The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial

Objectives: To evaluate impact of postnatal health education for mothers on infant care and postnatal family planning practices in Nepal.

Class in infant care and breastfeeding

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

Class in infant care and breastfeeding

General note: Title provided by Freda Leinwand.

Class in infant care and breastfeeding

Inscriptions: Verso: [stamped] Photograph by Freda Leinwand. [463 West Street, Studio 229G, New York, NY 10014].

Reduction of infant mortality in Latin America and the Caribbean: uneven progress requiring a variety of responses

Infant mortality has unquestionably declined throughout Latin America over the last decade, even under conditions of low and unstable economic growth and a meagre overall reduction of poverty in the region. The declines in infant mortality vary from one country to another. The persistence of high infant mortality rates is related to low income, teenage pregnancy and lack of access to basic services, as well as to the lack of appropriate health care infrastructure. At the same time, both the rural population as a whole, and the indigenous and Afro-descendent population in particular, has fallen markedly behind, with overall infant mortality rates much higher than among the rest of the population. Moreover, the cause and incidence of death in this age group have been changing according with the changes in neonatal and post-neonatal deaths. Our editorial line-up has created space for opinions from adolescents and youth, as well as from policy experts on the problem, its causes, and approaches to dealing with infant mortality. We also offer succinct information on a broad range of programmes—utilizing various interventions—in different countries of the region regarding maternal and infant care, in an attempt to bring about a reduction in mortality.

Improving the care of preterm infants: before, during, and after, stabilisation in the delivery room

Introduction Up to 10% of infants require stabilisation during transition to extrauterine life. Enhanced monitoring of cardiorespiratory parameters during this time may improve stabilisation outcomes. In addition, technology may facilitate improved preparation for delivery room stabilisation as well as NICU procedures, through educational techniques. Aim To improve infant care 1) before birth via improved training, 2) during stabilisation via enhanced physiological monitoring and improved practice, and 3) after delivery, in the neonatal intensive care unit (NICU), via improved procedural care. Methods A multifaceted approach was utilised including; a combination of questionnaire based surveys, mannequin-based investigations, prospective observational investigations, and a randomised controlled trial involving preterm infants less than 32 weeks in the delivery room. Forms of technology utilised included; different types of mannequins including a CO2 producing mannequin, qualitative end tidal CO2 (EtCO2) detectors, a bespoke quantitative EtCO2 detector, and annotated videos of infant stabilisation as well as NICU procedures Results Manual ventilation improved with the use of EtCO2 detection, and was positively assessed by trainees. Quantitative EtCO2 detection in the delivery room is feasible, EtCO2 increased over the first 4 minutes of life in preterm infants, and EtCO2 was higher in preterm infants who were intubated. Current methods of heart rate assessment were found to be unreliable. Electrocardiography (ECG) application warrants further evaluation. Perfusion index (PI) monitoring utilised in the delivery room was feasible. Video recording technology was utilised in several ways. This technology has many potential benefits, including debriefing and coaching in procedural healthcare, and warrants further evaluation. Parents would welcome the introduction of webcams in the NICU. Conclusions I have evaluated new methods of improving infant care before, during, and after stabilisation in the DR. Specifically, I have developed novel educational tools to facilitate training, and evaluated EtCO2, PI, and ECG during infant stabilisation. I have identified barriers in using webcams in the NICU, to now be addressed prior to webcam implementation.

Postpartum issues for expectant mothers and fathers.

OBJECTIVE: To investigate the postpartum psychosocial and infant care topics that women and men who attend preparation for parenthood classes have been thinking or worrying about during the pregnancy. Furthermore, to compare the rates of endorsement of such issues for women and men so that clinicians can use this information to help plan which topics to include in preparation for parenthood classes. DESIGN: A survey of expectant parents attending preparation for parenthood classes at a local public hospital. Participants completed a 17- to 19-item postpartum issues checklist devised for the study. SETTING: Preparation for parenthood classes conducted in a public hospital in South Western Sydney, Australia. PARTICIPANTS: People attending the session were in their 2nd to 3rd trimester, of low to middle socioeconomic status, and 95% were expecting their first child. Eighty-five percent of women were accompanied by their male partner at the session. Data are reported from 201 women and 182 men. MEASURE: A 17-item issues checklist was devised initially and later expanded to 19 items. The initial checklist covered three psychosocial issues: interpersonal, intrapersonal, and parental competency. The expanded checklist also included items on infant care issues. Participants rated each item as to the extent to which they had been thinking or worrying about it over the past few weeks. RESULTS: More than half of the men and women had been thinking or worrying about their ability to cope as new parents; just less than half of both men and women endorsed the item regarding the effect having a baby would have on their relationship with their partner; approximately 40% of women had thought that they might get bored or lonely when at home with the baby, and an equal rate of men reported that their partner experiencing this sense of boredom-or loneliness was an issue for them. There were few differences between the genders in the rate of endorsement on the issues checklist. CONCLUSION: That many of the issues on the checklist are prevalent in both women and men at this time in the pregnancy would suggest that these are topics that would be pertinent for inclusion at preparation for parenthood classes. Although the checklist is not exhaustive, the data reported give empirical justification for inclusion of these topics in such classes.

Birthing practices of traditional birth attendants in south Asia in the context of training programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes.

Hush-a-by mummy : interactions between co-sleeping and maternal sleep disturbance

Childbirth is an extraordinary, everyday experience; in 2011, 301 617 infants were born in Australia [1], resulting in countless potential occurrences of sleep disturbance and subsequent daytime sleepiness. While the relationship between sleep and sleepiness has been heavily investigated in the vulnerable sub-populations of shift workers and patients with sleep disorders, comparatively postpartum women have been overlooked. Previous research has reported slower reaction times to the Psychomotor Vigilance Task [2] and shorter sleep onset in the multiple sleep latency test [3] in new mothers compared with control women. However little is known about change in sleep and sleepiness over time or potential interactions with infant care behaviour choices, such as co-sleeping (mother and infant sharing a bed). This study aims to investigate change in new mothers sleep quantity, sleep quality and resulting daytime sleepiness over postpartum weeks 6, 12 and 18, while evaluating the impact of co-sleeping.

Differences in parent regulation beliefs and maternal postnatal depressive symptoms in early weeks

Postnatal depression is consistently associated with couple relationship qualities. Substantial infant care requirements in early weeks may highlight differences in parenting beliefs between mother and father. We calculated difference scores in parenting beliefs (disparity) in a community sample of 209 parent dyads. Contrary to previous research regarding ‘disagreement’ which could be interpreted as discord, independently measured disparity was not associated with maternal depressive symptoms. Coparenting interventions should promote respectful negotiation rather than resolution of differences.

A study of errors that can occur when weighing infants

When infants are weighed at well baby or infant welfare clinics, the weight change from one visit to the next is used as a guide to the welfare of the child. Infant welfare clinic nurses are expert clinicians who use weight measurements as a rough indicator of well-being only, as it is well known by them that these measurements are fraught with error. This paper calculates the amount of error which was found in repeated tests of weights of infants, and in the weight changes brought about by biological variation. As a result, it is recommended that babies under nine months of age be weighed at clinic visits no less than a fortnight apart, and older infants, at least one month apart. If they are weighed more often, then the weight changes detected will be less than the amount of error which affects the measurements.

西藏红拉雪山自然保护区黑白仰鼻猴 Rhinopithecus bieti 的生态与行为研究，中国及其邻近地区兽类动物地理区划数量分析

从 2002 年11 月至2005 年4 月，在西藏红拉雪山自然保护区（98°20' ~ 98°59'E，28°48' ~ 29°40'N）对小昌都黑白仰鼻猴（Rhinopithecus bieti）群（98°35'00" ~ 98°40'00"E，29°14'24" ~ 29°16'42"N）（210 只左右）的生境及其利用形式、食 性、活动时间分配、过夜树及过夜地选择、雄－婴照料和繁殖季节作了重点研究， 并对保护区内的猴群分布、种群数量、保护状态以及潜在的威胁因素等作了一般 性的考查研究。 红拉雪山自然保护区存在3 个黑白仰鼻猴群，数量至少有300 只。从北到南 分别是执娜群、小昌都群和米拉卡群，其中执娜群（29°22'，98°28'），是黑白仰 鼻猴最北分布群。猴群栖息范围中，人类的经济活动频繁。由于活动范围位于或 接近藏传佛教的神山，小昌都和执娜猴群保护最好，这两群之间存在生境走廊。 米拉卡猴群保护状态较差，主要是偷猎现象还没有杜绝。对过去20 年的农牧业 统计资料及藏族风俗习惯和民族传统综合分析发现：在红拉雪山自然保护区，尽 管人类经济活动频繁，但猴群与人类和谐共存是可能的。 小昌都猴群全年白天用49％的时间取食，20％的时间移动，18％的时间休 息，13％的时间作其他的活动。在6-8 月，猴群日间表现出明显的三个取食高峰， 两个休息高峰。在11-1 月，猴群有两个取食高峰，一个休息高峰，或者休息高 峰根本不明显（12 月）。尽管环境温度和食物组成等也会影响时间预算，但造成 这种现象的主要原因可能是白天长度的季节性变化。 小昌都猴群年家域为21.25 km2，且主要在3800 – 4250 米的针叶林中活动。 食物好的季节，猴群日移动距离长，日活动范围大；食物差的季节，则相反。秋 －冬季（10-12 月）由于取食川滇高山栎（Quercus aquifolioides），活动的海拔高 度高于其它季节；冬季（1-4 月）活动范围最低。猴群并不避免在人类间伐过的 次生针叶林中活动。小生境的使用强度与在此生境中过夜的次数有关。 小昌都猴群的食物以松萝为主。全年的食物组成：用单筒望远镜观察，松萝 82.1％，芽和叶12.1%，花、果实或种子占1.1%，无脊椎动物占0.6%，树皮、 树根、树胶，草等占4.2%；接近猴群用肉眼或双筒望远镜观察，松萝50.8％， 芽和叶28.5%，花、果实或种子占7.1%，无脊椎动物占6.5%，树皮、树根、树胶，草等占7.1%。根据动物在不同林层分布百分比整合后得到接近真实的食物 构成：松萝75.4％，芽和叶15.7%，花、果实或种子占2.9%，无脊椎动物占2.4%， 树皮、树根、树胶，草等占3.9%。猴群在夏季（6-8 月）会下地翻开小石块，取 食无脊椎动物。冬季（1-4 月）会取食至少6 种树皮和2-3 种干草。 基于避免捕食、安全、舒适、体温调节的考虑，小昌都猴群选择高大、底枝 高、底枝长以及层数多的树过夜，并在背风、阳坡和海拔低的过夜地过夜。在过 夜地的选择中，存在着阳坡和海拔高度的权衡决策。 小昌都猴群个体不同林层的分布：77.5％在树上，6.0％在灌丛，16.5％在地 上。成年雄猴和青年猴倾向于在地上活动。在地上活动时又倾向于移动，休息和 其他活动少。获得高质量的食物和避免被捕食是出现这种格局的原因。 在小昌都猴群中，婴猴受到雄猴照料时间百分比（percent time of infant care, PTIC）为17.2±3.3，其中身体接触（BC）、接近（IP）和监护（G）照料的时 间百分比分别为0.6±0.5、5.8±1.2 和10.8±3.8。G 照料的最低值和最高值分别 在8 月和3 月。雌猴总PTIC 为69.3±6.9，其中BC、IP 和G 的时间分别为42.0 ±8.6、21.6±5.3 和5.7±3.8。最低BC 和最高G 照料同时出现在3 月。对雄猴， （1）总PTIC 在能量压力高的季节明显高于能量压力低的季节；（2）G 照料PTIC 在能量压力高的季节也要比能量压力低的季节高；（3）BC 和IP 照料在两个季节 之间没有区别。对于雌猴，（1）总PTIC 在高能量压力季节要比低能量压力季节 低；（2）G 照料在高能量压力季节要比低能量压力季节高，而BC 照料在高能量 压力季节要比低能量压力季节低；（3）IP 照料在两个季节之间没有区别。这种 高强度的雄婴照料，特别是托儿所的照料方式，是由这种环境下过高的能量压力 所引起的。 小昌都群为严格季节性出生且出生季节在2 月初到3 月中旬之间，时间跨度 45 天，属脉冲型。这种格局是光周期、温度、食物等环境因子综合调控的结果。 综合以上结果我们认为小昌都群的行为和生态特点，除具备疣猴一般特点 外，还具有地点特殊性，是自然环境如光照、温度、食物供给季节变化和生物环 境如捕食压和人类活动相互作用的结果，或者可以看成是能量摄入和损耗之间以 及它们和安全之间的权衡结果，体现了猴群对极端环境的适应。

General and Respiratory Health Outcomes in Adult Survivors of Bronchopulmonary Dysplasia: A Systematic Review

Background: The purpose of this systematic literature review was to examine current empirical research on general and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia (BPD).

Methods: We searched seven databases up to the end of November 2010 (MEDLINE, PubMed, EMBASE, PsycINFO, Maternity and Infant Care, Cumulative Index of Nursing and Allied Health Literature, and Web of Knowledge). We independently screened and included only those studies concerning the assessment of outcome measures in adult survivors of BPD. Data on methodologic design and findings were extracted from each included study; in addition, the methodologic quality of each study was assessed using the Critical Appraisal Skills Programme checklist.

Results: Fourteen cohort studies met the review criteria. Of those, a total of eight studies were considered to be of high quality (score 9-12), five of moderate quality (score 5-8), and only one was of low quality (score 0-4). In all studies of adult survivors of BPD, differences were found between the index and control groups, suggesting that many adults survivors of BPD who were born preterm or with very low birth weight had more respiratory symptoms and pulmonary function abnormalities compared with their peers. Five studies concerning radiologic findings reported structural changes persisting into adulthood. Findings from three studies suggested impairment in exercise capacity, although firm conclusions were limited by the small sample size in the studies reviewed.

Conclusions: Compared with adults born at term, adult survivors of BPD have more impairment in general and respiratory health, which does not seem to diminish over time.

A systematic review of midwife led interventions to address post traumatic stress syndrome

Objective
to systematically identify interventions that midwives could introduce to address post-traumatic stress in women following childbirth.

Methods
a search strategy was developed and relevant papers were identified from databases including Cinahl, Cochrane Library, EMBASE, Maternity and Infant Care, MEDLINE, PsycINFO, and Web of Science. Key search terms used were post-traumatic stress, post partum, intervention, controlled trial and review. Papers eligible for inclusion were primary studies and reviews of research published from 2002–2012, focusing on interventions which could be implemented by midwives for the prevention and/or management of PTSD. For primary studies, RCTs, controlled clinical trials, and cohort studies with a control group were eligible. Eligible reviews were those with a specified search strategy and inclusion/exclusion criteria. Methodological quality was assessed using recognised frameworks.

Findings
six primary studies and eight reviews were eligible for inclusion. The majority of included studies or reviews focused on debriefing and/or counselling interventions; however the results were not consistent due to significant variation in methodological quality and use of dissimilar interventions. Two of the reviews considered the general management of post partum PTSD and one broadly covered anxiety during pregnancy and the post partum, incorporating a section on PTSD. The majority of women reported that the opportunity to discuss their childbirth experience was subjectively beneficial.

Conclusions and implications for practice
no evidence-based midwifery interventions were identified from this systematic review that can be recommended for introduction into practice to address PTSD. It is recommended that future research in this area should incorporate standardised interventions with similar outcome measures to facilitate synthesis of results. Further research on interventions used in non-maternity populations is needed in order to confirm their usefulness in addressing post partum PTSD.