Maternal pregravid body mass index and child hospital admissions in the first 5 years of life: results from an Australian birth cohort

Objectives: To examine the association of maternal pregravid body mass index (BMI) and child offspring, all-cause hospitalisations in the first 5 years of life. Methods: Prospective birth cohort study. From 2006 to 2011, 2779 pregnant women (2807 children) were enrolled in the Environments for Healthy Living: Griffith birth cohort study in South-East Queensland, Australia. Hospital delivery record and self-report baseline survey of maternal, household and demographic factors during pregnancy were linked to the Queensland Hospital Admitted Patients Data Collection from 1 November 2006 to 30 June 2012, for child admissions. Maternal pregravid BMI was classified as underweight (<18.5 kg m−2), normal weight (18.5–24.9 kg m−2), overweight (25.0–29.9 kg m−2) or obese (30 kg m−2). Main outcomes were the total number of child hospital admissions and ICD-10-AM diagnostic groupings in the first 5 years of life. Negative binomial regression models were calculated, adjusting for follow-up duration, demographic and health factors. The cohort comprised 8397.9 person years (PYs) follow-up. Results: Children of mothers who were classified as obese had an increased risk of all-cause hospital admissions in the first 5 years of life than the children of mothers with a normal BMI (adjusted rate ratio (RR) =1.48, 95% confidence interval 1.10–1.98). Conditions of the nervous system, infections, metabolic conditions, perinatal conditions, injuries and respiratory conditions were excessive, in both absolute and relative terms, for children of obese mothers, with RRs ranging from 1.3–4.0 (PYs adjusted). Children of mothers who were underweight were 1.8 times more likely to sustain an injury or poisoning than children of normal-weight mothers (PYs adjusted). Conclusion: Results suggest that if the intergenerational impact of maternal obesity (and similarly issues related to underweight) could be addressed, a significant reduction in child health care use, costs and public health burden would be likely.

High incidence of contaminating maternal cell overgrowth in human placental mesenchymal stem/stromal cell cultures: A systematic review

Placenta is a readily accessible translationally advantageous source of mesenchymal stem/stromal cells (MSCs) currently used in cryobanking and clinical trials. MSCs cultured from human chorion have been widely assumed to be fetal in origin, despite evidence that placental MSCs may be contaminated with maternal cells, resulting in entirely maternally derived MSC cultures. To document the frequency and determinants of maternal cell contamination in chorionic MSCs, we undertook a PRISMA-compliant systematic review of publications in the PubMed, Medline, and Embase databases (January 2000 to July 2013) on placental and/or chorionic MSCs from uncomplicated pregnancies. Of 147 studies, only 26 (18%) investigated fetal and/or maternal cell origin. After excluding studies that did not satisfy minimal MSC criteria, 7 of 15 informative studies documented MSC cultures as entirely fetal, a further 7 studies reported cultured human chorionic MSC populations to be either maternal (n=6) or mixed (n=1), whereas 1 study separately cultured pure fetal and pure maternal MSC from the same placenta. Maternal cell contamination was associated with term and chorionic membrane samples and greater passage number but was still present in 30% of studies of chorionic villous MSCs. Although most studies assume fetal origin for MSCs sourced from chorion, this systematic review documents a high incidence of maternal-origin MSC populations in placental MSC cultures. Given that fetal MSCs have more primitive properties than adult MSCs, our findings have implications for clinical trials in which knowledge of donor and tissue source is pivotal. We recommend sensitive methods to quantitate the source and purity of placental MSCs.

The v-MFG test: Investigating maternal, offspring and maternal-fetal genetic incompatibility effects on disease and viability

The MFG test is a family-based association test that detects genetic effects contributing to disease in offspring, including offspring allelic effects, maternal allelic effects and MFG incompatibility effects. Like many other family-based association tests, it assumes that the offspring survival and the offspring-parent genotypes are conditionally independent provided the offspring is affected. However, when the putative disease-increasing locus can affect another competing phenotype, for example, offspring viability, the conditional independence assumption fails and these tests could lead to incorrect conclusions regarding the role of the gene in disease. We propose the v-MFG test to adjust for the genetic effects on one phenotype, e.g., viability, when testing the effects of that locus on another phenotype, e.g., disease. Using genotype data from nuclear families containing parents and at least one affected offspring, the v-MFG test models the distribution of family genotypes conditional on offspring phenotypes. It simultaneously estimates genetic effects on two phenotypes, viability and disease. Simulations show that the v-MFG test produces accurate genetic effect estimates on disease as well as on viability under several different scenarios. It generates accurate type-I error rates and provides adequate power with moderate sample sizes to detect genetic effects on disease risk when viability is reduced. We demonstrate the v-MFG test with HLA-DRB1 data from study participants with rheumatoid arthritis (RA) and their parents, we show that the v-MFG test successfully detects an MFG incompatibility effect on RA while simultaneously adjusting for a possible viability loss.

Non-inherited maternal HLA alleles are associated with rheumatoid arthritis

Background. Rheumatoid arthritis (RA) is strongly associated with a series of HLA-DRB1 alleles that encode a conserved sequence of amino acids (70Q/R K/R R A A74) in the DRβ1 chain, known as the shared epitope (SE). However 30% of patients are negative for DRB1*04 and 15% are SE-negative. Exposure to these alleles as non-inherited maternal antigens (NIMA) might explain this discrepancy. We undertook a family study to investigate the role of NIMA in RA. Methods. One hundred families, including the RA proband and both parents, were recruited. HLA-DRB1 genotyping was performed using an allele-specific polymerase chain reaction by standard methods. The frequencies of NIMA and non-inherited paternal antigens (NIPA) were compared using contingency tables and a two-tailed P test. We then reviewed four previously published studies of NIMA in RA and conducted an analysis of the combined data Results. We identified 36 families in which the proband was DRB1*04-negative and 13 in which the proband lacked the SE. There was an excess of DRB1*04 and SE NIMA (P=0.05) compared with NIPA. Combined analysis with previous studies showed that 53/231 mothers (23%) versus 25/205 fathers (12%) had a non-inherited DRB1*04 (P=0.003) and 30/99 mothers versus 18/101 fathers had a non-inherited SE allele (P=0.03). Conclusion. A role for HLA NIMA in RA is suggested by these results.

Transition: Exchange establishing a visual arts practice based on personal pedagogy

There is a perceived tension in the relationship between the roles of art teacher and artist that led to the question: can an art teacher use their professional training and experience to establish an authentic artistic identity? This self-study tracked and analysed how the process of making her own art enabled an art teacher to also identify as an artist. Drawing on Lamina, the public exhibition of her multimedia artworks, the final exegesis proposes five conditions for art teachers in developing their own art practice: developing an identity as artist, using time and space mindfully, tolerating uncertainty, mentoring, and privileging the process.

Design thinking pedagogy: The educational design ladder

As global industries change and technology advances, traditional education systems might no longer be able to supply companies with graduates who possess an appropriate mix of skills and experience. The recent increased interest in Design Thinking as an approach to innovation has resulted in its adoption by non-design-trained professionals. This development necessitates a new method of teaching Design Thinking and its related skills and processes. As a basis for such a method, this research investigated 51 selected courses across 28 international universities to determine what Design Thinking is being taught (content), and how it is being taught (assessment and learning modes). To support the teaching and assessment of Design Thinking, this paper presents The Educational Design Ladder, an innovative resource/model that provides a process for the organisation and structuring of units for a multidisciplinary Design Thinking programme.

Conceptualising the challenge of integrating digital technologies in pedagogy

The integration of digital technologies in pedagogy is positioned as an important change in education, but widespread innovative use of digital technologies is yet to be truly realised. The gap between the potential and the reality of digital technology integration is commonly attributed to a range of challenging extrinsic and intrinsic influences. Activity Theory (Engeström, 2009) is used to analyse challenges created by extrinsic influences (Nielsen, Miller, & Hoban, 2012); a complementary theory is needed to conceptualise intrinsic influences. System 1 and System 2 thinking theory (Kahneman, 2011) will be advanced as a conceptual framework for understanding conscious and unconscious aspects of teacher practice, particularly the interaction between innovation and teacher routine, attitudes and beliefs. Transformative Learning Theory (Mezirow, 2009) will be positioned to comprehend the nexus of extrinsic and intrinsic influences. This paper will propose how, when faced with extrinsic and intrinsic influences on innovative practice, educators can use these theories to conceptualise the challenge of integrating digital technologies in pedagogy.

Motivation or demotivation of health workers providing maternal health services in rural areas in Vietnam: findings from a mixed-methods study

Background Motivation is an important driver for health professionals to maintain professional competencies, continue in a workforce and contribute to work tasks. While there is some research about motivation in health workers in low to middle income countries, maternal morbidity and mortality remains high in many low and middle income countries and this can be improved by improving the quality of maternal services and the training and skills maintenance of maternal health workers. This study examines the impact of motivation on maintenance of professional competence among maternal health workers in Vietnam using mixed methods. Methods The study consisted of a survey using a self-administered questionnaire of 240 health workers in 5 districts across two Vietnamese provinces and in-depth interviews with 43 health workers and health managers at the commune, district and provincial level to explore external factors that influenced motivation. The questionnaire includes a 23 item motivation instrument based on Kenyan health context, modified for Vietnamese language and culture. Results The 240 responses represented an estimated 95% of the target sample. Multivariate analysis showed that three factors contributed to the motivation of health workers: access to training (β = -0.14, p=0.03), ability to perform key tasks (β = 0.22, p=0.001), and shift schedule (β = -0.13, p=0.05). Motivation was higher in health workers self-identifying as competent or enabled to provide more care activities. Motivation was lower in those who worked more frequent night shifts and those who had received training in the last 12 months. The interviews identified that the latter was because they felt the training was irrelevant to them, and in some cases, they do not have opportunity to practice their learnt skills. The qualitative data also showed other factors relating to service context and organisational management practices contributed to motivation. Conclusions The study demonstrates the importance of understanding the motivations of health workers and the factors that contribute to this and may contribute to more effective management of the health workforce in low and middle income countries.

Future learning landscapes for architectural education: Linking space, place, pedagogy, technology + context

Diversification and expansion of global higher education in the 21st century, has resulted in Learning Landscapes for architectural education that can no longer be sustained by the traditional model. Changes have resulted because of surging student numbers, extensions to traditional curricula, evolving competency standards and accreditation requirements, and modified geographical and pedagogical boundaries. The influx of available new technology has helped to democratise knowledge, transforming when, where and how learning takes place. Pressures on government funded higher education budgets highlight the need for a critical review of the current approach to the design and use of learning environments. Efficient design of physical space contributes significantly to savings in provision, management and use of facilities, while also potentially improving pedagogical quality. The purpose of this research is to identify emerging trends in the design of future Learning Landscapes for architectural education in Australasia; to understand where and how students of architecture are likely to learn, in the future context. It explores the important linkages between space, place, pedagogy, technology and context, using a multi methodological qualitative research approach. An Australasian context study will explore the Learning Landscapes of 23 Schools of Architecture across Australia, New Zealand and Papua New Guinea. The focus of this paper is on the methodology which is being employed to undertake dynamic data collection for the study. The research will be determined through mapping all forms of architectural learning environments, pedagogical approaches and contextual issues, to bridge the gap between academic theory, and architectural design practice. An initial understanding that pedagogy is an intrinsic component imbedded within the design of learning environments, will play an important role. Active learning environments which are exemplified by the architectural design studio, support dynamic project based and collaborative connected learning models. These have recently become a lot more common in disciplines outside of design and the arts. It is anticipated, therefore, that the implications for this research may well have a positive impact far beyond the confines of the architectural studio learning environment.

"It makes you think anything is possible”: Representing diversity in music theory pedagogy

This paper critiques a traditional approach to music theory pedagogy. It argues that music theory courses should draw on pedagogies that reflect the diversity and pluralism inherent in 21st century music making. It presents the findings of an action research project investigating the experiences of undergraduate students undertaking an innovative contemporary art music theory course. It describes the students’ struggle in coming to terms with a course that integrated composing, performing, listening and analysing coupled with what for many was their first exposure to the diversity of contemporary art music. The paper concludes with suggesting that the approach could be adopted more widely throughout music programs.

Amber teething necklaces – medical marvel or maternal myth?

BACKGROUND: Baltic amber-bead necklaces or bracelets are commonly used for managing teething symptoms in infants. The effectiveness of these beads is claimed to be from succinic acid release (a compound with analgesic and anti-inflammatory properties), which is then absorbed through the skin. AIM: To investigate whether Baltic amber teething necklaces purchased in Australia contained succinic acid, and to quantify succinic acid release from the beads. METHODS: Infrared spectroscopy was used to confirm that the teething necklaces were made of Baltic amber. The amount of succinic acid contained within the beads was quantified, and succinic acid release from intact beads was measured in phosphate buffered saline (PBS) pH 5.5 or octanol to simulate aqueous or oily skin environments. RESULTS: Each necklace (33 beads in length) contained 19.17±4.89 mg of succinic acid (mean±se). Over a 6-month period, no succinic acid was detected in PBS, while 0.13±0.09 mg of succinic acid per necklace was released in octanol. Only one replicate of amber beads in octanol released succinic acid, and they had fragmented, with shards free-floating in the solvent. DISCUSSION: It is likely succinic acid was only detected because the beads were breaking down in octanol, which does not occur when worn around the neck of a child. Furthermore, the hydrophilic properties of succinic acid would not favour its absorption across hydrophobic layers of the skin and into the bloodstream. CONCLUSION: While the teething necklaces do contain small quantities of succinic acid, it is highly unlikely to be released from intact beads.

Meta-analysis of telomere length in 19 713 subjects reveals high heritability, stronger maternal inheritance and a paternal age effect

Telomere length (TL) has been associated with aging and mortality, but individual differences are also influenced by genetic factors, with previous studies reporting heritability estimates ranging from 34 to 82%. Here we investigate the heritability, mode of inheritance and the influence of parental age at birth on TL in six large, independent cohort studies with a total of 19 713 participants. The meta-analysis estimate of TL heritability was 0.70 (95% CI 0.64–0.76) and is based on a pattern of results that is highly similar for twins and other family members. We observed a stronger mother–offspring (r=0.42; P-value=3.60 × 10−61) than father–offspring correlation (r=0.33; P-value=7.01 × 10−5), and a significant positive association with paternal age at offspring birth (β=0.005; P-value=7.01 × 10−5). Interestingly, a significant and quite substantial correlation in TL between spouses (r=0.25; P-value=2.82 × 10−30) was seen, which appeared stronger in older spouse pairs (mean age ≥55 years; r=0.31; P-value=4.27 × 10−23) than in younger pairs (mean age<55 years; r=0.20; P-value=3.24 × 10−10). In summary, we find a high and very consistent heritability estimate for TL, evidence for a maternal inheritance component and a positive association with paternal age.

“Come in and look around.” Professional development of student teachers through public pedagogy in a library exhibition

This paper describes a public pedagogy project embedded into "The Global Teacher", a subject within the Bachelor of Education program for student teachers at an Australian university. The subject provides a global perspective on socio-political issues that shape education. In 2013, The Global Teacher introduced an approach that asked student teachers to create a museum-style exhibition depicting six global education themes. This exhibition was displayed in the State Library and the public were invited to engage with the installations and the student teachers who created them. Our paper describes how the project was implemented by means of close collaboration between the QUT teacher educators, curators at the State Library of Queensland (SLQ), and student groups working on visually translating their understandings of global educational issues into a public exhibition. We discuss what was learned by our students and ourselves, as teacher educators, by engaging in this public pedagogy.

Differences in parent regulation beliefs and maternal postnatal depressive symptoms in early weeks

Postnatal depression is consistently associated with couple relationship qualities. Substantial infant care requirements in early weeks may highlight differences in parenting beliefs between mother and father. We calculated difference scores in parenting beliefs (disparity) in a community sample of 209 parent dyads. Contrary to previous research regarding ‘disagreement’ which could be interpreted as discord, independently measured disparity was not associated with maternal depressive symptoms. Coparenting interventions should promote respectful negotiation rather than resolution of differences.

Maternal and paternal support for physical activity and healthy eating in preschool children: A cross-sectional study

BACKGROUND Parental support is a key influence on children's health behaviours; however, no previous investigation has simultaneously explored the influence of mothers' and fathers' social support on eating and physical activity in preschool-aged children. This study evaluated the singular and combined effects of maternal and paternal support for physical activity (PA) and fruit and vegetable consumption (FV) on preschoolers' PA and FV. METHODS A random sample comprising 173 parent-child dyads completed validated scales assessing maternal and paternal instrumental support and child PA and FV behaviour. Pearson correlations, controlling for child age, parental age, and parental education, were used to evaluate relationships between maternal and paternal support and child PA and FV. K-means cluster analysis was used to identify families with distinct patterns of maternal and paternal support for PA and FV, and one-way ANOVA examined the impact of cluster membership on child PA and FV. RESULTS Maternal and paternal support for PA were positively associated with child PA (r = 0.37 and r = 0.36, respectively; P < 0.001). Maternal but not paternal support for FV was positively associated with child FV (r = 0.35; P < 0.001). Five clusters characterised groups of families with distinct configurations of maternal and paternal support for PA and FV: 1) above average maternal and paternal support for PA and FV, 2) below average maternal and paternal support for PA and FV, 3) above average maternal and paternal support for PA but below average maternal and paternal support for FV, 4) above average maternal and paternal support for FV but below average maternal and paternal support for PA, and 5) above average maternal support but below average paternal support for PA and FV. Children from families with above average maternal and paternal support for both health behaviours had higher PA and FV levels than children from families with above average support for just one health behaviour, or below average support for both behaviours. CONCLUSIONS The level and consistency of instrumental support from mothers and fathers for PA and FV may be an important target for obesity prevention in preschool-aged children.