The NOURISH randomised control trial : positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children. Methods/Design This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure. Discussion Despite the strong rationale to focus on parents’ early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children’s eating patterns and behaviours. Trial Registration: ACTRN12608000056392

Promising Practices: Ensuring Choice Under the Ticket to Work Program - The Indiana PABSS Approach

The Ticket to Work program offered disabled and blind social security beneficiaries the promise of greater choice when selecting a vocational rehabilitation provider. With the issuance of Transmittal #17, much of the opportunity to choose a provider was removed. The Protection and Advocacy agency in Indiana took steps to protect the rights of disabled and blind beneficiaries to choose providers in the face of this significant policy change. Learn what was done to protect the rights and ability of beneficiaries to seek and choose vocational rehabilitation providers.

Safeguarding and promoting children in maternity services- implications for policy and practice

The article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or at risk of abuse, and in subsequent intervention and protection services. The study highlights how domestic violence increases during pregnancy and the postpartum period, and is significantly related to all types of child maltreatment up to the child's fifth year, and children under one being at the highest risk of injury, or death. Close inter-agency liaison is required with midwives who are accountable and not afraid to challeneg hiostorical working practices.

Peripartum urinary incontinence : a study of midwive's knowledge and practices

Urinary incontinence impacts on women's quality of life and their wellbeing. The objectives of this study were to obtain knowledge and information on midwives’ assessment and management practices of urinary incontinence in childbearing women and to explore midwives’ knowledge of risk factors associated with developing urinary incontinence. A non-experimental descriptive research design was used, and participants were current members of the Victorian branch of the Australian College of Midwives. Data was obtained using a survey tool that contained both qualitative and quantitative questions. Key findings indicated that the majority of midwives do not assess women for urinary incontinence during the peripartum period and guidelines for bladder management in maternity services were lacking.

Maternity waiting homes in Southern Lao PDR : the unique 'silk home'

The concept of maternity waiting homes (MWH) has a long history spanning over 100 years. The research reported here was conducted in the Thateng District of Sekong Province in southern Lao People’s Democratic Republic (PDR) to establish whether the MWH concept would be affordable, accessible, and most importantly acceptable, as a strategy to improve maternal outcomes in the remote communities of Thateng with a high proportion of the population from ethnic minority groups. The research suggested that there were major barriers to minority ethnic groups using existing maternal health services (reflected in very low usage of trained birth attendants and hospitals and clinics) in Thateng. Unless MWH are adapted to overcome these potential barriers, such initiatives will suffer the same fate as existing maternal facilities. Consequently, the Lao iteration of the concept, as operationalized in the Silk Homes project in southern Lao PDR is unique in combining maternal and infant health services with opportunities for micro credit and income generating activities and allowing non-harmful traditional practices to co-exist alongside modern medical protocols. These innovative approaches to the MWH concept address the major economic, social and cultural barriers to usage of safe birthing options in remote communities of southern Lao PDR.

The complexity of social practice : understanding inertia and change in maternity care organizations

Beyond the limited efficiency and economy goals of neoliberal health policy lies the promise of genuine health services reform. In maternity care in particular, recent policy developments have sought to make the management of birth more ‘women-centred and family-friendly’. Interprofessional collaboration and greater consumer participation in policy and decision-making are key means to achieve this goal, but changing the entrenched system of medicalised birth remains difficult. Recent social contestation of maternity care has destabilised but not eradicated pervasive medical hegemony. Further reform requires analysis both of institutionalised patterns of power, and attention to the fluidity and situated knowledge shaping organisational and professional practices. Accordingly, this paper outlines a framework with which to explore the multi-layered social processes involved in implementing organisational and cultural change in maternity care. Analysis of social interventions in health systems, we suggest, can be advanced by drawing on strands from critical organization studies, complexity and critical discourse theories and social practice approaches.

Maternity care experiences of Asia ethnic minorities in rural Tasmania, Australia : a mixed methods study

When migrating to Australia Asian women bring with them birthing cultural beliefs and practices, many of which are different from the Australian medical and cultural understanding of reproduction. Such cultural differences may result in conflicts between clients and health care providers especially when the migrants have a poor knowledge of English. The research investigates the maternity care experiences of Asian migrants in Tasmania. The barriers that Asian migrants face in accessing maternity care services and the factors that affect their views towards maternity care were also explored. A mix of quantitative and qualitative methods was employed. Ten women from different ethnic minorities were invited to semi-structured interviews. The qualitative data were analysed using grounded theory. Findings from the interviews were utilized to design a survey questionnaire. Of the 150 survey questionnaires posted, 121 questionnaires were returned. Descriptive statistics and Chi-square tests of independence were used to analyse the quantitative data. Asian migrants followed some traditional practices such as having good rest and eating hot food during the postpartum month. However, they tended to adapt or disregard traditional practices that were no longer applicable in the new environment including the practices of not washing or having a shower. Support is vital for women recovering after childbirth to prevent postnatal depression. Two main barriers migrant women face in accessing health care are language and cultural barriers. Country of origin, partner’s ethnicity, religion and length of stay in Australia are factors that shape the migrants’ views and attitudes towards and experience of maternity care. Providing interpreting services, social support for migrant women and improving the cross-cultural training for healthcare providers are recommended to improve available maternal care services. The factors that affect migrants’ view on maternity care should be taken into account when providing maternity care for Asian migrant women.

Maternity

Fruiting bodies represents human engagement with and consciousness of a corresponding presence in our landscape. ʻFruiting Bodiesʼ is an instance of the application of this practice employed to ask the viewer to consider how strange is the phenomenon of the fruiting tree. Is it promiscuous to offer your seed openly to the elements, to any who will take it. Is this forbidden? Is it profligate to hide your progeny inside gifts so tempting in their appeal to that most primitive desire, hunger? Is this wholly mere biological expedience evolved to ensure the widest migration of your offspring? Or does it derive from some boundless cosmic generosity? These images invite you to come close to the tree, where within its arms you will find shelter from the sun at its zenith and from the autumnal rains. Fruit is the focus of Jamesʼs lens as it circles deep into the embrace of limbs and leaves.

Regime change in Australian maternity hospitals

Contemporary attempts to ‘organise’ risk and manage uncertainty are remaking many ‘industrial-era’ institutions – including maternity hospitals. Health policies are encouraging a shift away from hierarchical, medically dominated structures towards new governance systems and ‘women-centred’ care, often led by midwives. To understand the resulting contestation, in this article we argue for a wider conceptual frame than a focus on neo-liberal state regulation of the professions. We utilise theories of the ‘second modernity’, in particular those concerning socio-cultural changes associated with shifts in risk regimes, to interpret findings from qualitative research studies undertaken in Australian maternity hospitals. Whereas analysis confined to macro or institutional levels emphasises stability and hegemony, we demonstrate that when cultural and interactional levels are examined, considerable fluidity and uncertainty in the identification and negotiation of risk is evident, resulting in new work practices with inevitable shifts in professional identities and allegiances.

Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol

Abstract Background Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners. Methods/Design This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated. Discussion The findings of this study will provide practitioners with an understanding of the cultural differences that affect women's dietary choices during maternity. We expect that the developed resources will be of immediate use within the women's units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

Observations in a maternity ward: Usability considerations for EHRs in an interrupt driven environment

With the increasing demand on healthcare systems it is imperative that all care is provided as efficiently and effectively as possible. Technology within the medical domain offers an exciting opportunity to augment work practices in order to meet these needs. This research project explores the implications of the interrupt-driven nature of work in clinical situations on documentation within an environment that increasingly involves electronic health records (EHRs). Midwives in a busy maternity ward were observed and interviewed about the work practices they employed to document information associated with patient care. The results showed that the interrupt-driven nature of the workplace, a feature common to many healthcare settings, led to a tension between the work and the work to document the work. Further, the IT environment in which the information was collected was not designed to cater for frequent interruption of the data entry process. Several recommendations for improving the IT environment are proposed to support health professionals in documenting patient data whilst attending to the interruptions. The recommendations include timeout screens, push technology, use of handheld PDAs, and cues to augment documentation in an interrupted session. Copyright © 2008 RMIT Publishing