Nina Aarhus Smeby

Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial.

In a randomized controlled trial at 12-months of age, the effect of the Mother Infant Transaction Program was tested on social interaction between mothers and moderately and late preterm infants with gestational age≥30.0 and <36 weeks. Ninety-three play sessions were videotaped and coded, 46 mothers-infants in the intervention group and 47 mothers-infants in the control group. The intervention mothers scored higher on maternal sensitivity/responsiveness (p=.05). Being a first-time mother was a moderator that enhanced the effects of the intervention. First-time mothers were more sensitive/responsive to their infants cues (p=.01), and the dyads evinced higher level of synchrony (p=.02) as compared with experienced mothers. More positive mood was observed among their infants (p=.04). The findings suggest that the intervention contributes to better mother-infant interactions in moderately and late preterm infants of first-time mothers.

Effects of early mother-infant intervention on outcomes in mothers and moderately and late preterm infants at age 1 year: a randomized controlled trial.

OBJECTIVEnThere is a dearth of knowledge about the effects of early interaction-based interventions on parenting and infant communication skills in moderately and late preterm infants.nnnAIMSnAssess in a RCT the effects of the Mother-Infant Transaction program (MITP) on maternal depression and stress, breastfeeding and mothers perception of infant temperament; and MITPs impact on preterm infant communication skills at 12 months.nnnMETHODSnMothers/preterm infants (30-36 weeks) were randomly assigned to MITP (intervention group) or standard care (control group). Mean gestational age in the intervention group was 33.3±1.5 (n=56) and in the control group (n=50) 33.0±1.6. Outcomes were assessed by CES-D, Parenting Stress Index; WHO breast-feeding categories, Infant Behavior Questionnaire and The Pictorial Infant Communication Scales.nnnRESULTSnIntervention mothers reported significantly less postpartum depression one month after discharge (p=.04) and more breastfeeding at 9 months (p=.02). No significant group differences in favour of the intervention group were found on total parenting stress at 6 (p=.08) and 12 months (p=.46) or on perceived infant communication skills at 12 months (p=.86). The intervention mothers reported significantly less infant smile and laughter at 6 (p=.02) and 12 (p=.006) months and less motor activity at 12 months (p=.04).nnnCONCLUSIONSnThe results suggest that MITP reduced postpartum depression and extended the period of breastfeeding, but did not support any positive effects of the intervention on self-reported maternal stress and perceived infant communication.

Patients’ experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting

Background: The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients’ detailed experiences, and give direction for future clinical practice. Aim: To explore the CABG patients’ symptoms and needs in the early rehabilitation phase. Methods: A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. Results: Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgerythe patients’ symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. Conclusion: CABG patients’ experiences indicate a need to extend the hospital’s discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.

Chronic pain in breast cancer survivors: comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain.

CONTEXTnAccording to the literature, 25%-60% of women treated for breast cancer, regardless of the stage, experience pain. Many risk factors have been suggested, with many possible confounding factors.nnnOBJECTIVESnThe aim was to investigate psychosocial, surgical, and medical factors associated with chronic pain by comparing breast cancer survivors with chronic pain with survivors without chronic pain. In addition, we investigated the prevalence, intensity, and body location of chronic pain after breast cancer treatment nationwide.nnnMETHODSnA nationwide postal survey of 1332 women who received surgery and adjuvant therapy for breast cancer in Norway two to six years before the onset of this study.nnnRESULTSnA total of 832 women (63%) returned the questionnaires, and 41% reported pain, of which 51% had mild, 41% moderate, and 8% severe pain. Among the women who experienced pain, 33.8% reported symptoms and signs of neuropathic pain. Young age (odds ratio [OR], 0.95; 95% CI, 0.93-0.98; P < 0.0001), axillary lymph node dissection with subsequent chemotherapy and radiotherapy (OR, 1.69; 95% CI, 1.07-2.67; P = 0.02), other illness that caused pain (OR, 2.37; 95% CI, 1.72-3.26; P < 0.0001), depression (OR, 2.07; 95% CI, 1.25-3.40; P = 0.004), and anxiety (OR, 1.83; 95% CI, 1.26-2.66; P = 0.002) were associated with chronic pain.nnnCONCLUSIONnYoung age, previous comorbidities (such as back pain, arthritis, arthrosis, and fibromyalgia), and combined treatment with axillary lymph node dissection, chemotherapy, and radiotherapy were risk factors for chronic pain. Whether depression or anxiety is a risk factor for chronic pain remains unclear.

Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: A randomized controlled study

UNLABELLEDnAim of the present study was to examine the long-term effect of an early intervention for preterm infants on cognitive, gross motor and behavioural outcomes at 36 months corrected age. One hundred and eighteen preterm infants born 2005-2006 with gestational age ≥ 30.0 and <36.0 weeks were randomized to an early intervention involving the Mother-Infant Transaction Program (n = 61) or a control group (n = 57). At 36 months, 32 children in the intervention and 30 in the control group were assessed.nnnOUTCOME MEASURESnAges & Stages Questionnaire, Ages & Stages Questionnaire: Social-Emotional, Child Behaviour Checklist 1½-5 and Mullen Scale of Early Learning. The intervention programme had no effect on cognitive, motor or behavioural development in this group of mainly moderate and late preterm infants at 36 months corrected age. Four explanations may be proposed: the programme has a less effect on moderate and late preterm infants than in more preterm infants; modifications of the intervention might increase efficacy; a cumulative effect of the intervention leads to more obvious effects at later ages, and an improved standard care in the Neonatal Intensive Care Units may support infant development.

Effects of a psychoeducational versus a support group intervention in patients with early-stage breast cancer: Results of a randomized controlled trial

Background: Limited documentation exists on the effectiveness of psychoeducational group (PEG) versus support group (SG) interventions among breast cancer patients during primary care. Support group is a component of the hospitals’ routine breast cancer care. Objective: The aim of this study was to investigate which of these approaches provides the greatest benefits to participants, particularly to women with low optimism (pessimists). The primary outcomes investigated here were anxiety, depression, and mental adjustment to cancer. Methods: A total of 367 women with early-stage breast cancer were randomized to the PEG or SG intervention starting 1 to 8 weeks after surgery. The PEG intervention included health education, enhancement of problem-solving skills, stress management, and psychological support. Results: Participants in both groups showed improvement over time; however, no significant differences in emotional distress were found. The PEG participants exhibited more positive attitude at 2 and 6 months (P < .001) and less helplessness/hopelessness (P = .01) at 2 months compared with the SG participants. However, no significant differences were found between the groups at 12 months. Pessimists did not benefit more from attending the PEG than they did from attending the SG. Conclusion: Both groups showed improvement in emotional distress and coping over time. Although the results were limited, the PEG intervention seems to enhance short-term, but not long-term, adaptive coping. Implications for practice: Psychoeducational group intervention yields benefits during the difficult period when patients receive adjuvant chemotherapy or radiotherapy. Thus, the hospital’s standard group interventions have been changed to include more health education and stress management, but within the same time frame as the original SG.

Parents of preterm-born children; sources of stress and worry and experiences with an early intervention programme – a qualitative study

BackgroundPreterm-born children are at increased risk of adverse developmental outcomes, and their parents may experience increased stress levels. The Mother–Infant Transaction Program (MITP) is an early intervention that aims to enhance the parent–infant relationship and child development. The present study investigated differences in parents’ experience of stress and concerns about caring for their preterm-born child according to whether they participated in the programme. Parental satisfaction with the intervention was also explored.MethodsAs part of a follow-up study at 36xa0months, a randomized controlled trial of the MITP—14 parents of 11 children from the intervention group, and 17 parents of 14 children from the control group were interviewed by the use of semi-structured focus group interviews. The interviews were analysed thematically.ResultsThe intervention parents reported that the knowledge, advice, guidance and emotional support given during the intervention made them feel less stressed and more confident, competent and secure caring for their preterm born child than they would otherwise have been. The control parents described feeling less involved and emotionally supported, and seemed more anxious about their child’s development than the intervention parents. All parents were vigilant and alert to their child’s needs and monitored developmental milestones carefully.ConclusionThis qualitative exploration of the influences of the MITP revealed a positive impact of the intervention and seems to be an important educational and supportive initiative. Thus, reducing parental stress and enhancing confidence in the parental role.

Stress in fathers of moderately and late preterm infants: a randomised controlled trial

The atypical behaviour of preterm infants can elicit stress in fathers and influence their ability to perceive and interpret infants’ cues. This study investigated whether fathers of moderately and late preterm infants were more stressed than fathers of term infants. In a randomised controlled trial, we also studied the effect of the Mother–Infant Transaction Program on fathers’ stress at six and 12 months by using the Parenting Stress Index. Infants with gestational age ≥ 30.0 and < 36 weeks were randomised to a preterm intervention group (n = 32) or a preterm control group (n = 37). A term reference group (n = 39) was also recruited. Fathers of preterm infants reported higher total stress than fathers of term infants at six (p = .002) and 12 months (p = .03). No significant differences were found in stress between preterm intervention and preterm control group. The intervention failed to reduce paternal stress, and the results may indicate that fathers require different intervention strategies.

Avoiding Control and Pressure When Working with Severely Intellectually Disabled and Disturbed Patients A Study of Interaction between Professional Caregivers and Patients

The behaviouristic tradition has been the mainstream method of treating intellectually disabled persons in Norway. This study describes an alternative, or rather a supplement to behavioural methods when facing psychiatric illnesses in intellectually disabled persons. Interventions described in the present study are based on authors like Lefcourt and Goffman, combined with the impact of the newer trends of user participation and empowerment in the health care system in Scandinavia. The role of the professional caregiver is the aim of the present study. Fifty-three caregivers working in a Psychiatric Department for intellectually disabled at Ullevaal University Hospital (UUS) in Oslo answered a 41 item questionnaire. Three items assessed how caregivers handled conflict situations during self-care activities, and responses on these three items showed the same pattern. When responding and working with patients who do not cooperate during morning rituals, meals and classroom activities, they mainly engaged in verbal interactions with the patients. The caregivers were able to handle conflict situations without using control and pressure in helping patients with daily self-care activities. The authors discuss how the underlying idea of intervening in this way will strengthen the patients ability to perceive the impact on the surroundings by their own actions, and how it will influence caregiver practice.

Psychosocial Support by Midwives of Women with a Fear of Childbirth: A Study of 80 Women

The purpose of this study was to evaluate the work performed by the Gaia Group midwives at a maternity unit in Oslo, Norway, and to gain more knowledge about women with an abnormal fear of childbirth. Since 1996 Gaia midwives have offered individual counselling to women with severe fear of childbirth. A self-report questionnaire was developed based on the written objectives of the Gaia initiative, as well as earlier studies about women suffering from fear of childbirth. The subjects were the first 100 Norwegian-speaking candidates to respond, and 80 (80%) replied. We found that 51% assessed themselves as having been troubled with fear prior to their most recent pregnancy. On average the women had 2.8 Gaia sessions. A total of 63% reported that they had negative feelings and expectations in regard to the upcoming birth prior to the pregnancy, while at full term the figure was reduced to 45%. In other studies, women have been found to rank «insufficient confidence in health personnels willingness and capability to provide help» as the most prevalent fear. Not so in our study where they felt they received help. Birth plans written down along with other things they wanted the midwives to know about ahead of time and postnatal sessions were confirmed as very useful. The overall rating was very high concerning satisfaction with the Gaia intervention.