Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.
A pilot study was conducted to assess the feasibility and acceptability of an intervention program for mothers of very low birth-weight infants in the neonatal intensive care unit (NICU).
Thirty-three mothers of infants born weighing less than 1500 g.
A single-group, pretest-posttest design was used.
Preintervention mothers completed self-report questionnaires and their interaction with their infant was observed. Mothers then received the intervention program. Mothers were assessed twice postintervention, first when the infant was 1/2 months old and again at 6 months. At the postintervention assessments, mothers completed the same questionnaires and interaction was observed.
Mothers completed the State-Trait Anxiety Inventory, the revised Parental Stress Scale: Neonatal Intensive Care Unit, the NICU Parental Beliefs Scale, and the Perinatal PTSD Questionnaire. Interactions between mothers and infants were rated by trained research staff using the Index of Parental Behaviour in the NICU. Postintervention mothers also responded to a questionnaire that assessed their perceptions of the intervention program.
It was feasible to enroll mothers because 62% of eligible mothers agreed to participate. However, 39% of mothers who enrolled withdrew. Most of the mothers who withdrew did so before even beginning the intervention, and many of these women were mothers of multiples. It was also feasible to provide the intervention because more than 80% of mothers who began the intervention received all 6 teaching sessions. Mothers found both the content and the format of the program to be acceptable. There were nonetheless several challenges in conducting an intervention study with mothers early in the NICU hospitalization.
The results of this pilot study are encouraging. It was found to be both feasible and acceptable to provide the intervention program to mothers during the NICU hospitalization. The effectiveness of this program needs to be assessed in a randomized controlled trial.
This study examined psychosocial risk factors for depressive symptomatology in a community sample of pregnant immigrant women in Montreal, Canada. One hundred and nineteen participants were recruited through hospitals and responded to questionnaires assessing depression, somatic symptoms, functional status, social support, stressful life events and marital adjustment. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. Transitions associated with migration may place pregnant immigrant women at high risk for depression.
This prospective study examined how characteristics of infants (i.e., birth weight and perinatal illness severity), mothers (i.e., anxiety and level of education), and the social context (i.e., maternal received and perceived helpfulness of support) related to mother-very low birth weight (VLBW) infant interaction in 72 dyads. Infant, mother, and contextual factors were assessed at 3 and 9 months of age, and mothers and infants were observed in teaching interactions at 9 months. Dyads whose interaction was more sensitive and responsive included mothers who were better educated and less anxious at 3 months and reported higher perceived support at 3 months. The findings highlight the importance of maternal education and well-being in the parenting of VLBW infants.
To compare the psychosocial adjustment and the quality of interaction with their infant of mothers and fathers of very low-birthweight infants at two time points in the first year of the infant's life.
Quantitative, longitudinal design.
Neonatal Intensive Care Unit of two Canadian urban hospitals.
Sixty-one couples who had an infant born weighing less than 1,500 g.
State-Trait Anxiety Inventory, Parenting Sense of Competence questionnaire, and the Support in Parenting Questionnaire were completed at 3 and 9 months of age. Parent-infant interaction was observed at 9 months and scored with the Nursing Child Assessment Teaching Scale.
Fathers' reported parenting self-efficacy was significantly lower than mothers' at both 3 and 9 months of age. Fathers reported more received support than mothers, and the amount of support that both mothers and fathers reported increased significantly from the 3-month to the 9-month assessment. Mothers and fathers reported similar levels of anxiety and perceived helpfulness of the support they received and were equally sensitive and responsive in interactions with their infants at 9 months of age.
Similarities and differences between mothers and fathers were observed. It is important for nurses to assess mothers and fathers, how any differences are perceived by the couple, and how any differences might be affecting them during the neonatal intensive care unit hospitalization and in early months after discharge.
Although maternal depression is a common emotional disorder, assessment and intervention rates are low. Using a cross-sectional survey design, we examined attitudes, beliefs, and practices of obstetrical and neonatology nurses toward the management of symptoms of maternal depression (SMD). Nurses believed they were responsible to assess for SMD and intervene with women showing SMD. However, only 50% assessed for SMD at least once monthly. Identified barriers to care were: lack of time, training, language, and patient and family beliefs. NICU nurses reported lower confidence, knowledge, and skills, than other nurses who participated in this study. This study shows there is a need to enhance nurses? confidence in assessing and intervening with SMD, and to clarify the referral process.
The first aim of our study was to validate the French version of the Reading the Mind in the Eyes test, a theory of mind test. The second aim was to test whether cultural differences modulate performance on this test.
A total of 109 participants completed the original English version and 97 participants completed the French version. Another group of 30 participants completed the French version twice, one week apart.
We report a similar overall distribution of scores in both versions and no differences in the mean scores between them. However, 2 items in the French version did not collect a majority of responses, which differed from the results of the English version. Test-retest showed good stability of the French version. As expected, participants who do not speak French or English at home, and those born in Asia, performed worse than North American participants, and those who speak English or French at home.
We report a French version with acceptable validity and good stability. The cultural differences observed support the idea that Asian culture does not use theory of mind to explain people's behaviours as much as North American people do.
Inflammatory arthritis is associated with a high degree of work instability and financial burden. In this study, we examine the extent of work instability and financial loss as well as their association with disease characteristics during the first 18 months of inflammatory arthritis.
One hundred and four patients in the early phase (more than 6 weeks,