The role of micro-organisms (Staphylococcus aureus and Candida albicans) in the pathogenesis of breast pain and infection in lactating women: study protocol

Background: The CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study will investigate the micro-organisms involved in the development of mastitis and &ldquo;breast thrush&rdquo; among breastfeeding women. To date, the organism(s) associated with the development of breast thrush have not been identified. The CASTLE study will also investigate the impact of physical health problems and breastfeeding problems on maternal psychological health in the early postpartum period.Methods/Design: The CASTLE study is a longitudinal descriptive study designed to investigate the role of Staphylococcus spp (species) and Candida spp in breast pain and infection among lactating women, and to describe the transmission dynamics of S. aureus and Candida spp between mother and infant. The relationship between breastfeeding and postpartum health problems as well as maternal psychological well-being is also being investigated. A prospective cohort of four hundred nulliparous women who are at least thirty six weeks gestation pregnant are being recruited from two hospitals in Melbourne, Australia (November 2009 to June 2011). At recruitment, nasal, nipple (both breasts) and vaginal swabs are taken and participants complete a questionnaire asking about previous known staphylococcal and candidal infections. Following the birth, participants are followed-up six times: in hospital and then at home weekly until four weeks postpartum. Participants complete a questionnaire at each time points to collect information about breastfeeding problems and postpartum health problems. Nasal and nipple swabs and breast milk samples are collected from the mother. Oral and nasal swabs are collected from the baby. A telephone interview is conducted at eight weeks postpartum to collect information about postpartum health problems and breastfeeding problems, such as mastitis and nipple and breast pain.Discussion: This study is the first longitudinal study of the role of both staphylococcal and candidal colonisation in breast infections and will help to resolve the current controversy about which is the primary organism in the condition known as breast thrush. This study will also document transmission dynamics of S. aureus and Candida spp between mother and infant. In addition, CASTLE will investigate the impact of common maternal physical health symptoms and the effect of breastfeeding problems on maternal psychological well-being.<br /

Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study

Aim: To identify the maternal and infant characteristics associated with an early transition from full breastfeeding to complementary or no breastfeeding during the first 2 months of life in a large, representative cohort of Australian infants. Method: Multinomial logistic modelling was performed on data for infants with complete breastfeeding and sociodemographic data (N = 4679) including maternal age, education, smoking, employment, pregnancy and birth outcomes. Results: Ninety-one percent of women initiated breastfeeding. Sixty-nine percent of infants were being fully breastfed at 1 month, and 59% were fully breastfed at 2 months. Maternal characteristics - age less than 25 years, smoking in pregnancy, early full-time postnatal employment and less educational attainment - were associated with early breastfeeding cessation. Infant factors - multiple birth, caesarean birth, infant or first birth - were associated with a transition to complementary breastfeeding in the first postnatal month. Conclusion: Breastfeeding duration is substantially affected by breastfeeding outcomes in the first postpartum month. The first month is an important window for evidence-based interventions to improve rates of full breastfeeding in groups of women identified as at risk of early breastfeeding cessation

Employment conditions and maternal postpartum mental health: Results from the Longitudinal Study of Australian Children

Maternal postpartum mental health is influenced by a broad range of risk and protective factors including social circumstances. Forty percent of Australian women resume employment in the first year postpartum, yet poor quality employment (without security, control, flexibility or leave) has not been investigated as a potential social determinant of maternal psychological distress. This paper examines whether poor quality jobs are associated with an increased risk of maternal postpartum psychological distress. Data were collected from employed mothers of infants =12 months (n=1,300) participating in the Longitudinal Study of Australian Children. Logistic regression analyses estimated the association between job quality and maternal psychological distress, adjusting for prior depression, social support, quality of partner relationship, adverse life events and sociodemographic characteristics. Only 21% of women reported access to all four optimal job conditions. After adjustment for known risk factors for poor maternal mood, mothers were significantly more likely to report psychological distress (adjusted OR=1.39, 95% CI 1.09, 1.77) with each reduction in the number of optimal employment conditions. Interventions for maternal postpartum affective disorders are unlikely to be successful if major risk factors are not addressed. These results provide strong evidence that employment conditions are associated with maternal postpartum mood, and warrant consideration in psychosocial risk assessments and interventions

Maternal Work-Family Conflict and Psychological Distress: Reciprocal Relationships Over 8 Years

The relationships between employed mothers' work-family conflict and psychological distress are unlikely to be static or one way. Using longitudinal data, the authors investigated reciprocal effects between work-family conflict and psychological distress across 8 years of the family life cycle. They modeled cross-lagged structural equations over 5 biennial waves of data, in 4 overlapping samples of Australian mothers reentering work between child ages 0-1 to 8-9 (N range: 1,027-2,449). The findings revealed that work-family conflict and psychological distress are distinctive aspects of mothers' well-being that influence each other over time. Reciprocal influences were not confined to one period of parenting but continued as children grew older. Associations persisted after controlling for a range of work and family characteristics, and there was no evidence of mediation by family socioeconomic status, maternal age, or job quality. The findings suggest that employed mothers may benefit from policies and workplace practices that both promote maternal well-being and reduce conflicts between employment and raising children

Psychosocial risk factors associated with fathers' mental health in the postnatal period: Results from a population-based study

Purpose: Fathers' psychological distress in the postnatal period can have adverse effects on their children's wellbeing and development, yet little is known about the factors associated with fathers' distress. This paper examines a broad range of socio-demographic, individual, infant and contextual factors to identify those associated with fathers' psychological distress in the first year postpartum. Methods: Secondary analysis of data from 3,219 fathers participating in the infant cohort of the Longitudinal Study of Australian Children at wave 1 when children were 0-12 months of age. Results: Approximately 10 % of fathers reported elevated symptoms of psychological distress. Logistic regression analyses revealed that the risk factors were poor job quality, poor relationship quality, maternal psychological distress, having a partner in a more prestigious occupation and low parental self-efficacy. Conclusion: These findings provide new information to guide the assessment of fathers' risk for psychological distress in postnatal period. There are also important social policy implications related to workplace entitlements and the provision of services for fathers

Parents\u27 transitions into and out of work-family conflict and children\u27s mental health: longitudinal influence via family functioning

The demands arising from the combination of work and family roles can generate conflicts (work-family conflicts), which have become recognized as major social determinants of mothers' and fathers' mental health. This raises the question of the potential effects on children. The current study of 2496 Australian families (7652 observations from children aged 4-5 up to 12-13 years) asks whether changes in children's mental health corresponds with changes in mothers' and fathers' work-family conflicts. Using longitudinal random-effect structural equation models, adjusting for prior child mental health, changes in work-family conflict were examined across four adjacent pairs of biennial data waves. Children's mental health deteriorated when their mother or father experienced an increase in work-family conflict, but improved when parents' work-family conflict reduced. Results held for mothers, fathers and couples, and the key pathways appear to be changes in children's relational environments. These results contribute new evidence that conflicts between the work-family interface are powerful social determinants of mental health which have an intergenerational reach.LL is supported by an Australian National Health and Medical Research Council Early Career Fellowship (#1035803)

Heightened maternal separation anxiety in the postpartum : The role of socioeconomic disadvantage

Maternal separation anxiety (MSA) refers to feelings of anxiety elicited in a mother during separation from her infant. The role of social and structural disadvantage in the etiology of high MSA has been overlooked. Secondary analysis of data from the Longitudinal Study of Australian Children (N = 3,897) revealed that compared to socioeconomically advantaged women, women of low socioeconomic position had a fourfold increased odds of reporting high (>80th percentile) MSA (odds ratio = 4.37, 95% confidence interval = 3.24-5.89), even when maternal and infant characteristics were controlled for. Inadequate social support and residing in a poor quality neighborhood were also significantly associated with high MSA in adjusted analyses. These findings indicate that high MSA is more common in socioeconomically disadvantaged women and might be a response to adverse circumstances. Mothers’ experience of, and reasons for, MSA needs to be considered in policy formulation about parental leave and postpartum employment, particularly for disadvantaged mothers

Father mental health during the early parenting period: Results of an Australian population based longitudinal study

Purpose: The primary objective of this study was to report on the occurrence of mental health difficulties for a large national sample of Australian fathers of children aged 0-5 years (n = 3,471). Secondary objectives were to compare fathers' mental health against normative data for the general male adult population, and to examine the course of mental health problems for fathers across the early childhood period. Methods: Secondary analysis of data from the infant cohort of the Longitudinal Study of Australian Children at three waves when children were 0-12 months, 2-3 and 4-5 years. Comparative data on the prevalence of psychological distress in the Australian adult male population sourced from the National Survey of Mental Health and Wellbeing. Results: Approximately nine per cent of fathers reported symptomatic or clinical psychological distress at each wave, as measured by the Kessler-6. Approximately 30 % reporting distress at wave 1 continued to report distress at a similar or worse level across waves 2 and 3. Fathers not living with their children also had high rates of distress (14 % at wave 1 and 10 % at wave 2). Finally, fathers in the present study had 1.38 increased odds (95 % CI 1.12-1.69) for psychological distress compared with the Australian adult male population. Conclusions: Fathers are at risk of experiencing postnatal mental health difficulties, which may persist across the early childhood period for some fathers. The results suggest routine assessment of fathers' wellbeing should be undertaken in the postnatal period with mental health interventions and support provided across the early childhood period

What influences parents' fear about children's independent mobility? Evidence from a state-wide survey of Australian parents

Purpose: To identify factors associated with generalized and stranger-specific parental fear (PF) about children’s independent mobility (CIM), a critical aspect of physical activity. Design: Cross-sectional survey; random sampling frame, minimum quotas of fathers, rural residents. Setting: State of Victoria, Australia. Subjects: Parents of children aged 9 to 15 years (n = 1779), 71% response rate. Measures: Validated measures of PF and fear of strangers (FoS); parent, child, social, and environmental factors. Analysis: Unadjusted and adjusted linear regression stratified by child age (9-10; 11-13; 14-15). Results: Adjusted models explained a substantial proportion of variance across all age groups (PF: 33.6%-36.7%; FoS: 39.1%-44.0%). Perceived disapproval from others was consistently associated with both outcomes (PF: β =.11 to 23, p ≤ .05; FoS: β =.17-.21, p ≤ .001) as was parents’ perception of children’s competence to travel safely (PF: β = −.24 to −.11, p ≤ .05; FoS: β = −.16 to −.13, p ≤ .01). Factors associated with FoS included having a female child (β = −.21 to −.13, p ≤ .001), language other than English (β = .09 to.11, p ≤ .01), and low levels of parent education (β = −.14 to −08, p ≤ .05). Conclusion: The current study suggests that social norms, child competence, and perceptions about the benefits of CIM underpin PF. This evidence informs the development of interventions to reduce PF and promote CIM and children’s physical activity.The “Parental Fear as a Barrier to Children’s Independent Mobility and Resultant Physical Activity” research study was initiated and funded by VicHealth (The Victorian Health Promotion Foundation). Authors A.R.C., J.M.N., S.C., S.K.B., and N.J.H. were additionally supported by Australian Communities Foundation through the Transition to Contemporary Parenthood Program, La Trobe University, Melbourne, Australia. S.Z. was supported by an Australian Research Council Centre of Excellence Grant (CE140100027)