No description available.

The number of babies that require care in the Neonatal Intensive Care Unit continues to rise in the UK and parents who have a baby who is born sick or prematurely find themselves adapting to this stressful and often unexpected event whilst also trying to establish their role as a new parent. With no current large British studies, this study explores the experiences of both mothers and fathers in the NICU in relation to adaptation and parental role development and how their experience changes over time. In total 76 parents were interviewed using semi structured interviews 7-10 days following the birth to capture their early experiences of the NICU and then again beyond 28 days to explore any changes in their views and feelings over time. Interviews were tape recorded, transcribed verbatim into the written word and imported into WINMAX PRO. Data analysis revealed nine major sections. These are preparation prior to birth, labour and delivery, first sight of infant, support from the partner, family, friends and other parents, support from and communication with staff, adaptation to the NICU experience, development of the parental role, changes with time and the experiences of fathers. Findings show differences in what mothers and fathers find stressful about their NICU experience, how they adapt to the birth of a sick or premature infant and in their development of the parental role. With the passage of time the events surrounding the birth became less significant as parents start to look to the future. Their role as a parent continued to develop with feelings that their baby needed and recognised them, but many parents felt that they were unable to influence what happened to their baby in the NICU. Recommendations are made for further research and for changes to NICU practice.

Background: Many children suffer from functional constipation. In case of functional constipation there is no underlying disease. In Sweden, functional constipation is very common in children. Risk factors include lack of physical activity, irregular toilet habits and insufficient intake of fibers and fluids. Child health nurse has the knowledge and skills to advise and treat children in functional constipation and to support and reduce the suffering. Aim: The aim of the study was to illuminate child health nurses' experiences in the care of children with functional constipation. Method: Ten child health nurses were interviewed during a semi structured interview used openended questions. The interviews were recorded as digital files and transcribed verbatim and then analyzed according to a qualitative content analysis. Results: The child health nurses described experiences in the care of children with functional constipation. There were two categories from the analyzed data: "to base on the child`s needs" and "the child´s physical and psychosocial environment". Conclusion: This study shows the child health nurses experiences in the care of children with functional constipation. The care is based on the childs neeeds and the environment around the child in terms of physical and psychosocial environment is taken into account. The child health nurses should be aware of the reason why parents seek care, how to find the cause of functional constipation and how to relieve the child's suffering. She creates a health promotion meeting with children and parents seeking care for functional constipation.

Background: Reactive attachment disorder (RAD) has been described as one of the least researched and most poorly understood psychiatric disorders (Chaffin et al., 2006). Despite this, given what is known about maltreatment and attachment, it is likely that RAD has profound consequences for child development. Very little is known about the prevalence and stability of RAD symptoms over time. Until recently it has been difficult to investigate the presence of RAD due to limited measures for informing a diagnosis. However this study utilised a new observational tool Method: A cross sectional study design with a one-year follow-up explored RAD symptoms in maltreated infants in Scotland (n=55, age range= 16-62 months) and associated mental health and cognitive functioning. The study utilised the Rating of Inhibited Attachment Behavior Scale (Corval, et al., unpublished 2014) that has recently been developed by experts in the field along side The Disturbances of Attachment Interview (Smyke & Zeanah, 1999). Children were recruited as part of the BeST trial, whereby all infants who came in to the care of the local authority in Glasgow due to child protection concerns were invited to participate. The study sample was representative of the larger pool of data in terms of age, gender, mental health and cognitive functioning. Results: The sample was found to be representative of the population of maltreated children from which it was derived. Prevalence of RAD was found to be 7.3% (n=3, 95% CI [0.43 – 14.17]) at T1, when children are first placed in to foster care. At T2, following one year in improved care conditions, 4.3% (n=2, 95% CI [below 0 – 10.16]) met a borderline RAD diagnosis. Levels of observed RAD symptoms decreased significantly at T2 in comparison to T1 but carer reported symptoms of RAD did not. Children whose RAD symptoms did not improve were found to be significantly older and showed less prosocial behaviour. RAD was associated with some mental health and cognitive difficulties. Lower Verbal IQ and unexpectedly, prosocial behaviour were found to predict RAD symptoms. Conclusions: The preliminary findings have added to the developing understanding of RAD symptoms and associated difficulties however further exploration of RAD in larger samples would be invaluable.

This thesis presents six studies concerned with the psychological status of people with audiological disorders, particularly tinnitus and hearing loss. Study One (Part I of the thesis) employed a structured interview and the General Health Questionnaire to investigate the emotional status of subjects with a variety of audiological symptoms. Psychological disorder was found to be more prevalent among subjects complaining of vertigo (64%) than among those complaining of tinnitus (45%); the prevalence of psychological disorder among subjects complaining of hearing loss was lower than among tinnitus subjects (27%). A higher prevalence of disturbance was found among subjects with multiple symptoms. A previous history of psychological distress correlated with current ratings of disturbance. Studies Two and Three (Part II) are concerned with the psychology of cochlear implantation. Methodological issues concerning psychological assessment in this context are discussed. Study Two uses Repertory Grid Technique to assess the psychological consequences of using an implant. Eight out of ten subjects reported important changes in psychological well-being related to their use of the device. Study Three identifies a group of subjects applying for an implant while having a non-organic hearing loss. The implications for the use of standardised assessment procedures are discussed. Studies Four, Five and Six (Part III) assess the cognitive functioning of subjects with tinnitus. Tinnitus subjects' performance on neuropsychological tests is compared with that of hearing impaired control subjects. Subjects were also assessed using the Cognitive Failures Questionnaire (CFQ). The emotional status of the subjects was assessed using the Speilberger State-Trait Anxiety Inventory. The Beck Depression Inventory was also used in Study Six. The groups were not distinguished by a number of neuropsychological tests, however it was found, in Studies Four and Five, that Tinnitus subjects' performance on verbal fluency tests was Significantly poorer than the Control subjects, after hearing loss was controlled for. In Study Six it was found that both Tinnitus and Control subjects performed less well than expected on the STROOP test; this was more apparent in the Tinnitus group. The Tinnitus group also obtained higher CFQ scores in Studies Four and Five. Trait anxiety was a feature of the Tinnitus groups. The implications for the cognitive functioning of both tinnitus and hearing impaired subjects are discussed in terms of Baddeley's model of working memory. The importance of these findings for complaint about tinnitus and hearing loss are considered.

No description available.

Summary: Adiposity is defined as the property of containing fat. Excessive adiposity is a cause of both morbidity and mortality in adults. Important consequences include increased risks of type 2 diabetes, coronary heart disease and stroke, (particularly through the increased risks of high blood pressure, dyslipidaemia and insulin resistance associated with adiposity), osteoarthritis, gall bladder disease and some cancers (particularly endometrial, breast, and colon). There is concern, both in the UK and in other settings, that levels of adiposity have risen during the past 20-30 years or so, both in adults and in children and adolescents, in whom relative increases in risk have been particularly large. Key adiposity indicators include markers of general adiposity, of which body mass index weight (kg)/height2 (m2) is the most commonly used and markers of central adiposity, of which waist circumference is the most commonly used; central adiposity is particularly related to increased risks of cardiovascular disease and type 2 diabetes. High levels of body mass index, and, increasingly waist circumference, have been used to define overweight and obesity, although the definition of cut-offs for abnormality is difficult, especially in children and adolescents. In British adults, there are marked geographic, social and ethnic variations in the occurrence of adiposity. Higher levels of adiposity have been reported in Northern England and Wales when compared to Southern England, in lower social class groups compared to higher ones and among South Asians compared to White Europeans. However, there is limited information on the extent of geographic, social and ethnic variation in adiposity in children. Although raised adiposity in an individual fundamentally reflects an imbalance between energy intake and expenditure, many potential determinants of adiposity have been identified. These include not only recent and previous dietary factors and physical activity, but also early life exposures and parental influences. In a population-based study of British 13-16 year-olds, this Thesis sets out to address four overall aims;- (i) to examine patterns of adiposity, including the interrelationships of different adiposity markers; (ii) to explore geographic, social and ethnic differences in adiposity and relate them to patterns observed in adults; (iii) to examine the association of three individual factors – current physical activity pattern, infant feeding and parental BMI – with adiposity; (iv) to examine the associations between adiposity markers, blood pressure and insulin resistance, particularly to determine which adiposity measures are most strongly related to these factors in adolescence.

Sleep is an important part of everyday life. It directly affects daytime cognition and general performance. In children, sleep is a crucial requirement for growth and learning and lack of sleep may manifest itself as a long lasting developmental deficit. Sleep disorders which disrupt the normal continuity of sleep therefore benefit from early identification and treatment. A common cause of sleep disruption is sleep disordered breathing which can be associated with frequent arousals from sleep. Many relevant areas of sleep research continue to generate new and interesting findings utilising biosignals such as EEGs. Respiratory cycle related EEG change (RCREC) is a good example of this. The method for quantification of RCREC relies on the appropriate application of signal processing and the signals involved in the procedure are polysomnographic. Furthermore, RCREC is thought to reflect morbid micro-arousals in sleep and is hence also of clinical importance. Given that the field of RCREC research is a recently established one, there is much room for constructive investigation. The current state of RCREC research is therefore expanded in this thesis. The method for calculation of respiratory cycle related EEG change (RCREC) is replicated and expanded in this project. Shortcomings of the method have been identified and accounted for where appropriate. In particular, the sensitivity of RCREC to airflow signal segmentation is addressed and alternative segmentation approaches are suggested. The general influence of airflow segmentation on RCREC is investigated and a mathematical explanation for RCREC sensitivity is given. Additionally, the ability of RCREC related parameters to predict daytime cognitive functions is assessed. Results suggest that RCREC parameters are capable of predicting quality of episodic memory, power (speed) of attention and internal processing speed.

No description available.

More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is known about the effect fruit and vegetable intake on perinatal outcomes. Omega-3 (n-3) fatty acids are essential dietary components and are known to affect inflammatory state, but little is known about how they affect inflammation in pregnancy. As current evidence is lacking, further research is needed to investigate the relationships between maternal nutrition in pregnancy, inflammation and birth outcomes. The purposes of this dissertation were to: 1) to review and evaluate the current evidence on the relationship between n-3 fatty acids and inflammation in pregnancy; 2) to evaluate the current state of the science on the impact of maternal dietary consumption of fruits and vegetables on preterm birth, gestational diabetes, preeclampsia, small for gestational age, gestational weight gain and measures of inflammation or oxidative stress in pregnancy; and 3) to examine relationships between maternal dietary intake of fruits and vegetables, cytokine expression in early and mid-pregnancy, preterm birth and gestational hypertension. A critical review of literature examining the relationship between inflammation and n-3 intake during pregnancy found that multiple inflammatory cytokines in maternal and fetal tissues were lower in women who received n-3 supplements. A second review of literature review supported an inverse relationship between fruit and vegetables and risk of preeclampsia and suboptimal fetal growth. The available evidence was insufficient to establish relationships between fruit and vegetable intake and gestational diabetes, preterm birth or inflammation. A study evaluating the relationships between maternal fruit and vegetable intake, inflammation and birth outcomes was conducted. This study provided evidence supporting a relationship between first and second trimester cytokine expression and maternal dietary intake of fruits and vegetables. Those who met recommended vegetable intake in the first trimester had higher first trimester serum CRP, IL1-α, IL-6 and TNF-α and lower first trimester cervicovaginal IL-6 levels. Those who met recommendations for first trimester fruit intake had 56% lower risk for preterm birth. Those who met second trimester vegetable intake recommendations had more than twice the risk of developing gestational hypertension. The results of this dissertation provide support for the beneficial effects of omega-3 fatty acids and fruit and vegetable intake in pregnancy. Maternal intake of these dietary components may promote optimal immune status during pregnancy. Supplementation of maternal omega-3 fatty acids may help regulate inflammation via the anti-inflammatory effects their bioactive eicosanoids exert. Fruit and vegetables have antioxidant and anti-inflammatory effects that may also help balance the inflammatory state during pregnancy. These dietary components may help promote favorable immune status during pregnancy and reduce risk of adverse perinatal outcomes such as poor fetal growth, hypertensive disorders of pregnancy and preterm birth.