A systems approach to reducing maternal obesity: The health in preconception, pregnancy and postbirth (HIPPP) collaborative

Obesity in our childbearing population has increased to epidemic proportions in developed countries; efforts to address this issue need to focus on prevention. The Health in Preconception, Pregnancy and Postbirth (HIPPP) Collaborative - a group of researchers, practitioners, policymakers and end-users - was formed to take up the challenge to address this issue as a partnership. Application of systems thinking, participatory systems modelling and group model building was used to establish research questions aiming to optimise periconception lifestyle, weight and health. Our goal was to reduce the burden of maternal obesity through systems change.

An examination of the influence of maternal depression trajectories on child cognitive development and adolescent psychotic experiences

 This thesis investigated trajectories of maternal depression over time, and their influence on offspring's cognitive development in childhood and subsequent risk of psychotic experiences in early adolescence. Offspring’s IQ was also examined as a potential mediator of the relationship between maternal depression and offspring’s risk of psychotic experiences.

Imagination, performance and affect: a critical pedagogy of the Holocaust?

Based on video testimony interviews held in the Shoah FoundationInstitute’s Visual History archive and the Melbourne JewishHolocaust Centre’s archive, this paper examines Holocaust survivortestimony as it relates to their return to the sites of atrocity,particularly Auschwitz-Birkenau. It analyses how survivor’s (re)encounters with material and imaginative landscapes revealsconceptions of, inter alia, agency, community, absence andbelonging in the performance of self. It uses these tensionsbetween landscapes of the past and present to develop thetheoretical relationship between performativity and ideas ofaffect. In doing so, it explores how these ideas can be used toengage students in a critical pedagogy of the Holocaust throughanalysis of survivor video-testimony and in visiting landscapes ofthe Holocaust.

Visual communication design as a form of public pedagogy

This paper identifies visual communication design as a form of public pedagogy. Communication design practices aim to achieve the successful transmission of a message to a recipient in a visual mode. Understanding the theories and practices of visual communication design can assist in enhancing the reception of the communication, as these practices become a tool to increase the effectiveness of learning in a public space. To demonstrate this, I will use the example of museums as an informal place of public learning, and argue design, and in particular visual communication design strategies, are extremely important in the creation of successful learning. If participants are not engaged or entertained, their capacity for learning will diminish. Engagement depends on the representation of the information and the successful interpretation of that information by the visitor. Further, this paper will emphasize the vital role communication design plays in all forms of public pedagogy, not just within the museum context. However, non-designers create many public learning environments and although this paper argues the benefits of communication design to increasing the effectiveness of learning, it recognizes the narrow opportunities of applying this knowledge.

Opportunities to promote healthy maternal weight during and following pregnancy

 This thesis has identified opportunities for provision of support for women to attain a healthy weight and healthy diet and physical activity behaviours during and following pregnancy. A better understanding of strategies to promote optimal support to women during the postpartum period has been achieved.

Pedagogy of the rural: implications of size on conceptualisations of rural

This paper proposes a concept of Pedagogy of the Rural that draws together current rural education theory and practice to illustrate the complexities of rural space and place often overlooked in teacher education more broadly. We firstly examine notions of size, and then we explore how this impacts on the ways in which teachers in rural locations are positioned in terms of their identity. Finally, we provide a way forward for valuing rural contexts for what they bring to teacher identities beyond traditional deficit positionings dominant in current discourses on rural education.

Socio-cultural disparities in GDM burden differ by maternal age at first delivery

Aims : Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are modifiable. However, few studies globally have examined socio-cultural associations. To eliminate confounding of increased risk of diabetes in subsequent pregnancies, elucidating socio-cultural associations requires examination only of first pregnancies.

Methods : Data for all women who delivered their first child in Victoria, Australia between 1999 and 2008 were extracted from the Victorian Perinatal Data Collection. Crude and adjusted GDM rates were calculated. Multivariate logistic regression was used to examine odds of GDM within and between socio-cultural groups.

Results : From 1999 to 2008, 269,682 women delivered their first child in Victoria. GDM complicated 11,763 (4.4%) pregnancies and burden increased with maternal age, from 2.1% among women aged below 25 years at delivery to 7.0% among those aged 35 years or more. Among younger women, GDM rates were relatively stable across socioeconomic levels. Amongst older women GDM rates were highest in those living in most deprived areas, with a strong social gradient. Asian-born mothers had highest GDM rates. All migrant groups except women born in North-West Europe had higher odds of GDM than Australian-born non-Indigenous women. In all ethnic groups, these differences were not pronounced among younger mothers, but became increasingly apparent amongst older women.

Conclusions : Socio-cultural disparities in GDM burden differ by maternal age at first delivery. Socio-cultural gradients were not evident among younger women. Health and social programs should seek to reduce the risk amongst all older women to that of the least deprived older mothers.

Mothers and sons: feminist maternal practice with boys

Through in-depth interviews with feminist mothers the research explores women’s experiences of raising sons. Analysis identifies that feminist mothers make a clear distinction between the boy and the discourse about the boy. Their maternal practice contests and shifts the dominant narrative enabling the foundation for the mother and son relationship to write a new script.

Detection of Candida spp. in the vagina of a cohort of nulliparous pregnant women by culture and molecular methods: is there an association between maternal vaginal and infant oral colonisation?

BACKGROUND: Most studies describing vaginal Candida spp. in pregnancy focus on symptomatic vaginitis, rather than asymptomatic colonisation, and solely utilise microbiological culture. The extent to which asymptomatic vaginal carriage may represent a reservoir for infant oral colonisation has been highly debated. MATERIALS AND METHODS: This study formed part of the Candida and Staphylococcus Transmission Longitudinal Evaluation (CASTLE) study, in Melbourne, Australia, from 2009 to 2011 and used culture and molecular methods to examine vaginal swabs collected late in the third trimester of pregnancy for Candida spp. Oral swabs from infants were also examined using culture methods. RESULTS: Overall, 80 of 356 (22%) women were positive for Candida spp; the majority being Candida albicans (83%). Candida glabrata and other Candida spp. were also identified, but in much lower numbers. Molecular analysis identified numerous positive samples not detected by culture, including 13 cases of C. albicans. In addition, some positive samples only recorded to genus level by culture were accurately identified as either C. albicans or C. glabrata following molecular analyses. Eighteen infants recorded positive Candida spp. cultures, predominantly C. albicans. However, there were only four (25%) mother/infant dyads where C. albicans was detected. CONCLUSIONS: This study provides valuable data on asymptomatic colonisation rates of Candida spp. within an asymptomatic population of women late in pregnancy. The utilisation of molecular methods improved the rate of detection and provided a more accurate means for identification of non-albicans Candida spp. The low mother/infant colonisation rate suggests that non-maternal sources are likely involved in determining infant oral colonisation status.

Dual-axis hormonal covariation in adolescence and the moderating influence of prior trauma and aversive maternal parenting

Adversity early in life can disrupt the functioning of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes and increase risk for negative health outcomes. The interplay between these axes and the environment is complex, and understanding needs to be advanced by the investigation of the multiple hormonal relationships underlying these processes. The current study examined basal hormonal associations between morning levels of cortisol, testosterone, and dehydroepiandrosterone in a cohort of adolescents (mean age 15.56 years). The moderating influence of childhood adversity was also examined, as indexed by self-reported trauma (at mean age 14.91), and observed maternal aggressive parenting (at mean age 12.41). Between-person regressions revealed significant associations between hormones that were moderated by both measures of adversity. In females, all hormones positively covaried, but also interacted with adversity, such that positive covariation was typically only present when levels of trauma and/or aggressive parenting were low. In males, hormonal associations and interactions were less evident; however, interactions were detected for cortisol-testosterone - positively covarying at high levels of aggressive parenting but negatively covarying at low levels - and DHEA-cortisol - similarly positively covarying at high levels of parental aggression. These results demonstrate associations between adrenal and gonadal hormones and the moderating role of adversity, which is likely driven by feedback mechanisms, or cross-talk, between the axes. These findings suggest that hormonal changes may be the pathway through which early life adversity alters physiology and increases health risks, but does so differentially in the sexes; however further study is necessary to establish causation.

Maternal depressive and anxiety symptoms, self-esteem, body dissatisfaction and preschooler obesity: a cross-sectional study

The primary aim of the present study was to cross-sectionally examine the associations between maternal psychosocial variables, child feeding practices, and preschooler body mass index z-score (BMI-z) in children (aged 2–4 years). A secondary aim was to examine differences in child weight outcomes between mothers scoring above and below specified cut-offs on the psychosocial measures. Two hundred and ninety mother–child dyads were recruited from Melbourne, Australia, and completed questionnaires examining demographic information, mothers’ depressive and anxiety symptoms, self-esteem and body dissatisfaction, restrictive and pressure child feeding practices, and preschoolers’ BMI-z scores. Independent t-tests and hierarchical multiple regression were employed to analyse the data. In the final regression model, none of the maternal psychosocial measures or feeding practices predicted child BMI-z scores; maternal body mass index and employment status were the only predictors of preschooler BMI-z. However, independent t-tests revealed that children of mothers with elevated body dissatisfaction scores had significantly higher BMI-z scores than children of mothers without elevated scores. The results suggest that psychosocial variables are not related, cross-sectionally, to preschooler weight outcomes; however, further research is needed to replicate the group differences noted between mothers with and without body dissatisfaction, and to track these relationships longitudinally.

Maternal prenatal mental health and placental 11β-HSD2 gene expression: initial findings from the mercy pregnancy and emotional wellbeing study

High intrauterine cortisol exposure can inhibit fetal growth and have programming effects for the child's subsequent stress reactivity. Placental 11beta-hydroxysteroid dehydrogenase (11β-HSD2) limits the amount of maternal cortisol transferred to the fetus. However, the relationship between maternal psychopathology and 11β-HSD2 remains poorly defined. This study examined the effect of maternal depressive disorder, antidepressant use and symptoms of depression and anxiety in pregnancy on placental 11β-HSD2 gene (HSD11B2) expression. Drawing on data from the Mercy Pregnancy and Emotional Wellbeing Study, placental HSD11B2 expression was compared among 33 pregnant women, who were selected based on membership of three groups; depressed (untreated), taking antidepressants and controls. Furthermore, associations between placental HSD11B2 and scores on the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale (EPDS) during 12-18 and 28-34 weeks gestation were examined. Findings revealed negative correlations between HSD11B2 and both the EPDS and STAI (r = -0.11 to -0.28), with associations being particularly prominent during late gestation. Depressed and antidepressant exposed groups also displayed markedly lower placental HSD11B2 expression levels than controls. These findings suggest that maternal depression and anxiety may impact on fetal programming by down-regulating HSD11B2, and antidepressant treatment alone is unlikely to protect against this effect.

Cross-curriculum design: enacting inclusive pedagogy and curriculum

The chapter is a practise led example of how the inclusive pedagogical approach in action (IPAA) framework lives as evidence of inclusive pedagogy. In particular it draws on understandings of cross-curriculum design as an approach that supports teaching practises for all children. Some readers may be familiar with the language of curriculum differentiation. Commonalties may be seen in the approaches that advocate for curriculum differentiation and cross-curriculum design, however not a lot is gained by adding another language game or rule of curriculum talk which asserts the power of difference by applying the language of differentiation as the focus for inclusive pedagogical action. As the IPAA framework stresses, teachers must believe that they are qualified and capable of teaching all children. Teachers who are engaged in the IPAA in action continually develop creative new ways of working and their professional stance is one where they are willing to work with others (including all of their students) to continually enhance their professional learning through practise orientations. Hence, in this chapter, both the theoretical underpinnings of effective teaching associated with the cross-curriculum design are assumed to have a potential link to any one of the other curricular areas specified in this book. Cross-curriculum design inherently foregrounds inclusive pedagogical possibilities and a concern for knowing more about curriculum theorising and reimaging classroom practice for all students, that is engaging in generative and productive pedagogical work.