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Ginsberg KH, Serlachius A, Rogers J, Alsweiler J. Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey. J Pediatr 2023; 259:113456. [PMID: 37172808 DOI: 10.1016/j.jpeds.2023.113456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand. STUDY DESIGN A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices. RESULTS Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents. CONCLUSIONS Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.
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Affiliation(s)
| | - Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Jen Rogers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jane Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
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Edmonds LK, Cram F, Bennett M, Lambert C, Adcock A, Stevenson K, Geller S, MacDonald EJ, Bennett T, Storey F, Gibson-Helm M, Ropitini S, Taylor B, Bell V, Hoskin C, Lawton B. Hapū Ora (pregnancy wellness): Māori research responses from conception, through pregnancy and ‘the first 1000 days’ – a call to action for us all. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2075401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Liza K. Edmonds
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, Aotearoa New Zealand
- Department of Women’s and Children’s, Otago School of Medicine, University of Otago, Dunedin, Aotearoa New Zealand
| | - Fiona Cram
- Katoa Limited, Auckland, Aotearoa New Zealand
| | - Matthew Bennett
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Charlie Lambert
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Anna Adcock
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Kendall Stevenson
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Stacie Geller
- Department of Obstetrics and Gynaecology, University of Illinois, Chicago, IL, USA
| | - Evelyn Jane MacDonald
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Tina Bennett
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Francesca Storey
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Melanie Gibson-Helm
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Sidney Ropitini
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Brittany Taylor
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Victoria Bell
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Caitlin Hoskin
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
| | - Beverly Lawton
- Te Tātai Hauora o Hine, National Centre for Women’s Health Research Aotearoa, Te Herenga Waka Victoria University of Wellington, Aotearoa New Zealand
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Edmonds LK, Sibanda N, Geller S, Cram F, Robson B, Filoche S, Storey F, Gibson-Helm M, Lawton B. He Tamariki Kokoti Tau: Tackling preterm incidence and outcomes of preterm births by ethnicity in Aotearoa New Zealand 2010-2014. Int J Gynaecol Obstet 2021; 155:239-246. [PMID: 34355389 DOI: 10.1002/ijgo.13855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore preterm birth among Māori indigenous peoples through Kaupapa Māori research of preterm birth in Aotearoa New Zealand. METHODS Linked maternity, mortality, and hospital data were analyzed for women and their infants born between January 1, 2010 and December 31, 2014. Relative risks (RR) were calculated for each ethnic group for preterm birth, small for gestational age (SGA), and mortality. RESULTS Adjusted rates showed that compared with Māori women, European women were at significantly less risk of having extremely and very preterm infants (RR 0.86, 95% confidence interval [CI] 0.76-0.95). Preterm infants of European women had a significantly lower adjusted RR of early neonatal death (RR 0.65, 95% CI 0.45-0.93) or post-neonatal death (RR 0.41, 95% CI 0.26-0.64). In addition to ethnicity, preterm rates were influenced by maternal age, body mass index, smoking status, and SGA status. CONCLUSION This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence-based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Māori women and their infants.
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Affiliation(s)
- Liza Kathleen Edmonds
- Dunedin Hospital, Department of Women's & Children's Health, University of Otago, Dunedin, Aotearoa New Zealand
| | - Nokuthaba Sibanda
- School of Mathematics and Statistics, Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Stacie Geller
- G William Arends Professor of Obstetrics and Gynecology Director, Center for Research on Women and Gender College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Fiona Cram
- Katoa Ltd, Auckland, Aotearoa New Zealand
| | - Bridget Robson
- Department of Public Health, Eru Pōmare Māori Health Research Centre, University of Otago, Wellington, Aotearoa New Zealand
| | - Sara Filoche
- Department of Obstetrics, Gynaecology and Women's Health, University of Otago, Wellington, Aotearoa New Zealand
| | - Francesca Storey
- Te Tātai Hauora O Hine: Centre for Women's Health Research, Wellington Faculty of Health, Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Melanie Gibson-Helm
- Te Tātai Hauora O Hine: Centre for Women's Health Research, Wellington Faculty of Health, Victoria University of Wellington, Wellington, Aotearoa New Zealand
| | - Beverley Lawton
- Te Tātai Hauora O Hine: Centre for Women's Health Research, Wellington Faculty of Health, Victoria University of Wellington, Wellington, Aotearoa New Zealand
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Lloyd-Johnsen C, Eades S, McNamara B, D'Aprano A, Goldfeld S. A global perspective of Indigenous child health research: a systematic review of longitudinal studies. Int J Epidemiol 2021; 50:1554-1568. [PMID: 33864092 DOI: 10.1093/ije/dyab074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Rigorously designed longitudinal studies can inform how best to reduce the widening health gap between Indigenous and non-Indigenous children. METHODS A systematic review was performed to identify and present the breadth and depth of longitudinal studies reporting the health and well-being of Indigenous children (aged 0-18 years) globally. Databases were searched up to 23 June 2020. Study characteristics were mapped according to domains of the life course model of health. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Reported level of Indigenous involvement was also appraised; PROSPERO registration CRD42018089950. RESULTS From 5545 citations, 380 eligible papers were included for analysis, representing 210 individual studies. Of these, 41% were located in Australia (n = 88), 22.8% in the USA (n = 42), 11.9% in Canada (n = 25) and 10.9% in New Zealand (n = 23). Research tended to focus on either health outcomes (50.9%) or health-risk exposures (43.8%); 55% of studies were graded as 'good' quality; and 89% of studies made at least one reference to the involvement of Indigenous peoples over the course of their research. CONCLUSIONS We identified gaps in the longitudinal assessment of cultural factors influencing Indigenous child health at the macrosocial level, including connection to culture and country, intergenerational trauma, and racism or discrimination. Future longitudinal research needs to be conducted with strong Indigenous leadership and participation including holistic concepts of health. This is critical if we are to better understand the systematic factors driving health inequities experienced by Indigenous children globally.
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Affiliation(s)
- Catherine Lloyd-Johnsen
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sandra Eades
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridgette McNamara
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anita D'Aprano
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Sharon Goldfeld
- Centre for Community Child Health, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Lawton B, Storey F, Sibanda N, Bennett M, Lambert C, Geller S, Edmonds L, Cram F. He Korowai Manaaki (Pregnancy Wraparound Care): Protocol for a Cluster Randomized Clinical Trial. JMIR Res Protoc 2021; 10:e18154. [PMID: 33512321 PMCID: PMC7880808 DOI: 10.2196/18154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 10/01/2020] [Accepted: 12/15/2020] [Indexed: 11/22/2022] Open
Abstract
Background Maternal and infant health inequities between Māori (the Indigenous peoples of Aotearoa New Zealand) and New Zealand European women are well documented and cannot be explained solely by socioeconomic status. A research center-iwi (tribal group) partnership aims to address these disparities and improve maternal and infant health outcomes by implementing an augmented maternity care pathway (He Korowai Manaaki) to improve access to services and evidence-informed care. Objective The objective of this study is to test whether an augmented maternity care pathway improves Māori infant health outcomes. Methods This is a Kaupapa Māori (by, with, and for Māori) cluster randomized clinical trial involving 8 primary care practices allocated to either an intervention arm or control arm. The intervention arm comprises an augmented maternity care pathway (He Korowai Manaaki) offering clinical care through additional paid health care appointments and improved access to social support (eg, housing, transport). The control arm is usual care. The primary outcome is increased timely vaccination for Māori infants, defined as all age-appropriate vaccinations completed by 6 months of age. Results Recruitment commenced in November 2018 and was completed in June 2020, with 251 enrolled women recruited in intervention primary care practices before 20 weeks of pregnancy. Publication of results is anticipated in late 2023. Conclusions The results will inform primary health care policy including whether the provision of augmented maternal care pathways reduces disparities in the structural determinants of health. If effective, He Korowai Manaaki will strengthen the health and well-being of pregnant Māori women and their babies and improve their health outcomes, laying a strong foundation for lifelong health and well-being. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619001155189; https://tinyurl.com/yypbef8q International Registered Report Identifier (IRRID) DERR1-10.2196/18154
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Affiliation(s)
- Beverley Lawton
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Francesca Storey
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Nokuthaba Sibanda
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Matthew Bennett
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Charles Lambert
- Centre for Women's Health Research, Victoria University of Wellington, Wellington, New Zealand
| | - Stacie Geller
- Center for Research on Women & Gender, Center of Excellence in Women's Health, Department of Obstetrics and Gynaecology, University of Illinois, Chicago, IL, United States
| | - Liza Edmonds
- Women's & Children's Health, University of Otago, Dunedin, New Zealand
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