Were Frailty Identification Criteria Created Equal? A Comparative Case Study on Continuous Non-Invasively Collected Neurocardiovascular Signals during an Active Standing Test in the Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: In this observational study, we compared continuous physiological signals during an active standing test in adults aged 50 years and over, characterised as frail by three different criteria, using data from The Irish Longitudinal Study on Ageing (TILDA). METHODS: This study utilised data from TILDA, an ongoing landmark prospective cohort study of community-dwelling adults aged 50 years or older in Ireland. The initial sampling strategy in TILDA was based on random geodirectory sampling. Four independent groups were identified: those characterised as frail only by one of the frailty tools used (the physical Frailty Phenotype (FP), the 32-item Frailty Index (FI), or the Clinical Frailty Scale (CFS) classification tree), and a fourth group where participants were not characterised as frail by any of these tools. Continuous non-invasive physiological signals were collected during an active standing test, including systolic (sBP) and diastolic (dBP) blood pressure, as well as heart rate (HR), using digital artery photoplethysmography. Additionally, the frontal lobe cerebral oxygenation (Oxy), deoxygenation (Deoxy), and tissue saturation index (TSI) were also non-invasively measured using near-infrared spectroscopy (NIRS). The signals were visualised across frailty groups and statistically compared using one-dimensional statistical parametric mapping (SPM). RESULTS: A total of 1124 participants (mean age of 63.5 years; 50.2% women) were included: 23 were characterised as frail only by the FP, 97 by the FI, 38 by the CFS, and 966 by none of these criteria. The SPM analyses revealed that only the group characterised as frail by the FI had significantly different signals (p < 0.001) compared to the non-frail group. Specifically, they exhibited an attenuated gain in HR between 10 and 15 s post-stand and larger deficits in sBP and dBP between 15 and 20 s post-stand. CONCLUSIONS: The FI proved to be more adept at capturing distinct physiological responses to standing, likely due to its direct inclusion of cardiovascular morbidities in its definition. Significant differences were observed in the dynamics of cardiovascular signals among the frail populations identified by different frailty criteria, suggesting that caution should be taken when employing frailty identification tools on physiological signals, particularly the neurocardiovascular signals in an active standing test.

Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum.

BACKGROUND: Sleep disturbance is common in gestational parents during pregnancy and postpartum periods. This study evaluated the feasibility and efficacy of a scalable cognitive behavioural therapy (CBT) sleep intervention tailored for these periods. METHODS: This is a two-arm, parallel-group, single-blind, superiority randomised controlled trial. Nulliparous females without severe medical/psychiatric conditions were randomised 1:1 to CBT or attention- and time-matched control. All participants received a 1 h telephone session and automated multimedia emails from the third trimester until 6 months postpartum. Outcomes were assessed with validated instruments at gestation weeks 30 (baseline) and 35 (pregnancy endpoint), and postpartum months 1.5, 3, 6 (postpartum endpoint), 12 and 24. RESULTS: In total, 163 eligible participants (age M ± s.d. = 33.35 ± 3.42) were randomised. The CBT intervention was well accepted, with no reported adverse effect. Intention-to-treat analyses showed that compared to control, receiving CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p values ⩽ 0.001), as well as at 24 months postpartum (p ranges 0.012-0.052). Group differences across the first postpartum year were non-significant. Participants with elevated insomnia symptoms at baseline benefitted substantially more from CBT (v. control), including having significantly lower insomnia symptoms throughout the first postpartum year. Group differences in symptoms of depression or anxiety were non-significant. CONCLUSIONS: A scalable CBT sleep intervention is efficacious in buffering against sleep disturbance during pregnancy and benefitted sleep at 2-year postpartum, especially for individuals with insomnia symptoms during pregnancy. The intervention holds promise for implementation into routine perinatal care.

Identifying post-traumatic stress disorder in women of refugee background at a public antenatal clinic.

The aim of this study was to investigate symptomatology and diagnoses of PTSD and subthreshold PTSD and the screening properties of the Harvard Trauma Questionnaire (HTQ) within a sample of Dari-speaking women of refugee background receiving antenatal care. This cross-sectional study administered the HTQ to 52 Dari-speaking women at a public pregnancy clinic. The trauma module from the Structured Clinical Interview (SCID-5) was administered. Interview material was presented to an expert panel, blinded to the HTQ screening results, in order to achieve consensus diagnoses of PTSD using Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria. Three women (5.8%) met DSM-5 criteria for PTSD. Eleven women (21.15%) met criteria for subthreshold PTSD, defined as meeting two or three of the DSM-5 criteria domains. A comparison of HTQ cut-off scores was conducted and a score of ≥ 2.25 on the HTQ demonstrated excellent sensitivity 1.00 (95% CI 0.29-1.00) and specificity 0.76 (95% CI 0.61-0.87) in detecting PTSD; however, a wide confidence interval for sensitivity was found. A cut-off score of ≥ 2 provided the best balance of sensitivity 1.00 (95% CI 0.72-1.00) and specificity 0.80 (95% CI 0.65-0.91) when assessing for subthreshold PTSD. Screening for perinatal PTSD for women of refugee background is recommended, in order to identify those at risk of DSM diagnosis and also those women experiencing distressing PTSD symptomatology.

Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition.

OBJECTIVE: This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recommendations from the previous 2013 edition of the Guidelines. METHOD: Systematic review of the international research was undertaken, with GRADE methodology used to assess the certainty of the evidence, and evidence to decision frameworks used to generate recommendations. The Guidelines are presented in an online format using MAGICApp. RESULTS: Key changes since the publication of the 2013 Guidelines include a new conditional recommendation for Child and Family Traumatic Stress Intervention for children and adolescents with symptoms within the first 3 months of trauma, and a strong recommendation for trauma-focused cognitive behaviour therapy for the child alone or with a caregiver, for those with diagnosed posttraumatic stress disorder. For adults with posttraumatic stress disorder, strong recommendations are made for specific types of trauma-focused cognitive behaviour therapy and conditional recommendations are made for five additional psychological interventions. Where medication is indicated for adults with posttraumatic stress disorder, venlafaxine is now conditionally recommended alongside sertraline, paroxetine or fluoxetine. CONCLUSION: These Guidelines, based on systematic review of the international literature, are intended to guide decision making for practitioners, service planners, funders and those seeking treatment for trauma related mental health concerns. For an Australian Guideline, a critical limitation is the absence of research on the treatment of Australian Aboriginal and Torres Strait Islander peoples. The new online format of the Australian posttraumatic stress disorder Guidelines means that they can be updated as sufficient new evidence becomes available.

A psychological group intervention for high-risk pregnant women: a protocol of a feasibility and acceptability study of the STAR Mums program.

BACKGROUND: In pregnancy, the attachment relationship between a mother and her baby begins to develop and women are more motivated and willing to make changes to become more engaged and responsive mothers and have better relationships with their children. A transgenerational framework has proposed that dysfunctional relationship patterns are often repeated across generations and this has broadened the understanding of early difficulties in parenting. Despite this there has been little research specifically examining high-risk perinatal women and how their interactions with their infants are related to attachment or relational outcomes. METHODS: This pilot study aims to evaluate, and to explore the acceptability and feasibility, of participating in the Supporting Transitions, Attachment and Relationships (STAR Mums) program, a psychodynamic attachment-based group intervention, for pregnant women with risk factors for attachment difficulties. The STAR Mums program aims to intervene during pregnancy to assist women with risk factors in the transition to parenthood with the desired outcome to improve the quality of mother-infant emotional interactions, regulation and the attachment relationship. This is a mixed-methods design study incorporating both qualitative and quantitative assessments of five groups of five first-time mothers over a 12-month period. CONCLUSIONS: This paper outlines the STAR Mums intervention and protocol for assessing acceptability and feasibility. The STAR Mums program takes a preventative approach and supports early intervention for parents at risk of attachment difficulties with their infants. The results of this study will inform revisions to the current treatment manual and a larger-scale program evaluation to further examine the efficacy of this intervention.

Cardiovascular Signal Entropy Predicts All-Cause Mortality: Evidence from The Irish Longitudinal Study on Ageing (TILDA).

In this study, the relationship between cardiovascular signal entropy and the risk of seven-year all-cause mortality was explored in a large sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA). The hypothesis under investigation was that physiological dysregulation might be quantifiable by the level of sample entropy (SampEn) in continuously noninvasively measured resting-state systolic (sBP) and diastolic (dBP) blood pressure (BP) data, and that this SampEn measure might be independently predictive of mortality. Participants' date of death up to 2017 was identified from official death registration data and linked to their TILDA baseline survey and health assessment data (2010). BP was continuously monitored during supine rest at baseline, and SampEn values were calculated for one-minute and five-minute sections of this data. In total, 4543 participants were included (mean (SD) age: 61.9 (8.4) years; 54.1% female), of whom 214 died. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for the associations between BP SampEn and all-cause mortality. Results revealed that higher SampEn in BP signals was significantly predictive of mortality risk, with an increase of one standard deviation in sBP SampEn and dBP SampEn corresponding to HRs of 1.19 and 1.17, respectively, in models comprehensively controlled for potential confounders. The quantification of SampEn in short length BP signals could provide a novel and clinically useful predictor of mortality risk in older adults.

Age-related normative changes in cerebral perfusion: Data from The Irish Longitudinal Study on Ageing (TILDA).

OBJECTIVE: To establish normative reference values for total grey matter cerebral blood flow (CBFGM) measured using pseudo-continuous arterial spin labelling (pCASL) MRI in a large cohort of community-dwelling adults aged 54 years and older. BACKGROUND: Quantitative assessment of CBFGM may provide an imaging biomarker for the early detection of those at risk of neurodegenerative diseases, such as Alzheimer's and dementia. However, the use of this method to differentiate normal age-related decline in CBFGM from pathological reduction has been hampered by the lack of reference values for cerebral perfusion. METHODS: The study cohort comprised a subset of wave 3 (2014-2015) participants from The Irish Longitudinal Study on Ageing (TILDA), a large-scale prospective cohort study of individuals aged 50 and over. Of 4309 participants attending for health centre assessment, 578 individuals returned for 3T multi-parametric MRI brain examinations. In total, CBFGM data acquired from 468 subjects using pCASL-MRI were included in this analysis. Normative values were estimated using Generalised Additive Models for Location Shape and Scale (GAMLSS) and are presented as percentiles, means and standard deviations. RESULTS: The mean age of the cohort was 68.2 ± 6.9 years and 51.7% were female. Mean CBFGM for the cohort was 36.5 ± 8.2 ml/100 g/min. CBFGM decreased by 0.2 ml/100 g/min for each year increase in age (95% CI = -0.3, -0.1; p ≤ 0.001) and was 3.1 ml/100 g/min higher in females (95% CI = 1.6, 4.5; p ≤ 0.001). CONCLUSIONS: This study is by far the largest single-site study focused on an elderly community-dwelling cohort to present normative reference values for CBFGM measured at 3T using pCASL-MRI. Significant age- and sex-related differences exist in CBFGM.

Clinical clustering of eight orthostatic haemodynamic patterns in The Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: Orthostatic hypotension (OH) can be assessed with non-invasive continuous beat-to-beat haemodynamic monitoring during active stand (AS) testing; this yields large volumes of data outside the scope of the traditional OH definition. We explored clinical associations of different AS patterns in participants from Wave 1 of the Irish Longitudinal Study on Ageing. METHODS: AS patterns were generated based on three sequential binary systolic blood pressure features: drop ≥40 mmHg within 10 sec post-stand ("immediate deficit"), failure to return to within 20 mmHg of supine level at 40 sec after standing ("stabilisation deficit") and drop ≥20 mmHg between >40 and 120 sec post-stand ("late deficit"). Eight AS groups resulted from combining the presence/absence of these three features. The groups were cross-sectionally characterised, and their ability to independently predict orthostatic intolerance (OI) during AS, and falls or syncope in the past year, was evaluated using multivariate logistic regression models. RESULTS: A total of 4,899 participants were included (mean age 61), of which 3,312 (68%) had no deficits. Older age was associated with stabilisation deficit and late deficits were seen in groups with higher proportions of beta blockers and psychotropic medications. Regression models identified independent associations between OI and three immediate-deficit groups; associations seemed stronger as more deficits were present. There was a significant association between falls history and the three-deficit group (odds ratio 1.54, 95% confidence interval: 1.15-2.07, P = 0.004). CONCLUSIONS: More deficits seemed associated with the higher risk of OI and falls history. Observations are not causal but the recognition of these patterns may help clinicians focus on careful prescribing.

Cancer during pregnancy: A qualitative study of healthcare experiences of Australian women.

OBJECTIVES: To identify features enhancing the quality of healthcare experiences for women with gestational cancer, and explore the impact of the heterogeneous Australian healthcare system on those experiences. METHODS: Semi-structured, qualitative interviews were conducted with women diagnosed with any cancer during pregnancy in the last five years. Recruitment occurred during 2018-2019 via social media and professional, clinical and community networks. Questions related to women's experiences of their healthcare, wellbeing and psychosocial needs. Interviews were analysed thematically. RESULTS: Study participants (n = 23) received treatment in the private sector (n = 10), public sector (n = 8), or both (n = 5). Five interview themes were found: Control over healthcare; Trust in clinicians, hospitals and systems; Coordination of care; An uncommon diagnosis; Holistic, future-oriented care. Women were most likely to have had a positive healthcare experience when (a)care was well-coordinated and adjusted to meet their unique needs/challenges, and (b)women perceived their care went beyond their immediate medical needs and encompassed future psychosocial wellbeing, including preparation for postpartum challenges. CONCLUSION: Existing 'usual care' in the public and/or private sector for both the pregnancy and the cancer is insufficient to meet these women's needs. Prioritising psychological wellbeing including psychosocial needs, and communication and planning around fertility and postnatal challenges are essential for this population.

Associations between Cardiovascular Signal Entropy and Cognitive Performance over Eight Years.

In this study, the relationship between non-invasively measured cardiovascular signal entropy and global cognitive performance was explored in a sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA), both cross-sectionally at baseline (n = 4525; mean (SD) age: 61.9 (8.4) years; 54.1% female) and longitudinally. We hypothesised that signal disorder in the cardiovascular system, as quantified by short-length signal entropy during rest, could provide a marker for cognitive function. Global cognitive function was assessed via Mini Mental State Examination (MMSE) across five longitudinal waves (8 year period; n = 4316; mean (SD) age: 61.9 (8.4) years; 54.4% female) and the Montreal Cognitive Assessment (MOCA) across two longitudinal waves (4 year period; n = 3600; mean (SD) age: 61.7 (8.2) years; 54.1% female). Blood pressure (BP) was continuously monitored during supine rest at baseline, and sample entropy values were calculated for one-minute and five-minute sections of this data, both for time-series data interpolated at 5 Hz and beat-to-beat data. Results revealed significant associations between BP signal entropy and cognitive performance, both cross-sectionally and longitudinally. Results also suggested that as regards associations with cognitive performance, the entropy analysis approach used herein potentially outperformed more traditional cardiovascular measures such as resting heart rate and heart rate variability. The quantification of entropy in short-length BP signals could provide a clinically useful marker of the cardiovascular dysregulations that potentially underlie cognitive decline.

Pervasive refusal syndrome in child asylum seekers on Nauru.

OBJECTIVES: Between 2013 and 2019, an estimated 200 children seeking asylum in Australia were detained on the island of Nauru. In 2018, 15 of these children developed the rare and life-threatening pervasive refusal syndrome (PRS). This paper describes the PRS case cluster, the complexities faced by clinicians managing these cases, and the lessons that can be learned from this outbreak. CONCLUSIONS: The emergence of PRS on Nauru highlighted the risks of long-term detention of children in settings that are unable to meet their physical and psycho-social needs. The case cluster also underscored (a) the difficulties faced by doctors working in conditions where their medical and legal obligations may be in direct conflict, and (b) the role of clinicians in patient advocacy.

Male callers to an Australian perinatal depression and anxiety help line-Understanding issues and concerns.

There is increasing recognition of the issues facing men in the perinatal period. Vulnerability factors and issues in the partner relationship contribute to mental health risk and can impact the quality of the father-infant relationship. Yet, there is limited understanding of fathers' help-seeking when they or their partner are experiencing mental health issues in the context of caring for a new baby. The present study examines fathers' contacts with the Perinatal Anxiety and Depression Australia (PANDA) National Helpline. The study reviewed contacts from fathers and their identified needs for assistance, relationship issues, and support needs; 70% of male callers (N = 129) reported concerns about the mother's mental health, and 57% were concerned about relationship breakdown. Significant numbers of men raised issues about their own mental health (43%) and many were concerned about the impact of maternal mental state on the relationship with the infant. When compared to community data, there were elevated rates of concerns about depression and anxiety. Men also described difficulties with the fathering role and with regulating their own feelings of guilt and frustration. These findings highlight the needs of men for support when a mother experiences perinatal problems and also the risk for distress in fathers.

Hay un incremento en el reconocimiento de los asuntos que enfrentan los hombres en el período perinatal.  Los factores de vulnerabilidad y asuntos en la relación con la pareja contribuyen al riesgo de salud mental y pueden tener impacto en la calidad de la relación papá-infante.  Aun así, hay una comprensión limitada acerca de la búsqueda de ayuda por parte de los papás cuando ellos o sus parejas están experimentando asuntos de salud mental en el contexto de cuidar a un nuevo bebé.  El presente estudio examina el contacto de los papás con la línea de ayuda nacional Ansiedad y Depresión Perinatal Australia (PANDA). El estudio revisó contactos de papás y sus identificadas necesidades para la asistencia, asuntos de la relación y necesidades de apoyo: 70% de los varones que llamaron (N = 129) reportaron preocupaciones acerca de la salud mental de la madre y 57% estaban preocupados acerca del rompimiento de la relación.  Un significativo número de hombres presentaron asuntos acerca de su propia salud mental (43%) y muchos estaban preocupados sobre el impacto del estado mental materno en la relación con el infante. Cuando se compara con la información comunitaria, hubo puntajes elevados de preocupaciones acerca de la depresión y la ansiedad. Los hombres también describieron dificultades con el papel de ser padres y con la forma de regular sus propios sentimientos de culpa y frustración.  Estos resultados subrayan las necesidades de los hombres de apoyo cuando una madre experimenta un problema perinatal y también el riesgo de angustia en los papás.

Les problèmes auxquels font face les hommes durant la période périnatale sont de plus en plus reconnus. Des facteurs et des problèmes de vulnérabilité dans la relation au partenaire contribuent au risque de santé mentale et peuvent avoir un impact sur la qualité de la relation père-enfant. Cependant on n'a que des connaissances limitées de l'appel à l'aide des pères lorsqu'ils font ou lorsque leur partenaire fait l'expérience de problèmes de santé mentale dans le contexte du soin à un nouveau-né. Cette étude a examiné les contacts des pères avec la ligne téléphonique nationale australienne pour l'anxiété et la dépression périnatales, abrégée PANDA selon l'anglais. Cette étude a passé en revue les contacts de pères et leurs besoins identifiés d'assistance et de soutien pour des problèmes liés à une relation: 70% des hommes ayant téléphoné (N = 129) ont fait état d'inquiétude à propos de la santé mentale de la mère et 57% étaient inquiets de la désintégration de la relation. Un nombre important d'hommes ont parlé de leur propre santé mentale (43%) et beaucoup d'entre eux étaient inquiets à propos de l'impact de l'état mental maternel sur la relation avec le nourrisson. Comparé aux données communautaires, on a trouvé des niveau élevés d'inquiétude sur la dépression et l'anxiété. Ces hommes ont aussi décrit des difficultés avec le rôle de père et avec la régulation de leurs propres sentiments de culpabilité et de frustration. Ces résultats mettent en évidence les besoins qu'ont les hommes de soutien quand une mère fait l'expérience d'un problème périnatal, et aussi le risque de détresse chez les pères.

Development and initial reliability and validity of a new measure of distorted maternal representations: The Mother-Infant Relationship Scale.

Distorted maternal representations (DMRs)-mother's ideas, understanding, and feelings about the infant-shape early interaction and the emerging relationship. Distorted interactions reportedly affect infant attachment and socioemotional development and may be associated with maternal early adversity and trauma. Limited measures are available that could be used as screening tools of DMRs. The aims of this study were to (a) describe the development of the Mother-Infant Relationship Scale (MIRS) and (b) to evaluate its psychometric properties. The development and validation of the MIRS closely followed standard guidelines for the development of psychometric tests. Psychometric properties were examined across two samples: 78 adult psychiatric patients with features of borderline personality and 86 individuals from a nonclinical sample (N = 164). The scale demonstrated excellent internal consistency (Cronbach's α = .91) for the clinical sample and adequate internal consistency (.78) for the nonclinical sample, excellent test-retest reliability (intraclass correlation coefficient = .81), and good concurrent validity with an observational (Pearson's correlation coefficients = -.35 to -.54) and a representational measure (.53). Factor analysis revealed three components: DMRs specific to (a) maternal hostility/rejection of the infant, (b) issues about parenting/attachment, and (c) anxiety/helplessness about infant care. Findings suggest that the MIRS is a reliable and valid screening tool of DMRs. Potential uses in clinical and research settings are discussed.

Las Representaciones Maternas Distorsionadas (DMR) - ideas, comprensión y sentimientos de la madre sobre el infante - le dan forma a la temprana interacción y la naciente relación. Las interacciones distorsionadas, según se dice, afectan la unión afectiva y el desarrollo socio-emocional del infante y pudieran estar asociadas con la temprana adversidad y trauma maternos. Limitadas medidas están disponibles para ser usadas como herramientas de detección de DMR. Las metas de este estudio fueron (1) describir el desarrollo de la Escala de la Relación Madre-Infante (MIRS) y (2) evaluar sus propiedades sicométricas. El desarrollo y validación de MIRS siguió muy de cerca los parámetros estándares para el desarrollo de pruebas sicométricas. Las propiedades sicométricas fueron examinadas en 2 grupos muestras: 78 pacientes siquiátricos adultos con características de personalidad limítrofe y 86 individuos de un grupo muestra no clínico (N=164). La escala demostró una consistencia interna excelente (alfa de Cronbach .91) para el grupo muestra clínico y adecuada (.78) para el no clínico, una excelente confiabilidad de prueba y re-prueba (ICC .81), y una buena validez simultánea con una medida de observación (coeficientes de correlación de Pearson entre -.35 y -.54) y una de representación (.53). Los análisis de factores revelaron 3 componentes: específicas DMR para (1) hostilidad materna/rechazo del infante, (2) asuntos sobre crianza/afectividad, (3) ansiedad/sentirse sin ayuda acerca del cuidado del infante. Los resultados sugieren que MIRS es una herramienta de detección de DMR confiable y válida. Se discuten los posibles usos en escenarios clínicos y la investigación.

Les Représentations Maternelles Déformées (RMD en français) - les idées des mères, leur compréhension, leurs sentiments sur le nourrisson - donnent forme à l'interaction et à la relation qui émerge. Il semblerait que les interactions déformées affectent l'attachement du nourrisson et le développement socio-émotionnel et qu'elles pourraient être liées à l'adversité maternelle précoce et au trauma. Des mesures limitées sont disponibles qui pourraient être utilisées comme outils de dépistages des RMD. Dans ce contexte, les buts de cette étude étaient de (1) décrire le développement de l'Echelle de la Relation Mère-Nourrisson (MIRS en anglais) et (2) évaluer ses propriétés psychométriques. Le développement et la validation de la MIRS ont suivi attentivement les lignes directrices standard pour le développement de tests psychométriques. Les propriétés psychométriques ont été examinées au travers de 2 échantillons: 78 patients psychiatriques adultes avec des traits de la personnalité limite, et 86 individus d'un échantillon non-clinique (N=164). L'échelle a fait preuve d'une cohérence interne excellente (alpha de Cronbach ,91) pour l'échantillon clinique et adéquate (,78) pour l'échantillon non-clinique, ainsi que d'une fiabilité test-re-test excellente (ICC s81), tout comme d'une bonne validité simultanée avec une mesure d'observation (coefficients de corrélation de Pearson allant de -,35 à -,54) et une mesure de représentation (,53). L'analyse de facteurs a révélé 3 composantes spécifiques aux RMD (1) de l'hostilité/la rejection du nourrisson, (2) des problèmes de parentage/attachement, (3) de l'anxiété / du désarroi à propos du soin du nourrisson. Les résultats suggèrent que la MIRS est un outil fiable et valide de détection des RMD. Des utilisations possibles dans des milieux cliniques et des milieux de recherche sont discutés.

Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features, maternal mental state, and observed interaction.

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother-infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother-infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self-as-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother-Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother-infant interaction. Implications for research and clinical practice are discussed.

A pesar de la larga asociación teorética en la literatura de la afectividad entre el historial de trauma materno y perturbaciones en la interacción madre-infante, pocos estudios han investigado mecanismos de transmisión de patrones de relación traumatogénicos en díadas madre-infante de alto riesgo. Este estudio investigó interrelaciones entre el historial de trauma materno, las distorsionadas representaciones maternas (DMR, v.g. pensamientos y sentimientos perturbados acerca del infante y de sí misma como madre), la mentalización materna (v.g. capacidad para concebir las intenciones propias y de otros en términos de estados mentales), y la calidad de interacción en un grupo muestra clínico de madres con características de Trastornos de Personalidad Limítrofe (BPD) y sus infantes (N = 61). Entre las medidas usadas están el Cuestionario de Trauma de Niñez, la Entrevista de Desarrollo de la Progenitora, la Escala de Relación Madre-Infante, la Lista de Verificación de Síntomas de Personalidad Limítrofe - 23, y las Escalas de Disponibilidad Emocional. Los resultados indicaron que las características BPD mediaron la relación entre el historial de trauma materno y las DMR prediciendo perturbaciones en la interacción. Es más, los análisis mostraron que la mentalización materna tenía un efecto amortiguador entre las DMR y la no hostilidad materna y aun así la severidad de las características BPD moderaron la relación entre la mentalización y las DMR. Los resultados sugieren que la patología limítrofe posterior al parto pudiera impactar adversamente la experiencia de ser madre para mujeres con historial de trauma, incluyendo déficits en la mentalización (v.g. la hipermentalización) y las perturbaciones en la interacción madre-infante. Se discuten las implicaciones para la investigación y la práctica clínica.

En dépit de la longue association théorique dans les recherches sur l'attachement entre le passé de trauma de la mère et les perturbations dans l'interaction mère-bébé, il existe peu d'études portant sur les mécanismes de transmission de patterns relationnels traumagénétiques chez les dyades mère-bébé à haut risque. Cette étude s'est penchée sur les interrelations entre le passé de trauma de la mère, des représentations maternelles déformées (des DMR, c'est-à-dire des pensées déformées ainsi que des sentiments déformés sur le bébé et soi-même en tant que parent), la mentalisation maternelle (c'est-à-dire la capacité de concevoir ses propres intentions ainsi que celles des autres en termes d'états mentaux), et la qualité de l'interaction chez un échantillon clinique de mères ayant les caractéristiques du trouble de la personnalité limite et leurs bébé (N = 61). Les mesures utilisées ont inclus le Questionnaire de Trauma de l'Enfance, l'Entretien du Développement du Parent, l'Echelle de Relation Mère-Bébé, la Checklist de Symptômes de la Personnalité Limite-23, ainsi que les Echelles de Disponibilité Emotionnelle. Les résultats ont indiqué que les traits de TPL affectaient la relation entre l'histoire de trauma de la mère et les DMS = R prédisant une perturbation dans l'interaction. De plus les analyses ont montré que la mentalisation maternelle faisait effet de tampon entre les DMR et la non-hostilité maternelle et pourtant la sévérité des traits TPL modérait la relation entre la mentalisation et les DMR. Les résultats suggèrent qu'une pathologie limite postpartum pourrait avoir un impact adverse sur l'expérience de parentage pour les femmes ayant un passé de trauma, y compris des déficits dans la mentalisation (par exemple, une hyper-mentalisation) et des perturbations dans l'interaction mère-bébé. Les implications pour les recherches et la pratique clinique sont discutées.

Attachment and child behaviour and emotional problems in autism spectrum disorder with intellectual disability.

BACKGROUND: Behaviour and emotional problems are highly prevalent in children with autism spectrum disorder (ASD). In typically developing children, attachment quality acts as a risk/protective factor for behavioural outcomes and adjustment, warranting investigation in children with ASD. METHOD: We investigated the relationship between attachment and child behaviour and emotional problems in children with ASD and comorbid intellectual disability. Data were collected from parent-child dyads where children were diagnosed with ASD and ID (n = 28) or other developmental disabilities (n = 20). RESULTS: Children with ASD had higher levels of behaviour and emotional problems and more attachment difficulties than children with other developmental disabilities. Poorer attachment quality contributed uniquely to the variance in child behaviour and emotional problems. CONCLUSIONS: Interventions targeting behaviour and emotional problems in children with ASD may benefit from an attachment model which addresses the child's difficulty in using caregivers as a coregulatory agent of emotions.

Associations between Neurocardiovascular Signal Entropy and Physical Frailty.

In this cross-sectional study, the relationship between noninvasively measured neurocardiovascular signal entropy and physical frailty was explored in a sample of community-dwelling older adults from The Irish Longitudinal Study on Ageing (TILDA). The hypothesis under investigation was that dysfunction in the neurovascular and cardiovascular systems, as quantified by short-length signal complexity during a lying-to-stand test (active stand), could provide a marker for frailty. Frailty status (i.e., "non-frail", "pre-frail", and "frail") was based on Fried's criteria (i.e., exhaustion, unexplained weight loss, weakness, slowness, and low physical activity). Approximate entropy (ApEn) and sample entropy (SampEn) were calculated during resting (lying down), active standing, and recovery phases. There was continuously measured blood pressure/heart rate data from 2645 individuals (53.0% female) and frontal lobe tissue oxygenation data from 2225 participants (52.3% female); both samples had a mean (SD) age of 64.3 (7.7) years. Results revealed statistically significant associations between neurocardiovascular signal entropy and frailty status. Entropy differences between non-frail and pre-frail/frail were greater during resting state compared with standing and recovery phases. Compared with ApEn, SampEn seemed to have better discriminating power between non-frail and pre-frail/frail individuals. The quantification of entropy in short length neurocardiovascular signals could provide a clinically useful marker of the multiple physiological dysregulations that underlie physical frailty.

The association between frontal lobe perfusion and depressive symptoms in later life.

BACKGROUND: Deficits in frontal lobe perfusion have been demonstrated in late-life depression; however, studies to date have generally involved small numbers, used neuroimaging rather than bedside testing and have not controlled for important covariates.AimsWe aimed to examine the association between depressive symptoms and frontal lobe perfusion during standing, in a large cohort of community-dwelling older people. METHOD: Participants aged ≥50 years underwent continuous measurement of orthostatic blood pressure by finometry, and frontal lobe perfusion by near-infrared spectroscopy. Depressive symptoms were assessed by the eight-item Centre for Epidemiological Studies Depression Scale. Real-time frontal lobe cerebral oxygenation was measured by the Portalite System, detecting changes in frontal lobe perfusion and reporting a tissue saturation index score. RESULTS: Almost 8% (209 out of 2616) had clinically significant depressive symptoms. Multilevel models demonstrated a significantly lower tissue saturation index in participants with depressive symptoms at both 60 and 90 s post-stand, with coefficients of -0.43 (95% CI -0.63 to -0.22) and -0.37 (95% CI -0.57 to -0.16), respectively. Controlling for relevant covariates did not significantly attenuate these associations. After addition of systolic blood pressure this association was no longer significant, suggesting lower blood pressure may modify this relationship. CONCLUSIONS: This study demonstrates that lower frontal lobe perfusion, related to lower values of baseline systolic blood pressure, is associated with clinically significant depressive symptoms in a cohort of community-dwelling older people. Given the recognised longitudinal association between lower blood pressure and depression in older people, this may represent a potential therapeutic target for prevention of incident depression.Declaration of interestNone.

Assessment of Placental Cortisol Pathway Gene Expression in Term Pregnant Women with Anxiety.

INTRODUCTION: The aim of this study was to expand on this field of work by examining, within a cohort of pregnant women with diagnosed clinical anxiety, the mRNA expression of a panel of genes associated with the cortisol pathway and comparing them to controls. METHODS: Placental samples were obtained from 24 pregnant women, 12 with a diagnosed anxiety disorder and 12 with no psychiatric history, within 30 min of delivery. Differential expression analysis of 85 genes known to be involved in glucocorticoid synthesis, metabolism or signalling was conducted for the: (1) full sample, (2) those at term without labour (5 cases, 7 controls) and (3) those at term with labour (7 cases, 5 controls). Correlation analyses between gene expression and measures of anxiety and depressive symptom severity were also conducted. RESULTS: No robust difference in placental gene expression between pregnant women with and without anxiety disorder was found nor did we detect robust differences by labour status. However, correlational analyses putatively showed a decrease in PER1 expression was associated with an increase in anxiety symptom severity, explaining up to 32% of the variance in anxiety symptom severity. DISCUSSION: Overall, the strongest correlation was found between a decrease in placental PER1 expression and increased anxiety scores. Labour status was found to have a profound effect on mRNA expression. The placental samples obtained from women following labour produced greater numbers of significant differences in mRNA species expression suggesting that in long-standing anxiety the placenta may respond differently under conditions of chronic stress.

A scalable cognitive behavioural program to promote healthy sleep during pregnancy and postpartum periods: protocol of a randomised controlled trial (the SEED project).

BACKGROUND: Poor sleep, including symptoms of insomnia are common during pregnancy and postpartum periods. Poor sleep during the perinatal period is linked to impaired daytime functioning, mood disturbance, and risk for chronic insomnia. Cognitive behavioural therapy (CBT) is consistently shown to be efficacious in treating insomnia, but it is largely inaccessible to new mothers, and surprisingly, not part of current perinatal care. This study aims to evaluate the feasibility and efficacy of a scalable CBT-based intervention for better sleep quality. METHODS: In this single-blind randomised controlled trial, eligible nulliparous women are randomised in a 1:1 ratio to either the intervention (CBT) or active control (healthy diet) condition. The interventions are provided from the third trimester till 6 months postpartum. The primary outcome is maternal sleep quality and secondary outcomes are maternal sleep-related impairment, mood, health-related quality of life, relationship satisfaction, and mother-infant-relationship, all assessed using validated instruments at 30- (baseline) and 35 weeks gestation (pregnancy endpoint), and 1.5, 3, and 6 months (postpartum endpoint) after childbirth, with follow-up assessments conducted at 1-year and 2-year postpartum. DISCUSSION: This study has the potential to address the need for an evidence-based, non-pharmacological sleep intervention tailored for the pregnancy and postpartum periods. The intervention is designed to maximise reach and minimise cost, with the potential to scale up and incorporate in routine perinatal care. With outcomes measured at 8 time points, from the third trimester of pregnancy to 2-year postpartum, this study has the potential to examine both short- and long-term impact on maternal sleep and wellbeing. TRIAL REGISTRATION: ACTRN12616001462471 ; retrospectively registered on 19/10/2016.

Maternal breast cancer and communicating with children: A qualitative exploration of what resources mothers want and what health professionals provide.

OBJECTIVE: To explore the communication and resource needs of mothers diagnosed with breast cancer treated with curative intent in communicating with their young children and to identify gaps in the resources and support provided to these women. METHODS: Data were collected via semi-structured telephone interviews from 13 mothers who were diagnosed with breast cancer while parenting a young child (age 3-12 years), and 10 health professionals in Victoria, Australia. Data were analysed qualitatively using the Framework Method. RESULTS AND CONCLUSION: Mothers and health professionals prioritised communication with children about the cancer diagnosis; however, health professionals and mothers differed in their views of parents' communication needs both in terms of the nature of the support/information needed and the delivery of this support/information. Mothers wanted easily accessible resources that were both instructive and practical. Mothers also emphasised quality over quantity of support. Health professionals were mostly aware of mothers' needs, however, emphasised less instructive support and information. This study highlights the need for improved coordination and tailoring of psychosocial resources and supports for these parents and families communicating about a cancer diagnosis with their young children.