An Intervention Program for Low Birth Weight Infants

It took me a little searching (and help of google scholar) to find a healthcare intervention study in Vermont.  I discovered this article, which is ten years old- nevertheless, I think it's still relevant to discuss, since the issue of low birth weight continues to impact low-socioeconomic classes throughout the United States.  The study, Nine-Year Outcome of the Vermont Intervention Program for Low Birth Weight Infants, examined the effectiveness of an educational intervention for mothers of low-birth weight babies.  The mothers were visited seven times in the hospital and four times in their homes during which a nurse gave individualized education and instruction and helped the mothers master hands-on baby-care skills.  The intervention stopped at 90 days after birth and this study was done nine years later, comparing the children who got the intervention to those who did not and comparing both with a normal birth weight cohort.  They were compared based on measures of cognitive development, and school achievement.  They found the low birth weight children who received the intervention performed significantly better on both measures and closely resembled the normal birth weight children.

This article is proves the effectiveness of a low-tech, low-cost intervention in significantly improving outcomes for children who are born at a low birth weight.  I am curious what the impact of this study is and what sort of education is routinely given to mothers of low-weight babies.  I did a quick search on UpToDate but couldn't find specific recommendations for caring for low birth weight babies after they are delivered.  UTD did include a good discussion of the various adult diseases that low birth weight babies are at increased risk for.  As far as evaluating intervention, according to the UpToDate article, "excessive or poor postnatal weight gain during the first four months of life appears to have a negative impact on neurodevelopmental outcome".  This made me think that part of the benefit of this intervention is helping babies make appropriate weight gain during the critical first three months of life.

In conclusion, this is a complex topic and I am not really doing it justice in a few paragraphs- however I think this is a very interesting intervention with potentially wide applicability.

The full-text article is available through the Upstate Library website.  The full citation is: Achenbach, TM, et al. 1993.  Nine-year outcome of the Vermont intervention program for low birth weight infants.  Pediatrics 91: 45 - 55.

Palliative Care Initiative Closes

For this month, I would like to discuss an innovative program in palliative care in Addison County that unfortunately was discontinued about a year ago.

The program, called Partners in Palliative and Home Care, was begun in 2009 under the leadership of two family physicians and with support of the local hospital, Porter Hospital.  The concept was to provide comprehensive high quality in-home palliative care for patients that did not meet the requirements of Medicaid for Hospice reimbursement, which include having a prognosis of less than six months to live.  This program in many ways mimicked the Hospice program, with an emphasis on crafting a treatment plan to best meet the patient's goals.

I think this program exemplifies several important features of the patient-practitioner relationship.  First, it shows that the two local physicians who started the program were well-acquainted with their patients and knew that there was a need for this type of service.  Furthermore, they were willing to reshape their practice to go into the patients' homes in order to improve their quality of care.

Unfortunately the program closed about a year ago, not because the need for it disappeared, but because of difficulties in securing reimbursement from Medicaid.

This story reminds me that in a broken system, even good ideas can fail.  I am all but certain that this program reduced hospitalizations, unwanted treatments and promoted the best possible quality of life for the patients.  How ironic that it was found to be financially untenable.

http://vtdigger.org/2011/10/28/palliative-care-program-at-porter-medical-center-in-middlebury-closes/

Addiction in Addison County

This article raises several important issues about addiction in Addison County, VT.  First, addiction rates are increasing with heroin and prescription drugs playing the largest role.  Addicts are younger, down to early teens.  Second, families report difficulty getting addiction care.  With few addiction service providers, addicts end up in the legal system instead of getting needed medical care.

Local police are concerned about crimes associated with drug addiction, however their numbers have recently been cut due to budget reductions.  Police are asking community members to attend meetings where they can discuss possible solutions.

http://www.addisonindependent.com/201208bristol-gathers-grapple-drug-crime

Farm First hotline for dairy farmers

Many farmers today work under a cloud of financial burdens which can lead to high stress levels, depression and in extreme cases, suicide. The Addison Independent article below cites the following two statistics, "farmers commit suicide at a rate twice the national average", and, "farmers experiencing high stress levels, particularly related to economic concerns, are two to three times more likely to have a serious injury than farmers with lower stress levels".  

In 2010, dairy farmers in Vermont faced extraordinary economic hardships as the national price of milk dropped below the cost of production. The state recognized the increased stress this placed on farmers and created the Farm First hotline. When farmers call the hotline they are paired with a mental health clinician in their local community for a face-to-face meeting. The counseling is strictly confidential and farmer's family members are also eligible to use the service. The hotline addresses a broad range of concerns that farmers might have from personal emotional wellbeing to employee management, retirement planning and legal questions.

One of the main concerns when the program was started was whether the stoicism and self-reliance characteristic of the dairy farm culture might prevent farmers from calling, even if they could benefit.  However, judging by this article, the hotline is being utilized and has already helped many farmers.

On a final note, I think it would also be nice if we- as health care professional and also members of our civil society- could do something to reduce the tremendous economic challenges that farmers face.  I try to do my own small part by buying locally grown produce when I can.  Also local food is usually fresher and therefore tastes better!  

Article describing the program's beginning:

http://www.addisonindependent.com/201005new-service-offers-crisis-hotline-struggling-farmers

Program website:

http://www.vacd.org/assistance

The Parent Child Center of Addison County, VT is a government and privately funded non-profit that addresses a variety of community health initiatives including maternal & infant health, STD, HIV, child & adolescent health, nutrition, tobacco use, substance use, family planning... Probably more! They offer a wide range of services to the entire community with specific support for adolescent families. Services include child integrated services, child care, weekly playdates, home visits, wellness classes, housing options, teen pregnancy prevention services, job training, etc. I had a chance to visit the center a few years ago and I got to sit in on a smoking cessation class for teens who were pregnant or newly postpartum.

http://www.addisoncountypcc.org/