Limited research has been done on naps, particularly in early childhood education centres (ECECs). The present study followed a study by Torok (2009) with sleep-disturbed infants in ECECs. The objective of the current study was to examine the quality of naps in infants described as “typical sleepers” across two settings: the home and the early childhood education centre (ECEC). Two males and two females, ranging in age from 15- to 17-months contributed to four case studies. These were: i) an infant transitioning to the ECEC; ii) and iii) infants described as “settled” in an ECEC; and iv) an infant reported to have sleeping difficulties at home after the occurrence of a major earthquake. Observations from digital recordings were coded to determine sleep states and patterns. The findings across each case study were: i) naps varied in both settings during the infant’s transition to an ECEC but settled in both settings once the infant was “settled” at the ECEC; ii) naps tended to be consistent across both settings in the “typical sleepers” who were settled at the ECEC; and iii) naps at home were varied in the infant reported to have reacted to the earthquake while her naps at the ECEC were consistent. Overall findings suggested that total nap periods tended to be longer at home, sleep efficiency tended to be higher at the ECEC, and that participants tended to engage in more active sleep than quiet sleep. Caregiver presence was a major difference between the home and ECEC setting. This study demonstrated differences and similarities across both settings with infants described as “typical sleepers”. This is an important area due to the increasing number of infants attending ECECs (Statistics NZ, 2010). Several directions for future research have been presented.

Feeding problems in preterm neonates stem from complications of early delivery. Attainment of independent feeding is a prerequisite for Neonatal Intensive Care Unit (NICU) discharges. Some quantitative studies of infant feeding involve excessive amounts of time for data processing. Multivariate spectral analysis was used to minimize time for investigation of variability in these rhythms. Auto and Cross-spectral parameters of the rhythms were correlated with Gestational Age (GA), Postmenstrual Age (PMA), Birthweight (BW), Days of Life (DOL), and Time Since First Nipple feeding (TSFN). Auto-spectral analysis showed 25.55% increase in Bandwidth of suck (bw-su) for a 2-week increase in GA (DOL fixed) and 8.99% increase in bw-su for a 10-day increase in DOL (GA fixed). Crossspectral analysis showed a decrease of 0.158Hz of Bandwidth of Suck-Swallow (bw-SS) for a 2-week increase in GA for GA later than 28 weeks. For GA earlier than 28 weeks, peak coherence decreased by 0.774 for a 2-week increase in GA (PMA fixed) and decreased by 0.126 for a 2-week increase in PMA (GA fixed). The method describes the progression of feeding rhythms through correlations with clinical indexes, thus providing clinicians with an understanding of the development of infant feeding and helps predict long-term developmental outcomes.

Bakgrund: Neonatalvården i Sverige är organiserad så att nyfödda barn i behov av intensivvård vårdas en tid på regionsjukhus innan de flyttas till hemsjukhuset för fortsatt vård. Tidigare studier har visat att flytten till hemsjukhuset är en stor och påfrestande händelse för föräldrar som befinner sig i anknytningsprocessen och därför behövs ny kunskap för att förbättra rutinerna och omhändertagandet av föräldrar i samband med återtransport. Syfte: Att undersöka föräldrars erfarenheter i samband med förflyttning av barnet från neonatal intensivvårdsavdelning på regionsjukhus till hemsjukhusets neonatalavdelning. Metod: För att genomföra studien valdes en deskriptiv och kvalitativ design. Resultat: Analysen av föräldrarnas berättelser resulterade i tre olika kategorier att lämna tryggheten, att möta det nya och likheter och skillnader. Resultatet visade att föräldrarna upplevde svårigheter med att lämna tryggheten på regionsjukhuset. De kände oro för flytten till hemsjukhuset och upplevde brist på förberedelser och information. Återtransporten kom ofta oväntat och föräldrarna upplevde många gånger att barnet tvingats att lämna regionsjukhuset för tidigt. Att föräldrar och barn separerades under transporten innebar en stor känslomässig påfrestning. Skillnader i rutiner skapade oro och vissa föräldrar upplevde att hemsjukhusens lokaler och kompetensen hos personalen var sämre. Slutsats: Omhändertagandet av familjer kan förbättras avseende förberedelser och kommunikation, rutiner och likvärdig vård. Rutiner för förberedelse och kommunikation behöver utvecklas för att flytten till hemsjukhuset skall bli så positiv som möjligt för familjen och minimera störningar i anknytningsprocessen. Gemensamma vårdrutiner skulle underlätta anpassningen för föräldrar och lokaler och kompetens behöver anpassas till den verksamhet som bedrivs för att garantera likvärdig vård i olika delar av landet. / Background: In Swedish neonatal care newborns in need of intensive care are transferred to specialized regional hospitals and when the infants’ condition has stabilized they are relocated to community hospitals for convalescent care. Previous studies have shown that moving from one hospital to another is a significant and stressful event for parents during the attachment process. In order to improve routines regarding the care of parents when their infants are transferred, further research is needed.  Aim: The aim of the study was to investigate parents’ experiences of their infants’ transfer from the intensive care unit at the regional center to the neonatal unit at the community hospital. Method: The study was performed in a descriptive and qualitative design. Findings: The analysis resulted in three different categories to leave the safe zone, to face the new and similarities and differences. The result shows that parents find it difficult to leave the safe environment of the intensive care unit. They were worried about going to the community hospital and they sensed a lack of preparations and information. The transfer often occurred unexpectedly and parents felt that their child was forced to leave the intensive care unit too early. During transport, the child was separated from the parents, which was perceived as emotionally stressful. Differences in routines created anxiety and some of the parents felt that the community hospitals did not possess the right premises and competence of staff. Conclusion: Improvements can be made regarding preparations and communication, routines and equal care. There is a need to further develop communication and routines regarding transfers within the Swedish neonatal care system in order to create a more positive experience for parents and minimize the impact on the attachment process. Standardized routines would facilitate the adaption for parents and all neonatal care units need to have adequate facilities and staff to guarantee equal health care in various parts of the country.

Background: The economic crisis that intensified in Zimbabwe between 2004 and 2009 could have exposed children under the age of 5 at an elevated risk of dying. The study investigates the determinants of childhood mortality in the country 4 years preceding the Zimbabwe Demographic and Health Survey of 2010-2011. Aims and Objectives: To establish child mortality determinants in Zimbabwe for the period 2006-2010 during the economic crisis. Methods: The study was a descriptive cross-sectional study which used data from the ZDHS 2010-2011. Using logistic regression and survival analysis, the study estimates the odds of dying and the survivorship probabilities for the birth cohort of 2006-2010. Results: The results indicate that children born to mothers age 40-49 had 88% higher chances of dying compared to children born to mothers in the age group 15-19 in a model that controls for age of mother and gender of child. Female children had 23% lower chances of dying compared to male children in a model that controls for gender and age of mother and was statistically significant at p-value<.05. Children born to mothers with higher levels of education had 16% lower chances of dying compared to children born to mothers with lower levels of education in a model that controls for maternal education, age of mother and gender of child. Children residing in households with higher socio-economic status had 12% lower chances of dying than children residing in households with lower socio-economic status in a model that controls for household socio-economic status, maternal education, age of mother and child’s gender. Children residing in rural areas had 17% lower chances of dying than children residing in urban areas in a model that controls for area of residence, household socio-economic status, maternal education, age of mother and gender of child. Children residing in some of the country’s poorest provinces namely Matabeleland North and South had 72% and 70% lower chances of dying respectively and both were statistically significant at p-value<.05 in a model that controls for province of residence, area of residence whether rural or urban, age of mother, maternal education, gender of child and household socio-economic status. Conclusions: The study established some of the determinants of childhood mortality during the country’s economic crisis. / Thesis (M.A.)--University of KwaZulu-Natal, Durban, 2013.

The purpose of this study was to examine maternal and infant factors associated with body mass index (e.g., maternal weight gain, infant birth weight, infant feeding methods, and motor coordination) among obese pre-adolescents and adolescents aged 8-18 years enrolled in the Pediatric OverWeight Education and Research (POWER) program operated by Riley Hospital for Children in Indianapolis, IN, between October 2008 and September 2011. POWER, a three-phase, 12-month multi-disciplinary program to reduce childhood obesity funded by Indiana University Health, enrolls obese children (Body Mass Index [BMI] greater than the 95th percentile for age and gender) through referrals from pediatricians throughout Indiana. Prior to the child’s initial visit, each family completes a comprehensive background and family history profile, approved by the Indiana University-Purdue University (IUPUI) Institutional Review Board, that includes questions related to the obese child’s motor skill development, infant feeding methods, maternal prenatal weight gain, and infant birth weight. Data related to these four categories collected during Phase 1 (12 weeks) was examined using date from 253 pre-adolescents (8-12 years of age), and 285 adolescents (13-18 years of age), to determine their impact on the subjects’ BMI. No relationship between a mother’s prenatal weight gain and the child’s BMI was seen. There was a significant correlation between infant birth weight and BMI in the pre-adolescent group. Breastfed subjects entered the POWER program at a lower BMI than non-breast fed subjects and had consistently lower BMIs throughout the program compared to the non-breastfed subjects. Differences in physical activity were observed between adolescents and pre-adolescents. Paired analysis indicated the POWER program was associated with a significant reduction in BMI overall, and among both age groups throughout Phase 1 of the program. Adolescents were especially successful in reducing their BMI compared to preadolescents. Further research is needed to identify the association of maternal and infant factors and BMI among obese children. / Department of Family and Consumer Sciences

African-American women are associated with having the lowest incidence of breast-feeding among ethnic groups. The purpose of this study was to examine attitudes toward infant feeding, feeding intentions, and previous breast-feeding exposure among African-American women. Leininger's Culture Care theory provided the framework. A convenience sample of 98 gravid, adult African-American women receiving care at community health centers was administered a 42-item questionnaire on infant feeding attitudes, intentions, and exposure. Findings indicated that mothers choosing breast-feeding agreed more with the benefits of breast-feeding, and were likely to have previous breastfeeding exposure. Formula feeding mothers agreed more with inconveniences of breast-feeding and advantages of formula feeding, and were more likely not to have had previous exposure. These findings suggest that providing culturally congruent education on the benefits of breast-feeding, information on skills to overcome barriers, and positive breast-feeding exposures could positively effect the incidence of breast-feeding in the African-American population. / School of Nursing

With increases in medical technology, infant mortality has decreased, while infant morbidity has increased over the past half century. Moreover, the definition of high-risk pregnancy continues to lack true universal acceptance. Thus, continued research in the area of perinatal complications is warranted. There have been studies that have suggested short-term and long-term deficits considered to be secondary to perinatal complications. Psychologists often gather information about a given child’s perinatal history, but do not always have means to interpret how those complications may impact the child later in life. The Maternal Perinatal Scale (MPS) has been shown to have good reliability and validity in past studies, but a scoring system has yet to be established. This project consisted of two studies. The first study created a preliminary scoring system for the developmental questionnaire, the Maternal Perinatal Scale. This questionnaire has proven to have potential for good clinical utility, but prior to this study, had nothing beyond item-by-item analysis for interpreting the results. To test the validity of the proposed scoring system, a second study was conducted to determine cutoff scores and classification rates for the scoring system on data previously collected with children in elementary school. Results revealed proposed scores for each item on the MPS and classification rates associated with certain developmental disorders later in life. / Department of Educational Psychology

Background - The first 1000 days of life (from conception to two years of age) is a critical period of nutritional vulnerability, affecting lifelong health. Iron deficiency (ID) and iron deficiency anaemia (IDA) are considered major public health problems that adversely affect development and growth, impair immunity, and increase morbidity and mortality in infants. ID and IDA in sub-Saharan Africa can be attributed to poor dietary, socioeconomic and disease conditions. One of the major obstacles in determining the prevalence of ID, using serum ferritin (SF) as marker of iron status, is that it not only reflects the amount of iron that is stored in the body, but also functions as an acute phase reactant that is raised in the presence of infection or inflammation. Aim - We conducted a re-analysis of the International Research on Infant Supplementation (IRIS) study’s baseline data to determine a more accurate estimation of the ID prevalence in apparently healthy four to thirteen-month-old infants from rural KwaZulu-Natal while accounting for the effect of chronic and acute inflammation on SF. Study design and methods - A cross-sectional analysis was performed on the baseline data (192 infants) of the IRIS study that was conducted in 2000. Infants’ haemoglobin (Hb), SF, C-reactive protein (CRP) and alpha-1 glycoprotein (AGP) concentrations were interpreted to determine the prevalence of ID. Literature of the past four years served as a guide to compare the ID prevalence obtained from four methods that account for the influence of inflammation on SF concentrations, to a reference method that does not take inflammation into consideration, and to what was reported in the original IRIS study. Weight and recumbent length measurements were converted to z-scores to interpret subjects’ anthropometric nutritional status. Results - A high prevalence of inflammation (52.6%) was present, with 11.5% of the subjects being in the incubation, 17.2% in the early convalescent, and 24% in the late convalescent phase of inflammation. SF was significantly associated with both CRP (ß = 0.200; P = 0.005) and AGP (ß = 0.223; P = 0.002) when adjusting for gender and age. The IRIS study reported an ID prevalence of 18.3%, whereas the results of this study ranged from 17.2 to 52.1%. We derived an IDA prevalence that ranged from 12 to 24.5% according to the different methods. The prevalence of stunting [length-for-age Z-score <-2SD] was 12.5%; while 25.1% of infants were overweight/obese [weight-for-length z-score >2SD]. Conclusion - A double burden of malnutrition was evident from the high prevalence of both overweight and ID, together with inflammation. The disconcertingly large variance in ID prevalence observed between the different methods that were employed highlights that iron supplementation interventions to treat anaemia must be based upon accurate estimates of IDA prevalence, otherwise they pose an increased risk of adverse effects to susceptible, iron-replete, but anaemic infants. Given the detrimental consequences of ID, it is imperative that governments, health care providers and parents must act to prevent or treat ID and IDA among vulnerable infants. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Metabolism is an integrated network of biochemical pathways involving a series of enzymecatalysed anabolic or catabolic reactions in cells. Metabolites are chemical compounds that are involved in or are products of metabolic pathways, and the metabolome is defined as the total complement of all the low molecular weight metabolites present in a cell at any given time. Metabolomics is a relatively new research technology utilised for the global investigation, identification and quantification of the metabolome. Three aims were defined for the metabolomics study presented here: • The use of metabolomics technology to generate new biological information; • Application of the metabolomics technology to gain information on the three natural perturbations, namely the menstrual cycle, pregnancy and aging; and • Reflection on metabolomic studies as a hypothesis-generating approach. I obtained three sets of urine samples from women during their menstrual cycle, samples from sixteen pregnant and eleven non-pregnant women for the second natural perturbation, and data sets from previous investigations on infant and child groups, as well as thirty-two urine samples from adults for the study of the metabolomic profiles due to age. These urine samples were analysed to determine the organic acid metabolite profiles. The metabolites were identified by means of AMDIS and were manually quantified. Data matrixes were compiled, which underwent certain data reduction steps, prior to statistical analysis. Different statistical approaches were used to generate information on these three natural perturbations due to the clear differences between the three experimental groups used. The investigation of the menstrual cycle did not show a distinct difference between the three phases involved in the cycle, whereas the pregnancy perturbation showed a difference between pregnant groups and non-pregnant groups. The most pronounced difference in metabolite profiles were found when the different age groups were compared to one another. Finally a hypothesis on the effect of age on metabolism was defined and an experimental approach was proposed to evaluate this hypothesis. In conclusion three proposals were formulated from this investigation: 1. If it appears that an insufficient number of participants can be generated for a metabolomics study, such a study should be discarded in the interest of a more feasible investigation. 2. It is advisable that a number of appropriate analytical validation parameters should be incorporated in the early stages of a metabolomics study, specifically linked to the context of the perturbation chosen for the investigation. 3. The control and experimental groups should be homogenous that is to say as comparable as possible with regard to age, ethnicity, diet, and gender, lifestyle habits and other possible confounding influences, except for the specific perturbation being studied. In a perfect world this would be possible, specifically when hypothesis formulation, testing and finally the expansion of scientific knowledge is a desired outcome of the investigation. / Thesis (M.Sc. (Biochemistry))--North-West University, Potchefstroom Campus, 2010.

Metabolism is an integrated network of biochemical pathways involving a series of enzymecatalysed anabolic or catabolic reactions in cells. Metabolites are chemical compounds that are involved in or are products of metabolic pathways, and the metabolome is defined as the total complement of all the low molecular weight metabolites present in a cell at any given time. Metabolomics is a relatively new research technology utilised for the global investigation, identification and quantification of the metabolome. Three aims were defined for the metabolomics study presented here: • The use of metabolomics technology to generate new biological information; • Application of the metabolomics technology to gain information on the three natural perturbations, namely the menstrual cycle, pregnancy and aging; and • Reflection on metabolomic studies as a hypothesis-generating approach. I obtained three sets of urine samples from women during their menstrual cycle, samples from sixteen pregnant and eleven non-pregnant women for the second natural perturbation, and data sets from previous investigations on infant and child groups, as well as thirty-two urine samples from adults for the study of the metabolomic profiles due to age. These urine samples were analysed to determine the organic acid metabolite profiles. The metabolites were identified by means of AMDIS and were manually quantified. Data matrixes were compiled, which underwent certain data reduction steps, prior to statistical analysis. Different statistical approaches were used to generate information on these three natural perturbations due to the clear differences between the three experimental groups used. The investigation of the menstrual cycle did not show a distinct difference between the three phases involved in the cycle, whereas the pregnancy perturbation showed a difference between pregnant groups and non-pregnant groups. The most pronounced difference in metabolite profiles were found when the different age groups were compared to one another. Finally a hypothesis on the effect of age on metabolism was defined and an experimental approach was proposed to evaluate this hypothesis. In conclusion three proposals were formulated from this investigation: 1. If it appears that an insufficient number of participants can be generated for a metabolomics study, such a study should be discarded in the interest of a more feasible investigation. 2. It is advisable that a number of appropriate analytical validation parameters should be incorporated in the early stages of a metabolomics study, specifically linked to the context of the perturbation chosen for the investigation. 3. The control and experimental groups should be homogenous that is to say as comparable as possible with regard to age, ethnicity, diet, and gender, lifestyle habits and other possible confounding influences, except for the specific perturbation being studied. In a perfect world this would be possible, specifically when hypothesis formulation, testing and finally the expansion of scientific knowledge is a desired outcome of the investigation. / Thesis (M.Sc. (Biochemistry))--North-West University, Potchefstroom Campus, 2010.