MEDIC: Development and validation of a new instrument to assess emotional reactivity to medical stimuli in a representative community sample of adults.

To support investigation of the etiology and psychophysiology of medical traumatic stress, we developed a standardized set of emotionally-salient medical images, called the 'MEDical Image Collection' (MEDIC), for use in neuroimaging or psychological research. This study aimed to establish internal consistency, test re-test reliability, and congruent validity of the image set. A representative sample of 300 adults in the United States were recruited via research recruitment platform, Prolific. Participants rated 124 images depicting medical stimuli on one of two dimensions: emotional arousal (i.e., how strongly an evoked emotion is felt) or affective valence (i.e., how positive or negative the evoked emotion is). Sociodemographic and health-related characteristics, including experiences during the COVID-19 pandemic, were also assessed. To assess test re-test reliability, a subset (n = 200) rated the images on the same dimension a second time, 3 months later. The MEDIC image set was found to: (a) elicit a range of emotional arousal and valence ratings, (b) have excellent inter-rater reliability, (c) moderate test-retest reliability, and (d) good face validity. Results indicate the new MEDIC 124-image set is a reliable and valid instrument, enabling researchers to provide context-specific and emotionally-salient stimuli to individuals when studying affective responses in relation to health and medicine.

Identifying the 'Active Ingredients' of an Effective Psychological Intervention to Reduce Fear of Cancer Recurrence: A Process Evaluation.

Purpose: Psychological interventions targeting fear of cancer recurrence (FCR) are effective in reducing fear and distress. Process evaluations are an important, yet scarce adjunct to published intervention trials, despite their utility in guiding the interpretation of study outcomes and optimizing intervention design for broader implementation. Accordingly, this paper reports the findings of a process evaluation conducted alongside a randomized controlled trial of a psychological intervention for melanoma patients. Methods: Men and women with a history of Stage 0-II melanoma at high-risk of developing new primary disease were recruited via High Risk Melanoma Clinics across Sydney, Australia and randomly allocated to receive the psychological intervention (n = 80) or usual care (n = 84). Intervention participants received a tailored psycho-educational resource and three individual psychotherapeutic sessions delivered via telehealth. Qualitative and quantitative data on intervention context, processes, and delivery (reach, dose, and fidelity), and mechanisms of impact (participant responses, moderators of outcome) were collected from a range of sources, including participant surveys, psychotherapeutic session audio-recordings, and clinical records. Results: Almost all participants reported using the psycho-educational resource (97%), received all intended psychotherapy sessions (96%), and reported high satisfaction with both intervention components. Over 80% of participants would recommend the intervention to others, and a small proportion (4%) found discussion of melanoma-related experiences confronting. Perceived benefits included enhanced doctor-patient communication, talking more openly with family members about melanoma, and improved coping. Of potential moderators, only higher FCR severity at baseline (pre-intervention) was associated with greater reductions in FCR severity (primary outcome) at 6-month follow-up (primary endpoint). Conclusions: Findings support the acceptability and feasibility of a psychological intervention to reduce FCR amongst individuals at high risk of developing another melanoma. Implementation into routine melanoma care is an imperative next step, with FCR screening recommended to identify those most likely to derive the greatest psychological benefit.

Mental health care for parents of babies with congenital heart disease during intensive care unit admission: Systematic review and statement of best practice.

INTRODUCTION: Congenital heart disease (CHD) is one of the most common causes of infant admission to pediatric intensive care and is associated with profound psychological stress for mothers, fathers and their infants. Intensive care unit admission represents an opportunity to offer evidence-based strategies to prevent or minimize severe psychological distress and promote secure bonding and attachment, alongside high-quality infant medical care. OBJECTIVES: We aimed to identify, synthesize and critically appraise published evidence on the efficacy and cost-effectiveness of mental health interventions delivered in neonatal, pediatric or cardiac intensive care units for parents of infants with CHD. A secondary goal was to develop recommendations for advancing health policy, practice and research in the field. METHODS: In accordance with a prospectively registered protocol (CRD42019114507), six electronic databases were systematically searched for studies reporting results of a controlled trial of a mental health intervention for parents of infants aged 0-12 months with a congenital anomaly requiring intensive care unit admission. To maximize generalizability of results, trials involving infants with any type of structural congenital anomaly requiring surgery were included. Outcomes included intervention type, process, efficacy, and cost-effectiveness. RESULTS: Across all forms of congenital anomaly, only five trials met inclusion criteria (four in CHD, one in gastrointestinal malformation). All interventions engaged parents face-to-face, but each had a distinct therapeutic approach (parent-infant interaction and bonding, early pediatric palliative care, psycho-education, parenting skills training, and family-centered nursing). Four of the five trials demonstrated efficacy in reducing maternal anxiety, although the quality of evidence was low. Positive results were also found for maternal coping, mother-infant attachment, parenting confidence and satisfaction with clinical care, as well as infant mental (but not psychomotor) development at 6 months. Mixed results were found for maternal depression and infant feeding. No evidence of efficacy was found for improving parent, infant or family quality of life, physical health or length of infant hospital stay, and there were no data on cost-effectiveness. CONCLUSIONS: Stronger evidence for the efficacy of mental health interventions to buffer the effects of intensive care unit admission for parents of infants with CHD is urgently needed. Robust, high-quality trials are lacking, despite the established need and demand, and health policies prioritizing parent mental health care in the context of early childhood adversity are needed.

What can the gut microbiome teach us about the connections between child physical and mental health? A systematic review.

A deeper understanding of the gut-brain axis is of significance in pediatrics, given the influential role of early childhood experiences and exposures in shaping the microbiome, and health, across the life course. This systematic review synthesized evidence on the connection between the gut microbiome and mental health in children with physical illness. Six electronic databases were systematically searched and data extracted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of 1,476 identified articles, 11 articles reporting on nine unique studies (all randomized controlled trials) were included. Most studies examined the gut microbiome in infants with colic, while the remaining studies investigated outcomes in children aged 1 day to 18 years at risk for atopic dermatitis or irritable bowel syndrome. Baseline and postintervention gut microbiome differences varied across studies. Findings on psychological functioning also varied, with only half of the captured studies showing a positive effect of intervention on psychological well-being. Only two studies analyzed the association between the gut microbiome and psychological outcomes, each with a different pattern of results. As the field moves forward, it will be critical to gain a better understanding of the microbiome characteristics that influence mental health outcomes in pediatric populations.

Ghosts of mother's past: Previous maternal stress leads to altered maternal behavior following a subsequent pregnancy in rats.

A rodent model was used to explore whether mothers that experienced a postnatal stressor in the past (i.e., daily separations from her previous litter) exhibited altered maternal behavior during a typical, subsequent rearing experience. Stress-naïve female rats were bred and then separated from their pups (maternal separation) or remained with their pups (standard-rearing). After those pups were weaned, mothers were bred again with all pups from the subsequent litter being standard-reared. In the first week of life, various maternal behaviors directed towards these subsequent offspring were observed, including levels of nursing and pup retrieval. After weaning, mothers were tested for anxiety-like behavior, as well as memory on the object-recognition and object-placement tasks. The results show that previously stressed mothers retrieve their offspring significantly faster compared to mothers with no stress history, which may reflect a more "overprotective" mothering style. No other differences on maternal care were observed. Also, while previously stressed mothers were no more anxious than control mothers, they had impaired spatial memory on the object-placement task. This was not due to a general memory impairment as mothers performed equally on the object-recognition task, suggesting that previous maternal stress has specific effects on hippocampal-dependent tasks. That is, stress exerts lasting effects on types of behavior that are proposed to be beneficial to mothers and their offspring (i.e., efficient foraging and navigation abilities). Taken together, these results provide evidence that stress has specific and persistent effects on caregivers.

A mother's past can predict her offspring's future: Previous maternal separation leads to the early emergence of adult-like fear behavior in subsequent male infant rat offspring.

Recent evidence has shown that pups exposed to maternal separation exhibit profound changes in their emotional development, for example, early emergence of adult-like fear retention and fear inhibition (Callaghan & Richardson, 2011; Callaghan & Richardson, 2012). Numerous studies have shown that maternal separation is also a significant stressor for the mother. However, no studies have examined how a mother's prior parenting experience affects emotion development of pups in her subsequent litters. In this study female rats were bred and were then separated from their pups (maternal separation, MS) or remained with their pups (standard rearing, SR). After those pups were weaned, females were bred again with all pups from the subsequent litters being standard reared. Hence, these subsequent litter pups had mothers that were either previously separated (MS) or not (SR) from their prior litter. Those pups underwent fear conditioning at postnatal Day 17 and tested for fear retention, or had their fear extinguished and then tested for the renewal effect. The results show that the MS infants respond similarly to infants that had been directly exposed to MS. That is, the MS infants exhibited better retention of fear and more relapse after extinction compared with SR infants. Further experiments demonstrated that MS rats were not more anxious than SR infants. Taken together, these experiments are the first to demonstrate that infant offspring exhibit atypical emotional development of fear conditioning (but not anxiety) as a consequence of their mother's prior exposure to stress. (PsycINFO Database Record

In vitro bone strain analysis of implant following occlusal overload.

OBJECTIVES: To enumerate peri-implant bone strain pattern under quantified occlusal load and verify the bone response through comparison with the critical strain thresholds defined by Frost's bone mechanostat theory. MATERIAL AND METHODS: Mandibular unilateral recipient sites in two greyhound dogs were established with posterior teeth extractions. After 6 weeks, four titanium implants were placed in each dog mandible. Following 12 weeks of healing, successfully osseointegrated implants were placed in supra-occlusal contact via screw-retained non-splinted metal crowns. Plaque control and a dental health enhancing diet were prescribed. A bite force detection device was used to quantify in vivo occlusal load as the dogs functioned with supra-occlusal contact. After 8 weeks, the dogs were sacrificed. In vitro peri-implant bone strain under quantified occlusal load was measured using bonded stacked rosette strain gauges. RESULTS: The average and peak in vivo occlusal load measured were 434 and 795 newton (N). When individually and simultaneously loaded in vitro (≤476 N), absolute bone strains up to 1133 and 753 microstrains (µÎµ) were measured at implant apices, respectively. Bone strain reaching 229 µÎµ was recorded at distant sites. For bone strain to reach the pathological overload threshold defined by Frost's bone mechanostat theory (3000 µÎµ), an occlusal load of 1344 N (greater than peak measured in vivo) is required based on the simple linear regression model. CONCLUSION: Under the in vivo and in vitro conditions investigated in this study, peri-implant bone was not found to be under pathological overload following supra-occlusal contact function. Strain dissipation to distant sites appeared to be an effective mechanism by which implant overload was avoided.