The effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants : study protocol for a randomized controlled trial

Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. Methods/design: A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. Primary outcome: proportion of mothers exclusively breastfeeding at eight weeks after discharge. Secondary outcomes: proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be undertaken with mothers and staff. Discussion: This paper presents the rationale, study design and protocol for a RCT providing person-centred proactive telephone support to mothers of preterm infants. Furthermore, with a health economic evaluation, the cost-effectiveness of the intervention will be assessed. Trial registration: NCT01806480

Can humming caregivers´ facilitate feeding during mealtime situations with persons with dementia? A qualitative study

Background. ‘Music Therapeutic Caregiving’, defined as when caregivers’ sing for or together with persons with dementia care situations, has been shown to facilitate the caring situation, and enhance positive and decrease negative expressions in persons with dementia. No studies about singing during mealtimes have been conducted, and this project was designed to elucidate this. However, since previous studies have shown that there is a risk that persons with dementia will start to sing along with the caregiver, the caregiver in this study hummed such that the person with dementia did not sing instead of eat. Aim. To describe professional caregivers’ experiences of humming during meal time while feeding persons with dementia. Method. An intervention with caregivers humming was implemented during lunch time. Focus group interviews were conducted to fetch the caregivers experiences. Qualitative content analysis was used to analyse the interviews. Results. The caregivers described that humming disseminated relaxation and joy, and awakened memories about the songs hummed which encouraged the persons with the dementia to join in the songs. They also described that humming seemed to make the persons with dementia associate with mealtime and could make them eat more. However it also revealed suspiciousness and agitation from the persons with dementia. Conclusion. Humming during mealtime revealed mainly positive as well as some negative influences. More and larger studies are needed to be able to draw general conclusions.

How do early parenting centres support women with an infant who has a sleep problem?

Some women who have an infant experiencing sleep problems are so sleep deprived themselves that admission to an early parenting centre is needed to help them better manage the situation. This paper reports on a qualitative study that used focus group methods to interview familes who were admitted to an early parenting centre for persistent infant sleep problems. Results showed that parents needed a variety of strategies such as instructional, emotional and physical supports to develop confidence to manage infant's sleep disturbance at home.

A blue whale (Balaenoptera musculus) feeding ground in a southern Australian coastal upwelling zone

A localised aggregation of blue whales. which may be pygmy blue whales (B. m. brevicauda), occurs in southern Australian coastal waters (between I39°45'E-143°E) during summer and autumn (December-May), where they feed on coastal krill (Nyctiphanes australis). a species which often forms surface swarms. While the abundance of blue whales using this area is unknown, up to 32 blue whales have been sighted in individual aerial  surveys. Krill appear to aggregate in response to enhanced productivity  resulting from the summer-autumn wind-forced Bonney Coast upwelling along the continental shelf. During the upwelling's quiescent (winter-spring) period. blue whales appear to be absent from the region. Krill surface  swarms have been associated with 48% of 261 blue whale sightings since 1998, with direct evidence of feeding observed in 36% of all sightings. Mean blue whale group size was 1.55 (SD =0.839), with all size classes represented including calves. This seasonally predictable upwelling system is evidently a regular feeding ground for blue whales, and careful  management of human activities is required there.

A preliminary examination of the diet and feeding of sea sweep Scorpis aequipinnis (Pisces: Scorpididae) from coastal waters of south-western Victoria, Australia

The diet and feeding of sea sweep (Scorpis aequipinnis) was investigated from 230 specimens collected from the south-western Victorian coastline between January and July, 2002. Stomach content analysis indicated that S. aequipinnis are browsing omnivores (55.6% algae, 25.4% animal, by dry weight), with rhodophytes found to be the most important component of their diet (93.5% frequency of occurrence; 42.6% dry weight; 45.5% prey-specific abundance). However, the relative proportions of the major dietary components differed significantly between size classes. The dietary composition of small individuals ( < 150 mm total length) was significantly different to larger individuals, primarily due to a higher degree of carnivory exhibited by the smaller fish. S. aequipinnis were found to be highly flexible feeders exploiting both benthic and pelagic food resources, characterised by irregular periods of selective carnivorous feeding.

Performance of murray cod, Maccullochella peelii peelii (Mitchell) in response to different feeding schedules

The Australian freshwater fish Murray cod, Maccullochella peelii peelii (Mitchell) is gaining popularity as a suitable species for intensive culture, particularly in closed systems. The aim of this study was to evaluate the performance of Murray cod in response to different feeding schedules. Growth, survival, food conversion and a range of other related parameters including carcass proximate composition were evaluated for fish in five feed management regimes. The feeding regimes used in the experiment were hand fed to satiation twice daily (SAT), a pre-determined ration of 1.2% of the body weight day−1 which was hand fed twice daily (HFR), and belt fed through the day only (B/D), belt fed through the night only (B/N) and belt fed for 24 h (B/DN). Each of the five feeding regimes was randomly allocated to three tanks (triplicates). All of the feeding regimes used a commercially prepared diet formulated specifically for Murray cod, containing ≈50% protein and ≈16% lipid. The experiment was conducted for 84 days. Specific growth rate ranged from 0.89±0.01 to 1.07±0.04% day−1. Food conversion ratio (FCR) ranged from 1.09±0.02 to 0.92±0.03. The fastest growth and greatest final body weight were observed in the SAT treatment; however, the highest FCR, visceral fat index (VFI %) and hepatosomatic index (HSI %) were also observed in this treatment. Significant differences were found in specific growth rate and final mean weight between fish in the B/D and SAT treatments. B/N and B/DN feeding regimes appeared to result in the most favourable fish performance.

Feeding the chooks in the country: a study of successful public relations media strategies in regional Victoria

"Media reporting on regional issues has tended to focus on the negative leaving many urban based Australians with a bleak portrait of rural Australia and it's fuure." (McNeill 2003) This paper looks at the two regional centres of Ballarat and Warrnambool. Through analysis of local papers and in conjunction with interviews with local journalists and public relations practitioners, it begins a dissection of the news production process in these locales. Content analysis reveals the nature of news coverage and the role of key sources, in particular public relations, determining the type of coverage in these centres.

Foraging ecology of ground-feeding woodland birds in temperate woodlands of Southern Australia

Ground-foraging birds of temperate woodlands of southern Australia are prominent among bird species considered to be susceptible to population decline. We examined the foraging ecology, including foraging substrates, actions and heights, of 13 ground-foraging species at four woodland sites in northern Victoria. Nine species are regarded as declining in southern Australia and four are considered common. Ten foraging substrates were identified, of which leaf-litter (54% of observations) and bare ground (17%) were most frequently used. In all woodland sites, litter was used more frequently than expected from its proportional cover. Bare ground was frequently used as a substrate by individual species, and fallen timber and grass were important for some species. Most species were generalists in their use of substrates. Six foraging actions were observed, of which gleaning and pouncing were most frequently recorded. All species foraged close to the ground and four foraged almost entirely at ground level. For pouncing birds, dead branches and fallen timber were the most important launch substrates from which pouncing actions were initiated. Eight of the 13 species differed in some aspect of their foraging ecology between woodland sites, especially in relation to the use of substrates (seven species). Fewer species (four) displayed differences in foraging ecology between seasons, with the greatest seasonal variation being in use of foraging substrates (three species). Overall, no significant differences were evident in the foraging ecologies of common and declining species. Species in both groups encompassed a wide range of foraging behaviours. Owing to this range in foraging ecology, the conservation of diverse assemblages of ground-foraging birds requires the maintenance of heterogeneous ground layers and careful management of disturbance processes.

Selective feeding centres in refugee settings: evaluation framework protocol

Selective feeding programs are centres for the treatment of persons suffering from acute malnutrition. Unlike chronic malnutrition, acute malnutrition reflects recent problems. In a crisis situation, wasting is preferred above other indicators because it is sensitive to rapid change, indicates present change, can be used to monitor the impact of interventions and is a good predictor of immediate mortality risk. This paper reviews the current approach being used in the field to evaluate the effectiveness of feeding programs. There is no comprehensive evaluation framework in place to assess the impact of feeding programs on mortality due to malnutrition. Some loose outcome measures, such as the number of children enrolled in a feeding centre, are being used to determine if a feeding centre should continue. In addition, malnutrition prevalence and crude mortality rates determined through nutritional and mortality surveys are used to assess the impact of feeding programs. This procedure does not take into account potential confounding factors that impact on malnutrition prevalence, including access to non-relief foods and the general food ration. Therefore, one could not confidently say that the reduction of malnutrition prevalence is a result of feeding programs. This paper presents an alternative approach to evaluating feeding centres.

Parental decision-making surrounding complicated births: the impact on parent-infant and infant-marital relationships

This paper reviews current research regarding the impact of birth complications on parental decisionmaking, and the resulting effects on parent-infant and infant-marital relationships. It discusses the importance of informed decision-making on parental satisfaction of the birthing experience, and the benefits of certain strategies, such as kangaroo care, in the facilitation of greater levels of attachment and improved relationships. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

Gardner; re BWW: Victorian Supreme Court makes landmark Australian ruling on tube feeding

• The Victorian Supreme Court has decided that artificial nutrition and hydration provided through a percutaneous gastrostomy tube to a woman in a persistent vegetative state may be withdrawn.
• The judge ruled, in line with a substantial body of international medical, ethical and legal opinion, that any form of artificial nutrition and hydration is a medical procedure, not part of palliative care, and that it is a procedure to sustain life, not to manage the dying process.
• Thus, the law does not impose a rigid obligation to administer artificial nutrition or hydration to people who are dying, without due regard to their clinical condition. The definition of key terms such as “medical treatment”, “palliative care”, and “reasonable provision of food and water” in this case will serve as guidance for end-of-life decisions in other states and territories.
• The case also reiterates the right of patients, and, when incompetent, their validly appointed agents or guardians, to refuse medical treatment.
• Where an incompetent patient has not executed a binding advance directive and no agent or guardian has been appointed, physicians, in consultation with the family, may decide to withdraw medical treatment, including artificial nutrition or hydration, on the basis that continuation of treatment is inappropriate and not in the patient’s best interests. However, Victoria and other jurisdictions would benefit from clarification of this area of the law

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.

Time-budget and feeding behaviour of the squirrel glider (petaurus norfolcensis) in remnant linear habitat

The squirrel glider (Petaurus norfolcensis) occurs in forests and woodlands in eastern Australia. In Victoria it is now largely restricted to small, fragmented areas and is considered endangered. In this study, the time-budget, feeding behaviour and related habitat use of the squirrel glider were investigated in a linear remnant of roadside vegetation near Euroa, Victoria. Timed observations of three males and three females, fitted with radio-collars, were made in each of four seasons. Gliders were observed for a total of 53.2 h, during which they devoted 72% of time to foraging activities. Grooming accounted for 16% of observation time. Exudates associated with homopterous insects were the primary food items consumed throughout the year. Arthropods, nectar and pollen, and Acacia gum formed the remainder of the diet. The proportion of time devoted to harvesting these food items showed marked seasonal variation. The primary dependence on homopterous insect exudates in this study area contrasts with other investigations at sites of greater floristic diversity where nectar and pollen were the most important dietary resources. This highlights the need to obtain ecological information from the range of habitats occupied by a species. Large trees are a vital habitat component of remnant linear vegetation in this study area, providing gliders with critical foraging resources. Retention of such trees is essential for the longevity of glider populations.

What about the mother and family when an infant doesn`t sleep?

Becoming a new parent is a time of enormous change in the lifestyle of women, particularly as women are expected to take on prime responsibly for caring for the child. Motherhood can be exhausting and lonely as women cope with the demands of a new baby. These demands are exacerbated when infants do not sleep. This causes many parents to seek professional intervention with persistent infant sleep problems. Through focus group interviews, this study sought to understand the experiences of 28 women and families in how they coped with and managed an infant with sleep problems. Results indicated that women experienced major role confusion as they internalised the image that 'a good mother does it all'. Persistent infant crying and their own sleep deprivation exacerbated their loss of identity and shattered their self image, and caused anger and confusion in some partners. Each woman sought primary health care support through a five day residential stay in an Early Parenting Centre in Victoria. The women found that this professional support facilitated confidence building and feelings of normality. Most important, staff encouraged the women to feel good about themselves and their ability to manage future sleep problems.