Unresolved Trauma and Reorganization in Mothers: Attachment and Neuroscience Perspectives

The onset of motherhood is characterized by significant psychological and neurobiological changes. These changes equip the mother to care for her new child. Although rewarding, motherhood is also an inherently stressful period, more so for mothers with unresolved trauma. Past research has looked at how unresolved trauma can hamper a mother’s caregiving response toward her infant, which further affects the development of secure attachment in her own infant. The Dynamic Maturational Model of Attachment and Adaptation (DMM) has introduced a unique concept of “attachment reorganization” which can be described as a process whereby individuals with unresolved trauma are transitioning toward attachment security based on their enhanced understanding of past and present experiences. Preliminary results from one of our previous studies have shown that, among mothers with unresolved trauma, mothers who themselves demonstrated “reorganizing attachment” toward security, had infants with secure attachment, thereby indicating the potential to halt the intergenerational transmission of insecure attachment. While this concept is of great clinical relevance, further research is required to assess the benefits of attachment reorganization as a protective factor and its positive implications for child development. Thus, the aim of the current review is to expand on the concept of attachment reorganization in mothers with unresolved trauma from both attachment and neuroscience perspectives. To that effect, we will first review the literature on the transition to motherhood from attachment and neuroscience perspectives. Second, we will use attachment and neuroscience approaches to address deviations from normative experiences during motherhood with a specific focus on the role of a mother’s unresolved trauma. Lastly, we will expand on the concept of reorganization and the promise this concept holds in resolving or halting the intergenerational transmission of trauma from mothers to their children

Rethinking multiphase leisure experience: a hermeneutic phenomenological approach to experiences of art museum visitation

Since Clawson and Knetsch (1966) first proposed the multiphase leisure experience (MLE) model, the phasic nature of leisure experience has been given substantial attention by tourism and leisure scholars who to date have largely focused on the dynamic on-site experience with quantitatively measurable values. However, their traditional goal-oriented, post-positivist approach is limited in its ability at both the practical and theoretical levels to fully reflect the holistic aspect of the model that emphasizes not only the connectivity of phases from anticipation through recollection, but also the equal value between phases. In this dissertation, I have applied the multiphase leisure experience model from a hermeneutic phenomenological perspective and explored the experience of a visit to the Seoul Museum of Art (SeMA) based on this meaning-based approach in order to investigate the meanings of the multiphase leisure experience for art museum visitors. This approach emphasizes understanding an individual’s life experience as a reflection of cultural traditions that are transferred through language. The methodological framework is based on hermeneutic phenomenology and Gadamer’s fusion of horizons. This multidimensional concept enabled me to apply the MLE model to interpreting the meaning of the museum visit as a cultural leisure experience. By engaging in analysis of the symbolic metaphors that emerged from and delivered a node of crucial values, meanings and concerns of each participant, I was able to consider both the individually different experiences and their socio-cultural contexts that assisted in comprehending the evolving meaning of their visits. Through in-depth interviews and reflexive journals with twelve participants, I sought to understand the meanings of the multiphase leisure experience for art museum visitors beyond the physical boundaries of the museum. Furthermore, I sought to understand how the verbal interaction between interlocutors influenced the meanings of their visits. Participants’ narratives were interpreted with six symbolic metaphors that led to the identification of a representative image of their visits: learning for those who consistently interpreted SeMA as an educational institution and showed interest in exhibits they considered worth learning; aesthetic for those whose aesthetic appreciation neglected the external values of exhibits and played a crucial role in constructing the meaning of their visits throughout all the phases; high-culture for those who alienated themselves from this cultural institution, considering it exclusively for the wealthy and educated; everyday-ness for those who signified their everyday concerns and interests without paying attention to the aesthetic value of the exhibits; trigger for those whose experiences at SeMA directly triggered them to visit other art institutions; diary for those who focused on telling and creating their own stories in relation to their on-site experiences. Their self-reflective stories at the intra-textual level were analyzed and situated with sociocultural traditions at the inter-textual level. This showed that the meanings of their visits reverberated with contemporary Korean orientations such as collective authority, disinterestedness, post-museum, cultural capital and cultural autobiography. These multi-layered interpretations enabled me to understand how the initial signification of their visits became recessed, conserved, altered and expanded in the final recollection phase. The findings encourage leisure and tourism scholars to escape from the narrow interpretation of leisure as a frozen, snapshot-like immediate experience and to understand leisure as a contextualized phenomenon that erodes the boundaries between extraordinary and ordinary experiences, off- and on-site activities, work and leisure, and leisure and tourism. My interpretation of the findings supports the need to consider leisure experience as an evolving set of meanings

Sociodemographic factors associated with the use of mental health services in depressed adults: results from the Korea National Health and Nutrition Examination Survey (KNHANES)

Background: The aims of this study were to determine the utilization of mental health services (MHSs) by adults with a depressive mood and to identify the influencing sociodemographic factors, using a nationwide representative Korean sample. Methods: The study included 2735 subjects, aged 19 years or older, who had experienced a depressive mood continuously for over 2 weeks within the previous year, using the data from the KNHANES IV (Fourth Korea National Health and Nutrition Examination Survey), which was performed between 2007 and 2009, and involved a nationally representative sample of the Korean community population who were visited at home. A multivariate logistic regression analysis was used to estimate the adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for the use of MHSs, which was defined as using healthcare institutions, consulting services, and inpatient or outpatient treatments due to mental health problems. Results: MHSs had been used by 9.6% of the subjects with a depressive mood. The use of the MHSs was significantly associated with age, education level, and employment status, after adjusting for sociodemographic and health-related factors. Specifically, the OR for the nonuse of MHSs by the elderly (≥65 years) relative to subjects aged 19–34 years was 2.55 (95% CI = 1.13–5.76), subjects with a lower education level were less likely to use MHSs compared to those with a higher education level (7–9 years, OR = 2.35, 95% CI = 1.19–4.64; 10–12 years, OR = 1.66, 95% CI = 1.07–2.56; ≥13 years, reference), and the OR of unemployed relative to employed was 0.47 (95% CI = 0.32–0.67). Conclusions: Among Korean adults with a depressive mood, the elderly, those with a lower education level, and the employed are less likely to use MHSs. These findings suggest that mental health policies should be made based on the characteristics of the population in order to reduce untreated patients with depression. Greater resources and attention to identifying and treating depression in older, less educated, and employed adults are warranted

Changes in the Contribution of Termites to Mass Loss of Dead Wood among Three Tree Species during 23 Months in a Lowland Tropical Rainforest

This study investigated the contribution of termites to mass loss of dead wood (Macaranga bancana, Elateriospermum tapos, and Dillenia beccariana) in a lowland tropical rainforest, Brunei Darussalam. Mesh bag method was used to exclude termites, and the mass remaining was monitored after 3, 7, 13, and 23 months. C/N ratio of the samples was analyzed after 13 and 23 months. Initial wood density was 0.63, 0.92, and 1.02 g/cm3 for M. bancana, E. tapos, and D. beccariana, respectively, and the termite contribution to mass loss was an average (range) of 13.05±5.68 (4.17-29.59%), 3.48±1.13 (2.20-6.49), and 3.40±1.92% (0.74-10.78), respectively. Until 7 months, termites contributed highly to mass loss, given the low initial wood density, and interaction effect of species and treatment was significant. After 7 months, the contribution decreased in M. bancana and E. tapos, whereas it increased consistently in D. beccariana. The interaction effect was not significant, whereas differences in C/N ratio among the species were significant, with a lower C/N ratio in M. bancana and E. tapos than in D. beccariana. After 23 months, the differences in C/N ratio were not significant, and ants were present at 40% of control samples in M. bancana and E. tapos. Our results suggest that the contribution of termites to mass loss varies by dead wood species and is temporally variable. Initial wood traits could affect the termite feeding in the beginning, however, termites thereafter could forage in response to the varying C/N ratio among species and predators

Efficacy of fermented grain using Bacillus coagulans in reducing visceral fat among people with obesity: a randomized controlled trial

BackgroundObesity is a socioeconomic problem, and visceral obesity, in particular, is related to cardiovascular diseases or metabolic syndrome. Fermented grains and various microorganisms are known to help with anti-obesity effects and weight management. Studies on the relationship between Bacillus coagulans and anti-obesity effects are not well known, and studies on the application of fermented grains and microorganisms to the human body are also insufficient.ObjectivesThis study aimed to evaluate the efficacy of Curezyme–LAC, an ingredient mixed with six-grain types fermented by B. coagulans, in reducing fat mass in adults with obesity.MethodsIn this randomized double-blinded placebo-controlled study, 100 participants [aged 40–65 years; body mass index (BMI) ≥ 25 to ≤ 33 kg/m2) were randomly allocated to two groups: 4 g/day Curezyme–LAC administered as a granulated powder or placebo (steamed grain powder mixture).ResultsAfter 12 weeks, visceral adipose tissue decreased significantly in the Curezyme–LAC group compared with that in the placebo group (mean ± standard error, SE of −9.3 cm2 ± 5.1) vs. (6.8 cm2 ± 3.4; p = 0.008). Compared to the placebo group, the Curezyme–LAC group also showed significant reductions in total fat mass (−0.43 ± 0.24 kg vs. 0.31 ± 0.19 kg, p = 0.011), body weight (−0.4 ± 0.3 kg vs. 0.3 ± 0.2 kg, p = 0.021), BMI (−0.14 ± 0.12 vs. 0.10 ± 0.07, p = 0.028), and waist circumference (−0.6 ± 0.2 cm vs. −0.1 ± 0.2 cm, p = 0.018) without a change in dietary intake and physical activity.ConclusionCurezyme–LAC supplementation for 12 weeks may benefit individuals with obesity by reducing visceral fat mass

Social determinants of health rather than race impact health-related quality of life in 10-year-old children born extremely preterm

Background: Reducing healthcare disparities among children is extremely important given the potential impact of these disparities on long-term health-related quality of life (HRQL). Race and parental socioeconomic status (SES) are associated with child health-related quality of life (HRQL), but these associations have not been studied in infants born Extremely Preterm (EP), a population at increased risk for physical, cognitive, and psychosocial impairments. Achieving health equity for infants born EP across their life course requires identifying the impact of racism and SES on HRQL. Objective: To evaluate the association between self-reported maternal race, SES factors, and HRQL among 10-year-old children born EP. Design/ Methods: Participants were identified from an ongoing multicenter prospective longitudinal study of Extremely Low Gestational Age Newborns (ELGAN Study), born between 2002-2004, and evaluated at 10 years of age using the Pediatric Quality of Life (QoL) Inventory completed by their parent or guardian, assessing physical, emotional, social, school, and total (composite) QoL domains. Multivariable regression models were used to evaluate the relationship between QoL scores and self-identified maternal race, adjusting for SES factors (education level, marital status, and public insurance). Results: Of 1198 study participants who were alive at 10 years of age, 863 (72.0%) were evaluated at 10 years of age. Differences in mean 10-year QoL scores across racial groups were observed and were significant on univariate analysis. However, these associations attenuated when adjusted for mother’s marital status, public insurance status, and education status. Comparing children with English as primary language spoken at home versus any other language revealed a significant difference only in school QoL, in which non-English language was associated with more favorable school QoL scores. Conclusions: Among 10-year-old children born EP, differences in parent-reported QoL were associated with maternal SES factors but not with race. Our results suggest that interventions designed to improve mothers’ SES may enhance QoL of children born EP. Furthermore, these results underscore that race is a social construct, rather than a biological variable, as we work towards greater equity in care provision

Association of prenatal modifiable risk factors with attention-deficit hyperactivity disorder outcomes at age 10 and 15 in an extremely low gestational age cohort

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes

Association between Iodine Nutrition Status and Thyroid Disease-Related Hormone in Korean Adults: Korean National Health and Nutrition Examination Survey VI (2013–2015)

This study aimed to observe the relationship between iodine nutrition status (dietary iodine intake and estimated iodine intake based on urinary iodine concentration (UIC)) and thyroid disease-related hormones. This study involved 6090 subjects >19 years old with valid UIC, assessed between 2013 and 2015 by the Korean National Health and Nutrition Examination Survey, using a stratified, multistage, clustered probability-sampling design. The estimated iodine intake in participants was measured using UIC and urine creatinine. To examine the effect of iodine intake on thyroid disease, the iodine intake was divided into Korean Dietary Reference Intakes groups, and logistic regression analysis was performed via the surveylogistic procedure to obtain odds ratios (ORs) and 95% confidence intervals (CIs). The estimated iodine intake showed a significant positive correlation with dietary iodine intake (r = 0.021, p < 0.001), UIC (r = 0.918, p < 0.001), and thyroid-stimulating hormone (TSH) (r = 0.043, p < 0.001), but a significant negative correlation with free thyroxine (FT4) (r = −0.037, p < 0.001). Additionally, as the estimated iodine intake increased, age, TSH, and UIC increased, but FT4 decreased (p for trend < 0.0001). The risk of thyroid disease was higher in the “≥tolerable upper intake level (UL ≥ 2400 µg/day)” group than in the “<estimated average requirement (EAR < 150 µg/day)” group in females (OR: 2.418; 95% CI: 1.010–5.787). Also, as iodine intake increased, the risk of thyroid disease increased (p for trend < 0.038)