Low-income first time mothers: Effects on advanced practice nurse (APN) follow up telephone calls on maternal and infant health and health care charges

The United States has over 4 million births annually. Currently healthy women with non-complicated deliveries receive little to no routine postpartum support when discharged from the hospital. This is especially problematic if mothers are first time mothers, poor, have language barriers and little to no social support after giving birth. The purpose of this randomized clinical trial was to compare maternal and infant health outcomes, and health care charges between 2 groups of mothers and newborns. A control ( n = 69) group received routine posthospital discharge care. An intervention group (n = 70) received routine posthospital discharge care plus follow up telephone calls by advanced practice nurses (APNs) on days 3,7,14,21,28 and week 8. Both groups were followed for the first 8 weeks posthospital discharge following delivery to examine maternal health outcomes (perceived maternal stress, social support and perceived maternal physical health), infant health outcomes (routine medical follow up visits immunizations, weight gain), morbidity (urgent care visits, emergency room visits, rehospitalizations), health care charges (urgent care visits, emergency room visits, rehospitalizations) in both groups and charges for APN follow up in the intervention group only. Data were analyzed using descriptive statistics and two-sample t-tests. Study findings indicated that intervention group had significantly lower perceived maternal stress, significantly higher rating of perceived maternal health and higher levels of social support and by the end of the 2nd month posthospital discharge compared to control group mothers. Infants in the intervention group had: increased number of immunizations; fewer emergency room visits; and 1 infant rehospitalization compared to 3 infant rehospitalizations in the control group. The intervention groups' health care charges were significantly lower compared to the control group $14,333/$497 vs. $70,834/$1,068. These study results indicate that an intervention of APN follow up telephone calls in this sample of first time low-income culturally diverse mothers was an effective, safe, low cost, easy to apply intervention which improved mothers' and infants' health outcomes and reduced healthcare charges.

Fatty acids and stable isotopes as indicators of early-life feeding and potential maternal resource dependency in the bull shark Carcharhinus leucas

The degree of reliance of newborn sharks on energy reserves from maternal resource allocation and the timescales over which these animals develop foraging skills are critical factors towards understanding the ecological role of top predators in marine ecosystems. We used muscle tissue stable carbon isotopic composition and fatty acid analysis of bull sharks Carcharhinus leucas to investigate early-life feeding ecology in conjunction with maternal resource dependency. Values of δ13C of some young-of-the-year sharks were highly enriched, reflecting inputs from the marine-based diet and foraging locations of their mothers. This group of sharks also contained high levels of the 20:3ω9 fatty acid, which accumulates during periods of essential fatty acid deficiency, suggesting inadequate or undeveloped foraging skills and possible reliance on maternal provisioning. A loss of maternal signal in δ13C values occurred at a length of approximately 100 cm, with muscle tissue δ13C values reflecting a transition from more freshwater/estuarine-based diets to marine-based diets with increasing length. Similarly, fatty acids from sharks >100 cm indicated no signs of essential fatty acid deficiency, implying adequate foraging. By combining stable carbon isotopes and fatty acids, our results provided important constraints on the timing of the loss of maternal isotopic signal and the development of foraging skills in relation to shark size and imply that molecular markers such as fatty acids are useful for the determination of maternal resource dependency.

Effects of Contingent Maternal Imitation vs. Contingent Motherese Speech on Infant Canonical Babbling

Maternal vocal stimulation plays a vital role in infants’ language acquisition. Contingent maternal imitation and contingent motherese speech were used in an alternating sequence as reinforcers to a 12 month-old infant’s canonical babbling. Both vocal contingencies function as reinforcers; however, motherese speech produced the highest frequency of canonical babbling.

The effects of paternal and maternal nurturance and involvement on young adult academic outcomes

The present study examines how mothering and fathering impact child academic outcomes in divorced and intact families, and if there are unique influences of mothering and fathering variables for sons and daughters. An ethnically diverse sample of 1,714 university students from Florida International University (n=1371) and Florida State University (n=343) responded to measures on a questionnaire that included the Nurturant Fathering and Mothering Scales (Finley & Schwartz, 2004; Schwartz & Finley, 2005; Finley & Schwartz, 2006), the Mother and Father Involvement Scales (Finley, Mira, & Schwartz, 2008), demographic measures, and academic outcome measures. In intact families, mothering and fathering variables were significantly correlated with each other, and positively correlated with child academic outcomes including grades, GPA, academic satisfaction, and academic importance. In divorced families, mothering and fathering variables were not correlated with each other. Furthermore, when analyzing divorced families, significant effects were found for both parent and child gender. Mothering variables were found to have the greatest positive impact for sons' academic outcomes. Maternal nurturance and maternal involvement were correlated positively with academic outcomes for sons from divorced families and accounted for 3-4% of the unique variance explained. Consistently, desired mother involvement, how much involvement the child wished they had received, was negatively correlated with academic outcomes for sons from divorced families and accounted for 10-15% of the unique variance explained. This means that when the amount of maternal involvement that sons in divorced families received matched or exceeded their desired level of involvement, sons had more positive academic outcomes including grades, GPA, satisfaction with academics and academic importance. This suggests that in intact family forms, nurturant and involved mothering and fathering have a positive effect on academic outcomes for sons and daughters. In divorced family forms, the effects of fathering on child academic outcomes were not significant. Therefore, in divorced families, the positive effects fathering on academic outcomes of sons and daughters drop out, and mothers are uniquely important for sons' academic success.^

The use of quantitative polymerase chain reaction amplification method to determine sex ratio of human spermatozoa in semen and to determine maternal contamination of amniotic fluid samples

We have modified a technique which uses a single pair of primer sets directed against homologous but distinct genes on the X and Y chromosomes, all of which are coamplified in the same reaction tube with trace amounts of radioactivity. The resulting bands are equal in length, yet distinguishable by restriction enzyme sites generating two independent bands, a 364 bp X-specific band and a 280 bp Y-specific band. A standard curve was generated to show the linear relationship between X/Y ratio average vs. %Y or %X chromosomal content. Of the 51 purified amniocyte DNA samples analyzed, 16 samples showed evidence of high % X contamination while 2 samples demonstrated higher % Y than the expected 50% X and 50% Y chromosomal content. With regards to the 25 processed sperm samples analyzed, X-sperm enrichment was evident when compared to the primary sex ratio whereas Y-sperm was enriched when we compared before and after selection samples.

The Effects of Paternal and Maternal Nurturance and Involvement on Young Adult Academic Outcomes

The present study examines how mothering and fathering impact child academic outcomes in divorced and intact families, and if there are unique influences of mothering and fathering variables for sons and daughters. An ethnically diverse sample of 1,714 university students from Florida International University (n=1371) and Florida State University (n=343) responded to measures on a questionnaire that included the Nurturant Fathering and Mothering Scales (Finley & Schwartz, 2004; Schwartz & Finley, 2005; Finley & Schwartz, 2006), the Mother and Father Involvement Scales (Finley, Mira, & Schwartz, 2008), demographic measures, and academic outcome measures. In intact families, mothering and fathering variables were significantly correlated with each other, and positively correlated with child academic outcomes including grades, GPA, academic satisfaction, and academic importance. In divorced families, mothering and fathering variables were not correlated with each other. Furthermore, when analyzing divorced families, significant effects were found for both parent and child gender. Mothering variables were found to have the greatest positive impact for sons’ academic outcomes. Maternal nurturance and maternal involvement were correlated positively with academic outcomes for sons from divorced families and accounted for 3-4% of the unique variance explained. Consistently, desired mother involvement, how much involvement the child wished they had received, was negatively correlated with academic outcomes for sons from divorced families and accounted for 10-15% of the unique variance explained. This means that when the amount of maternal involvement that sons in divorced families received matched or exceeded their desired level of involvement, sons had more positive academic outcomes including grades, GPA, satisfaction with academics and academic importance. This suggests that in intact family forms, nurturant and involved mothering and fathering have a positive effect on academic outcomes for sons and daughters. In divorced family forms, the effects of fathering on child academic outcomes were not significant. Therefore, in divorced families, the positive effects fathering on academic outcomes of sons and daughters drop out, and mothers are uniquely important for sons’ academic success.

Maternal-Fetal Attachment and Health Behaviors among Women with HIV/AIDS

Background: Mothers with HIV often face personal and environmental risks for poor maternal health behaviors and infant neglect, even when HIV transmission to the infant was prevented. Maternal-fetal attachment (MFA), the pre-birth relationship of a woman with her fetus, may be the precursor to maternal caregiving. Using the strengths perspective in social work, which embeds MFA within a socio-ecological conceptual framework, it is hypothesized that high levels of maternal-fetal attachment may protect mothers and infants against poor maternal health behaviors. Objective: To assess whether MFA together with history of substance use, living marital status, planned pregnancy status, and timing of HIV diagnosis predict three desirable maternal health behaviors (pregnancy care, adherence to prenatal antiretroviral therapy–ART, and infant’s screening clinic care) among pregnant women with HIV/AIDS. Method: Prospective observation and hypothesis-testing multivariate analyses. Over 17 consecutive months, all eligible English- or Spanish-speaking pregnant women with HIV ( n = 110) were approached in the principal obstetric and screening clinics in Miami-Dade County, Florida at 24 weeks’ gestation; 82 agreed to enroll. During three data collection periods from enrollment until 16 weeks after childbirth (range: 16 to 32 weeks), participants reported on socio-demographic and predictor variables, MFA, and pregnancy care. Measures of adherence to ART and infant care were extracted from medical records. Findings: Sociodemographic, pregnancy, and HIV disease characteristics in this sample suggest changes in the makeup of HIV-infected pregnant women parallel to the evolution of the HIV epidemic in the USA over the past two decades. The MFA model predicted maternal health behaviors for pregnancy care (R2 = .37), with MFA, marital living status, and planned pregnancy status independently contributing ( = .50, = .28, = .23, respectively). It did not predict adherence to ART medication or infant care. Relevance: These findings provide the first focused evidence of the protective role of MFA against poor maternal health behaviors among pregnant women with HIV, in the presence of adverse life circumstances. Social desirability biases in some self-report measures may limit the findings. Suggestions are made for orienting future inquiry on maternal health behaviors during childbirth toward relationship and protection.

The Broken Mirror: Maternal Agency and Identity in Charles Dickens's Bleak House

This paper examined how Esther Summerson, Dickens’s ideal good mother, can be understood as a woman who has maternal agency and identity both as a character and as a narrator, and how she contrasts with other maternal characters in the novel, both major and minor. While more transgressive mothers, such as Lady Dedlock, Mrs. Jellyby and even Krook’s cat, are doomed to death, ineffectiveness and madness, Esther moves from a frozen, “unsexualized” state into a space of life and sexual possibility. In addition, Esther has agency and identity as a narrator since she shares the narration with a third-person male narrator. Esther becomes the one who speaks rather than the one who is spoken of, and her maternal, nurturing voice provides a balm for the often harsh, judgmental voice of the male narrator. As the narrator’s patriarchal voice dies away at the end, it is Esther’s maternal voice that survives.