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

项目摘要 这项研究由一项随机临床试验的参与者(N=742)组成，为期30年。 护士-家庭伙伴关系(NFP)是一项由护士为低收入家庭提供产前和婴幼儿家访的计划 以前没有活产的妇女，重点是母亲和第一个出生的后代的紧急慢性病。 先前的评估是在登记时、怀孕36周和孩子6个月时进行的 以及1、2、4.5、6、9、12和18岁。NFP护士负责改善：1)妊娠结局；2) 儿童的健康和发展；以及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，照顾她们的孩子，计划再次怀孕，完成她们的 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感/掌握能力， 促进非正式社会支持(包括让父亲参与)，并将家庭与健康和公共服务联系起来。我们 建议继续监测登记参加第二次NFP的母亲和子女的健康状况 试验，重点是非常低收入，主要是非裔美国人(89%)妇女及其后代。八十个- 5%的随机母亲和子女在最近18年的随访中进行了评估。 已发现NFP对18岁以下儿童的一系列产妇结局有影响，包括 妊娠高血压综合征(PIH)，近距离连续怀孕，婚姻，掌控感， 使用政府福利；在女性的母亲中，血压降低，自我报告的肾脏和心脏 有问题。在出生的孩子中，18岁之前接受护士探视的孩子可预防的死亡率较低 对于应对能力有限、低出生体重率和认知功能受损的母亲， 领取社会保障；在女性中，肥胖率较低。 在30年的随访中，我们预计将完成对594名随机调查对象中至少80%的人的评估 母亲和后代。来自早期随访的发现导致了我们的一般假设，在 在生命过程中，干预会导致心血管疾病的出现减少，慢性 母亲和第一个孩子的肾脏疾病、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)采集随机尿液以测量微白蛋白/肌酐比率和 可替宁；d)使用SPhygmoCor和标准外周血压仪器评估动脉僵硬；e)进行 面谈以评估诊断、药物、更年期、住院、残疾、久坐和 体力活动、睡眠、饮食、使用物质、抑郁、焦虑、主动感、慢性疼痛、持续时间 以及伴侣关系、教育、工作和监禁的质量；f)审查住院记录；以及 G)根据国家死亡指数对死因进行分类。我们将估计护士访视(NV)-控制 (C)母亲和头胎子女在这些结果领域的差异。

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.