"It's fundamental to the work that we do": Genetic counselors' perceptions of their role in clients' mental well-being.

The role of a genetic counselor is to assist individuals and their families to comprehend and adapt to genetic information. However, a genetic counselor's role in clients' mental well-being is unclear. Mental well-being is an important component of overall health and it can be affected during the adaptation to genetic information. It is, therefore, essential to consider how mental well-being is viewed in genetic counseling practice. Our research aimed to investigate genetic counselors' perceptions of their role in clients' mental well-being. Our objectives were to (1) understand what genetic counselors perceived their role to be in clients' mental well-being and (2) investigate what factors influence genetic counselors' perceptions of practice. We recruited participants via advertisements in the Human Genetics Society of Australasia and the Australasian Society of Genetic Counselors newsletters, and through the Genetic Support Network of Victoria social media. We completed semi-structured in-depth interviews with 12 Australian genetic counselors and analyzed the interviews using inductive thematic analysis. We found that genetic counselors viewed clients' mental well-being as an important and crucial part of their practice. Three key themes were identified, first, all the participants' views of clients' mental well-being were shaped by personal and professional beliefs. Second, all participants noted that there were factors external to them, such as workplace and professional guidelines, which shaped their role in clients' mental well-being. Third, all those interviewed noted the boundaries of their professional role in clients' mental well-being. From these three themes, we determined that genetic counselors see clients' mental well-being as an integral part of their practice. Our findings add to the extant literature and can shape future practice in this field. Furthermore, we identified how future research priorities could further our knowledge in this area.

The application of positive parenting interventions to academic school readiness: A scoping review.

BACKGROUND: Positive parenting interventions were traditionally developed for use in infant and preschool mental health. However, there is increasing application to a broader range of developmental outcomes. A scoping review was conducted to map the landscape of the diverse applications of positive parenting interventions to academic school readiness. METHODS: Positive parenting interventions that took place in the early childhood period (prenatal to 6 years) and included an assessment of academic readiness were eligible (i.e., problem-solving/reasoning, language, executive functions and preacademics). The search strategy included four electronic databases from inception to July 2020 and backward/forward searching of the majority of eligible studies. Data charting was completed by double, independent reviewers and included theoretical frameworks, academic readiness outcomes, parenting behaviour targets, populations serviced and methodological approaches used. The synthesis included quantitative descriptives and tabular/visual representations. RESULTS: Ninety-nine studies met eligibility criteria. There has been a steady increase in published studies since 2005, with each academic readiness skill represented in varying proportions. Attachment theory was the most commonly referenced framework for applying interventions to academic readiness, with a more recent shift towards biobehavioural frameworks. The majority of studies included parental responsiveness as a parent behaviour target, whereas behavioural management was more commonly used with older children and/or those with social-emotional/behavioural difficulties. Most studies used a selective prevention approach, with low socioeconomic families being the most frequently studied group. Research gaps were identified in the measurement of follow-up and parenting behaviour. CONCLUSION: We discuss changing conceptualizations of academic readiness, applications to public health and practice, and future directions in research.

Reviewing the Evidence on Prenatal Opioid Exposure to Inform Child Development Policy and Practice.

Prenatal opioid use is increasingly common and can have adverse impacts on maternal and child health. In Ontario, there are no clear guidelines or universal programs to support the healthy development of children with prenatal opioid exposure. We present the epidemiology of prenatal opioid exposure in Ontario, summarize research examining child health outcomes with a focus on child development, review emerging guidelines for child health and developmental surveillance and highlight promising programs. We emphasize the need to strengthen current Canadian recommendations for routine enhanced developmental and vision screening and ensure funding for evidence-based integrated maternal/child services.

Technology-Assisted Parenting Interventions for Families Experiencing Social Disadvantage: a Meta-Analysis.

Technology-assisted interventions have been identified as a means to increase accessibility and enhance engagement of parenting programs. The current meta-analytic review examines the effectiveness of these interventions in families experiencing social disadvantage. A literature search was conducted spanning March 2007-June 2019. Nine studies met inclusion criteria (total of 864 participants) which included an evaluation of a parenting intervention for families with at least one of the following demographic challenges, low socioeconomic status, single parenthood, and/or young parenthood. Interventions (or a component of the intervention) were delivered by computer, cell phone, smartphone, and/or tablet. Data were organized into three categories: parental psychological well-being (e.g., self-esteem, social support), parenting (e.g., observed or self-reported parenting behavior), and child behavior (e.g., disruptive behavior). Effect sizes (Hedges' g) were calculated and moderators (i.e., contact with an interventionist, intervention length, publication year, % female parents, mean parent age, parental education, % minority, and child age) were examined through Q-statistics and meta-regression, as appropriate. Intervention showed a near-significant impact on parental psychological well-being (g = .35, p = .051). Furthermore, interventions that did not include direct contact with an interventionist showed no evidence of effectiveness (g = - .02); interventions that incorporated contact were significantly more effective (g = .68). In addition, intervention length moderated intervention effectiveness; shorter interventions yielded greater improvements in well-being, compared with longer interventions. Interventions were also associated with significant improvements in parenting (g = .38) and child behavior (g = .39). These findings provide support for the use of technology-assisted parenting interventions in populations experiencing social disadvantage.

Microglial activation in Parkinson's disease using [18F]-FEPPA.

BACKGROUND: Neuroinflammatory processes including activated microglia have been reported to play an important role in Parkinson's disease (PD). Increased expression of translocator protein (TSPO) has been observed after brain injury and inflammation in neurodegenerative diseases. Positron emission tomography (PET) radioligand targeting TSPO allows for the quantification of neuroinflammation in vivo. METHODS: Based on the genotype of the rs6791 polymorphism in the TSPO gene, we included 25 mixed-affinity binders (MABs) (14 PD patients and 11 age-matched healthy controls (HC)) and 27 high-affinity binders (HABs) (16 PD patients and 11 age-matched HC) to assess regional differences in the second-generation radioligand [18F]-FEPPA between PD patients and HC. FEPPA total distribution volume (V T) values in cortical as well as subcortical brain regions were derived from a two-tissue compartment model with arterial plasma as an input function. RESULTS: Our results revealed a significant main effect of genotype on [18F]-FEPPA V T in every brain region, but no main effect of disease or disease × genotype interaction in any brain region. The overall percentage difference of the mean FEPPA V T between HC-MABs and HC-HABs was 32.6% (SD = 2.09) and for PD-MABs and PD-HABs was 43.1% (SD = 1.21). CONCLUSIONS: Future investigations are needed to determine the significance of [18F]-FEPPA as a biomarker of neuroinflammation as well as the importance of the rs6971 polymorphism and its clinical consequence in PD.

Maternal Childhood Maltreatment History and Child Behavior Problems: Developmental Patterns and Mediation via Maternal Depressive Symptoms and Parenting Behavior.

Maternal exposure to childhood maltreatment (CM) is associated with offspring behavioral problems; however, little work has examined these associations longitudinally across child development. This study examined the effects of maternal history of CM on trajectories of child internalizing and externalizing behavior measured from toddlerhood to preschool, and the role of maternal depressive symptoms and parenting behavior as potential mediators. Participants included 115 mother-child dyads recruited from a hospital maternity ward. Maternal CM was measured at 3-months postpartum. At 18, 36, and 60 months, maternal depressive symptoms and child behavior were assessed via maternal report and parenting behavior was assessed through direct observation. Findings indicated that children of mothers exposed to CM demonstrated poorer trajectories of problem behavior across early childhood. Maternal depressive symptoms mediated the relation between CM and children's internalizing problems. Findings highlight the importance of screening for maternal depressive symptoms and early intervention for maternal and child mental health.

Examining the effects of household chaos on child executive functions: A meta-analysis.

Household chaos-characterized by disorganization and instability within the home-is inversely associated with child executive functioning and effortful control, although a quantitative synthesis of the findings is currently lacking. This meta-analysis incorporated 35 studies with 36 independent effect sizes including 16,480 children. Several moderators were assessed, the most fundamental involving method (i.e., informant-completed questionnaire vs. direct assessment) of assessing executive functions. The analyses revealed a significant overall effect of r = .16. Only measurement approach of executive functions significantly moderated this association: Informant-completed questionnaires yielded an effect of r = .23, as compared with direct assessment, r = .11; however, both effects were significant. Based on substantive and statistical considerations, questionnaire and direct assessment effects were then meta-analyzed separately. Although effect sizes proved heterogeneous in the context of questionnaires, analyses revealed no significant moderators. Within direct assessment effects, both household chaos dimensions were significantly related to child executive functions, but instability was a stronger correlate (r = .17) than disorganization (r = .06). Results highlight the need for fuller investigation of differences in construct measurement presented by questionnaire and direct assessment approaches to child executive functions. At present, it appears prudent to adopt a multimethod approach to assessment. Ultimately, a greater focus on quasi-experimental designs examining the mechanisms by which events destabilize child executive functions is essential to a rigorous understanding of the relation between environmental features and child cognitive function. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Maternal adverse childhood experiences, executive function & emotional availability in mother-child dyads.

BACKGROUND: Maternal adverse childhood experiences (ACEs) are associated with difficulties in parent-child relationships; however, current research has primarily used cross-sectional designs. Parent and child behavior may be differentially affected by ACEs as children develop and caregiving demands change. Furthermore, diminished executive function (EF) is associated with both ACEs and parenting difficulties and may be a mechanism underlying the intergenerational effects of ACEs. OBJECTIVE: This study examined longitudinal associations between maternal ACEs, maternal EF, and patterns of change in maternal and child emotional availability (EA). PARTICIPANTS: Mother-child dyads (N = 114) participated in five assessments over a 5-year period. METHODS: Maternal ACEs were measured retrospectively at 3 months, maternal EF was assessed at 8 months, and mother-child interactions were videotaped at 18, 36 and 60 months postpartum. Multilevel modelling was used to model growth curves. RESULTS: Maternal EA did not significantly change, while child EA increased from 18 to 60 months postpartum. Maternal ACEs were negatively associated with maternal and child EA at 18 months postpartum; this effect was not significant at 60 months postpartum. In contrast, there was a persistent, positive effect of maternal EF on EA trajectories. Maternal EF did not mediate the association between ACEs and EA. There were also significant within-dyad associations between maternal and child EA. CONCLUSIONS: The effects of maternal ACEs on parenting are not necessarily persistent. Findings also support sustained relations between maternal EF and mother-child interactions across early childhood, suggesting the utility of EF as an intervention target.

Positron emission tomography imaging of tau pathology in progressive supranuclear palsy.

Progressive supranuclear palsy is a rare form of atypical Parkinsonism that differs neuropathologically from other parkinsonian disorders. While many parkinsonian disorders such as Parkinson's disease, Lewy body dementia, and multiple system atrophy are classified as synucleinopathies, progressive supranuclear palsy is coined a tauopathy due to the aggregation of pathological tau in the brain. [18F]AV-1451 (also known as [18F]-T807) is a positron emission tomography radiotracer that binds to paired helical filaments of tau in Alzheimer's disease. We investigated whether [18F]AV-1451 could be used as biomarker for the diagnosis and disease progression monitoring in progressive supranuclear palsy. Six progressive supranuclear palsy, six Parkinson's disease, and 10 age-matched healthy controls were recruited. An anatomical MRI and a 90-min PET scan, using [18F]AV-1451, were acquired from all participants. The standardized uptake value ratio from 60 to 90 min post-injection was calculated in each region of interest, using the cerebellar cortex as a reference region. No significant differences in standardized uptake value ratios were detected in our progressive supranuclear palsy group compared to the two control groups. [18F]AV-1451 may bind selectivity to the paired helical filaments in Alzheimer's disease, which differ from the straight conformation of tau filaments in progressive supranuclear palsy.

Disrupted Nodal and Hub Organization Account for Brain Network Abnormalities in Parkinson's Disease.

The recent application of graph theory to brain networks promises to shed light on complex diseases such as Parkinson's disease (PD). This study aimed to investigate functional changes in sensorimotor and cognitive networks in Parkinsonian patients, with a focus on inter- and intra-connectivity organization in the disease-associated nodal and hub regions using the graph theoretical analyses. Resting-state functional MRI data of a total of 65 participants, including 23 healthy controls (HCs) and 42 patients, were investigated in 120 nodes for local efficiency, betweenness centrality, and degree. Hub regions were identified in the HC and patient groups. We found nodal and hub changes in patients compared with HCs, including the right pre-supplementary motor area (SMA), left anterior insula, bilateral mid-insula, bilateral dorsolateral prefrontal cortex (DLPFC), and right caudate nucleus. In general, nodal regions within the sensorimotor network (i.e., right pre-SMA and right mid-insula) displayed weakened connectivity, with the former node associated with more severe bradykinesia, and impaired integration with default mode network regions. The left mid-insula also lost its hub properties in patients. Within the executive networks, the left anterior insular cortex lost its hub properties in patients, while a new hub region was identified in the right caudate nucleus, paralleled by an increased level of inter- and intra-connectivity in the bilateral DLPFC possibly representing compensatory mechanisms. These findings highlight the diffuse changes in nodal organization and regional hub disruption accounting for the distributed abnormalities across brain networks and the clinical manifestations of PD.

Delivering care for women seeking refuge.

Maternity services in many parts of the UK are providing care for asylum-seekers. These women are among the most vulnerable and socially excluded in our care, and in many instances they have fled from horrific circumstances to reach this country. In addition to the trauma and psychological effects of their experiences, many also have complex physical health needs. Women seeking asylum in the U.K. often begin to receive support late in their pregnancy and may have had no previous antenatal care. The problems they may face include poor general health, anaemia, high parity, closely-spaced pregnancies, HIV, hepatitis B and female genital mutilation.