Impact of maternal mental health interventions on child-related outcomes in low- and middle-income countries: a systematic review and meta-analysis.

AIMS: Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). METHODS: We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. RESULTS: We identified 21 trials with 28 284 mother-child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13-1.71, ten trials, N = 4749 mother-child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02-0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. CONCLUSIONS: These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems.

PURPOSE: Suicide is a leading cause of death among Nepali women of reproductive age. Suicidal ideation has known associations with stressful life events, which Nepali widows disproportionately experience. We aimed to identify risk and protective factors that could lead to effective interventions for this population. METHODS: To study suicidal ideation in Nepali widows, we collected data from 204 women in urban, semi-urban, and rural areas whose husbands died at least one year prior. The questionnaire included sociodemographic information, the Hopkins Symptom Checklist-25, PTSD Checklist-Civilian Version, Somatic Symptom Scale-8, and the Multidimensional Scale of Perceived Social Support. Overall severity of prolonged grief was assessed by a counselor after completing a structured clinical interview. Using multivariate regression models, we assessed associations of sociodemographic and psychosocial indicators with past-year suicidal ideation. Latent profile analysis was also performed to estimate profiles of comorbidities. RESULTS: Past-year suicidality was high, with 16.2% (N = 33). Each year increase since husband's death was protective and reduced odds of ideation 8% (95% CI 0.85-0.98) and being educated and of older age also reduced the odds of ideation by 0.21 (95% CI 0.06-0.70), and 0.09 (95% CI 0.01-0.64), respectively. Depression (OR = 6.37, 95% CI 2.78-14.59), PTSD (OR = 3.84, 95% CI 2.15-6.86), prolonged grief (OR = 6.04, 95% CI 3.04-12.00) and anxiety (OR = 6.52, 95% CI 2.96-14.38) were highly associated with suicidality, and mapped onto the three profiles of increasing mental distress severity. CONCLUSION: Suicide remains a major issue among Nepali widows, showing high comorbidity with other mental disorders. Screening for depression, anxiety, and prolonged grief, may aid in identifying widows at increased risk of suicidal ideation.

Lessons learned evaluating the baby friendly spaces program for south Sudanese refugees in Gambella, Ethiopia: strengthening research and programmatic partnerships to address maternal and child health and psychosocial needs in humanitarian emergencies.

BACKGROUND: During humanitarian crises, women and children are particularly vulnerable to morbidity and mortality. To address this problem, integrated child health interventions that include support for the well-being of mothers must be adapted and assessed in humanitarian settings. Baby Friendly Spaces (BFS) is a holistic program that aims to improve the health and wellbeing of pregnant and lactating women and their children under two years of age by providing psychosocial support and enhancing positive infant and young child-care practices. Using a mixed-methods, pre-post design, this study explored ways to strengthen the implementation and acceptability of the BFS program, and assess outcomes associated with participation among South Sudanese mothers and their children living in the Nguenyyiel refugee camp in Gambella, Ethiopia. DISCUSSION: A stronger evidence-base for integrated maternal and child health interventions, like BFS, in humanitarian emergencies is needed, but effectively conducting this type of research in unstable settings means encountering and working through myriad challenges. In this paper we discuss lessons learned while implementing this study, including, challenges related to ongoing local political and tribal conflicts and extreme conditions; implementation of a new digital data monitoring system; staff capacity building and turnover; and measurement were encountered. Strategies to mitigate such challenges included hiring and training new staff members. Regular weekly skype calls were held between Action Against Hunger Paris headquarters, the Action Against Hunger team in Gambella and Johns Hopkins' academic partners to follow study implementation progress and troubleshoot any emerging issues. Staff capacity building strategies included holding brief and focused trainings continuously throughout the study for both new and current staff members. Lastly, we engaged local Nuer staff members to help ensure study measures and interview questions were understandable among study participants. CONCLUSIONS: Research focused on strengthening program implementation is critically important for improving maternal and child health in humanitarian emergencies. Research in such settings demands critical problem-solving skills, strong supervision systems, flexibility in timeline and logistics, and tailor-made training for program and research staff members and context- adapted strategies for retaining existing staff.

A novel method of intravascular temperature modulation to treat severe hypothermia.

Intravascular rewarming may provide an efficient and reliable method of restoring normal body core temperature in patients, while avoiding after-drop. The system provides continuous temperature monitoring and automatically adjusts warm saline delivery until the desired temperature is reached.

Managing inotrope therapy noninvasively.

Intermittent and continuous outpatient and home inotrope infusions have contributed to a decreased mortality rate and improved quality of life in the patient with end-stage congestive heat failure. Before the advent of noninvasive hemodynamic monitoring, available with thoracic electrical bioimpedance, initial dosage and titration were determined solely with invasively acquired data requiring hospital admission or with patients' subjective data. Thoracic electrical bioimpedance monitoring of patients receiving inotrope therapy provides objective documentation of drug efficacy, developing tolerance, and optimal dosage.

The view within: the emerging technology of thoracic electrical bioimpedance.

With the increasing incidence of catheter-related sepsis and recognition of increased mortality and cost of care with pulmonary artery catheters, the need for a safe, cost-effective, and clinically accurate means of obtaining hemodynamic data has become evident. Through the technology of thoracic electrical bioimpedance (TEB), non-invasive hemodynamic monitoring is now possible with the BioZ.com, manufactured by CardioDynamics International Corporation. The BioZ.com provides continuous hemodynamic readings safely, accurately, and inexpensively. TEB is proving to be a valuable adjunct to patient assessment and treatment across multiple health care settings.

The effect of a nurse-managed CHF clinic on patient readmission and length of stay.

Hospital readmission for exacerbation of symptoms of Congestive Heart Failure (CHF) is a major home healthcare problem and expense. To address this problem and curb the increasing expense and patient lifestyle disruption, a group of staff nurses at the Medical University of South Carolina Medical Center developed a nurse-managed clinic to follow all patients with CHF after discharge. Within 6 months of the clinic's operation, readmissions of these patients decreased by 4%, and the length of stay decreased by 1.6 days.

Nursing grand rounds: Wolff-Parkinson-White syndrome: a challenging case study.

Wolff-Parkinson-White (WPW) syndrome involves connections of myocardial fibers between the atrium and ventricle that can carry electrical impulses outside of the normal conduction system. Treatment options include pharmacologic management, surgical interruption, antitachycardia devices, or transvenous catheter ablation. This is a case study of a patient who underwent surgical ablation of an accessory pathway and reoperation because of continued abnormal conduction. She had tachypalpitations after both procedures and later underwent radiofrequency ablation. Nursing care was complicated because she spoke very little English and was extremely anxious about her illness.

Strategies for organizational change in home healthcare.

There has been an unprecedented increase in the use of home healthcare services in the past decade. Opportunities for the professional advancement of nurses and a decrease of healthcare costs abound with the growth of home healthcare, if home health services are managed wisely. A proactive approach to organizational change embracing four paradigms of organizational functioning will enable the nurse administrator involved in home healthcare to adequately confront the demands of the future.

Government documents and the online catalog.

Prior to planning for implementing the NOTIS system, the Vanderbilt Medical Center Library had not fully cataloged its government publications, and records for these materials were not in machine-readable format. A decision was made that patrons should need to look in only one place for all library materials, including the Health and Human Services Department publications received each year from the central library's Government Documents Unit. Beginning in 1985, these publications were added to the library's database, and the entire 7,200-piece collection is now in the online catalog. Working with these publications has taught the library much about the advantages and disadvantages of cataloging government documents in an online environment. It was found that OCLC cataloging copy is eventually available for most titles, although only about 10% of the records have MeSH headings. Staff time is the major expenditure; problems are caused by documents' irregular nature, frequent format changes, and difficult authority work. Since their addition to the online catalog, documents are used more and the library has better control.