Effects of prone and supine positions on sleep state and stress responses in preterm infants

Aim

The purpose of the study is to assess the influence of prone or supine position on sleep states and on withdrawal and approach reactions of preterm infants.

Methods

Thirty-two preterm infants from Meir Medical Center, Israel, mean post menstrual age 30.37 ± 2.57, mean birth weight 1250 g ± 313.86, participated in the study. Infants were studied during 48 h. Positions (prone and supine) were alternated every 3-4 h after feedings. Sleep states were assessed by Actigraph measurement and by two daily 30-min Naturalistic Observations of Newborn Behavior (NONB) to confirm sleep states and for recording the behavioral reactions (approach and withdrawal).

Results

In the prone position there were more approach reactions as compared to withdrawal reactions (p < .001) while in the supine position, the approach and withdrawal reactions were comparable. In the prone position more sleep patterns (deep sleep, light sleep, drowsy) were observed as opposed to more awake patterns (quiet awake, active awake and agitated fussy) that were seen in the supine position.

Conclusions

Clinical implications encourage placing the preterm infant in the prone position while in the NICU. This enables important achievements such as longer periods of quality sleep, and production of adaptive self-regulatory reactions.     

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self‐reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence‐based components—entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre‐suicidal mental state, regardless of their self‐reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.     

The Salient Stressor Impact Questionnaire (SSIQ): a measurement of the intensity and chronicity of stress

High stress is known to affect health, but stress impact, determined by events and responses to them, has not been studied systematically. For the Salient Stressor Impact Questionnaire (SSIQ), the impact of events was assumed to depend on their salience and chronicity and the impact of responses on their chronicity and intensity with greater unfavorable appraisal associated with greater response. The SSIQ assessed a person's two most salient stressors. Chronicity items discriminated between clinically stressed and nonclinical participants and measured the chronicity of stressful feelings (distress) and the event. The remaining items measured the degree of distress and unfavorable appraisal. The SSIQ showed good test-retest and internal consistency reliability, concurrent validity, and stability across diverse populations. Exploratory analyses grouped items into distress, chronicity, and appraisal elements, and confirmatory analysis revealed a good fit to the hypothesized model. Preliminary data suggest that the SSIQ will be useful for studying relationships between stress and health.     

Fluid compensation following threats to self-concept clarity

We examined defensive responses to self-clarity threats, finding that self-uncertain participants gave larger rewards to a social hero, but larger punishments to a social transgressor, than self-certain participants (Study 1). To examine whether there are individual differences in defensiveness to meaning threats, we included moderators, showing that high self-esteem individuals (HSE) thinking about self-inconsistencies gave more polarized evaluations of someone criticizing vs. complimenting their ingroup than self-consistent HSEs (Study 2). We found similar responses to a relational self-clarity threat, among individuals for whom relationships are self-defining (Study 3). Results held controlling for the impact of the self-clarity manipulations on self-esteem. This research is compatible with the meaning maintenance model, which stipulates that various meaning threats elicit fluid compensatory efforts designed to restore general feelings of meaningfulness. We discuss limitations and future directions.     

Psychiatry,Cultural Competency,and the Care of Ultra-Orthodox Jews: Achieving Secular and Theocentric Convergence Through Introspection

Several socio-cultural factors complicate mental health care in the ultra-Orthodox Jewish population. These include societal stigma, fear of the influence of secular ideas, the need for rabbinic approval of the method and provider, and the notion that excessive concern with the self is counter-productive to religious growth. Little is known about how the religious beliefs of this population might be employed in therapeutic contexts. One potential point of convergence is the Jewish philosophical tradition of introspection as a means toward personal, interpersonal, and spiritual growth. We reviewed Jewish religious-philosophical writings on introspection from antiquity (the Babylonian Talmud) to the Middle Ages (Duties of the Heart), the eighteenth century (Path of the Just), the early Hasidic movement (the Tanya), and modernity (Alei Shur, Halakhic Man). Analysis of these texts indicates that: (1) introspection can be a religiously acceptable reaction to existential distress; (2) introspection might promote alignment of religious beliefs with emotions, intellect and behavior; (3) some religious philosophers were concerned about the demotivating effects of excessive introspection and self-critique on religious devotion and emotional well-being; (4) certain religious forms of introspection are remarkably analogous to modern methods of psychiatry and psychology, particularly psychodynamic psychotherapy and cognitive-behavioral therapy. We conclude that homology between religious philosophy of emotion and secular methods of psychiatry and psychotherapy may inform the choice and method of mental health care, foster the therapist-patient relationship, and thereby enable therapeutic convergence.     

The Structure of Evolutionary Theory : on Stephen Jay Gould's Monumental Masterpiece

Stephen Jay Gould's monumental The Structure of Evolutionary Theory “attempts to expand and alter the premises of Darwinism, in order to build an enlarged and distinctive evolutionary theory … while remaining within the tradition, and under the logic, of Darwinian argument.” The three branches or “fundamental principles of Darwinian logic” are, according to Gould: agency (natural selection acting on individual organisms), efficacy (producing new species adapted to their environments), and scope (accumulation of changes that through geological time yield the living world's panoply of diversity and morphological complexity). Gould's efforts to contribute something important to each of these three fundamental components of Darwinian Theory are far from successful.     

Do Mindsets Shape Students’ Well-Being and Performance?

“Mindsets (or implicit theories) are people’s lay beliefs about the nature of human attributes, such as intelligence or personality”. Individuals with a fixed mindset believe that intelligence is an unchangeable trait, whereas those with a growth mindset think of it as a malleable quality that can be increased and developed. This study explored the relationships among growth mindset, wellbeing, and performance in a sample of 1,240 students from a multi-campus private university located in 18 states across Mexico. Our results indicated that individuals who scored high in growth (vs. fixed) mindset showed increased levels of wellbeing and also performed better in school. Furthermore, we found that wellbeing mediated the relationship between growth mindset and performance and that the effect of growth mindset on grades was higher among younger students. These findings have interesting implications for psychology and education.