Treatment of maternal mood disorder and infant behaviour disturbance in an Australian private mothercraft unit: a follow-up study.

Australia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five-night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.

Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit.

OBJECTIVE: To characterize psychological distress of women admitted with their infants to a private hospital mother-baby unit. METHODS: A cross-sectional self-report survey including standardized psychometric questionnaires of consecutive admissions to Masada Private Hospital Mother-Baby Unit, Melbourne between 1 June and 30 November 1997. Scores on the Profile of Mood States, Edinburgh Postnatal Depression Scale, Intimate Bonds Measure, Parental Bonding Instrument, Social Support Questionnaire, Vulnerable Personality Scale self-report instruments and responses to a structured self-report questionnaire. Of the women admitted, 109 out of 146 participated in the survey. RESULTS: Clinically significant fatigue was almost universal in this cohort. Psychological distress clustered into three distinct groups: (i) probable depression; (ii) fatigue and distress; and (iii) fatigue only. It may be more accurate to conceptualise postpartum psychological distress either as a continuum, or as a wide range of distinct states, rather than as a dichotomous condition in which individuals are categorized as being or not being cases. In this cohort, the severity of distress was associated most consistently with the quality of a woman's relationship with her partner and with infants who were difficult to settle. CONCLUSIONS: It appears that some cases of psychological distress in women following childbirth may be inaccurately conceptualised as depression. Clinically significant fatigue and moderate distress are distinguishable from depression, and warrant specifically tailored assessment strategies and treatments. Following the birth of a baby, the partner of a mother has a strong influence on her emotional health and should be included in any assessment and intervention.

Can asthma education improve clinical outcomes? An evaluation of a pediatric asthma education program.

Asthma is a common, costly, and chronic disease that has a significant impact on children, their families, and the health care system. This study investigated whether formal asthma education can reduce asthma severity and morbidity and further questioned whether the method of education is an important factor in this process. Study subjects were recruited from the emergency department of the Royal Children's Hospital, Melbourne (RCHM), and controls were recruited from the neighboring Western Hospital, Sunshine (WHS). Subject parents were randomized to receive face-to-face education, group education, or home-based video education. Controls had similar medical treatment but received no formal asthma education. Subject and control parents were asked to complete questionnaires before the intervention and at 1, 6, and 12 months. These questionnaires measured demographics, the levels of parent asthma knowledge, anxiety, child asthma severity, and morbidity. Results showed that any method of education increased parent asthma knowledge and immediately decreased their anxiety and child asthma morbidity scores. Despite this, asthma severity was reduced only when knowledge was imparted in an interactive, face-to-face setting. When this happened, asthma severity scores were significantly reduced in both the short- and long-term. These findings call into question mass asthma education campaigns and have important implications for the design of future asthma education programs.

Helicobacter pylori and recurrent abdominal pain in children.

Recurrent abdominal pain is one of the most common presentations to pediatricians; yet an organic etiology can be found in only 10% of cases. Because infection with Helicobacter pylori in adults and children results in gastritis, a causative role for the organism has been postulated. To investigate this theory, we conducted a prospective case-control study in children with recurrent abdominal pain using serum H. pylori IgG antibodies measured by an enzyme immunoabsorbent assay. Age, sex, ethnicity, and socioeconomic status were adjusted in the statistical model. Five subjects (5.1%) and 14 controls (14.3%) had raised serum IgG antibodies to H. pylori (adjusted OR, 0.21; 95% confidence interval, 0.05, 0.85). The negative association between H. pylori and recurrent abdominal pain indicates that this organism is unlikely to have an important etiologic role in this disorder.

Landau-Kleffner syndrome: six patients including discordant monozygotic twins.

This is the first published report of Landau-Kleffner syndrome occurring discordantly in monozygotic twins. The implications of this finding in the understanding of the etiology of this condition are discussed. Five other patients are reported and comparisons are drawn with other series.