In adults, the availability of certain kinds of cues prior to a recognition task facilitates performance (often called “priming”). Studies have found that conceptual and perceptual priming improves neural efficiency and thus shortens response time in adults. In infant research, various visual and auditory/visual events are used as attention getters to orient the infant to a screen and alert them to upcoming information for their detection, discrimination, and/or recognition. However, the influence of attention-getters on infants’ performance has rarely been systematically evaluated, even though these attention cues could be acting as perceptual/conceptual primes. This study investigated the effect of priming on infants’ preferences for infant-directed speech (IDS) compared to adult-directed speech (ADS). IDS, an inherently social event, can be described as a moderator between attention systems and later language development. Thus, if the attentional network is primed in advance of hearing IDS, it is possible that the magnitude of the IDS preference may change. In this study, 20, 12- to 18-month old infants were provided with either a nonsocial or social prime in an infant-controlled, speech preference procedure with both IDS and ADS speech types. The infant’s total looking duration to IDS relative to ADS was compared for the social versus nonsocial prime condition. Results indicated a main effect for speech and overall IDS preference. However, no significant effect of prime was detected. Results are discussed in terms of future directions to investigate social priming of language in infancy. / Master of Science / In infant research, short duration events are used before the task of interest to orient infants to the screen, increase their attention, and prepare them for the following information to come. These events are called “attention getters” in developmental research, and are used internationally as a way to garner infants’ attention before the main test of interest. Labs use different attention getters based on their prior experience of what works best, and these attention getters vary in content (e.g., social, nonsocial), and format (e.g., audio, visual, audiovisual). The effect of the content of the attention getter on infants’ subsequent performance has never previously been studied, although the content could be acting as a prime for the following task. This study investigated the effect of a social, as opposed to nonsocial, attention getter on infants’ subsequent performance on a speech preference task. Infants (N = 20, 12- to 18-month olds) received both infant-directed speech (IDS; or how caregivers speak to their infants, characterized by shorter sentences, slower rate of speech, and exaggerated vowels) and adult-directed speech (ADS; or how adults speak to other adults, characterized by complex grammar, faster rates of speech, and shorter vowel sounds) which were preceded by either a social (woman saying “Hi Baby” in IDS) or nonsocial (swirling target with chimes) attention getter to investigate their preferences for speech type. It was predicted that infants who received a social prime would demonstrate a stronger preference for IDS over ADS relative to infants who received the nonsocial prime. Results indicated a main effect for speech and overall IDS preference. However, no significant effect of attention getter was detected, and the interaction between speech type and attention getter was not significant. Thus, our predicted results were not supported; the content of the attention getter did not attenuate or augment infants’ speech type preferences. Results are discussed in terms of future directions to better detect social priming in infancy.

The purpose of this integrative literature review was to provide a compilation and review of literature related to perinatal outcomes of clients with antepartum or intrapartum oligohydramnios and management decisions applied to these clients. This paper is intended to synthesize and summarize the most current knowledge retrieved in these topics between the years of 1990- 2000. A general search using key terms was conducted, and yielded 63 prospective articles comprised of full articles, abstracts, and literature reviews. Seventeen articles on oligohydramnios, amniotic fluid volume measurements, and perinatal outcomes were retained out of the 35 that were found. The search for the literature discussing management of oligohydramnios produced 9 articles, of which 3 were found to be pertinent to this project. Twelve of the total 39 articles retained were literature reviews and were used for citation and identification of additional information material to this topic. Seven of the 39 articles were retained for the sole purpose of enabling the author to provide a descriptive, thorough review on the relevant concepts of this review. Studies reviewing amniotic fluid volume/oligohydramnios and perinatal outcomes suggest great variance among likelihood of adverse perinatal outcomes. Studies reviewing management of oligohydramnios suggest amnioinfusion may have obstetrical and perinatal benefits for the client with oligohydramnios. Aggressive management including indication for cesarean section related to fetal distress and labor induction were implied with minimal discussion on conservative management for these clients.

Yes / Despite being a preventable disease, pediatric HIV infection continues to be a public health concern due to the morbidity and mortality associated with the disease. Vertical transmission of HIV occurs when a mother living with HIV passes the virus to her baby during pregnancy, childbirth, or breastfeeding. Globally, the vertical transmission rate of HIV is 9% with sub-Saharan Africa accounting for 90% of these infections. In Kenya, the national vertical transmission rates of HIV stood at 11.5% by the end of 2018, with a target to reduce vertical transmission rates to below 5% and 2% in breastfeeding and non-breastfeeding infants respectively, by the end of 2021. To determine the prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya. A prospective cohort study design was adopted. HIV exposed infants were recruited at six weeks to determine HIV-free survival over 12 months follow up. Simple random sampling was used to select 166 infants and data were collected from the mothers using semi-structured interviewer-administered questionnaires. Log-rank tests were used to test for associations at the bi-variable level while Cox-proportional regression was used to analyze data at the multi-variable level, with the aid of STATA 14 software. Ethical approval was obtained from Kenya Medical Research Institute, Scientific Ethics Review Unit. The overall infant HIV incidence rate over one-year follow-up was 9 cases per 100 person-years (95% CI: 5.465-16.290). The failure event was defined as an infant with a positive PCR test during the study period with total failures being 13 (9.41%) over 12 months. Prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and mothers with a recent HIV diagnosis of ≤ 2 years since a positive HIV diagnosis (HR 5.97 CI: 1.20, 29.58) and (HR 6.97 CI: 1.96, 24.76), respectively. Maternal prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and recent maternal HIV diagnosis of ≤ 2 years since positive HIV diagnosis. The study recommended the development of an intervention package with more rigorous adherence counseling and close monitoring for young mothers, and mothers with recent HIV diagnoses.

The purpose of this study was to examine differences in early intervention (EI) referral and service frequency for children with blindness or visual impairment (BVI) and gather information about the practices and experiences of vision professionals across the United States. The study focused on obtaining data from certified teachers of students with visual impairment (CTVI) and certified orientation and mobility specialists (COMS) in the United States. Information collected included descriptive statistics and professional information about EI for children with BVI, and information about the referral process and service frequency for children with BVI during EI. Thirty-three states were represented in the collected data. Of these states, 26 had responses from four or more professionals, the criteria for inclusion in the analyses. Participants provided information based on a researcher-developed survey requesting information related to the procedures used to provide EI services for children with BVI. Questions were adapted from established instruments where possible. Across states, there were some statistically significant differences in CTVIs and COMS reports of procedures regarding the role of professional collaboration, parent/caregiver participation in IFSP meetings, strengths/resources utilized by vision professionals, and challenges parents/families encountered when accessing EI services for their child with BVI. No statistically significant differences were identified across states for type of referral method, most commonly initiated by health care professionals, or method by which service frequency was determined. Results will be used to inform future research to further examine EI for children with BVI in the United States.

The purpose of the study was to determine if mothers who breast-feed their babies for nine months and longer experience problems when weaning. This research also determines the type of problems and weaning practices used by those mothers. In this descriptive study, data was collected from 150 mothers by means of questionnaires and interviews. The subjects were mothers who breast-fed their children for nine months or longer, who attended antenatal and postnatal clinics at Coronation Hospital. Reasons for weaning were inter alia the belief that the baby was old enough to be weaned. The results revealed that 42 (31,34%) of the respondents experienced problems during weaning. The problems included, among others, guilt feelings in the mother. Mothers use harsh methods of weaning such as sending a child away to a relative. There is minimal involvement of health workers in the health education of mothers on weaning. / Health Studies / M.A. (Nursing Science)

No description available.

O refluxo gastro-esofágico é considerado fator responsável pela dificuldade alimentar na infância. A ocorrência de experiências negativas como vômitos, regurgitações, muitas vezes associadas a engasgos, esofagite, disfagia, odinofagia, pirose e dor retroesternal geram comportamentos de aversão ou recusa alimentar e desorganizam o processo de deglutição e alimentação. O presente estudo teve por objetivo avaliar a deglutição em crianças com diagnóstico clínico de refluxo gastroesofágico (RGE). Foram selecionadas 37 crianças, com diagnóstico clínico de refluxo gastro-esofágico e refluxo gastro-esofágico associado a queixas de dificuldades alimentares, com idades variando de 7 meses a 3 anos e 1 mês, idade média de 15,35 meses, sendo 25 (67,6%) do gênero masculino e 12 (32,4%) do gênero feminino. Participaram do grupo controle 15 crianças, saudáveis (estado geral e nutricional), que foram cuidadosamente triadas para assegurar adequado desenvolvimento neuropsicomotor e ausência de sintomas de refluxo gastro-esofágico e problemas respiratórios de repetição, na faixa etária de 6 meses a 3 anos e 2 meses, idade média de 20,5 meses; 9 (60,0%) do gênero feminino e 6 (40,0%) do gênero masculino. Para a avaliação funcional da deglutição foram utilizadas dietas de consistências líquida, pastosa e sólida em volume inicialmente de 5 ml e após em volume livre, habitualmente utilizado pela criança. Na avaliação videofluoroscópica, utilizou-se das dietas de consistências líquida e pastosa, em volume livre para o leite e 5 ml para a dieta pastosa, adicionadas ao contraste de bário. As crianças com refluxo gastro-esofágico apresentaram alterações na avaliação clínica com ingestão menos freqüente de consistência sólida, presença de náusea, recusa alimentar, engasgos e irritabilidade alimentar. Na avaliação objetiva para o alimento de consistência líquida houve penetração laríngea e movimento compensatório de cabeça em extensão, sendo este último também observado para o alimento de consistência pastosa. Entretanto, não houve diferença entre os tempos das fases da deglutição. O estudo permitiu concluir que crianças com RGE apresentam dificuldades relacionadas à aceitação alimentar, porém os tempos da dinâmica orofaríngea da deglutição não se alteram. / Gastroesophageal reflux is considered cause of infants feeding disorder. Negative experience such as vomiting, regurgitation; several times may be associated to choking, dysphagia and painfull swallowing produce aversion or feed refusal and causes a break up in the swallowing and feeding processes. This study evaluated the swallowing process in children with gastroesophageal reflux (GER), confirmed clinically and radiographically. We selected 37 children, with GER and GER complaints of feeding disorders, ages range from 7 months to 37 months, mean age of 15,4 months, consisted 25 males (67,6%) and 12 females (32,4%). The control group (GC) consisted of 15 healthy children (general and nourishing states), carefully chosen for not having any symptoms of GER, repetitive breathing disorders or developmental delays. The ages varied form 6 to 38 months, with mean age of 20,5 months, being 6 males (40%) and 9 females (60%). Swallowing evaluation (functional) considered three diets consistency: liquid, semi-solid and solid, beginning with 5 ml followed by free volume taken habitually by children. Free volume of milk and 5 ml of semi-solid, mixed with barium, were used during the videofluoroscopy. Children with GER presented alteration in clinical evaluations on 64,9% (n=24) and the control group on 13,3% (n=2), swallowing less diet solid diet, presents nausea, feeding refusal, choking and irritation. Videofluoroscopy evaluation for liquids, showed laryngeal penetration on 61,8 % (n =21) , GC 33,3% (n=5), and backward compensatory movement in 64,7% (n=22) e GC 0%, it was similar for the semi-solid diet 41,2% (n=14) e GC (n=0). There was no difference in time of the swallowing phases. This study shows that children with GER present difficulties to accepting feeding although no alteration on the oropharyngeal dynamics timing of swallowing was founded.

Introdução: Recém-nascidos prematuros são considerados vulneráveis às complicações da prematuridade, incluindo o insulto neurológico e os déficits a longo prazo no crescimento e no desenvolvimento. Objetivo: Investigar o desenvolvimento psicomotor e o crescimento de crianças prematuras, nascidas com muito baixo peso, aos 8 e 18 meses de idade corrigida, comparando com seus pares nascidos de termo; e verificar a relação do crescimento com os resultados do desenvolvimento. Método: Estudo de coorte prospectivo, incluindo 83 recém-nascidos com peso de nascimento≤1500g e idade gestacional≤32 semanas, e um grupo controle de 52 crianças nascidas de termo saudáveis. A Alberta Infant Motor Scale (AIMS) e a Escala Brunet-Lèzini (EBL) foram utilizadas para avaliar o desenvolvimento aos 8 e 18 meses de idade (corrigida para a prematuridade - ICo). Medidas antropométricas foram coletadas para avaliar o crescimento nas duas faixas etárias. Resultados: Aos 8 meses de ICo, os prematuros pontuaram significativamente inferior no escore bruto da AIMS (p=0,001). Aos 18 meses, pontuaram significativamente inferior na subescala em pé da AIMS (p=0,040) e apresentaram pobre desenvolvimento psicomotor na EBL (p=0,006). O estado nutricional apresentou diferenças significativas entre os grupos, nas duas faixas etárias (p<0,001). Ocorreu correlação positiva do estado nutricional dos prematuros com a AIMS (r=0,395; p<0,001) e com a EBL (r=0,346; p<0,01) aos 8 meses de ICo; e do perímetro cefálico com a AIMS (r=0,282; p<0,05) aos 18 meses de ICo. Conclusões: Crianças prematuras, nascidas com muito baixo peso, aos 8 e 18 meses de ICo, apresentaram diferenças significativas no desenvolvimento e no padrão de crescimento, quando comparadas aos seus pares de termo. Os resultados demonstram o impacto do crescimento junto ao desenvolvimento, reforçando a importância do acompanhamento multidisciplinar dessa população de risco. / Introduction: Preterm infants are considered vulnerable to the prematurity complications, including the neurological insult and the deficits in the long term growth and development. Objective: To investigate the psychomotor development and growth of preterm infants born with very low weight, at 8 and 18 months corrected age, compared with their peers born at term; and to verify the growth relation with the development results. Methods: A prospective cohort study including 83 infants with birth weight≤1500g and gestational age≤32 weeks, and a control group of 52 healthy term born children. Alberta Infant Motor Scale (AIMS) and Brunet-Lèzini scale (EBL) were used to evaluate the development at 8 and 18 months of age (corrected for prematurity-CA). Anthropometric measurements were collected to evaluate the growth in both age groups. Results: At 8 months of CA, premature infants scored significantly lower in gross score of the AIMS (p=0.001). At 18 months, they scored significantly lower on the standing up subscale from AIMS (p=0.040) and exhibited poor psychomotor development in the EBL (p=0.006). The nutritional status showed significant differences between the groups, in both age groups (p<0.001). There was a positive correlation of nutritional status of preterm infants with the AIMS (r=0.395; p<0.001) and with the EBL (r=0.346; p<0.01) at 8 months of CA; and the head circumference at birth with the AIMS (r=0.282; p<0.05) at 18 months of CA. Conclusions: Preterm infants born with very low birth weight, at 8 and 18 months of CA, showed significant differences in the development and growth pattern, when compared with their peers born at full term. The results demonstrate the impact of growth on the development, reinforcing the importance of monitoring this at risk population.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

Background: The Zanzibar Infant Nutrition Campaign is a large-scale randomised control trial investigating the effects of iron and zinc supplementation on the morbidity and mortality of infants and young children on Pemba Island, Zanzibar, Tanzania. The Child Development Study is a substudy of the larger ZINC control trial assessing the effects of 12 months of iron and zinc supplementation on motor and language development. The Caregiver-Infant Interaction Study is a substudy of the Child Development Study, assessing the effects of 1 to 3 months of iron and zinc supplementation on caregiver-infant interaction among 9-month-old dyads. This thesis reports on the dyads enrolled in the Caregiver-Infant Interaction Study. While not examining treatment effects1 • Formulate behavioural and developmental hypotheses specific to a population of 9-month-old caregiver-infant dyads affected by a history of IDA , hypothesised disturbances in the behaviour and development of infants affected by a history of iron deficiency anaemia (IDA) are examined. Objectives: • Develop a hypothesis-driven observational coding system and establish the psychometric properties of this measure • Test hypotheses about the relationship between a history of IDA and the behaviour and development of 9-month-old caregiver-infant dyads Rationale: Iron deficiency anaemia is the most common nutritional disorder in the world. Prevalence is especially high among women, young children and infants in developing countries. As a public health concern, the effects of IDA are various and insidious, however the relationship between IDA and infant behaviour and development is not known. The majority of studies concerned with the impact of IDA in infancy have relied on global developmental scales, such as the Bayley Scales of Infant Development (Bayley, 1969, 1993). While infants with IDA consistently score worse than non-anaemic comparisons on mental and motor subscales, the value of this form of assessment is known to be limited. Apart from being of questionable validity as indices of abilities or functions (e.g., Fagan & Singer, 1983), the scores and ratings produced by traditional developmental scales are not designed to assess the specific functions hypothesised to be affected by IDA (Lozoff, De Andraca, Castillo, Smith, Walter & Pino, 2003). Over-reliance on this kind of measure thus rules out meaningful hypothesis-driven research. Recently, malnutrition researchers have begun to made use of systematic behavioural observation as a means of assessment. While a promising approach, extant research is limited to only two studies (see Footnote 6), and both of these have been conducted by the same research group. Moreover, these studies have relied on fairly rudimentary behavioural coding to examine a version of the ‘Functional Isolation Hypothesis', originally proposed some time ago in the infrahuman literature (Levitsky & Barns, 1972, 1973). More sophisticated hypotheses are available, especially given the ready availability of insights from developmental psychobiology and cognitive science. Design: A correlational design was used to examine the behaviour and development of 9-month old caregiver-infant dyads with a history of IDA. Setting: Wete District, Pemba Island, Zanzibar, Tanzania. Participants: 160 Caregiver-infant dyads assessed observationally at 9-month of age. Main Outcome Measure: Systematic observational coding. Main Findings: Infants with a history of more severe IDA spent significantly less time in high energy states during free play, and their caregivers made less physically demanding requests. A history of IDA also correlated with developmental disturbances in postural control. Affectively, IDA infants were hypo-responsive, and caregivers showed more (overt) positive affect for healthy males, but not females. Caregivers coordinated actions and vocalizations less often during interaction with infants affected by a history of IDA. Conclusion: A history of IDA among 9-month old infants is related to behavioural and developmental disturbances in both motor and socio-cognitive domains. Note to reader: The present research was first submitted as a Masters dissertation in 2008. The author was subsequently offered the opportunity rather to upgrade to a Doctoral thesis and resubmit the work as PhD. Chronologically then, studies which did not inform the design and development of the coding system used for data collection, or which published findings after the first submission of the present work, are discussed in the final chapter. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.