For analyses of longitudinal repeated-measures data, statistical methods include the random effects model, fixed effects model and the method of generalized estimating equations. We examine the assumptions that underlie these approaches to assessing covariate effects on the mean of a continuous, dichotomous or count outcome. Access to statistical software to implement these models has led to widespread application in numerous disciplines. However, careful consideration should be paid to their critical assumptions to ascertain which model might be appropriate in a given setting. To illustrate similarities and differences that might exist in empirical results, we use a study that assessed depressive symptoms in low-income pregnant women using a structured instrument with up to five assessments that spanned the pre-natal and post-natal periods. Understanding the conceptual differences between the methods is important in their proper application even though empirically they might not differ substantively. The choice of model in specific applications would depend on the relevant questions being addressed, which in turn informs the type of design and data collection that would be relevant.

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a  local Federal Healthy Start (HS) program in Michigan  that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

Strategies for addressing the public health problem of depressive symptoms in mid-pregnancy will benefit from a life course perspective.

A preliminary quasi-experimental, longitudinal study was conducted to explore differences in maternal mood states, self-esteem, family functioning, maternal-infant interaction, and home environment between mothers of preterm infants who participated in a nurse-managed program of parent-to-parent support and those who served as a comparison group. Mothers who participated in the intervention scored significantly higher on the Barnard NCATS interaction measure and the HOME total scale and subscales of maternal responsiveness and organization (N = 58) at 12 months following discharge from a neonatal intensive care unit. Using repeated measures analysis for a subset of mothers (n = 32), there were significant differences between the two groups on the mood state anxiety-tension (POMS) during the first 4 months postdischarge, with the treatment group having less anxiety. There was also a group by time interaction effect on self-esteem during the first 4 months, with self-esteem of the treatment group mothers increasing and comparison mothers decreasing. Findings suggest that one-to-one veteran parent support, in a nurse-managed program, may influence maternal and maternal-infant interaction outcomes.