Fact-finding survey of doctors at the departments of pediatrics and pediatric surgery on the transition of patients with childhood-onset chronic disease from pediatric to adult healthcare.

BACKGROUND: The number of adult patients with childhood-onset chronic diseases is increasing. However, the process of transitioning these patients from child- to adult-centered medical services faces many difficulties. Despite the key role that doctors in the pediatric field are considered to play in transition, few fact-finding surveys about transition have been conducted among these doctors. OBJECTIVE: The aim of this study was to demonstrate the current status and challenges in the transition of patients with childhood-onset chronic diseases by a fact-finding survey of pediatricians and pediatric surgeons at a university hospital. METHODS: A cross-sectional survey was performed using an anonymous self-administered questionnaire. Seventy-six doctors of pediatrics and pediatric surgery (excluding junior residents) in a university hospital were asked to answer an anonymous self-report questionnaire. A multidisciplinary research team selected items related to the transitional process. RESULTS: Sixty (79%) doctors participated, of whom 52 (87%) showed awareness of transition. No doctor answered that "Transition is conducted smoothly." Doctors with shorter pediatric department experience had lower awareness and poorer experience with transition. In contrast to pediatric surgeons, pediatricians explained "job-seeking activities" and "contraceptive methods" to the patient, and reported a higher patient age at which to initiate explanation of transition to the patient and his/her family. Among factors inhibiting transition, 39 (65%) respondents selected "The patient's family members do not desire transition" and 34 (57%) selected "Although a relevant adult healthcare department is available, it will not accept the patient." The medical providers most frequently considered to have responsibility for playing a central role in the transition process were "pediatrician/pediatric surgeon," "medical social worker," and "regional medical liaison office." DISCUSSION: To promote transition, pediatric and adult healthcare departments should share concerns about and cooperate in the establishment of more effective methods of transition, and provide multidisciplinary collaboration to support patients and their families.

Reliability and Validity of the Japanese Version of the Short Form of the Expanded Version of the Posttraumatic Growth Inventory (PTGI-X-SF-J): A Cross-Sectional Study.

A Japanese version of the short form of the expanded Posttraumatic Growth Inventory (PTGI-X-SF-J) was developed in this study, as the extended version captures broader, more diverse personal growth perspectives, such as existential spiritual growth. We collected cross-sectional data from 408 (first sample) and 284 (second sample) Japanese university students using the expanded version of the Posttraumatic Growth Inventory (PTGI-X-J). Exploratory factor analysis (EFA) was performed with the first sample and confirmatory factor analysis (CFA) with the second; reliability and validity were examined. The short-form version resulting from the EFA and CFA comprised 10 items and five factors. Cronbach's alpha for the PTGI-X-SF-J total and subscale scores ranged from 0.671 to 0.875. The intraclass correlation coefficient for the total and subscale scores between the PTGI-X-J and PTGI-X-SF-J ranged from 0.699 to 0.821. Regarding external validity, no significant correlation was found between posttraumatic growth and posttraumatic stress disorder checklists. Due to its brevity, the PTGI-X-SF-J can help assess diverse spiritual and existential personal growth experiences among clients, patients, and trauma survivors while reducing physical and psychological burdens.

Development of A Japanese Version of the Family Poly-Victimization Screen (FPS-J).

This study developed a Japanese version of the Family Poly-Victimization Screen (FPS-J) and assessed its validity. A cross-sectional study using self-report questionnaires was conducted with parents of children in Tokyo, Japan, from January to February 2022. To test the validity of the FPS-J, we used the Japanese versions of the revised Conflict Tactics Scale Short Form (J-CTS2SF) as the gold standard for intimate partner violence (IPV), the Conflict Tactics Scale Parent-Child (J-CTS-PC) for child abuse (CAN), the Conflict Tactics Scale (J-MCTS) for elder abuse, the K6-J for depression and anxiety, the PCL5-J for post-traumatic stress disorder, and the J-KIDSCREEN for Health-related Quality of Life among children. Data from 483 participants (response rate: 22.6%) were used. The J-CTS2SF and J-CTS-PC scores were significantly higher among the IPV/CAN-victim groups than in the non-victimized groups classified by the FPS-J (p < 0.001). The JMCTS scores did not differ significantly between the victim and non-victim groups (p = 0.44), but the PCL5-J, K6-J, and J-KIDSCREEN-10 scores were either significantly higher or lower among victims of violence than among the non-victim groups (p < 0.05). This study suggests the validity of parts of the FPS-J, especially the IPV against respondents and CAN by respondents.

Development of the Training Program on Child Abuse Prevention for Citizens (TCAP-C) and Its Effects and Acceptability: Community-Based Participatory Research.

AIM: We developed the Training Program on Child Abuse Prevention for Citizens (TCAP-C) and tested its effects and acceptability among citizen leaders (CLs). METHODS: Community-based participatory research using a pretest-posttest follow-up design was conducted in Tokyo, Japan from September 2021 to March 2022. Participants completed questionnaires before, upon completion, and one month and three months after TCAP-C. Recognition, knowledge, and behaviors regarding child abuse and community consciousness were collected and compared before and one and three months after TCAP-C, and the degree of satisfaction, understanding, and meaningfulness were collected upon completion. We analyzed data using repeated-measures ANCOVA. RESULTS: A total of 111, 98, 101, and 94 participants completed the questionnaires before, upon completion, and one and three months after TCAP-C, respectively. Overall, the recognition, knowledge, and community consciousness scores significantly improved from before to one month and three months after TCAP-C. Regarding the behaviors, only the behaviors of learning and watching over were significantly improved from before to one month after TCAP-C; however, those behaviors were not different between before and three months after TCAP-C. Furthermore, 95% participants reported being entirely satisfied with TCAP-C, and 85% and 91% reported good understanding and meaningfulness of the program. CONCLUSIONS: TCAP-C is acceptable and can improve CL recognition, knowledge, and community consciousness.

Initial testing of components of the cultural determinants of trauma recovery (CDTR) theory amongst American Gender-Based violence survivors: Structural equation modelling.

AIM: We tested key hypotheses derived from the Cultural Determinants of Trauma Recovery Theory (CDTR) with an American sample. DESIGN: A cross-sectional study using anonymous online surveys. METHODS: This study was conducted with 225 American survivors of gender-based violence (GBV) between August to November 2019. Demographics, distress (depression: PHQ8; PTSD: PCL-5), mental health service utilization (counselling and medication), sense of coherence (SOC), internal barriers to help-seeking (shame, frozen and problem management subscales: BHS-TR Internal) and the GBV healing (GBV-Heal) were used. Structural equation modelling (SEM) was conducted to test the hypotheses. RESULTS: The final SEM model showed that the relationship between distress and mental health service utilization was not mediated by internal help-seeking barriers; the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers; the relationship between internal help-seeking barriers and trauma healing was partially mediated by SOC; mental health service utilization was not significantly associated with trauma healing. Overall, the relationship between distress and trauma healing was partially mediated by internal help-seeking barriers and SOC. CONCLUSIONS: This study confirmed some hypothetical pathways between distress and trauma healing. Further research with larger and international samples should be necessary to test the overall CDTR and compare groups. IMPACT: This study can help us focus on psychological interventions that enhance meaning and mitigate internal help-seeking barriers to promote holistic trauma recovery. Public and public contribution: The sample was gathered from a clinical population registry that alerts patients of potential research opportunities.

The Efficacy of a Resilience-Enhancement Program for Mothers Based on Emotion Regulation: A Randomized Controlled Trial in Japan.

This study evaluated the efficacy of a brief (four 2-h sessions) group-based resilience-enhancement program focused on emotion regulation in Japan. Mothers (n = 123) of children aged 3-6 years were recruited in two prefectures and allocated with stratified randomization by the prefecture to either a bi-weekly intervention or treatment as usual. Mothers self-reported online at pre/post-intervention and at 2-month follow-up. Analysis of covariance was used to compare groups. At post-intervention and 2-month follow-up, the intervention group mothers showed significant improvements compared to the control group in resilience (p < 0.001/p = 0.001), self-esteem (p = 0.008/p = 0.001), anger control toward the child (p < 0.001/p = 0.012), and positive attribution toward the child's misbehavior (p < 0.001/p = 0.003). The partners of mothers in both groups answered the same questionnaire at the same timepoints without participating in either program; no differences between groups were found. This study was the first randomized controlled trial investigating how a resilience-enhancement program improves maternal resilience, emotion regulation, and cognition toward children and themselves. This preliminary study provides evidence that improving resilience may reduce the risk of child maltreatment. Further research regarding implementing this intervention in the community is warranted.

"Knitting Together the Lines Broken Apart": Recovery Process to Integration among Japanese Survivors of Intimate Partner Violence.

OBJECTIVE: This study used narrative interviewing and grounded theory analysis to discover the phases of trauma integration for Japanese women who had experienced intimate partner violence (IPV). METHOD: We interviewed 23 Japanese women who had experienced IPV using the Clinical Ethnographic Narrative Interviews (CENI) from November 2017 to September 2018 in Tokyo, Japan. The data from 11 participants who had achieved trauma integration using the Trauma Recovery Rubric were analyzed using a modified grounded theory approach. RESULTS: Six phases of the trauma integration journey after IPV were discovered: (1) Chaos, (2) Burning out, (3) Focusing, (4) Challenging, (5) Deepening insights, and (6) Re-building. The survivors described the processes of exploration of themselves and their reactions to their concurrent challenges. They focused on finding ways to protect, re-discover, and re-embrace themselves by healing from physical, psychological, and spiritual distresses. They also rebuilt relationships with others and acquired knowledge and skills to achieve a new life. Notably, the primary components of their recovery processes were changes in self-perception and self-interpretation of the trauma itself and its impacts on one's life and within oneself from multiple angles. In addition, traditional Japanese norms and gender roles, such as beliefs concerning the "ideal life of a woman" and fear of not behaving differently from others, profoundly influenced their recovery process. CONCLUSION: This study highlights the importance of incorporating individuals' cultures and their phase, needs, and personal self-development timeframes when developing trauma integration interventions.

Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries.

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

The association between self-compassion in the postnatal period and difficult experiences with COVID-19 pandemic-related changes during pregnancy: An observational study for women at 1-month postnatal in Japan.

AIM: This observational study aimed to describe the rate and degree of difficult experiences with COVID-19 pandemic-related changes (DE) during pregnancy, clarify the relationship between DE and self-compassion of women postnatally, and investigate the influence of compassion from a partner (CP) and compassion from the woman's mother (CM) on this relationship. METHODS: Data from 46 1-month postnatal women in Japan were collected through a self-report questionnaire from October to December 2020. Self-compassion was measured using the Japanese version of the Self-Compassion Scale; DE, CP, and CM were measured using original questions based on prior studies. RESULTS: Almost all participants (97.8%) experienced more than one DE during pregnancy. Data analyses revealed that DE in maternity hospitals (d = 0.76), DE in social support (d = 0.53), and CM (d = 0.64) were associated with self-compassion. A two-way analysis of variance suggested that CM moderated the relationship between self-compassion and DE in preparation for the baby (η2  = 0.11) and the birth plan (η2  = 0.11), whereas CP moderated the relationship between self-compassion and DE in social support (η2  = 0.07). CONCLUSIONS: Our findings suggest that self-compassion negatively correlates with DE in maternity hospitals and social support. Additionally, CM may buffer the influence of DE in preparation for the baby and the birth plan on self-compassion; moreover, CP may buffer the influence of DE in social support on self-compassion. This study highlights the importance of supporting perinatal women to adapt to COVID-19-related changes through cooperation with their families, which may increase self-compassion.

Efficacy of a Transitional Support Program Among Adolescent Patients With Childhood-Onset Chronic Diseases: A Randomized Controlled Trial.

It is recommended that patients with childhood-onset chronic diseases (CCD) be transferred from pediatric to adult healthcare systems when they reach adulthood. Transitional support helps adolescents with CCD transition smoothly. Transition readiness is one of the key concepts to assess the efficacy of transitional support programs. This study aims to investigate the effect of a transitional support program on transition readiness, self-esteem, and independent consciousness among Japanese adolescents with various CCD using a randomized controlled trial. Adolescents with CCD aged 12-18 years participated in a randomized controlled trial evaluating the efficacy of a transitional support program. The patients in the intervention group visited transitional support outpatient clinics twice. They answered questionnaires regarding their disease and future perspectives to healthcare professionals and independently made a short summary of their disease. All the participants answered the questionnaires four times. Eighty patients participated in this study. Among those in the intervention group, transition readiness within one, three, and 6 months after interventions, and self-esteem within 1 month after interventions were higher than that of the control group. The scores on the "dependence on parents" subscale at 6 months after interventions were lower for the intervention group as compared to the control group. This program is expected to help patients transition smoothly from pediatric to adult healthcare systems.

Reliability and validity of the Japanese version of the Caregiving Interface Work Scale in employed Japanese family caregivers.

AIM: This study aimed to develop a Japanese version of the Caregiving Interface Work Scale (J-CIWS) for use with employed Japanese family caregivers. METHODS: Permission was obtained from the developer of the original CIWS. The CIWS contains 20 items: 10 measuring care interface work (CIW) and 10 measuring work interface care (WIC). Responses are measured on a five-point Likert scale. The J-CIWS was developed through forward- and back-translation and cognitive interviews of employed family caregivers. An internet survey was conducted with 116 employed family caregivers, and 78 participants answered a retest. Questionnaire items included the J-CIWS and demographic factors. Factor analysis was conducted to determine the J-CIWS factor structure. Validity was assessed based on known-groups, convergent and discriminant validity. Internal consistency was examined by calculating Cronbach's α. Test-retest reliability was examined by calculating the Pearson's correlation coefficient. RESULTS: The mean participant age was 50.3 years; 74 (63.8%) were male. The average weekly working and caregiving hours were 41.6 and 12.1 h, respectively. Confirmatory factor analysis supported the original two-factor model. High internal consistency (Cronbach's alpha >0.90) and sufficient test-retest reliability (weighted κ score >0.45) were demonstrated for both subscales. Convergent and discriminant validity were acceptable for the two subscales (CIW and WIC). CONCLUSIONS: This study confirmed the usefulness of the CIWS within a Japanese context. The J-CIWS may be useful for evaluating the extent of the conflict between work and care among employed family caregivers. Geriatr Gerontol Int 2021; 21: 254-261.

Impact of intimate partner violence and childhood maltreatment on maternal-infant maltreatment: A longitudinal study.

AIM: This study identifies the impact of intimate partner violence (IPV) during pregnancy, and childhood maltreatment on mothers' perpetration of child maltreatment on 1-month postnatal infants. METHODS: A longitudinal study was conducted on women in the third trimester of pregnancy in two obstetric hospitals in Tokyo, Japan, from June 2016 to September 2017. Participants were asked to complete online self-reported questionnaires during their pregnancy period and at 1 month postnatal. The relationship between suffering from IPV during pregnancy, experiencing childhood maltreatment before the age of 18 years, and perpetration of child maltreatment toward infants was measured among mothers using the Violence Against Women Screen and a survey of four and 14 ad hoc questions. To identify the impact of poly-victimizations of IPV and childhood maltreatment on maternal-infant maltreatment, the study implemented logistic regression models. RESULTS: The data from 533 respondents to the first and second surveys were analyzed. Maternal-infant maltreatment at 1 month postnatal was strongly associated with poly-victimizations of IPV during pregnancy and childhood maltreatment (adjusted odds ratio [AOR] = 5.17; p < .001; 95% CI = 2.39-11.20), single victimization of IPV (AOR = 3.43, p < .001, 95% CI = 1.76-6.72), and single victimization of childhood maltreatment (AOR = 1.75, p = .03, 95% CI = 1.04-2.93; neither = reference). CONCLUSION: The results emphasize the importance of individuating pregnant women with poly-victimizations of IPV during pregnancy and childhood maltreatment and providing intensive and continuous support for such women to prevent maternal-infant maltreatment after childbirth.

A Follow-Up Study on the Continuity and Spillover Effects of Intimate Partner Violence During Pregnancy on Postnatal Child Abuse.

Previous studies have not focused on how intimate partner violence (IPV) during pregnancy predicts early postnatal child abuse. This study identifies the continuity and spillover effects of IPV during pregnancy on IPV and child abuse and neglect (CAN) at 1-month and 3-month postnatal periods. A total of 822 pregnant women were recruited at the third trimester of pregnancy at two obstetric hospitals in Tokyo, Japan, from June 2016 to September 2017. IPV during pregnancy and IPV and CAN at 1 month and 3 months postnatal were obtained through self-reported questionnaires. Results show that the rate of IPV was highest during pregnancy (16.4%), and there was significant continuance (69.4%) of this occurrence of IPV after childbirth (1 month: 13.9%; 3 months: 13.7%). In addition, the rate of CAN was 20.0% at 1 month postnatal and slightly increased at 3 months postnatal (21.8%). Furthermore, this study indicates that IPV during pregnancy was significantly associated with CAN at 1 month and 3 months postnatal (ß = .16 and ß = .14) and with IPV at 1 month (ß = .68), and subsequently, IPV at 1 month was significantly associated with IPV at 3 months postnatal (ß = .56). This study suggests the importance of conducting screenings for IPV during the perinatal period and providing intensive health interventions for abused women to support their parenting from pregnancy to 3 months postnatal to prevent or reduce CAN at 1 month and 3 months postnatal.

Development and validation of a Japanese version of the TRANSITION-Q.

BACKGROUND: The evaluation of transition readiness is indispensable for long-term follow-ups of adolescent patients with childhood-onset chronic diseases (CCD). We developed a Japanese version of the TRANSITION-Q (TRANSITION-Q-J) and used it to assess Japanese patients with CCD. METHODS: The TRANSITION-Q-J was developed through forward and backward translations followed by cognitive interviews with five adolescent patients. The field test was conducted with 125 adolescent patients, and a retest was conducted with 113 adolescent patients. RESULTS: Confirmatory factor analysis supported the two-factor analysis model including F1 (communication and self-management) and F2 (examination behavior). Sufficient internal consistency and test-retest reliability were demonstrated among the total 14 items, F1, and F2 (Cronbach's α > 0.80, intraclass correlation coefficient > 0.85). Convergent and discriminant validity for the 14 items and F1 were acceptable; however, F2 did not correlate significantly with the Rosenberg Self-Esteem Scale and Independent Consciousness Scale. Regarding known-groups validity, the older group had a significantly higher mean TRANSITION-Q-J score (50.05) than the younger group (43.28; P = 0.04). The same results were found for both F1 and F2. CONCLUSIONS: The TRANSITION-Q-J for adolescent patients with CCD was developed and its reliability and validity were verified. This scale is easy to administer. In addition to being a tool for transition period support, it could be used to verify effective factors and in program outcome evaluation, including intervention studies.

Mediating effect of resilience during pregnancy on the association between maternal trait anger and postnatal depression.

OBJECTIVE: The association between anger and postnatal depression has been reported in previous studies. However, whether this association is mediated by resilience is unknown. Resilience is a dynamic process of individuals' positive adaptation to stress and adversity. This study investigated the mediating effect of resilience during pregnancy on the association between trait anger during pregnancy and postnatal depression at one-month. METHODS: A longitudinal study from the third trimester to one-month postnatal using online self-report questionnaires was conducted in two maternity clinics in Tokyo. Trait anger and resilience during pregnancy and postnatal depression at one-month were measured by the State-Trait Anger Expression Inventory, resilience test, and the Edinburgh Postnatal Depression Scale. To test the hypothesis, Structural Equation Modeling was used. RESULTS: Data of 531 participants were analyzed. The final Structural Equation Modeling model demonstrated that resilience during pregnancy had a partial mediating effect on the association between trait anger during pregnancy and postnatal depression at one-month. Trait anger was significantly associated with resilience during pregnancy (ß = -0.28) and postnatal depression (ß = 0.24). Resilience during pregnancy was significantly associated with postnatal depression (ß = -0.20). CONCLUSIONS: This study demonstrated that resilience during pregnancy had a partial mediating effect on the association between trait anger during pregnancy and postnatal depression at one-month. The findings highlight the importance of identifying pregnant women with high trait anger and providing interventions to enhance their resilience to decrease the risk of postnatal depression.

Randomized comparative study of child and caregiver responses to three software functions added to the Japanese version of the electronic Pediatric Quality of Life Inventory (ePedsQL) questionnaire.

BACKGROUND: Patient-reported outcomes (PROs) refer to any report of the status of a patient's health condition, health behavior, or experience with healthcare directly from the patient, without interpretation of the patient's response by a clinician or any other external party. While many PROs, such as the Pediatric Quality of Life Inventory (PedsQL), were originally administered in paper-and-pencil format, these are now available as electronic versions (ePROs). Although ePROs might well have used the same structure as their paper versions, we developed an alternate ePedsQL incorporating three software functions: 1) a non-forcing non-response alert, 2) a conditional question branch of the School Functioning Scale that only displays for (pre) school children, and 3) a vertical item-by-item display for small-screen devices. This report evaluated the effect of these functions on item non-response rate, survey completion time, and user experience. METHODS: All surveys were conducted via the online/computer mode. We compared the dynamic format containing the three functions with the basic format in a randomized comparative study in 2803 children and 6289 caregivers in Japan. RESULTS: We found that the non-response alert lowered the item non-response rate (0.338% to 0.046%, t = - 4.411, p < 0.001 by generalized linear mixed model analysis). The conditional question branch had mixed effects on survey completion time depending on the respondents' age. Surprisingly, respondents rated the vertical question display for handheld devices less legible than the matrix format. Further, multigroup structural equation modelling revealed that the same configuration for both formats showed an acceptable fit (CFI 0.933, RMSEA 0.060, SRMR 0.038) but the errors of observed variables were larger for the dynamic format than the basic format. CONCLUSIONS: We confirmed the robustness of the ePedsQL in different formats. The non-response rate of ePedsQL was very low even in the absence of an alert. The branch and item-by-item display were effective but unnecessary for all populations. Our findings further understanding of how humans respond to special software functions and different digital survey formats and provide new insight on how the three tested functions might be most successfully implemented.

Nurses' perceptions regarding transitional care for adolescents and young adults with childhood-onset chronic diseases.

AIM: Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood-onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood-onset chronic diseases. METHODS: A cross-sectional study using self-report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%). RESULTS: Among 623 adult unit nurses who had care experience for adult patients with a childhood-onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators. CONCLUSION: Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood-onset chronic disease continuing support through adult unit nurses.

Does Antenatal Social Support Affect the Relationships Between Intimate Partner Violence During Pregnancy And Perinatal Mental Health?

Intimate partner violence (IPV) causes adverse perinatal mental health outcomes; however, few studies have identified why. We focused on antenatal social support to reveal how it affects the relationship between IPV during pregnancy and mental health outcomes. A prospective cohort study was conducted during the third trimester and 1-month postnatal. The relationship between IPV during pregnancy and antenatal depressive symptoms, which were associated with mother-infant bonding failure and postnatal depressive symptoms, was affected by mother's satisfaction with antenatal social support. Perceived social support for abused women must be increased to prevent antenatal depressive symptoms and adverse postnatal mental health outcomes.

Intimate Partner Violence, Negative Attitudes Toward Pregnancy, and Mother-to-Fetus Bonding Failure Among Japanese Pregnant Women.

We examined the associations between intimate partner violence (IPV) before and during pregnancy, negative attitudes toward pregnancy, and mother-to-fetus bonding. Participants were 636 pregnant women in the third trimester, who completed the Mother-to-Infant Bonding Scale, Violence Against Women Screen, and ad hoc questions (for IPV before pregnancy, negative attitudes, and demographics). We found association between IPV during pregnancy and mother-to-fetus bonding failure was mediated by negative attitudes toward pregnancy in the third trimester. IPV before pregnancy was associated with negative attitudes at the beginning of pregnancy, which predicted negative attitudes in the third trimester and mother-to-fetus bonding failure. Careful assessments and psychological interventions are needed to reduce negative attitudes toward pregnancy among abused women in antenatal health settings to prevent mother-to-fetus bonding failure.

Associations among behavioral and psychological symptoms of dementia, care burden, and family-to-work conflict of employed family caregivers.

AIM: The present study aimed to examine the associations among behavioral and psychological symptoms of dementia (BPSD) of persons with dementia (PWD), care burden and family-to-work conflict (FWC) of employed family caregivers. METHOD: A cross-sectional study was carried out with employed adult daughter or son (or in-law) caregivers for PWD from two rural cities in Japan. FWC, care burden and the degree of BPSD were evaluated by the Survey Work-Home Interaction-NijmeGen, Zarit Burden Scale-Short Version and Dementia Behavior Disturbance Scale, respectively. Of the 200 questionnaires distributed, 130 were returned. A total of 53 respondents were not employed, and seven questionnaires had missing data for demographic variables, Survey Work-Home Interaction-NijmeGen, Zarit Burden Scale-Short Version or Dementia Behavior Disturbance Scale. Thus, complete data from 70 respondents were analyzed through structural equation modeling. RESULTS: The mean age of employed family caregivers was 56 years, and 34 (48.5%) were men. The mean age of PWD was 84 years, and there were 68 (68.6%) men. The path model with a good fit was shown (root mean square error of approximation 0.136, comparative fit index 0.960 and goodness of fit index 0.965). The path model showed that BPSD affected FWC, and that the association was partially mediated by care burden. CONCLUSIONS: The results show that a decrease in not only care burden, but also BPSD, of PWD is important for employed family caregivers to reduce their FWC and maintain their work-life balance. Geriatr Gerontol Int 2019; 19: 51-55.