Parent-Child Attachment: A Principle-Based Concept Analysis.

INTRODUCTION: Extensive evidence indicates that the quality of parent-child attachment is related to later socio-emotional and physical health outcomes. Yet, despite its clinical relevance, the parent-child attachment concept has been inconsistently applied across the disciplines of nursing, medicine and psychology and is often conflated with parent-child bonding in nursing literature. OBJECTIVES: To provide readers with a critical analysis of the concept of parent-child attachment. Using a principle-based concept analysis, we clarify how parent-child attachment is understood from a multidisciplinary perspective to advance the use of this concept in nursing practice.Concept Description: Attachment is an affectionate, mutually satisfying relationship between a child and a caregiver that serves the purpose of making the child feel safe, secure, and protected. DISCUSSION: In this principle-based concept analysis, each definitional (i.e., epistemological, pragmatic, linguistic, and logical) principle contributes to an understanding of the strengths and limitations of the state of science about this concept. The discussion highlights how applying the concept of parent-child attachment security may offer exciting and promising opportunities for nursing clinical work with families. CONCLUSION: The understanding of the concept of parent-child attachment differs among disciplines of nursing, medicine and psychology and offers exciting and promising opportunities for clarity and collaborative, multi-disciplinary work.

Association between obesity in 4- to 7-year-old children and eight types of crime: a hierarchical linear modelling approach.

OBJECTIVE: Evidence of the association between childhood obesity and neighbourhood crime is inconclusive. Most previous studies have included children of all ages, and few have examined different types of crime. The objective of this study was to investigate the association between obesity and eight different types of crime (i.e. commercial robbery, street robbery, assault, other violence, commercial break and enter, residential break and enter, theft of vehicle and theft from vehicle) among 4- to 7-year-old children in a large western Canadian city. METHODS: Cross-sectional, epidemiological study (N = 10,069) using spatial analysis and hierarchical generalized linear modelling. The outcome variable was normal weight or obesity. The exposure variable was the distance between the child's residential postal code and the closest occurrence of each type of crime. RESULTS: Controlling for distance to the closest park, frequency of each type of crime in the child's neighbourhood and neighbourhood factors (proportion of visible minorities, education and median family income), there was no association between any of the crime types and childhood obesity. CONCLUSIONS: Crime did not contribute to obesity in this sample of 4- to 7-year-old children. Replication of this study in other jurisdictions would increase confidence in these results.

Maternal adverse childhood experiences, mental health, and child behaviour at age 3: The all our families community cohort study.

Links between adverse childhood experiences (ACEs) and threats to health and well-being later in life are well established. The current study extends those findings into younger populations of pregnant women and their children; investigating how ACEs relates to maternal postpartum well-being, coping, and parenting, as well as child outcomes. Participants included 1994 mothers and children from the All Our Families community-based cohort in Alberta, Canada, followed from pregnancy (from 2008 to 2011) until child age 3 years. The sample is representative of the pregnant population in an urban Canadian centre. Mothers completed questionnaires on ACEs, postpartum mental health, as well as parenting morale, efficacy, coping, and personality. Child outcomes included internalizing and externalizing behavior, as well as temperament. Approximately 62% of participants experienced at least one ACE; 25% experienced 3 or more ACEs. The presence of 3 or more ACEs was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms, lower optimism and higher neuroticism, and lower reported parenting morale. In children, 3 or more maternal ACEs was associated with higher levels of internalizing (e.g., anxiety) and externalizing difficulties (aggression and hyperactivity), as well as temperament (surgency and negative affectivity). Cumulative maternal ACEs are associated with postpartum mental health and parenting morale, as well as maladaptive coping strategies. The demonstrated downstream consequences of maternal ACEs for child outcomes suggests that early intervention strategies and community resources to improve life course outcomes for parents and children are critical for breaking intergenerational continuities of risk.

Mothers' and health care providers' perspectives of the barriers and facilitators to attendance at Canadian neonatal follow-up programs.

BACKGROUND: Despite the benefits of Neonatal Follow-Up (NFU) programs for infants at risk for developmental problems subsequent to preterm birth, non-attendance continues to be a problem within Canada and beyond. This study investigated the barriers and facilitators to attendance at Canadian NFU programs from mothers' and health care providers' (HCP) perspectives. METHODS: In this multi-site qualitative descriptive study, we conducted semi-structured individual interviews with 12 mothers, six from each of two NFU programs; and focus groups with 20 HCPs from nine NFU programs. Interviews were audio-recorded and transcribed and then subjected to thematic analysis. RESULTS: The predominant barriers represented a complex interplay of cumulative factors: mothers' isolation and feeling overwhelmed, with limited support, experiencing difficulty attending because of limited resources, who viewed NFU as not needed until problems arose for their child. Other barriers included vulnerability and fear of bad news. Mothers reported the need to protect their vulnerable child from risks, whereas HCPs reported creating vulnerability by monitoring the child's development over time. HCPs perceived fear of bad news as a barrier, whereas mothers viewed that impending bad news increased their need to attend to address the issue. The predominant facilitators were support, family centred-care and mothers with adequate resources. CONCLUSIONS: Attendance is most problematic for mothers with limited support, capacity and resources. First and foremost, targeted approaches to NFU service provision are needed to address the cumulative barriers and improve experiences for mothers who find it difficult to attend NFU. A continuous relationship with a single point of contact is needed and merits further investigation - a provider who works across the traditional silos of neonatal intensive care, NFU and community services, minimizes duplication and navigates transitions.

Facebook: an effective tool for participant retention in longitudinal research.

BACKGROUND: Facebook is currently one of the world's most visited websites, and home to millions of users who access their accounts on a regular basis. Owing to the website's ease of accessibility and free service, demographic characteristics of users span all domains. As such, Facebook may be a valuable tool for locating and communicating with participants in longitudinal research studies. This article outlines the benefit gained in a longitudinal follow-up study, of an intervention programme for at-risk families, through the use of Facebook as a search engine. RESULTS: Using Facebook as a resource, we were able to locate 19 participants that were otherwise 'lost' to follow-up, decreasing attrition in our study by 16%. Additionally, analysis indicated that hard-to-reach participants located with Facebook differed significantly on measures of receptive language and self-esteem when compared to their easier-to-locate counterparts. CONCLUSIONS: These results suggest that Facebook is an effective means of improving participant retention in a longitudinal intervention study and may help improve study validity by reaching participants that contribute differing results.

Research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder: revealing the gap.

BACKGROUND: Alcohol use during pregnancy can result in a continuum of effects including growth deficits, dysmorphology and/or complex patterns of behavioural and cognitive difficulties that influence an individual's functioning throughout their lifespan. We conducted a systematic review to identify research-based interventions for children and youth with a Fetal Alcohol Spectrum Disorder and areas for future study. METHODS: We identified the substantive literature by searching 40 peer-reviewed and 23 grey literature databases, as well as reference lists. We hand-searched eight relevant journals, and undertook a systematic search of Internet sites and review of reports and documents received from key stakeholders. Two reviewers independently assessed eligibility and quality, and extracted data. Given the small number of studies that met all inclusion criteria, both experimental and quasi-experimental studies were included. RESULTS: Ten intervention studies were identified, of which three were experimental or quasi-experimental, and four were non-experimental. Despite multiple attempts, three studies (two in foreign languages and one unpublished) could not be acquired. A meta-analysis could not be undertaken because the included studies examined different interventions or outcomes. Interventions targeted in the included studies were as follows: (i) psychostimulant medications (methyphenidate, pemoline and dextroamphetamine); and (ii) Cognitive Control Therapy. The identified studies were limited by very small sample sizes and weak designs. CONCLUSION: There is limited scientific evidence upon which to draw recommendations regarding efficacious interventions for children and youth with a Fetal Alcohol Spectrum Disorder. Clinicians, researchers, service providers, educators, policy makers, affected children and youth and their families, and others need to urgently collaborate to develop a comprehensive research agenda for this population.

In-home nursing care for women with high-risk pregnancies: outcomes and cost.

OBJECTIVE: To evaluate a program that provides in-home care to women with pregnancies threatened by preterm delivery (including preterm labor, preterm premature rupture of membranes, and multiple gestation) and women with pregnancy-related hypertension. METHODS: Data from hospital discharge summaries were used to compare birth outcomes and cost of care for women in the in-home program and a cohort of women who received in-hospital antenatal care before the new program. Birth outcomes included data for mothers and infants. The sample included 437 women with threatened preterm delivery (n = 228 in-home, n = 209 in-hospital) and 308 with hypertension (n = 155 in-home, n = 153 in-hospital). The cost per woman included all costs of services for mothers and infants. RESULTS: Women at risk of preterm delivery who received in-home care were half as likely to have their infants in the neonatal intensive care unit more than 48 hours (odds ratio 0.53, 95% confidence interval 0.36, 0.78). On average, their infants weighed more (2732 +/- 716 g versus 2330 +/- 749 g, P <.001) and were 2 weeks older at birth (36.1 +/- 3.1 weeks versus 34.0 +/- 4.0 weeks, P <.001). There was a wide range in the total cost per woman and no significant difference between cohorts. For women with hypertension, there were no significant differences between in-home and in-hospital cohorts in birth outcomes or costs of care per woman. CONCLUSION: The program with current admission criteria, staffing, and guidelines for antenatal hospital admission provides safe care to women at similar cost to that of hospitalization.

Symbolic interactionism as a theoretical perspective for multiple method research.

RATIONALE: Qualitative and quantitative research rely on different epistemological assumptions about the nature of knowledge. However, the majority of nurse researchers who use multiple method designs do not address the problem of differing theoretical perspectives. Traditionally, symbolic interactionism has been viewed as one perspective underpinning qualitative research, but it is also the basis for quantitative studies. Rooted in social psychology, symbolic interactionism has a rich intellectual heritage that spans more than a century. Underlying symbolic interactionism is the major assumption that individuals act on the basis of the meaning that things have for them. AIM: The purpose of this paper is to present symbolic interactionism as a theoretical perspective for multiple method designs with the aim of expanding the dialogue about new methodologies. CONCLUSION: Symbolic interactionism can serve as a theoretical perspective for conceptually clear and soundly implemented multiple method research that will expand the understanding of human health behaviour.

Building Canada's health research capacity within the framework of the Canadian Institutes of Health Research.

The establishment of the Canadian Institutes of Health Research (CIHR) generated considerable excitement about the capacity for health research in Canada. The long term success of the CIHR will be determined, in part, by its ability to recruit, train and retain a cadre of talented researchers. During a workshop to develop the research agenda for one of the proposed institutes within the CIHR, a national, multidisciplinary group of clinical and basic science research trainees were invited to present their views about the challenges that face Canadian researchers of tomorrow. The objective of this paper is to present the challenges associated with recruiting, training and retaining health researchers, and to identify new opportunities provided by the creation of the CIHR. The present paper concludes with suggestions that may improve the success of researchers and, ultimately, the success of the CIHR.

Fathers' scores on the Nursing Child Assessment Teaching Scale: are they different from those of mothers?

Fathers of 103 Canadian infants (ages 2 to 12 months) were observed interacting with their child using the Nursing Child Assessment Teaching Scale (NCATS). Compared with the NCATS reference data for 387 mothers of similar-aged infants with similar marital status and ethnic background, there was no significant difference on the overall total score. However, fathers had significantly lower scores than mothers on the total parent score. Infants interacting with the fathers had significantly higher total child scores than those interacting with the mothers. Although mothers and fathers were equally sensitive to their infant's cues, fathers were less contingent in interaction with their infants. Implications for practitioners are discussed.

Impact of marital quality and parent-infant interaction on preschool behavior problems.

This study examined the relationships between parent interactions with healthy term and preterm infants at 12 months of age, marital quality, family socioeconomic status, and preschool behavior problems. Eighty mothers and 74 fathers were observed in the home during an interaction with their child (Nursing Child Assessment Teaching Scale), and this group of parents completed the Dyadic Adjustment Scale questionnaire (marital quality) 12 months after the child was discharged from the hospital. Each parent completed the Eyberg Child Behavior Inventory when their child was four years of age. The parent and infant interaction scores were not predictive of later child behavior problems. Maternal perceptions of marital quality at 12 months predicted the frequency (Eyberg Intensity score) and impact (Eyberg Problem score) of the child's problematic behaviors reported by mothers. Marital quality and family socioeconomic status predicted the impact of behavior problems for fathers. There were no significant differences between preterm and term children or between boys and girls in the frequency or impact of problematic behaviors. Mothers reported a significantly greater frequency of behavior problems than fathers of the same children. The implications of these findings for nurses who work with families and young children are discussed.