Influence of Prenatal and Early Childhood Home-Visiting by Nurses on Development of Chronic Disease: 29-year Follow-Up of a Randomized Clinical Trial

护士进行产前和儿童早期家访对慢性病发展的影响：一项随机临床试验的 29 年随访

• 批准号: 10200138
• 负责人: Dana Dabelea
• 金额: $ 179.42万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-22 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200138
• 关键词: Address; African American; Age; Anxiety; Behavior assessment; Birth; Blood; Breast Feeding; Cardiovascular Diseases; Caring; Cause of Death; Cessation of life; Charge Nurses; Child; Child Health; Chronic Disease; Chronic Kidney Failure; Control Groups; Cotinine; Creatinine; Development; Diagnosis; Diet; Early Intervention; Economics; Education; Enrollment; Family; Family Nursing; Fathers; Female; Fostering; Government; Health; Health behavior; Heart; Home visitation; Hospitalization; Human; Hypertension; Immune; Imprisonment; Infant; Inflammatory; Intervention; Interview; Kidney; Life Cycle Stages; Link; Live Birth; Low Birth Weight Infant; Low income; Marriage; Measures; Mediating; Mediator of activation protein; Menopause; Mental Depression; Metabolic; Mothers; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Obesity; Outcome; Participant; Patient Self-Report; Peripheral; Pharmaceutical Preparations; Physical activity; Positioning Attribute; Postpartum Period; Pregnancy; Pregnancy Outcome; Premature Birth; Premature Mortality; Public Health; Randomized; Randomized Clinical Trials; Recording of previous events; Records; Reporting; Resources; Risk; Sampling; Self Efficacy; Services; Sleep; Social Security; Social support; Thyroid Gland; Toddler; Urine; Visiting Nurse; Woman; Women' s Health; Work; arterial stiffness; blood pressure reduction; cardiometabolism; cardiovascular disorder risk; chronic pain; cognitive function; coping; design; disability; disparity reduction; early childhood; family structure; follow-up; health assessment; health economics; improved; indexing; inflammatory marker; instrument; macrovascular disease; maternal outcome; mortality; offspring; pregnancy hypertension; prenatal; prenatal health; prenatal influence; preventable death; programs; sedentary activity; substance use; tv watching

Project Summary This study consists of a 30-year follow-up of participants (N=742) in a randomized clinical trial of the Nurse-Family Partnership (NFP), a program of prenatal and infant/toddler home-visiting by nurses for low-income women with no previous live births, focusing on emergent chronic disease in mothers and first-born offspring. Previous assessments were conducted at registration, at the 36th week of gestation, and at the child’s 6th month and years 1, 2, 4.5, 6, 9, 12, and 18. NFP nurses are charged with improving: 1) pregnancy outcomes; 2) children’s health and development; and 3) women’s health and economic self-sufficiency. They do this by promoting women’s health behaviors, care of their child, planning subsequent pregnancies, completing their educations and finding work. Nurses explicitly promote women’s self-efficacy/mastery in managing challenges, foster informal social support (including involving fathers), and link families with health and human services. We propose to continue surveillance of health outcomes among mothers and offspring enrolled in this second NFP trial, which focused on very low-income, primarily African American (89%) women and their offspring. Eighty- five percent of the randomized mothers and offspring were assessed at the most recent 18-year follow-up. NFP effects have been found on a range of maternal outcomes through child age 18, including Pregnancy-Induced Hypertension (PIH), closely spaced subsequent pregnancies, marriage, sense of mastery, use of government benefits; and among mothers of females, reduced BP and self-reported kidney and heart problems. Nurse-visited offspring, through age 18, had lower rates of preventable mortality; among those born to mothers with limited coping capacity, lower rates of low birthweight and compromised cognitive functioning, receipt of Social Security Disability; and, among females, lower rates of obesity. At the 30-year follow-up, we expect to complete assessments on at least 80% of those randomized, 594 mothers and offspring. Findings from earlier follow-ups have led to our general hypothesis that, over the life-course, the intervention will lead to reductions in the emergence of cardio-vascular disease, chronic kidney disease, type-2 diabetes, and premature mortality among both mothers and their first-born offspring. We will a) conduct anthropometric assessments; b) draw blood to measure cardio-metabolic and immune-inflammatory factors; c) collect random urines to measure the microalbumin/creatinine ratio and cotinine; d) evaluate arterial stiffness using SphygmoCor and a standard peripheral BP instrument; e) conduct interviews to assess history of diagnoses, medications, menopause, hospitalizations, disability, sedentary and physical activity, sleep, diet, use of substances, depression, anxiety, sense of mastery, chronic pain, duration and quality of partnered relationships, education, work, and incarceration; f) review hospitalization records; and g) classify causes of death from the National Death Index (NDI). We will estimate Nurse-Visited (NV) - Control (C) differences in these outcome domains for both mothers and first-born offspring.

项目摘要 这项研究包括参与者的30年随访（n = 742）。 护士家庭合作伙伴关系（NFP），一项护士的产前和婴儿/幼儿家庭访问的计划 以前没有活产的妇女，专注于母亲的新兴慢性疾病和长子后代。 先前的评估是在注册，妊娠第36周和孩子的第6个月进行的 以及第1、2、4.5、6、9、12和18年。NFP护士被指控改善：1）妊娠结局； 2） 儿童健康与发展； 3）妇女的健康和经济自给自足。他们这样做 促进妇女的健康行为，照顾孩子，计划随后的怀孕，完成他们的 教育和寻找工作。护士明确促进妇女在管理挑战方面的自我效率/精通， 促进非正式的社会支持（包括涉及父亲），并将家庭与健康和人类服务联系起来。我们 在第二个NFP中招收的母亲和后代的健康结果的建议 审判的重点是非常低收入的初级非裔美国人（89％）妇女及其后代。八十- 在最近的18年随访中评估了5％的随机母亲和后代。 NFP效应已经在18岁的儿童到18岁的一系列孕产妇效果中发现 怀孕引起的高血压（PIH），随后的怀孕紧密间隔，婚姻，掌握感， 利用政府利益；在女性的母亲中，BP和自我报告的肾脏和心脏减少了 问题。在18岁之前，访问护士的后代的预防死亡率较低。在那些出生的人中 对于应对能力有限的母亲，低出生体重和受损的认知功能率较低， 收到社会保障残疾；在女性中，肥胖率较低。 在30年的随访中，我们预计将对至少80％的随机分析完成评估，594 母亲和后代。早期后续行动的发现导致了我们的一般假设，即 生命过程，干预措施将导致心脏血管疾病的出现，慢性 肾脏疾病，2型糖尿病和母亲的早死亡 后代。我们将a）进行人体测定； b）抽血以测量心甲替代谢和 免疫炎性因素； c）收集随机尿液以测量微硫蛋白/肌酐比率和 cotinine; d）使用香菜木器和标准外围BP仪器评估动脉刚度； e）行为 访谈以评估诊断，药物，更年期，住院，残疾，久坐和 体育锻炼，睡眠，饮食，物质的使用，抑郁，动画，精通感，慢性疼痛，持续时间 和合作关系，教育，工作和进化的质量； f）审查住院记录；和 g）对国家死亡指数（NDI）的死亡原因进行分类。我们将估计护士访问（NV） - 控制 （c）母亲和长子后代的这些结果领域的差异。