Caring relationships: an investment in health?

Although the US has created the most expensive, technologically advanced medical system in the world, health outcomes are not commensurate with investment. The author argues that providers and policy makers have neglected the effect of human relationships on health, citing research showing that better relationships lead to better health. The author concludes with recommendations for improving public health by supporting society's investments in social capital.

Is community important for health?: examining the biopsychosocial interface.

The United States has created the most expensive, technologically advanced medical system in the world. Health outcomes, however, fail to achieve results commensurate with investment. After identifying the scope of population health concerns untreated by the current U.S. healthcare system, an explanatory model suggests that the relational basis of health and adaptation has been neglected by providers and policymakers. Finding root sources of health in the strength of relationships between individuals and within communities, recommendations are made for applying an integrated model of personal, community, and national health.

Perinatal outcome and the social contract--interrelationships between health and humanity.

Rates of infant mortality and prematurity or low birth weight serve as indirect measures of the health of a nation. This paper presents current population data documenting the still serious problem of perinatal outcome in the United States as well as in other economically developed countries. International comparisons suggest that nations with the greatest inequality of income and social opportunity also have the most adverse perinatal, child, and adult health outcomes. Furthermore, the data assert that these effects are independent of average national wealth or gross national economic productivity. Health status differs by social class and race, even among the most affluent sectors of the population. All social classes, even the wealthiest, suffer the health consequences of social inequalities. An explanatory sociopsychologic theory of causality is proposed.

Perinatal outcome and the social contract: interrelationships between health and society.

Rates of infant mortality and prematurity or low birthweight serve as indirect measures of the health of a nation. This paper presents current population data documenting the still serious problem of perinatal outcome in the USA as well as in other economically developed countries. International comparisons suggest that nations which have the greatest inequality of income and social opportunity also have the most adverse perinatal, child and adult health outcomes. Furthermore, the data assert that these effects are independent of average national wealth or gross national economic productivity. Health status differs by social class and race, even among the most affluent sectors of the population. All social classes, even the wealthiest, suffer the health consequences of social inequalities. An explanatory socio-psychological theory of causality is proposed.

Health-care professionals' attitudes toward the current level and need for developmental services in neonatal intensive care units.

For this descriptive study a survey was constructed to determine neonatal intensive care unit (NICU) health-care staff's perceptions of the present level of and need for developmental services in NICUs. In 14 level III NICUs throughout the state of Illinois, 530 multidisciplinary team members responded. NICU staff described the current and ideal roles of the developmental specialist (DS) in their NICU. In addition, using a 5-point scale, the staff rated six categories of 46 specific developmental protocols that might be incorporated into their current daily care routine. These categories included individualized supportive care, direct caregiving procedures, parent participation, environmental modification, stimulation, and positioning. Then the value of these same protocols in an ideal NICU program were rated. The results indicate that 86% of the staff perceive a need for a DS. Within each of the six categories significantly more developmental interventions were rated ideal, compared with the number of such interventions currently practiced. Individualized supportive care was rated as the most important category, and stimulation was rated as the least useful. Overall, neonatal health care professionals support the implementation of developmental services in the NICU.

Developmental intervention during neonatal hospitalization. Critiquing the state of the science.

Recent investigations, such as those discussed, focus attention on the need for additional studies that explore the emerging neuroregulatory mechanisms in premature infants. Data from these investigations may augment current high standards of neonatal medical care that now focus on treating the heart, lungs, and digestive systems. The various studies of early developmental processes encourage clinicians to recognize and treat premature infants as individuals, a principle acknowledged long ago about full-term infants and parents. Through understanding the critical role of parents in guiding the continued health and development of infants after hospital discharge, hospital staff are exploring methods for helping parents feel involved, respected, and supported as primary caregivers. Similarly, staff are reacting to the growing realization that optimal developmental outcome requires close coordination between hospital and community services for infants and families. Continued attention to the developmental needs of hospitalized infants and their parents, along with further integration of medical, developmental, and emotional care, will surely succeed in bringing early hope to the fragile beginning of life after high-risk birth.

Promoting infant development during neonatal hospitalization: critiquing the state of the science.

Contemporary neonatal intensive care units treat infants with very different medical conditions from those of a decade ago. Approaches to ensuring optimal outcome following high-risk birth must reflect the changing conditions and needs of these infants. This paper will review the cause and nature of change in infant status and attempt to reconcile the increasing demand for supporting stages of neuromaturation and social-emotional development during hospitalization with our current limited understanding of how fragile infants process and respond to interventions. Special cautions will be directed to well-meaning caregivers who may unwittingly jeopardize infant health and development by implementing new clinical models without empirical support. Opportunities for integrating psychosocial and medical care of these infants will also be highlighted.

Handling preterm infants in hospitals. Stimulating controversy about timing of stimulation.

The authors' research draws from a primary concern for the effects of the animate and inanimate caregiving environment on brain growth and central nervous system organization in hospitalized preterm infants. The current report presents data on physiologic trends in preterm infant heart rate and oxygenation as related to the timing and content of caregiver stimulation, specifically medical and social forms of touch. Results indicate that while most instances of bradycardia were not closely preceded by tactile stimulation, prebradycardia periods, which included touch, had lower pO2 levels than did baseline periods that included touch. These findings suggest that medical or "developmental" tactile stimulation presented when the infant was already physiologically compromised (with low pO2) may potentiate an underlying vulnerability to bradycardia. Timing, versus type, may be the better predictor of the physiologic effect of caregiver interventions on preterm infants.

Advances in neonatal and infant behavioral assessment: toward a comprehensive evaluation of early patterns of development.

Recognizing the impressive range of behavioral capacities of newborn infants, clinicians and researchers have long searched for valid assessment instruments to help evaluate infant behavior. Behavioral assessments with high predictive validity would aid the goals of developmental diagnostic, prognostic, and treatment programs for infants born at risk from biological or environmental circumstances. The failure of current assessments to predict developmental outcome based on infant behavior may be due to the limited information about higher central nervous system (CNS) functioning obtained from available measures, or to the very dynamic nature of CNS organization in young infants. We begin our review by discussing some major functional characteristics of neonates and then proceed to describe critically the commonly used methods of neurological and behavioral assessment. Noting the need for measures that are more predictive, we turn next to a discussion of a number of experimental techniques that seem to hold great promise for developmental prediction and clinical application.

Direct computer recording of premature infants and nursery care: distress following two interventions.

Prematurely born neonates are born with an immature central nervous system. Temporal associates between care-giver interventions and infant biobehavioral responses can be recorded. A new methodology for continuous naturalistic computer-assisted recording of infants in nursery care is described. To illustrate a clinical implication of this recording, an infant's responses to two seemingly contrasted care-giver interventions were analyzed: chest physical therapy and close social interaction. There was significantly increased subtle as well as gross behavioral and physiologic distress following both chest physical therapy and close social interaction when compared with base line distress incidence. Perhaps timing of interventions is as consequential as their content toward safeguarding a preterm infant's developing autonomic regulation, motor patterns, and sleep/wake state.