Effect of dietary n-6: n-3 Poly-Unsaturated fatty acids ratio on gestational diabetes mellitus: a prospective cohort.

OBJECTIVE: The aim of this study was to investigate the relationship between dietary n-6: n-3 poly-unsaturated fatty acids (PUFA) ratio and the risk of developing gestational diabetes mellitus (GDM). MATERIALS AND METHODS: A total of 100 pregnant women were prospectively included for detailed information on dietary intake at 16-18 weeks evaluated using a three-day food record, and subsequent GDM diagnosis at 24-28 weeks. Participants were divided into two groups for analysis: GDM group (n = 22) and control group (n = 78) based on oral glucose tolerance test results performed between 24 and 28 weeks. RESULTS: The average dietary n-6: n-3 PUFA ratio in the control group was 5.63 ± 2.12 and that in the GDM group was 8.35 ± 3.45, within a significant difference (p < .05). A significant difference was associated with a higher dietary n-6: n-3 PUFA ratio and GDM (adjusted odds ratio = 4.29, 95%confidence interval:1.303, 14.124). CONCLUSIONS: Higher dietary n-6: n-3 PUFA ratio was associated with higher odds of GDM. Given the small sample, further studies are required to confirm this hypothesis.

Enrollment and outcomes of home visiting for mothers with and without a history of out-of-home care.

Women previously in out-of-home care (i.e., foster care) experience poorer health and psychosocial outcomes compared to peers, including higher pregnancy rates and child protective services involvement. Home visiting programs could mitigate risks. Studies examining home visiting enrollment for women with a history of out-of-home care are needed. Women previously in out-of-home care based on child welfare administrative data between 2012 and 2017 (n = 1375) were compared to a demographically matched sample (n = 1375) never in out-of-home care. Vital records data identified live births in the two groups. For those who had given live birth (n = 372), linked administrative data were used to determine and compare rates of referral and enrollment into home visiting, and two indicators of engagement: number of days enrolled, and number of visits received. Women previously in out-of-home care were referred for home visiting more often than their peers. There were no differences in rates of enrollment. Women previously in out-of-home care remained enrolled for shorter durations and completed fewer home visits than peers. Findings suggest barriers to home visiting enrollment and retention in home visiting programs for women previously in out-of-home care. Studies with larger samples and more complete assessments of outcomes are warranted.

Introducción: Las mujeres que previamente han estado bajo cuidado fuera de cada (v.g. hogares de cuidado adoptivo temporal) experimentan una más débil salud y resultados sicosociales en comparación con las compañeras, incluyendo tasas más altas de embarazos y participación en servicios de protección a la niñez. Los programas de visitas a casa pudieran mitigar los riesgos. Se necesitan estudios que examinen la entrada en programas de visitas a casa de mujeres con un historial de cuidado fuera de casa. Métodos: Se comparó la información administrativa entre 2012 y 2017 de mujeres (n = 1375) que previamente estuvieron en cuidados fuera de casa basados en la beneficencia infantil con un grupo muestra demográficamente emparejado (n = 1375) que nunca habían estado bajo cuidado fuera de casa. Los datos vitales registrados identificaron nacimientos vivos en los dos grupos. Para quienes habían tenido un parto y nacimiento vivo (n = 372), se usó la información administrativa conectada para determinar y comparar las tasas de referencia y entrada en programas de visitas a casa, y dos indicadores de participación: el número de días en que estuvieron matriculadas y el número de visitas recibidas. Resultados: A las mujeres previamente bajo cuidado fuera de casa se les refirió a los programas de visita a casa más a menudo que a sus compañeras. No se dieron diferencias en las tasas de matrícula. Las mujeres previamente bajo cuidado fuera de casa permanecieron matriculadas por duraciones más cortas y completaron menos visitas a casa que sus compañeras. Conclusiones: Los resultados identifican barreras a la matrícula y retención en programas de visitas a casa para mujeres previamente bajo cuidado fuera de casa. Se justifican los estudios con grupos muestras más grandes y evaluaciones más completas de los resultados.

Les femmes ayant été placées en famille ou foyer d'accueil font l'expérience d'une plus mauvaise santé et de résultats psychologiques moins bons que les autres femmes, y compris des taux de grossesse plus élevés et l'intervention de services de protection de l'enfance. Les programmes de visite à domicile peuvent mitiger les risques. Les études examinant l'inscription aux visites à domicile pour les femmes ayant un passé de placement en famille ou en foyer sont nécessaires. Méthodes: des femmes ayant vécu un placement en famille ou en foyer selon les données administratives de la protection de l'enfance entre 2012 et 2017 (n = 1375) ont été comparées à un échantillon assorti démographiquement (n = 1375) de femmes n'ayant jamais été placées en famille ou foyer d'accueil. Nous avons identifié des naissances vivantes chez les deux groupes. Pour celles ayant donné naissance (naissance vivante) (n = 372) les données administratives liées ont été utilisées afin de déterminer et de comparer les taux d'orientation et d'inscription aux visites à domicile, et deux indicateurs d'engagement: le nombre de jours inscrites et le nombre de visites reçues. Résultats: les femmes ayant été placées dans des familles ou des foyers d'accueil étaient dirigées vers les visites à domicile plus souvent que leurs pairs. Il n'y avait aucune différence dans les taux d'inscription. Les femmes ayant été en familles ou foyers d'accueil sont restées inscrites pendant des durées plus courtes et ont eu moins de visites à domiciles que leurs pairs. Conclusions: les résultats suggèrent qu'il existe des barrières à l'inscription aux visites à domicile et à la rétention dans les programmes de visites à domicile pour les femmes ayant été placées en famille ou en foyer. Des études avec des échantillons plus grands et des évaluations plus compètes sont justifiées.

Implications of Family Cohesion and Conflict for Adolescent Mood and Well-Being: Examining Within- and Between-Family Processes on a Daily Timescale.

Family-level conflict and cohesion are well-established predictors of adolescent mental health. However, traditional approaches focusing on between-family differences in cohesion and conflict may overlook daily intrafamily variability that might provide important new information. We used data from a 21-day daily diary protocol in a sample of 151 caregivers (95.3% female) and their adolescent child (61.5% female) in two-caregiver families to test whether daily changes in family functioning are associated with daily changes in adolescent well-being and whether adolescent well-being depends on average levels of family functioning. We examined family cohesion and conflict in relation to adolescent angry, depressed, and anxious mood, as well as happiness, life satisfaction, and meaning and purpose in life in multilevel models. Both cohesion and conflict exhibited meaningful daily variation. Adolescent-reported cohesion and conflict had unique within-family associations with all six adolescent outcomes. Models using parent reports of family functioning yielded fewer associations than models with adolescent reports; however, several findings remained. Cross-level interactions indicated that within-family variations in cohesion were only associated with adolescent depression in families with lower average levels of cohesion across days. In sum, this study provides compelling evidence that families exhibit meaningful variability from day to day and that daily variation has important implications for adolescent well-being.

El conflicto y la cohesión a nivel familiar son predictores bien establecidos de la salud mental adolescente. Sin embargo, los enfoques tradicionales que se centran en diferencias interfamiliares en la cohesión y el conflicto pueden pasar por alto la variabilidad intrafamiliar diaria que podría proporcionar información importante y nueva. Utilizamos datos de un protocolo de registro diario de 21 días en una muestra de 151 cuidadores (el 95.3 % de sexo femenino) y su hijo adolescente (el 61.5% de sexo femenino) en familias de dos cuidadores para evaluar si los cambios diarios en el funcionamiento familiar están asociados con los cambios diarios en el bienestar de los adolescentes, y si el bienestar de los adolescentes depende de los niveles promedio de funcionamiento familiar. Analizamos la cohesión y el conflicto familiar en relación con los estados de ánimo de enojo, depresión y ansiedad así como de felicidad, satisfacción con la vida, y significado y propósito en la vida en modelos multinivel. Tanto la cohesión como el conflicto demostraron una variación diaria significativa. La cohesión y el conflicto informados por los adolescentes tuvieron asociaciones únicas dentro de las familias con los seis resultados de los adolescentes. Los modelos que utilizaron informes de los padres del funcionamiento familiar indicaron menos asociaciones que los modelos con informes de los adolescentes, sin embargo, quedaron varios hallazgos. Las interacciones a nivel transversal indicaron que las variaciones en la cohesión intrafamiliar estuvieron solamente asociadas con la depresión de los adolescentes en las familias con niveles promedio más bajos de cohesión a lo largo de los días. En resumen, este estudio ofrece pruebas convincentes de que las familias demuestran una variabilidad significativa día a día y de que la variación diaria tiene importantes implicancias para el bienestar de los adolescentes.

Differentiation of Self and Dyadic Adjustment in Couple Relationships: A Dyadic Analysis Using the Actor-Partner Interdependence Model.

Bowen's multigenerational theory provides an account of how the internalization of experiences within the family of origin promotes development of the ability to maintain a distinct self whilst also making intimate connections with others. Differentiated people can maintain their I-position in intimate relationships. They can remain calm in conflictual relationships, resolve relational problems effectively, and reach compromises. Fusion with others, emotional cut-off, and emotional reactivity instead are common reactions to relational stress in undifferentiated people. Emotional reactivity is the tendency to react to stressors with irrational and intense emotional arousal. Fusion with others is an excessive emotional involvement in significant relationships, whilst emotional cut-off is the tendency to manage relationship anxiety through physical and emotional distance. This study is based on Bowen's theory, starting from the assumption that dyadic adjustment can be affected both by a member's differentiation of self (actor effect) and by his or her partner's differentiation of self (partner effect). We used the Actor-Partner Interdependence Model to study the relationship between differentiation of self and dyadic adjustment in a convenience sample of 137 heterosexual Italian couples (nonindependent, dyadic data). The couples completed the Differentiation of Self Inventory and the Dyadic Adjustment Scale. Men's dyadic adjustment depended only on their personal I-position, whereas women's dyadic adjustment was affected by their personal I-position and emotional cut-off as well as by their partner's I-position and emotional cut-off. The empirical and clinical implications of the results are discussed.

La teoría multigeneracional de Bowen (1978) ofrece una explicación de cómo la internalización de experiencias dentro de la familia de origen promueve el desarrollo de la capacidad para mantener un yo diferenciado y a su vez conectarse de forma íntima con otras personas. Las personas diferenciadas pueden mantener su posición del yo en las relaciones amorosas. Pueden mantener la calma en relaciones conflictivas, resolver problemas relacionales eficazmente y llegar a acuerdos. En cambio, la fusión con los demás, el distanciamiento emocional y la sensibilidad emocional son reacciones comuntes al estrés relacional en las personas indiferenciadas. La sensibilidad emocional es la tendencia a reaccionar a factores desencadentes de estrés con excitación emocional irracional e intensa. La fusión con los demás es una implicación emocional excesiva en las relaciones significativas, mientras que el distanciamiento emocional es la tendencia a controlar la ansiedad relacional mediante la distancia física y emocional. Este estudio se basa en la teoría de Bowen, comenzando desde la suposición de que la adaptación diádica puede verse afectada tanto por la diferenciación del yo de un integrante de la pareja (efecto actor) como por la diferenciación del yo de su pareja (efecto pareja). Utilizamos el modelo de interdependicia actor-pareja (Cook & Kenny, 2005) para estudiar la relación entre la diferenciación del yo y la adaptación diádica en una muestra de conveniencia de 137 parejas italianas heterosexuales (datos diádicos, no independientes). Las parejas contestaron la "Encuesta sobre la diferenciación del yo" (Differentiation of Self Inventory, Skowron & Schmitt, 2003) y la "Escala de adaptación diádica" (Dyadic Adjustment Scale, Spanier, 1976). La adaptación diádica de los hombres dependió solo de su posición personal del yo, mientras que la adaptación diádica de las mujeres estuvo afectada por su posición personal del yo y el distanciamiento emocional así como por la posición del yo y el distanciamiento emocional de su pareja. Se debaten las consecuencias empíricas y clínicas de los resultados.

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting.

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

The Italian validation of the MIES adapted to the healthcare setting yielded a three-factor structure: (a) 'perceived transgressions by self'; (b) 'perceived transgressions by others'; (c) 'perceived betrayals by others'.Findings suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency.Future research should consider the role of individualising and social binding moral principles in shaping moral injury experiences among healthcare professionals across different socio-cultural settings.

Sleeve gastrectomy improved microvascular phenotypes from obesity cohort, detected with optical coherence tomography angiography.

AIMS: To examine how metabolic status is associated with microvascular phenotype and to identify variables associated with vascular remodeling after bariatric surgery, using noninvasive optical coherence tomography angiography (OCTA). METHODS: The study included 136 obese subjects scheduled for bariatric surgery and 52 normal-weight controls. Patients with obesity were divided into metabolically healthy obesity (MHO) and metabolic syndrome (MetS) groups according to the diagnosis criteria of the Chinese Diabetes Society. Retinal microvascular parameters were measured by OCTA, including superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities. Follow-ups were performed at the baseline and 6 months after bariatric surgery. RESULTS: Fovea SCP, average DCP, fovea DCP, parafovea DCP, and perifovea DCP vessel densities were significantly lower in the MetS group, compared to controls (19.91% vs. 22.49%, 51.60% vs. 54.20%, 36.64% vs. 39.14%, 56.24% vs. 57.65% and 52.59% vs. 55.58%, respectively, all p < .05). Parafovea SCP, average DCP, parafovea DCP, and perifovea DCP vessel densities significantly improved in patients with obesity 6 months after surgery, compared to baseline (54.21% vs. 52.97%, 54.43% vs. 50.95%, 58.29% vs. 55.54% and 55.76% vs. 51.82%, respectively, all p < .05). Multivariable analyses showed that baseline blood pressure and insulin were independent predictors of vessel density changes 6 months after surgery. CONCLUSIONS: Retinal microvascular impairment occurred mainly in MetS rather than MHO patients. Retinal microvascular phenotype improved 6 months after bariatric surgery and baseline blood pressure and insulin status may be key determinants. OCTA may be a reliable method to evaluate the microvascular complications associated with obesity.

The 10-item Adverse Childhood Experience International Questionnaire (ACE-IQ-10): psychometric properties of the Dutch version in two clinical samples.

BACKGROUND: Childhood trauma has been associated with adult mental disorders, physical illness, and early death. The World Health Organization (WHO) supported the development of the Adverse Childhood Experiences International Questionnaire (ACE-IQ) to explore childhood trauma in adults. We report the psychometric properties of the Dutch version of the Adverse Childhood Experiences International Questionnaire 10 items version (ACE-IQ-10) in the Netherlands. METHODS: Confirmatory factor analysis was performed in two convenience samples of consecutive patients presenting at an outpatient specialty mental health setting between May 2015 and September 2018: Sample A (N = 298), patients with anxiety and depressive disorders; and sample B (N = 234), patients with Somatic Symptom and Related Disorders (SSRD). Criterion validity of the scales of the ACE-IQ-10 was explored by their correlation with the PHQ-9, the GAD-7, and the SF-36. The correlation between reporting sexual abuse on the ACE-IQ-10 and in a face-to-face interview was assessed as well. RESULTS: We found support for a two-factor structure in both samples: one for directly experiencing childhood abuse and another for household dysfunction, but also support for using the total score. The correlation between reporting a sexual trauma in childhood at face-to-face interview and the sexual abuse item of the ACE-IQ-10 was r = .98 (p < .001). CONCLUSIONS: The current study provides evidence on the factor structure, reliability, and validity of the Dutch ACE-IQ-10 in two Dutch clinical samples. It shows clear potential of the ACE-IQ-10 for further research and clinical use. Further studies are needed to assess the ACE-IQ-10 in the Dutch general population.

This is the first study reporting the psychometric properties of the Dutch version of the short version of the Adverse Childhood Experiences International Questionnaire (ACE-IQ-10).We found support for a two-factor structure: one for directly experiencing childhood abuse and another for household dysfunction, but also support for using the total score. The sexual abuse item of the ACE-IQ-10 correlates highly with face-to-face exploration (r = .98).The ACE-IQ-10 shows clear potential for clinical use, for example as a first screener to support further exploration of adverse childhood experiences.

Longitudinal changes in brain structure and their relationship with subclinical psychiatric symptoms in parents who lost their only child in China.

BACKGROUND: Losing an only child (Shidu) is a grievous traumatic event that may affect brain structure, even if it does not lead to psychiatric disorders. However, longitudinal changes in brain structure and their relationship to subclinical psychiatric symptoms (SPS) have not been well investigated in Shidu parents without any psychiatric disorders (SDNP). OBJECTIVES: This study aimed to investigate cross-sectional and longitudinal changes in cortical thickness and surface area in SDNP, and to explore their relationship with SPS. METHODS: A total of 50 SDNP and 40 matched healthy controls (HC) were enrolled. All participants underwent structural MRI scans and clinical assessment at baseline and at the 5-year follow-up. Differences in brain structural phenotypes (cortical thickness, surface area, and their annual rate of change) between the SDNP and HC groups were compared using FreeSurfer. Correlations between significant brain structural phenotypes and SPS in the SDNP group were evaluated using multiple linear regressions. RESULTS: The SDNP group showed a smaller surface area in the left inferior parietal cortex than the HC group at baseline and follow-up. The SDNP group showed slower rates of cortical thinning and surface area loss in several brain regions than the HC group from baseline to follow-up. Moreover, slower rates of cortical thinning in the left insula, superior frontal cortex, and superior temporal cortex were associated with greater reductions in avoidance, depression, and trauma re-experiencing symptoms scores over time in the SDNP group, respectively. CONCLUSIONS: Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms. The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

This study focused on longitudinal changes in cortical thickness and surface area and their relationship with subclinical psychiatric symptoms in Shidu parents without any psychiatric disorders.Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms.The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

Alchemical dragons: Winnicott's reaching towards the objective psyche.

This paper was presented to the inaugural joint conference of The Society of Analytical Psychology and the West Midlands Institute of Psychotherapy in the autumn of 2020. It develops the author's interest (2011, 2015, 2016) in Winnicott's engagement with Jung by looking at the imagery of Michael Maier's alchemical work of 1617, Atalanta Fugiens, through the lens of Matte Blanco's bi-logic.

Cet article a été présenté à la conférence inaugurale commune à la Society of Analytical Psychology et à l'Institut de Psychothérapie des West Midlands, à l'automne 2020. L'article représente le prolongement de l'intérêt de son auteur (2011, 2015, 2016) pour l'implication de Winnicott avec Jung, ceci en se penchant sur l'imagerie du travail alchimique de Michael Maier en 1617 dans son Atalanta Fugiens, et en le regardant à travers la perspective de la bi-logique de Matte Blanco.

El presente trabajo fue presentado en la Conferencia inaugural conjunta de la Sociedad de Psicología Analítica y el Instituto de Psicoterapia West Midlands en otoño del 2020. Desarrolla el interés del autor (2011, 2015, 2016) en el involucramiento de Winnicott con Jung, contemplando la imaginería del trabajo alquímico Atalanta Fugiens de Michael Maier de 1617, a través de la lente bi-lógica de Matte Blanco.

Crossover design and its application in late-phase diabetes studies.

Crossover design has been widely used in late-phase clinical studies, as well as in pharmacokinetic and pharmacodynamic, bioequivalence, and medical device studies; however, its interpretability and applicability continue to be debated. Herein we provide discussions around a crossover design's scientific benefit, applicability, and how it can be implemented in late-phase diabetes studies by properly handling key issues: carryover effect, washout period, and baseline selection. Specifically, detailed considerations are provided about the validity and situations of having appropriate length of study duration to deal with carryover effects so that a washout period may not be needed. A simulation study and data mining results on 12 crossover late-phase insulin clinical trials are presented to examine the discussion points and proposals.