Pain behavior of neonates was compared across sleep/waking states and sex. From Gate-Control Theory (Melzack and Wall, 1982) it was hypothesized that pain behavior would vary depending on the ongoing functional state of the infant, in contrast with Specificity Theory (Mountcastle, 1980), from which one would expect neonatal pain expression to be solely a function of degree of tissue damage. The findings of facial action variation across sleep/waking state was interpreted as consistent with Gate-Control Theory. Awake alert infants responded with the most facial activity, which supported Brazelton's (1973) view that infants in this state are most receptive to environmental stimulation. Fundamental frequency of cry was not related to sleep/waking state. This suggested that findings from the cry literature on pain cry as a reflection of nervous system "stress", in unwell newborns, do not generalize directly to healthy infants under varying degrees of stress as a function of state. Sex differences were apparent in speed of response, with boys showing shorter time to cry and facial action following heel-lance. Issues raised by the study include the importance of using measurement techniques which are independent of pre-conceived categories of affective response, and the surprising degree of responsivity of the neonate to ongoing events. Exploratory analyses suggested obstetric factors were related to overall facial action. Caution was expressed in this interpretation due to the great complexity of the inter-relationships of medical, physiological and maternal variables which go far beyond the scope of this study. It was concluded that obstetric features such as mode of delivery should be considered in sample selection for neonatal pain studies, in contrast to current practise which has been to assume healthy newborns form an homogeneous population. It was clear from these findings that the issues are multifaceted, and the optimal way to proceed with research in the area of neonatal pain is with an interdisciplinary team format. / Graduate and Postdoctoral Studies / Graduate

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This research was designed to assess 7-week-old infants' preference for infant directed and adult directed talk. (IDT and ADT) using the infant controlled habituation/dishabituation looking procedure. Infants were presented with short audio recordings of either a female or a male speaking in IDT during habituation and ADT during dishabituation or the reverse. In the control conditions, the stimulus did not change. Infants demonstrated preference for IDT over ADT in both male and female speaker conditions. They also demonstrated preference for the female speaker used in this study over the male speaker. Interactions among the dependent variables (first three looks), and the independent variables (infant gender, and style of speaking as well as infant gender, and speaker gender), suggest that the preference might not be as robust as the preference found in infants over 4 months. Evidence for discrimination between IDT and ADT was inferred from the between group demonstration of preference, but no evidence of within infant discrimination was found. Because the evidence suggests that 7-week-old infants demonstrate weaker preference for IDT over ADT than do infants of 4 months, it is assumed that infant preferences follow a developmental sequence. Thus, it is possible that developing preferences are influenced by experiential factors. / Arts, Faculty of / Psychology, Department of / Graduate

Sudden unexplained infant death (SUID) is a sudden death of an infant under 1 year of age that cannot be explained after an investigation or an autopsy. SUID is the leading cause of infant deaths in the United States; SUID is considered a sentinel event to the birth hospital. Birth hospitals are held accountable for education, training, and role modeling of infant safe sleep practices (SSP) to reduce infant sleep-related deaths up to 1 year of age. This educational project was designed to answer the project-focused question of whether the implementation of an evidence-based, safe sleep training program for nurses would improve their knowledge of SSP. Bandura's social cognitive theory and the root cause analysis theory were used to guide the project that provided education on SSP and methods for teaching SSP for 48 nurses who work in a postpartum unit in a large hospital in the northeastern United States. A search of the literature provided the content from the National Institute of Child Health and Human Development for the education program and served the basis for the 15-item multiple-choice test, which was used for the pretest, posttest design project. The test was administered to the nurse participants who ranged in education from associate degree, baccalaureate degree, to master's degrees. The project goal was to increase nurses' knowledge by training and role modeling infant safe sleep environments and to reduce SUIDs. Results of the pretest and posttest evaluation revealed significant improvement in test scores from a pretest M = 72.9 to a posttest M = 90.0 (p <.05). The implications of this project for social change are that each nurse's knowledge and abilities to teach parents and families about SUID prevention strategies improve, sudden infant deaths may decrease in this hospital setting.

A necessidade de usar a idade corrigida nos recém-nascidos pré-termos (RNPTs) ao avaliar o desenvolvimento motor (DM) é um assunto controverso. Para verificar a necessidade de usar a correção de idade nos primeiros seis meses de idade corrigida, 43 RNPTs foram analisados, por meio da Alberta Infant Motor Scale (AIMS), como um todo e divididos em dois grupos segundo a idade gestacional. Os resultados sugerem que há diferença estatística significativa no DM, quando se utiliza a idade cronológica. Portanto, há necessidade de corrigir a idade, para não subestimar o DM dos RNPTs, classificando-os como atrasado / The need of using the corrected age in pre-term infants (PT) to assess the motor development (MD) is a controversial issue. To verify the need of using the corrected age, during the first six months the corrected age, 43 PT were analysed according to Alberta Infant Motor Scale (AIMS), as one group and as divided into two groups according to gestational age. The results suggested that there is statistically significance in the MD, when the chronological age is used. In conclusion, there is the need of correcting the age, in order not to under-estimate the MD of PT, classifying them as delayed

Lee Chor To. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 102-112). / Abstracts in English and Chinese. / List of appendices --- p.xi / List of tables --- p.xii / List of figures --- p.xii / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Chapter CHAPTER 2. --- LITERATURE REVIEW / Introduction --- p.3 / Prematurity --- p.3 / Parental feelings of a preterm birth --- p.5 / Transition from hospital to home care --- p.11 / Maternal information need --- p.13 / Discharge education --- p.15 / Use of video education --- p.18 / Summary --- p.21 / Chapter CHAPTER 3. --- OBJECTIVES AND METHODOLOGY / Aims and Objectives --- p.22 / Operational definitions --- p.23 / Research design --- p.23 / Sample --- p.24 / Inclusion criteria --- p.24 / Sample size --- p.25 / Sampling procedure --- p.26 / Educational program of infant care --- p.27 / Usual care --- p.27 / Educational video --- p.27 / Data collection methods --- p.30 / Phase I: / Instruments --- p.31 / Chinese version State Scale of the State-Trait Anxiety Inventory for Adults --- p.31 / The Chinese version of the Maternal Confidence Questionnaire --- p.31 / Knowledge Test Infant Care --- p.33 / Social Support Questionnaire --- p.35 / Demographic information --- p.35 / Satisfaction Questionnaire of the Video Education --- p.36 / Date Collection procedure in Phase I --- p.37 / Phase II: / Instrument --- p.39 / Interview guide --- p.39 / Data collection procedure in Phase II --- p.39 / Data analysis --- p.40 / Phase I of the quantitative data --- p.40 / Phase II of the qualitative data --- p.41 / Pilot study --- p.42 / Ethical considerations --- p.42 / Chapter CHAPTER 4. --- FINDINGS / Introduction --- p.44 / Phase I / Sample --- p.45 / Sociodemographic and other characteristics of participating women --- p.45 / Demographic characteristics of infants --- p.46 / Comparison of sociodemographic data between groups --- p.47 / "Maternal outcomes of knowledge, confidence and anxiety about infant care" --- p.52 / Knowledge of infant care --- p.52 / Confidence in infant care --- p.53 / Anxiety concerning infant care --- p.55 / Correlation between outcome measures and sociodemographic data --- p.56 / Video group women perceived satisfaction of the study video --- p.58 / Summary of major findings in Phase I --- p.61 / Phase II / Characteristics of informants --- p.62 / Six categories emerged from the content analysis --- p.63 / Feelings about infant care at home --- p.64 / Concerns about the infant --- p.65 / Perceptions of the discharge process --- p.67 / Sources of support --- p.69 / Help-seeking activities --- p.70 / Perceptions of the usefulness of video education --- p.74 / Differences and similarities in the perceptions of the video group and non-video group women about the experience of caring for their infants at home --- p.77 / Summary of major findings in Phase II --- p.78 / Chapter CHAPTER 5. --- DISCUSSION / Introduction --- p.80 / Sociodemographic characteristics of participants --- p.80 / Effects of video education on knowledge of infant care --- p.83 / Effects of video education on confidence about infant care --- p.85 / Effects of video education on anxiety about infant care --- p.88 / Women's feelings about caring for infants at home and their information need --- p.90 / Preferred methods of learning about infant care --- p.92 / Contributions of the study video --- p.93 / Chapter CHAPTER 6. --- CONCLUSION / Limitations --- p.96 / Implications for nursing practice --- p.98 / Recommendations for farther research --- p.100 / Conclusion --- p.101 / REFERENCES --- p.102 / APPENDICES / Appendix 1a State Scale of State-Trait Anxiety Inventory for Adults (English) --- p.113 / Appendix 1b State Scale of State-Trait Anxiety Inventory for Adults (Chinese) --- p.114 / Appendix 2a Maternal Confidence Questionnaire (English) --- p.115 / Appendix 2b Maternal Confidence Questionnaire (Chinese) --- p.116 / Appendix 3a Knowledge Test of Infant Care (English) --- p.117 / Appendix 3b Knowledge Test of Infant Care (Chinese) --- p.120 / Appendix 4a Social Support Questionnaire (English) --- p.123 / Appendix 4b Social Support Questionnaire (Chinese) --- p.125 / Appendix 5 Demographic information --- p.127 / Appendix 6a Satisfaction Questionnaire of the Video Questionnaire (English) --- p.128 / Appendix 6b Satisfaction Questionnaire of the Video Questionnaire (Chinese) --- p.129 / Appendix 7a Interview guide (English) --- p.130 / Appendix 7b Interview guide (Chinese) --- p.131 / Appendix 8a Ethics approval 2001 --- p.132 / Appendix 8b Ethics approval 2004 --- p.133 / Appendix 9 Permission from Prince of Wales Hospital --- p.134 / Appendix 10 Consent form --- p.135 / Appendix 11 Comments about the video provided by video group women --- p.136 / Appendix 12 Other topics of interest provided by video group women --- p.137

<p>The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. </p><p>Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found.</p><p>Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. </p><p>The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society. </p>

The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found. Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Thesis (M.S.)--University of Michigan, 1982.