The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

The evolution of freedom of association in Australia's federal industrial relations law: from trade union security to workplace rights

The early provisions protecting freedom of association in Australian federal industrial relations law supported trade union security. The interests of individuals were seen as adequately protected by collective groups. This principle dominated the industrial relations laws from 1904 to the mid-1970s. However, from the late 1970s, the laws were incrementally altered to promote freedom of choice and the rights of individuals not to be part of trade unions. The reframing of the laws also reflected changes in the wider Australian community, manifested particularly in the decline of union density rates. These changes were also part of an international trend, favouring the ideology of neoliberalism which contributed to an unsympathetic environment for trade unions. The current Fair Work Act 2009 (Cth) has signalled a return to collectivism, although freedom of choice is at the heart of the laws rather than the promotion of collective groups. In the absence of legislative support promoting the viability of collective groups, this freedom to choose is threatened, leaving many workers with little choice but to disassociate.

Asian immigrant parents’ and New Zealand early childhood teachers’ views of parent-teacher relationships

The growing number of Asian children entering the New Zealand early childhood education system means that teachers cannot ignore the need to develop an understanding of Asian cultures and practices that support working collaboratively with Asian families. This paper examines the views of a small number of Asian immigrant parents and New Zealand early childhood teachers about parent-teacher partnerships in children’s early education and care. The findings point to challenges for both parents and teachers. The paper highlights some major problems or barriers to the achievement of effective partnerships between Asian immigrant parents and New Zealand early childhood teachers, namely parental and teacher confidence, time, and willingness or perception of need to develop a partnership. Some recommendations for improving teacher practices are outlined. It is concluded that given the limitations of this study and yet the issues it has raised, that this is topic which needs to be more systematically researched.

Negotiating and creating intercultural relations: Chinese immigrant children in New Zealand early childhood education centres

A multiple-case study investigation of the experiences of eight Chinese immigrant children in New Zealand early childhood centres suggested that the immigrant children’s learning experiences in their first centre can be understood as a process of negotiating and creating intercultural relations. The children’s use of family cultural tools, such as the Chinese language, was a distinctive feature of their learning experiences, simultaneously revealing and extending their exploration of the intercultural practices and their establishment of a sense of belonging. In the presence of Chinese-speaking peers who acted as ‘bridges’ and ‘boundary objects’, the Chinese language was actively used by the immigrant children in English-speaking early childhood centres and, as a result, they created intercultural relations which: (i) bridged the two cultures; (ii) brought the cultures into convergence; (iii) enabled the children to claim group identity; and (iv) battled intercultural constraints. The absence of Chinese speakers, on the other hand, constrained possibilities for intercultural relations. The focus on intercultural relations in this study is expected to lead to educational initiatives to support the incorporation of diverse cultures in early childhood services.

The extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) Program : a cluster-randomized controlled trial of an early intervention to prevent childhood obesity

BACKGROUND: Understanding how we can prevent childhood obesity in scalable and sustainable ways is imperative. Early RCT interventions focused on the first two years of life have shown promise however, differences in Body Mass Index between intervention and control groups diminish once the interventions cease. Innovative and cost-effective strategies seeking to continue to support parents to engender appropriate energy balance behaviours in young children need to be explored. METHODS/DESIGN: The Infant Feeding Activity and Nutrition Trial (InFANT) Extend Program builds on the early outcomes of the Melbourne InFANT Program. This cluster randomized controlled trial will test the efficacy of an extended (33 versus 15 month) and enhanced (use of web-based materials, and Facebook® engagement), version of the original Melbourne InFANT Program intervention in a new cohort. Outcomes at 36 months of age will be compared against the control group. DISCUSSION: This trial will provide important information regarding capacity and opportunities to maximize early childhood intervention effectiveness over the first three years of life. This study continues to build the evidence base regarding the design of cost-effective, scalable interventions to promote protective energy balance behaviors in early childhood, and in turn, promote improved child weight and health across the life course. TRIAL REGISTRATION: ACTRN12611000386932 . Registered 13 April 2011.

Cross-fostering reduces obesity induced by early exposure to monosodium glutamate in male rats

Maternal obesity programmes a range of metabolic disturbances for the offspring later in life. Moreover, environmental changes during the suckling period can influence offspring development. Because both periods significantly affect long-term metabolism, we aimed to study whether cross-fostering during the lactation period was sufficient to rescue a programmed obese phenotype in offspring induced by maternal obesity following monosodium L-glutamate (MSG) treatment. Obesity was induced in female Wistar rats by administering subcutaneous MSG (4 mg/g body weight) for the first 5 days of postnatal life. Control and obese female rats were mated in adulthood. The resultant pups were divided into control second generation (F2) (CTLF2), MSG-treated second generation (F2) (MSGF2), which suckled from their CTL and MSG biological dams, respectively, or CTLF2-CR, control offspring suckled by MSG dams and MSGF2-CR, MSG offspring suckled by CTL dams. At 120 days of age, fat tissue accumulation, lipid profile, hypothalamic leptin signalling, glucose tolerance, glucose-induced, and adrenergic inhibition of insulin secretion in isolated pancreatic islets were analysed. Maternal MSG-induced obesity led to an obese phenotype in male offspring, characterized by hyperinsulinaemia, hyperglycaemia, hyperleptinaemia, dyslipidaemia, and impaired leptin signalling, suggesting central leptin resistance, glucose intolerance, impaired glucose-stimulated, and adrenergic inhibition of insulin secretion. Cross-fostering normalized body weight, food intake, leptin signalling, lipid profiles, and insulinaemia, but not glucose homeostasis or insulin secretion from isolated pancreatic islets. Our findings suggest that alterations during the lactation period can mitigate the development of obesity and prevent the programming of adult diseases.

Trial application of a model of resource utiliztion, costs, and outcomes for stroke (MORUCOS) to assist priority setting in stroke.

Background and Purpose— Cost-effectiveness data for stroke interventions are limited, and comparisons between studies are confounded by methodological inconsistencies. The aim of this study was to trial the use of the intervention module of the economic model, a Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS) to facilitate evaluation and ranking of the options.

Methods— The approach involves using an economic model together with added secondary considerations. A consistent approach was taken using standard economic evaluation methods. Data from the North East Melbourne Stroke Incidence Study (NEMESIS) were used to model "current practice" (base case), against which 2 interventions were compared. A 2-stage process was used to measure benefit: health gains (expressed in disability-adjusted life years [DALYs]) and filter analysis. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic uncertainty analysis was undertaken.

Results— Aspirin, a low-cost intervention applicable to a large number of stroke patients (9153 first-ever cases), resulted in modest health benefits (946 DALYs saved) and a mean ICER (based on incidence costs) of US $1421 per DALY saved. Although the health gains from recombinant tissue-type plasminogen activator (rtPA) were less (155 DALYs saved), these results were impressive given the small number of persons (256) eligible for treatment. rtPA dominates current practice because it is more effective and cost-saving.

Conclusions— If used to assess interventions across the stroke care continuum, MORUCOS offers enormous capacity to support decision-making in the prioritising of stroke services.

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.

The impact of guanxi on export performance: A study of New Zealand firms exporting to China

Broadly defined as interpersonal relationship in Chinese society, guanxi embodies several intricate and unique Chinese cultural values. Although more and more western business people are becoming increasingly aware of the importance of guanxi in doing business in China, its potential impacts on the performance of business are still not well understood by western business people. This paper uses path analysis to assess the impacts of guanxi on export performance of a sample of New Zealand firms exporting to China. The results show that guanxi variables significantly facilitate trade partnering, business negotiating, and problem solving and generally contributes positively to the overall export performance of firms.

Primary healthcare costs associated with sleep problems up to age 7 years: Australian population-based study

This article studies Australian 0-7-year olds with and without sleep problems and compares the type and costs to government of non-hospital healthcare services and prescription medication in each year of age and  the cumulative costs according to persistence of the sleep problem.