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"My nurse taught me how to have a healthy baby and be a good mother:" nurse home visiting with pregnant women 1888 to 2005.

Nurse home visiting with pregnant women and new mothers in the early decades of the twentieth century was designed to improve birth and newborn outcomes, hasten Americanization of immigrant mothers, and improve their parenting skills. Today the Nurse Family Partnership home visitation program improves newborn and child outcomes by positively influencing maternal role attainment and significantly decreasing maternal smoking and other substance abuse, child abuse and neglect, and children's emergency room visits. It also improves life possibilities for vulnerable young women by decreasing the interval and frequency of subsequent pregnancies and reduces dependence on welfare by increasing workforce participation. This article reviews the history of home visits by nurses to pregnant women and demonstrates the benefits achieved by these programs today.

Community Health Nursing↗

Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program.

Adolescent pregnancy remains a significant social, economic, and health issue in the United States. The unique developmental needs of the pregnant adolescent require attention when designing prenatal care services. The CenteringPregnancy model of group prenatal care provides education and support for young women in an active and developmentally appropriate environment. Thirteen groups of adolescents (N = 124) have completed the Centering program at the Teen Pregnancy Center at Barnes Jewish Hospital in St. Louis, Missouri. Evaluation data suggest that the model has encouraged excellent health care compliance, satisfaction with prenatal care, and low rates of preterm birth and low birth weight infants.

Adolescent↗

Changes in innate and acquired immune responses in mice with targeted deletion of the dopamine transporter gene.

The dopamine transporter (DAT) is responsible for the re-uptake of dopamine into presynaptic nerve terminals and thereby controls dopaminergic neurotransmission. Deletion of DAT results in a hyperdopaminergic phenotype and DAT(-/-) mice are characterized by pituitary hypoplasia, impaired maternal behavior, and increased locomotion. From earlier studies, we have evidence that the activity of the central dopaminergic system may play a role in determining immune reactivity and disease susceptibility. To further explore the functional relation between the dopaminergic system and the immune system, we investigated the activity of the immune system in DAT(-/-) mice. We show that in vitro, splenocytes from DAT(-/-) mice displayed reduced natural killer cell activity and reduced mitogen-induced cytokine responses. In contrast, LPS-induced cytokine production by macrophages was enhanced. In vivo, the cellular response to immunization with ovalbumine (OVA-induced delayed type hypersensitivity response) was significantly reduced. Interestingly, the OVA-induced humoral response (anti-OVA IgG) was increased in DAT(-/-) mice compared to wild-type animals. Plasma levels of catecholamines and corticosterone did not differ significantly between DAT(-/-) and wild-type animals. In conclusion, we show in the present study that interfering with the dopaminergic system has major consequences for both the acquired and the innate immune response.

Analysis of Variance↗

How is maternal psychosocial health assessed and promoted in the early postnatal period? Findings from a review of hospital postnatal care in Victoria, Australia.

OBJECTIVE: to describe how women's maternal health, particularly at a psychosocial level, is assessed and promoted during the postnatal hospital stay. DESIGN: postal survey of public hospitals providing postnatal care and interviews with care providers. SETTING: all publicly funded maternity units and selected health professionals in Victoria, Australia. PARTICIPANTS: hospital postal survey: sixty six hospital respondents; interviews: 38 maternity unit managers, clinical midwives and medical practitioners. FINDINGS: there was little consistency across the State in relation to routine observations of the mother. Physical checks were much more common than enquiring about how women felt physically. Practice in psychosocial assessment was also diverse, with care plans/maps (clinical pathways) being the main tool to guide assessment. Most participants reported that psychosocial assessment was undertaken during pregnancy. Follow-up after birth also varied. Hospital respondents reported that emotional well-being is assessed postnatally by observation and conversation with women. Participants who were interviewed reported that midwives had mixed skills in assessing and dealing with complex psychosocial issues. Three hospitals administer the Edinburgh Postnatal Depression Scale to women in the days after birth, and three hospitals provide routine sessions of structured debriefing. Survey participants reported that the busy and, at times, chaotic nature of postnatal wards affected the provision of care and the level of psychosocial support offered to women. KEY CONCLUSIONS: although one of the stated aims of early postnatal care is the promotion of maternal well-being, the diversity of practices and the routine nature of many of these practices suggest that care is often not individualised or woman-centred. The reliance of detecting and managing women with particular psychosocial issues during pregnancy results in this aspect of care being given less priority postnatally than may be ideal. IMPLICATIONS FOR PRACTICE: strategies are required to provide health professionals with guidelines and skills to enhance the detection of women who have, or have the potential to develop, health problems after birth. This requires a reorganisation of the way early postnatal care is provided in relation to the use of routine practices; the ability of caregivers to spend time with women in an environment that offers privacy and confidentiality; the structuring of care around individual needs; and opportunities for women to be cared for by caregiver/s with whom they have met before.

Adult↗

Preliminary study of the effects of morphine treatment on opioid receptor gene expression in brain structures of the female rat.

Opioid receptors play an important role in female physiology. They modulate directly and indirectly neuroendocrine phenomena that influence pregnancy maintenance, pain threshold, parturition, lactation, maternal behavior, rewarding and addiction. Thus understanding the gene expression levels of the three major opioid receptors, mu, delta and kappa in different brain regions is essential for investigating dynamic mechanisms of opioidergic transmission. Adult virgin female rats were treated acutely with morphine sulfate (3.5 mg/kg or 20 mg/kg s.c.) or chronically for 5 days (3.5 mg/kg). Rats were killed 1 h after the last injection. In the acute treatment, expression levels for the encoded mu-opioid receptor Oprm1, as detected by reverse transcription-polymerase chain reaction, were significantly decreased in the periaqueductal gray. In chronic treatment, both Oprk1 and Oprm1 expression levels, that encoded kappa and mu-opioid receptor respectively, showed significant decreases in the periaqueductal gray and striatum. Regional changes in opioid receptor gene expression levels might reflect highly specialized roles for these receptors with possible functional meaning for the plasticity of the opioidergic transmission.

Analysis of Variance↗

Glucocorticoid-mediated effects of systemic oxytocin upon memory retrieval.

During the last decade, a considerable amount of evidence has accumulated to show that oxytocin (OT) is involved with functions other than its classical roles in reproduction-associated processes, such as social recognition, maternal behavior and neuroendocrine regulation of the stress response. It has been shown, for instance, that post-training systemic administration of oxytocin in mice produces an amnestic effect on the step-through inhibitory avoidance. Since it is still unclear how systemic levels of OT may affect CNS memory processes, our aim here was to investigate the hypothesis that systemic OT effects on memory retrieval might be mediated through an oxytocin-induced decrease in glucocorticoid release. In our first experiment, we have found an amnestic effect of i.p. pre-test 0.4 microg/kg of OT upon memory retrieval in the inhibitory avoidance task (IA); this OT dose was shown to (a) significantly decrease plasma corticosterone levels when compared to the saline group, and (b) not to cause any anxiety effects by itself in a plus-maze task. At last, an ineffective-by-itself dose of dexamethasone was able to reverse the amnestic effect of this OT dose. Our results suggest that the amnestic effect of systemically administered oxytocin upon memory retrieval in the inhibitory avoidance task was probably caused by an oxytocin-induced decrease in glucocorticoid release from the adrenal gland.

Animals↗

Prefrontal and tegmental electrical activity during olfactory stimulation in virgin and lactating rats.

This study was designed to analyze if the electroencephalographic (EEG) activity of the medial prefrontal cortex (mPFC) and the ventral tegmental area (VTA) was modified throughout various reproductive stages of female rats exposed to pup-associated or non-associated odors. Simultaneous EEG recordings were obtained from right and left mPFC and VTA in adult female rats during the smelling of nest bedding and female bedding under three reproductive states: proestrus-estrus (P-E), diestrus (D) and lactation (L). Absolute (AP) and relative (RP) powers of three EEG band frequencies, and interhemispheric correlation (r) of EEG activity were calculated and compared among conditions. During the awake-quiet condition, RP of the 12-21 Hz band was significantly higher in the right and left mPFC as well as in the right VTA of lactating rats as compared to P-E rats. During the smelling of nest bedding, the RP of the 8-11 Hz in the mPFC became increased while that of the 6-7 and 12-21 Hz decreased in the three reproductive stages. In the VTA, this phenomenon was mainly observed in lactating rats. Only the RP of the lower frequencies (6-7 and 8-11 Hz bands) was higher in the right mPFC and in the left and right VTA, respectively, of the lactating rats with respect to P-E rats, while that of the 12-21 Hz band was lower in lactating as compared to P-E rats. Moreover, the interprefrontal correlation of the lower-frequency bands was higher in relation to smelling of nest bedding in diestrus and lactating rats, whereas during the smelling of female bedding the correlation of the 6-7 Hz band was increased only in the diestrus rats as compared to P-E rats. These data indicate that EEG activity recording is a sensitive tool to study the functionality of the mPFC and VTA during different reproductive states and suggest the possible participation of these structures in the processing of olfactory stimuli associated to pups to modulate the motivational and performance processes, crucial for the expression of maternal behavior.

Animals↗

Relationship of preschool special education outcomes to instructional practices and parent-child interaction.

Developmental outcomes attained by children receiving preschool special education services in relationship to both the general instructional approach used by their teachers and their parents' style of interaction were examined. The sample included 70 children from 41 Early Childhood Special Education (ECSE) classrooms. The type of instructional model children received was determined by dividing the sample into three clusters based upon six global ratings of children's classroom environment: Choice; Cognitive Problem-Solving; Child-Initiated Learning; Developmental Match; Child-Centered Routines; and Rewards and Discipline Strategies. Based on this analysis, 27 children were classified as receiving developmental instruction; 15 didactic instruction; and 28 naturalistic instruction. Observations of parent-child interaction collected at the beginning and end of the year were classified along four dimensions using the Maternal Behavior Rating Scale: Responsiveness, Affect, Achievement Orientation and Directiveness. Results indicated that the kinds of experiences that children received varied significantly across the three instructional models. However, there were no significant differences in the impact of these instructional models on children's rate of development. Regression analyses indicated that children's rate of development at the end of intervention was significantly related to their parents' style of interaction but was unrelated to the type of instructional model they received.

Autistic Disorder↗

Paternal responsiveness in biparental dwarf hamsters (Phodopus campbelli) does not require estradiol.

Males of the biparental hamster species Phodopus campbelli act as midwives and are responsive to an experimentally displaced pup. Males also have peripheral estradiol concentrations that are similar to conspecific females. Castration reduces peripheral estradiol, yet does not affect paternal responsiveness despite the known role of estradiol in maternal behavior. Synthesis of estradiol within the central nervous system, however, might not be affected by castration. Males received implants of osmotic pumps containing the aromatase inhibitor letrozole to reduce both peripheral and central estradiol concentrations. Though estradiol was effectively reduced, it had no effect on paternal responsiveness or reproductive success. Neither testosterone nor aggression directed towards an intruder was altered. Results support the emerging conclusion that estradiol is not required for the exceptional paternal behavior of male P. campbelli.

Aggression↗

Developmental plasticity of HPA and fear responses in rats: a critical review of the maternal mediation hypothesis.

Developmental plasticity of HPA and fear responses in rats has been proposed to be mediated by environment-dependent variation in active maternal care. Here, we review this maternal mediation hypothesis based on the postnatal manipulation literature and on our own recent research in rats. We show that developmental plasticity of HPA and fear responses in rats cannot be explained by a linear single-factor model based on environment-dependent variation in active maternal care. However, by adding environmental stress as a second factor to the model, we were able to explain the variation in HPA and fear responses induced by postnatal manipulations. In this two-factor model, active maternal care and environmental stress (as induced, e.g., by long maternal separations or maternal food restriction) exert independent, yet opposing, effects on HPA reactivity and fearfulness in the offspring. This accounts well for the finding that completely safe and stable, as well as, highly stressful maternal environments result in high HPA reactivity and fearfulness compared to moderately challenging maternal environments. Furthermore, it suggests that the downregulation of the HPA system in response to stressful maternal environments could reflect adaptive developmental plasticity based on the increasing costs of high stress reactivity with increasingly stressful conditions. By contrast, high levels of environmental stress induced by environmental adversity might constrain such adaptive plasticity, resulting in non-adaptive or even pathological outcomes. Alternatively, however, developmental plasticity of HPA and fear responses in rats might be a function of maternal HPA activation (e.g., levels of circulating maternal glucocorticoid hormones). Thus, implying a U-shaped relationship between maternal HPA activation and HPA reactivity and fearfulness in the offspring, increasing maternal HPA activation with increasing environmental adversity would explain the effects of postnatal manipulations equally well. This raises the possibility that variation in active maternal care is an epiphenomenon, rather than a causal factor in developmental plasticity of HPA and fear responses in rats. Developmental plasticity of HPA and fear responses in rats and other animals has important implications for the design of animal experiments and for the well-being of experimental animals, both of which depend on the exact underlying mechanism(s). Importantly, however, more naturalistic approaches are needed to elucidate the adaptive significance of environment-dependent variation of HPA reactivity and fearfulness in view of discriminating between effects reflecting adaptive plasticity, phenotypic mismatch and pathological outcomes, respectively.

Animals↗

[Oxytocin and maternal stress during the post-partum period].

Oxytocin is required for lactation by promoting milk expulsion. Oxytocin has also been reported to exert a positive role in social attachment. The postpartum period has been shown to be crucial for maternal behavior initiation, and required self-trust reinforcement. However, this period is also remarkable for the high risk exposure of either psychic or physical stress. A negative impact on young mother is suspected, both in the short, medium or long term, which can even be deleterious for child-mother relationships. During lactation in female rats and sheep, oxytocin production has been proved to decrease stress-induced hormonal changes and later consequences. In human beings, only the first hour after breast-feeding seems to protect against physical or psychic stress. Oxytocin improves the stress-induced response by reducing the ACTH and cortisol secretion thus representing a potential therapeutic pathway in post-partum pathologies such as depression. Thus, this review of recent literature about oxytocin and stress during post-partum period, leads to the assumption that oxytocin, at the moment of installation of breastfeeding, acts not only on the physiological condition, but also on the psychic condition of the mother.

Adult↗

Differential sex-independent amygdala response to infant crying and laughing in parents versus nonparents.

BACKGROUND: Animal and human studies implicate forebrain neural circuits in maternal behavior. Here, we hypothesized that human brain response to emotional stimuli relevant for social interactions between infants and adults are modulated by sex- and experience-dependent factors. METHODS: We used functional magnetic resonance imaging and examined brain response to infant crying and laughing in mothers and fathers of young children and in women and men without children. RESULTS: Women but not men, independent of their parental status, showed neural deactivation in the anterior cingulate cortex, as indexed by decreased blood oxygenation level-dependent signal, in response to both infant crying and laughing. The response pattern changed fundamentally with parental experience: in the amygdala and interconnected limbic regions, parents (independent of sex) showed stronger activation from crying, whereas nonparents showed stronger activation from laughing. CONCLUSIONS: Our data show sex- and experience-dependent modulation of brain response to infant vocalizations. Successful recognition and evaluation of infant vocalizations can be critical for bonding mechanisms and for offspring well-being and survival. Thus, the modulation of responses by experience seems to represent an adaptive mechanism that can be related to reproductive fitness.

Acoustic Stimulation↗

Time course of induction of oxytocin messenger ribonucleic acid levels in the hypothalamic paraventricular nucleus of ovariectomized rats following gonadal steroid administration.

The nonapeptide oxytocin (OT) is important for uterine contractility at parturition, milk ejection during lactation, and the induction of maternal behavior. OT messenger ribonucleic acid (mRNA) levels increase in the paraventricular and supraoptic nuclei (PVN and SON) of late pregnant and lactating rats and are modulated by the steroid milieu that accompanies these states. Specifically, sequential exposure to estradiol (E2) and progesterone (P) followed by P withdrawal 48 hrs prior to sacrifice increases PVN, and to a lesser but significant degree, SON OT mRNA. To better define the time course of induction of OT mRNA levels following P withdrawal, ovariectomized Sprague-Dawley rats were treated with empty or steroid-filled capsules. On day 1, animals received an E2-filled or empty capsule, followed by P-filled or empty capsules on day 3. On day 14, P-filled or empty capsules were removed and animals were sacrificed 24, 36, or 48 hrs later. The hypothalamic PVN were analyzed for OT mRNA by in situ hybridization histochemistry. Significant differences in PVN OT mRNA were found among the groups (P<0.0001, Kruskal-Wallis). Animals in the 48 hr (P=0.007) and 36 hr (P=0.005), but not the 24 hr, steroid-treated groups had significantly increased OT mRNA relative to their respective sham-treated cohorts (Mann-Whitney U test). The relative abundance of PVN OT mRNA differed among the steroid-treated groups (Kruskal-Wallis, P<0.0003), with highest levels at 48 hr. We conclude that increases in PVN OT mRNA occur by 36 hrs, and are highest at 48 hrs, after P withdrawal in the E2-primed rat. Future studies will determine if OT-mediated changes in behavior or physiology that surround parturition are related to these changes in OT mRNA.

Animals↗