Childhood, infant and perinatal mortality, 1996; social and biological factors in deaths of children aged under 3

This article comments on statistics recently published by ONS relating to infant and childhood mortality in 1996. Several factors--birthweight, mother's age, marital status of parents, father's social class, mother's country of birth, multiple birth status, and sex--are known to be associated with the risk of mortality in infants under one year of age. For the first time, ONS is now able to analyse the deaths of 1 and 2 year-old children according to these same factors. The results indicate that these factors are also associated with mortality rates in these older children.     

Effects of social, familial, and maternal state variables on neonatal and infant health.

The medical protocols of a Danish birth cohort of 5,036 infants were summarized into 5 infant outcome measures: birth weight, neonatal physical health, neonatal neurological status, 1-yr physical health, and 1-yr motor development. All Ss received uniform medical care during pregnancy. 17 indices representing both medical and environmental variables were used as predictors in hierarchical regression analyses. Consistent negative environmental influences on neonatal outcomes were not found, presumably due to the uniform medical care during pregnancy that each mother received. A stronger environmental influence was observable at 1 yr of age. Institutional daycare, mother's employment, family size, whether the child was planned, and SES all contributed significantly to the regression equation for 1-yr physical health. This effect was anticipated, since no uniform medical treatment was provided the cohort subsequent to birth. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Size at birth, maternal nutritional status in pregnancy, and blood pressure at age 17: population based analysis

OBJECTIVE: To assess the effect of size at birth, maternal nutrition, and body mass index on blood pressure in late adolescence. DESIGN: Population based analysis of birth weight corrected for gestational age, mother's weight before pregnancy and weight gain in pregnancy, obtained from the Jerusalem perinatal study, and blood pressure and body mass index at age 17, available from military draft records. SETTING: Jerusalem, Israel. SUBJECTS: 10,883 subjects (6684 men and 4199 women) born in Jerusalem during 1974-6 and subsequently drafted to the army. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressures measured at age 17 and their correlation with birth weight, size at birth, mother's body mass index and weight gain during pregnancy, and height and weight at age 17. RESULTS: Systolic and diastolic blood pressures were significantly and positively correlated with body weight, height, body mass index at age 17, and with mother's body weight and body mass index before pregnancy, but not with birth weight or mother's weight gain in pregnancy. CONCLUSION: Variables reflecting poor intrauterine nutrition, including low maternal body mass index before pregnancy, poor maternal weight gain in pregnancy, and being born small for gestational age, were not associated with a higher blood pressure in late adolescence.     

Risk status for dropping out of developmental followup for very low birth weight infants

Not keeping scheduled visits for medical care is a major health care issue. Little research has addressed how the interaction of demographic and biomedical parameters with psychosocial processes has an impact on appointment keeping. Typical factors are stress of daily living, methods of coping, social support, and instrumental support (that is, tangible assistance). In this study, the authors examine the role of these parameters and processes in the risk status for dropping out of a developmental followup program for very low birth weight infants. The findings suggest that the stress of daily living is a significant predictor for the mother's return when the infant is 6 months of age (corrected for prematurity). The predictors for return at 24 months corrected age include marital status, race, gestational age of the infant, maternal intelligence, and efficacy expectations. Providing transportation was found to be a successful intervention strategy for a subgroup at very high risk for dropping out due to a constellation of biomedical, demographic, and psychosocial factors.     

Measuring excess risk of child mortality: an exploration of DHS I for Burundi, Uganda and Zimbabwe

This paper proposes a new method of measuring excess risk of child mortality in cross-sectional surveys, which is applied to DHS I data for Burundi, Uganda and Zimbabwe. The expected child mortality experience is estimated for each mother on the basis of child's age, mother's age at child's birth and her parity, and compared with her observed experience. Mothers who exceed their expected child mortality experience and also had more than one child die are considered to have excess child mortality. Zimbabwe had the greatest concentration of child deaths as measured by a simple ratio of mothers to deaths, but when observed experience was compared with expected it had less than half as many excess deaths as Uganda and Burundi. In all three countries mother's education had a strong negative association with the risk of excess child mortality, and in Zimbabwe and Burundi there were significant regional differences.     

Correlates and consequences of harsh discipline for young children

OBJECTIVE: To examine the incidence, predictors, and consequences of harsh discipline in a sample of low-birth-weight children at 1 and 3 years of age. DESIGN: Analysis of data from the Infant Health and Development Program, an 8-site randomized clinical trial of low-birth-weight infants. The sample for analysis consisted of 715 children who were 3 years of age. The independent measurements of primary interest were the mother's hitting and scolding of her child as disciplinary practice. Analyses were run separately for boys and girls. Bivariate and logistic analyses were used to examine the predictors of the mother's hitting and scolding behavior. Multivariate analysis of variance was used to examine the consequences of the mother's harsh discipline on a child's IQ measured at age 3 years. MAIN OUTCOME MEASURES: The mother's self-report of whether she used more than 1 physical punishment in the past week, as well as an observer's report from 2 home visits of whether the mother hit or scolded the child during the 2-hour home visit. In addition, the Stanford-Binet Intelligence Scale was used to examine the consequences of persistent harsh discipline on child well-being. RESULTS: Findings demonstrate child, maternal, and environmental factors that might aggravate a parent's use of corporal punishment. Boys received higher amounts of harsh discipline on all outcome measures. For boys, growing up in an impoverished home was predictive of the greater likelihood of receiving harsh punishment. Using IQ at age 3 years as the outcome measure, girls were found to be vulnerable to persistent harsh discipline and lack of maternal warmth. Maternal harsh discipline in a context of low maternal warmth was associated with IQ scores for girls that are 12 points lower than the IQ scores of girls who received low punishment and high warmth.     

Menarcheal age in Stockholm girls, 1967

Using the status quo method on 917 girls aged 10-17 years in 1967, mean age at menarche was computed to be 13-09 +/- 0-08 years (SD 1-10). There was no difference in mean age at menarche between girls from different social groups defined by father's or mother's occupation. The menstrual periods evoked severe discomfort in 9 per cent of the individuals. These were on an average significantly younger at menarche than the other girls. The percentage of the girls feeling discomfort during the menstrual periods as well as its intensity increased with time since menarche.     

Adolescent modeling of parent substance use: The moderating effect of the relationship with the parent.

This study examined a hypothesis derived from social learning theory, that adolescents would be more likely to model the substance use of each parent if they had a relatively good relationship with the parent than if their relationship with that parent was relatively poor. Data from 657 adolescents (51% female; 11 to 15 years of age at the 1st assessment), 357 fathers, and 633 mothers across a 6-year assessment period were used for these analyses. As hypothesized, all adolescents modeled mother's cigarette use and father's marijuana use, older adolescents modeled mother's marijuana use and younger girls and older boys modeled father's alcohol use if they had a relatively good or moderate relationship with that parent but did not model their parent's use if the relationship with that parent was relatively poor. Caution is noted in assuming that relatively good relationships with a parent are always protective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trends in cesarean section rates for the United States, 1970--78

With National Hospital Discharge Survey data collected by the National Center for Health Statistics as a basis, rates of cesarean section deliveries were computed for the United States and its regions for 1970 through 1978. For each year and within each region, trends were examined according to variations in the mother's color, age, and marital status and in the hospital size (number of beds), the form of hospital ownership, and the length of the mother's hospital stay. Within each region and for each variable considered, cesarean section deliveries rose fairly uniformly. Nationally, C-sections comprised 5.5 percent of all deliveries in 1970, but rose steadily to comprise 15.2 percent of all deliveries in 1978. Overall, 1978 rates were highest in the Northeast, among whites, among women age 30 and over, among married women, in hospitals with 500 beds or more, and in proprietary hospitals. The mean length of the mother's hospital stay in 1978 was 6.7 days for cesarean section deliveries and 3.2 days for other deliveries, down from the mean hospital stay of 7.8 days for C-sections and 3.9 days for other deliveries observed in 1970.     

The amount, distribution, and timing of lifetime nursing home use

OBJECTIVES: Information on lifetime nursing home use is needed to design and evaluate long-term care financing reforms. Whereas a number of studies have estimated mean lifetime use or its distribution, very little is known about variation in use among subgroups of the population, the timing of use, the number of distinct episodes of care experienced by nursing home users, and the risk and expected use at ages other than age 65. The purpose of the study was to fill these gaps in knowledge. METHODS: The study used a data base constructed to represent decedents who used nursing homes. The sample was derived from the sample of discharges collected as part of the 1985 National Nursing Home Survey. Weights were constructed for the purpose of making projections of remaining lifetime nursing home use at selected ages in 1995. RESULTS: There was considerable variation in lifetime use among demographic groups. Overall, estimates of the amount of use remaining at selected ages tended to be relatively constant at approximately 1 year. Mean years until nursing home admission, however, decreased sharply from almost 40 years at age 45 to approximately 5 years at age 85. CONCLUSIONS: The distribution of lifetime use was highly skewed, providing support for efforts to spread risk through public or private insurance. With roughly one quarter of all use occurring after 5 years of nursing home residence, however, a substantial share of use would exceed benefit maximums that are part of many proposals for public financing of long-term care as well as private insurance policies.     

Perinatal complications in births to low socioeconomic status schizophrenic and depressed women.

Pregnancy and birth complications in births to 57 schizophrenic, 28 depressed, and 31 well women were studied. The sample was of low socioeconomic status (SES) and predominantly African-American. The study extended earlier work on the perinatal status of infants born to schizophrenic women by including measures of severity of maternal disturbance; mother's age, IQ, and premorbid social competence; and family composition. The results show that maternal competence and the mother's diagnosis of schizophrenia were significant variables in determining the likelihood of less adequate prenatal care and more complicated births. The results indicate the importance of an assessment not only of a disturbed woman's diagnosis but also of her personal background and social competence in determining the likelihood of obstetrical complications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of infraorbital nerve section on survival, growth, and suckling behaviors of developing rats.

Examined the role of tactile sensory processes by surgical section of the infraorbital nerve in Wistar rats at 17, 12, 7, and less than 1 day of postnatal age. All sectioned Ss showed anesthesia of snout, upper lip, and vibrissal pads, and severe impairment of nipple attachment for at least the 1st day after denervation. Seven-day-olds failed to recover, and all died after 3–6 days of relentless weight loss. 17-day-olds showed no weight loss after denervation if already weaned to solid food, but they lost weight for 2 days before recovering if fed solely by nursing. 12-day-olds lost weight for 3 days, and 25% failed to recover. Behavioral observations showed that denervated Ss were activated by the mother's ventrum; they probed for the nipple in the appropriate area, but failed to focus head sweeping or licking and mouthing on the nipple itself. Data show that tactile cues are necessary for normal nursing in the rat and suggest that important tactile sensorimotor adaptations may occur during the early and late phases of nursing. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toddlers' context-varying emotions, maternal responses to emotions, and internalizing behaviors.

Relations of toddlers' observed negative affect in high- and low-threat contexts to maternal perceptions of their toddlers' internalizing problems and to mothers' responses to emotions (RTE) for fear and sadness were examined. Child-driven, parent-driven, and reciprocal transactional models across 1 year were directly compared. Two-year-old toddlers (N = 106) participated in lab-based activities to elicit distress, and their negative affect was coded. Mothers completed measures of their child's internalizing behaviors and their responses to their toddler's fear and sadness at ages 2 and 3. At age 2, only negative affect in low-threat contexts was associated with greater internalizing problems. Mothers' punishing and minimizing RTE at age 2 predicted an increase in internalizing problems across 1 year. Age 2 internalizing problems predicted an increase in mother's use of supportive RTE over time. Results highlight the importance of considering the context of toddlers' negative affective displays and supported a reciprocal conceptualization of toddlers' internalizing behaviors and mothers' RTE. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Influence of diet, physical activity and parents' obesity on children's adiposity: a four-year longitudinal study

OBJECTIVE: To assess the relationships between diet, body composition, physical activity, parents' obesity and adiposity in children at the age of 8 y and four years later. STUDY DESIGN: Prospective observational study of anthropometric measures initiated in 1992, follow-up examination in 1996. METHODS: 112 prepubertal (age: 8.6 +/- 1.0 y) children were studied. Energy and nutrient intakes were assessed by diet history, body composition by anthropometry and physical activity, by a questionnaire. Obesity was defined as relative body mass index (BMI) (rel BMI) > 120%, where rel BMI = (BMI/BMI at 50th centile for age and gender) x 100. RESULTS: Prevalence of obesity was not statistically different at baseline (22.3%) than four years later (19.8%): rel BMI at the age of 8 y was positively self-related with rel BMI at the age of 12 y (r = 0.73, P < 0.001). After four years, eight (32%) obese children became non obese and five (6%) non obese children became obese. Multiple regression analysis (stepwise procedure) revealed that, in the final equation, the mother's BMI and TV viewing (independent variables) accounted for 17% of the children's rel BMI variance at the age of 8 y (R = 0.42, P < 0.001) while the parents' BMIs accounted for 13.5% of the children's rel BMI variance at the age of 12 y (R = 0.37, P < 0.001). Other variables such as total energy intake, nutrient intake percentage and amount of physical activity, were all rejected. An autoregressive unbalanced measures model regression analysis recognised the mother's and father's BMIs as the only variables able to predict rel BMI in the children (mother's BMI coeff. 2.53 (s.e.m. 0.26), P < 0.0001; father's BMI coeff. 2.07 (s.e.m. 0.23), P < 0.0001). A multivariate logistic regression analysis was also performed. The children who participated in the follow-up, were divided into two groups based on the positive or negative change in the rel BMI between final and baseline measurements. Of all the variables considered, only rel BMI at baseline was selected in the final equation. Other variables such as age, gender, energy and nutrient intake, TV viewing and amount of physical activity, as well as the parents' BMI, were all removed. CONCLUSIONS: The parents' obesity was the main risk factor for obesity in this group of children. Sedentary behaviour (TV viewing) was independently associated with overweight at the age of 8 y. Physical activity and energy and nutrient intakes did not significantly affect the change in rel BMI over the four-year period when the parents' obesity was taken into account.     

Eight-year follow-up of cognitive development in 33 twin pairs

This is a follow-up study of twins, including 33 twinpairs from the Stockholm area, aiming to study the cognitive development of twins at eight years of age. The twins have been followed at different ages from birth onwards. All children were tested with the Wechsler Intelligence Scale for Children in a Swedish translation (WISC). The WISC test consists of a Verbal and a Performance Scale. There were no significant differences between twin girls and twin boys on these Scales. On the Performance subtests Block Design, Object Assembly, and Coding, however, the twin girls performed significantly better than the twin boys. In comparing cognitive development for twins and singletons, the twin group had somewhat lower average scores than the singletons. Prematurity and low birth weight continued to be related to cognitive development at eight years of age. Also at this age the school teacher completed a questionnaire about the twins social behaviour and some personality traits. There was a relation between one questionnaire factor, a low score of assertiveness, and the mother's negative or ambivalent expectations concerning the twin pregnancy. The twin group with the mother's negative expectations also had significantly lower results on the subtests Comprehension and Coding. Negative mothers had more premature twins than mothers who were positive toward the twin pregnancy.     

Maternal language in infancy.

Observations of 36 preterm infants and their English-speaking mothers suggest that maternal language to the infant varies as a function of the age and ordinal position of the infant and maternal education. The relationship between maternal language at 1 mo of age and the mother's verbal style to her older infant allows for early identification of maternal language input styles and, therefore, has important implications for mother–infant intervention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal-foetal interaction, antibody formation, and metabolic response in mice immunized with pneumococcal polysacharides

The maternal transfer of pneumococcal polysaccharides to foetus, as well as the antibody formation and metabolic response were studied in mice exposed to pneumococcal polysaccharides during pregnancy. Type 19 and type 57 pneumococcal polysaccharides display cross-placental transfer to foetus. These polysaccharides also transfer through mother's milk to neonates. Maternal immunization of type 19 polysaccharide during pregnancy induced higher antibody formation in the offspring than the group from non-immunized mothers. Young mice, which received a second dose of polysaccharide at 2 weeks of age, showed a higher antibody response than those which did not receive polysacharide. Treatment of mothers with anti-lymphocyte serum, following by administration of polysaccharide, significantly increased the neonatal immune response to the polysaccharide. Treatment of the mother with a high dose of type 19 or type 57 polysaccharide did not cause significant changes in neonatal growth and organ weights. The offspring from mothers treated with high doses of these polysaccharides did not exhibit abnormalities in chemical contents of their tissues.     

Illness and injury in family day care: a seasonal survey

Many mothers with children under age 6 are employed and it is not usually feasible for a parent to stay home with a child who is mildly ill. Such ill children likely remain in child day care programs. The extent to which this occurs and the management of these children in family day care was studied. Over the course of a year, 1 to 3 visits were made to 714 family day care homes in order to survey providers. With enrollments ranging between 0 and 18 children per day care home at the time of each visit, information on 3,630 "child enrollment days" was collected. The median age of children in care was 2 years. An average of 16% of all children were ill on any one day (with seasonal variation); 1% were injured. Of ill children, 82% attended day care that day, 49% had contacted a physician about that illness, and 28% were administered a medication at the day care setting. Twenty-one percent of children receiving medication in day care had no contact with a physician for that illness. These data show that mild childhood illnesses are routinely managed by child day care providers. Physicians who traditionally limit their illness-management education to parents need to recognize the health education and consultation needs of day care providers.     

Cardiac and behavioral interrelationships in the reactions of infants to strangers.

Recorded cardiac and various behavioral reactions of 80 5- and 9-mo-old infants to strangers to determine (a) whether the shift with age from attentiveness to fearfulness of strangers is accompanied by a shift from heart rate (HR) deceleration to acceleration; (b) whether testing infants in the presence of the mother attenuates cardiac and behavioral manifestations of stranger distress; and (c) whether the direction of HR change is related to the direction of change of facial expression, even when age is held constant. Results are generally positive. Behavioral data confirmed that most 5-mo-olds were not frightened by the stranger, and many but not all 9-mo-olds were. HR responses also changed with age, being predominantly deceleratory to the stranger at 5 mo of age and acceleratory at 9 mo. The accelerations were of much greater frequency and larger magnitude when 9-mo-olds were tested in the mother's absence. In contrast, behavioral reactions were not significantly affected by the mother's absence. The direction of HR responding was linked at both ages to affective expression: Whether 5 or 9 mo of age, behaviorally distressed Ss gave progressively acceleratory responses, whereas behaviorally undistressed Ss did not. It is concluded that future studies can profit from careful recording of both HR and behavioral expression in the infant. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)