Olds D L, Henderson C R, Kitzman H
Department of Pediatrics, University of Rochester School of Medicine and Dentistry.
Pediatrics. 1994 Jan;93(1):89-98.
To examine, during the 3rd and 4th years of life, the health, development, rates of child maltreatment, and living conditions of children who had been enrolled in a randomized trial of nurse home visitation during pregnancy and first 2 years of their lives.
Prospective follow-up of families who had been randomly assigned to nurse-visited and comparison conditions.
Study conducted in semirural community in upstate New York. Families dispersed among 14 other states during 2-year period after children's second birthdays.
Four hundred women were recruited through a health department antepartum clinic and offices of private obstetricians and were registered before 30th week of pregnancy. All women had no previous live births and 85% were either teenaged (< 18 years at registration), unmarried, or from Hollingshead social classes IV or V. Analysis focused on whites, who comprised 89% of sample.
Nurse home visitation from pregnancy through second year of the child's life.
There were no treatment differences in the rates of child abuse and neglect or children's intellectual functioning from 25 to 48 months of age. Nurse-visited children, nevertheless, lived in homes with fewer hazards for children; they had 40% fewer injuries and ingestions and 45% fewer behavioral and parental coping problems noted in the physician record; and they made 35% fewer visits to the emergency department than did children in the comparison group. Nurse-visited mothers were observed to be more involved with and to punish their children to a greater extent than were mothers in the comparison group. The functional meaning of punishment differed between the nurse-visited and comparison families.
The program does have enduring effects on certain aspects of parental caregiving, safety of the home, and children's use of the health care system, but it may be necessary to extend the length of the program for families at highest risk to produce lasting reductions in child abuse and neglect.
研究在儿童3岁和4岁时，那些在孕期及生命的头两年参加了护士家访随机试验的儿童的健康、发育、受虐待率及生活状况。
对随机分配到接受护士家访组和对照组的家庭进行前瞻性随访。
在纽约州北部的半农村社区开展研究。儿童两岁生日后的两年内，家庭分散到其他14个州。
通过卫生部门的产前诊所及私人产科医生办公室招募了400名女性，她们在怀孕第30周前登记。所有女性此前均未生育过活产婴儿，85%为青少年（登记时年龄小于18岁）、未婚或来自霍林斯黑德社会阶层IV或V。分析集中在白人身上，白人占样本的89%。
从孕期至儿童两岁，进行护士家访。
在25至48个月大的儿童中，虐待和忽视儿童的发生率或儿童的智力功能方面，治疗组间没有差异。然而，接受护士家访的儿童生活的家庭对儿童的危害较少；他们的受伤和摄入不良情况减少了40%，医生记录中行为和父母应对问题减少了45%；与对照组儿童相比，他们去急诊科就诊的次数减少了35%。观察发现，接受护士家访的母亲比对照组母亲更多地参与孩子的事务，并对孩子进行更多的惩罚。护士家访组和对照组家庭中惩罚的功能意义有所不同。
该项目确实对父母养育的某些方面、家庭安全以及儿童使用医疗保健系统产生了持久影响，但可能有必要延长该项目的时长，以对高危家庭产生持久影响，从而持续减少虐待和忽视儿童的情况。
