Thesis (M.S.)--Boston University by Beatriz Fernandez. Sargent College of Allied Health Professions. Dept. of Occupational Therapy. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The principle of proximo-distal direction of motor development is investigated in this study. Treatment of motor dysfunction has often been based upon the assumption that development occurs first in proximal muscle groups and then in distal groups. A longitudinal study was done on ten infants at five, seven, and nine months of age. Proximal and distal skills were measured and the relationship between them was studied. Two scales were used to assess the infant's reaching abilities (proximal skills), and prehension abilities (distal skills). The scales were developed by Loria (1978) and represented a combination of fmdings from studies done by Halverson (1931, 1932), Gesell and Amatruda (1947) and Kopp (1974). In Loria's scales (1980) unequal weight was given to the criteria used. In the present study however, the scales were modified so that each item was weighted equally. Both scales were used in this research, Loria's Original Scales and the new Adapted Scales. High positive correlations were found between proximal and distal scales of infant motor development at 5, 7, and 9 months of age. An exception was observed at the 9 months of age when using Loria's Original Scales, where results showed significantly lower correlations. However, when using the modified version of the scales, the correlations found suggest that both skills develop simultaneously or co-occur in infants at these ages. / 2031-01-01

Thesis advisor: Pamela J. Grace / Background: Advances in clinical care over the past 40 years have saved the lives of many infants who previously would not have survived. However, a substantial proportion of these children need on-going technological support and are cared for at home by family caregivers with or without the assistance of home care services. Existing studies describe the experience of family caregivers of technology-dependent children post-discharge, but there is a gap in knowledge related to caregivers’ perceptions of nurse-led discharge teaching. Purpose: To describe caregivers’ perceptions of nurse-led discharge education designed to prepare them to care for their technology-dependent infant in the home setting and to uncover factors that facilitate or hinder its effectiveness. Method: A qualitative descriptive study design was employed to explore caregivers’ perceptions of nurse-led discharge education efforts. Demographic data was collected prior to conducting a semi-structured interview. Interview data were analyzed in an iterative fashion using qualitative content analysis. Sample Recruitment was via purposive sampling aimed to find caregivers of technology-dependent infants under the age of three. Nine participants completed the study. Results: An overarching theme, caregiver learning and self-advocacy is enhanced by positive nurse/caregiver relationships and team cohesion, especially during anxiety-producing transitions in care, emerged from the data. The overarching theme encompasses five major themes and several major themes. The five main themes are: the nurse/caregiver relationship enhances learning; the complexity of care presents challenges to the learning process; team performance affects caregivers’ level of anxiety/uncertainty; caregivers’ level of expertise improves self-advocacy; and transitions in care settings contribute to caregiver anxiety. Conclusion: Insights that contribute to nursing knowledge of the caregivers’ experience of nurse-led discharge education and their perceptions of factors that help or hinder their learning were gained. Implications for nursing include the importance of caregivers’ involvement in care team discussions, the necessity of basing teaching approaches and materials in knowledge of best practices, and improved care coordination and discharge planning. Further nursing research, that can generalize findings and generate interventions is also needed to improve the care of this population. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thirty-two children were assessed for dietary, clinical, biochemical and anthropometric status at 6 months, 1 year and 2 years of age. Development was assessed by the Bayley Scales of Infant Development (BSID) Index. Using a dietary history and record, dietary iron was estimated and compared to the National Food Consumption Survey (1985) and Recommended Dietary Allowances (RDA) 10th edition. Daily iron intake decreased from 13.2 mg at 6 months to 10.3 mg iron at 1 year of age and 7.4 mg iron at 2 years of age. Iron intake and mental development were not related at statistically significant levels at any age. A stepwise multiple regression technique was employed to investigate the extent to which mental and motor development was explained with dietary variables, blood iron parameters and anthropometric measurements. Hematocrit concentration was the only variable which was consistently useful in predicting development at 1 and 2 years of age.

The development of perceptual-cognitive processes during infancy has been traditionally studied using visual habituation and paired-comparison techniques. There has been extensive work within the field of infant attention that has focused on the development of visual attention. Within this field, it has been well established that there are two distinct classifications of infants' visual behavior; infants with short visual fixations who perform well in a recognition task following familiarization and infants with long visual fixation with impaired performance. There are two hypotheses for the differences underlying these groups. First, that visual fixation duration is reflective of the speed of information processing such that long-looking infants process information more slowly than short-looking infants. The second hypothesis is that infants who are long-looking have difficulty disengaging and shifting their attention to another location. There has not been any work exploring how these differences manifest themselves in other modalities. Thus, this project has three purposes: (1) to explore whether group differences emerge in an auditory recognition task similar to those found in the visual recognition phase of the paired-comparison task, (2) to better understand how performance differences in the visual task correspond to any observed differences in an auditory task, and (3) to identify any potential mechanisms which may account for the observed differences in group performance on an auditory task. / Ph. D.

The aims of the study were to examine postural development in very low birthweight and normal birthweight infants and to determine whether deviant postures were predictive of adverse neurodevelopmental outcome. In the first part of the study the 7 postural responses selected by Vojta to evaluate neuromotor development were applied to 69 very low birthweight (VLBW < 1 500 grams) infants and to 28 healthy full-term infants of normal birthweight (> 2500 grams). Of the 69 VLBW infants, 43 were small for gestational age and 26 appropriate for gestational age. All infants were examined at term and 4 months corrected age. They were all later assessed on the Griffiths Mental Development Scale at 12 and 18 months corrected age. There were significant differences in postural reactions between the 2 groups which confirmed the lower tone and greater extension previously described in VLBW infants. An important finding in the study was that poor head and trunk righting noted at 4 months corrected age in VLBW infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Development Scale. Thus, a delay in maturation in VLBW infants which was apparent from the assessment of postural responses was still identifiable on the locomotor sub-scales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants. In the second part of the study, the 5 useful Vojta responses were incorporated into the Infant Neurodevelopmental Assessment (INA) which was used to assess 76 high risk VLBW infants. The 76 infants consisted of 34 infants with intracranial lesions on ultrasound and 42 without intracranial lesions. All infants were assessed at term and 4 % months corrected age using the INA. At 12 months corrected age they were all assessed on the Griffiths Mental Development Scale. Six infants were diagnosed as having cerebral palsy, all of whom had intracranial lesions. Several clinical signs indicative of cerebral palsy were significant at 4 % months corrected age and will be useful in future studies to diagnose cerebral palsy early. The association between lack of head and trunk control at 4 % months corrected age and a lower locomotor score at 12 months corrected age proved to be significant again and reinforces the finding that early delay in maturation is identifiable on the locomotor scale at 12 months corrected age.

Hearing conservation specialists are aware of the need for early identification and diagnosis of impaired hearing. This awareness of need has led to the development of several identification methods in the United States. Public awareness programs designed to inform laymen and professionals of the danger signals of infant hearing impairment currently are coming into focus, both as a separate entity and as part of total identification procedures. Current public awareness programs regarding infant hearing loss were surveyed in the present study and recommendations on a model awareness program of this type were obtained. Fifty-one hearing conservation specialists participated in the survey. The data from questionnaire returns indicated existence of eighteen programs from among the total respondents. It also shoed strong support for dissemination of pertinent information of hearing loss to the professional and parent populations of the United States. The data further revealed that program direction and finance should primarily be through state health departments with federal governmental assistance.

High quality infant and toddler (IT) child care has repeatedly been linked to better outcomes for children. However, in the U.S., IT child care has also been plagued by poor quality. Using a mixed-methods design, the purpose of this study was to provide an indepth explanation of quality change in IT classrooms and the myriad of factors that contribute to higher quality. Framed in an ecological model that views quality as the product and interaction of process, structural, and caregiver characteristics, this study addressed the impact of a variety of variables on quality change. The sample was comprised of 86 classrooms nested within 48 centers that participated in Baby Steps, a quality improvement project administered by the Utah Office of Child Care. Quantitative data included ITERS-R scores, wages, turnover, capacity, geographic location, and parent fees collected between 2003 and 2010 as part of the Baby Steps Project. Seven center directors completed semi-structured interviews that provided an insider perspective on their perceptions of the barriers and contributors to improved quality. A mixed model analysis was used to examine quality change over time. Results indicate that classroom quality scores (as measured by the ITERS-R) did increase by the second year of participation in Baby Steps; however, subsequent years of participation did not lead to significantly higher scores. Specialized training also appears to contribute to higher quality but high turnover was associated with lower quality programs. Non-urban programs appeared to be especially receptive to the intervention. Center directors echoed these findings and spoke to the

Indiana University-Purdue University Indianapolis (IUPUI) / The benefits of breastfeeding are widely known and documented, yet breastfeeding rates at six months have remained well below desired levels. In order to fully understand the breastfeeding experience in the early postpartum period and all the intricacies involved, researchers need to provide mothers with the opportunity to talk about their experiences during the time when there are the most difficulties and when they are most likely to discontinue, the first four weeks postpartum. The purpose of this study was to more fully understand, in their own words, the experiences of mothers who began breastfeeding their infant after birth and may or may not have been breasting at four weeks postpartum. A single research question guided this study: What are the lived experiences of breastfeeding mothers during the first four weeks postpartum? Eight mothers who delivered in the past four to six weeks were interviewed. Data were analyzed using a Heideggerian hermeneutic phenomenological approach. This method was chosen because it allowed the researcher to conduct interviews and explore the lived experience of breastfeeding mothers and to uncover the concealed meaning within the phenomena. This methodology provided a richness that might not be possible through description alone. The narratives shared by the mothers demonstrated that initiating breastfeeding and sustaining it in the early postpartum period was a complex process. Each mother’s breastfeeding experience was unique to her but also similar to someone else’s. The overall constitutive pattern of Getting the Hang of It was selected and consisted of four themes and nine subthemes. The four themes included: Physical Experiences, Emotional Complexities, Infant Involvement in Breastfeeding Process, and Support. These themes and their subsequent subthemes provide insight into the complexities experienced by mothers in order to acquire the skills they needed to breastfeed their infants. Breastfeeding mothers, who have had favorable and unfavorable experiences, are willing to share a wealth of information. Health professionals should encourage mothers to talk about their experiences and listen to what they are saying. Through listening they can provide mothers with the resources and support needed to meet their breastfeeding goals.

A dissertation presented in partial fulfilment of the requirements for the degree of Masters in Clinical Psychology in the Department of Psychology, University of Witwatersrand. March 2016. / Attachment theory is an extensive yet emerging body of research which emphasises the centrality of the mother-infant bond in healthy socio-emotional and cognitive development, particularly during infancy. The last two decades in particular have seen a proliferation of attachment research involving indigenous populations in the developing world. This has also seen our understanding of the concept of ‘mothering’ grow in breadth and depth. However, with the increased interest in these contexts, so questions are being raised by the scientific community as to the cross-cultural reliability and validity of the findings of such research. A central point of contention surrounds the measure’s suitability to the contextual and/or cultural idiosyncrasies of the sample’s characteristics. Related to this are issues of construct equivalence, item and/or methodological biases, as well as theoretical discordance between Western and non-Western principles which invariably underscore such research. Debate is particularly rife in situations where the measures have been imported and ‘imposed’ upon the sample under study without prior, appropriate adaptation. The mini Maternal Behaviour Q-Sort (MBQS-mini) was employed for the first time in a South African research initiative, the Ububele Mother-Baby Home Visiting Project (UMBHVP), to assess the maternal sensitivity scores of a group of mothers residing in Alexandra Township (Alex), Johannesburg. Maternal sensitivity is thought to be a key concept in the study of parent-infant interactions, and its influence on child development has been significantly correlated to the developmental outcomes of the infant. The MBQS-mini was designed and normed in Canada and is based on the notion of the ‘prototypically sensitive’, Canadian mother. This brings into focus some of the concerns raised above regarding the measure’s appropriateness for use in a distinctly high-risk context like Alex. This research aimed to explore the coders’ and trainer’s experiences of the first time use and application of the measure in the Ububele research initiative in Alex. A focus group and semi-structured interview elicited important information on the participants’ experiences of the training and reliability procedures and further highlighted some of the contextual/cultural constituents that were thought to have impacted the measure’s overall performance and thus also its suitability, utility and applicability to a South African setting. The analysis was inductive and exploratory in nature insofar as a prescribed theoretical interest did not necessarily inform the themes that were identified. The findings indicate that despite the significant impact of the context and the possibility of further adaptation to some items, the MBQS-mini is a suitable measure with utility for assessing maternal behaviours within South Africa. / GR2017

A research report submitted to Faculty of Health Sciences, as a requirement for completion of Masters of Medicine in Paediatrics, University of the Witwatersrand, Johannesburg, 2018 / Background. Candidemia is a significant cause of morbidity and mortality in infants. The mortality rate ranges between 21% and 76%. Non-albicans candida (NAC) is increasing in incidence and resistance to azoles. Very low birth weight (VLBW) infants have numerous risk factors which predispose them as a group to invasive candidemia. Methods. A retrospective case control study of candidemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital (CMJAH) between 01 January 2015 to 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidemia, commonest Candida species, antifungal susceptibility profiles and outcomes defined as death were identified. 71 infants with confirmed positive blood cultures for candidemia from the NHLS database were selected and each case was allocated 3 controls; the final sample comprised 284 infants. Results. Bacterial sepsis, chronic lung disease (CLD), necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases respectively. The difference in death between the two groups was not statistically significant. 7 A research report submitted to Faculty of Health Sciences WITS, as a requirement for completion of Masters of Medicine; Paediatrics. Johannesburg, South Africa 2018. Conclusions. The study demonstrated a predominance of NAC isolates, increasing rate of candidemia and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented / GR 2020