Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the Hospital Anxiety and Depression Scale

Background

Perinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers’ anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding.

Methods

A repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS) was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results.

Results

The mean anxiety levels at baseline for the fathers in the intervention group (n=289) and control group (n=244) were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs), intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048). Depression scores for intervention fathers at baseline (mean =1.09) and at six weeks (mean=1.09) were very similar to fathers in the control group at baseline (mean=1.11) and at six weeks (mean =1.07) with no significant changes.

Conclusions

Both intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their knowledge and potentially lower the risk of postnatal anxiety.

Trial registration

(Australian New Zealand Clinical Trials Registry ACTRN12609000667213)

Extending the clinical research network approach to all of healthcare

The development of Clinical Research Networks (CRN) has been central to the work conducted by Health Departments and research funders to promote and support clinical research within the NHS in the UK. In England, the National Institute for Health Research has supported the delivery of clinical research within the NHS primarily through CRN. CRN provide the essential infrastructure within the NHS for the set up and delivery of clinical research within a high-quality peer-reviewed portfolio of studies. The success of the National Cancer Research Network is summarized in Chapter 5. In this chapter progress in five other topics, and more recently in primary care and comprehensively across the NHS, is summarized. In each of the 'topic-specific' networks (Dementias and Neurodegenerative Diseases, Diabetes, Medicines for Children, Mental Health, Stroke) there has been a rapid and substantial increase in portfolios and in the recruitment of patients into studies in these portfolios. The processes and the key success factors are described. The CRN have worked to support research supported by pharmaceutical, biotechnology and medical device companies and there has been substantial progress in improving the speed, cost and delivery of these 'industry' studies. In particular, work to support the increased speed of set up and delivery of industry studies, and to embed this firmly in the NHS, was explored in the North West of England in an Exemplar Programme which showed substantial reductions in study set-up times and improved recruitment into studies and showed how healthcare (NHS) organizations can overcome delays in set up times when they actively manage the process. Seven out of 20 international studies reported that the first patient to be entered anywhere in the world was from the UK. In addition, the CRN have supported research management and governance, workforce development and clinical trials unit collaboration and coordination. International peer reviews of all of the CRN have been positive and resulted in the continuation of the system for a further 5 years in all cases.

Physical activity status and postprandial lipaemia in older adults

Physical activity-induced lowering of postprandial lipaemia is short-lived. However, little is known regarding the role of physical activity status on postprandial lipaemia. The purpose of the present study was to compare postprandial triacylglycerol concentrations in active and inactive older adults. A total of 26 older adults (aged 69.8±0.9 years, mean±SEM; 10 male and 16 female) were analysed in a cross-sectional design. Based on accelerometer data, participants were divided into either the active group (≥150 min/week of moderate-intensity physical activity, N=15) or the inactive group (<150 min/week of moderate-intensity physical activity, N=11). After a 48-h period of physical activity avoidance and a 10-h overnight fast, participants consumed a test meal of moderate fat content (35%). Capillary blood samples were collected in the fasted state and at 2, 4, and 6 h postprandially. After adjusting for fasting triacylglycerol concentrations, body mass, body mass index and waist circumference, postprandial capillary triacylglycerol concentrations were significantly lower in the active than inactive group ( P=0.046). These findings demonstrate that regular physical activity lowers postprandial lipaemia independent of the acute effects of physical activity in older adults.

The protocol of a randomized controlled trial for playgroup mothers: Reminder on Food, Relaxation, Exercise, and Support for Health (REFRESH) Program

BACKGROUND

Mother's physical activity levels are relatively low, while their energy consumption is generally high resulting in 58% of Australian women over the age of 18 years being overweight or obese. This study aims to confirm if a low-cost, accessible playgroup based intervention program can improve the dietary and physical activity behaviours of mothers with young children.

METHODS/DESIGN

The current study is a randomized controlled trial lifestyle (nutrition and physical activity) intervention for mothers with children aged between 0 to 5 years attending playgroups in Perth, Western Australia. Nine-hundred participants will be recruited and randomly assigned to the intervention (n = 450) and control (n = 450) groups. The study is based on the Social Cognitive Theory (SCT) and the Transtheoretical Model (TTM), and the Precede-Proceed Framework incorporating goal setting, motivational interviewing, social support and self-efficacy. The six month intervention will include multiple strategies and resources to ensure the engagement and retention of participants. The main strategy is home based and will include a specially designed booklet with dietary and physical activity information, a muscle strength and flexibility exercise chart, a nutrition label reading shopping list and menu planner. The home based strategy will be supported by face-to-face dietary and physical activity workshops in the playgroup setting, posted and emailed bi-monthly newsletters, and monthly Short Message Service (SMS) reminders via mobile phones. Participants in the control group receive no intervention materials. Outcome measures will be assessed using data that will be collected at baseline, six months and 12 months from participants in the control and intervention groups.

DISCUSSION

This trial will add to the evidence base on the recruitment, retention and the impact of community based dietary and physical activity interventions for mothers with young children.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.

Application of UKHCDO 2004 guidelines in type 1 von Willebrand Disease--a single centre paediatric experience of the implications of altered or removed diagnosis

Diagnosis of type I von Willebrand Disease (VWD) can be challenging. In 2004, the United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO) proposed more stringent diagnostic criteria to replace the 1995 guidelines. To determine the true number of cases of type 1 VWD in a single paediatric centre, the 2004 UKHCDO Guideline for the diagnosis of VWD was used to evaluate 114 patients on our type 1 VWD register. Clinical and laboratory data were collected and analysed to see whether they met the criteria for type 1 VWD. Only 8% remained on the type 1 VWD register. 18% have been classified as 'possible type 1 VWD'. Twenty five surgical procedures have since been performed on patients from the group in which the diagnosis was removed without any haemostatic support or bleeding complications. Reaction to the removal of the VWD diagnosis or delivery of an alternative diagnosis was positive for most patients and families. This study is the first to assess the impact of the 2004 UKHCDO Guidelines on the diagnosis of VWD. It provides evidence that the prevalence of type 1 VWD may actually be closer to that of haemophilia instead of the previously reported 1-3% of the general population. We propose that all centres should review their patients with a diagnosis of VWD to revalidate this disease that claims to be our most common inherited bleeding disorder.

Recommendations for translation and reliability testing of International Spinal Cord Injury Data Sets

OBJECTIVE

To provide recommendations regarding translation and reliability testing of International Spinal Cord Injury (SCI) Data Sets.

SETTING

The Executive Committee for the International SCI Standards and Data Sets.

RECOMMENDATIONS

Translations of any specific International SCI Data Set can be accomplished by translation from the English version into the target language, and be followed by a back-translation into English, to confirm that the original meaning has been preserved. Another approach is to have the initial translation performed by translators who have knowledge of SCI, and afterwards controlled by other person(s) with the same kind of knowledge. The translation process includes both language translation and cultural adaptation, and therefore shall not be made word for word, but will strive to include conceptual equivalence. At a minimum, the inter-rater reliability should be tested by no less than two independent observers, and preferably in multiple countries. Translations must include information on the name, role and background of everyone involved in the translation process, and shall be dated and noted with a version number.

CONCLUSION

By following the proposed guidelines, translated data sets should assure comparability of data acquisition across countries and cultures. If the translation process identifies irregularities or misrepresentation in either the original English version or the target language, the working group for the particular International SCI Data Set shall revise the data set accordingly, which may include re-wording of the original English version in order to accomplish a compromise in the content of the data set.

Playgroups as a setting for nutrition and physical activity interventions for mothers with young children: exploratory qualitative findings

ISSUE ADDRESSED

The child bearing years are associated with increased risk of weight gain for many women. Little is known about the attitudes and preferences for nutrition and physical activity interventions in this population. This research investigated the barriers and facilitators of mothers with young children to engage in healthy physical activity and nutrition behaviours.

METHODS

Eight focus groups were conducted with mothers (n = 65) who attended Perth, metropolitan playgroups. Transcriptions from the groups plus observer notes were used to conduct a thematic analysis.

RESULTS

Participants were aware of the need for good nutrition and adequate physical activity but many failed to meet public health recommendations. Many participants were keen to improve their diet and increase their levels of physical activity. However, a major barrier to adopting and maintaining healthy diets and adequate physical activity levels was a shift in priorities from investing in their own health to investing in their children's.

CONCLUSIONS

Interventions using a 'whole family' approach are more likely to be successful in engaging mothers. Interventions should focus on strengthening mothers' self efficacy surrounding eating and physical activity.

Characterization of neurological recovery following traumatic sensorimotor complete thoracic spinal cord injury

STUDY DESIGN

Retrospective, longitudinal analysis of sensory, motor and functional outcomes from individuals with thoracic (T2-T12) sensorimotor complete spinal cord injury (SCI).

OBJECTIVES

To characterize neurological changes over the first year after traumatic thoracic sensorimotor complete SCI.

METHODS

A dataset of 399 thoracic complete SCI subjects from the European Multi-center study about SCI (EMSCI) was examined for neurological level, sensory levels and sensory scores (pin-prick and light touch), lower extremity motor score (LEMS), ASIA Impairment Scale (AIS) grade, and Spinal Cord Independence Measure (SCIM) over the first year after SCI.

RESULTS

AIS grade conversions were limited. Sensory scores exhibited minimal mean change, but high variability in both rostral and caudal directions. Pin-prick and light touch sensory levels, as well as neurological level, exhibited minor changes (improvement or deterioration), but most subjects remained within one segment of their initial injury level after 1 year. Recovery of LEMS occurred predominantly in subjects with low thoracic SCI. The sensory zone of partial preservation (ZPP) had no prognostic value for subsequent recovery of sensory levels or LEMS. However, after mid or low thoracic SCI, ≥3 segments of sensory ZPP correlated with an increased likelihood for AIS grade conversion.

CONCLUSION

The data suggest that a sustained deterioration of three or more thoracic sensory levels or loss of upper extremity motor function are rare events and may be useful for tracking the safety of a therapeutic intervention in early phase acute SCI clinical trials, if a significant proportion of study subjects exhibit such an ascent.

Perceived Muscle Soreness in Recreational Female Runners

The purpose of this study was to determine if rating of perceived exertion correlated with perceived muscle soreness during delayed onset muscle soreness (DOMS) in female runners. This study examined the pre and post running economy measures and perceived muscle soreness before and after a 30-min downhill run (DHR) at -15% grade and 70% of the subjects predetermined maximum oxygen uptake (VO2 peak). Six female recreational runners (mean age = 24.5) performed level running at 65%, 75%, and 85% of their VO2 peak prior to DHR (baseline economy runs), as well as, immediately following and 4 successive days after the DHR.

RESULTS

Subjective response related to perceived muscle soreness increased significantly from a mean of 2 (pre DHR) to 62 (2 days post DHR) on a scale of 1-100. Creatine kinase levels and oxygen consumption increased post DHR compared to pre DHR. Rating of perceived exertion did not change between the economy runs performed prior to or at any point after the DHR.

CONCLUSION

Perceived muscle soreness is a better tool than the RPE scale to monitor exercise intensity for recreational female runners during periods of DOMS and running economy is adversely affected by DOMS.

Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia

BACKGROUND

The ability to breastfeed and continue the practice requires dedication, commitment, persistence and support. Mothers often need to overcome many obstacles to successfully breastfeed their babies and maintain their balance of home, family and work commitments. Evidence suggests that fathers want to be involved and be part of the parenthood process, including infant feeding. The role transition from couple to family poses challenges to both parents. Sharing the experience of childbirth and supporting each other in the subsequent infant feeding practices is one of those challenges.

METHODS

A qualitative exploratory design was chosen to identify parents' perceptions of what constitutes support for breastfeeding, particularly focusing upon paternal support. Focus groups were conducted with mothers and a focus group, interviews and an online survey were developed for fathers. Thematic analysis was used to identify the main themes.

RESULTS

From a total of 76 participants, the major theme emerging from mothers' data identified that "Dads do make a difference". Three sub-themes included: Anticipating needs and getting the job done; Encouragement to do your best; and Paternal determination and commitment, associated with effective partner support. "Wanting to be involved" was identified from fathers' data as the major theme around their needs. Three sub-themes included: Wanting more information; Learning the role; and Being an advocate.

CONCLUSION

Sharing the experience of childbirth and supporting each other in the subsequent infant feeding practices was perceived as the best outcome for the majority of new mothers and fathers. Paternal emotional, practical and physical supports were identified as important factors to promote successful breastfeeding and to enrich the experience for the mother and subsequently the father. TRAIL REGRISTRATION: Australia and New Zealand Clinical Trials Registry: ACTRN12609000667213.

Thrombotic thrombocytopenic purpura following transurethral resection of the prostate

A 65-year old man developed anaemia, profound thrombocytopenia and acute renal failure 2 days after transurethral resection of the prostate. Based on the clinical picture and blood film evidence of microangiopathic haemolysis, thrombotic thrombocytopenic purpura was diagnosed. The patient was treated with a course of plasma exchange, renal replacement therapy and methylprednisolone and made a good recovery. Thrombotic thrombocytopenic purpura is an uncommon cause of haematological and renal abnormalities in the postoperative period. It has a high mortality if untreated, and should be considered in the differential diagnosis of any postoperative patient with a low platelet count and anaemia, since prompt investigation and treatment is life-saving.

A Cardiac Sound Reproduction Apparatus for Improved Stethoscope Testing

Valvular heart disease is a significant problem. The primary case physician initially does assessment through auscultation. Accuracy in classification of sounds is suboptimal (20 to 40%). Lower frequencies of heart sounds are important in classification of murmurs associated with valvular heart disease. We find stethoscope sound intensity capture falls significantly at the 1500 Hz range and lower. Strategies to improve auscultation accuracy include improving stethoscope features or developing a device that, when used with the stethoscope, augments sound capturing abilities at lower frequencies. Testing necessitated development of a reliable (without significant intra-sound variation) cardiac sound reproduction device. A sound permeable contracting polymer when used with a stethoscope signficantly increases sound intensity captured in the 625 Hz to 1500 Hz range, when tested with a reliable cardiac sound reproduction device. We prepared an air-sealed device with an amplifier, four internal speakers capable of emitting high quality, low frequency sounds, and a listening pad. An existing electronic stethoscope with, and then without, a sound permeable contracting polymer captured three sounds (normal, innocent systolic murmur, pathological systolic murmur) five times per sound. The sounds were placed in computer files. FFTs were constructed. Sound intensity within the 625 Hz to 1400 Hz range, when the sound permeable contracting polymer is used with the electronic stethoscope, relatively improves, on average, approximately 11 dB, compared to sound captured with the same electronic stethoscope without the sound permeable contracting polymer. This difference is numerically statistically significant (p<0.001). Intra-sound variability testing (standard deviation) of FFTs was not significant. A sound permeable contracting polymer used with an electronic recording stethoscope significantly improves sound intensity in an important auscultation frequency range. Intra-sound testing variation was insignificant. A study is underway to demonstrate impact using an absolute reference point. However, as amplification within existing electronic stethoscopes is commercially available, potential variation in relative reference points may be overcome with existing amplification features on electronic stethoscopes, allowing improved capture of heart sounds within the 625 Hz to 1400 Hz range. Limitations include the need for human subject study. Further testing, including human subjects testing is needed prior to application for FDA approval. FDA approval is needed before any use on humans. The methodology should not be utilized clinically without FDA approval.

Variable Self-Optimizing Cochlear Model for Heart Murmur Detection/Classification

Accurate detection and classification of heart murmurs by auscultation is suboptimal and not always definitive. The murmur information perceived by the physician brain is the combined effect of both patient's (human) heart and the physician's ear. The information containing the murmur characterization which is retrieved by the human brain resides in the electrical signal coming out of the cochlea. For the very reasons described here, cochlea-like processing has been successfully applied to multiple speech recognition related technologies. This had not, before our prior work, been applied to human heart murmur analysis. Our prior research consisted of three steps: (1) capturing heart sounds, (2) processing the sounds using a cochlea-like filter, and then, (3) classifying each sound as being normal or a murmur using an artificial neural network (ANN). Previously in our research, we used a static cochlea-like filter model in step 2 as described above, which resulted a significant improvement in terms of accuracy of heart murmur classification. Our cochlear filter analysis helped identify information-rich frequency segments in human heart sound. We want to advance the cochlear filter model from a static to a variable frequency selective model with feedback from ANN for better optimization of the heart murmur classification. The heart sounds will be processed in ways more closely replicating the human cochlea than the static cochlear filter. A variable self optimizing cochlear filter will better reproduce the mechanism of the human cochlea in that it will contain a feedback system from ANN to cochlear processing to automatically select the most useful frequencies based upon a threshold mechanism filtering out those frequencies which do not contain significantly useful information about classification of heart murmur. The output of the sounds in the frequency range remaining (variable self-optimizing cochlear filtered sounds) may then be used by the neural network to make a final decision about murmur classification. Our hypothesis is that a variable self-optimizing cochlear filter will significantly improve the accuracy in classification of heart sounds as normal or murmur when compared to a static cochlear filter. Using this approach, we plan to develop an AI based system which will classify heart sounds with a success rate significantly better than the static cochlear filter previously developed.