English-speaking Mothers Research Articles

Implementing universal maternal depression screening in head start: A convergent mixed methods study

AimsImplementing maternal depression screening in child-serving programs can help ensure that more mothers receive mental health services. This study examined the implementation of universal maternal depression screening in community-based Head Start programs. MethodsQuantitative and qualitative data were merged in a convergent mixed method design to assess four domains from the RE-AIM implementation science framework (Reach, Adoption, Implementation, and Maintenance). Qualitative data included interviews with stakeholders and meeting minutes from the implementation period. Quantitative data included intervention outcomes and administrative data. ResultsIn terms of reach, 85% of eligible Head Start mothers were screened for depression, and English-speaking mothers were more likely to refuse screening than Spanish-speaking or bilingual mothers. Barriers to screening included lack of availability, stigma, privacy concerns, lack of interest, and lack of trust. In terms of adoption, all sites and staff adopted screening due to organizational mandates. In terms of implementation, there was wide variation in rates of positive screenings across staff completing the screening (ranging from 0% to 46%), and barriers included concerns about staff role and lack of training. In terms of maintenance, screening was not sustained after the study period due to organizational priorities and lack of buy-in from staff. ConclusionUniversal maternal depression screening has the potential to reach low-income Head Start mothers, but additional efforts should be made to build staff capacity to engage mothers in screening.

An Exploration of Voice Quality in Mothers Speaking Canadian English to Infants

ABSTRACT Research on the acoustic characteristics of Infant Directed Speech (IDS) in North American English indicates that it is generally higher-pitched than Adult Directed Speech (ADS) and has unique prosodic characteristics, which is commonly found across many spoken languages. However, very little research has addressed another important aspect of prosody: voice quality. In the current study, 25 English-speaking mothers from Canada were recorded speaking to their infant children and to an adult peer. Five acoustic measures of voice quality, including glottal constriction, spectral tilt, Harmonic-to-Noise Ratio (HNR), and Cepstral Peak Prominence (CPP), were analyzed. Only CPP, a measure of the breathiness of a speaker’s voice, and corrected H1-A2, a measure of vocal creakiness, were found to be significantly different between the IDS and ADS registers. Sociolinguistic research identifies voice quality as a key indicator of speech style and persona; we connect the pattern of breathiness in IDS to a possible “parental persona” that builds on the affective intent of IDS (rather than the pedagogical intent), with suggestions for future research.

The moderating role of gender and acculturative status in the socialization of cultural values in U.S. Mexican families.

Familismo and respeto are traditional Latine values often taught to U.S. Latine children by their caregivers. Deference to authority figures and restraint from defiance to such figures are also taught. Despite the central role of these as markers of Latine ethnic identity and their relevance to children's health and well-being, little is known on how these traditional cultural values are socialized and whether differences exist in these values between English-speaking and Spanish-speaking U.S. Latine mothers and between boys and girls. We examined expressions of familismo, respeto, deference, and defiance in conversations of low-income, U.S. Mexican mothers and their children as a function of mothers' acculturative status and children's gender. One hundred thirty-eight video-recorded U.S. Mexican mother-child conversations (65 girls; age: M = 10.5 years, SD = 0.53) were transcribed and coded to obtain indices of respeto, familismo, deference, and defiance. There were 70 Spanish-speaking mothers and 68 English-speaking mothers (age: M = 34.9 years, SD = 5.8) from the Early Head Start Research and Evaluation project. Spanish-speaking children were more deferent than English-speaking children. English-speaking children were more defiant. There were no group differences, however, in familism and respect. The findings advance a more nuanced conceptual framework of cultural values socialization that is sensitive to acculturative status in U.S. Latine populations and can inform the development of effective intervention efforts (e.g., parenting education programs) aimed at supporting enculturative practices that can enhance U.S. Latine children's health and well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Tension Between AAP Safe Sleep Guidelines and Infant Sleep.

To understand tension mothers experience when attempting to follow American Academy of Pediatrics safe sleep guidelines and enhancing infant and parental sleep. Surveys and focus groups were conducted from November 2022 and March 2023 with United States-based English-speaking mothers of infants <6 months of age recruited via social media and who reported a nonrecommended sleep position and/or location ≥2 times the prior week. Twenty-five mothers participated in focus groups and surveys. A total of 80% reported holding or rocking their infant to sleep; 76% fed their infant to sleep. Almost all were aware of the ABCs (Alone, Back, Crib) of safe sleep and intended to follow them before delivery. Many felt that ABCs were unrealistic and placed their infants in nonrecommended locations or positions because they perceived them as more comfortable and helping their infant fall and stay asleep. Mothers were more likely to use nonrecommended practices when they were awake or sleeping nearby and believed they could closely monitor their infant. Some questioned whether ABCs were the only way to achieve safe sleep. Some prioritized other safety concerns (eg, fall prevention) over sudden infant death syndrome or sudden unexpected infant death prevention. Mothers expressed confidence about getting their baby to sleep in general but were less confident that they could do this while following guidelines. Despite awareness of the ABCs, mothers regularly engaged in nonrecommended practices with the goal of improving their own and their infant's sleep. Interventions focused on improving infant and parental sleep while maintaining sleep safety are needed.

Mothers’ perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds

ABSTRACT HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers’ hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.

Barriers to referral and evaluation and corresponding navigation services for toddlers screening positive for autism spectrum disorder.

Children from disadvantaged populations receive referrals, diagnoses, and services for autism spectrum disorder (ASD) late or not at all. We describe barriers to referral for and receipt of evaluation for ASD among young children from disadvantaged families and activities by autism family navigators (AFNs) to address these barriers. Trained AFNs offered navigation to families of children aged 16-30 months with positive ASD screens from community health center clinics in 2015-2018. AFNs interviewed families to identify perceived barriers to care and documented system barriers and navigation activities. We coded, categorized, and described barriers and AFN activities. Case studies illustrate barriers and navigation activities. Of 22 participating mothers, 82% were Latinx and 64% were native Spanish-speaking; 71% had household incomes <$30,000/year and 57% had no high school diploma. Half of the families experienced five or more barriers to ASD evaluation, most commonly pragmatic barriers. Information barriers/needs were 5 times more common among Spanish-speaking than English-speaking mothers. One-fifth of families identified negative experiences or expectations of care. System barriers included incomplete screening tests, inadequate referrals, and waiting lists. AFNs implemented navigation activities, most frequently categorized as care coordination (95%), education (68%), social/emotional support (36%), family advocacy (27%), and self-advocacy coaching (23%). AFNs also trained providers and staff to improve screening and referral implementation. In this largely Latinx sample, families experienced numerous barriers to obtaining ASD evaluations for their screen-positive children, likely reflecting the complexity of negotiating both healthcare and educational systems. Trained AFNs can assist parents to overcome barriers to timely diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

0754 Sleep Ecology in Low-Income Mexican American Toddlers

Abstract Introduction Healthy sleep is critical for child development, yet disparities exist, with Latino children disproportionately affected by deficient sleep. Most of what is known about sleep ecology and interventions to improve sleep in young children is based on studies of primarily White, non-Latino, and economically-advantaged families. To ensure the effectiveness of interventions, it is important to understand the contribution of socioecological factors on sleep among toddlers in low-income Mexican American families. Methods This study employed in-depth interviews with a purposeful sample of low-income Mexican American Spanish-speaking (n=10) and English-speaking mothers (n=10) of toddlers (18-34 months old). Interviews focused on daily sleep routines, perceptions of toddler sleep behaviors, and environmental contributors. Transcripts were coded by two investigators and analyzed using a content analytic approach. Results For sleep-related parenting practices, 70% of mothers reported late child bedtimes (≥9:00 pm), 75% reported room/bed sharing, and almost a third of children fell asleep at bedtime with a bottle or cup. Maternal beliefs about child sleep included concerns that child crying during the night might disturb neighbors or wake siblings, and child sleep quality improved when the child is not hungry. Contextual factors impacting sleep included schedules, neighbors, and siblings. Specifically, later weekday bedtimes were attributed to maternal (but not paternal) work schedules, while wake times were often a result of a sibling’s school schedule. Weekend bedtimes were commonly reported to be delayed for toddlers due to families watching movies. Noisy neighbors, in particular upstairs neighbors, were identified as disrupting children’s sleep. Siblings were identified as both facilitating sleep (e.g., helping with routines) and disrupting sleep (e.g., distracting child at nap time). Conclusion Findings provide insights on socioecological factors and parental beliefs about sleep ecology in low-income Mexican American toddlers that have implications for the design of interventions to improve child sleep. For example, commonly used behavioral sleep interventions have children sleeping in their own room, or require some crying during the night. However, these approaches may not be a good fit or feasible for this population. To address sleep health disparities, further work is needed to understand socioecological factors that require inclusive adaptations to pediatric sleep interventions. Support (if any) R01HL163859

Experiences of Mothers of Preterm Infants in the Neonatal Intensive Care Unit During the COVID-19 Pandemic.

The neonatal intensive care unit (NICU) stay following the birth of a preterm infant can be stressful and traumatic for families. During the COVID-19 pandemic, the NICU environment changed precipitously as infection control and visitor restriction measures were implemented. Our study aimed to examine the impact of the pandemic policies on the experiences of mothers of preterm infants during their stay in the NICU. Semistructured interviews were conducted with mothers of preterm infants hospitalized in a Canadian tertiary-level NICU. Informed by interpretive description methodology, interview content was transcribed and analyzed using a thematic analysis approach. The identified themes were validated, clarified, or refined using investigator triangulation. Nine English-speaking mothers, aged 28 to 40 years, were interviewed. Four themes emerged from the analysis of their experiences: (1) disrupted family dynamic, support, and bonding; (2) physical and emotional isolation; (3) negative psychological impact compounded by added concerns, maternal role change, and survival mode mentality; and (4) positive aspects of the pandemic management measures. During the pandemic, the way that care was provided in the NICU changed. This study helps to explore how neonatal clinicians can foster individual and organizational resilience to keep patients and families at the center of care, even when the healthcare system is under intense stress. : Our results show that these changes heightened mothers' distress, but also had a modest positive impact. Further research about long-term consequences of pandemic policies on the mother and preterm infant after NICU discharge is warranted.

Characterizing U.S. mothers with high human papillomavirus vaccine intent yet unvaccinated adolescents

HPV vaccination rates remain suboptimal in the United States. While the current literature focuses on expressly hesitant parents, few studies have examined parents with “high intent”, or those indicating they definitely will vaccinate and have had the opportunity but not yet vaccinated their adolescents. Our objective was to differentiate characteristics of mothers with high intent from those who already vaccinated their adolescents using various socioeconomic, previous vaccine decision-making, and healthcare provider relationship-related variables. English-speaking mothers or female guardians of adolescents ages 11–14 years living in low HPV vaccine uptake states within the U.S. in September 2018 were recruited from a national survey panel as part of a larger study. We assessed HPV vaccine status of their adolescents and categorized respondents into two categories: Already Vaccinated and High Intent. We assessed differences using a multivariable logistic regression model. Among 2406 mothers, 18% reported high intent vs. 82% already having vaccinated. Mothers with high intent were more likely to identify as non-Hispanic White (p = 0.01), to have a younger adolescent (p < 0.001), and to report not receiving a provider HPV vaccination recommendation (p < 0.001). Mothers who estimated that half/more (vs. less) of their child's friends have received/will receive the vaccine had higher odds of already vaccinating (p < 0.001). Our findings suggest that clinicians may be able to improve HPV vaccination uptake within their practices by giving repeated, high-quality recommendations to parents of children who are not yet vaccinated. Additionally, these findings indicate perceived social norms may play a large role in on-time vaccine uptake. Reassuring hesitant parents that most parents accept the vaccine may also improve uptake in clinical practice.

Cultural Variations in the Care and Support of Breastfeeding

Breastfeeding MedicineVol. 18, No. 2 EditorialFree AccessCultural Variations in the Care and Support of BreastfeedingArthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding MedicineSearch for more papers by this authorPublished Online:15 Feb 2023https://doi.org/10.1089/bfm.2023.29234.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail This month's issue of Breastfeeding Medicine highlights two disparate articles that on first reading seemingly have absolutely nothing to do with each other. In one, in a comment in the Perspective Section, Segev and colleagues discuss the “unique” problem of which oral contraceptives should be recommend to Orthodox Jewish breastfeeding mothers. In the Clinical Research section Cordova Ramos and colleagues report on their study of the association of the mother's primary language and subsequent breastfeeding rates.As Segev notes, traditionally, estrogen-only medications have been the recommended oral contraceptive for breastfeeding mothers because of a concern that combined therapy (estrogen/progesterone) contraceptives run the risk of reducing the mother's milk production. For the general population the increased risk of breakthrough bleeding from the use of estrogen-only pills posed a relatively “minor adverse outcome,” surely offset by the confidence that the mothers are producing their maximum capacity of milk.However, as Segev details, the concern of breakthrough bleeding is not a minor inconvenience in a population that conducts its life under strict religious (halachic) law. Per this religious code, a single menstrual-like breakthrough bleeding results in a prohibition of any sexual contact for periods of days and repeated bleeds may result in months of deferred marital relationships with all the inevitable negative consequences for the couple. Thus, not surprising for this population the risk–benefit ratio based on its particular social cultural priorities would support the use of combine hormonal contraceptive preparations.Cordova-Ramos study of the association of the mothers' primary language and breastfeeding rates and patterns is no less intriguing and enlightening. This study was performed in the context of what has already been reported about the realities of the inequalities in medical care and the need for more detailed and nuanced cultural sensitivity in developing medical services. Given the reports of the racial and ethnic disparities in human milk intake in neonatal intensive care units,1–3 such a study was clearly of high priority.What Cordova-Ramos proceed to do is expand how we categorize the mothers beyond the standard labels of race and ethnicity by adding the variable of primary language into their analysis of the results. The authors justified this expanded analysis on the assumption that the mothers' primary language would serve as a marker of cultural identity (let alone immigrant or native born status). What was found, surprisingly, was that there was different and opposite association of the mothers' primary language with mother's milk provision among different groups.For example among Hispanic mothers, non-English- versus English-speaking mothers had lower rates of milk provision, whereas among Black mothers, non-English- versus English-speaking mothers had higher rates of milk provision. These differences likely reflected a much more complex interplay of social and cultural factors that influence continuation of mother's milk provision in minority mothers and highlights the heterogeneity that exists within conventionally labeled racial/ethnic minority groups. Surely it is difficult to justify combining under the label of Hispanic data regarding third-generation Puerto Rico mothers living in New York with data regarding Mexican or other Central American immigrants living in Texas or California.4What is the common thread in these two seemingly unrelated articles and what we should learn from the data presented? The clear message that we should neither analyze the clinical manifestation of any given medical situation only utilizing the broad and somewhat at times simplistic construct of race and ethnicity. No less so, we should be careful in promoting global recommendations or standard management protocols that are not adjusted for specific groups and subgroups. Clearly there is need for greater sophistication and sensitivity to the various subsets of the standard racial and ethnic categories,Homogenizing the differences between mothers based on the standard labels without factoring the specific social, cultural, beliefs, and practices in subgroups preclude appropriate individualized care and therapy. Simply put, we need not only to be attuned to the language (and cultural context) that specific mothers are talking, but also we need to adjust, in turn, our language to be appropriately attuned to these mothers.

Maternal language disparities in neonatal intensive care unit outcomes.

To examine associations of maternal primary language with neonatal intensive care unit (NICU) outcomes (mother's milk at discharge, necrotizing enterocolitis [NEC], late-onset sepsis, weight gain) DESIGN: We performed a retrospective cohort study of mother-infant dyads (<34 weeks' gestation) in 9 NICUs (1/2016-12/2019), examining associations of maternal language (English [ref], Spanish, Other) with NICU outcomes, adjusting for birth weight for gestational age z-score, race/ethnicity, maternal age, and clustering by hospital. Among 1402 mothers, 85% spoke English, 7% spoke Spanish, and 7% spoke another language. Compared to English, infants with Spanish-speaking mothers had slower growth (-0.34 z-score units [-0.58, -0.10]). Infants with other non-English-speaking mothers had increased mother's milk at discharge (aOR 1.48 [1.18, 1.85]), NEC (aOR 1.43 [1.05, 1.95]), late-onset sepsis (aOR 2.84) [1.67, 4.83] and slower growth (-0.17 z-score units [-0.29, -0.05]). After adjustments, preterm infants with non-English-speaking mothers had worse outcomes than infants with English-speaking mothers.

Interactions of culture and depression in infant-directed speech

Infant-directed speech (IDS) is a change in voice register adopted by adults when speaking to young children. Maternal depression is known to affect IDS, resulting in a lower fundamental frequency (f0) range that can in turn affect infant response. However, there is little information regarding the interaction of culture and language with depression. The goal of this study was to determine if significant differences in IDS exist between Spanish- and English-speaking mothers and to explore potential interactions with the severity of depression. Whole-day audio recordings were collected in the home from 14 mother-infant dyads, 7 English-speaking and 7 Spanish-speaking, all with infants 6 months of age. 10 examples of adult-directed speech and infant-directed speech were segmented from each recording andthe f0 mean and range were measured for each speaker, normalizing infant-directed by adult-directed values to account for speaker variation. The Edinburgh Postnatal Depression Scale (EPDS) was used to determine maternal depression levels. A weak negative correlation was found between depression scores and f0, confirming that depression adversely impacts IDS, but there was no effect or interaction regarding language, suggesting that the mechanism may be common across cultures.

Factors That May Influence Social Communication Questionnaire (SCQ) Scores: An Examination of the Spanish and English SCQ in School-Aged Students

This study examined child and family factors that may influence the Social Communication Questionnaire (SCQ) in English- and Spanish-speaking samples. A total of 199 English- or Spanish-speaking mothers completed the SCQ. Results indicated that Spanish-speaking mothers with limited educational attainment were more likely to report higher scores on the SCQ than those with higher educational attainment. Moreover, differences in response patterns were also observed between Spanish- and English-speaking mothers. That is, SCQ scores tended to be influenced by maternal education in the Spanish-speaking sample and by teachers’ reports of behavior/emotional problems in the English-speaking sample. These findings suggest that when using the SCQ, researchers, clinicians, and school providers need to be mindful that a high score on the SCQ does not necessarily indicate autism symptoms or characteristics. Rather, high SCQ scores might represent factors unrelated to autism symptoms, such as child and family characteristics. IMPACT STATEMENT The Social Communication Questionnaire (SCQ), an autism spectrum disorder screener, was administered to English- or Spanish-speaking mothers of school-aged children. Results from this study showed that the SCQ scores should be interpreted with caution when used with diverse students and students with emotional and behavior problems. Supplemental data for this article is available online at https://doi.org/10.1080/2372966X.2021.1927830

Evaluation of a Home Visiting Program: Perspectives of Mothers.

Home visiting programs provide families with an array of services that contribute to decreased infant and maternal morbidity and mortality. However, little is known as to how mothers perceive participation in home visiting programs, and questions remain regarding what improvements can be made to better serve these families. The purpose of this program evaluation was to assess mothers' perceived benefits and barriers to participation in established home visiting and outreach programs at Child Developmental Resources (CDR) in Williamsburg, Virginia. The program evaluation was a descriptive project consisting of 30-minute telephone interviews. Participants included 23 English-speaking mothers enrolled in CDR programs. Maternal demographics and perception of benefits/barriers were measured. Descriptive statistics were performed to describe sample demographics and outcome variables. Overall, most mothers perceived CDR programs as beneficial and were very satisfied with the services; however, a few changes could be made to improve programs and combat barriers to participation. Potential alternatives to supplement programs were suggested including the use of mobile technology in the participant's home.

Cultivating social relationships and disrupting social isolation in low-income, high-disparity neighbourhoods in Ohio, USA.

Social isolation undermines health. Inequities in social networks exist due to historical and contemporary practices of socioeconomic and racial segregation. Thus, lower income and minority families are less likely to have the number, strength, and variety of social connections as higher income and white families. Therefore, social isolation may contribute to inequities in health and well-being across socioeconomic and racial groups.Disrupting social isolation by strengthening social networks may be a meaningful way to equitably improve population health. In this study we aimed to better understand the factors that influence the formation and sustainment of social connections in neighbourhoods experiencing a disproportionate burden of social needs and poor health outcomes. Participants were recruited through our community-academic partnership, Healthy Homes (HH). Healthy Homes serves families with pregnant women and/or children <6years in two low-income, high-morbidity neighbourhoods, focusing on supporting families' needs and hopes. Between October 2016 and April 2017, we conducted in-depth qualitative interviews (n=20) with English-speaking mothers and grandmothers of children under <6years. Interviews were audio-recorded, transcribed verbatim and independently coded. After applying an a priori code list, we conducted emergent coding to identify additional themes. Themes focused on the social environment, including social connections and social isolation, among vulnerable populations in included neighbourhoods. Families want connection to one another and to resources but look to others to facilitate those connections. Families may want or need social connections but do not engage if it means sacrificing their values or sense of self-worth. These findings provide a deeper understanding of the factors that might allow us to disrupt social isolation by building relationships in communities that face social and health inequities.

The Interpersonal Mindfulness in Parenting Scale in Mothers of Children and Infants: Factor Structure and Associations With Child Internalizing Problems.

Objectives: Mindful parenting, measured by the Interpersonal Mindfulness in Parenting scale (IMP), is beneficial for parents and children. However, the IMP has not been validated in English-speaking parents. Further, little is known about whether mindful parenting is similar in parents of children vs. infants, or how it reduces child internalizing problems. We sought to validate the IMP in English-speaking mothers of children and infants, and to examine relationships between the facets of mindful parenting, child internalizing problems and parent variables related to internalizing.Methods: Using confirmatory factor analyses, we examined the fit of various models of mindful parenting in English-speaking community-recruited mothers of children aged 3–18 years (n = 396) and infants aged 0–2 years (n = 320). We used regression analyses to investigate relationships between the facets of mindful parenting, child internalizing problems, and parent variables including parental experiential avoidance, unhelpful beliefs about child anxiety and accommodation of child anxiety.Results: Mindful parenting can be measured in English-speaking mothers, using either a 5- or 6-factor, 29-item version of the IMP. These versions of the IMP operate similarly for mothers of children and infants. Child internalizing problems and related parent variables were best predicted by non-judgmental acceptance of parenting in mothers of children, and emotional self-awareness and non-reactivity in mothers of infants.Conclusions: The IMP is a valid measure of mindful parenting in English-speaking mothers of children and infants. Mindful parenting predicts child internalizing problems and related parent variables, suggesting that mindful parenting programs could benefit families of children with internalizing problems, potentially by reducing parental experiential avoidance, unhelpful beliefs about or accommodation of child anxiety.

An Explosive Workup for Diarrhea: The Cascade Effect From an Incidental Finding on a Laboratory Panel.

A 19-month-old boy with a medical history of 1 febrile seizure presented to the emergency department (ED) with 2 days of vomiting and 1 day of diarrhea. He was accompanied by his non–English-speaking mother, who reported several episodes of nonbloody, nonbilious emesis and dark brown, watery stools. The patient had decreased intake of solid foods, but he had been breastfeeding well. Because of his diarrhea, the patient’s mother was unsure how many voids he had had in the past day. He had not had fevers. The family history was significant for the patient’s father recently being diagnosed with hepatitis C. The patient’s mother brought him into the ED because of his symptoms and concern that he looked “yellow.” In the ED, the patient was afebrile with normal vital signs for his age (including heart rate of 146 beats per minute), and he was “well appearing and active” with moist mucous membranes and a capillary refill of <2 seconds. However, the ED provider additionally documented that the patient appeared “moderately dehydrated [and] slightly jaundiced,” and he ordered a comprehensive metabolic panel (CMP). All values were within normal limits, including total bilirubin, except for a low bicarbonate of 16 mmol/L (normal 21–30 mmol/L) and an elevated alkaline phosphatase (ALP) of 926 U/L (normal 129–291 U/L). The provider consulted endocrinology for the elevated ALP, who noted a broad differential for elevated ALP and that transient hyperphosphatasemia is a diagnosis of exclusion. They recommended checking 25-hydroxyvitamin D, phosphate, and parathyroid hormone to evaluate for underlying parathyroid, vitamin D, and bone disease. They also wrote that the team could check total and isoenzymes of ALP “if desiring further testing to help confirm [the] diagnosis of transient hyperphosphatasemia.” The ED provider obtained these recommended laboratories, including the ALP laboratories, as well as a gamma-glutamyl transferase, acute …

Gender Differences in the Nature, Antecedents and Consequences of Parental Burnout

Parenthood remains one of the most gender-typed social roles in adulthood. Given gender inequality in parenting, it has been very surprising to find that parental burnout affects both mothers and fathers in equal proportion. The aim of the present study was to properly test gender effects in the nature, average level, antecedents, and consequences of parental burnout. Data were collected from a strictly matched sample of about 900 French- and English-speaking mothers and fathers. We found measurement invariance across genders and a higher average level of parental burnout among mothers than fathers. We also found the same antecedent mechanism at work in both mothers and fathers (i.e., an imbalance of risks over resources in the specific context of parenting), but fathers were seen to be more vulnerable to such imbalance in this specific area. Burnout ultimately was seen to have more detrimental consequences for fathers than for mothers. In particular, escape and suicidal ideations as well as neglectful behaviors toward children were more common in burned-out fathers than in mothers. Our findings are discussed together with considerations of the gender-role socialization process, social roles as shared norms, and the salience of parental identity in women and men.

Reading with Mom: Reading Habits among Rural Readers in Sarawak

The role of the mother in the literacy development of a child has been well studied, but only a few have linked this development with reading habits practiced amongst nonnative English-speaking mothers. The current study investigates the choices of English language reading materials for at home reading activities for the mother and child in addition to the motivation that influences this reading habit. Results from the 31 participants from a rural area of Sarawak have shown a significant pattern in favor of fiction genre materials compared to nonfiction reading materials for at home reading activities. This suggests that the variety of information from the fiction-based materials draws more interest and motivation for these mothers to read with their children. Other factors which determine the choices of materials are the proficiency levels of these nonnative English-speaking mothers and the age of the child involved. The findings are significant because this population is often overlooked and thus this study supplements the perspectives of nonnative English-speaking mothers toward literacy activities in the home.

Sociodemographic, clinical and birth hospitalization characteristics and infant Hepatitis B vaccination in Washington State

ObjectiveHepatitis B (HepB) vaccine is recommended at birth; however, national coverage estimates fall far below target levels. Studies describing the factors associated with infant HepB vaccination are lacking. This study aimed to identify the sociodemographic, clinical and birth hospitalization factors associated with timely receipt of the first HepB vaccine dose. Study DesignThis retrospective cohort study included Washington State infants born weighing ≥2000 g who received birth hospitalization care at an urban academic medical center between January 2008–December 2013. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between maternal and infant characteristics and HepB vaccine receipt during the birth hospitalization. ResultsOf the 9080 study infants, 75.5% received HepB vaccine during the birth hospitalization. Infants had higher odds of being vaccinated during the birth hospitalization if they were Hispanic (AOR 2.08; CI: 1.63, 2.65), non-Hispanic black (AOR 2.34; CI: 1.93, 2.84) or Asian (AOR 2.70; CI: 2.22, 3.28) compared to non-Hispanic white. Infants with a Spanish- vs. English-speaking mother (AOR 1.97; CI: 1.46, 2.68), public vs. private insurance (AOR 2.01; CI: 1.78, 2.29), and those hospitalized ≥96 h vs. 24 to <48 h (AOR 1.67; CI: 1.34, 2.09) also had higher odds of vaccination. ConclusionsPopulations that are typically underserved (e.g., publicly insured, racial/ethnic minorities) had higher odds of receiving HepB vaccine during the birth hospitalization. These findings may aid in identifying high-risk infants who could benefit from targeted interventions to increase initial HepB vaccination.