Parents of preterm-born children; sources of stress and worry and experiences with an early intervention programme - a qualitative study.

BACKGROUND: Preterm-born children are at increased risk of adverse developmental outcomes, and their parents may experience increased stress levels. The Mother-Infant Transaction Program (MITP) is an early intervention that aims to enhance the parent-infant relationship and child development. The present study investigated differences in parents' experience of stress and concerns about caring for their preterm-born child according to whether they participated in the programme. Parental satisfaction with the intervention was also explored. METHODS: As part of a follow-up study at 36 months, a randomized controlled trial of the MITP-14 parents of 11 children from the intervention group, and 17 parents of 14 children from the control group were interviewed by the use of semi-structured focus group interviews. The interviews were analysed thematically. RESULTS: The intervention parents reported that the knowledge, advice, guidance and emotional support given during the intervention made them feel less stressed and more confident, competent and secure caring for their preterm born child than they would otherwise have been. The control parents described feeling less involved and emotionally supported, and seemed more anxious about their child's development than the intervention parents. All parents were vigilant and alert to their child's needs and monitored developmental milestones carefully. CONCLUSION: This qualitative exploration of the influences of the MITP revealed a positive impact of the intervention and seems to be an important educational and supportive initiative. Thus, reducing parental stress and enhancing confidence in the parental role.

Multifamily group treatment in a program for patients with first-episode psychosis: experiences from the TIPS project.

Psychoeducational multifamily group treatment based on the McFarlane model was implemented for adult patients experiencing a first episode of psychosis and for the families of 301 patients. Patients were participants in a research project in Norway and Denmark. Of 301 patients 246 were invited to participate and 147 agreed. Patients' reluctance to participate increased with age. Most had to wait between six and 12 months until a sufficient number was gathered to start a group. Treatment was well received by patients and families. Care should be taken to prevent a long delay before group commencement at this stressful period in the lives of patients and families.

Effects of a psychoeducational versus a support group intervention in patients with early-stage breast cancer: results of a randomized controlled trial.

BACKGROUND: Limited documentation exists on the effectiveness of psychoeducational group (PEG) versus support group (SG) interventions among breast cancer patients during primary care. Support group is a component of the hospitals' routine breast cancer care. OBJECTIVE: The aim of this study was to investigate which of these approaches provides the greatest benefits to participants, particularly to women with low optimism (pessimists). The primary outcomes investigated here were anxiety, depression, and mental adjustment to cancer. METHODS: A total of 367 women with early-stage breast cancer were randomized to the PEG or SG intervention starting 1 to 8 weeks after surgery. The PEG intervention included health education, enhancement of problem-solving skills, stress management, and psychological support. RESULTS: Participants in both groups showed improvement over time; however, no significant differences in emotional distress were found. The PEG participants exhibited more positive attitude at 2 and 6 months (P < .001) and less helplessness/hopelessness (P = .01) at 2 months compared with the SG participants. However, no significant differences were found between the groups at 12 months. Pessimists did not benefit more from attending the PEG than they did from attending the SG. CONCLUSION: Both groups showed improvement in emotional distress and coping over time. Although the results were limited, the PEG intervention seems to enhance short-term, but not long-term, adaptive coping. IMPLICATIONS FOR PRACTICE: Psychoeducational group intervention yields benefits during the difficult period when patients receive adjuvant chemotherapy or radiotherapy. Thus, the hospital's standard group interventions have been changed to include more health education and stress management, but within the same time frame as the original SG.

Patients' experiences with symptoms and needs in the early rehabilitation phase after coronary artery bypass grafting.

BACKGROUND: The first month after discharge for Coronary artery bypass graft (CABG) is particularly challenging for the patients. A larger interview study is warranted to elicit CABG patients' detailed experiences, and give direction for future clinical practice. AIM: To explore the CABG patients' symptoms and needs in the early rehabilitation phase. METHODS: A qualitative, mixed method design integrating qualitative and quantitative approaches was used. Ninety-three CABG patients aged 39-77, participated in interviews at home after 2 and 4 weeks. The semi-structured interview guide covered: experiences of relief of angina pectoris after surgery, experiences with prescribed discharge medications, psychological experiences: anxiety, depression, sexuality, health professional contact persons, and patient defined experiences. RESULTS: Two weeks after CABG the patients symptoms and needs were characterised by a substantial amount of uncertainty and worries related to what to expect and what was normal for postoperative pain, assessment and sensation of surgical site, different experiences with physical activity/exercise, uncertainty about medications, difficulties with sleep pattern, irritability, postoperative complications,uncertainty about return to work, and insufficient information at discharge. Four weeks after surgery the patients' symptom level was decreased, and they experienced life beginning to return back to normal. Patency with grafts after CABG, decision to drive a car, impotence (erectile dysfunction), and a missing link to the hospital remained challenges. CONCLUSION: CABG patients' experiences indicate a need to extend the hospital's discharge care to the first month after surgery for specific themes to promote rehabilitation outcomes.

Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: a randomized controlled study.

UNLABELLED: Aim of the present study was to examine the long-term effect of an early intervention for preterm infants on cognitive, gross motor and behavioural outcomes at 36 months corrected age. One hundred and eighteen preterm infants born 2005-2006 with gestational age ≥ 30.0 and <36.0 weeks were randomized to an early intervention involving the Mother-Infant Transaction Program (n = 61) or a control group (n = 57). At 36 months, 32 children in the intervention and 30 in the control group were assessed. OUTCOME MEASURES: Ages & Stages Questionnaire, Ages & Stages Questionnaire: Social-Emotional, Child Behaviour Checklist 1½-5 and Mullen Scale of Early Learning. The intervention programme had no effect on cognitive, motor or behavioural development in this group of mainly moderate and late preterm infants at 36 months corrected age. Four explanations may be proposed: the programme has a less effect on moderate and late preterm infants than in more preterm infants; modifications of the intervention might increase efficacy; a cumulative effect of the intervention leads to more obvious effects at later ages, and an improved standard care in the Neonatal Intensive Care Units may support infant development.

Effects of early mother-infant intervention on outcomes in mothers and moderately and late preterm infants at age 1 year: a randomized controlled trial.

OBJECTIVE: There is a dearth of knowledge about the effects of early interaction-based interventions on parenting and infant communication skills in moderately and late preterm infants. AIMS: Assess in a RCT the effects of the Mother-Infant Transaction program (MITP) on maternal depression and stress, breastfeeding and mothers' perception of infant temperament; and MITP's impact on preterm infant communication skills at 12 months. METHODS: Mothers/preterm infants (30-36 weeks) were randomly assigned to MITP (intervention group) or standard care (control group). Mean gestational age in the intervention group was 33.3±1.5 (n=56) and in the control group (n=50) 33.0±1.6. Outcomes were assessed by CES-D, Parenting Stress Index; WHO breast-feeding categories, Infant Behavior Questionnaire and The Pictorial Infant Communication Scales. RESULTS: Intervention mothers reported significantly less postpartum depression one month after discharge (p=.04) and more breastfeeding at 9 months (p=.02). No significant group differences in favour of the intervention group were found on total parenting stress at 6 (p=.08) and 12 months (p=.46) or on perceived infant communication skills at 12 months (p=.86). The intervention mothers reported significantly less infant smile and laughter at 6 (p=.02) and 12 (p=.006) months and less motor activity at 12 months (p=.04). CONCLUSIONS: The results suggest that MITP reduced postpartum depression and extended the period of breastfeeding, but did not support any positive effects of the intervention on self-reported maternal stress and perceived infant communication.

Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial.

In a randomized controlled trial at 12-months of age, the effect of the Mother Infant Transaction Program was tested on social interaction between mothers and moderately and late preterm infants with gestational age≥30.0 and <36 weeks. Ninety-three play sessions were videotaped and coded, 46 mothers-infants in the intervention group and 47 mothers-infants in the control group. The intervention mothers scored higher on maternal sensitivity/responsiveness (p=.05). Being a first-time mother was a moderator that enhanced the effects of the intervention. First-time mothers were more sensitive/responsive to their infant's cues (p=.01), and the dyads evinced higher level of synchrony (p=.02) as compared with experienced mothers. More positive mood was observed among their infants (p=.04). The findings suggest that the intervention contributes to better mother-infant interactions in moderately and late preterm infants of first-time mothers.