Innovating Maternal and Child Health: Incentive Prizes to Improve Early Childhood Development.

PURPOSE: Protecting and advancing maternal and child health is a critical goal to both society and to the economy, given that their health is a predictor of the next generation's health. Yet despite this recognition, many of the communities aiming to improve maternal and child health still problem-solve in silos: age silos, disease silos, organizational silos, disciplinary silos, data silos, and communication silos, often created or exacerbated by the disconnected approaches to research, funding, and reporting. These silos limit discovery and spread of new solutions to important maternal and child health problems. DESCRIPTION: In this paper, we will discuss federal incentive prizes as a tool to break down silos and to engineer cognitive diversity and transdisciplinary collaboration. ASSESSMENT: In 2018, the United States Health Resources and Services Administration, Maternal and Child Health Bureau (HRSA MCHB) launched the "Maternal and Child Health Bureau Grand Challenges," a suite of four prize competitions totaling $1.5 million addressing critical issues in maternal and child health. These included federal challenges designed to (1) prevent childhood obesity in low-income communities, (2) improve the remote monitoring of pregnancy, (3) improve care coordination and planning for children with special health care needs, and (4) prevent opioid misuse among pregnant women and new mothers. CONCLUSION: The ability to incentivize innovation to address critical public health issues cannot rest in the private sector alone. Complementing other investments, the Challenge mechanism's power to catalyze the rapid development of innovative solutions can improve how we address barriers to achieve optimal maternal and child health for the families that we serve.

Advancing Social Mission in Nursing Education: Recommendations From an Expert Advisory Board.

BACKGROUND: Social mission refers to a set of concepts and perspectives that promote health equity in health care delivery and within health professions. Little is known about social mission within the context of nursing education. This article clarifies the role of social mission in nursing education, offers current applications, and identifies future opportunities to maximize social mission within nursing to foster a more just culture of health. METHOD: A multidisciplinary advisory board of experts in nursing education convened to review pertinent literature, current case exemplars, and craft a conceptual framework of social mission in nursing education. RESULTS: The resulting framework consisted of three action-oriented domains to implement social mission into nursing education: board accreditation, curriculum building and faculty training, and developing institutional culture. CONCLUSION: Successful implementation of social mission into nursing education, and subsequently the nursing workforce, offers the opportunity to further embed equity into health care. [J Nurs Educ. 2020;59(8):433-438.].

Háblame Bebé: A phone application intervention to support Hispanic children's early language environments and bilingualism.

The early language environments of low-income Hispanic children can be negatively affected when their Spanish-speaking caregivers face racism, assimilation pressure, and/or misinformed advice based on English-only ideologies. This article reports on the design and efficacy of Háblame Bebé, a language-promoting phone application that encourages low-income Hispanic mothers to talk more to their children in their native Spanish with the goals of (1) improving their children's early language environment, (2) promoting bilingualism, and (3) monitoring developmental milestones. The app was designed and tested across three phases as mandated by the US HRSA Bridging the Word Gap Challenge. In Phase I, we developed a curriculum that promotes high-quality language interactions in Spanish and designed the app components. In Phase II, we tested the app with 20 Hispanic mothers (half high school-educated, half college-educated) in a pretest-posttest design in which we examined their language interactions before and after two months of using the app. Preliminary results indicated that mother-child verbal interactions increased, but not always in their native Spanish, and the difference was not statistically significant. Focus group data revealed that many of the mothers had experienced linguistic racism and that tropes surrounding Spanish-speaking identity in the USA needed to be explicitly addressed within the intervention. In Phase III, a sociolinguistic pride component was added and the app was again tested with 12 additional Hispanic mothers (all high school-educated only). This time, a statistically significant increase in mother-child verbal interactions was found. Mothers also reported feeling prouder to use Spanish with their children. These results suggest that Háblame Bebé may be a viable means to reach low-income Hispanic caregivers who face obstacles in accessing health information and/or home-visiting programs for their children.

Home environment, brain injury, & school performance in LBW survivors.

BACKGROUND: There has been substantial research on low birthweight (LBW) as a predictor of adverse educational and cognitive outcomes. LBW infants perform worse on cognitive battery tests compared to children born at normal birthweight; however, children exposed to similar risks do not all share the same experiences. The complex, interrelated factors responsible for poor cognitive and achievement performance vary for different populations, but researchers hypothesize that the home environment may influence the infants' long-term health outcomes. PURPOSE: Examine the home environment as a moderator in the causal pathway from neonatal brain injury to school performance in a secondary analysis of a prospectively studied, geographically defined cohort from the Neonatal Brain Hemorrhage Study. METHOD: The secondary analysis sample included 543 infants with birthweights of 501 to 2,000 g who were born consecutively in three community hospitals in New Jersey between 1984 and 1986. School performance at age 9 was measured by the Woodcock-Johnson Tests of Achievement. The home environment variables were tested and analyzed using multistep hierarchical regression modeling. RESULTS: A moderating effect between the variable neighborhood observations and brain injury was demonstrated for the outcome math score. The moderating relationship was found in the category of children without brain injury (ß = 1.76, p = .005). CONCLUSION: There were statistically significant and potentially clinical meaningful models when looking at the home environmental variables as they relate to reading and math scores. The findings suggest that at least one variable within a LBW child's socio-environmental milieu can moderate the effects of perinatal brain injury on school performance outcomes.

Respiratory disorders in moderately preterm, late preterm, and early term infants.

Even when it is just a few weeks before term gestation, early birth has consequences, resulting in higher morbidity and mortality. Respiratory issues related to moderate prematurity include delayed neonatal transition to air breathing, respiratory distress resulting from delayed fluid clearance (transient tachypnea of the newborn), surfactant deficiency (respiratory distress syndrome), and pulmonary hypertension. Management approaches emphasize appropriate respiratory support to facilitate respiratory transition and minimize iatrogenic injury. Studies are needed to determine the impact of respiratory distress coupled with mild-moderate prematurity on long-term outcome.

Autism spectrum disorders and prematurity: a review across gestational age subgroups.

Autism spectrum disorders (ASDs) are increasingly recognized as a public health problem. According to the Centers for Disease Control and Prevention, the prevalence for ASD is now 1 in 88. The prevalence of ASDs in children has increased over the past 2 decades, nearly doubling the prevalence since the Centers for Disease Control and Prevention began tracking these numbers. Infants are defined as premature when birth takes place before 37 weeks' gestation (259 days from the first day of the mother's last menstrual period). More than 4 million live births occur in the United States each year. Preterm births account for approximately half a million of those births. The rate of premature birth has increased by more than 20% between 1990 and 2006. Cognitive impairment and atypical brain development are thought to be sequelae of preterm delivery. Low birth weight and preterm birth place these infants at higher risk for disturbances in social interaction, communication, and other psychoaffective disorders in adulthood. Major advances in the field of early autism detection include validated screening tools to facilitate early screening for children with ASD as well as those considered to be at high risk for the disorder. Given the significant maternal and neonatal morbidities that are often coupled with prematurity, understanding the prevalence and risk factors that are implicated in changes in the fetal brain may provide researchers with vital links to autism in this population.

Perinatal brain injury, visual motor function and poor school outcome of regional low birth weight survivors at age nine.

AIMS AND OBJECTIVES: To explore the relationship between perinatal brain injury, visual motor function (VMF) and poor school outcome. BACKGROUND: Little is known about the status and underlying mechanism of poor school outcome as experienced by low birth weight survivors. DESIGN: This is a secondary data analysis. METHODS: The parental study recruited 1104 low birth weight (LBW) infants weighing ≤ 2000 g from three medical centres of Central New Jersey between 1984 and 1987. Seven hundred and seventy-seven infants survived the neonatal period, and their developmental outcomes had been following up regularly until now. The development data of the survivors were used to achieve the research aims. Initial school outcome assessment was carried out in 9-year-old, using the Woodcock-Johnson Academic Achievement Scale. The severity and range of perinatal brain injury was determined by repeated neonatal cranial ultrasound results obtained at 4 hours, 24 hours and 7 days of life. RESULTS: Seventeen and a half per cent of the sample experienced poor school performance at age 9 as defined by lower than one standard deviation (SD) of average performance score. Children with the most severe injury, PL/VE, had the lowest mathematics (F = 14·54, p = 0·000) and reading (anova results: F = 11·56, p = 0·000) performances. Visual motor function had a significant effect on children's overall school performance (Hotelling's trace value was 0·028, F = 3·414, p = 0·018), as well as subtest scores for reading (p = 0·006) and mathematics (p = 0·036). However, visual motor function was not a mediator in the association of perinatal brain injury and school outcome. CONCLUSIONS: Perinatal brain injury had a significant long-term effect on school outcome. RELEVANCE TO CLINICAL PRACTICE: Low birth weight infants with history of perinatal brain injury need be closely monitored to substantially reduce the rates of poor school outcome and other neurodevelopmental disabilities.