Preventing mental health problems in children : the families in mind population-based cluster randomised controlled trial.

Background

Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care).
Design

Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months. Participants: Families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care. Intervention: (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems. Analysis: Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective.
Discussion

This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed.

Reality therapy and the human energy field : working with needs that influence mind and body

There is accumulating evidence that body and mind, or rather the physical and the non-physical, are intrinsically connected. The mechanisms through which reality therapy works on mind and body may be explained via positive dynamics in the central nervous system, the body's biochemistry and the human energy field. The purpose of this paper is to show the relationship between choice theory and the nature of the power centers in the human energy field. Understanding the drivers behind human behavior and facilitating the choice to think realistically and to make responsible choices assists wholeness and enhances the physical, mental and spiritual health.

Representing the mind: adult talk to speech-delayed preschoolers

There is evidence from a range of studies that adult input influences a young child's language development Of interest is how adult input contributes to emotional and cognitive understandings. Children with special needs in mainstream schools are expected to develop social skills which entails the understanding of a situation from the perspective of other participants. The question is whether children with a speech delay hear adult language that helps them develop a theory of mind. The study of the acquisition of a theory of mind has focused on children who have been asked to carry out tasks demonstrating their understanding of what another person might be thinking. Tager-Flusberg et al. (2001) have found that children who perform better on theory of mind tasks are children who talk about thoughts and feelings. The present study looks at mental state language input provided to children that might help them learn to talk about thoughts and feelings. Activities involving children and their mothers, and activities in a preschool program were studied for cognitive and emotional content in the adult input. The input provided to normally developing children would be more supportive of the development of their talk about thoughts and feelings.

Portals of the mind

The idea of a gateway or portal to another world is common in myth and fantasy, and, obviously, far older than the use of the same notion in computing. While computing portals take researchers to other domains of data, the use of portals in myths is often far more complex. In creation myths, the passing of portals has immense consequences for humankind, as in Adam and Eve's expulsion from their carefree existence in the Garden of Eden (unleashing the world's woes upon their descendants), and in the carrying away of Persephone by Pluto into the Underworld (leaving a legacy of cold and sunless months each year). In other types of myths, and in the fantastic tales they have bequeathed, portals provide heroes with strange and wonderful adventures, and with experiences that leave heroes irrevocably changed. This article will now explore these types of portals in more detail.The idea of a gateway or portal to another world is common in myth and fantasy, and, obviously, far older than the use of the same notion in computing. While computing portals take researchers to other domains of data, the use of portals in myths is often far more complex. In creation myths, the passing of portals has immense consequences for humankind, as in Adam and Eve's expulsion from their carefree existence in the Garden of Eden (unleashing the world's woes upon their descendants), and in the carrying away of Persephone by Pluto into the Underworld (leaving a legacy of cold and sunless months each year). In other types of myths, and in the fantastic tales they have bequeathed, portals provide heroes with strange and wonderful adventures, and with experiences that leave heroes irrevocably changed. This article will now explore these types of portals in more detail.

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.