Perceived workplace discrimination on the basis of parent status in Australia: who is vulnerable and how does it link to mothers' and fathers' mental health?

OBJECTIVE: This study focused on employees' perceived discrimination due to parenthood; and mental health, occupational stress and turnover intention. METHODS: Survey (2016) of an Australian convenience sample of employed parents: women (n = 2950) and men (n = 1318). RESULTS: Forty-two percent of all mothers reported missing out on promotion (n = 1,234/2950); one third reported negative comments from managers (n = 805/2950, 27%) or colleagues (n = 832/2950, 28%). One in five fathers reported these forms of discrimination. In adjusted analyses perceived discrimination was associated with poorer mental health (ß = 0.23, p < .001); higher occupational stress (ß = 0.30, p < .001); and increased odds of turnover intention (aOR = 1.5, p < .001) for mothers; and poorer mental health (ß = 0.34, p < .001); stress (ß = 0.35, p < .001); and increased odds of turnover intention (aOR = 1.7, p < .001) for fathers. CONCLUSIONS: Experiences of negativity and hostility at work are common, and link to employee health and wellbeing.

How the mental health of working parents in Australia changed during COVID-19: A pre- to during pandemic longitudinal comparison.

BACKGROUND: Cross-sectional studies indicate that mental health has deteriorated in Australia during the COVID-19 pandemic, including for parents. However, robust longitudinal studies interrogating change from before to during the pandemic remain rare. The current study analysed data from Australian parents surveyed in 2016 and August 2020. We investigate whether distress was higher in the COVID-19 period compared to pre-pandemic levels, and whether any increases in distress were greatest for parents living in Victoria (who had entered their second prolonged lockdown). METHODS: A community cohort of Australian working parents (n = 5197) was recruited online in 2016. In August 2020, 25.9 % (n = 1348) completed a follow-up survey. Analyses were restricted to those employed at both time-points (n = 1311). Random effects longitudinal models examined the association between time (i.e. pre vs. during-pandemic) and distress (K6 scale). Fixed effects models specifically tested change between time periods in association with change in distress. LIMITATIONS: The initial sample were recruited online with highly educate parents over-represented. Attrition between survey time-points may also limit generalisability. RESULTS: All models consistently showed that the pandemic period was associated with greater distress. Overall, serious mental illness (i.e. K6 score ≥ 18) increased by 5.3 percentage points (from 8.0 to 13.3). This increase was greater (by 4.7 percentage points) for those parents in Victoria. CONCLUSIONS: This study is one of few to longitudinally assess mental health pre- to during the pandemic. Psychological distress and serious mental illness increased for Australian working parents, and this effect was greatest for those experiencing a prolonged lockdown in Victoria.

Does place matter in the implementation of an evidence-based program policy in an Australian place-based initiative for children?

Policy-mandated requirements for use of evidence-based programs (EBP) in place-based initiatives are becoming more common. Little attention has been paid to the geographic aspects of uneven market development and urbanicity in implementing EBPs in large place-based initiatives. The aim of this study was to explore geographic variation in knowledge, attitudes, and experiences of service providers who implemented an EBP policy in Australia's largest place-based initiative for children, Communities for Children. A cross-sectional online survey of Communities for Children service providers was conducted in 2018-2019, yielding 197 participants from all of Australia's eight states and territories. Relationships between two measures of 'place' (thick and thin market states; urbanicity: urban, regional and remote) and study-designed measures of knowledge, attitudes, and implementation experiences were analyzed using adjusted logistic and multinomial regressions. Participants from thin market states (outside the Eastern Seaboard) were more resistant to the policy and experienced greater implementation challenges than those from thick market states (Eastern Seaboard). Regional participants reported greater knowledge about EBPs but experienced greater dissatisfaction and implementation challenges with the policy than both urban and remote participants. Our study found that place does matter when implementing EBPs in a place-based initiative.

Maternal and Child Health Nursing education before and during COVID-19: An exploratory descriptive study.

BACKGROUND: Major disruptions to higher education during COVID-19 resulted in a rapid shift to online learning and associated adaptations to teaching and assessment practices, including for postgraduate programs requiring practical skill development such as nursing and midwifery. Educator perspectives of this transition have not been widely studied. PURPOSE: This qualitative descriptive study aimed to describe Australian postgraduate Maternal, Child and Family Health nurse educators' perceptions of COVID-19 impacts on student knowledge of theory and practice, and lessons learned through their responses. METHOD: Semi-structured interviews were reflexively thematically analyzed. RESULTS: All participants recognized struggles, opportunities and innovations within three key themes: "We've learned how to be flexible": Grappling with COVID-safe teaching and assessment; "Chat rooms and Zoomland": Learning in a virtual community; and "We've had a few struggles": Clinical placement tensions. Educators described a sense of uncertainty, increased flexibility, opportunities for change and new ways of connecting. They adapted by developing new online resources and broadening clinical practicum and assessment requirements to address new practice approaches including telehealth. CONCLUSIONS: Rapidly changing practice requirements and concerns about risk of disease transfer between workplace and placement venues restricted placement opportunities. Educators learned and incorporated new skills and strategies into their teaching, while aiming to meet professional expectations and maintain quality of education. Some strategies are likely to be maintained for future education programs.

Place-based approaches to improve health and development outcomes in young children: A scoping review.

This scoping review examines the strength of evidence for the effectiveness of public policy-led place-based initiatives designed to improve outcomes for disadvantaged children, their families and the communities in which they live. Study designs and methods for evaluating such place-based initiatives were assessed, along with the contexts in which initiatives were implemented and evaluated. Thirty-two reports relating to 12 initiatives were included. Eleven initiatives used a quasi-experimental evaluation to assess impact, although there were considerable design variations within this. The remaining initiative used a pre- and post- evaluation design. Place-based initiatives by definition aim to improve multiple and interrelated outcomes. We examined initiatives to determine what outcomes were measured and coded them within the five domains of pregnancy and birth, child, parent, family and community. Across the 83 outcomes reported in the 11 studies with a comparison group, 30 (36.4%) demonstrated a positive outcome, and all but one initiative demonstrated a positive outcome in at least one outcome measure. Of the six studies that examined outcomes more than once post baseline, 10 from 38 outcomes (26.3%) demonstrated positive sustained results. Many initiatives were affected by external factors such as policy and funding changes, with unknown impact on their effectiveness. Despite the growth of place-based initiatives to improve outcomes for disadvantaged children, the evidence for their effectiveness remains inconclusive.

Healing the Past by Nurturing the Future: Aboriginal parents' views of what helps support recovery from complex trauma.

We aimed to understand support needs for Aboriginal and Torres Strait Islander parents experiencing complex trauma.Becoming a parent is an exciting yet challenging transition, particularly for parents who have experienced past hurt in their own childhood which can have long lasting effects, including complex trauma. Complex trauma-related distress can make it harder to care for a baby, but the parenting transition offers unique opportunities for recovery.This formative research is part of a community-based participatory action research project which aims to co-design perinatal awareness, recognition, assessment and support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. We used an Indigenist approach and grounded theory methods. Aboriginal and Torres Strait Islander parents who were pregnant and/or have children up to two years old were recruited through perinatal care services and community networks in three Australian sites (Alice Springs, Adelaide and Melbourne). Parents were offered a group discussion or individual interview, facilitated by Aboriginal researchers. Third-person scenarios and visual tools were used to facilitate reflections about the impact of past experiences, what keeps parents strong, hopes and dreams, and what is needed to achieve those dreams. Parents were also shown themes from a previous systematic review of parents' experiences as a prompt to identify any additional key issues.Seventeen Aboriginal and Torres Strait Islander parents participated in August to September 2019. Most were mothers (n = 15).  The study's grounded theory methods provided the foundation of a theoretical supposition that positions the transformation of the compounding cycle of trauma, to a reinforcing cycle of nurturing at the intersection of: 1) parents' connectedness; 2) social and emotional wellbeing; and 3) the transition to parenting. Unique opportunities and challenges situated at the interface are bound to the compounding or reinforcing nature of the intersecting factors. Findings reveal complexity, differing experiences by gender and age, as well as within and between communities.

Ethical Considerations in Using Social Media to Engage Research Participants: Perspectives of Australian Researchers and Ethics Committee Members.

Researchers increasingly use social media (SM) to recruit, retain, and trace participants, yet empirical literature investigating the ethics of engaging participants via SM is lacking. We conducted a survey of 401 Australian researchers and human research ethics committee (HREC) members to examine their experience, attitudes, and ethical concerns toward engaging participants via SM. Data revealed that researchers and HREC members share similar concerns and attitudes about using SM in general and in research. We identified a strong demand for additional support, training, and guidance on SM research ethics. This need reflects researchers' and HREC members' limited confidence and knowledge of ethical issues in this context and a lack of awareness of available SM-specific ethical guidelines.

Healing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment.

BACKGROUND: Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. METHODS: A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. FINDINGS: The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. CONCLUSIONS: Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.

Normal foetal kidney volume in offspring of women treated for gestational diabetes.

AIMS: The worldwide prevalence of gestational diabetes mellitus (GDM) is increasing. Studies in rodent models indicate that hyperglycaemia during pregnancy alters kidney development, yet few studies have examined if this is so in humans. The objective of this study was to evaluate the association of treated GDM with foetal kidney size. MATERIALS AND METHODS: Participants were recruited from an Australian tertiary hospital, and clinical data were collected from women without GDM and women diagnosed and treated for GDM and their offspring. Participants underwent an obstetric ultrasound at 32-34 weeks gestation for foetal biometry and foetal kidney volume measurement. RESULTS: Sixty-four non-GDM and 64 GDM women participated in the study. Thirty percent of GDM women were diagnosed with fasting hyperglycaemia, while 89% had an elevated 2-hour glucose level. Maternal age, weight and body mass index were similar in women with and without GDM. Estimated foetal weight, foetal kidney dimensions, total foetal kidney volume and birth weight were similar in offspring of women with and without GDM. CONCLUSIONS: We conclude that a period of mild hyperglycaemia prior to diagnosis of GDM and treatment initiation, which coincides with a period of rapid nephron formation and kidney growth, does not alter kidney size at 32-34 weeks gestation.

Healing the Past by Nurturing the Future-co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study.

INTRODUCTION: Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal parents experiencing complex trauma. METHODS AND ANALYSIS: This formative research project is being conducted in three Australian jurisdictions (Northern Territory, South Australia and Victoria) with key stakeholders from all national jurisdictions. Four action research cycles incorporate mixed methods research activities including evidence reviews, parent and service provider discussion groups, development and psychometric evaluation of a recognition and assessment process and drafting proposals for pilot, implementation and evaluation. Reflection and planning stages of four action research cycles will be undertaken in four key stakeholder workshops aligned with the first four Intervention Mapping steps to prepare programme plans. ETHICS AND DISSEMINATION: Ethics and dissemination protocols are consistent with the National Health and Medical Research Council Indigenous Research Excellence criteria of engagement, benefit, transferability and capacity-building. A conceptual framework has been developed to promote the application of core values of safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. These include related principles and accompanying reflective questions to guide research decisions.

Using Paid and Free Facebook Methods to Recruit Australian Parents to an Online Survey: An Evaluation.

BACKGROUND: The prevalence of social media makes it a potential alternative to traditional offline methods of recruiting and engaging participants in health research. Despite burgeoning use and interest, few studies have rigorously evaluated its effectiveness and feasibility in terms of recruitment rates and costs, sample representativeness, and retention. OBJECTIVE: This study aimed to determine the feasibility of using Facebook to recruit employed Australian parents to an online survey about managing work and family demands, specifically to examine (1) recruitment rates and costs; (2) sample representativeness, compared with a population-based cohort of parents; and (3) retention, including demographic and health characteristics of parents who returned to complete a follow-up survey 6 weeks later. METHODS: Recruitment was conducted using 20 paid Facebook advertising campaigns, supplemented with free advertising approaches such as posts on relevant Facebook pages and requests for professional networks to circulate the survey link via Facebook. Recruitment rates and costs were evaluated using the Checklist for Reporting Results of Internet E-Surveys, including view rate, participation rate, completion rate, cost per consent, and cost per completer. Sample representativeness was evaluated by comparing demographic and outcome variables with a comparable sample from the Longitudinal Study of Australian Children including educational attainment, marital status, country of birth, neighborhood disadvantage, work-family conflict, and psychological distress. Retention was evaluated by comparing the number and demographic characteristics of participants at recruitment and at 6-week follow-up. RESULTS: Recruitment strategies together resulted in 6653 clicks on the survey link, from which 5378 parents consented to participate and 4665 (86.74%) completed the survey. Of those who completed the survey, 85.94% (4009/4665) agreed to be recontacted, with 57.79% (2317/4009) completing the follow-up survey (ie, 43.08% [2317/5378] of parents who consented to the initial survey). Paid Facebook advertising recruited nearly 75% of the sample at Aus $2.32 per completed survey (Aus $7969 spent, 3440 surveys completed). Compared with a population-based sample, participants at baseline were more likely to be university educated (P<.001), experience greater work-family conflict (P<.001) and psychological distress (P<.001), and were less likely to be born outside Australia (P<.001) or live in a disadvantaged neighborhood (P<.001). CONCLUSIONS: Facebook provided a feasible, rapid method to recruit a large national sample of parents for health research. However, some sample biases were observed and should be considered when recruiting participants via Facebook. Retention of participants at 6- to 8-week follow-up was less than half the initial sample; this may reflect limited ongoing participant engagement for those recruited through social media, compared with face-to-face.

Ethical issues in using the internet to engage participants in family and child research: A scoping review.

BACKGROUND: The internet is an increasingly popular tool in family and child research that is argued to pose new ethical challenges, yet few studies have systematically assessed the ethical issues of engaging parents and children in research online. This scoping review aims to identify and integrate evidence on the ethical issues reported when recruiting, retaining and tracing families and children in research online, and to identify ethical guidelines for internet research. METHODS: Academic literature was searched using electronic academic databases (Scopus, PsycINFO, Embase, ERIC, CINAHL and Informit) and handsearching reference lists for articles published in English between January 2006 and February 2016. Grey literature was searched using Google to identify relevant ethical guidelines. RESULTS: Sixty-five academic articles were included after screening 3,537 titles and abstracts and 205 full-text articles. Most articles reported using the internet to recruit participants (88%) with few reporting online retention (12%) or tracing (10%). Forty percent commented on ethical issues; the majority did not discuss ethics beyond general consent or approval procedures. Some ethical concerns were specific to engaging minors online, including parental consent, age verification and children's vulnerability. Other concerns applied when engaging any research participant online, including privacy and confidentiality, informed consent and disparities in internet access. Five professional guidelines and 10 university guidelines on internet research ethics were identified. Few academic articles (5%) reported using these guidelines. CONCLUSIONS: Engaging families and children in research online introduces unique challenges requiring careful consideration. While researchers regarded themselves as responsible for ensuring research is conducted ethically, lack of use of available guidelines and limited academic literature suggests internet research is occurring without suitable guidance. We recommend broad dissemination of ethical guidelines and encourage researchers to report the methodological and ethical issues of using the internet to engage families and children in research.

Maternal Fat Feeding Augments Offspring Nephron Endowment in Mice.

Increasing consumption of a high fat 'Western' diet has led to a growing number of pregnancies complicated by maternal obesity. Maternal overnutrition and obesity have health implications for offspring, yet little is known about their effects on offspring kidney development and renal function. Female C57Bl6 mice were fed a high fat diet (HFD, 21% fat) or matched normal fat diet (NFD, 6% fat) for 6 weeks prior to pregnancy and throughout gestation and lactation. HFD dams were overweight and glucose intolerant prior to mating but not in late gestation. Offspring of NFD and HFD dams had similar body weights at embryonic day (E)15.5, E18.5 and at postnatal day (PN)21. HFD offspring had normal ureteric tree development and nephron number at E15.5. However, using unbiased stereology, kidneys of HFD offspring were found to have 20-25% more nephrons than offspring of NFD dams at E18.5 and PN21. Offspring of HFD dams with body weight and glucose profiles similar to NFD dams prior to pregnancy also had an elevated nephron endowment. At 9 months of age, adult offspring of HFD dams displayed mild fasting hyperglycaemia but similar body weights to NFD offspring. Renal function and morphology, measured by transcutaneous clearance of FITC-sinistrin and stereology respectively, were normal. This study demonstrates that maternal fat feeding augments offspring nephron endowment with no long-term consequences for offspring renal health. Future studies assessing the effects of a chronic stressor on adult mice with augmented nephron number are warranted, as are studies investigating the molecular mechanisms that result in high nephron endowment.

Maternal glucose intolerance reduces offspring nephron endowment and increases glomerular volume in adult offspring.

BACKGROUND: Animal studies report a nephron deficit in offspring exposed to maternal diabetes, yet are limited to models of severe hyperglycaemia which do not reflect the typical clinical condition and which are associated with foetal growth restriction that may confound nephron endowment. We aimed to assess renal morphology and function in offspring of leptin receptor deficient mice (Leprdb /+) and hypothesized that exposure to impaired maternal glucose tolerance (IGT) would be detrimental to the developing kidney. METHODS: Nephron endowment was assessed in offspring of C57BKS/J Leprdb /+ and +/+ mice at embryonic day (E)18 and postnatal day (PN)21 using design-based stereology. Transcutaneous measurement of renal function and total glomerular volume were assessed in 6-month-old offspring. Only +/+ offspring of Leprdb /+ dams were analysed. RESULTS: Compared with +/+ dams, Leprdb /+ dams had a 20% and 35% decrease in glucose tolerance prior to pregnancy and at E17.5 respectively. Offspring of IGT Leprdb /+ dams had approximately 15% fewer nephrons at E18.5 and PN21 than offspring of +/+ dams. There was no difference in offspring bodyweight. Despite normal renal function, total glomerular volume was 13% greater in 6-month-old offspring of IGT Leprdb /+ dams than in +/+ offspring. CONCLUSIONS: IGT throughout gestation resulted in a nephron deficit that was established early in renal development. Maternal IGT was associated with glomerular hypertrophy in adult offspring, likely a compensatory response to maintain normal renal function. Given the increasing prevalence of IGT, monitoring glucose from early in gestation may be important to prevent altered kidney morphology. Copyright © 2016 John Wiley & Sons, Ltd.

Validation of a Three-Dimensional Method for Counting and Sizing Podocytes in Whole Glomeruli.

Podocyte depletion is sufficient for the development of numerous glomerular diseases and can be absolute (loss of podocytes) or relative (reduced number of podocytes per volume of glomerulus). Commonly used methods to quantify podocyte depletion introduce bias, whereas gold standard stereologic methodologies are time consuming and impractical. We developed a novel approach for assessing podocyte depletion in whole glomeruli that combines immunofluorescence, optical clearing, confocal microscopy, and three-dimensional analysis. We validated this method in a transgenic mouse model of selective podocyte depletion, in which we determined dose-dependent alterations in several quantitative indices of podocyte depletion. This new approach provides a quantitative tool for the comprehensive and time-efficient analysis of podocyte depletion in whole glomeruli.

Altered ureteric branching morphogenesis and nephron endowment in offspring of diabetic and insulin-treated pregnancy.

There is strong evidence from human and animal models that exposure to maternal hyperglycemia during in utero development can detrimentally affect fetal kidney development. Notwithstanding this knowledge, the precise effects of diabetic pregnancy on the key processes of kidney development are unclear due to a paucity of studies and limitations in previously used methodologies. The purpose of the present study was to elucidate the effects of hyperglycemia on ureteric branching morphogenesis and nephrogenesis using unbiased techniques. Diabetes was induced in pregnant C57Bl/6J mice using multiple doses of streptozotocin (STZ) on embryonic days (E) 6.5-8.5. Branching morphogenesis was quantified ex vivo using Optical Projection Tomography, and nephrons were counted using unbiased stereology. Maternal hyperglycemia was recognised from E12.5. At E14.5, offspring of diabetic mice demonstrated fetal growth restriction and a marked deficit in ureteric tip number (control 283.7 ± 23.3 vs. STZ 153.2 ± 24.6, mean ± SEM, p<0.01) and ureteric tree length (control 33.1 ± 2.6 mm vs. STZ 17.6 ± 2.7 mm, p = 0.001) vs. controls. At E18.5, fetal growth restriction was still present in offspring of STZ dams and a deficit in nephron endowment was observed (control 1246.2 ± 64.9 vs. STZ 822.4 ± 74.0, p<0.001). Kidney malformations in the form of duplex ureter and hydroureter were a common observation (26%) in embryos of diabetic pregnancy compared with controls (0%). Maternal insulin treatment from E13.5 normalised maternal glycaemia but did not normalise fetal weight nor prevent the nephron deficit. The detrimental effect of hyperglycemia on ureteric branching morphogenesis and, in turn, nephron endowment in the growth-restricted fetus highlights the importance of glycemic control in early gestation and during the initial stages of renal development.