Impact of trajectories of maternal postpartum depression on infants' socioemotional development.

BACKGROUND: We assessed (a) the effects of postpartum depression (PPD) trajectories until 6 months postpartum on infants' socioemotional development (SED) at age 12 months, and (b) the mediating role of maternal self-efficacy (MSE), and the additional effect of postpartum anxiety at age 12 months. METHODS: We used data from POST-UP trial (n = 1843). PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 1, 3, and 6 months. Infants' SED was assessed at 12 months using the Ages and Stages Questionnaire-Social-Emotional (ASQ-SE). Structural equations were applied to estimate the effect of PPD trajectories on infants' SED and mediation by MSE. The additional effects of postpartum anxiety were assessed with conditional regression. RESULTS: Higher levels of PPD over time were associated with a lower SED (coefficient for log-EPDS 3.5, 95% confidence interval 2.8; 4.2, e.g., an increase in the EPDS score from 9 to 13 worsens the ASQ-SE by 1.3 points). About half of this relationship was mediated by MSE. Postpartum anxiety had an independent adverse effect on SED. CONCLUSIONS: PPD and postpartum anxiety have a negative impact on infants' SED. MSE as a mediator may be a potential target for preventive interventions to alleviate the negative effects of maternal psychopathology on infants' SED. IMPACT: The trajectories of postpartum depression (PPD) from 1 month to 6 months were negatively related to infants' socioemotional development (SED) at age 12 months, underlining the importance of repeated assessment of PPD. Maternal self-efficacy (MSE) mediated the association between PPD and SED, implying MSE could be a potential target for preventive interventions. An additional independent negative effect of postpartum anxiety was identified, implying the assessment of postpartum anxiety also has a surplus value to identify mothers at risk.

Identifying patterns of lifestyle behaviours among children of 3 years old.

BACKGROUND: To identify the patterns of lifestyle behaviours in children aged 3 years, to investigate the parental and child characteristics associated with the lifestyle patterns, and to examine whether the identified lifestyle patterns are associated with child BMI and weight status. METHODS: Cross-sectional data of 2090 children 3 years old participating in the Dutch BeeBOFT study were used. Child dietary intakes, screen times and physical activity were assessed by parental questionnaire, and child weight and height were measured by trained professionals according to a standardized protocol. Latent class analysis was applied to identify patterns of lifestyle behaviours among children. RESULTS: Three subgroups of children with distinct patterns of lifestyle behaviours were identified: the 'unhealthy lifestyle' pattern (36%), the 'low snacking and low screen time' pattern (48%) and the 'active, high fruit and vegetable, high snacking and high screen time' pattern (16%). Children with low maternal educational level, those raised with permissive parenting style (compared those with authoritative parents), and boys were more likely be allocated to the 'unhealthy lifestyle' pattern and the 'active, high fruit and vegetable, high snacking and high screen time' pattern (P < 0.05). No association was found between the identified lifestyle patterns and child BMI z-score at age 3 years. CONCLUSIONS: Three different lifestyle patterns were observed among children aged 3 years. Low maternal educational level, permissive parenting style and male gender of the child were associated with having unhealthy lifestyle patterns for the child.

Through the professional's eyes: transfers of care during pregnancy, childbirth and the postpartum period.

BACKGROUND: In the Netherlands, the obstetric and neonatal healthcare system consists of multiple healthcare organizations. Due to this system, transfers between healthcare professionals are inevitable. Transfers can interrupt the continuity of care, which is an important aspect of care quality. The aim of this study is to examine how healthcare professionals transfer their clients and to understand factors that facilitate or impede continuity of care. METHODS: We conducted 15 semi-structured interviews with community midwives (4), obstetricians/clinical midwives (4), maternity care assistants (4), and youth healthcare nurses (3) between June and September 2016. After discussing the meaning of transfers of care, we introduced a vignette on the care process of a pregnant woman and asked about the methods the professional would use to transfer a client and about factors that facilitate or impede continuity of care. RESULTS: Obstetric and neonatal healthcare professionals mentioned 19 factors that facilitate or impede continuity of care. The facilitating factors were, e.g., usage of protocols and standard formats, transfers in person, being accessible, and multidisciplinary meetings. Impeding factors included, e.g., acute situations, experienced hierarchy, insufficient knowledge of protocols, and privacy concerns. CONCLUSION: Professionals mentioned a broad variety of factors facilitating and impeding continuity of care.

Factors associated with early introduction of complementary feeding and consumption of non-recommended foods among Dutch infants: the BeeBOFT study.

BACKGROUND: Timing and types of complementary feeding in infancy affect nutritional status and health later in life. The present study aimed to investigate the factors associated with early introduction of complementary feeding (i.e., before age 4 months), and factors associated with infants consumption of non-recommended foods, including sweet beverages and snack foods. METHODS: This study used cross-sectional data from the BeeBOFT study (n = 2157). Data on complementary feeding practices and potential determinants were obtained by questionnaire at infant's age of 6 months. Logistic regression models were used to investigate factors associated with early introduction of complementary feeding and infants' consumption of non-recommended foods. RESULTS: 21.4% of infants had received complementary feeding before 4 months of age. At the age of 6 months, 20.2% of all infants were consuming sweet beverages daily and 16.5% were consuming snack foods daily. Younger maternal age, lower maternal educational level, absence or shorter duration of breastfeeding, parental conviction that "my child always wants to eat when he/she sees someone eating" and not attending day-care were independently associated with both early introduction of complementary feeding and the consumption of non-recommended foods. Higher maternal pre-pregnancy BMI and infant postnatal weight gain were associated only with early introduction of complementary feeding. CONCLUSIONS: We identified several demographical, biological, behavioral, psychosocial, and social factors associated with inappropriate complementary feeding practices. These findings are relevant for designing intervention programs aimed at educating parents. TRIAL REGISTRATION: The trail is registered at Netherlands Trial Register, trail registration number: NTR1831 . Retrospectively registered on May 29, 2009.

Effects of a computerised guideline support tool on child healthcare professionals' response to suspicions of child abuse and neglect: a community-based intervention trial.

BACKGROUND: Healthcare professionals' adherence to guidelines on child protection is not self-evident. This study assessed the effects of a computerised support tool on child healthcare professionals' adherence to the seven recommended guideline activities, and on time spent seeking information presented in this guideline. METHODS: A community-based intervention trial design was applied, comparing access to a paper-based guideline (control) with access to a paper-based guideline supplemented with a computerised guideline support tool (intervention). A total of 168 child healthcare doctors and nurses working in one large Dutch organisation were allocated to an intervention or control group. Outcomes were professionals' performance of seven recommended guideline activities and the amount of time spent seeking information presented in the guideline. Professionals' adherence was measured using two methods: health record analysis and a self-report questionnaire. The questionnaire was also used to collect data on the amount of time spent seeking guideline information. RESULTS: In total, 152 health records (102 in the intervention group and 50 in the control group) were available for analysis. The tool was registered in 14% of the records in the intervention group. Performance of activities, corrected for intentional non-adherence, was except for one activity, high (range 80-100%); no differences were found between the control and intervention groups. Forty-nine questionnaires (24 in the intervention group and 25 in the control group) were analysed. Sixty-three percent of the questionnaire respondents (15/24) claimed to have used the tool. No differences in guideline adherence were found between the two groups. Respondents in the intervention and control groups spent, on average, 115 and 153 min respectively seeking relevant information presented in the guideline. CONCLUSIONS: The results regarding use of the tool were inconclusive as the outcomes differed per method. In contrast to expectations, performance of guideline activities was high in both groups. The support tool may decrease the amount of time spent on seeking guideline information. However, given the high adherence scores and small number of questionnaire respondents, the outcomes failed to reach statistical significance. Future research should focus on studying the effects of the tool after a longer period of availability.

The course of skull deformation from birth to 5 years of age: a prospective cohort study.

In a continuation of a prospective longitudinal cohort study in a healthy population on the course of skull shape from birth to 24 months, at 5 years of age, 248 children participated in a follow-up assessment using plagiocephalometry (ODDI-oblique diameter difference index, CPI-cranio proportional index). Data from the original study sampled at birth, 7 weeks, 6, 12, and 24 months were used in two linear mixed models. MAIN FINDINGS: (1) if deformational plagiocephaly (ODDI <104%) and/or positional preference at 7 weeks of age are absent, normal skull shape can be predicted at 5 years of age; (2) if positional preference occurs, ODDI is the highest at 7 weeks and decreases to a stable lowest value at 2 and 5 years of age; and (3) regarding brachycephaly, all children showed the highest CPI at 6 months of age with a gradual decrease over time. CONCLUSION: The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, brachycephaly is within the normal range for all children, whereas the severity of plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate/severe range in 1%. Medical consumption may be reduced by providing early tailored counselling. What is Known: • Skull deformation prevalence increased after recommendations against Sudden Infant Death Syndrome, little is known about the longitudinal course. • Paediatric physical therapy intervention between 2 and 6 months of age reduces deformational plagiocephaly at 6 and 12 months of age. What is New: • The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, deformational brachycephaly is within the normal range for all children, whereas the severity of deformational plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate to severe range in only 1%. • Paediatric physical therapy intervention does not influence the long-term outcome; it only influences the earlier decrease of the severity of deformational plagiocephaly.

Through the client's eyes: using narratives to explore experiences of care transfers during pregnancy, childbirth, and the neonatal period.

BACKGROUND: The client experience is an important outcome in the evaluation and development of perinatal healthcare. But because clients meet different professionals, measuring such experiences poses a challenge. This is especially the case in the Netherlands, where pregnant women are often transferred between professionals due to the nation's approach to risk selection. This paper explores questions around how clients experience transfers of care during pregnancy, childbirth, and the neonatal period, as well as how these experiences compare to the established quality of care aspects the Dutch Patient Federation developed. METHOD: Narratives from 17 Dutch women who had given birth about their experiences with transfers were collected in the Netherlands. The narratives, for which informed consent was obtained, were collected on paper and online. Storyline analysis was used to identify story types. Story types portray patterns that indicate how clients experience transfers between healthcare providers. A comparative analysis was performed to identify differences and similarities between existing quality criteria and those clients mentioned. RESULTS: Four story types were identified: 1) Disconnected transfers of care lead to uncertainties; 2) Seamless transfers of care due to proper collaboration lead to positive experiences; 3) Transfers of care lead to disruption of patient-provider connectedness; 4) Transfer of care is initiated by the client to make pregnancy and childbirth dreams come true. Most of the quality aspects derived from these story types were identified as being similar or complementary to the Dutch Patient Federation list. A 'new' aspect identified in the clients' stories was the influencing role of prior experiences with transfers of care on current expectations, fears, and wishes. CONCLUSIONS: Transfers of care affect clients greatly and influence their experiences. Good communication, seamless transfers, and maintaining autonomy contribute to more positive experiences. The stories also show that previous experiences influence client's expectations for the next pregnancy, childbirth, and transfers of care.

Screening for Postpartum Depression in Well-Baby Care Settings: A Systematic Review.

Introduction Postpartum depression (PPD) is a mental health problem frequently experienced by mothers in the first year postpartum. Early detection and treatment can help to reduce its negative effect on the development of the newborn child. Well-baby care (WBC) is a promising screening setting for early detection of PPD. This systematic review investigates the evidence of the effectiveness of screening for PPD in WBC settings regarding mother and child outcomes. Methods Three electronic databases were searched: SCOPUS, PsychINFO and CINAHL. Two reviewers independently performed the study selection. Data extraction was based on a predefined data extraction form. Results Six studies were included; a quality assessment rated two studies as strong and four as weak. Four studies measuring outcomes at process level showed improvement in detection, referral and/or treatment rates. Four studies, including the two strong ones, where screening and enhanced care were combined, showed improvements in the Edinburgh Postnatal Depression Scale scores of the mothers in the intervention groups. No improvements were reported on other outcomes at parent level or at child level. At child level, weight was the only outcome that was measured. Discussion This review provides limited yet positive evidence for the value of screening for PPD in a WBC setting. The outcomes are comparable with studies on screening for PPD in general. The evidence that we found is very promising but the small number of available studies shows a need for additional high-quality studies, to strengthen the evidence regarding the potential benefits of screening in a WBC setting.

Personalized Web-Based Advice in Combination With Well-Child Visits to Prevent Overweight in Young Children: Cluster Randomized Controlled Trial.

BACKGROUND: Overweight is a major health issue, and parent-targeted interventions to promote healthy development in children are needed. OBJECTIVE: The study aimed to evaluate E-health4Uth Healthy Toddler, an intervention that educates parents of children aged 18 to 24 months regarding health-related behaviors, as compared with usual care. The effect of this intervention on the following primary outcomes was evaluated when the children were 36 months of age: health-related behaviors (breakfast daily, activity and outside play, sweetened beverage consumption, television (TV) viewing and computer time), body mass index (BMI), and the prevalence of overweight and obesity. METHODS: The BeeBOFT (acronym for breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing) study is a cluster randomized controlled trial involving 51 Youth Health Care (YHC) teams. In total, 1094 parents participated in the control group, and 1008 parents participated in the E-health4Uth Healthy Toddler intervention group. The intervention consisted of Web-based personalized advice given to parents who completed an eHealth module and discussion of the advice during a regular well-child visit. In this study the eHealth module was offered to parents before two regular well-child visits at 18 and 24 months of age. During the well-child visits, the parents' personalized advice was combined with face-to-face counseling provided by the YHC professional. Parents in the control group received usual care, consisting of the regular well-child visits during which general information on child health-related behavior was provided to parents. Parents completed questionnaires regarding family characteristics and health-related behaviors when the child was 1 month (inclusion), 6 months, 14 months, and 36 months (follow-up) of age. The child's height and weight were measured by trained health care professionals from birth through 36 months of age at fixed time points. Multilevel linear and logistic regression models were used to evaluate the primary outcomes at 36 months of age. RESULTS: At 36 months, we observed no differences between health-related behaviors of children, BMI or the percentage of children having overweight or obesity in the control and intervention group (P>.05). An analysis of the intervention effect revealed that boys benefited from eating breakfast daily, non-Dutch children spent more time being active or playing outdoors, children of low-educated parents and of overweight and obese mothers spent less time watching TV or using the computer, and children of normal weight mothers drank less sweetened beverages (P<.05) compared with the control group. CONCLUSIONS: The E-health4Uth Healthy Toddler intervention resulted in small improvements in health-related behaviors among subgroups but had no significant effects with respect to the children's BMI. We conclude that the E-health4Uth Healthy Toddler intervention may be useful for pediatric health care professionals in terms of providing parents with personalized information regarding their child's health-related behaviors. TRIAL REGISTRATION: Netherlands Trial Register: NTR1831; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1831 (Archived by WebCite at http://www.webcitation.org/6mm5YFOB0).

How do parents experience support after the death of their child?

BACKGROUND: A child's death is an enormous tragedy for both the parents and other family members. Support for the parents can be important in helping them to cope with the loss of their child. In the Netherlands little is known about parents' experiences of the support they receive after the death of their child. The purpose of this study is to determine what support parents in the Netherlands receive after the death of their child and whether the type of care they receive meets their needs. METHOD: Parents who lost a child during pregnancy, labour or after birth (up to the age of two) were eligible for participation. They were recruited from three parents' associations. Sixty-four parents participated in four online focus group discussions. Data on background characteristics were gathered through an online questionnaire. SPSS was used to analyse the questionnaires and Atlas ti. was used for the focus group discussions. RESULTS: Of the 64 participating parents, 97% mentioned the emotional support they received after the death of their child. This kind of support was generally provided by family, primary care professionals and their social network. Instrumental and informational support, which respectively 80% and 61% of the parents reported receiving, was mainly provided by secondary care professionals. Fifty-two per cent of the parents in this study reported having received insufficient emotional support. Shortcomings in instrumental and informational support were experienced by 25% and 19% of the parents respectively. Parental recommendations were directed at ongoing support and the provision of more information. CONCLUSION: To optimise the way Dutch professionals respond to a child's death, support initiated by the professional should be provided repeatedly after the death of a child. Parents appreciated follow-up contacts with professionals at key moments in which they were asked whether they needed support and what kind of support they would like to receive.

Implementation of Child Death Review in the Netherlands: results of a pilot study.

BACKGROUND: Child mortality in the Netherlands declined gradually in the past decades. In total 1130 children and youth aged 0 to 19 years died in 2014 (i.e. 29.4 per 100,000 live births). A better understanding of the background and the circumstances surrounding the death of children as well as the manner and cause of death may lead to preventive measures. Child Death Review (CDR) is a method to systematically analyze child deaths by a multidisciplinary team to identify avoidable factors that may have contributed to the death and to give directions for prevention. CDR could be an addition to further reduce avoidable child deaths in the Netherlands. The purpose of this study is to explore the strengths, weaknesses, opportunities and threats (SWOT) of the pilot-implementation of CDR in a Dutch region. The results are translated in recommendations for future implementation of the CDR method in the Netherlands. METHODS: Children who lived in the pilot region and died aged 29 days after birth until 2 years were, after parental consent, included for reviewing by a regional CDR team. Eighteen logs and seven transcribed records of CDR meetings concerning 6 deceased children were analyzed using Atlas ti. The SWOT framework was used to identify important themes. RESULTS: The most important strengths identified were the expertise of and cooperation within the CDR team and the available materials. An important weakness was the poor cooperation of some professional groups. The fact that parents and professionals endorse the objective of CDR was an important opportunity. The lack of statutory basis was a threat. CONCLUSIONS: Many obstacles need to be taken away before large-scale implementation of CDR in the Netherlands becomes possible. The most important precondition for implementation is the acceptance among professionals and the statutory basis of the CDR method.

Insufficient vitamin D supplement use during pregnancy and early childhood: a risk factor for positional skull deformation.

Vitamin D insufficiency during pregnancy is associated with disturbed skeletal homeostasis during infancy. Our aim was to investigate the influence of adherence to recommendations for vitamin D supplement intake of 10 µg per day (400 IU) during pregnancy (mother) and in the first months of life (child) on the occurrence of positional skull deformation of the child at the age of 2 to 4 months. In an observational case-control study, two hundred seventy-five 2- to 4-month-old cases with positional skull deformation were compared with 548 matched controls. A questionnaire was used to gather information on background characteristics and vitamin D intake (food, time spent outdoors and supplements). In a multiple variable logistic regression analysis, insufficient vitamin D supplement intake of women during the last trimester of pregnancy [adjusted odds ratio (aOR) 1.86, 95% (CI) 1.27-2.70] and of children during early infancy (aOR 7.15, 95% CI 3.77-13.54) were independently associated with an increased risk of skull deformation during infancy. These associations were evident after adjustment for the associations with skull deformation that were present with younger maternal age and lower maternal education, shorter pregnancy duration, assisted vaginal delivery, male gender and milk formula consumption after birth. Our findings suggest that non-adherence to recommendations for vitamin D supplement use by pregnant women and infants are associated with a higher risk of positional skull deformation in infants at 2 to 4 months of age. Our study provides an early infant life example of the importance of adequate vitamin D intake during pregnancy and infancy.

Parents' decision for helmet therapy in infants with skull deformation.

PURPOSE: Helmet therapy is regularly prescribed in infants with positional skull deformation. Evidence on the effectiveness is lacking, which complicates decision making. This study aims to assess the relation between parents' decision for treatment of skull deformation in their infant and their level of anxiety, decisional conflict, expectations of treatment effect, perceived severity of deformation and perceived side effects. METHODS: Parents of 5-month-old infants with skull deformation were invited to participate in a survey. Data collection included background characteristics, anthropometric assessment, parent-reported outcomes, decision for treatment (helmet therapy or awaiting natural course), decisional conflict scale and questions about perceived (side) effects of helmet therapy. Factors significantly correlated with treatment decision (p < 0.1) were tested in a multiple logistic regression analysis. RESULTS: The results of 186 respondents were included in the analysis. Parental satisfaction with their infant's head shape (adjusted odds ratio (aOR) 0.2; 95 % confidence interval (CI) 0.1 to 0.4), expected effect of helmet therapy compared to natural course (aOR 13.4; 95 % CI 5.0 to 36.1) and decision uncertainty (aOR 1.0; 95 % CI 0.9 to 1.0; p = .03) were related to the decision for helmet therapy in infants with skull deformation. CONCLUSION: With the outcomes of this study, we can better understand parental decision-making for elective 'normalizing' treatments in children, such as helmet therapy in infants with skull deformation. Health care professionals should address the parents' perception of the severity of skull deformation and their expectations of helmet therapy. Furthermore, they can support parents in decision-making by balancing medical information with parents' expectations, values and beliefs.

Primary prevention of overweight in preschool children, the BeeBOFT study (breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing): design of a cluster randomized controlled trial.

BACKGROUND: Two overweight prevention interventions were developed to be offered by preventive Youth Health Care (YHC) in addition to the currently applied overweight prevention protocol to parents of 0-3 year old children. The two interventions aim to support parents of preschool children to realize healthy child nutrition and activity behaviors of their young child. The aim of this study is to assess the effects of the two overweight prevention interventions with regard to child health behaviors and child Body Mass Index. METHODS/DESIGN: A cluster randomized controlled trial was conducted among parents and their preschool children who attend one of 51 participating YHC teams. The teams were randomly allocated to one of the two intervention groups, or to the control group (care as usual).The 'BBOFT+' intervention focuses on effective child rearing by parents from birth onwards by enlarging parental skills concerning healthy behavioural life-style habits. Parents who are allocated to the 'E-health4Uth Healthy toddler' intervention group, at the child age of circa 18 and 24 months old, are invited to complete an online E-health module providing tailored health education regarding healthy child nutrition and activity behaviors. The E-health messages are discussed and reinforced during the subsequent regularly scheduled visits by YHC professionals, and were repeated after 4 weeks.The primary outcome measures at child age 3 years are: overweight inducing/reducing behaviors, (for 'BBOFT+' only) healthy sleep, Body Mass Index and prevalence of overweight and obesity. Secondary outcome measures are attitudes and other cognitive characteristics of the parents regarding the overweight-related behaviors of their child, parenting styles and practices, and health-related quality of life of the children. DISCUSSION: We hypothesize that the use of the additional interventions will result in a healthier lifestyle of preschool children and an improved BMI and less development of overweight and obesity compared to usual care. TRIAL REGISTRATION: Nederlands Trial Register NTR1831.

#sleepingbaby on Instagram: Nonadherence of images to safe sleeping advice and implications for prevention of Sudden Unexpected Death in Infancy.

OBJECTIVES: Safe sleep of infants is important to reduce the risk of Sudden Unexpected Death in Infancy (SUDI). The depiction of infant care behavior which is inconsistent with the safe sleep recommendations on social media has an impact on parental infant care thoughts, norms and behaviors. This study aims to determine the adherence of Instagram images to the Dutch safe sleeping advice. DESIGN: A systematic social media analysis on Instagram was performed using 22 hashtags and 9 accounts of Dutch companies or platforms related to infants. Images of sleeping infants were analyzed on consistency with the criteria: supine sleeping position, own cot or crib, sleep sack, and an empty bed. RESULTS: Based on 514 collected images, 5.9% was consistent with sleep sack use, 16.8% with an empty bed, 30.7% with an own cot or crib, and 67.5% with the supine sleeping position. For 311 images (60.5%), all four criteria could be rated, as for the others, at least one criterion was not clearly depicted. Only 6 of these images (1.9%) were consistent with all four criteria. CONCLUSIONS: Although Instagram images are probably not representative of regular infant care behavior, the exposure to these images that are mostly inconsistent with the safe sleep advice can contribute to the formation of norms, and therefore influence parental care behavior. Accurate communication of the safe sleep recommendations through social media is needed, and opportunities are described for preventive health professionals to engage more in this communication with their public.

Predicting participation in ultrasound hip screening from message framing.

The use of ultrasound (US) screening for developmental dysplasia of the hip (DDH) is an innovation in preventive child health care in the Netherlands. What is not known is whether parents will accept this screening method and will actually participate in it. It is widely known that health behaviors can be influenced by the framing of information. The objective of this study was to examine the influence of a gain- versus loss-framed brochure on parental participation in US screening for DDH. In total, 4150 parents of infants born between August 2007 and December 2008 received either a gain-framed or a loss-framed brochure. Parents could participate in the screening when their infant was 3 months old. The participation rate in the US screening was 74.3%. In contrast to the predictions of prospect theory, the results indicated that parents who had received the gain-framed message were more likely to participate in the screening compared to parents who had received the loss-framed message. This effect may be explained by the low risk perception of parents and by the possibility that the screening was perceived as a health-affirming behavior rather than an illness-detecting behavior. To increase participation rates, it is recommended that parents be informed about the positive aspects of partaking in screening for DDH.

Social connectedness through ICT and the influence on wellbeing: the case of the CareRabbit.

The CareRabbit has been introduced as a technological innovation in the care for children, enabling family and friends to stay in touch while the child is hospitalized. This study addresses influence of this innovation on the wellbeing of the children, and uses the validated KINDL questionnaire, eliciting information from children and parents at the end of hospitalization. A baseline and an experimental measurement are compared. The children in the CareRabbit group scored slightly higher on the KINDL questionnaire than children in the control group. For young children (age 4-7) the difference was large. Initial findings indicate that CareRabbit has a positive influence on wellbeing, although sample size and measured differences limit the support for this conclusion. The measured difference suggests that CareRabbit may be more valuable for younger children.

Risk and Preventive Factors for SUDI: Need We Adjust the Current Prevention Advice in a Low-Incidence Country.

Background: The incidence of Sudden Unexpected Death in Infancy (SUDI) is low in the Netherlands, with an incidence rate of 0.18 per 1,000 live births. Therefore, prevention advice may receive less attention, potentially leading to increasing incidence rates. It is currently unknown whether the risks for SUDI changed in the Netherlands, and if other risk factors might be present. The aim of this study was to examine the current risks and preventive factors for SUDI in Dutch infants, in order to determine if it is necessary to adapt the prevention advice toward the current needs. Methods: A case-control study was conducted comparing SUDI cases aged <12 months from 2014-2020 in the Netherlands (n = 47), to a Dutch national survey control group from 2017 including infants <12 months of age (n = 1,192). Results: Elevated risks for several well-known factors were observed, namely: duvet use (aOR = 8.6), mother smoked during pregnancy (aOR = 9.7), or after pregnancy (aOR = 5.4) and the prone sleeping position (aOR = 4.6). Reduced risks were observed for the well-known factors: room-sharing (aOR = 0.3), sleep sack use (aOR = 0.3), breastfeeding (aOR = 0.3), and the use of a pacifier (aOR = 0.4). For infants <4 months, the risk for SUDI was higher when bed-sharing (aOR = 3.3), and lower when room-sharing (aOR = 0.2) compared to older infants. For older infants, the sleep sack was found to be more protective (aOR = 0.2). A high risk for SUDI when bed-sharing was found when mother smoked, smoked during pregnancy, or if the infant did not receive any breastfeeding (respectively aOR = 17.7, aOR = 10.8, aOR = 9.2). Conclusions: Internationally known factors related to the sudden unexpected death of infants were also found in this study. Relatively new findings are related to specific groups of infants, in which the strengths of these risk factors differed. In a low-incidence country like the Netherlands, renewed attention to the current prevention advice is needed. Furthermore, additional attention for prevention measures in low educated groups, and additional advice specifically targeting high-risk groups is recommended.

Renewed Attention Needed for Prevention of Sudden Unexpected Death in Infancy in the Netherlands.

Background: The incidence of sudden unexpected death in infancy (SUDI), which includes sudden infant death syndrome (SIDS), has declined in developed countries since the 1980s, including the Netherlands. To identify improvement opportunities in SUDI prevention, we monitored the adherence of parents to the prevention advice on infant care habits over the past 20 years, especially in relation to the SUDI incidence over time. Potential changes in parental adherence between the latest surveys are of specific interest, as these indicate where current focus is needed. Methods: Description of the prevalence of infant care factors related to the risk of SUDI, assessed from five Dutch national surveys from 1999 to 2017 among parents of infants under 12 months, and analysis of the potential differences in these prevalences between the two latest surveys in 2010/11 and 2017 with a z-test. Results: Supine sleeping position decreased from the highest prevalence of 92% in 2010/11, to 83% in 2017. Sleep sack use has increased to 55%, the highest prevalence up to now. Avoiding a duvet has remained reasonably stable since 2002/03 and now 95% of parents do not use a duvet. The prevalence of room-sharing, without sharing the bed, increased from 14% in 1999 to the highest prevalence in 2017 (31%). However, also bed-sharing almost doubled from 5.6% in 2010/11 to 10% in 2017. Breastfeeding decreased between 1999 and 2010/11, but increased from 34% in 2010/11 to 42% in 2017. An increased prevalence of mothers who abstained from smoking during pregnancy, as well as both parents not smoking, was observed, although mostly higher educated parents showed this beneficial behavior. Discussion and Conclusion: Much has already been achieved first by decreasing prone sleeping since the 80's, and subsequently promoting supine as the safest sleep position. The decrease in duvet use and smoking, and an increase in breastfeeding have also had impact. Indications of a recent decreased prevalence of the supine sleeping position and higher prevalence of bed-sharing might relate to the slightly increasing SUDI incidence in the Netherlands. Renewed attention for prevention of SUDI and specific advice targeting high-risk groups is needed. Modern, picture driven information via internet is recommended.

Postpartum depression and anxiety: a community-based study on risk factors before, during and after pregnancy.

BACKGROUND: Depression and anxiety occur frequently postpartum, calling for early detection and treatment. Evidence on risk factors may support early detection, but is inconclusive. Our aim was to identify risk factors for postpartum depression and anxiety, before, during and after pregnancy. METHODS: We used data from 1406 mothers of the intervention arm of the Post-Up study. Risk factors were collected at 3 weeks and 12 months postpartum. Depression and anxiety symptoms were measured in the first month postpartum by the Edinburgh Postnatal Depression Scale (EPDS) and 6-item State-Trait Anxiety Inventory (STAI-6), respectively. We used stepwise logistic regression to identify relevant risk factors. RESULTS: Of the mothers, 8.0% had EPDS-scores ≥9 and 14.7% STAI-6-scores ≥42. Factors associated with higher risk of depression were: foreign language spoken at home, history of depression, low maternal self-efficacy and poor current health of the mother. No initiation of breastfeeding was associated with lower risk of depression, no breastfeeding at 3 weeks postpartum increased the risk. Factors associated with higher risk of anxiety were: higher educational level, history of depression, preterm birth, negative experience of delivery and first week postpartum, excessive infant crying, low maternal self-efficacy, low partner support and poor current maternal health. LIMITATIONS: Use of a self-report instrument, potential bias by postpartum mood status, and no inclusion of emerging depression cases after one month postpartum. CONCLUSIONS: The shared and separate risk factors for postpartum depression and anxiety may help professionals in identifying mothers at increased risk and provide opportunities for preventive interventions and treatment.