48 research outputs found
Measurement of motherinfant interactions and the home environment in a European setting: preliminary results from a cross-cultural
Background: Infant development is adversely affected in the context of postnatal depression. This relationship may be mediated by both the nature of early motherinfant interactions and the quality of the home environment.
Aim: To establish the usefulness of the Global Ratings Scales of MotherInfant Interaction and the InfantToddler version of the Home Observation for the Measurement of the Environment (ITHOME), and to test expected associations of the measures with characteristics of the social context and with major or minor depression.
Method: Both assessments were administered postnatally in four European centres; 144 mothers were assessed with the Global Ratings Scales and 114 with the ITHOME. Affective disorder was assessed by means of the Structured Clinical Interview for DSMIV Disorders.
Results: Analyses of motherinfant interaction indicated no main effect for depression but maternal sensitivity to infant behaviour was associated with better infant communication, especially for women who were not depressed. Poor overall emotional support also reduced sensitivity scores. Poor support was also related to poorer ITHOME scores, but there was no effect of depression.
Conclusions: The Global Ratings Scales were effectively applied but there was lessCIHR184pub152
Postnatal depression across countries and cultures : a qualitative study
Background: Postnatal depression seems to be a universal condition with
similar rates in different countries. However, anthropologists question the
cross-cultural equivalence of depression,
particularly at a life stage so influenced by
cultural factors.
Aims: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and
described and to enquire into people’s
perceptions of remedies and services for
morbid states of unhappiness within the
context of local services.
Method: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and
grandmothers, and interviews with health
professionals.Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres.
Results: All centres described morbid unhappiness after childbirth comparable
to postnatal depression but not all saw this
as an illness remediable by health interventions.
Conclusions: Although the findings of
this study support the universality of a
morbid state of unhappiness following childbirth, they also support concerns
about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals;
this has implications for future research
Perceptions of postnatal depression across countries and cultures: from a TransCultural Study of PostNatal Depression (TCS-PND)
Objectives
The qualitative study was conducted within the international
“Transcultural study of postnatal depression (PND)” in 17 centres
located in 13 different countries. The aim was to explore
perceptions of PND by lay and professional key informants,
specifically regarding description of symptoms, awareness of this
pathology and of possible care.
Methods
Broad areas of inquiry and open-ended probes were developed by
the TCS-PND research group during international workshops to
obtain data comparable between countries on perceptions of
PND. A non-random convenience sampling method was used to
recruit postpartum mothers for focus groups, and fathers and
grandmothers for interviews. Influential healthcare planners and
clinicians were interviewed as professional key informants in each
centre. Within sites, transcripts of focus groups and interviews
underwent a process of text analysis in the original language until
exhaustive theme extraction was achieved. Themes (in English)
from all the centres were combined into broader categories and
after consensus discussions these categories were revalidated.
Results and discussion
Qualitative data were supplemented in each centre with sociodemographic
data to address the issues of: (i) whether perceptions
of PND are related to some specific cultural perception of mental
heath and/or of status of parenthood and (ii) how high or low
levels of general care and specificity of health policy relate to
differences in perception of needs for care. Data collected using
the same probes and methodology in different countries and
cultures has enabled a comparative analysis of perceptions of
PND. In addition it has shown that, although not described with
the same words, PND is a well-recognised condition by recent
mothers in all countries in this study. Data on focus groups and
interviews from selected countries are given in the following
abstracts to illustrate some similarities and differences in
perceptions between countries
Pain and Frailty in Hospitalized Older Adults
Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people
The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry
Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features
Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both
Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population
Rappresentazione materna e paterna in gravidanza in un campione di coppie sottoposte a procreazione medicalmente assistita
Rappresentazioni materne in gravidanza in un campione di donne sottoposto a fecondazione assistita
Depressioni materne e legame col bambino,
La ricerca qui presentata, pubblicata su una qualificata rivista italiana referata e indicizzata, appartiene ad uno studio internazionale piĂą ampio sui fattori di rischio per la depressione post-partum, tematica di estremo interesse anche ai fini della progettazione di interventi preventivi.
La ricerca fa parte, nello specifico, di un progetto di ricerca internazionale sulla depressione post partum (Transcultural Study of Postnatal Depression Group) svolto nel periodo 1998-2001 in otto differenti paesi. Lo studio, basato sull’utilizzo di metodiche qualitative e quantitative, ha l’obiettivo di mettere a punto una metodologia comune per indagare i fattori di rischio psicosociale della depressione postpartum e lo scopo di attuare un confronto dei dati tra i diversi contesti culturali. Nello studio sono nello specifico considerati i seguenti fattori: diagnosi clinica, contesto psicosociale, stile di attaccamento adulto, relazione precoce madre-bambino, ambiente del bambino e risorse delle strutture sociosanitarie nei vari paesi. Nella presente ricerca vengono riportati i dati emersi dall’utilizzo, accanto alla SCID-I/NP per l’assessment diagnostico, dei seguenti strumenti: l’intervista Contextual Assessment of Maternity Experience (CAME) (Bernazzani, Bifulco e Marks, 1998), che indaga i fattori di rischio psicosociale per la depressione in gravidanza e post-partum e che viene somministrata alle donne durante la gravidanza; la Global Rating Scale for Mother-Infant Interaction (GRS) (Murray, Fiore-Cowley e Hooper, 1996), un sistema di codifica, basato sulla videoregistrazione di cinque minuti di interazione spontanea face to face tra madre e bambino, che valuta la sintonizzazione del comportamento materno (in particolare, sensitività , intrusività , distanza, depressione) e l’impegno del bambino nell’interazione, la sua vivacità e la sua tensione.
Il campione è composto da 296 donne intervistate nel terzo trimestre di gravidanza e da 144 coppie madre-bambino che hanno completato la GRS in un periodo di tempo che va dai 45 ai 75 giorni dopo la nascita.
I primi risultati della ricerca confermano la frequenza della depressione nel puerperio ed il ruolo fondamentale sull’insorgenza di un esordio depressivo nel periodo perinatale della percezione della donna di un insoddisfacente supporto del partner e delle figure significative della rete sociale. Inoltre, i dati indicano correlazioni tra depressione post-partum e qualità della relazione precoce madre bambino, in particolare differenze tra madri con e senza depressione in sottoscale qualitative della relazione, quali l’intrusività materna e la vivacità del bambino.
Il lavoro si conclude con una riflessione clinico-dinamica sul ruolo del partner nella depressione post partum della madre e sulla relazione tra depressione materna e qualità dell’interazione col figlio. Questa attività di ricerca è stata svolta in collaborazione con l’Università degli Studi di Firenze
Procreazione medicalmente assistita e rappresentazioni materne in gravidanza
Obiettivo. Analizzare le rappresentazioni materne in un campione di donne in gravidanza tramite fecondazione assistita. Nello specifico si intende analizzare: 1) il contenuto dell’esperienza della gravidanza e dell’essere madre e 2) lo stile delle rappresentazioni materne relative a sé e al bambino. Metodologia. Campione: 20 donne italiane di età compresa tra i 28 e i 42 anni (età media 35; d.s. 4) in attesa del primo figlio. Strumento: Intervista per le Rappresentazioni Materne in Gravidanza (Ammaniti et al., 1995). Risultati. Il tema dell’infertilità emerge con forza dalle interviste; il modo in cui è avvenuta la fecondazione influenza l’esperienza della gravidanza che viene vissuta in maniera più concreta e meno affettiva. Inoltre, soprattutto se la gravidanza è stata a forte rischio medico, le donne hanno maggiore difficoltà a lasciarsi andare alla gravidanza e tendono ad usare meccanismi di difesa volti a mantenere il controllo su di sé