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: 10421061
• 负责人: Dana Dabelea
• 金额: $ 182.52万
• 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/10421061
• 关键词: Address; African American; African American population; 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.

项目概要 本研究对一项随机临床试验的参与者 (N=742) 进行了 30 年的随访。 护士家庭合作伙伴关系 (NFP)，一项由护士为低收入人群提供的产前和婴幼儿家访计划 以前没有活产过的妇女，重点关注母亲和第一胎后代的突发慢性疾病。 之前的评估是在登记时、妊娠第 36 周和孩子第 6 个月时进行的 以及第 1、2、4.5、6、9、12 和 18 年。NFP 护士负责改善： 1) 妊娠结局； 2） 儿童的健康和发展； 3）妇女的健康和经济自给自足。他们这样做是通过 促进妇女的健康行为、照顾孩子、计划随后的怀孕、完成她们的计划 教育和找工作。护士明确促进女性在应对挑战方面的自我效能/掌控力， 促进非正式社会支持（包括父亲的参与），并将家庭与卫生和公共服务联系起来。我们 建议继续监测参加第二次 NFP 的母亲和后代的健康状况 试验的重点是收入非常低、主要是非裔美国 (89%) 的妇女及其后代。八十- 5% 的随机母亲和后代在最近 18 年的随访中接受了评估。 已发现 NFP 对 18 岁儿童期间的一系列孕产妇结局产生影响，包括 妊娠高血压 (PIH)、间隔较近的后续怀孕、婚姻、掌控感、 使用政府福利；在女性母亲中，血压和自我报告的肾脏和心脏降低 问题。 18 岁之前有护士探访的后代，可预防的死亡率较低；在那些出生的人中 对于应对能力有限、低出生体重率较低和认知功能受损的母亲， 残疾社会保障收据；而且，女性的肥胖率较低。 在 30 年的随访中，我们预计将完成对至少 80% 的随机分组的评估，594 母亲和后代。早期后续研究的结果得出了我们的一般假设： 在整个生命过程中，干预措施将减少心血管疾病、慢性疾病的发生 母亲及其长子的肾脏疾病、2 型糖尿病和过早死亡 后代。我们将 a) 进行人体测量评估； b) 抽血测量心脏代谢和 免疫炎症因子； c) 收集随机尿液以测量微量白蛋白/肌酸酐比率，以及 可替宁； d) 使用 SphygmoCor 和标准外周血压仪评估动脉僵硬度； e) 进行 访谈以评估诊断、药物、更年期、住院、残疾、久坐和 体力活动、睡眠、饮食、物质使用、抑郁、焦虑、掌控感、慢性疼痛、持续时间 合作关系、教育、工作和监禁的质量； f) 审查住院记录；和 g) 根据国家死亡指数 (NDI) 对死亡原因进行分类。我们将估计护士就诊 (NV) - 对照 (C) 母亲和第一个出生的后代在这些结果领域的差异。