Tuesday, July 08, 2014

Prevention: Home Visiting Programs Reduce Preventable Deaths

MedicalResearch.com reports good news on prevention from David Olds!

Home visiting programs make a difference.  Have one in your community?

If not, the Children's Alliance may be able to help:
Nurse Visitation During Pregnancy and Infancy Reduced Maternal and Child Mortality
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MedicalResearch.com Interview with: David Olds, Ph.D. Professor of Pediatrics and Director Prevention Research Center for Family and Child Health University of Colorado Department of Pediatrics Aurora, Colorado   80045MedicalResearch.com Interview with: David Olds, Ph.D. Professor of Pediatrics and Director
Prevention Research Center for Family and Child Health
University of Colorado Department of Pediatrics

Medical Research: What are the main findings of the study?Dr. Olds: We’ve conducted a randomized controlled trial of a program of nurse home visiting for low-income women with no previous live firths during pregnancy and the first two years of the child’s life, with randomization of participants beginning in 1990.
In our most recent follow-up of mothers and children in Memphis, those who received nurse-visitation were less likely to have died over a 2-decade period following the child’s birth than those in the control group.  Death among mothers and children in these age ranges in the US is rare and extraordinarily important for what it tells us about the health of the population studied in this trial.
For children, the reduction in death was present for preventable causes, that is, sudden infant death syndrome, injuries, and homicide.  All of the child deaths for preventable causes were in the control group, for whom the rate was 1.6%.  None of the nurse-visited children died of preventable causes.
The reductions in maternal mortality were found for two nurse-visited groups combined for this report: one received prenatal and newborn visitation and a second received visitation during pregnancy and through child age two.  Overall, mothers assigned to the control group were nearly 3 times more likely to die than those assigned to the two nurse-visited conditions.  The relative reduction in maternal mortality was particularly pronounced for deaths linked to maternal behaviors — suicide, drug overdose, injuries, and homicide; for these external causes of death, 1.7% of the mothers in the control group had died, compared to 0.2% of those visited by nurses.
Medical Research: Were any of the findings unexpected? Dr. Olds: All of these findings were unexpected as we thought that the rates of maternal and child mortality for women and children in these age ranges would be too infrequently occurring to discern program effects.
Medical Research: What should clinicians and patients take away from your report?Dr. Olds: Nurse visitation during pregnancy and the early years of the child’s life among low-income mothers with no previous live births is a promising means of improving maternal and child health and reducing maternal and child mortality.
Medical Research: What recommendations do you have for future research as a result of this study?Dr. Olds: These findings need to be replicated with other highly disadvantaged low-income families.
Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. Published online July 07, 2014. doi:10.1001/jamapediatrics.2014.472. 
And more from HealthDay.com
Home Nurse Visits May Improve Survival of Moms, Babies
Deaths were far more common when poor women did not receive follow-up care, study findsHome Nurse Visits May Improve Survival of Moms, BabiesBy HealthDay ReporterMONDAY, July 7, 2014 (HealthDay News) -- Home visits from nurses during pregnancy and a child's first two years help improve survival odds for both mothers and children, according to new research.
The study followed more than 1,100 mother-child pairs from disadvantaged, urban neighborhoods in Memphis, Tenn., for two decades. Poor women have much higher death rates than wealthier women, according to background research in the study. And their children are more likely to die from accidents, homicide and sudden infant death syndrome, research has shown.
"Often these are mothers living on the margins of society," said study researcher David Olds, professor of pediatrics at the University of Colorado, Aurora. "And we now know if we reach out to them and engage them, we can make a big difference in the health and development of the mothers and the children, including their survival.''
The study, published online July 7 in JAMA Pediatrics, began in 1990. Researchers assigned the first-time mothers-to-be to one of four treatment groups.
One group received only transportation for prenatal care. Another received transportation plus screening for infants and toddlers to evaluate their development. A third group received transportation plus home visits. A fourth group received all the services.
Mothers without home visits were about three times as likely to die during the follow-up period as the moms who got nurse visits, Olds found. About 3.7 percent of those who weren't visited died compared to 1.3 percent of those who received all the services, including visits by nurses.
The children benefited as well. By age 20, those whose mothers received all of the services were still alive while 1.6 percent of kids whose moms got only transportation and screening had died, the study found.
The results didn't surprise Dr. David Mendez, an attending neonatologist at Miami Children's Hospital in Florida.
"Sometimes an extra pair of hands, an extra pair of eyes to see what's going on in the household with a new baby can be important," said Mendez, who was not involved in the study.
"Nurses perhaps take a role similar to what a good grandmother does," he said. "They are able to give the mother cues as to when the babies aren't doing so well [and may need medical help]."
The program -- known as the Nurse-Family Partnership -- operates in about 500 sites, Olds said. "The schedule calls for nurses to visit about once every two weeks during pregnancy and once a week for the first six weeks after delivery and then essentially every other week until the baby is 2 years," Olds said.
In this study, nurses completed about half of those visits, he said. In some cases, the get-togethers were difficult to schedule because some of the mothers became homeless and were hard to reach, he said.
While visiting, nurses discuss how to have a healthy pregnancy and how to be attentive to a child's needs, among other topics. On average, the publicly funded program costs about $9,000 per family over the 2.5 years of enrollment, Olds said.
According to one analysis, the return in savings from unneeded hospitalization and other health care services is about $5.70 for every dollar spent, he said.

The program is funded in various ways, he said. Some women have been covered under the Affordable Care Act. Others are supported by various state funds, he said.
The link between the at-home visits and improved survival is very strong, Olds said, although he can't say with certainty it is a cause-and-effect relationship.
However, "in this study, within the limits of statistical probability, we can say with 95 percent confidence that the mothers and children visited by nurses were less likely to die," he said. "That is almost as good as it gets."
More informationTo learn more about the prenatal period, visit the American Academy of Pediatrics.
SOURCES: David Olds, Ph.D., professor, pediatrics, University of Colorado, Aurora, Colo.; David Mendez, M.D., attending neonatologist, Miami Children's Hospital, Miami, Fla.; July 7, 2014 online JAMA Pediatrics