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- Evaluating Universal Education and Screening for Postpartum Depression Using Population-Based Data. [JOURNAL ARTICLE]
- J Womens Health (Larchmt) 2014 Jul 29.
Abstract Background: In 2006, New Jersey was the first state to mandate prenatal education and screening at hospital delivery for postpartum depression. We sought to evaluate provision of prenatal education and screening at delivery, estimate the prevalence of postpartum depressive symptoms, and identify venues where additional screening and education could occur. Methods: For women who delivered live infants during 2009 and 2010 in New Jersey, data on Edinburgh Postnatal Depression Scale scores assessed at hospital delivery and recorded on birth records were linked to survey data from the Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of mothers completed 2-8 months postpartum (n=2,391). The PRAMS survey assesses postpartum depressive symptoms and whether the woman's prenatal care provider discussed the signs and symptoms of perinatal depression with her, used as a proxy for prenatal education on depression. Results: Two-thirds (67.0%) of women reported that a prenatal care provider discussed depression with them and 89.6% were screened for depression at hospital delivery. Among the 13% of women with depressive symptoms at hospital delivery or later in the postpartum period, over a third were Women, Infants, and Children program (WIC) participants, 13% to 32% had an infant in the neonatal intensive care unit (NICU), over 80% attended the maternal postpartum check-up, and over 88% of their infants attended ≥1 well baby visits. Conclusions: Prenatal education and screening for depression at hospital delivery is feasible and results in the majority of women being educated and screened. However, missed opportunities for education and screening exist. More information is needed on how to utilize WIC, NICU, and well baby and postpartum encounters to ensure effective education, accurate diagnosis, and treatment for depressed mothers.
- Assessment of women, infants and children providers' perceptions of oral health counseling and availability of associated resources. [Journal Article]
- J Dent Hyg 2014.:31-9.
Children from low-income families and ethnic minority groups are associated with an increased risk of developing dental disease and are often enrolled in the Women, Infants and Children (WIC) nutritional program. It has been an intention of the Michigan Department of Community Health (MDCH) Oral Health Program (OHP) to collaborate with WIC to provide preventive oral health resources and education to their population. This project focused on achieving the goals outlined in the Michigan 2010 State Oral Health Plan.An 18 question survey was designed to identify gaps existing in oral health counseling in Michigan WIC agencies. The survey was disseminated to 56 MI WIC agencies.WIC providers perceive oral health risk assessment to be important and are asking oral health questions during certification and re-certification appointments. Seventy-nine percent of participants indicated they never had training in oral health counseling, and 79% are interested in learning more about oral health. Agencies are interested in obtaining oral health education resources for their clients.The 2010 State Oral Health Plan's goals recognized the need for oral health related resources and education within community-based programs like WIC. The results of the survey support the need for additional oral health counseling and associated resources in WIC agencies. This information will be used to help the MDCH OHP find ways to address these gaps.
- Characteristics Associated with Breastfeeding Behaviors Among Urban Versus Rural Women Enrolled in the Kansas WIC Program. [JOURNAL ARTICLE]
- Matern Child Health J 2014 Jul 22.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public nutritional assistance program for low-income women and their children up to age five. This study provides insight into maternal characteristics associated with breastfeeding among urban versus rural women. A secondary analysis was conducted using the Pregnancy Nutrition Surveillance System dataset of women enrolled in the Kansas WIC program in 2011. Geographic residency status was obtained through application of the Census tract-based rural-urban commuting area codes. Descriptive variables included maternal demographics, health, and lifestyle behaviors. A multivariable binary logistic regression was used to obtain adjusted odds ratios with 95 % confidence intervals. The outcome variable was initiation of breastfeeding. A P value of ≤0.05 was considered statistically significant. The total sample size was 17,067 women. Statistically significant differences regarding socio-demographics, program participation, and health behaviors for urban and rural WIC participants were observed. About 74 % of all WIC mothers initiated breastfeeding. Urban women who were Hispanic, aged 18-19, high school graduates, household income >$10,000/year, and started early prenatal care were more likely to breastfeed. Urban and rural women who were non-Hispanic black with some high school education were less likely to breastfeed. Increased breastfeeding initiation rates are the result of a collaborative effort between WIC and community organizations. Availability of prenatal services to rural women is critical in the success of breastfeeding promotion. Findings help inform WIC program administrators and assist in enhancing breastfeeding services to the Kansas WIC population.
- Food Insecurity, Neighborhood Food Access, and Food Assistance in Philadelphia. [JOURNAL ARTICLE]
- J Urban Health 2014 Jul 22.
An estimated 17.6 million American households were food insecure in 2012, meaning they were unable to obtain enough food for an active and healthy life. Programs to augment local access to healthy foods are increasingly widespread, with unclear effects on food security. At the same time, the US government has recently enacted major cuts to federal food assistance programs. In this study, we examined the association between food insecurity (skipping or reducing meal size because of budget), neighborhood food access (self-reported access to fruits and vegetables and quality of grocery stores), and receipt of food assistance using the 2008, 2010, and 2012 waves of the Southeastern Pennsylvania Household Health Survey. Of 11,599 respondents, 16.7 % reported food insecurity; 79.4 % of the food insecure found it easy or very easy to find fruits and vegetables, and 60.6 % reported excellent or good quality neighborhood grocery stores. In our regression models adjusting for individual- and neighborhood-level covariates, compared to those who reported very difficult access to fruits and vegetables, those who reported difficult, easy or very easy access were less likely to report food insecurity (OR 0.62: 95 % CI 0.43-0.90, 0.33: 95 % CI 0.23-0.47, and 0.28: 95 % CI 0.20-0.40). Compared to those who reported poor stores, those who reported fair, good, and excellent quality stores were also less likely to report food insecurity (OR 0.81: 95 % CI 0.60-1.08, 0.58: 95 % CI 0.43-0.78, and 0.43: 95 % CI 0.31-0.59). Compared to individuals not receiving food assistance, those receiving Supplemental Nutrition Assistance Program (SNAP) benefits were significantly more likely to be food insecure (OR 1.36: 95 % CI 1.11-1.67), while those receiving benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (OR 1.17: 95 % CI 0.77-1.78) and those receiving both SNAP and WIC (OR 0.84: 95 % CI 0.61-1.17) did not have significantly different odds of food insecurity. In conclusion, better neighborhood food access is associated with lower risk of food insecurity. However, most food insecure individuals reported good access. Improving diet in communities with high rates of food insecurity likely requires not only improved access but also greater affordability.
- Comparison of Charlson's weighted index of comorbidities with the chronic health score for the prediction of mortality in septic patients. [Journal Article]
- Chin Med J (Engl) 2014 Jul; 127(14):2623-7.
Comorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients. Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS), which is a component of the acute physiology and chronic health evaluation (APACHE) II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of-sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score (APS), sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS. The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WIC, CHS, APACHE II, and SOFA scores than the non-surviving patients (P < 0.05). Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WIC, CHS and APS scores (P < 0.05). The AUC for the hospital mortality were 0.564 (95% confidence interval (CI) 0.496-0.631) of CHS, 0.663 (95% CI 0.599-0.727) of WIC, 0.770 (95% CI 0.718-0.822) of APACHE II, 0.856 (95% CI 0.815-0.897) of the CHS combined with other administrative data, and 0.857 (95% CI 0.817-0.897) of the WIC combined with other administrative data. The diagnostic value of WIC was better than that of CHS (P = 0.0015).The WIC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WIC might be an even better predictor of the mortality of septic patients with comorbidities than CHS.
- Preventing Childhood Obesity: What Are We Doing Right? [JOURNAL ARTICLE]
- Am J Public Health 2014 Jul 17.:e1-e5.
After decades of increases, the prevalence of childhood obesity has declined in the past decade in New York City, as measured in children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and public school students, with the greatest reductions occurring in the youngest children. Possible explanations were changes in demographics; WIC, day care, and school food policies; citywide obesity prevention policies, media messages; and family and community food consumption. Although the decreases cannot be attributed to any one cause, the most plausible explanation is changes in food consumption at home, prompted by media messages and reinforced by school and child care center policy changes. Continued media messages and policy changes are needed to sustain these improvements and extend them to other age groups. (Am J Public Health. Published online ahead of print July 17, 2014: e1-e5. doi:10.2105/AJPH.2014.302015).