<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Olds, D. L.</style></author><author><style face="normal" font="default" size="100%">Robinson, J.</style></author><author><style face="normal" font="default" size="100%">O'Brien, R.</style></author><author><style face="normal" font="default" size="100%">Luckey, D. W.</style></author><author><style face="normal" font="default" size="100%">Pettitt, L. M.</style></author><author><style face="normal" font="default" size="100%">Henderson, C. R.</style></author><author><style face="normal" font="default" size="100%">Ng, R. K.</style></author><author><style face="normal" font="default" size="100%">Sheff, K. L.</style></author><author><style face="normal" font="default" size="100%">Korfmacher, J.</style></author><author><style face="normal" font="default" size="100%">Hiatt, S.</style></author><author><style face="normal" font="default" size="100%">Talmi, A.</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Home visiting by paraprofessionals and by nurses: a randomized, controlled trial.</style></title><secondary-title><style face="normal" font="default" size="100%">Pediatrics</style></secondary-title><alt-title><style face="normal" font="default" size="100%">Pediatrics</style></alt-title></titles><keywords><keyword><style  face="normal" font="default" size="100%">Female</style></keyword><keyword><style  face="normal" font="default" size="100%">House Calls</style></keyword><keyword><style  face="normal" font="default" size="100%">Humans</style></keyword><keyword><style  face="normal" font="default" size="100%">Infant</style></keyword><keyword><style  face="normal" font="default" size="100%">Infant Welfare</style></keyword><keyword><style  face="normal" font="default" size="100%">Infant, Newborn</style></keyword><keyword><style  face="normal" font="default" size="100%">Maternal Welfare</style></keyword><keyword><style  face="normal" font="default" size="100%">Maternal-Child Nursing</style></keyword><keyword><style  face="normal" font="default" size="100%">Outcome and Process Assessment (Health Care)</style></keyword><keyword><style  face="normal" font="default" size="100%">Proportional Hazards Models</style></keyword><keyword><style  face="normal" font="default" size="100%">Regression Analysis</style></keyword></keywords><dates><year><style  face="normal" font="default" size="100%">2002</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2002 Sep</style></date></pub-dates></dates><volume><style face="normal" font="default" size="100%">110</style></volume><pages><style face="normal" font="default" size="100%">486-96</style></pages><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;OBJECTIVE: To examine the effectiveness of home visiting by paraprofessionals and by nurses as separate means of improving maternal and child health when both types of visitors are trained in a program model that has demonstrated effectiveness when delivered by nurses.&lt;/p&gt;
&lt;p&gt;METHODS: A randomized, controlled trial was conducted in public- and private-care settings in Denver, Colorado. One thousand one hundred seventy-eight consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance were invited to participate. Seven hundred thirty-five women were randomized to control, paraprofessional, or nurse conditions. Nurses completed an average of 6.5 home visits during pregnancy and 21 visits from birth to the children&amp;#39;s second birthdays. Paraprofessionals completed an average of 6.3 home visits during pregnancy and 16 visits from birth to the children&amp;#39;s second birthdays. The main outcomes consisted of changes in women&amp;#39;s urine cotinine over the course of pregnancy; women&amp;#39;s use of ancillary services during pregnancy; subsequent pregnancies and births, educational achievement, workforce participation, and use of welfare; mother-infant responsive interaction; families&amp;#39; home environments; infants&amp;#39; emotional vulnerability in response to fear stimuli and low emotional vitality in response to joy and anger stimuli; and children&amp;#39;s language and mental development, temperament, and behavioral problems.&lt;/p&gt;
&lt;p&gt;RESULTS: Paraprofessional-visited mother-child pairs in which the mother had low psychological resources interacted with one another more responsively than their control-group counterparts (99.45 vs 97.54 standard score points). There were no other statistically significant paraprofessional effects. In contrast to their control-group counterparts, nurse-visited smokers had greater reductions in cotinine levels from intake to the end of pregnancy (259.0 vs 12.32 ng/mL); by the study child&amp;#39;s second birthday, women visited by nurses had fewer subsequent pregnancies (29% vs 41%) and births (12% vs 19%); they delayed subsequent pregnancies for longer intervals; and during the second year after the birth of their first child, they worked more than women in the control group (6.83 vs 5.65 months). Nurse-visited mother-child pairs interacted with one another more responsively than those in the control group (100.31 vs 98.99 standard score points). At 6 months of age, nurse-visited infants, in contrast to their control-group counterparts, were less likely to exhibit emotional vulnerability in response to fear stimuli (16% vs 25%) and nurse-visited infants born to women with low psychological resources were less likely to exhibit low emotional vitality in response to joy and anger stimuli (24% vs 40% and 13% vs 33%). At 21 months, nurse-visited children born to women with low psychological resources were less likely to exhibit language delays (7% vs 18%); and at 24 months, they exhibited superior mental development (90.18 vs 86.20 Mental Development Index scores) than their control-group counterparts. There were no statistically significant program effects for the nurses on women&amp;#39;s use of ancillary prenatal services, educational achievement, use of welfare, or their children&amp;#39;s temperament or behavior problems. For most outcomes on which either visitor produced significant effects, the paraprofessionals typically had effects that were about half the size of those produced by nurses.&lt;/p&gt;
&lt;p&gt;CONCLUSIONS: When trained in a model program of prenatal and infancy home visiting, paraprofessionals produced small effects that rarely achieved statistical or clinical significance; the absence of statistical significance for some outcomes is probably attributable to limited statistical power to detect small effects. Nurses produced significant effects on a wide range of maternal and child outcomes.&lt;/p&gt;
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