Parental Readiness Research Articles

Factors Associated With Parental Readiness Amongst Japanese Female Undergraduate Nursing Students: A Cross-Sectional Study

Factors Associated With Parental Readiness Amongst Japanese Female Undergraduate Nursing Students: A Cross-Sectional Study

Parents’ perception and level of readiness to change toward childhood obesity and overweight in Riyadh

Abstract Background: Childhood obesity is considered one of the most prevalent health problems in Saudi Arabia. When attempting to prevent such a problem, parents’ perceptions of their child’s weight status are critical factors to consider. Objectives: This research aimed to understand parents’ perception and level of readiness to bring change to mitigate childhood obesity and overweight in Riyadh. Materials and Methods: This is a cross-sectional study conducted in primary schools of National Guard Housing Compounds in Riyadh, Saudi Arabia. In this study, 320 primary school children of both genders and their parents were recruited. Measurements of weight and height and the body mass index (BMI) percentile were done, and the questionnaire was distributed to be filled out by their parents. Items of the questionnaire included demographic information about the parents and their perceptions of the child’s weight status, their beliefs toward obesity, their assessment of dietary and physical activity, and their level of readiness to change the child’s diet and physical activity. Results: A total of 28% of parents misperceive their children to be overweight or obese. Furthermore, parents with a higher BMI have children with a higher BMI, and the relationship was found to be statistically significant (p-value of 0.05) for fathers and (p-value of 0.01) for mothers. Moreover, the parental belief that spending more screen time is the cause of childhood obesity was also found to be significantly associated with the higher BMI status of the child at a P value of 0.02. Furthermore, with a P value of 0.001, parental readiness to change the diet and physical activity of children is significantly associated with an improved lifestyle in children. Conclusions: The parents included in the current study demonstrated a higher level of readiness to make positive changes in the diet of their children as well as improve their physical activity. These findings provide hope for involving parents in the prevention of childhood obesity in Saudi Arabia.

Stress perceived by pregnant and decision-making factors of maternal caesarean section request

Abstract Background Pregnancy is a time of psychological vulnerability which can generate intense stress. This represents a maternal and child public health problem. Prenatal stress has harmful impacts on the foetus, the newborn and can cause an increased maternal request for caesareans sections, with nonmedical grounds. The perceived level of prenatal stress factors was assessed in women, as well as mothers’ incentives and decision-making factors for a caesarean section on maternal request. Methods A descriptive study on 203 pregnant women, then a comparative study between primiparas (n = 72) and multiparas (n = 131) were carried out with the Antenatal perceived stress inventory. Incentives and decision-making factors for a caesarean on the mother’s demand were studied by in-depth interviews with primiparas mothers (n = 16) who had made this choice. Results The perception of stress level during pregnancy is higher at the first quarter regarding the foetus’ health, medical and obstetric risks and reverses with the perception of projections linked to giving birth at the last quarter. Primiparas are significantly (p < 0.001) more stressed. All the elements of the three assessed factors are very significantly (p < 0.001) correlated for the whole population. Among them, 75% choose a caesarean section on maternal request during the first quarter. This choice is confirmed at the end of the second quarter or during the third one for 50% of them, with a one-month time to think for 58.3% of them. The main incentives are tokophobia (66.7%) and preserving the baby’s health (50%). Conclusions Pregnancy causes important stress, which is pronounced in primiparas. In France, these results speak in favour of screening tokophobia and an earlier start of birth and parenthood preparation classes in order to handle stress from the first quarter of pregnancy, when medical and prenatal exams are initiated. Birth preparation should be taken on at the last quarter. Key messages Investigate stress perceived and identification incentives and decision-making factors of maternal caesarean section request it’s a solution to building bridge for solidarity with tokophobic women. The relation enter stress perceived by pregnant women and decision-making factors of maternal caesarean section request, represents a maternal and child public health problem.

Parent Readiness for Hospital Discharge Scale: Psychometrics and Association With Postdischarge Outcomes.

The purpose of this study is to validate the Readiness for Hospital Discharge Scale (RHDS) for use with parents of hospitalized children. PedRHDS is a structured tool for a discharge readiness assessment before pediatric discharge. Using combined data from four studies with 417 parents, psychometric testing and item reduction proceeded with principal component analysis for factor structure delineation, Cronbach's alpha for reliability estimation, and regression analysis for predictive validity. A 23-item PedRHDS retained the a priori factor structure. Reliability ranged from 0.73 to 0.85 for the 23-item and 10- and 8-item short scales. PedRHDS (all forms) was associated with postdischarge coping difficulty (explaining 12%-16% of variance) and readmission (odds ratio = 0.71-0.80). The PedRHDS and both short forms (PedRHDS-SF10 and PedRHDS-SF8) are reliable and valid measures of parental discharge readiness that can be used as outcome metrics of hospital care and risk indicators for postdischarge coping difficulty and readmission.

Maternal Immigrant Status and Readiness to Transition to Home From the NICU.

Evaluate effects of immigrant status on perceptions of discharge readiness in mothers of preterm infants <37 weeks' gestation and identify the impact of primary language and years in the United States. Immigrant (n = 176) and native (n = 556) mothers of preterm infants cared for in the NICU for >5 days between 2012 and 2015 completed the Fragile Infant Parental Readiness Evaluation (FIPRE), a NICU-discharge readiness questionnaire. Group comparisons were made on the basis of immigrant status. Regression models examined effects of immigrant status, primary language, and years in the United States on discharge readiness. Immigrant mothers were more likely to be older, gravida >1, multiracial or people of color, and non-English speaking; have less than a high school education; and receive Medicaid but less likely to have child protective services involvement, substance abuse, and mental health disorder (MHD). Whereas rates of non-English primary language, low education, and Medicaid decreased, rates of MHDs increased with years in the United States. At NICU discharge, immigrant mothers had poorer perceptions of infant well-being, maternal well-being, maternal comfort, and time impact. In adjusted analyses, immigrant status, non-English primary language, and MHD predicted unfavorable scores. Among immigrant mothers, increased years in the United States and MHD predicted unfavorable scores. Although findings suggest acculturation with increased years in the United States, immigrant mothers perceived less discharge readiness in multiple domains, highlighting the need for culturally competent care and discharge services specifically tailored to help this vulnerable population.

Women's views on contact with a health visitor during pregnancy: an interview study.

To explore recent mothers' views of the health visiting antenatal contact in England. English health visitors are mandated to be in contact with all women in the third trimester of pregnancy. The aim of this antenatal contact is to assess the needs of the family before the birth and support preparation for parenthood. Recent data show that this contact is provided fragmentarily and not always face-to-face. More information on how women view this contact could inform service provision. Twenty-nine mothers with a baby less than 1 year old were recruited via social media and word of mouth. Having had antenatal contact with a health visitor was not a requirement to participate in the study. Women took part in face-to-face or phone interviews and all recordings were transcribed verbatim. Data were analysed using systematic thematic analysis. Eleven women had contact with a health visitor during pregnancy: nine through a home visit, one via a letter and one via a phone call. The remaining 18 women were asked about what they would have wanted from an antenatal contact. Three themes were identified: relationship building, information provision, and mode and time of contact. Some participants who had experienced a home visit reported building rapport with their health visitor before the postnatal period, but not everyone had this experience. Women reported requesting and receiving information about the health visiting service and the role of the health visitor. Finally, women suggested different modes of contact, suggesting a letter or that the information about health visiting could be provided by a midwife. A few women preferred a home visit. These study findings show women were unclear regarding the aim of the health visitor antenatal contact. As such, the contact is unlikely to reach its full potential in supporting parents-to-be.

The earlier, the better? Diagnostic experiences of parents in a community-based early intervention system for preschool children with autism

Background and aims In many countries, early detection and diagnosis of autism spectrum disorder is largely dependent on parents’ initial concern with early symptoms of autism spectrum disorder. Previous research on parental perceptions of the autism spectrum disorder diagnostic process indicates that parental satisfaction may be due to either the timing of the diagnostic notification or the provision of post-diagnostic support. The objective of this research is to study the diagnostic notification process and its impact on parents who are informed of their young child’s diagnosis before they notice a problem and whose child undergoes early intervention therapy. Methods Eighty parents of preschool children diagnosed and undergoing early intervention for autism were surveyed to examine their experience of the diagnostic disclosure process. Results Of 68 respondents, 39 (58.2%) approved of the timing of diagnostic notification, while 10 of 13 dissatisfied respondents indicated that the diagnosis was communicated too late. However, there was no correlation between a higher degree of parental satisfaction with the diagnostic notification process and earlier timing of notification. Conclusions Although it is preferable to communicate a diagnosis of childhood autism as soon as possible, findings suggest that a highly individualized approach, allowing a degree of latitude in the timing of notification, may be permissible, depending on the individual case and parental readiness to receive the diagnosis. Implications Findings have clinical implications related to the concept of optimality of diagnostic disclosure as related to the diagnostic notification process, though later notification tends to lead to more dissatisfaction.

Prenatal neural responses to infant faces predict postpartum reflective functioning

Pregnancy is shaped by unfolding psychological and biological changes in preparation for parenthood. A growing literature has examined the postpartum maternal brain. However, few studies examine the maternal brain during pregnancy, and whether brain function in pregnancy may have implications for postpartum caregiving. Using event-related potentials, we examined the late positive potential (LPP) elicited by infant distress and neutral faces in 35 women during their third trimester of pregnancy. Then, at 3 months postpartum, mothers completed a measure of parental reflective functioning to capture how they regarded their capacity to consider their child’s thoughts and feelings. We found that in the third trimester, infant distress faces elicited larger LPPs compared to infant neutral faces. Moreover, the LPP elicited by infant neutral faces predicted levels of postpartum reflective functioning. Specifically, a larger LPP elicited by neutral infant faces predicted greater maternal self-reported difficulty recognizing and understanding their own infant’s thoughts and feelings. Our findings suggest that studying the pregnant brain may have predictive value for facets of postpartum caregiving and may inform clinical interventions with new mothers.

Smokers with children with asthma: Parental perceptions about prototype intervention messages focused on reducing child tobacco exposure and use.

Formative research is needed to develop effective interventions that eliminate secondhand smoke exposure (SHSe) and prevent tobacco use (TU) among children with asthma. This online study included 300 parents who smoke and had a child with asthma (ages 10-14) and evaluated their perceptions about prototypes of parent-directed and child-directed feedback intervention messages focused on reducing child SHSe and future TU; correlates of perceptions were explored. Parents rated examples of parent-directed messages on motivation and helpfulness for eliminating SHSe and promoting conversations about TU and also rated child-directed messages on acceptability and helpfulness for promoting conversations about TU. Messages differed by level of personalization, theoretical background, or message content. Parents found all parent-directed messages similarly motivating and helpful and all child-directed messages similarly acceptable and helpful for reducing child tobacco exposure. Differences in perceptions about feedback emerged based on parent gender, parent readiness to quit, smoking ban status, and the presence of additional smokers in the home. Overall, parents rated parent-directed and child-directed feedback message prototypes positively, including established and novel types of feedback. Parent-child feedback interventions may hold promise for breaking the intergenerational transmission of smoking among families with a parent who smokes and a child with asthma.

Do family environment, parental care and adolescent externalizing problem mediate the relationship between parental readiness and adolescent school performance among commuter families?

ABSTRACTThe lifestyle of commuter families has become a concern in Malaysian society. Commuting and separation from nuclear families may result in negative impacts on the commuters and their families. This study aimed to investigate the relationships among family environment, parental care, parental readiness, and adolescent externalizing problems and adolescent school performance among commuter families by proposing a mediation model. A total of 434 respondents (dyadic-relation) from commuter families in Peninsular Malaysia completed a set of questionnaires. Model comparison showed that the mediation model was established with an acceptable fit index. Findings reported that parental care and family environment were significantly partial mediated the relationship between parental readiness and adolescent academic performance. However, adolescent externalizing problem was not statistically significant. The findings accounted 38% of the variability in adolescent academic performance explained by the model with total effect 0.69. Results suggests the importance of families’ roles and functions in adolescent school performance. It supports the theoretical backgroud of the research which explains the effect of family functions and parental roles in adolescent development and school performance. Parental roles need to be addressed to ensure commuting families play a parenting responsibilities in adolescent development and create a work-family balance situation.

Improving the Discharge to Home Experience for Pediatric Heart Center Patients and Families

PurposeThe purpose of this study was to determine if implementation of the discharge specialist role improves family perception of discharge readiness and determines whether the use of the role decreases the number of tasks needing completion on the day of discharge. Design and MethodsA prospective descriptive study was designed to compare parent readiness for discharge from two groups of participants. One group had a discharge specialist the day of discharge. The other group did not have the assistance of the discharge specialist on the day of discharge. Participants were contacted after discharge and surveyed on their perception of readiness for discharge based on a modified version of the Care Transitions Method Survey. Patient responses were either Strongly Agree or Less than Strongly Agree. ResultsA total of 60 patients (30 in each group) were analyzed. There were no statistically significant differences in demographic variables between the two groups. The overall average score of the composite proportion responding with Strongly Agree was higher among caregivers using a discharge specialist (Mean = 88.2) as compared to those without (Mean = 55.9, U = 157.0, p < .001). ConclusionThe use of a discharge specialist on the day of discharge resulted in a higher parent perception of discharge readiness in this sample of children with complex cardiac diagnosis. Practice ImplicationsThe use of a discharge specialist in the heart center can assist with the successful transition from hospital to home. Future research should examine the effect of the discharge specialist on hospital re-admission rates and clinical outcomes.

The Framework of NICU-discharge Plan System for Preterm Infants in Iran: Duties, Components and Capabilities.

Introduction:The development of comprehensive discharge plan system Not only, will facilitate the discharge process, increase staff and parent satisfaction, improve the care of preterm infants, also reduce the human error.Aim:to determine duties, components and capabilities of NICU discharge plan system as a multidimensional tool for facilitating the complex process of transition preterm infants to the home and support parents for post-discharge care.Method:The descriptive and qualitative study conducted in 2017. Firstly by literature review, components of framework were determined in 38 statements under 3 major themes: duties, components, and capabilities and then related questionnaire was provided. Cronbach’s alpha test was used to assess the reliability of the questionnaire. The result was more than 0.82 for all statements of questionnaire. The validity of the instrument was determined based on concepts in the valid scientific texts and comments of experts. The analysis was performed using SPSS software.Result:In overall, 29 experts participated in the consensus process. In the duties section, all of the statements reach more than 50% consensus. Among statements of the components and capabilities consensus was achieved in 12 out of 17, 12 out of 16 statements respectively.Conclusion:according to survey, checkout infant readiness determined as the main duty of the system. Alarm message for special examination before discharge and parent readiness checklist considered as the most important components. The ability to send alarm message, register and log in system were the key capabilities of the discharge system.

Neonatal nurses’ perceptions of supportive factors and barriers to the implementation of skin-to-skin care in extremely low birth weight (ELBW) infants - A qualitative study

There is currently a lack of evidence around perceptions of implementation of skin-to-skin care (SSC) in infants weighing <1000 gms amongst neonatal nurses. Majority of published work mainly focuses on infants weighing <2500 gms. AimThis study aimed to investigate neonatal nurses’ perceptions of supportive factors and barriers to the implementation of SSC in extremely low birth weight (ELBW) infants in a tertiary level neonatal intensive care unit (NICU) in London. MethodsA broad qualitative approach that included semi-structured interviews with seven neonatal nurses was used. ResultsAll seven nurses interviewed supported SSC in ELBW infants. There was a general consensus on barriers of its implementation. Humidity was perceived as a significant barrier for SSC in ELBW infants. Other barriers included concerns for infant safety, insufficient training, increased workload, lack of clear guidelines and management support. ConclusionsThis study identified supportive factors and barriers of SSC in ELBW infants in a tertiary neonatal unit. It ascertained the facilitation of parental readiness, development of clear guidelines, provisions of continuing education as well as organisational support as supportive factors in the implementation of SSC in ELBW infants. Furthermore, humidity was perceived as an additional barrier for SSC in these infants.

About weldability and welding of Al alloys: case study and problem solving

Purpose: Among many disciplines within engineering, welding is probably one of the most inexact – rather more of an art than a science. As weldment is meant the complete joint comprising the weld metal, heat affected zones (HAZ) and the adjacent parent metal and should have the same properties as the parent metal. This paper aims provides a basic understanding of the metallurgical principles involved in how aluminium alloys achieve their strength and how welding can affect these properties. The most important and applied welding processes to Al alloys are here shortly introduced, as well as the preparation of parent metals prior to welding and good welding practice to avoid and/or keep under control defects and failures. Some case studies with possible failures will be introduced together with actions and suggestions to solve the observed problems. Design/methodology/approach: Two sheets of the EN AW 5454 (AlMg3Mn) alloy were weld with resistance welding process and after a mechanical processing of lamination was observed the presence of the defect. The microstructure of the defect as well as the welded part were evaluated with stereomicroscope (LEICA MS5), optical microscope (LEICA MEF4M), and with SEM analysis (LEO 1540 VP equipped with an energy dispersive X-ray spectroscope Oxford Link Pentafet). Findings: The well welded part was analysed with optical microscopy and electronic microscopy resulting with the attended mechanical properties. Micro-hardness indentations on the joint demonstrated the good mechanical properties of the joint while with the microscopic observations were identified the orientation and presence of precipitates typical of this alloy. In the defect, microscopically observations showed the presence of oxide inclusions. Research limitations/implications: There are a number of problems associated with the welding of aluminium and its alloys that make it difficult to achieve this ideal. The features and defects that may contribute to the loss of properties comprise the following: gas porosity, oxide inclusions and oxide filming, solidification (hot) cracking or hot tearing, reduced strength in the weld and HAZ, lack of fusion, reduced corrosion resistance and reduced electrical resistance. Originality/value: This case study illustrated clearly the importance of the cleaning on the surfaces to obtain a well welded joint ensuring the desired mechanical properties.

Assessing Parental Readiness to Change: A Psychometric Evaluation of the READI-SF in a Community Sample

Engagement in behavioral parent training programs continues to be a barrier to service delivery. Parental readiness is an important construct for understanding parental engagement in parent training services, as these programs place a high level of action-oriented demands on caregivers. The present study examines the performance of one parental readiness measure, the Readiness, Efficacy, Attributions, Defensiveness, and Importance Scale—Short Form (READI-SF) in a community-based sample. Participants included 103 families of children ages three to seven recruited from an urban charter school. Mothers completed an abbreviated version of the READI as well as indices of child disruptive behavior and a second measure of parental readiness. The psychometric properties and factor structure of the READI-SF are explored as well as indices of reliability and validity. Exploratory factor analysis revealed a three-factor model of readiness to change, treatment readiness, and perceived importance of the problem. Analyses also supported the validity and clinical utility of the measure, as READI-SF scores were found to predict attendance at a one-time parenting group. Lastly, the study examines the relationship between parental readiness and child disruptive behavior. Limitations and future directions are discussed.

Parental knowledge and attitudes to childhood hearing loss and hearing services in the Solomon Islands

ObjectiveAn understanding of parental knowledge and attitudes towards childhood hearing loss is essential to the successful implementation of audiology services. The present study aimed to investigate parental knowledge and attitudes among parents in the Solomon Islands. Methods and materialsA total of 100 mothers and 50 fathers were administered a questionnaire via semi-structured interviews. ResultsHighest parental awareness of aetiology of childhood hearing loss was noted for otitis media (94%), noise exposure (87.3%), and family history (72.7%). The highest parental awareness concerning public health initiatives to reduce/prevent otitis media was noted for routine childhood immunizations (84%) and breast-feeding (76%). Higher rates of knowledge in fathers than in mothers included otitis media (p = 0.038), noise exposure (p = 0.007), and breast-feeding (p = 0.031). Approximately half of parents (56%) agreed that curses may cause hearing loss. Overall parental responses showed positive support for infant hearing screening programs (96%) and school-based ear and hearing health examinations (99.3%). ConclusionsHigh levels of parental readiness and support for childhood hearing services in the Solomon Islands was evident. Knowledge of aetiology of childhood hearing loss was highest for otitis media, noise exposure, and family history. Knowledge and attitudes of fathers to childhood hearing loss and hearing services was either the same or better than that of mothers.

Parent engagement and attendance in PEACH\u2122 QLD \u2013 an up-scaled parent-led childhood obesity program

BackgroundParenting, Eating and Activity for Child Health (PEACH™) is a multicomponent treatment program delivered over ten group sessions to parents of overweight/obese primary school-aged children. It has been shown to be efficacious in an RCT and was recently translated to a large-scale community intervention funded by the Queensland (Australia) Government. Engagement (enrolment and attendance) was critical to achieving program outcomes and was challenging. The purpose of the present study was to examine sample characteristics and mediating factors that potentially influenced program attendance.MethodsData collected from parents who attended at least one PEACH™ Queensland session delivered between October 2013 and October 2015 (47 programs implemented in 29 discrete sites), was used in preliminary descriptive analyses of sample characteristics and multilevel single linear regression analyses. Mediation analysis examined associations between socio-demographic and parent characteristics and attendance at group sessions and potential mediation by child and parent factors.Results365/467 (78%) enrolled families (92% mothers) including 411/519 (79%) children (55% girls, mean age 9 ± 2 years) attended at least one session (mean 5.6 ± 3.2). A majority of families (69%) self-referred to the program. Program attendance was greater in: advantaged (5.9 ± 3.1 sessions) vs disadvantaged families (5.4 ± 3.4 sessions) (p < 0.05); partnered (6.1 ± 3.1 sessions) vs un-partnered parents (5.0 ± 3.1 sessions) (p < 0.01); higher educated (6.1 ± 3.0 sessions) vs lower educated parents (5.1 ± 3.3 sessions) (p = 0.02); and self-referral (6.1 ± 3.1) vs professional referral (4.7 ± 3.3) (p < 0.001). Child (age, gender, pre-program healthy eating) and parent (perceptions of child weight, self-efficacy) factors did not mediate these relationships.ConclusionsTo promote reach and effectiveness of up-scaled programs, it is important to identify ways to engage less advantaged families who carry higher child obesity risk. Understanding differences in referral source and parent readiness for change may assist in tailoring program content. The influence of program-level factors (e.g. facilitator and setting characteristics) should be investigated as possible alternative mediators to program engagement.

First-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period: Implications for early parenthood preparation

Objectiveto describe first-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period. Designa qualitative study was conducted and data was analysed with a phenomenographical approach. Setting and participants15 first-time fathers were recruited from three postnatal units in southern Sweden and interviewed approximately one month after their baby was born. Measurements and findingsthree categories and 14 conceptions about fathers’ experiences of their preparation emerged from the data. ‘Acquiring knowledge and forming realistic expectations’ was essential for ‘Developing strategies’ and ‘Being facilitated and supported’ enhanced these processes. Key conclusions and implications for practicesupporting fathers to develop strategies for life with a new baby and providing expert guidance to fruitful and accurate information may help the construction of a fatherhood identity and strengthen the fatherhood role. The findings can be used to develop a parental preparation for early parenthood that will correspond to fathers’ needs.

Antenatal classes as a form of preparation for parenthood: analysis of benefits of participating in prenatal education

Abstract Prenatal education in the form of antenatal classes, referred to as School of Birth in Poland, aims at preparing both pregnant women and their partners for parenthood, on theoretical and practical basis. This is achieved by providing women with information on safe pregnancy, labor and puerperium, developing healthy behaviors and preparing parents to look after the newborn/infant. The course program covers all psychophysical issues related to pregnancy, labor, puerperium and early stages of the child’s life. The objective is to strengthen the health of mothers and children, alleviate pregnancy-related anxiety and fear, decrease the number of premature births and reduce the perinatal mortality rate. However, the scope of potential advantages of Schools of Birth depends not only on individual traits of the participants, but also on the engagement of professionals who teach the courses and the type of the school.

Impact of kangaroo care on parental anxiety level and parenting skills for preterm infants in the neonatal intensive care unit

ObjectiveTo assess impact of kangaroo care (KC) on parental anxiety levels, breastfeeding rates and readiness at discharge. MethodsObservational, prospective, pre-post interventional study. State–Trait Anxiety Inventory (STAI) surveys pre-post successful KC sessions and parental readiness survey were administered to eligible parents of preterm infants as well as breastfeeding data was collected. ResultsThe mean change in pre- and post-KC STAI scores was significantly different for state anxiety (12.0 ± 10.9, p < 0.0001) and trait anxiety (5.8 ± 6.6, p < 0.0001) and correlated with parental age and income, but not sex, marital status, education or employment. 91% of parents performing KC vs 66% of parents NOT performing KC reported being very or extremely confident in caring for their infant at discharge. 81% of mothers initiated breastfeeding in NICU with 76% continuing at discharge. ConclusionsKC is associated with a lower parental anxiety level, greater confidence in parenting skills and higher breastfeeding rates.