The purpose of this study was to examine the effects of cry pitch and attributions that crying infants had or had not been abused on the perceptual ratings of maltreating and comparison parents. Twenty maltreating parents and 20 comparison parents rated 12 cries which varied in the pattern of their fundamental frequency on (a) the cry's similarity to their own child's cry, (b) the likelihood that the crying infant would be abused in the future, (c) 5 perceptual items and (d) 7 caregiving response items. Attributions of whether the crying infant was "abused" or "not abused" were varied before each cry sound during the ratings of the perceptual and caregiving response items. Results showed that as the pitch of the cries increased, all parents rated the cries' as less similar to their own infant's cries and the crying infants as more likely to be abused. Maltreating parents, however, rated mixed- and high-pitched cries as more similar to their own child's cries than comparison parents did. Generally, more sympathetic perceptions and responses were given to "abused" infants. However, perceptions of how "arousing" and "distressing" cries sounded were equally high for high-pitched "abused" and "not abused" infants' cries. Maltreating parents were more likely to "ignore" cries, and their ratings of urgency for mixed- and high-pitched cries were lower than comparison parents' ratings. The results are discussed within the framework of how children may contribute to the development of their own abuse or neglect. / M.S.

The Special Supplemental Food Program for Women, Infants and Children (WIC) is a public health intervention targeted to reach a high risk pregnant population in order to promote beneficial effects on pregnancy outcome. The ultimate goal of this research was to examine the pregnancy outcomes, relative to selected biological, socio-demographic and nutritional risk variables, of pregnant women enrolled in the Virginia WIC Program. The study proposed that duration of WIC participation is associated with improved pregnancy outcomes, including higher infant birth weight, a decrease in low birth weight (LBW) and decreased incidences of prematurity, neonatal mortality and abnormal births. Nutritional and non-nutritional risk variables and birth outcomes were examined in 2,133 pregnant women enrolled in the Virginia WIC Program from December 1, 1984 to September 30, 1985. A WIC Pregnant Women Tracking Form was the designed instrument utilized by staff at health department clinic sites to record the data at time of program entry. Duration of participation in WIC was calculated by weeks and stratified into three groups by months (or trimesters) of participation. Results indicated that this subject population was demographically and nutritionally at higher risk for poor pregnancy outcomes. Stratification by demographic subpopulations showed the most vulnerable may be those prenatal subjects less than 18 years of age, and of black racial/ethnic status. Statistical analyses between the duration of indicated a positive correlation participation, especially when in the WIC Program and pregnancy birth weight, LBW, and birth stratified by trimester, outcome described by complications. It was concluded that for this high risk group of prenatal subjects, increased participation in the WIC Program is associated with enhanced pregnancy outcomes. While these findings suggest that birth weight and birth outcome differences are a function of WIC participation, other related factors may be basis for this causal effect. / M.S.

This study aimed to provide empirical verification to the hypothesis that unwanted fertility could lead to mortality, with underinvestment as an intervening mechanism. Unwanted fertility was defined as a live birth that deviated from parental expectation in some distinguishable characteristics or set of characteristics. Births defined as unwanted were: 1) births which respondent indicated she preferred to have occurred later or births which she did not want at all, 2) those whose birth order exceeded the mother’s desired family size, and 3) those which exceeded the number of desired boys of the number of desired girls of the mother. Underinvestment as defined by Scrimshaw (1978) involved the idea that mothers would not go to extremes to save the life of a child and might invest more time and resources in other children. To measure underinvestment, a scale was constructed made up of the following items: 1) source of prenatal care, 2) frequency of prenatal care, 3) age started supplementary feeding, 4) length of breastfeeding, 5) source of medical treatment, 6) length of time before treatment was sought, and 7) time spent cuddling and playing with child. Mortality was classified into two types: postneonatal mortality and childhood mortality. Postneonatal mortality involved deaths from ages one to eleven months. Childhood mortality involved deaths at ages one to four years. Thus, analysis proceeded in two ways: 1) that involving all live births born at least a year before the time of the interview and 2) that involving only live births born at least five years before the time of the interview. Results of the study did not support the hypothesis that unwanted fertility could lead to mortality, with underinvestment as an intervening mechanism. In general, no significant association was found between unwantedness and mortality. However, underinvestment and mortality (postneonatal and childhood) were significantly associated for both wanted and unwanted births. Underinvestment and childhood mortality were significantly related for births in lower class families and for births in middle and upper class families. Postneonatal mortality was significantly related to underinvestment among lower class births only. Postneonatal mortality was not significantly related to SES. Childhood mortality was significantly related to SES with underinvestment as an intervening variable. The study underscored the difficulties involved in measuring the variables of interest -- unwantedness and underinvestment. Several limitations of the study were pointed out and recommendations for further research were stated. / Ph. D.

This study was conducted to investigate why women participating in the WIC Program chose bottlefeeding rather than breastfeeding. Additionally, this investigator sought to determine the extent of prenatal education provided on the topic of breastfeeding within the health department population versus private care patients. An anonymous survey was administered by WIC nutritionists in the state of Virginia to mothers of newborns who were bottlefeeding. A total of 152 women completed questionnaires which were analyzed. Data were subjected to Chi-square analysis to determine association between demographic variables and specific reasons identified for not choosing to breastfeed. Source and type of prenatal education on the topic of breastfeeding was also examined. The majority of the respondents were black women under age 25 with no more than a high school education. Many of the women were not married and most received prenatal medical care at their local health departments. Results indicated that women attending health department clinics received more prenatal education on the topic of breastfeeding than did those attending private physicians. The main reasons cited for not choosing to breastfeed were related to the perceived inconvenience of breastfeeding. This was especially true for those who had less than a high school education. Younger women appeared to be more concerned that breast size would affect their ability to successfully breastfeed. These same women were also concerned with being able to return to school. White women were more concerned about returning to work than were blacks. Marital status, or living arrangements seemed to be related to fear of embarrassment; married women were less concerned about this than the other groups. It is the hope of this researcher that the information gathered in this study can assist in developing education and intervention programs which may help to increase the incidence of breastfeeding among the WIC Program population. / Master of Science

A clinical need exists for a blood oxygenator and pumping system for the support of neonates with respiratory deficiencies. Such systems now available for support of adults are not suitable for neonatal patients. In vitro evaluation of a new blood oxygenator and blood pumping system was performed. The data obtained suggested that this system may be applicable to neonates. In vivo studies with rabbits to further analyze the new system were done. Preliminary data from these studies indicate that the new blood oxygenator and blood pump system may be applicable to supporting neonates with respiratory deficiencies. Suggestions for future development of this system are presented. / Master of Science

Previous studies have reported that spontaneous startles occur most frequently in the quiet sleep states, and have posited an energy release model in which spontaneous startles occur to release energy which would otherwise wake the infant. An alternative suggestion is that startles serve a homeostatic function by increasing the activity of the infant during periods of low arousal. The purpose of the current study was to examine the function of spontaneous startles using the ongoing cardiac and respiratory activity as indices of arousal. Twenty-six newborn infants were assigned to two groups. The first group was exposed to auditory stimulation which previously had been shown to decrease heart rate and respiratory rate for the first half of the one hour observation period. To the extent that spontaneous startles are related to periods of low arousal, decreasing the ongoing activity via the auditory intervention was expected to increase the rate of startles. The second group received no auditory stimulation. The occurrence of spontaneous startles was preceded by periods of lower than average heart rate and decreasing respiratory rate. Startles were followed by periods of increasing heart rate and further decreasing respiratory rate. In addition, the auditory intervention group reliably showed both a lower heart rate and an increased number of startles while exposed to the auditory stimulation, while the nonintervention group showed comparable rates of startles and heart rates in both halves of the observation period. Further, regardless of group status, most infants had their higher rate of startles in the period in which they had their lower heart rate. Finding lower heart rate and decreasing respiratory rate preceding startles, and lower heart rate and increased number of startles when exposed to the auditory stimulation, suggests that spontaneous startles modulate periods of low arousal in newborn infants. / Ph. D.

Nonnutritive Sucking (NNS) has long been used to soothe crying infants. Systematic observations of this effect in newborn infants have revealed that NNS reduces arousal in general. Among preterm infants NNS has been used as an effective intervention in the newborn intensive care unit. However, there has been little systematic research on the immediate behavioral effects of NNS in this population of infants. The purpose of this study was to examine the effects of NNS on behavioral state in preterm infants. The results indicated that the amount of quiet sleep was increased following NNS, but that this increase was not greater than the amount of quiet sleep observed in two hours of undisturbed rest. These results are discussed in terms of intervention strategies which are designed to increase the amount of quiet sleep among preterm infants. It is suggested that a pacifier can increase the amount of quiet sleep when longer periods of uninterrupted sleep cannot be arranged. Additional results indicated that the rhythmic organization of state was more complex following NNS than during control conditions. A basic 40- to 60-minute rhythm in state was not affected by NNS. However, spectral analysis indicated that there were other faster frequency fluctuations in state. Following NNS there were more of these fluctuations and they accounted for more variance in state. This pattern is more similar to the pattern observed in low-risk newborns. These results are discussed in terms of inducing behavior patterns in preterm infants which are more similar to behavior seen in full term infants. Finally, a model is presented which suggests that the reduced arousal seen following NNS is an adjunct to an increase in parasympathetic activity. This increase in parasympathetic activity is hypothesized to be adaptive. Through this mechanism sucking is hypothesized to have a distinct behavioral effect on energy regulation in newborn infants outside of the requirements for feeding. / Ph. D.

Yes / Background: Group B Streptococcus (GBS) is a leading cause of morbidity and mortality in infants in both developed and developing countries. To our knowledge, only a few studies have been reported the clinical features, treatment and outcomes of the GBS disease in China. The severity of neonatal GBS disease in China remains unclear. Population-based surveillance in China is therefore required. Methods: We retrospectively collected data of <3 months old infants with culture-positive GBS in sterile samples from three large urban tertiary hospitals in South China from Jan 2011 to Dec 2014. The GBS isolates and their antibiotic susceptibility were routinely identified in clinical laboratories in participating hospitals. Serotyping and multi-locus sequence typing (MLST) were also conducted for further analysis of the neonatal GBS disease. Results: Total 70 cases of culture-confirmed invasive GBS infection were identified from 127,206 live births born in studying hospitals, giving an overall incidence of 0.55 per 1000 live births (95% confidence interval [CI] 0.44–0.69). They consisted of 49 with early-onset disease (EOD, 0.39 per 1000 live births (95% CI 0.29–0.51)) and 21 with late-onset disease (LOD, 0.17 per 1000 live births (95% CI 0.11–0.25)). The incidence of EOD increased significantly over the studying period. Five infants (4 EOD and 1 LOD) died before discharge giving a mortality rate of 7.1% and five infants (7.1%, 2 EOD and 3 LOD) had neurological sequelae. Within 68 GBS isolates from GBS cases who born in the studying hospitals or elsewhere, serotype III accounted for 77.9%, followed by Ib (14.7%), V (4.4%), and Ia (2.9%). MLST analysis revealed the presence of 13 different sequence types among the 68 GBS isolates and ST-17 was the most frequent sequence type (63.2%). All isolates were susceptible to penicillin, ceftriaxone, vancomycin and linezolid, while 57.4% and 51.5% were resistant to erythromycin and clindamycin, respectively. Conclusions: This study gains the insight into the spectrum of GBS infection in south China which will facilitate the development of the guidance for reasonable antibiotics usage and will provide evidence for the implementation of potential GBS vaccines in the future. / Supported by medical and health science and technology projects of Health and Family Planning Commission of Guangzhou Municipality (grant number 20151A010034) and Guangdong provincial science and technology planning projects (grant number 2014A020212520).

This study was concerned with establishing the extent to which various components of the environment were exposed to the three toxic minerals, arsenic, mercury and lead. The concentration of these three elements were determined in groundwater and surface water, soil, plants, animals such as goats, and humans in potentially contaminated areas in the Limpopo Province of South Africa. The focus of the study was to assess the possible exposure to infants through ingestion to arsenic, mercury and lead. Comparison of the mineral content of water at the study sites with international and national drinking water standards, indicated water from Rooiberg, Leeupoort and Gravelotte are not fit for human consumption due to high arsenic and lead concentrations. Water at Gravelotte also has unacceptably high levels of mercury. The soil, plants, goat’s milk and mother’s milk at Rooiberg have higher levels of arsenic and lead than have been recorded for many other countries. Mother’s milk and goat’s milk are the main sources of arsenic, lead and mercury contamination at Rooiberg. It is therefore newborns and toddlers who are most at risk from exposure to arsenic and lead. This is a cause for environmental and health concerns, but as this research is only a base-line study, it is imperative that more comprehensive surveys of potentially toxic mineral contamination be conducted in the province. / Environmental Sciences / (M.Sc. (Environmental Science))

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)