Psychometric Testing of the Caregiver Attitudes on Substance Use in Pregnancy Instrument.

OBJECTIVE: To modify an existing instrument used to measure the attitudes of perinatal nursing caregivers about pregnant women with substance use disorder (SUD) and to psychometrically test the new instrument: Caregiver Attitudes on Substance Use in Pregnancy (CASUD-OB). DESIGN: Instrument modification and psychometric testing of results from a modified instrument. SETTING: Multi-hospital health care system in the midwestern United States. PARTICIPANTS: A total of 147 perinatal nursing caregivers (perinatal nurses: n = 131; unlicensed assistive personnel: n = 16) who worked on obstetric and neonatal nursing units. METHODS: We modified the existing instrument, and 12 experts in perinatal nursing (1 who also had expertise in SUD in the perinatal period) evaluated the items for content validity. We administered the CASUD-OB via online survey between November 2019 and December 2019. We used item reduction, calculated item-total correlations, and conducted exploratory factor analysis to modify the instrument and assessed its internal consistency. RESULTS: After psychometric testing, we reduced the number of items from 26 to 16. Through item reduction and exploratory factor analysis, we identified three subscales (Caregiver Bias, Caregiver Self-Awareness, and Caregiver Perception of Parental Fitness). The Cronbach's alpha for the overall instrument was .92. CONCLUSION: This study provides preliminary evidence to suggest that the CASUD-OB may be a valid and reliable instrument for measuring nurses' attitudes toward pregnant women with SUD. Through additional testing, this instrument has the potential to become a valuable resource to evaluate quality improvement initiatives, staff education programs, and other interventions designed to transform the attitudes of nursing caregivers toward pregnant women with SUD.

Intraoperative Mother and Baby Skin-to-Skin Contact during Cesarean Birth: Systematic Review.

PURPOSE: Experts recommend immediate skin-to-skin (SSC) contact for all alert and stable mothers and newborns after birth. Clinicians are working to incorporate immediate (intraoperative) SSC during cesarean birth. The purpose of this systematic review is to describe the state of the science of intraoperative SSC for mother and baby and increase clinician's awareness of its potential benefits and risks. STUDY DESIGN AND METHODS: A systematic approach was followed throughout the review process. CINAHL, PubMed, and Embase databases were searched using strategies constructed by an academic health sciences librarian. Articles included in the review focused on SSC initiated during cesarean birth. RESULTS: Thirteen studies were selected for the mixed-method systematic review. Six prospective studies, four retrospective chart reviews, and three qualitative studies met the inclusion criteria. Maternal stress levels were reduced, whereas comfort, oxytocin, and antioxidant levels increased with intraoperative SSC. Physiologic measures of successful newborn transition showed little difference between newborns held in intraoperative SSC and those who were not. Synthesis of qualitative experiences revealed mothers' intense desire to hold and know their baby immediately after birth. CLINICAL IMPLICATIONS: Intraoperative SSC is a safe, beneficial, and highly desirable practice for mothers and newborns experiencing cesarean birth. Although barriers exist to its implementation, nurses can facilitate and support this practice. Evidence-based, family-centered intraoperative SSC should be offered to all stable mothers and babies according to recommendations and in a manner that promotes safe outcomes, including following current nurse staffing guidelines.

Biobehavioral Factors in Child Health Outcomes: The Roles of Maternal Stress, Maternal-Child Engagement, Salivary Cortisol, and Salivary Testosterone.

BACKGROUND: Exposure to high levels of maternal stress and ineffective maternal-child engagement (MC-E) may adversely affect child health-related outcomes. OBJECTIVE: The aim of this study was to examine the impact of maternal stress and MC-E on maternal and child biological responses (salivary cortisol and testosterone) and child health outcome in mother-child dyads of preschool children (3-5.9 years) in a low socioeconomic setting. METHODS: Observational and biobehavioral data were collected from 50 mother-child dyads in a preschool setting. Assessments included maternal stress with the Perceived Stress Scale, child health outcomes with the Pediatric Quality of Life Inventory, and MC-E with videotaped mother-child interactions and scored with the Keys to Interactive Parenting Scale. Morning and evening saliva samples were collected from mother and child for biological assays. RESULTS: Maternal stress was negatively correlated with MC-E (r = -.32, p < .05) and child health outcome (r = -.33, p < .05). Lower levels of MC-E predicted higher morning cortisol (p = .02) and higher morning and bedtime testosterone levels in children (p = .03 and p = .04, respectively). Child biological responses did not predict child health outcome. DISCUSSION: Maternal stress and MC-E during mother-child interactions play a significant role in the regulation of child stress physiology and child health outcome. Elevated cortisol and testosterone related to high maternal stress and low MC-E may increase the child's vulnerability to negative health outcomes-if sustained. More biobehavioral research is needed to understand how parent-child interactions affect child development and health outcomes in early childhood.

Social Support and Cognition: Early Childhood Versus Older Adulthood.

Cognitive development in early childhood and cognitive preservation in older adulthood are critical for leading healthy life. Social engagement can significantly affect cognition, but their relationships are unclear. The purpose of this review was to synthesize current findings on the relationship between social engagement and cognition in early childhood and older adulthood. PubMed, Web of Science, Ovid Medline, and PsycINFO were searched for studies published in 1995-2015 for a comprehensive review. Included in this review were 42 articles written in English, published in peer-reviewed journals with participants' age being 2 to 6 or ≥65 years, and measurement of social engagement and cognition. Overall, greater social engagement was associated with higher levels of cognition across the life span, association of which seemed more prominent in populations at risk of cognitive impairment. Additional research is needed to elucidate biobehavioral mechanisms underlying these relationships and to test the efficacy of new interventions.