Attendance at Neonatal Follow-up (NFU) programs is crucial for parents to gain access to timely diagnostic expertise, psychosocial support, and referral to needed services for their infants. Although NFU programs are considered beneficial, up to 50% of parents do not attend these programs with their infants. Non-attending infants have poorer outcomes (e.g., higher rates of disabilities and less access to required services) as compared to attenders. The purpose was to determine factors that predicted attendance at NFU. Naturally occurring attendance was monitored and maternal-infant factors including predisposing, enabling, and needs factors were investigated, guided by the Socio-Behavioral Model of Health Services Use. A prospective two-phase multi-site descriptive cohort study was conducted in 3 Canadian Neonatal Intensive Care Units that refer to 2 NFU programs. In Phase 1, standardized questionnaires were completed by 357 mothers (66% response rate) prior to their infant’s (N= 400 infants) NICU discharge. In Phase 2, attendance patterns at NFU were followed for 12 months. Higher maternal stress at the time of the infant’s NICU hospitalization was predictive of attendance at NFU. Parenting alone, more worry about maternal alcohol or drug use, and greater distance to NFU were predictive of non-attendance at NFU. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months. Two distinct attendance patterns emerged: no or minimal attendance (18.5%) and attendance at all or the majority of scheduled appointments (81.5%). The most frequent point of withdrawal from NFU occurred between NICU discharge and the first scheduled appointment; followed by drop-out following the first NFU appointment. These results provide new insight into patterns of attendance and the maternal-infant factors that characterize attenders/non-attenders at NFU and serve as the critical first step in developing interventions targeted at improving attendance, infant outcomes, and reporting of developmental sequelae.

Doctor of Philosophy / Department of Horticulture, Forestry, and Recreation Resources / Candice A. Shoemaker / The objectives of this study were to determine exercise intensity of common gardening tasks in older adults and to investigate if older gardeners meet the physical activity (PA) recommendations (intensity and time) through their daily gardening. Kinds of gardening tasks, body postures, and bodily pain while gardening of older gardeners were investigated and the possibility of gardening as a predictor for a physically active lifestyle and life satisfaction in older adults was determined. Older participants were randomly recruited from the community of Manhattan, KS. To determine the exercise intensity of gardening, the heart rates of older adults were measured by radiotelemetry during gardening or garden tasks, and then oxygen uptake and energy expenditure were measured via indirect calorimetry using a submaximal graded exercise test. Overall health conditions by the Short Form 36 Health Survey (SF-36), hand functions by hydraulic hand dynamometer and pinch gauge, and bone mineral density (BMD) by dual-energy x-ray absorptiometry were measured. An observational study and weekly logs were conducted to study kinds of gardening, postures, and bodily pain of older gardeners. The Community Healthy Activities Model Program for Senior (CHAMPS) questionnaire was used to measure leisure-time PAs (frequency per week of all PAs and calories expended per week in all PAs). In conclusion, the nine gardening tasks were found to be low to moderate intensity PA in healthy older adults (1.6 ± 3.6 METs). Gardening observed was moderate intensity (3.8 ± 1.4 METs) PA in older adults and the subjects met the PA recommendation, which is at least 30 minutes of moderate intensity PA on most days of the week through their daily gardening (moderate intensity; average 33 hrs/wk in May and 15 hrs/wk in June and July). The older gardeners showed higher values for hand function and some SF-36 domains (physical function, bodily pain, and physical summary) than older non-gardeners. Gripping, stooping, lifting, stretching, walking, standing, kneeling, sitting, and squatting were observed while older adults gardened and lower back pain was the main bodily pain reported. Furthermore, gardening was found to be a predictor for leading a physically active lifestyle and high life satisfaction in older adults.

Master of Science / Department of Family Studies and Human Services / Anthony Jurich / This study explored the parents’ perspective of having a child with Autism living in the home. Specifically, the researcher was looking to explore the attachment style between the parent and child, as well as the process of the parents’ changing their expectations of their child, from the expectation of raising a normal child to raising a child with Autism. In order to understand the experience of both families interviewed, the researcher, through semi-structured, qualitative interviews, interviewed each parent separately. A multiple case study approach was used in order to allow for comparison within each family. Methods for analyzing the data included coding the data, so that the data could be analyzed from the individual interviews and also analyzed based on family response. For the parents interviewed in the study, four themes emerged that were similar for all parents. These themes included the diagnosis process, the differences in attachment before and after their child was diagnosed, the changing expectations of themselves, each other and their diagnosed child, and the parents’ views on getting professional help, such as therapy. Both families shared the experience of confusion during the diagnostic process, especially confusion surrounding the cause and prognosis of Autism. All parents in the study illustrated the attachment injury after their child’s diagnosis, in addition to when the child began showing the classic signs of Autism. The study also found that each parent’s expectations changed from higher ones of themselves, spouse and diagnosed child to more moderate and low expectations of their spouse and diagnosed child. Last, all parents interviewed expressed that seeking therapy would have helped them deal with the diagnostic process and better cope with having a child with Autism. It is believed by the researcher that these themes have emerged because of the families’ shared experience of raising an Autistic child.