Lived Experiences of Fatherhood After Infertility.

OBJECTIVE: To explore the lived experiences of fathers in the perinatal period after infertility. DESIGN: A descriptive, phenomenological study. SETTING: Researcher's private office and participants' homes in an Eastern Canadian province. PARTICIPANTS: Eight fathers who met the eligibility criteria. METHODS: We recruited a purposive sample of eight participants and held one-on-one interviews in person, by telephone, and via virtual platforms. We analyzed the verbatim transcripts of the audiotaped interviews using Colaizzi's phenomenological data analysis method. RESULTS: We uncovered seven themes that described the lived experiences of participants: The Journey: A Long Winding Road, Roles and Responsibilities: Supporter and Protector, Support: The Often-Forgotten Parent, Challenges and Hurdles: Bumps on the Road, So Many Feelings: The Rollercoaster, Coping: Living on the Road, and Reflection: An Unforgotten Journey. Participants shared their experiences of the perinatal period after infertility as long journeys and described how bumps along the road marked these journeys. The journeys were essential parts of their lives that they continued to remember years later. CONCLUSION: The perinatal experience after infertility is an important and remembered time for fathers. It is essential to involve and support them in the perinatal process to facilitate positive experiences and overall family health, especially after infertility. There is an ongoing need to conduct research with fathers and to develop evidence-based programming and resources to assist them in the perinatal period after infertility.

When Fear Surrounding Childbirth Leads Women to Request a Planned Cesarean Birth.

Fear surrounding childbirth requires a more in-depth understanding from women's perspectives, especially those who request a planned cesarean due to that fear. Therefore, we explored primiparous and multiparous women's lived experiences of fear surrounding childbirth in relation to their decision to request a planned cesarean birth. We used Colaizzi's (1978) phenomenological method to interview 16 women from 4 provinces and to analyze the data. Women expressed numerous fears and most experienced more than one fear. Most feared their baby/babies being injured or dying during childbirth or developing complications themselves. Others feared experiencing a traumatic birth. Women described numerous emotional and physical manifestations of fear, and all believed that a planned cesarean birth would provide more control over the birth process. For some, the birth of their healthy baby/babies began a healing process, whereas others noted that their fear subsided or resolved upon confirmation that they would have a planned cesarean.

Relationships Among Factors Related to Childbirth and Breastfeeding Outcomes in Primiparous Women.

OBJECTIVES: To explore the relationships among potentially modifiable factors related to childbirth and effective breastfeeding initiation at approximately 36 hours after birth and duration and exclusivity at hospital discharge, 2 weeks, 2 months, and 6 months after birth in primiparous women and to explore whether modifiable and nonmodifiable secondary factors and covariates influenced the relationships among factors related to childbirth and these breastfeeding outcomes. DESIGN: A prospective, longitudinal, cohort study. SETTING: The postpartum units of two general hospitals in eastern Canada. PARTICIPANTS: Ninety-seven mother-infant dyads. METHODS: We recorded demographic, childbirth, obstetric history, and breastfeeding data through chart review. A breastfeeding observation was completed at approximately 36 hours after birth by unit nurses. Participants maintained breastfeeding logs in hospital and for 6 months after birth and completed three self-report questionnaires before discharge. We analyzed outcomes using backward stepwise linear and logistic regression. RESULTS: One childbirth factor, labor induced with oxytocin, was negatively associated with effective initiation of breastfeeding, and none was related to breastfeeding duration and exclusivity at any time point. Maternal weight; professional support; and newborn's gestational age at birth, 5-minute Apgar score, weight loss, LATCH score, and active feeds (newborn actively suckled at the breast) were significantly associated with breastfeeding outcomes. CONCLUSION: Induction of labor with oxytocin should be used judiciously; when used, nurses must be hypervigilant to assess the mother-infant dyad for breastfeeding issues and to intervene to prevent or remediate them.

Transmission infrared spectroscopy for rapid quantification of fat, protein, and lactose concentrations in human milk.

OBJECTIVE: To develop partial least squares regression (PLSR) calibration models in combination with transmission infrared (TIR) spectroscopy for rapid and optimal quantification of human milk macronutrient concentrations. STUDY DESIGN: Human milk samples (n = 306) were characterized simultaneously by reference chemical analytical methods and TIR spectroscopy. Reference macronutrient concentrations were linked to pre-processed spectra and divided into two (training and test) sets. PLSR was used to develop trial calibration models using training set, and the test set was used to assess the accuracy of the trial analytical methods. RESULTS: For the methods selected as optimal, the concordance correlation coefficients between reference and TIR-based methods were 0.93 for fat, 0.96 for protein, and 0.52 for lactose. The Bland-Altman plots showed no evidence of systematic bias between TIR and reference methods. CONCLUSIONS: TIR spectroscopy provides the basis for accurate and rapid quantification of human milk fat and protein concentrations but is less accurate for measuring lactose concentration.

Centrifugal ultrafiltration of human serum for improving immunoglobulin A quantification using attenuated total reflectance infrared spectroscopy.

Attenuated total reflectance infrared (ATR-IR) spectroscopy is a simple, rapid and cost-effective method for the analysis of serum. However, the complex nature of serum remains a limiting factor to the reliability of this method. We investigated the benefits of coupling the centrifugal ultrafiltration with ATR-IR spectroscopy for quantification of human serum IgA concentration. Human serum samples (n = 196) were analyzed for IgA using an immunoturbidimetric assay. ATR-IR spectra were acquired for whole serum samples and for the retentate (residue) reconstituted with saline following 300 kDa centrifugal ultrafiltration. IR-based analytical methods were developed for each of the two spectroscopic datasets, and the accuracy of each of the two methods compared. Analytical methods were based upon partial least squares regression (PLSR) calibration models - one with 5-PLS factors (for whole serum) and the second with 9-PLS factors (for the reconstituted retentate). Comparison of the two sets of IR-based analytical results to reference IgA values revealed improvements in the Pearson correlation coefficient (from 0.66 to 0.76), and the root mean squared error of prediction in IR-based IgA concentrations (from 102 to 79 mg/dL) for the ultrafiltration retentate-based method as compared to the method built upon whole serum spectra. Depleting human serum low molecular weight proteins using a 300 kDa centrifugal filter thus enhances the accuracy IgA quantification by ATR-IR spectroscopy. Further evaluation and optimization of this general approach may ultimately lead to routine analysis of a range of high molecular-weight analytical targets that are otherwise unsuitable for IR-based analysis.

Exploration of attenuated total reflectance mid-infrared spectroscopy and multivariate calibration to measure immunoglobulin G in human sera.

Immunoglobulin G (IgG) is crucial for the protection of the host from invasive pathogens. Due to its importance for human health, tools that enable the monitoring of IgG levels are highly desired. Consequently there is a need for methods to determine the IgG concentration that are simple, rapid, and inexpensive. This work explored the potential of attenuated total reflectance (ATR) infrared spectroscopy as a method to determine IgG concentrations in human serum samples. Venous blood samples were collected from adults and children, and from the umbilical cord of newborns. The serum was harvested and tested using ATR infrared spectroscopy. Partial least squares (PLS) regression provided the basis to develop the new analytical methods. Three PLS calibrations were determined: one for the combined set of the venous and umbilical cord serum samples, the second for only the umbilical cord samples, and the third for only the venous samples. The number of PLS factors was chosen by critical evaluation of Monte Carlo-based cross validation results. The predictive performance for each PLS calibration was evaluated using the Pearson correlation coefficient, scatter plot and Bland-Altman plot, and percent deviations for independent prediction sets. The repeatability was evaluated by standard deviation and relative standard deviation. The results showed that ATR infrared spectroscopy is potentially a simple, quick, and inexpensive method to measure IgG concentrations in human serum samples. The results also showed that it is possible to build a united calibration curve for the umbilical cord and the venous samples.

Factors influencing the reasons why mothers stop breastfeeding.

OBJECTIVES: To explore the reasons why women stop breastfeeding completely before their infants are six months of age and to identify the factors associated with cessation and the timing of cessation. METHODS: For all singleton live newborns born between January 1, 2008 and December 31, 2009 in two district health authorities in Nova Scotia, Canada, mother's self-reported breastfeeding status was collected at hospital discharge and at five follow-up visits until infants were six months of age. Mothers who stopped breastfeeding before six months were also questioned about the time of weaning and the reason they discontinued all breastfeeding. Eleven categories were created from the open-ended responses women provided. These data were linked with the Nova Scotia Atlee Perinatal Database in order to obtain information on maternal and neonatal characteristics. The relationship between maternal, obstetrical, and neonatal characteristics and each reason for stopping breastfeeding completely were examined. RESULTS: Of the 500 mothers who stopped breastfeeding completely before six months and provided a reason for discontinuing, the majority (73.6%) stopped within the first six weeks. The most common reasons cited were inconvenience or fatigue associated with breastfeeding (22.6%) and concerns about milk supply (21.6%). Return to work or school was associated with length of time that infants were breastfed: 20% of women who stopped after six weeks citing this as the reason. Most of the reasons, however, were not found to be associated with a specific duration of breastfeeding or with the examined maternal and infant characteristics. CONCLUSION: This study highlights factors associated with the reasons why women stop breastfeeding completely before six months and how these reasons varied with weaning age. The results will help inform future research aimed at identifying interventions to reduce early breastfeeding cessation.

Incidence of prenatal alcohol exposure in Prince Edward Island: a population-based descriptive study.

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a leading preventable cause of neurodevelopmental disability in North America. The stigma associated with alcohol use and abuse during pregnancy makes it difficult to obtain information on prenatal alcohol use through self-reporting. We assessed the incidence of prenatal alcohol exposure in Prince Edward Island to facilitate future public health initiatives addressing FASD. METHODS: Prenatal alcohol exposure was examined via population-based collection of meconium and analysis of fatty acid ethyl esters (FAEEs). Fatty acid ethyl esters are nonoxidative metabolites of ethanol that are produced in the fetus. Meconium FAEE concentrations of 2.0 nmol/g or greater are indicative of frequent prenatal alcohol exposure during the last 2 trimesters of pregnancy. Samples were collected from 1307 neonates between Nov. 8, 2010, and Nov. 8, 2011, in hospitals in PEI, or from those born to mothers who resided in PEI but gave birth in Halifax, Nova Scotia. Samples were frozen and shipped for analysis. Fatty acid ethyl esters were analyzed by gas chromatography-mass spectrometry and quantified by means of deuterated internal standards. RESULTS: Of the 1307 samples collected, 1271 samples were successfully analyzed. Positive results for FAEEs were obtained in 3.1% (n = 39) of samples collected within the first 24 hours after birth. INTERPRETATION: Not all neonates exposed to heavy prenatal alcohol in utero will exhibit FASD; based on current estimates of predictive value for disease by exposure, our findings suggest that 1.3% of neonates born in PEI during this 1-year period will have FASD. In its application to an entire provincial birth cohort, this study successfully implemented a public health-centred approach for evaluating population-based risk of FASD, with implications for practice across Canada.

Postnatal parental education for optimizing infant general health and parent-infant relationships.

BACKGROUND: Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time. OBJECTIVES: The primary objective was to assess the effects of structured postnatal education delivered to an individual or group related to infant general health or care and parent-infant relationships. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013). SELECTION CRITERIA: We included randomized controlled trials of any structured postnatal education provided to individual parents or groups of parents within the first two months post-birth related to the health or care of an infant or parent-infant relationships. DATA COLLECTION AND ANALYSIS: Two review authors (JB, CTB) assessed trial quality and extracted data from published reports. MAIN RESULTS: Of the 27 trials (3949 mothers and 579 fathers) that met the inclusion criteria, only 15 (2922 mothers and 388 fathers) reported useable data. Educational interventions included: five on infant sleep enhancement, 12 on infant behaviour, three on general post-birth health, three on general infant care, and four on infant safety. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only 13 were measured similarly enough by more than one study to be combined in meta-analyses. Of these 13 meta-analyses, only four were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education about sleep enhancement resulted in a mean difference of 29 more night-time minutes of infant sleep in 24 hours at six weeks of age (95% confidence interval (CI) 18.53 to 39.73) than usual care. However, it had no significant effect on the mean difference in minutes of crying time in 24 hours at six weeks and 12 weeks of age. Education related to infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91). AUTHORS' CONCLUSIONS: The benefits of educational programs to participants and their newborns remain unclear. Education related to sleep enhancement appears to increase infant sleep but appears to have no effect on infant crying time. Education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm these findings.

Rates and determinants of exclusive breastfeeding in first 6 months among women in Nova Scotia: a population-based cohort study.

BACKGROUND: Despite compelling evidence that exclusive breastfeeding for the first 6 months of life provides important health benefits to both mothers and their infants, most mothers do not follow this practice. We conducted a study to identify predictors of early cessation of exclusive breastfeeding (before 6 months after delivery). METHODS: For this population-based longitudinal cohort study, we linked data from a perinatal database and a public health database for infants born between 2006 and 2009 in 2 regions in the province of Nova Scotia, Canada. The cohort was followed from the mother's first prenatal visit until her infant was 6 months old. Hazard ratios (HRs) for early cessation of exclusive breastfeeding were determined through Cox proportional hazards regression modelling. RESULTS: Overall, 64.1% (2907/4533) of the mothers in the cohort initiated breastfeeding. Only 10.4% (413/3957) exclusively breastfed for the recommended 6 months. The largest drop in exclusive breastfeeding occurred within the first 6 weeks after birth. Among the mothers who initiated breastfeeding, significant predictors of early cessation of exclusive breastfeeding identified by multivariable modelling included less than high school education (HR 1.66, 95% confidence interval [CI] 1.35-2.04), lowest neighbourhood income quintile (HR 1.35, 95% CI 1.13-1.60), single motherhood (HR 1.24, 95% CI 1.10-1.41), prepregnancy obesity (HR 1.43, 95% CI 1.23-1.65), smoking throughout pregnancy (HR 1.39, 95% CI 1.21-1.60), no early breast contact by the infant (< 1 hour after birth) (HR 1.44, 95% CI 1.29-1.62) and no intention to breastfeed (HR 1.78, 95% CI 1.44-2.16). INTERPRETATION: We found that most predictors of early cessation of breastfeeding were intertwined with social determinants of health. However, we identified potentially modifiable risk factors. Providing opportunities for early breast contact by the infant and continued efforts in smoking cessation and obesity reduction may contribute to a longer duration of exclusive breastfeeding.

A province-wide school nutrition policy and food consumption in elementary school children in Prince Edward Island.

OBJECTIVE: Although the majority of Canadian provinces have indicated that they have adopted new school nutrition policies, there have been few if any systematic evaluations of these policies. In Prince Edward Island, a nutrition policy for elementary schools was adopted province-wide in 2006. In the present study, we assessed the nutritional benefits of the new policy by examining changes in student food consumption prior to and one year following implementation of the policy. METHODS: We surveyed fifth and sixth grade children from 11 elementary schools in Prince Edward Island in 2001/02 (pre-policy implementation) and fifth and sixth grade children from the same 11 schools in 2007 (post-policy implementation). Food consumption was assessed using a self-administered validated food frequency questionnaire. We applied multilevel logistic regression to compare pre-/post-policy implementation differences in the proportion of students meeting Canada's Food Guide recommendations for vegetables and fruit (VF) and milk and alternatives (MA) and in the proportion of students consuming < 3 servings of low nutrient dense foods (LNDF) daily. RESULTS: Relative to students in 2001/02, students surveyed in 2007 were 2.14 (95% CI 1.62-2.82) times more likely to report consuming less than three daily servings of LNDF and were more likely to meet recommendations for VF (OR 1.44, 95% CI 1.00-2.07) and MA (OR 1.27, 95% CI 0.98-1.64). CONCLUSION: The present study is the first in Canada to show favourable changes in student food consumption that parallel the introduction of a school nutrition policy.

Postnatal parental education for optimizing infant general health and parent-infant relationships.

BACKGROUND: Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time. OBJECTIVES: The primary objective was to assess the effects of structured postnatal education delivered by an educator to an individual or group on infant general health and parent-infant relationships. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009), CINAHL (1982 to July 2009), ERIC (1966 to July 2009), HealthSTAR (1966 to July 2009), PsycINFO (1806 to July 2009), Sociological Abstracts (1974 to July 2009), ClinicalTrials.gov (August 2009), Current Controlled Trials (August 2009), and Trialscentral.org (August 2009). SELECTION CRITERIA: We included randomized controlled trials of any structured postnatal education provided by an educator to individual parents or groups of parents within the first two months post birth related to the care of an infant or parent-infant relationships. We excluded studies of educational interventions for parents of infants in neonatal intensive care units. DATA COLLECTION AND ANALYSIS: Both authors assessed trial quality and extracted data from published reports. MAIN RESULTS: Of the 25 trials (3689 mothers and 793 fathers) that met the inclusion criteria, only 15 (2868 mothers and 613 fathers) reported useable data. Educational interventions included: four on infant sleep enhancement, 13 on infant behaviour, two on general post-birth health, two on infant care, three on infant safety, and one on father involvement/skills with infants. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only six were measured similarly enough by more than one study to be combined in meta-analyses. Of these six meta-analyses, only two were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education on sleep enhancement resulted in a mean difference of 29 more minutes of infant sleep in 24 hours (95% confidence interval (CI) 18.53 to 39.73) than usual care. Education on infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91). AUTHORS' CONCLUSIONS: The benefits of educational programs to participants and their newborns remain unclear. Education on sleep enhancement appears to increase infant sleep and education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm this.

Does perception of the childbirth experience predict women's early parenting behaviors?

Evidence regarding the predictors of positive parenting behaviors in the early transition to parenting is inconsistent and limited. In this prospective, cohort study, we examined whether women's perceptions of their childbirth experience, as well as selected demographic, obstetrical, and psychosocial variables, predicted positive parenting behaviors at 1 month postpartum in 175 Canadian mothers. Women's birth experience did not predict early parenting behaviors, however being better educated and having a vaginal birth did. Excellent partner support and maternal mental health were also significantly associated with positive parenting at 1 month. Nurses have a responsibility to assess women for possible risks for sub-optimal parenting, based on the predictors found, and intervene to enhance parenting behaviors.

Postnatal parental education for optimizing infant general health and parent-infant relationships.

BACKGROUND: Many learning needs arise in the early postpartum period and it is important to examine interventions being used to educate new parents about caring for themselves and their newborns during this time. OBJECTIVES: To assess the effects of structured postnatal education delivered by an educator to an individual or group on maternal/paternal and infant outcomes and health services, and whether the effects of structured postnatal education vary by length or type of intervention and by population. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2007), MEDLINE (1950 to September 2007), CINAHL (1982 to September 2007), ERIC (1966 to September 2007), HealthSTAR (1966 to September 2007), PsycINFO (1806 to September 2007), Sociological Abstracts (1974 to September 2007), ClinicalTrials.gov (August 2007), Current Controlled Trials (August 2007), Trialscentral.org (August 2007) and The National Research Register (August 2007). SELECTION CRITERIA: We included randomized controlled trials of any structured postnatal education provided by an educator to individual parents or groups of parents within the first two months post birth related to the care of an infant or of the family. We excluded studies of educational interventions for parents of infants in neonatal intensive care units. DATA COLLECTION AND ANALYSIS: Both authors assessed trial quality and extracted data from published reports. MAIN RESULTS: We included 14 trials (2934 women) and excluded 24. Of the 14 included studies, education tested included: four on infant sleep enhancement, four on infant behaviour, two on general post-birth health, three on infant safety, and one on father involvement/skills with infants. Details of the randomization procedures, allocation concealment, blinding of outcome assessors, and/or participant accrual/loss were often not reported. Of the outcomes analyzed, only five were measured similarly enough by more than one study to be combined in meta-analyses and these included the same two studies. Of these five meta-analyses, only one was found to have a low enough level of heterogeneity to provide an overall estimate of effect; education on sleep enhancement resulted in a mean difference of 29 more minutes of sleep in 24 hours (95% confidence interval 18.53 to 39.73) than usual care. AUTHORS' CONCLUSIONS: The benefits of educational programs to participants and their newborn infants remain unclear. Education on sleep enhancement appears to increase infant sleep although more and larger studies are needed to confirm this.

Predictors of early parenting self-efficacy: results of a prospective cohort study.

BACKGROUND: Parenting self-efficacy has been identified as one determinant of positive parenting. The literature is inconsistent regarding the predictors of parenting self-efficacy, and there is limited evidence regarding these predictors in the early postpartum period. OBJECTIVES: To determine the factors predictive of parenting self-efficacy at 12 to 48 hr after childbirth and at 1 month postpartum. METHOD: Six-hundred fifty-two women were recruited consecutively from the postpartum units of two general hospitals on Prince Edward Island, Canada. Data were collected at 12 to 48 hr postpartum using self-report and chart review. On the basis of scoring positive or negative on their childbirth perceptions, 175 of these mothers were assigned to two cohorts. They were visited at home at 1 month postpartum, where data were collected using self-report. RESULTS: Using multiple logistic regression, greater parenting self-efficacy at 12 to 48 hr after childbirth was predicted by multiparity and single marital status and correlated with positive perception of the birth experience, higher general self-efficacy, and excellent partner relationship. Greater parenting self-efficacy at 1 month was predicted by age

Predictors of women's perceptions of the childbirth experience.

OBJECTIVE: To determine the factors that predict women's perceptions of the childbirth experience and to examine whether these vary with the type of birth a woman experiences. DESIGN: Prospective cohort study. SETTING: The postpartum units of two eastern Canadian hospitals. PARTICIPANTS: Six hundred fifty two women and their newborns. DATA COLLECTION: Data were collected in hospital at 12 to 48 hours postpartum using self-report questionnaires and chart review. MAIN OUTCOME MEASURE: Perception of the childbirth experience was measured for women having a vaginal and emergency cesarean birth using the Questionnaire Measuring Attitudes About Labor and Delivery and planned cesarean birth using the Modified Questionnaire Measuring Attitudes About Labor and Delivery. RESULTS: Of the 20 predictors of women's childbirth perceptions, the strongest were type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. CONCLUSIONS: Of the predictors of a quality birth experience, most were amenable to nursing interventions: enhancement of patient awareness, relaxation, and control; promotion of partner support; and provision of immediate opportunities for women to be with their babies.

Nutritional concerns in aboriginal children are similar to those in non-aboriginal children in Prince Edward Island, Canada.

OBJECTIVE: To assess food consumption among aboriginal children living on Mi'kmaq reserves in Prince Edward Island, Canada. DESIGN: Data were collected as part of a larger study of health perceptions and behaviors in Mi'kmaq children and youth ages 1 to 18 years. Food consumption was assessed using a self-administered food frequency questionnaire during an in-home interview. SUBJECTS/SETTING: Fifty-five children living on a reserve (53% of total population) ages 9 to 18 years. STATISTICAL ANALYSES PERFORMED: The number of servings of milk products, vegetables and fruit, and snack foods/beverages was calculated by adding the responses to the frequency of consumption of foods assessed in each group. chi(2) analysis was used to assess differences in food consumption according to sex and age. RESULTS: Only one child reported consuming the recommended minimum of five vegetables and fruit daily (Canada's Food Guide to Healthy Eating, 1992) (mean [+/-standard deviation]=2.8+/-1.1 servings). Twenty-five (49%) of the children consumed three or more servings of milk products daily (mean=2.6+/-1.3 servings). Approximately half of the children had three or more snack foods/beverages daily (mean=3.1+/-2.2 servings). Younger children (grades 4 to 6) consumed more cereal, peanut butter, and yogurt than older children. There were no significant differences in food consumption between boys and girls. CONCLUSIONS: Our findings are consistent with past reports in aboriginal children. However, except for higher consumption of french fries, results are similar to recent surveys of other Prince Edward Island school children, suggesting a province-wide rather than cultural health issue.

Tub bathing versus traditional sponge bathing for the newborn.

OBJECTIVE: To compare selected effects of tub bathing versus traditional sponge bathing in healthy, term newborns and their mothers' ratings of pleasure and confidence with the bath. DESIGN: Randomized controlled study. SETTING: The maternity unit of an eastern Canadian hospital. PARTICIPANTS: One hundred two mother-baby pairs were randomly assigned to an experimental tub bath or a sponge bath control group. INTERVENTIONS: Fifty-one newborns were tub bathed and 51 sponge bathed according to the study protocols for their initial and one additional bath. MAIN OUTCOME MEASURES: (a) Newborn temperature stability was assessed by recording axillary temperatures pre- and postbath, (b) umbilical cord healing was identified by daily observations and infection control surveillance, (c) infant contentment was quantified by applying the Brazelton Neonatal Behavioral Assessment Scale, and (d) maternal pleasure with the bath and confidence with bathing at discharge were self-rated on a 5-point scale. RESULTS: Tub-bathed babies experienced significantly less temperature loss (t = 4.79, p = .00) and were significantly more content (t = -6.48, p = .00) than were those who were sponge bathed. No differences in cord healing scores were found. Mothers of tub bathed babies rated their pleasure with the bath significantly higher than did mothers of sponge bathed babies (t = 4.15, p = .00). No differences in maternal confidence were noted. CONCLUSIONS: Tub bathing is a safe and pleasurable alternative to sponge bathing in healthy, term newborns.

Assessing antenatal psychosocial health. Randomized controlled trial of two versions of the ALPHA form.

OBJECTIVE: To determine whether participants preferred a provider-completed or self-reported antenatal psychosocial health assessment (ALPHA) form, to evaluate the forms' effectiveness in facilitating disclosure of psychosocial issues, and to determine whether different providers gathered different information. DESIGN: Randomized controlled study. SETTING: Offices of family physicians and public health nurses (PHNs) in three health regions on Prince Edward Island. PARTICIPANTS: Physicians, PHNs, and 76 pregnant women. INTERVENTIONS: Participants completed one form and a questionnaire on theirexperience. Providers were also interviewed. MAIN OUTCOME MEASURES: Suitability and effectiveness of the forms and frequency of issues disclosed by type of form and provider. RESULTS: Most participants would recommend routine use of the ALPHA form for all pregnant women. Of the 238 psychosocial issues disclosed, significantly more were disclosed to physicians than to PHNs. CONCLUSION: Both forms were acceptable to women and providers (no clear preference emerged) and were effective at gathering information. Physicians gathered significantly more information than PHNs.