MOSAIC (MOthers' Advocates In the Community): protocol and sample description of a cluster randomised trial of mentor mother support to reduce intimate partner violence among pregnant or recent mothers

Background : Intimate partner violence (IPV) is prevalent globally, experienced by a significant minority of women in the early childbearing years and is harmful to the mental and physical health of women and children. There are very few studies with rigorous designs which have tested the effectiveness of IPV interventions to improve the health and wellbeing of abused women. Evidence for the separate benefit to victims of social support, advocacy and non-professional mentoring suggested that a combined model may reduce the levels of violence, the associated mental health damage and may increase a woman's health, safety and connection with her children. This paper describes the development, design and implementation of a trial of mentor mother support set in primary care, including baseline characteristics of participating women.

Methods/Design : MOSAIC (MOtherS' Advocates In the Community) was a cluster randomised trial embedded in general practice and maternal and child health (MCH) nursing services in disadvantaged suburbs of Melbourne, Australia. Women who were pregnant or with infants, identified as abused or symptomatic of abuse, were referred by IPV-trained GPs and MCH nurses from 24 general practices and eight nurse teams from January 2006 to December 2007. Women in the intervention arm received up to 12 months support from trained and supported non-professional mentor mothers. Vietnamese health professionals also referred Vietnamese women to bilingual mentors in a sub-study. Baseline and follow-up surveys at 12 months measured IPV (CAS), depression (EPDS), general health (SF-36), social support (MOS-SF) and attachment to children (PSI-SF). Significant development and piloting occurred prior to trial commencement. Implementation interviews with MCH nurses, GPs and mentors assisted further refinement of the intervention. In-depth interviews with participants and mentors, and follow-up surveys of MCH nurses and GPs at trial conclusion will shed further light on MOSAIC's impact.

Discussion : Despite significant challenges, MOSAIC will make an important contribution to the need for evidence of effective partner violence interventions, the role of non-professional mentors in partner violence support services and the need for more evaluation of effective health professional training and support in caring for abused women and children among their populations.

The development and validation of Australian indices of child development — part II : validity support

The two outcome indices described in a companion paper (Sanson et al., Child Indicators Research, 2009) were developed using data from the Longitudinal Study of Australian Children (LSAC). These indices, one for infants and the other for 4 year to 5 year old children, were designed to fill the need for parsimonious measures of children’s developmental status to be used in analyses by a broad range of data users and to guide government policy and interventions to support young children’s optimal development. This paper presents evidence from Wave 1data from LSAC to support the validity of these indices and their three domain scores of Physical, Social/Emotional, and Learning. Relationships between the indices and child, maternal, family, and neighborhood factors which are known to relate concurrently to child outcomes were examined. Meaningful associations were found with the selected variables, thereby demonstrating the usefulness of the outcome indices as tools for understanding children’s development in their family and socio-cultural contexts. It is concluded that the outcome indices are valuable tools for increasing understanding of influences on children’s development, and for guiding policy and practice to optimize children’s life chances.

Maternal self-efficacy regarding children's eating and sedentary behaviours in the early years : Associations with children's food intake and sedentary behaviours

Introduction. This cross-sectional study aimed to describe parents' views regarding self-efficacy to influence children's eating and sedentary behaviours at two time points in early childhood, and to examine associations between these views and children's eating and sedentary behaviours.

Methods. Mothers of 1-year (n=60) and 5-year-old children (n=80) were recruited through Maternal and Child Health Centres and kindergartens in Victoria, Australia. Mothers reported children's dietary intake, television viewing and perceptions of their self-efficacy regarding children's eating and sedentary behaviours.

Results. Overall, 5-year-old children consumed significantly more energy-dense food and drink and spent significantly more time viewing TV/DVD and video. Mothers of 1-year-olds were significantly more likely to report they felt confident to limit child's consumption of non-core foods/drinks, and to limit screen access (p<0.001). Measures of maternal self-efficacy were directly associated with 5-year-old children's water (p<0.05), and fruit and vegetable consumption (p<0.005), and with 1-year-old children's vegetable consumption (p<0.05), and were inversely associated with cordial and cake consumption (p<0.05). Maternal self-efficacy to limit viewing time was inversely associated with screen-time exposure in both age groups (p<0.01).

Conclusion. This study suggests that mother's self-efficacy regarding limiting non-core foods/drinks and limiting screen-time exposures may decline during the first few years of a child's life. Higher maternal self-efficacy was associated with children having more obesity protective eating and sedentary behaviours at both ages. Interventions to support the development of healthy lifestyle behaviours may be most effective if they target mothers' self-efficacy in these domains early in their child's life.

Mothers' AdvocateS In the Community (MOSAIC)- non-professional mentor support to reduce intimate partner violence and depression in mothers: a cluster randomised trial in primary care

Background : Effective interventions to increase safety and wellbeing of mothers experiencing intimate partner violence (IPV) are scarce. As much attention is focussed on professional intervention, this study aimed to determine the effectiveness of non-professional mentor support in reducing IPV and depression among pregnant and recent mothers experiencing, or at risk of IPV.

Methods : MOSAIC was a cluster randomised trial in 106 primary care (maternal and child health nurse and general practitioner) clinics in Melbourne, Australia. 63/106 clinics referred 215 eligible culturally and linguistically diverse women between January 2006 and December 2007. 167 in the intervention (I) arm, and 91 in the comparison (C) arm. 174 (80.9%) were recruited. 133 (76.4%) women (90 I and 43 C) completed follow-up at 12 months.

Intervention: 12 months of weekly home visiting from trained and supervised local mothers, (English & Vietnamese speaking) offering non-professional befriending, advocacy, parenting support and referrals.

Main outcome measures: Primary outcomes; IPV (Composite Abuse Scale CAS) and depression (Edinburgh Postnatal Depression Scale EPDS); secondary measures included wellbeing (SF-36), parenting stress (PSI-SF) and social support (MOS-SF) at baseline and follow-up.

Analysis: Intention-to-treat using multivariable logistic regression and propensity scoring.

Results : There was evidence of a true difference in mean abuse scores at follow-up in the intervention compared with the comparison arm (15.9 vs 21.8, AdjDiff -8.67, CI -16.2 to -1.15). There was weak evidence for other outcomes, but a trend was evident favouring the intervention: proportions of women with CAS scores ≥7, 51/88 (58.4%) vs 27/42 (64.3%) AdjOR 0.47, CI 0.21 to 1.05); depression (EPDS score ≥13) (19/85, 22% (I) vs 14/43, 33% (C); AdjOR 0.42, CI 0.17 to 1.06); physical wellbeing mean scores (PCS-SF36: AdjDiff 2.79; CI -0.40 to 5.99); mental wellbeing mean scores (MCS-SF36: AdjDiff 2.26; CI -1.48 to 6.00). There was no observed effect on parenting stress. 82% of women mentored would recommend mentors to friends in similar situations.

Conclusion : Non-professional mentor mother support appears promising for improving safety and enhancing physical and mental wellbeing among mothers experiencing intimate partner violence referred from primary care.

Maternal scaffolding of analogy and metacognition in the early pretence of gifted children.

This study investigated whether mothers of children assessed as having gifted/high IQ at 5 years were more likely to scaffold their children in analogical and metacognitive thinking during the infant/toddler period than mothers of children with more typical IQs. The researcher videotaped 21 children in monthly play sessions with their mothers, from the time that the children were 8 months old until they were 17 months old, and coded the mothers' verbalizations for scaffolding of analogical and metacognitive thinking. A psychologist assessed these children on the Stanford-Binet IV (Thorndike, 1986) and found ability levels ranging from average to high. Analysis showed that mothers of the children with high IQs introduced analogical and metacognitive scaffolding earlier than mothers of children with average IQs. The findings are consistent with a bidirectional model of gifted development in which mothers respond to support advanced development from infancy.

Maternal feeding practices predict weight gain and obesogenic eating behaviours in young children : a prospective study

Background Maternal feeding practices have been proposed to play an important role in early child weight gain and obesogenic eating behariours. However, to date longitudinal investigations in young children exploring these relationships have been lacking. The aim of the present study was to explore prospective relationships between maternal feeding practices, child weight gain and obesogenic eating behaviours in 2-year-old children. The competing hypothesis that child eating behaviours predict changes in maternal feeding practices was also examined.

Methods A sample of 323 mother (mean age = 35 years, + 0.37) and child dyads (mean age = 2.03 years, + 0.37 at recruitment) were participants. Mothers completed a questionnaire assessing parental feeding practices and child eating behaviours at baseline and again one year later. Child BMI (predominantly objectively measured) was obtained at both time points.

Results Increases in child BMI z-scores over the follow-up period were predicted by maternal instrumental feeding practices. Furthermore, restriction, emotional feeding, encouragement to eat, weight-based restriction and fat restriction were associated prospectively with the development of obesogenic eating behaviours in children including emotional eating, tendency to overeat and food approach behaviours (such as enjoyment of food and good appetite). Maternal monitoring, however, predicted decreases in food approach eating behaviours. Partial support was also observed for child eating behaviours predicting maternal feeding practices.

Conclusions Maternal feeding practices play an important role in the development of weight gain and obesogenic eating behaviours in young children and are potential targets for effective prevention interventions aiming to decrease child obesity.

Maternal dietary intake during pregnancy has longstanding consequences for the health of her offspring

Over the past 100 years, advances in pharmaceutical and medical technology have reduced the burden of communicable disease, and our appreciation of the mechanisms underlying the development of noncommunicable disease has broadened. During this time, a number of studies, both in humans and animal models, have highlighted the importance of maintaining an optimal diet during pregnancy. In particular, a number of studies support the hypothesis that suboptimal maternal protein and fat intake during pregnancy can have long-term effects on the growing fetus, and increase the likelihood of these offspring developing cardiovascular, renal, or metabolic diseases in adulthood. More recently, it has been shown that dietary intake of a number of micronutrients may offset or reverse the deleterious effects of macronutrient imbalance. Furthermore, maternal fat intake has also been identified as a major contributor to a healthy fetal environment, with a beneficial role for unsaturated fats during development as well as a beneficial impact on cell membrane physiology. Together these studies indicate that attempts to optimise maternal nutrition may prove to be an efficient and cost-effective strategy for preventing the development of cardiovascular, renal, or metabolic diseases.

Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth

Postpartum weight retention can predict future weight gain and long-term obesity. Moreover, failure to lose weight gained during pregnancy can lead to increased body mass index for subsequent pregnancies, increasing the risk of adverse maternal and foetal pregnancy outcomes. This systematic review evaluates the effectiveness of lifestyle interventions aimed at reducing postpartum weight retention. Seven electronic databases were searched for intervention studies and trials enrolling women with singleton pregnancies and published in English from January 1990 to October 2012. Studies were included when postpartum weight was a main outcome and when diet and/or exercise and/or weight monitoring were intervention components. No limitations were placed on age, body mass index or parity. Eleven studies were identified as eligible for inclusion in this review, of which 10 were randomized controlled trials. Seven studies were successful in decreasing postpartum weight retention, six of which included both dietary and physical activity components, incorporated via a range of methods and delivered by a variety of health practitioners. Few studies utilized modern technologies as alternatives to traditional face-to-face support and cost-effectiveness was not assessed in any of the studies. These results suggest that postpartum weight loss is achievable, which may form an important component of obesity prevention in mothers; however, the optimal setting, delivery, intervention length and recruitment approach remains unclear.

A comparison of maternal calcium and magnesium levels in pre-eclamptic and normotensive pregnancies: an observational case–control study

Objective : Supplementing pregnant women at high risk of developing pre-eclampsia with calcium may reduce the incidence of the disease. This study examines differences in serum and hair concentrations of calcium and magnesium between women with pre-eclamptic and normotensive pregnancies.Design : Observational case–control study.Setting : Two teaching hospitals in Cape Town, South Africa.PopulationWomen with pre-eclamptic (N = 96) or normotensive (N = 96) pregnancies, who delivered a single, live infant.MethodsDemographic and current pregnancy details were retrieved from clinical notes. Each participant completed a dietary questionnaire. Venous blood samples were taken from each participant to assess serum calcium and magnesium concentrations. Hair samples were obtained from all participants and calcium and magnesium levels were measured by inductively coupled plasma optical emission spectrometry (ICPOES).Main outcome measureHair and serum calcium and magnesium concentrations were compared between women with pre-eclamptic and normotensive pregnancies.ResultsDiet and socio-economic status in the two groups were similar. There was no significant difference in the hair calcium level between women with pre-eclamptic [1241 parts per million (ppm); range, 331–4654 ppm] and normotensive (1146 ppm; range, 480–4136 ppm) pregnancies (P = 0.5). Hair calcium levels in both groups were not affected by HIV infection.ConclusionWoman with pre-eclampsia showed no difference in chronic calcium status relative to normotensive women. This finding does not support the current belief that the mechanism by which calcium supplementation reduces the risk of developing pre-eclampsia is by correcting a nutritional deficiency.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30–50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women’s weight and related lifestyle behaviours in child-bearing years is an outstanding ‘missed opportunity’ for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Maternal correlates of maternal child feeding practices: a systematic review.

Establishing healthy eating habits early in life is one important strategy to combat childhood obesity. Given that early maternal child feeding practices have been linked to child food intake and weight, identifying the maternal correlates of maternal child feeding practices is important in order to understand the determinants of childhood obesity; this was the overall aim of the current review. Academic databases were searched for studies examining the relationship between maternal child feeding practices and parenting, personal characteristics and psychopathology of mothers with preschoolers. Papers were limited to those published in English, between January 2000 and June 2012. Only studies with mothers of normally developing children between the ages of 2 and 6 years were included. There were no restrictions regarding the inclusion of maternal nationality or socioeconomic status (SES). Seventeen eligible studies were sourced. Information on the aim, sample, measures and findings of these was summarised into tables. The findings of this review support a relationship between maternal controlling parenting, general and eating psychopathology, and SES and maternal child feeding practices. The main methodological issues of the studies reviewed included inconsistency in measures of maternal variables across studies and cross-sectional designs. We conclude that the maternal correlates associated with maternal child feeding practices are complex, and the pathways by which maternal correlates impact these feeding practices require further investigation.

The impact of maternal smoking during pregnancy on depressive and anxiety behaviors in children: the Norwegian Mother and Child Cohort Study.

BACKGROUND: Maternal smoking during pregnancy (MSDP) is associated with multiple adverse childhood outcomes including externalizing behaviors. However, the association between MSDP and internalizing (anxiety and depressive) behaviors in offspring has received less investigation. We aimed to assess the association between MSDP and childhood internalizing (anxiety and depressive) behaviors in a very large, well-characterized cohort study. METHODS: We assessed the association between MSDP and internalizing behaviors in offspring utilizing information drawn from 90,040 mother-child pairs enrolled in the Norwegian Mother and Child Cohort Study. Mothers reported smoking information, including status and frequency of smoking, twice during pregnancy. Mothers also reported their child's internalizing behaviors at 18 months, 36 months, and 5 years. Associations between MSDP and childhood internalizing behaviors, including dose-response and timing of smoking in pregnancy, were assessed at each time point. RESULTS: MSDP was associated with increased internalizing behaviors when offspring were aged 18 months (B = 0.11, P <0.001) and 36 months (B = 0.06, P <0.01), adjusting for numerous potential confounders. Higher rates of smoking (e.g., >20 cigarettes per day) were associated with higher levels of internalizing behaviors. Maternal smoking during early pregnancy appeared to be the critical period for exposure. CONCLUSIONS: We found evidence supporting a potential role for MSDP in increasing internalizing (anxiety and depressive) behaviors in offspring. We also found evidence supportive of a possible causal relationship, including dose-dependency and support for a predominant role of early pregnancy exposure. Further investigation utilizing genetically informed designs are warranted to assess this association.

Maternal efficacy and sedentary behavior rules predict child obesity resilience

Abstract
Background:
To identify longitudinal individual, social and environmental predictors of adiposity (BMI z-score),
and of resilience to unhealthy weight gain, in healthy weight children and adolescents.
Methods:
Two hundred healthy weight children aged 5–12 years at baseline and their parents living in socio-economically disadvantaged neighborhoods were surveyed at baseline and three years later. Children’s height and weight were objectively measured, parents completed a detailed questionnaire that examined the home, social and neighborhood environments, and objective measures of the neighborhood environment were assessed using geographic information system data. Ch
ildren classified as healthy weight at baseline who had
small or medium increases in their BMI z-score between baseline and three year follow up (those in the bottom
and middle tertiles) were categorized as‘ resilient to unhealthy weight gain’. Where applicable, fully adjusted
multivariable regression models were employed to determine baseline intrapersonal, social and environmental predictors of child BMI z-scores at follow-up, and resilience to unhealthy weight gain at
follow-up.
Results:
Maternal efficacy for preventing their child from engaging in sedentary behaviors (B = − 0.03, 95 % CI: 0.06, 0.00) was associated with lower child BMI z-score at follow up. Rules to limit sedentary behaviors (OR = 1.14, 95 % CI: 1.03, 1.25) was a predictor of being resilient to unhealthy weight gain.
Conclusion:
The findings suggest that strategies to support parents to limit their children ’s sedentary behavior may be important in preventing unhealthy weight gain in socioeconomically disadvantaged communities.

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.

Engaging Faculty in Online Education: Rightsizing Incentives and Optimizing Support

: Colleges and universities of all types are pursuing increasingly ambitious goals for online education for a range of reasons—enhancing learning, increasing access, growing enrollment, managing costs. However, concerns about workload, support resources, autonomy, and course quality leave many faculty skeptical of online instruction, and most institutions expanding online offerings are struggling to get sufficient numbers of faculty both willing and prepared to teach online. This study presents best practices in managing the strategic and operational challenges associated with increasing the number of fully online and hybrid courses