre-school children. Hb and MCV values increased, suggesting some evidence of subclinical iron deficiency in this group.

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A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial

Psychological Medicine ◽

10.1017/s0033291715000409 ◽

2015 ◽

Vol 45 (11) ◽

pp. 2413-2425 ◽

Cited By ~ 23

Author(s):

A. J. Daley ◽

R. V. Blamey ◽

K. Jolly ◽

A. K. Roalfe ◽

K. M. Turner ◽

...

Keyword(s):

Usual Care ◽

Postnatal Depression ◽

Exercise Intervention ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

International Classification Of Diseases ◽

Exercise Group ◽

Mean Difference ◽

Classification Of Diseases

BackgroundPostnatal depression affects about 10–15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression.MethodWomen who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization.ResultsA total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a −2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) −4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = −2.26, 95% CI −4.36 to −0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up.ConclusionsThis trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.

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Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial

Annals of General Psychiatry ◽

10.1186/s12991-020-00320-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Hongling Liu ◽

Yang Yang

Keyword(s):

Postpartum Depression ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

Behavior Intervention ◽

Anxiety And Depression ◽

Control Group ◽

Cognitive Behavior ◽

Randomized Controlled ◽

Primiparous Women

Abstract Background Anxiety and postpartum depression are the most common psychological problems in women after delivery. Cognitive behavior intervention has been reported to have an effect in the therapy of postpartum depression. This research aimed to investigate whether cognitive behavior intervention could prevent the pathogenesis of postpartum depression in primiparous women. Methods In this randomized controlled trial, primiparous women who were prone to postpartum depression were recruited. Participates in the control group received routine postpartum care and those in the intervention group received both routine postpartum care and cognitive behavior intervention. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Edinburgh Postpartum Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were evaluated before and after the intervention. Results In the intervention group, the post-intervention scores of HAMA, HAMD, EPDS and PSQI were all significantly lower than the baseline scores (p = 0.034, p = 0.038, p = 0.004, p = 0.014, respectively). The proportion of participants with postpartum depression in the intervention group (11.5%) was significantly lower than the control group (24.3%) after the 6-week intervention. Participants in the intervention group were significantly more satisfied with the care than those in the control group (p = 0.032). Conclusion This research provided evidence that cognitive behavioral intervention in postpartum period could alleviate anxiety and depression in primiparous women, and inhibit the pathogenesis of postpartum depression. Trial registry This clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000040076).

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Study protocol to assess the impact of an integrated nutrition intervention on the growth and development of children under two in rural Bangladesh

BMC Public Health ◽

10.1186/s12889-019-7777-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Gulshan Ara ◽

Kazi Istiaque Sanin ◽

Mansura Khanam ◽

Shafiqul Alam Sarker ◽

Sihan Sadat Khan ◽

...

Keyword(s):

Developing Countries ◽

Growth And Development ◽

Controlled Trial ◽

Intervention Group ◽

Nutrition Intervention ◽

Control Group ◽

Child Feeding ◽

Critical Window ◽

Rural Bangladesh ◽

The Impact

Abstract Background The period from birth to two years is the “critical window” for achieving optimal growth and development. An inadequate quality and quantities of complementary foods, poor child-feeding practices and infection negatively impact the growth of under-twos. Approximately one-third of under-fives in developing countries are stunted; many are also micronutrient deficient. An estimated 6% of mortalities among under-fives can be prevented by ensuring optimal complementary feeding. The objective of the study was to assess the ability of a 12-month integrated nutrition intervention to improve the nutritional status (length-for-age Z-score) of 6 to 12-month-old children in rural Bangladesh. Methods In this community-based randomized controlled trial, the intervention group received a package of interventions that includes, food vouchers; to prepare egg-based nutritious snacks (suji firni for < 1-year-olds, suji halwa for > 1-year-olds), micronutrient powder to fortify children’s food at home, child feeding counselling and water, sanitation and hygiene (WASH), behaviour change communication. The control group received routine health messages provided by the government. Baseline and endline surveys were conducted; Data collection was performed monthly on children’s growth, food voucher utilization, child feeding and morbidity. In addition, we assessed the cognitive development of the children after 12 months of intervention. Conclusion This trial aims to explore whether an integrated nutrition intervention can mitigate childhood stunting during the critical window of opportunity in rural Bangladesh. The results may provide robust evidence to improve the linear growth of children in developing countries. Trial registration The study was retrospectively registered on August 17, 2018 and is available online at ClinicalTrials.gov (ID: NCT02768181).

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Mamma Mia – A randomized controlled trial of an internet-based intervention for perinatal depression

Psychological Medicine ◽

10.1017/s0033291718002544 ◽

2018 ◽

Vol 49 (11) ◽

pp. 1850-1858 ◽

Cited By ~ 11

Author(s):

Silje Marie Haga ◽

Filip Drozd ◽

Carina Lisøy ◽

Tore Wentzel-Larsen ◽

Kari Slinning

Keyword(s):

Depressive Symptoms ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

Control Group ◽

Group Data ◽

Perinatal Depressive Symptoms ◽

Group 2 ◽

And Control

AbstractBackgroundStudies suggest that 10–15% of perinatal women experience depressive symptoms. Due to the risks, problems with detection, and barriers to treatment, effective universal preventive interventions are needed. The aim of this study was to assess the effectiveness of an automated internet intervention (‘Mamma Mia’) on perinatal depressive symptoms. Mamma Mia is tailored specifically to the perinatal phase and targets risk and protective factors for perinatal depressive symptoms.MethodsA total of 1342 pregnant women were randomized to an intervention (‘Mamma Mia’) and control group. Data were collected at gestational week (gw) 21–25, gw37, 6 weeks after birth, and 3 and 6 months after birth. We investigated whether (1) the intervention group displayed lower levels of depressive symptoms compared with the control group, (2) the effect of Mamma Mia changed over time, (3) the effect on depressive symptoms was moderated by baseline depressive symptoms, previous depression, and parity, and (4) this moderation changed by time. Finally, we examined if the prevalence of mothers with possible depression [i.e. Edinburgh Postnatal Depression Scale (EPDS)-score ⩾10] differed between the intervention and control group.ResultsParticipants in the Mamma Mia group displayed less depressive symptoms than participants in the control group during follow-up [F(1) = 7.03, p = 0.008]. There were indications that the effect of Mamma Mia was moderated by EPDS score at baseline. The prevalence of women with EPDS-score ⩾10 was lower in the Mamma Mia group at all follow-up measurements.ConclusionsThe study demonstrated the effects of the automated web-based universal intervention Mamma Mia on perinatal depressive symptoms.

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Pragmatic randomized trial of antenatal intervention to prevent post-natal depression by reducing psychosocial risk factors

Psychological Medicine ◽

10.1017/s0033291799002937 ◽

2000 ◽

Vol 30 (6) ◽

pp. 1273-1281 ◽

Cited By ~ 115

Author(s):

T. S. BRUGHA ◽

S. WHEATLEY ◽

N. A. TAUB ◽

A. CULVERWELL ◽

T. FRIEDMAN ◽

...

Keyword(s):

Risk Factors ◽

Social Support ◽

Risk Factor ◽

Preventive Intervention ◽

Psychosocial Support ◽

Controlled Trial ◽

Intervention Group ◽

Depression Scale ◽

Problem Solving Skills ◽

Post Natal Depression

Background. Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression. We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention.Methods. We conducted a pragmatic randomized controlled trial in antenatal clinics. We screened 1300 primiparous women and 400 screened positive, 69 screen-positive women were untraceable or not eligible. Of 292 women who completed baseline assessment, 209 consented to randomization, of these 190 provided outcome data 3 months post-natally. ‘Preparing for Parenthood’, a structured antenatal risk factor reducing intervention designed to increase social support and problem-solving skills, was compared with routine antenatal care only. We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Questionnaire Depression scale and Edinburgh Post-natal Depression Scale (EPDS), and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview.Results. Assignment to the intervention group did not significantly impact on post-natal depression (odds ratio for GHQ-Depression 1·22 (95% CI 0·63–2·39), P = 0·55) or on risk factors for depression. Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective. Attenders benefited no more than non-attenders.Conclusions. Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods. The development of novel, low cost interventions effective in reducing risk factors should be completed before further trial evaluation.

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Effects of water, sanitation, handwashing, and nutritional interventions on telomere length among children in a cluster-randomized controlled trial in rural Bangladesh

eLife ◽

10.7554/elife.29365 ◽

2017 ◽

Vol 6 ◽

Author(s):

Audrie Lin ◽

Benjamin F Arnold ◽

Andrew N Mertens ◽

Jue Lin ◽

Jade Benjamin-Chung ◽

...

Keyword(s):

Clinical Trial ◽

Pregnant Women ◽

Telomere Length ◽

Controlled Trial ◽

Intervention Group ◽

Unexpected Finding ◽

Telomere Attrition ◽

Trial Number ◽

Rural Bangladesh ◽

Geographical Clusters

Background:Shorter childhood telomere length (TL) and more rapid TL attrition are widely regarded as manifestations of stress. However, the potential effects of health interventions on child TL are unknown. We hypothesized that a water, sanitation, handwashing (WSH), and nutritional intervention would slow TL attrition during the first two years of life.Methods:In a trial in rural Bangladesh, we randomized geographical clusters of pregnant women into individual water treatment, sanitation, handwashing, nutrition, combined WSH, combined nutrition plus WSH (N + WSH), or control arms. We conducted a substudy enrolling children from the control arm and the N + WSH intervention arm. Participants and outcome assessors were not masked; analyses were masked. Relative TL was measured at 1 and 2 years after intervention, and the change in relative TL was reported. Analysis was intention-to-treat.Results:Between May 2012 and July 2013, in the overall trial, we randomized 720 geographical clusters of 5551 pregnant women to a control or an intervention arm. In this substudy, after 1 year of intervention, we assessed a total of 662 children (341 intervention and 321 control) and 713 children after 2 years of intervention (383 intervention and 330 control). Children in the intervention arm had significantly shorter relative TL compared with controls after 1 year of intervention (difference −163 base pairs (bp), p=0.001). Between years 1 and 2, TL increased in the intervention arm (+76 bp) and decreased in the controls (−23 bp) (p=0.050). After 2 years, there was no difference between the arms (p=0.305).Conclusions:Our unexpected finding of increased telomere attrition during the first year of life in the intervention group suggests that rapid telomere attrition during this critical period could reflect the improved growth in the intervention group, rather than accumulated stress.Funding:Funded by The Bill and Melinda Gates Foundation.Clinical trial number:NCT01590095.

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