Maternal and neonatal influences on, and reproducibility of, neonatal aortic pulse wave velocity

Aortic pulse wave velocity (aPWV), a noninvasive measure of vascular stiffness, is an independent predictor of cardiovascular disease both before and in overt vascular disease. Its characteristics in early life and its relationship to maternal factors have hardly been studied. To test the hypothesis that infant aPWV was positively related to maternal anthropometry and blood pressure (BP) at 28 weeks gestation, after adjusting for neonatal anthropometry and BP, 148 babies born in Manchester were measured 1 to 3 days after birth. A high reproducibility of aPWV, assessed in 30 babies within 3 days of birth, was found with a mean difference between occasions of –0.04 m/s (95% CI: –0.08 to 0.16 m/s). Contrary to our hypothesis, a significant inverse relation was found between neonatal aPWV (mean: 4.6 m/s) and maternal systolic BP (mean: 108.9 mm Hg; r=–0.57; 95% CI: –0.67 to –0.45) but not maternal height nor weight. Neonatal aPWV was positively correlated with birth length, birth weight, and systolic BP. In multiple regression, neonatal aPWV remained significantly inversely associated with maternal systolic BP (adjusted ß coefficient: –0.032; 95% CI: –0.040 to –0.024; P<0.001), after adjustment for maternal age, birth weight, length, and neonatal BP (all independently and positively related to aPWV) and for gestational age, maternal weight, and height (unrelated). These results suggest that infant aPWV may be a useful index of infant vascular status, is less disturbing to measure than infant BP, and is sensitive to the gestational environment marked by maternal BP.

The costs of a community-based intervention to promote maternal health

The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating ‘mother-friendly’ environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also ‘induced’ costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272 490 per rural community and A$313 900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1–2 worth of local resources, predominantly in the form of volunteer time or donated services.

Improving infant sleep and maternal mental health: a cluster randomised trial

Objectives: To determine whether a community-delivered intervention targeting infant sleep problems improves infant sleep and maternal well-being and to report the costs of this approach to the healthcare system.

Design: Cluster randomised trial.

Setting: 49 Maternal and Child Health (MCH) centres (clusters) in Melbourne, Australia.

Participants: 328 mothers reporting an infant sleep problem at 7 months recruited during October–November 2003.

Intervention: Behavioural strategies delivered over individual structured MCH consultations versus usual care.

Main outcome measures: Maternal report of infant sleep problem, depression symptoms (Edinburgh Postnatal Depression Scale (EPDS)), and SF-12 mental and physical health scores when infants were 10 and 12 months old. Costs included MCH sleep consultations, other healthcare services and intervention costs.

Results: Prevalence of infant sleep problems was lower in the intervention than control group at 10 months (56% vs 68%; adjusted OR 0.58 (95% CI: 0.36 to 0.94)) and 12 months (39% vs 55%; adjusted OR 0.50 (0.31 to 0.80)). EPDS scores indicated less depression at 10 months (adjusted mean difference –1.4 (–2.3 to –0.4) and 12 months (–1.7 (–2.6 to –0.7)). SF-12 mental health scores indicated better health at 10 months (adjusted mean difference 3.7 (1.5 to 5.8)) and 12 months (3.9 (1.8 to 6.1)). Total mean costs including intervention design, delivery and use of non-MCH nurse services were £96.93 and £116.79 per intervention and control family, respectively.

Conclusions: Implementing this sleep intervention may lead to health gains for infants and mothers and resource savings for the healthcare system.

Mediators of the relationship between maternal education and children's TV viewing

Background: Maternal education is consistently found to be inversely related to children’s television viewing and is associated with aspects of the family television environment. This study investigates whether family television environment mediates the relationship between maternal education and children’s television viewing.

Methods: Parents of 1484 children reported maternal education, time their child spends watching television, and 21 aspects of the family television environment (potential mediators) during 2002 and 2003. Separate regression analyses were conducted in 2006 for each potential mediator that met two initial conditions for mediation (associated with both maternal education and children’s television viewing (p<0.10)), to assess whether inclusion reduced the association between maternal education and children’s television viewing. Multivariable regression assessed the combined impact of all mediators.

Results: Twelve of 21 potential mediators met the initial conditions for mediation. Inclusion of each resulted in decreased β values (3.2% to 15.2%) for the association between maternal education and television viewing. Number and placement of televisions in the home appeared to have the greatest mediating effect, followed by frequency of eating dinner in front of the television with the child and rules about television viewing during mealtimes. Together, the 12 mediators accounted for more than one-third of the association between maternal education and children’s television viewing time.

Conclusions: This study suggests the strong inverse relationship between maternal education and children’s television viewing is partly mediated by aspects of the family television environment.

Managing professionals : the emerging leadership role of Victorian Maternal and Child Health coordinators

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neoliberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses' identity and collegial relations and to the coordination role. It argues that coordinators emerged as a Significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.

Differences in foraging strategy and maternal behaviour between two sympatric fur seal species at the Crozet Islands

Marine top-predators such as marine mammals forage in a heterogeneous environment according to their energetic requirements and to the variation in environmental characteristics. In this study, the behaviour of breeding females in 2 sympatric fur seal species, Antarctic fur seal Arctocephalus gazella and Subantarctic fur seal A. tropicalis, was investigated in relation to foraging effort. Foraging effort was hypothesised to be greater in Antarctic fur seal than in Subantarctic fur seal due to their shorter lactation period. Using satellite telemetry, time-depth recorders and satellite images of sea-surface temperature and chlorophyll a concentration, the foraging grounds, the at-sea activity budgets and the environmental features were determined for both species breeding on the Crozet Archipelago. Foraging cycle duration was similar for the 2 species, and the seals exhibited similar at-sea activity budgets. Only the proportion of time spent at sea was higher in Antarctic fur seals. Separate foraging areas were identified for the 2 species. Antarctic fur seal distribution was related to bathymetric features, while we did not find any direct relationship between chlorophyll a concentration and seal foraging areas. Our results suggest that Antarctic fur seals tend to respond to the higher needs of their pups by having a higher foraging efficiency and concentrating their foraging activity in the most productive areas.

Variation in maternal provisioning by lactating Antarctic fur seals: response to experimental manipulation in pup demand

An experiment involving the supplementary feeding of pups was conducted on Antarctic fur seals to investigate the factors influencing maternal foraging-attendance cycles and the differential use of nutritional resources for growth, maintenance and storage by pups. For 40% of the lactation period, male pups were given a supplement mimicking the chemical composition of Antarctic fur seal milk at a dose equivalent to 35% of the normal mass-specific milk energy intake for the species. Milk consumption, body composition and growth rates were monitored during and after the supplementary feeding period and maternal foraging-attendance cycles were monitored throughout lactation. During the supplementary feeding period, treatment pups (n=8) grew 32% faster and deposited greater adipose tissue stores than controls (n=8) but consumed the same amount of maternal-delivered milk. When supplementary feeding was stopped (timed to coincide with peak maternal milk yield in this species), treatment pups lost mass whereas control group pups continued to grow. Treatment pups weaned at a younger age (109 days) than control pups (116 days) but at the same mass (13 kg). Maternal attendance durations did not differ between the treatment and control groups throughout lactation. However, mothers of treatment pups had significantly shorter foraging trip durations (3.74 days) than mothers of control pups (4.74 days) during the period of supplementary feeding (there were no significant differences throughout the rest of lactation). These findings are in accordance with predictions of a marginal-value model of fur seal lactation behaviour.

Maternal postpartum adjustment in Victoria's south west : a rural perspective

Aims & Rationale/Objectives
This study examined maternal postpartum adjustment in the first 12 months. Firstly, we were interested in examining whether Parental Functioning would be affected by living or not living in a major South West regional centre. Secondly, we were interested in whether Parental Functioning would differ as a function of infants being under or over 6 months of age. Thirdly, we were interested in whether Parental Functioning would differ as a function of pregnancy and birth complications. Finally, we were interested in whether postpartum perceptions of Role Competence/Satisfaction and Social Support would be associated with the Postnatal Depression.

Methods
The (preliminary) sample included 69 rural mothers recruited from across five shire regions within South West Victoria. Indicators of Parental Functioning were assessed using self-report questionnaires. Demographic and medical information was also collected. Respondents to the study were mailed a questionnaire pack which was returned in a reply-paid envelope.

Principal Findings
The results regarding geographical location were non-significant. There were significant differences in Wellbeing but not Role Competence/Satisfaction, or Social Support as a function of infant age. There were significant differences in Wellbeing, Role Competence/Satisfaction, and Social Connectedness (but not actual social support) as a function of Pregnancy Complications but not Birth Complications. Finally, Role Competence/Satisfaction and Social Connectedness (but not actual social support) significantly contributed to the variance in Postnatal Depression.

Discussion
Findings suggest that mothers did not differ as a function of their geographical location. Overall, mothers had higher levels of parental functioning when their infants were over 6 months of age, and also, if they did not experience pregnancy complications (physical, emotional, both). Additionally, findings suggest that perceptions of competence in and satisfaction with the parenting role, and also feelings of 'connectedness' to social others, are protective factors against the development of postpartum adjustment disorders.

Implications
Given that depressive episodes are common during childbearing years, and have both short- and long-term developmental effects on the infant, these findings support a need for the development and examination of a perinatal and infant mental health programme for rural mothers and infants.

Dive behaviour, foraging locations and maternal-attendance patterns in Australian fur seals (Arctocephalus pusillus doriferus)

The dive behaviour, foraging locations, and colony-attendance patterns of female Australian fur seals (Arctocephalus pusillus doriferus) from Kanowna Island (39°10'S, 146°18'E) in Bass Strait, southeastern Australia, were determined throughout lactation during 1997–1999. Foraging-trip durations increased as lactation progressed, being shortest in summer (3.71 ± 0.24 days; mean ± 1 SE) and longest in winter (6.77 ± 0.57 days, P < 0.05), but maternal-attendance periods did not differ in duration (1.70 ± 0.10 days, P > 0.5). Individual mean attendance periods and trip durations were positively correlated (r² = 0.21, P < 0.005). Diving commenced shortly after seals left the colony (2.6 ± 0.4 h), was continuous for long periods (up to 36 h), occurred mostly during daylight hours, and lacked regular diel variation in depth. The majority of dives (78%) were typically U-shaped and reached depths corresponding to the prevailing depths in Bass Strait (65–85 m), indicating that these animals forage mostly on the benthos of the shallow continental shelf in this region. Such behaviour is unusual for fur seals but is reminiscent of that of some sea lion species. Mean dive durations varied between 2.0 and 3.7 min (maximum 8.9 min) and the theoretical aerobic dive limit (3.91–4.26 min) was exceeded on 17.3% of dives. Dive frequency (8.3 ± 0.6/h) and the proportion of time at sea spent diving (40.7 ± 2.1%) were weakly negatively related to the duration of the foraging trip (r²= 0.07, P < 0.004, and r² = 0.13, P < 0.0001, respectively). Data from at-sea locations showed that lactating females forage almost exclusively within Bass Strait during all seasons.