The role of maternal and child healthcare providers in identifying and supporting perinatal mental health disorders.

BACKGROUND: Perinatal depression (PND) is underdiagnosed in the clinical setting. This study explores the role of obstetricians, and other primary care providers of maternal and child healthcare in detecting, screening, and referring women during the perinatal period identified as depressed, anxious, or exhibiting other symptoms of mental health disorders. METHOD: Information was gathered from obstetricians (n = 16), and other primary care providers (pediatricians, nurse practitioners, physician assistants) (n = 85), on identifying and supporting childbearing women with symptoms of perinatal depression using an online survey. RESULTS: Statistical comparisons across participant groups were adjusted for years of practice in the profession. Statistically significant differences were noted. Obstetricians inquired more about the mother's social support network (p = .011) and addressed mothers that appeared sad, upset, or unhappy (p = .044) compared to other primary care providers. Other primary care providers were more likely to refer patients to mental health support services (p = .005), provide PND-related information in their waiting rooms (p = .008), and use the Edinburgh Postnatal Depression Scale (EPDS) (p = .027). There was also a significant difference in positively identifying eight symptoms of PND between provider groups. Obstetricians had higher rates of identifying the following symptoms: excessive crying (p < .001), feeling little or no attachment to the infant (p < .001), little feeling of enjoyment (p = .021), feelings of failure (p < .001), hopelessness (p < .001), agitation with self and infant (p < .001), fear of being alone with the infant (p = .011), and fear that these symptoms would last (p < .001). CONCLUSION: Although certain screening practices were performed well, especially by the obstetrician group, screening deficits were noted within each group, and screening practices differed between groups. Training offered to maternal child health primary care providers on addressing perinatal mental health disorders may help improve provider screening practices and detection of PND symptoms in perinatal women. PND screening that combines face-to-face open-ended interviews with standardized screening tools can enhance patient-provider communication, potentially improving PND detection rates and follow-up care in perinatal women.

Exploring Factors Linked to Weight Status in Salvadoran Infants.

INTRODUCTION: Potential risk factors of infant overweight/obesity in Salvadoran mother-infant dyads (N = 88) at routine 9- to 12-month wellbaby visits were examined in a correlational study at two pediatric offices on Long Island, New York. METHOD: Maternal factors and infant feeding practices in the first 5 months were self-reported; infant birth weight, current weight/recumbent length were obtained. Bivariate logistic regression measured the relationship of the variables with infant weight status >85th percentile weight-for-length (WFL) for sex. RESULTS: The majority of mothers were born in El Salvador, with a mean age of 28.5 years (SD = 5.9); 43% of infants had WFL >85th percentile. Infant birth weight was significantly associated with WFL >85th percentile, p = .0007. After controlling for maternal age, insurance type, education, and marital status, no significant associations with infant WFL >85th percentile were found. Feeding practices during infants' first 5 months, mothers' pre-pregnancy weight, pregnancy weight gain, and history of gestational diabetes mellitus, were not associated with infant weight status. CONCLUSION: This was the first study to examine infant weight status in Salvadorans. Future studies should objectively measure infant feeding practices and other potential factors among Salvadoran mother infant dyads, since nearly half of the infants had WFL >85th percentile.

Applying Ecological Frameworks in Obesity Intervention Studies in Hispanic/Latino Youth:: A Systematic Review.

INTRODUCTION: In the United States, Hispanic children have higher rates of obesity compared with non-Hispanic White children. An ecological framework provides a holistic view of the environment to which Hispanic/Latino children are exposed that can potentially inform prevention and treatment initiatives for this vulnerable population. METHOD: This systematic review examines the existing evidence on the use of an ecological framework in intervention studies targeting overweight and obesity in Hispanic youth from birth to 8 years. Key terms guided the search of PubMed, Google Scholar, CINAHL, and EBSCOhost databases from 1997 to 2016. Results were organized using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method. RESULTS: Seven studies met the inclusion and exclusion criteria. Significant improvements in body mass index z scores in treatment children were evident in five of the seven studies. Increases in fruit, water, and vegetable consumption and physical activity levels were reported in four of the seven studies. CONCLUSION: Multilevel interventions targeting a child's home and community suggest efficacy in reducing or preventing obesity; increasing fruit, water, and vegetable consumption; and increasing physical activity in overweight/obese young Hispanic children. Future research is needed to explore the sustainability of multilevel obesity prevention interventions in this vulnerable population.