Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=-2.04, P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=-1.76 (0.86), t=2.28, P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world. Trial registration Current Controlled Trials ISRCTN25664149.

Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trail

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=−2.04 , P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=−1.76 (0.86), t=2.28 , P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world.

Measurement of mother-infant interactions and the home environment in a European setting: preliminary results from a cross-cultural study

Background Infant development is adversely affected in the context of postnatal depression. This relationship may be mediated by both the nature of early mother-infant interactions and the quality of the home environment. Aim To establish the usefulness of the Global Ratings Scales of Mother-Infant Interaction and the Infant-Toddler version of the Home Observation for the Measurement of the Environment (IT-HOME), and to test expected associations of the measures with characteristics of the social context and with major or minor depression. Method Both assessments were administered postnatally in four European centres; 144 mothers were assessed with the Global Ratings Scales and 114 with the IT-HOME. Affective disorder was assessed by means of the Structured Clinical Interview for DSM-IV Disorders. Results Analyses of mother-infant interaction indicated no main effect for depression but maternal sensitivity to infant behaviour was associated with better infant communication, especially for women who were not depressed. Poor overall emotional support also reduced sensitivity scores. Poor support was also related to poorer IT-HOME scores, but there was no effect of depression. Conclusions The Global Ratings Scales were effectively applied but there was less evidence of the usefulness of the IT-HOME. Declaration of interest None.

The effect of cleft lip on cognitive development in school-aged children: a paradigm for examining sensitive period effects

Background:  Our previous investigation showed that infants with cleft lip who had undergone late (three-month) surgical repair (but not those with early, neonatal, repair) had significantly poorer cognitive development at 18 months than a group of unaffected control children. These differences were mediated by the quality of early mother–infant interactions. The present study examined whether this pattern persisted into later childhood. Method:  At 7 years, 93 index (44 early, and 49 late repair) and 77 control children were followed up and their cognitive development assessed (IQ, language and school achievements). Results:  Index children (particularly those with late lip repair) scored significantly lower than controls on tests of cognitive development. Group differences in Verbal IQ were mediated by 2 months’ maternal sensitivity; this was associated with 7-year Verbal IQ, even after controlling for later mother–child interactions. Conclusions:  Social interactions in the first few months may be of especial importance for child cognitive development. Interventions for infants with cleft lip should be directed at fostering the best possible parental care in infancy.

The FunFOLD2 server for the prediction of protein-ligand interactions

The FunFOLD2 server is a new independent server that integrates our novel protein–ligand binding site and quality assessment protocols for the prediction of protein function (FN) from sequence via structure. Our guiding principles were, first, to provide a simple unified resource to make our function prediction software easily accessible to all via a simple web interface and, second, to produce integrated output for predictions that can be easily interpreted. The server provides a clean web interface so that results can be viewed on a single page and interpreted by non-experts at a glance. The output for the prediction is an image of the top predicted tertiary structure annotated to indicate putative ligand-binding site residues. The results page also includes a list of the most likely binding site residues and the types of predicted ligands and their frequencies in similar structures. The protein–ligand interactions can also be interactively visualized in 3D using the Jmol plug-in. The raw machine readable data are provided for developers, which comply with the Critical Assessment of Techniques for Protein Structure Prediction data standards for FN predictions. The FunFOLD2 webserver is freely available to all at the following web site: http://www.reading.ac.uk/bioinf/FunFOLD/FunFOLD_form_2_0.html.

Parent-child interactions and adolescent anxiety: a systematic review

Parental behaviours have been implicated in the development and maintenance of anxiety in children and young people; however the degree to which findings apply to adolescents specifically remains unclear. We conducted a systematic review of studies examining the evidence for an association between parental behaviours and adolescent anxiety. Twenty two studies were identified. The results of this systematic review provide fairly consistent preliminary evidence for an association between anxiety and perceived parental control and anxious rearing in adolescence. The findings relating to an association between adolescent anxiety and perceived parental rejection and lack of warmth are somewhat less consistent. Methodological shortcomings in the studies mean that these results should be interpreted with caution. Future research should be conducted using observational and experimental design with adolescents from referred, clinical populations to help identify the critical parental processes and clarify the direction of effects.

The water quality of the LOCAR Pang and Lambourn catchments

The water quality of the Pang and Lambourn, tributaries of the River Thames, in south-eastern England, is described in relation to spatial and temporal dimensions. The river waters are supplied mainly from Chalk-fed aquifer sources and are, therefore, of a calcium-bicarbonate type. The major, minor and trace element chemistry of the rivers is controlled by a combination of atmospheric and pollutant inputs from agriculture and sewage sources superimposed on a background water quality signal linked to geological sources. Water quality does not vary greatly over time or space. However. in detail, there are differences in water quality between the Pang and Lambourn and between sites along the Pang and the Lambourn. These differences reflect hydrological processes, water flow pathways and water quality input fluxes. The Pangs pattern of water quality change is more variable than that of the Lambourn. The flow hydrograph also shows both a cyclical and 'uniform pattern' characteristic of aquifer drainage with, superimposed, a series of 'flashier' spiked responses characteristic of karstic systems. The Lambourn, in contrast, shows simpler features without the 'flashier' responses, The results are discussed in relation to the newly developed UK community programme LOCAR dealing with Lowland Catchment Research. A descriptive and box model structure is provided to describe the key features of water quality variations in relation to soil, unsaturated and groundwater flows and storage both away from and close to the river.

Rainfall and runoff water quality of the Pang and Lambourn, tributaries of the River Thames, south-eastern England

The water quality of rainfall and runoff is described for two catchments of two tributaries of the River Thames, the Pang and Lambourn. Rainfall chemistry is variable and concentrations of most determinands decrease with increasing volume of catch probably due to 'wash out' processes. Two rainfall sites have been monitored, one for each catchment. The rainfall site on the Lambourn shows higher chemical concentrations than the one for the Pang which probably reflects higher amounts of local inputs from agricultural activity, Rainfall quality data at a long-term rainfall site on the Pang (UK National Air Quality Archive) shows chemistries similar to that for the Lambourn site. but with some clear differences. Rainfall chemistries show considerable variation on an event-to-event basis. Average water quality concentrations and flow-weighted concentrations as well as fluxes vary across the sites, typically by about 30%. Stream chemistry is much less variable due to the main Source of water coming from aquifer sources of high storage. The relationship between rainfall and runoff chemistry at the catchment outlet is described in terms of the relative proportions of atmospheric and within-catchment sources. Remarkably, in view of the quantity of agricultural and sewage inputs to the streams, the catchments appear to be retaining both P and N.

The water quality of the River Carnon, west Cornwall, November 1992 to March 1994: the impacts of Wheal Jane discharges

In January 1992, there was a major pollutant event for the River Canon and downstream with its confluence to the River Fal and the Fal estuary in the west Cornwall. This incident was associated with the discharge of several million gallons of highly polluted water from the abandoned Wheal Jane tin mine that also extracted Ag, Cu and Zn ore. Later that year, the Centre for Ecology and Hydrology (CBH; then Institute of Hydrology) Wallingford undertook daily monitoring of the River Canon for a range of major, minor and trace elements to assess the nature and the dynamics of the pollutant discharges. These data cover an 18-month period when there remained major water-quality problems after the initial phase of surface water contamination. Here, a summary is provided of the water quality found, as a backdrop to set against subsequent remediation. Two types of water-quality determinant grouping were observed. The first type comprises the determinants B, Cs, Ca, Li, K, Na, SO4, Rb and Sr, and their concentrations are positively correlated with each other but inversely correlated with flow. This type of water-quality determinant shows variations in concentration that broadly link to the normal hydrogeochemical processes within the catchment, with limited confounding issues associated with mine drainage. The second type of water-quality determinant comprises Al, Be, Cd, Ce, Co, Cu, Fe, La, Pb, Pr, Nd, Ni, Si, Sb, U, Y and Zn, and concentrations for all this group are positively correlated. The determinants in this second group all have concentrations that are negatively correlated with pH. This group links primarily to pollutant mine discharge. The water-quality variations in the River Camon are described in relation to these two distinct hydrogeochemical groupings. (C) 2004 Elsevier B.V All rights reserved.

Quality of Life Issues and Second-Generation Migration: the Case of 'Bajan-Brit Returnees'

This paper forms part of research that is investigating the migration of young Bajan-Brits to Barbados. Specifically, it explores the role of quality of life issues in the decision-making processes of young Bajan-Brits as they negotiate their 'return' to Barbados. The research, based on 51 in-depth qualitative interviews conducted with an under-researched cohort of young Bajan-Brits living in Barbados, argues from a 'lure of home' conceptualisation that the return of young Bajan-Brits to Barbados can best be understood from the context of a search for a better quality of life in the face of social and economic disenfranchisement in the UK context. Subsequently, the paper examines the extent to which the quality of life factors which formed the basis of return to Barbados have in fact been realised on the part of young Bajan-Brits in their adjustment to life in Barbados. The paper ultimately argues that despite problems of adjustment, young Bajan-Brits have generally been successful in actualising a better quality of life in Barbados. Copyright (C) 2009 John Wiley & Sons, Ltd.

Distribution of salinity in the root zone affects the yield, quality of tomato fruit

Tomato plants (Lycopersicon esculentum Mill. var. DRK) were grown with a split root system to determine the effect of an unequal distribution of salinity in the root zone on yield and quality. The roots of the plant were divided into two portions and each portion was irrigated with nutrient solutions differing in EC levels achieved by adding Na or K. The maximum yield was observed in treatments with unequal EC when one portion of the roots received only water and the lowest in the high EC treatments. The reduced yield in the high EC treatment was due to the incidence of blossom-end rot and reduced fruit size. Fruit size in the treatments receiving solutions of unequal EC was up to 12% greater than that in the control. No significant differences were found in soluble solids and acidity between control and all other unequal EC treatments. Ca concentration was significantly higher in the treatments where one portion of the root system received water. It was concluded that high salinity had positive effects on yield and quality provided that one portion of the root system were placed in low EC or only water.

Intake, growth and meat quality of steers given diets based on varying proportions of maize silage and grass silage

Simmental × Holstein-Friesian steers were offered four forage diets. These comprised grass silage (G); proportionately 0·67 grass silage, proportionately 0·33 maize silage (GGM); 0·33 grass silage, 0·67 maize silage ( MMG); maize silage ( M) from 424 (s.d. = 11·5) kg to slaughter at a minimum weight of 560 kg. Forages were mixed and offered ad libitum. Steers were offered 2 kg of a concentrate daily, the concentrate being formulated such that all steers had similar crude protein intakes across dietary treatments. A sample of steers was slaughtered at the beginning of the experimental period to allow the calculation of the rate of gain of the carcass and its components. Carcass dissection of a sample of steers allowed the development of a prediction equation of carcass composition based on thoracic limb dissection of all carcasses. Forage dry matter intake and live-weight gain increased linearly as maize silage replaced grass silage in the forage mixture, resulting in improvements in food conversion ratio (all P = 0·001). Killing-out proportion increased with maize silage inclusion ( P < 0·001) but fat and conformation scores did not differ significantly between diets. However, increasing maize inclusion in the diet resulted in a greater weight ( P = 0·05) and proportion ( P = 0·008) of fat in the carcass, and significant increases in internal fat deposition. The inclusion of maize led to a progressive increase in the daily gains of carcass ( P < 0·001), and significant increases in the daily gains of both fat ( P < 0·001) and lean tissue ( P < 0·001). Fat colour was more yellow in cattle given diets G and GGM than diets MMG and M ( P < 0·001) and colour intensity was lower on diet M than the other three diets ( P < 0·001). There were no significant differences in any aspects of eating quality between diets. Therefore, maize silage has the potential to reduce the time taken for finishing beef animals to achieve slaughter weight with no apparent detrimental effects on subsequent meat quality.

Quality of medicines stored together in multi-compartment compliance aids

Background and Objective: Dispensing medicines into compliance aids is a common practice in pharmacy contrary to manufacturers’ advice and studies have shown the appearance of light-sensitive tablets is compromised by such storage; we previously found evidence of reduced bioavailability at elevated temperature and humidity. Our objective was to examine the physicochemical stability of two generic atenolol tablets in different compliance aids and with aspirin co-storage at room temperature and at 40 °C/75% relative humidity. Methods: The physicochemical stability of atenolol tablets was evaluated after 28 days of storage and compared with controls by examining visual appearance, weight, disintegration, dissolution, friability and hardness to accepted standards and using a previously validated HPLC method for chemical assay. Results and Discussion: The response to storage was brand-dependent and not straightforward. With one make of atenolol (Alpharma), storage in compliance aids even at room temperature impacted on physical stability, reducing tablet hardness, with storage in Dosett® exerting a greater impact than storage in Medidos® (t-test P < 0·001). Co-storage at elevated temperature and humidity also impacted on the appearance of non-coated aspirin tablets (Angette™). The chemical stability of atenolol was not affected and we did not find evidence of changes to bioavailability with either make. Certainly data for one atenolol make (CP Pharmaceuticals) co-stored with aspirin (Angette™ and Nu-Seals) in both compliance aids at room temperature provided evidence of short-term stability. But medicines are dispensed into compliance aids in multi-factorial ways so our study highlights not only the lack of evidence but also a realization that evidence to support real practice may not be accomplished through research. Conclusion: Reassuring practitioners of the continued stability of medicines in compliance aids under the countless condition in which they are dispensed in practice may requires a different approach involving medical device regulators and more definitive professional guidance.

The effects of electronic prescribing on the quality of prescribing

Aims To investigate the effects of electronic prescribing (EP) on prescribing quality, as indicated by prescribing errors and pharmacists' clinical interventions, in a UK hospital. Methods Prescribing errors and pharmacists' interventions were recorded by the ward pharmacist during a 4 week period both pre- and post-EP, with a second check by the principal investigator. The percentage of new medication orders with a prescribing error and/or pharmacist's intervention was calculated for each study period. Results Following the introduction of EP, there was a significant reduction in both pharmacists' interventions and prescribing errors. Interventions reduced from 73 (3.0% of all medication orders) to 45 (1.9%) (95% confidence interval (CI) for the absolute reduction 0.2, 2.0%), and errors from 94 (3.8%) to 48 (2.0%) (95% CI 0.9, 2.7%). Ten EP-specific prescribing errors were identified. Only 52% of pharmacists' interventions related to a prescribing error pre-EP, and 60% post-EP; only 40% and 56% of prescribing errors resulted in an intervention pre- and post-EP, respectively. Conclusions EP improved the quality of prescribing by reducing both prescribing errors and pharmacists' clinical interventions. Prescribers and pharmacists need to be aware of new types of error with EP, so that they can best target their activities to reduce clinical risk. Pharmacists may need to change the way they work to complement, rather than duplicate, the benefits of EP.