Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial
Effects of nurse home visiting on maternal and child functioning: Age-9 follow-up of a randomized trial
复制标题
DOI：
10.1542/peds.2006-2111
复制
发表时间：
2007-10-01
期刊：
影响因子：
8
通讯作者：
Bondy, Jessica
中科院分区：
文献类型：
--
作者：
Olds, David L.;Kitzman, Harriet;Bondy, Jessica
目标。我们的目标是测试产前和婴儿期护士家访对母亲生育能力和儿童功能的影响，该项目在儿童2岁时结束7年后。我们在公共产科和儿科护理系统中进行了一项随机对照试验。总共有743名主要是黑人妇女，妊娠< 29周，以前活产，至少有2个社会人口学风险特征（未婚，教育程度< 12年，失业），被随机分配接受护士家访或比较服务。主要结局包括第一胎和第二胎出生的间隔时间以及每年出生的孩子数量；母亲与伴侣关系以及与孩子生父关系的稳定性；母亲对福利、食品券和医疗补助的使用情况；母亲使用药物的情况；母亲被逮捕和监禁；以及孩子的学习成绩、学校行为和精神障碍。次要结局是随后怀孕的后遗症、妇女的就业情况、家庭暴力经历和儿童死亡率。接受护士探视的妇女生育第一胎和第二胎的间隔时间较长，每年累计生育的孩子较少，与现任伴侣的关系也较长。从出生到9岁，接受护士探访的女性使用福利和食品券的时间较短。在护士的探访下，心理资源较低的母亲所生的孩子在一年级到三年级的平均成绩和数学和阅读成绩都比对照组的孩子好。护士探视的儿童，作为一种趋势，从出生到9岁死亡的可能性较低，这一影响可以归因于潜在可预防原因的死亡。到儿童9岁时，该项目降低了妇女的续产率，延长了生育第一胎和第二胎的间隔时间，增强了她们与伴侣关系的稳定性，促进了儿童对小学的学业适应，似乎还降低了儿童因可预防原因造成的死亡率。
OBJECTIVE. Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2.METHODS. We conducted a randomized, controlled trial in a public system of obstetric and pediatric care. A total of 743 primarily black women < 29 weeks' gestation, with previous live births and at least 2 sociodemographic risk characteristics ( unmarried, < 12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality.RESULTS. Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with control-group counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes.CONCLUSIONS. By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.