Like Taking a Magnifying Glass Into Everyday Life: Vulnerable Parents’ Experiences With Video Guidance in an Infant Mental Health Clinic

Background: Parents are a central focus in clinical infant mental health interventions because of the key importance of the caregiver-infant relationship, especially when dyads are burdened by psychosocial and parental mental health problems. However, knowledge is scarce about the lived experience of vulnerable parents who undergo video-based guidance. Aim: The study explores how parents in an infant-psychiatric outpatient clinic who struggled to mentalize and remain emotionally connected to their infant experienced helpful and challenging elements in video guidance. Method: We analyzed the interviews of a strategic sample of 12 parents after undergoing Marte Meo video guidance, using a team-based, reflexive thematic analysis (TA). Results: We identified four main themes: (a) Handling initial feelings of fear and loss of control; (b) Filming as a disturbing or agentic experience; (c) Feeling validated or devalued in the therapeutic relationship; and (d) Bringing insights from video guidance into everyday life. Therapeutic and existential factors became apparent in the main themes of adjustment to the guidance, experiences with filming, the therapeutic relationship and integration of new experiences. Conclusion: The parents’ sense of agency, dignity, and shame may be important for their ability to integrate new ideas about themselves. Implications: Video guidance for vulnerable parents in specialized clinical treatment should address relational challenges, parental mental health, and issues of recognition.publishedVersio

Seeing and being seen: An investigation of video guidance processes with vulnerable parents of infants

The psychosocial development of infants is closely interrelated with the relationship with their caregivers, especially with the caregivers’ capacity to emotionally attune themselves to and mentalize the infants. Parents’ difficulties to mentalize and remain emotionally connected with their infants are therefore a central focus for infant mental health interventions. Marte Meo video guidance supports infant development, interaction quality, parental mentalizing and sensitivity. Yet, there is a lack of knowledge about using the method with parents thus challenged and in specialized clinical work. The present thesis explored video guidance for parents with difficulties mentalizing and remaining emotionally connected with their infants. Which psychological and therapeutic processes were involved in the guidance? The thesis comprises two separate studies presented in Papers 1- 3. Study 1 (Paper 1) aimed to analyze how Marte Meo therapists experienced and handled challenging guidance processes with parent-infant dyads. Study 2, a cooperation with a specialized infant mental health team, investigated how parents who struggled to mentalize and remain emotionally connected with their infants experienced video guidance. Two separate analyses were presented in Papers 2 and 3. Paper 2 aimed to explore what the parents experienced as supportive and challenging elements in video guidance as a method. Paper 3 aimed to investigate the parents’ experiences of change during video guidance. Both studies were based on a phenomenological-hermeneutic approach using team based reflexive thematic analysis. Study 1 explored focus group interviews of a purposive sample of thirteen Marte Meo therapists with experience in guiding parent-infant dyads. Study 2 investigated in-depth interviews of a strategically recruited sample of twelve parents referred to specialized treatment who had difficulties mentalizing and remaining emotionally connected with their infants. Strategic recruitment by criterion sampling was based on a narrative interview with attachment-focus. In Paper 1, four main themes were drawn from therapists’ experiences and handling of challenging guidance processes with parent-infant dyads: 1) promoting relational growth in a coercive context; 2) building an alliance that feels safe for the parents; 3) looking at positive moments in difficult lives; 4) handling intense feelings as a therapist. In Paper 2, we identified four main themes describing parents’ experiences of challenging and helpful elements in video guidance: a) handling initial feelings of fear and loss of control; b) filming as a disturbing or agentic experience; c) feeling validated or devalued in the therapeutic relationship; and d) bringing insights from video guidance into everyday life. In Paper 3, four main themes summarized parents’ experience of the change process: a) feeling inadequate or disconnected as a parent; b) discovering the infant as a relating and intentional person; c) becoming more agentic and interconnected, and d) still feeling challenged by personal mental health issues. The overall results indicate that Marte Meo can assist profound change processes for parents with difficulties mentalizing the infants and manifest mental health problems.Video could create an opening that made parents accessible to new experiences and ideas about themselves. Feeling connected was a key ingredient for further changes in interacting, mentalizing, and feeling more confident and self-efficacious, centrally supported by the therapeutic relationship. Our findings suggest further research topics for video guidance with these vulnerable parents. Their requirements should be recognized by clinical practice and met with structural and method development. A rationale for Marte Meo in child protective contexts, cooperation with parents’ mental health treatment, therapist supervision, and expansion of training curriculum seem indicated. Early systematic assessment of parents’ vulnerabilities and child protective issues could facilitate an adapted guidance process, attending to parents’ health struggles, self-conscious emotions, and need for recognition. Our findings indicate that Marte Meo guidance can strengthen vulnerable parents’ connectedness, mentalization and self-regulation, and self-efficacy, both as parents and in other areas of life.Doktorgradsavhandlin

Learning to mentalize: Exploring vulnerable parents’ experiences of change during video guidance in an infant mental health clinic

Background: Interventions that promote infant mental health face challenges when applied for parents who struggle with psychosocial and psychological burdens. Video-based guidance using the Marte Meo method is used in specialized clinical settings with high-risk families to improve parent-child interaction, parental sensitivity and mentalizing. However, knowledge about the lifeworlds of these parents and their experiences of the therapeutic process during video guidance is limited. Aim: This qualitative study explores how parents in an infant mental health outpatient clinic who had difficulties mentalizing and maintaining an emotional connection with their infants experienced the change process during Marte Meo video guidance. Methods: We identified a strategic sample of parents with difficulties mentalizing and maintaining an emotional connection with their infants through the Parent Development Interview. Twelve parents received video guidance and were afterwards interviewed in-depth. The research interviews were qualitatively analysed via a team-based reflexive thematic analysis. Result: We identified four themes: a) feeling inadequate or disconnected as a parent; b) discovering the infant as a relating and intentional person; c) becoming more agentic and interconnected; and d) still feeling challenged by personal mental health issues. Conclusion: Parents described positive changes in their interactions, in mentalizing their infants, the relationship and themselves as parents, in their experiences of self-efficacy and on a representational level. They also described increased confidence and improved coping despite ongoing personal mental health challenges. The findings suggest that video guidance using the Marte Meo method can be a critical intervention for vulnerable parents but should be coordinated with parents’ primary treatments when complex parental mental health issues are involved.publishedVersio

Improving universal prenatal screening for human immunodeficiency virus.

OBJECTIVE: To evaluate the effect of implementation of a human immunodeficiency virus (HIV) educational intervention on universal screening for HIV in a prenatal clinic setting. METHODS: In this retrospective cohort study, frequencies of offering and acceptance of HIV testing were compared before and after an educational intervention performed by an HIV-focused nurse. The records of 293 women seeking prenatal care before the intervention and 206 women seeking prenatal care after the intervention were reviewed for offering and acceptance of HIV testing. Fisher's exact test and logistic regression were used to evaluate the relationship between the educational intervention and the offering and acceptance of HIV testing. RESULTS: The frequency of HIV test offering at first visit and test acceptance before the educational intervention were 96.5% and 74.8%, respectively, and after the intervention were 99.5% and 84.3%, respectively. This improvement in offering (3% change) and acceptance (9.5% change) was statistically significant (offering at first visit: OR = 7.27, 95% CI = 1.02 to 316.9; test acceptance: OR = 1.82, 95% CI = 1.14 to 2.88). Test acceptance was statistically significantly improved in the post-intervention group after controlling for confounding variables (OR = 2.02, 95% CI = 1.2 to 3.39). CONCLUSION: The addition of an HIV-focused nurse to a clinic setting improved the frequency of test offering at first visit and of acceptance of HIV testing by pregnant women

Reflexiones sobre el sistema penal juvenil argentino

El presente trabajo se centrará en el estudio de la conflictividad penal de las personas menores de edad. Primeramente, se intentará indagar si existe la posibilidad de explicar cuáles serían las circunstancias que llevarían a un niño, niña o adolescente a involucrarse en una situación de conflicto con la ley penal. En segundo lugar, sea cual fuere la respuesta a la que se arribe respecto del interrogante mencionado, esbozaré cómo debería actuar el Poder Judicial ante tales casos. Esto último no puede obviarse, más allá de conocer o no efectivamente las causas del delito juvenil, ya que el problema del conflicto de las personas menores de edad con la ley penal nos ocupa, a diario, como operadores del derech

High Rate of Severe Fetal Outcomes Associated with Maternal Parvovirus B19 Infection in Pregnancy

Objective. To augment the understanding of parvovirus B19 infection in pregnancy with respect to maternal characteristics and their corresponding fetal outcomes. Study Design. Retrospective case-series of all women referred to Magee-Women_s Hospital with serologically-documented parvovirus B19 infection during pregnancy from 1998–2001. Results. All 25 cases that are available for analysis occurred from January through June. The frequency of cases varied substantially from year to year, with 14 cases in 1998, 0 cases in 1999 and 2000, and 11 cases in 2001. In contrast to previous reports, the minority of women [4/25(16%)] experienced symptoms attributable to parvovirus B-19 infection although 3 of 25 (12%) fetuses developed hydrops fetalis and 4/25 (16%) suffered an intrauterine of fetal death. Conclusions. These findings suggest that parvovirus B19 infection in pregnancy follows seasonal and annual trend variation, may produce a lower frequency of maternal symptoms and a higher fetal loss rate than previously reported. Synopsis. Maternal parvovirus B19 infection follows seasonal and annual variation is often asymptomatic and may have higher fetal loss rates than previously reported. Continued surveillance is warranted

Racial differences in hypogonadal improvement and prostate-specific antigen levels in hypogonadal men treated with testosterone replacement therapy

Purpose: To observe hypogonadal men undergoing testosterone replacement therapy (TRT) and assess racial differences in hypogonadal improvement and prostate-specific antigen (PSA) levels. Materials and Methods: In a retrospective analysis, 75 hypogonadal men were followed for an average 34 months after initiating TRT. Total testosterone and PSA levels were assessed every 6 months, and patients diagnosed with prostatitis or prostate cancer during treatment were excluded. Results: For 16 African American men, the average age at diagnosis of hypogonadism was 53.5 years, compared with 57.8 years in 59 Caucasian men (p = NS). Pre- and post-treatment testosterone was 219 ng/dL and 310 ng/dL in African American men, and 247 ng/dL and 497 ng/dL in Caucasian men (p = NS). Symptomatic response was 81% in African American men and 93% in Caucasian men (p = NS). Baseline PSA level was 1.32 ng/mL in African American men and 1.27 ng/mL in Caucasian men, and there was no significant difference in PSA between racial groups at 6-month intervals, although there was a small decreasing trend in the PSA of African Americans compared with Caucasians. Conclusions: Hypogonadal African American men have a similar normalization of testosterone and symptomatic response as hypogonadal Caucasian men, and PSA levels remain stable over time in both groups. In this hypogonadal cohort, in contrast to studies of eugonadal men, higher PSA levels in African Americans were not observed

Cyclic AMP increases COX-2 expression via mitogen-activated kinase in human myometrial cells

Cyclic AMP (cAMP) is the archetypal smooth muscle relaxant, mediating the effects of many hormones and drugs. However, recently PGI2, acting via cAMP/PKA, was found to increase contraction-associated protein expression in myometrial cells and to promote oxytocin-driven myometrial contractility. Cyclo-oxygenase-2 (COX-2) is the rate-limiting enzyme in prostaglandin synthesis, which is critical to the onset and progression of human labour. We have investigated the impact of cAMP on myometrial COX-2 expression, synthesis and activity. Three cAMP agonists (8-bromo-cAMP, forskolin and rolipram) increased COX-2 mRNA expression and further studies confirmed that this was associated with COX-2 protein synthesis and activity (increased PGE2 and PGI2 in culture supernatant) in primary cultures of human myometrial cells. These effects were neither reproduced by specific agonists nor inhibited by specific inhibitors of known cAMP-effectors (PKA, EPAC and AMPK). We then used shRNA to knockdown the same effectors and another recently described cAMP-effector PDZ-GEF1-2, without changing the response to cAMP. We found that MAPK activation mediated the cAMP effects on COX-2 expression and that PGE2 acts through EP-2 to activate MAPK and increase COX-2. These data provide further evidence in support of a dual role for cAMP in the regulation of myometrial function

The Learning Curve for a Fetal Cardiac Intervention Team

Objectives. Multiple technical difficulties are encountered when a multidisciplinary team of subspecialists begins a minimally-invasive fetal cardiac interventional program. We describe the learning curve. Study Design. Ten pregnant sheep underwent ultrasound-guided balloon valvuloplasty of the aortic valve. Team members and their roles remained constant through the trial. The time between needle insertion and entrance of the left ventricle at the aortic root was recorded. F-test was used to assess significance (P ≤ .05). Results. The time required to accurately position the needle tip at the aortic root decreased significantly over the course of the trial, from 12 minutes with the first attempt to one minute with the last (P = .003). Conclusion. A significant learning curve is encountered when a multidisciplinary team begins a minimally-invasive fetal cardiac intervention program. However, technical proficiency can be achieved with practice. Institutions interested in developing such a program should consider practice in an animal model before proceeding to the human fetus

Thermal behaviour of zircon/zirconia-added chemically durable borosilicate porous glass

Macroporous alkali resistant glass has been developed by making additions of zirconia (ZrO2) and zircon (ZrSiO4) to the sodium borosilicate glass system SiO2–B2O3 Na2O. The glass was made using a traditional high temperature fusion process. Differential thermal analysis (DTA) was carried out to identify the glass transition temperature (Tg) and crystallisation temperature (Tx). Based on these findings, controlled heat-treatments were implemented to separate the glass into two-phases; a silica-rich phase, and an alkali-rich borate phase. X-ray diffraction (XRD) was used to identify any crystal phases present in the asquenched and heat-treated glasses. Fourier transform infrared (FTIR) spectroscopy also proved effective in investigating phase separation and crystallisation behaviour. After leaching, a silica-rich skeleton with an interconnected pore structure and a uniform pore distribution was observed. Pore characterisation was carried out using mercury porosimetry. The size and shape of the pores largely depended on the heattreatment temperature and time. ZrO2/ZrSiO4 additions increased the alkali resistance of the porous glass 3–4 times