Gabriela Buccini

Background: Maternal mortality continues to rise in concerning rates in the United States. Maternal mortality risks are increased by clinical factors like cardiovascular disease or infection and nonclinical factors like food insecurity, unequal access to healthcare, and systemic racism. Integrated care coordination programs aimed at addressing care needs are emerging as best practices to improve maternal health outcomes at and post birth. Our goal was to (i) evaluate the care needs during pregnancy and postpartum and (ii) formulate recommendations for integrating a clinic-level model and community-level model to develop an integrated maternal health services model. Methods: Human Centered Design (HCD) activities were used to identify the care needs from pregnancy through postpartum involving 35 participants across three groups. Group 1 included community members; Group 2, clinicians and healthcare providers from an academic obstetric clinic; and Group 3, care coordination and social service providers. Each group completed three to four HCD sessions between April to July 2024. An inductive qualitative analysis of HCD outputs captured frequency, complementary, expansion, and divergence among groups, which subsequently informed the recommendations for designing the model. Results: Four categories captured the recommendations for designing the IMHS program: (1) Pregnancy needs (e.g., center the care of the pregnant women and their social support), (2) Pregnancy specialist needs (e.g., include doulas, midwives, and other specialties within care coordination), (3) Community system needs (e.g., create coordinated outreach systems to reach populations), and (4) Healthcare system needs (e.g., provide skill-based training for clinical staff). Conclusion: Recommendations for addressing pregnancy, specialist, community, and healthcare needs should be integrated into the design of the IMHS demonstration program to improve the care of pregnant women in Southern Nevada.

Objective: Food insecurity is prevalent among underserved communities and contributes to maternal–child health disparities. The perinatal period – from pregnancy through 1 year postpartum – provides a critical window of opportunity to identify and address food insecurity. However, perinatal providers face barriers that prevent them from providing screening, referrals and follow-up services. The study aimed to understand barriers perceived by perinatal providers to implement strategies to screen, refer and follow up for food-insecure pregnant people and children living in underserved areas. Design: This qualitative phenomenological study explored multi-level barriers perceived by perinatal providers when implementing strategies for screening, referral and follow-up for food insecurity guided by the socio-ecological model. Setting: This study was conducted within five zip codes of Southern Nevada (89101, 89106, 89030, 89031 and 89032) selected for their prevalence of food insecurity and health disparities. Participants: Semi-structured interviews were conducted with fifteen perinatal providers. Results: Barriers at the individual provider level included lack of knowledge and education on food insecurity; at the interpersonal level included patient hesitancy to reveal sensitive information to providers; at the institutional level included lack of standard procedures to conduct screening, referrals and follow-up services; and at the community and policy levels identified organisational capacity and historical distrust of healthcare systems as obstacles to offering equitable care for food insecurity in perinatal settings. Conclusion: Addressing these multi-level barriers is essential to implementing effective food insecurity mitigation strategies within perinatal care settings. Utilising the created recommendations may promote equitable care for food insecurity within clinical and community perinatal settings.

This study aimed to learn managers' points of view on maternity leave and breastfeeding and find promotion, protection, and support strategies for breastfeeding in the work environment. This qualitative study, using Laurence Bardin's content analysis, was conducted with eight managers in 2023 in Uberlândia, Minas Gerais State, Brazil. We used a semi-structured script with questions about how managers organized women workers' activities before they took their maternity leaves and after their return to work and questions about managers' points of view about breastfeeding and maternity leave. Answers were analyzed using NVivo. We established three big topics from the content of the interviews, namely: (1) managers' point of view regarding the duration of maternity leave and breastfeeding; (2) rights, incentives, and work conditions; and (3) the organization of the work environment during maternity leave. We verified compliance with the 4-month maternity leave provided for in the Brazilian Consolidation of Labor Laws, highlighting the disagreement of leave duration and the health recommendation for exclusive breastfeeding of up to six months. We also found that managers' lack of awareness about government programs encourage companies to support breastfeeding by tax reduction benefits and extended maternity leaves. Managers' point of view and personal experiences permeate knowledge about laws protecting female workers. The pro-breastfeeding strategy only involved complying with the maternity leave duration provided by law, which indicates the need for greater investments in awareness-raising actions for managers regarding the review of the concept of maternal protection.

Background: Household food insecurity (HFI), defined as the lack of reliable access to adequate food because of limited money or resources, may influence children’s nutritional status. This study aimed to examine the association between HFI risk, based on a single screening item, and underweight and obesity among kindergarten children in Nevada. Methods: Cross-sectional data from the Kindergarten Health Survey (KHS) collected across three school years (2022–2023, 2023–2024, and 2024–2025) were analyzed using a pooled sample of 7267 children. HFI risk was assessed using one item from the Hunger Vital Sign. Weight status was determined using Body Mass Index (BMI) guidelines from the Centers for Disease Control and Prevention (CDC). Descriptive statistics and multinomial logistic regression examined associations between HFI risk and underweight and obesity, adjusting for confounders. Results: Across the pooled sample, 16.3% were at risk for HFI, 16.0% were underweight, and 21.9% had obesity. In pooled analysis, HFI risk was associated with higher odds of obesity (Adjusted Odds Ratio [AOR] 1.29; 95% Confidence Interval [CI]: 1.05–1.59), but not underweight, compared with food-secure children. In year-specific analyses, higher odds of underweight were observed in 2023–2024 (AOR 1.74; 95% CI: 1.14–2.66) and 2024–2025 (AOR 1.58; 95% CI: 1.04–2.38). Conclusions: HFI risk was associated with obesity among kindergarten children in Nevada, while associations with underweight were observed only in certain school years and should be interpreted cautiously. These findings suggest HFI risk as an important early childhood health concern and support the need for nutrition support, family assistance, and longitudinal research.

This cross‐sectional study investigated associations between food insecurity, food poverty, and early childhood development (ECD) among Brazilian children under 5 years of age, and explored whether the association between food poverty and ECD varied across food insecurity levels. Data were drawn from 14,062 participants from the Brazilian National Survey on Child Nutrition. ECD was assessed using milestone scores from the Survey of Well‐Being of Young Children—Brazilian Version (SWYC‐BR). Exposures included food insecurity levels (secure, mild, or moderate/severe) and food poverty (lack of minimum dietary diversity). Crude and adjusted linear regression models estimated associations and 95% confidence intervals (CIs), with stratified and interaction analyses by food insecurity levels. The mean SWYC‐BR score was 14.14; 46.2% of children experienced moderate food poverty, 16.0% severe food poverty, 38.0% mild food insecurity, and 10.2% moderate or severe food insecurity. Mild food insecurity (adjusted β = −0.41; 95% CI: −0.74, − 0.09) and severe food poverty (adjusted β = −0.91; 95% CI: −1.37, − 0.44) were associated with lower SWYC‐BR scores. In stratified analyses, children from food‐secure (fully adjusted β = −0.87; 95% CI: −1.50, − 0.24) and mildly food‐insecure (fully adjusted β = −1.17; 95% CI: −1.93, − 0.41) households experiencing severe food poverty had lower SWYC‐BR scores. Findings indicate that food poverty is associated with ECD in Brazil and this association varies across food insecurity levels, underscoring the need for public health policies that address both nutritional quality and household food security among vulnerable populations.

Background/Objectives: Breast cancer is one of the most prevalent cancers among women, with notable increases among women younger than 50 years. Knowledge about breast cancer and preventive measures (e.g., early detection) are key to reducing breast cancer morbidity and mortality. Many graduate students fall within an age range when breast cancer risk starts to rise. However, research focused specifically on graduate students’ breast cancer knowledge and practices of preventive measures are sparse. Methods: This scoping review aims to synthesize the literature on breast cancer knowledge and practice of preventive measures among graduate students in a global context. Four databases (PubMed, CINAHL, APA PsycINFO, Embase) were searched for articles published between 2014 and 2024, and the following inclusion criteria were applied: full-text peer-reviewed articles available online; target population includes graduate students aged 20 to 50 years; English language; and, cross-sectional, cohort, case–control, ecological, and experimental/intervention studies. Two reviewers independently conducted article screening and data extraction using Covidence. Results: Sixteen studies met the selection criteria. Knowledge of breast cancer was examined in 94% (15/16) of the included studies and 75% (12/16) of the studies assessed practice of prevention measures (e.g., breast self-examination) among graduate students. Overall, most studies reported poor knowledge and limited uptake of prevention practices. Educational background (e.g., years of education, academic discipline and GPA), access to healthcare services, and other socioeconomic characteristics were commonly reported factors significantly associated with breast cancer knowledge and practice of preventive measures in graduate students. Conclusions: These findings may inform targeted educational interventions to increase knowledge and promote the early detection and prevention of breast cancer among graduate students.

This scoping review aims to identify facilitators and barriers to the formulation of public policies on food and nutrition across different contexts. The Scope review was conducted in seven databases. The search strategy was designed using research terms (and their derivatives) and included combinations of ‘nutrition’, ‘food’, ‘policy’, ‘guideline’, ‘action plan’, ‘strategy’, and ‘process’. All stages of data selection and extraction were independently performed by pairs of researchers. A narrative synthesis was developed to present the findings. A total of 17 articles were published in scientific journals, containing data from 28 countries across five continents (Africa, North and South America, Asia, Europe, and Oceania). The studies, published between 1979 and 2023, documented processes for developing policies, programs, and public plans for food and nutrition. The facilitators and barriers described in the policy development process were identified, and they were grouped into seven categories: (1) governance, (2) intersectoral negotiations, (3) political will, (4) policy characteristics, (5) team profile, (6) availability and use of data, and (7) conflict of interest and interference from the private sector. Except for conflict of interest, all categories were pointed out as elements that can potentially facilitate or hinder the policy development process. Understanding the facilitators and barriers to public policy formulation can impact the development process, such as reducing development time or formulating responses that are better aligned with the needs of the population. Policymakers can develop strategies to minimize the impact of barriers and leverage facilitators to develop more efficient policies with better outcomes.

Resumo Os cartões em alimentação responsiva (AR) visam encorajar a autonomia alimentar e impulsionar o desenvolvimento cognitivo, emocional e social, tornando-se uma ferramenta crítica na promoção da nutrição infantil na atenção primária. Este estudo teve como objetivos (1) avaliar a fidelidade na implementação dos cartões de AR por agentes comunitários da saúde (ACS) treinados, (2) investigar a aceitabilidade e adequação dos cartões na perspectiva de cuidadores de crianças de 0 a 3 anos em contextos rural-ribeirinho e urbano brasileiros. Foram oferecidas oito horas de qualificação a 45 ACS para utilização de cartões de AR culturalmente apropriados. Observações sobre a condução das sessões através de um checklist foram realizadas em quatro sessões de educação em grupo. A percepção dos cuidadores foi captada por meio de codificação dedutiva com base nas gravações transcritas por um profissional. A qualificação garantiu fidelidade na entrega das mensagens em AR. Cuidadores destacaram a adequação e aceitabilidade das mensagens nas sessões de educação em grupo. O estudo documenta uma estratégia viável para a fidelidade do uso dos cartões de AR na atenção primária, destacando a importância de materiais culturalmente adaptados para diferentes populações.

The program impact pathway (PIP) theory represents the architecture and causal mechanisms by which a program achieves its intended outcomes. We sought to identify and analyze the main applications of PIPs in the public health nutrition field. This scoping review selected 24 studies in March 2024. Four objectives for applying PIPs were identified: to ascertain the processes and identify mediators; to identify critical quality control points; to guide data collection and define program evaluation indicators; to analyze the processes, adaptations, and fidelity of implementation. The analyses use five methodological steps: I) construct the initial PIP diagram; II) confirm/revise the PIP diagram; III) identify evaluation indicators; IV) compare the implementation process with the PIP diagram; and V) evaluate outcomes or impact based on PIP analysis. In conclusion, PIP analysis offers immense possibilities for application, and the interactive analysis methodology supports program managers in the implementation process.