Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

Clinicians and supervisors' experiences with developing practices of open dialogue in network meetings in public mental health services

Open Dialogue is a dialogical approach focusing on the perspectives of patients and their social networks on treatment and recovery processes. As part of a larger research project, this prospective cohort study explores what promotes and hinders the development of Open Dialogue in network meetings (ODNM) based on the experiences of thirty-seven clinicians and seven supervisors. Multistage focus group interviews were used to collect data and were analysed thematically. We generated two main themes: (1) togetherness and isolation and (2) challenging and evolving. The findings show that ODNM can be developed in public mental healthcare, but this leads to both challenges and opportunities at the organisational level, such as conflicting perspectives, the difficulty of maintaining interest in ODNM, the need for committed and involved leaders, and the growing change in the traditional view of treatment, which has made clinicians collaborate more with patients and their relatives.     

Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

Phoneme errors in Broca's aphasia: three Finnish cases

The phonemic errors of three Finnish Broca's aphasics were analyzed according to various phonological features, frequency of segments, syllable, word, and stress positions, as well as for the phonotactic structure of the uncanonical products. It was found, e.g., that the distance between the syntagmatic error and its source could not be satisfactorily counted by phonemes, since the syllable had to be taken into account also in pathological Finnish. As regards the paradigmatic dimension of the errors, the number of incorrect features is even here in reverse relation to the frequency of the erroneous phonemes. Moreover, it was found that pure quantity errors and vowel harmony deviations are infrequent in the speech of Finnish Broca's aphasics.     

Mother – infant group psychotherapy as an intensive treatment in early interaction among mothers with substance abuse problems

In this article we present a novel method of outpatient care: brief, dynamic mother – infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother – infant relationship in this high-risk group. The clinical material is taken from 16 mother – infant dyads from six psychotherapy groups, which met weekly over six months from pregnancy to post-partum. The therapy process consists of 20 – 24 three-hour sessions. The basis of the therapy is to offer mothers experience of care, which they, in turn, can give to their infants. In this paper we analyse the core therapeutic elements that may contribute to better mothering and child development. They involve: the group providing a symbolic maternal lap, and the meeting of the mothers' and the infants' needs. It is hoped that this may offer the mothers a new experience within which to reappraise their early memories. This may help prevent them from projecting traumatic past experiences onto their infants. Our analyses show that in the therapy, mothers, feeling safe within the group, gradually experienced pleasure with their infants and their peers. These effects, according to the mothers, were the most noticeable. Brief dynamic mother – infant group psychotherapy seems to be a promising form of treatment for those substance-abusing women able to commit to outpatient care and examine the causes of their drug dependence. The groups may also be used as a diagnostic tool to detect problems in early mother-baby interaction.     

Literacy programs efficacy for developing children’s early reading skills in familiar language in Zambia

This study investigated the comparative efficacy of a phonics-based reading program and a language experience approach based literacy program to develop reading skills among Zambian early childhood school learners. The learners (n = 1 986; Grade 2 level; females = 50.1%) took either the phonics-based reading program (n = 1 593) or the alternative language experience approach based program (n = 393). They were all assessed for reading skills utilising the Early Grade Reading Assessment test (EGRA) in four languages (Cinyanja, Icibemba, Kiikaonde, and Silozi). Results suggest that learners in phonics-based literacy program were significantly better in letter-sound knowledge in all the four languages. Additionally, they were significantly better in reading skills (non-word reading, oral passage reading, and reading comprehension), yet only in Icibemba and Silozi, as compared to those who took the alternative program. Results reveal that children in the Primary Literacy Program (PLP) had significantly better performance in most reading skills than in the Primary Reading Program (PRP). However, the effect sizes were small or medium. The high floor effect in all reading-related measures is an indication that by following either PRP or the recently implemented PLP, most children do not acquire basic reading skill of the transparently written language they are familiar with. Instruction of the sounds of letters requires special attention where digital training tools (such as GraphoGame) may provide the most effective help to both teachers and children.     

Magnetoencephalography in pediatric neuroimaging

Neural currents give rise to electroencephalogram (EEG) and magnetoencephalogram (MEG). MEG has selective sensitivity to tangential currents (from fissural cortex), and less distorted signals compared with EEG. A major goal of MEG is to determine the location and timing of cortical generators for event‐related responses, spontaneous brain oscillations or epileptiform activity. MEG provides a spatial accuracy of a few mm under optimal conditions, combined with an excellent submillisecond temporal resolution, which together enable spatiotemporal tracking of distributed neural activities, e.g. during cognitive tasks or epileptic discharges. While the present focus of pediatric MEG is on tailored epilepsy surgery, the complete noninvasiveness of MEG also provides unlimited possibilities to study the brain functions of healthy and developmentally deviant children.     

APPARENT PROPERTIES OF INSPECTION FIGURES AS DETERMINERS OF FIGURAL AFTER-EFFECTS

Figural after-effects (FAE) were studied using the Hering, the Ehrenstein, and the Orbisson illusion, patterns in two ways. In one condition, the total pattern was used as inspection figure (IF), and that part of the pattern in which the illusion normally appears, as test figure (TF). The resulting FAE was in a direction opposite to that of the illusion. In the second condition, the illusion producing part of the total pattern served as IF, and the illusion suffering part as TF. This produced an after-effect, the direction of which was the same as that of the illusion.     

Health enhancing physical activity as perceived in interviews based on the theory of planned behaviour

Abstract

The perception of behaviours from two categories of health enhancing physical activity (HEPA): outdoor aerobic exercise (OAE) and everyday commuting activity (ECA) was examined in a sample of middle-aged persons (N= 50). A focused semi-standardised interview was constructed on the bases of the components of the Theory of Planned Behaviour (TPB). The participants perceived OAE behaviours predominantly from the viewpoint of exercise and those of the ECA from that of the fluency of daily routines. They considered the OAE as sensible and associated it with positive health or fitness outcomes, but only those practising it also attributed positive psychological effects to OAE behaviours. A slightly better congruence with the TPB was found for the OAE behaviours than for those of the ECA. The difference is discussed in the light of the higher degree of decisional control with the OAE behaviours and the greater psychological heterogeneity of the ECA.