Transient changes in mothers' negative emotional reactivity predict changes in the intensity, persistence, and variability of their aversive behavior.

Applying theories of emotion to understanding the regulation of aversive parenting, we used microanalytic observational methods to test whether transient changes in a mother's negative emotional reactivity predict changes over time in key parameters of her moment-to-moment aversive behavior: its intensity, variability, persistence, and connection to difficult child inputs. At multiple times over 2 years, 319 divorcing mothers and their 5- to 12-year-old children were observed as they discussed mutual disagreements. Sequences of talk-turns were recorded and coded for affect and content. Relative to days when a mother was low in negative emotional reactivity, on days when she was high she displayed more intensely aversive behavior, more variable aversiveness, more transitions from average to high or low aversiveness, tendencies to remain aversive longer following spikes in her aversiveness, and difficulty maintaining low aversiveness following drops in her aversiveness. As her negative emotional reactivity increased, she went from being relatively unaffected by children's difficult behavior to being aversively reactive; from ceasing aversive sequences increasingly quickly to ceasing aversive sequences increasingly slowly; from deviating more from her nonreactive low-aversive parenting to deviating less from her reactive high-aversive parenting. Independent of stable individual differences in mothers and children, transient variations in mothers' emotional reactivity may correspond to key moment-to-moment parameters of aversive parenting, even when interactions are relatively noncontentious. The data provide a viable account of how initially transient, context-specific reactivity could initiate moment-to-moment changes in aversive patterns that in some families influence problematic family trajectories over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Examining Children's Problem Behaviors and Mothers' Dating for Mothers' Depressive Symptoms Following Divorce.

Although divorce is typically stressful for mothers, the formation of post-divorce dating relationships can help to ease this stress. Unfortunately, research has yet to empirically consider children's post-divorce adjustment for mothers' wellbeing leading up to and during mothers' post-divorce dating. This study addresses the following questions: 1) How do children's problem behaviors predict mothers' depressive symptoms following divorce? 2) How do children's problem behaviors predict the quality of mothers' dating relationships and the rapport between children and mothers' dating partners? 3) How do children's problem behaviors, the quality of mothers' dating relationships, child-dating partner rapport, and length of mothers' dating simultaneously impact mothers' depressive symptoms? Data for this study comes from a longitudinal investigation of recently divorced mothers and their children (N = 232). Hierarchical linear models revealed that mothers experienced more depressive symptoms when their children exhibited more internalizing behaviors. Children's internalizing behaviors were negatively associated with the quality of mothers' dating relationships. When examining these variables simultaneously, increases in children's internalizing behaviors and decreases in relationship quality predicted increases in mothers' depressive symptoms. Promoting family-level adjustment appears best for mothers' wellbeing following divorce. Other implications for post-divorce adjustment are discussed.

Examining the Direct and Indirect Effects of Mothers' Rejection from the Ex-Spouse on Time to Repartnering.

Individuals who feel rejected following relationship dissolution typically experience reductions in their health and wellbeing. Although feelings of rejection can be painful, the acquisition of a new romantic relationship can help to ease this pain. The goal of this study is to examine the direct and indirect effects of divorced residential mothers' rejection from the ex-spouse on their time to entering post-divorce romantic relationships. Results indicate that mothers' rejection from the ex-spouse is significantly associated with delays in repartnering. Results indicated two marginally significant indirect effects, providing some evidence that mothers' rejection from the ex-spouse and delayed repartnering is transmitted through decreases in mothers' depressive symptoms and increases in mothers' barriers to repartnering. These findings demonstrate the importance of promoting divorced mothers' self-perceptions following divorce.

Comparing Lumbar Disc Space Preparation With Fluoroscopy Versus Cone Beam-Computed Tomography and Navigation: A Cadaveric Study.

STUDY DESIGN: Cadaveric study. OBJECTIVE: This cadaveric study sought to evaluate the efficacy of disc space preparation with cone beam-computed tomography with navigation (CBCT+N) for instrument placement compared with instrument placement with conventional fluoroscopy. SUMMARY OF BACKGROUND DATA: Disc space preparation from a transforaminal lumbar approach is challenging with respect to visualization, and surgeons currently rely on tactile feel and two-dimensional imaging in the operating room to assess instrument positioning. METHODS: Two orthopedic spine surgeons performed 40 disc space preparations after eight cadavers were randomly assigned to fluoroscopy versus CBCT+N. Digital images of each vertebral endplate were captured and the percent disc removed by area for the total disc and by quadrants was determined using digital imaging software. RESULTS: There were 20 lumbar disc levels prepared in the fluoroscopy group. There were 3 thoracolumbar, and 17 lumbar disc levels prepared in the experimental group. Percent disc removed relative to the total area of the disc, as determined by the digital imaging software, was higher in the CBCT+N group (P ≤ 0.0001). More disc was removed in both the anterior contralateral and posterior contralateral quadrants in the CBCT+N group (P = 0.0006 and P ≤ 0.0001 respectively). The intraclass correlation coefficient among blinded reviewers for percent disc removed was 0.759 (95% confidence interval, 0.587-0.866)]. There was no difference in time to complete disc space preparation, number of instrument passes, or number of endplate violations between the two groups (P = 0.28, P = 0.92, and P = 0.34 respectively). CONCLUSION: The results of this cadaveric investigation reveal that CBCT+N guidance may be used to assess instrument placement for interbody disc space preparation in a similar length of time, with no difference in instrument passes or endplate violations, in comparison with fluoroscopy. LEVEL OF EVIDENCE: 5.

Differentiating Declining Commitment and Breakup Using Commitment to Wed.

The relationship literature describes that declining commitment leads to breakup. The goal of this manuscript is to distinguish declining commitment and breakup to clarify this claim to better understand relationship processes. Data comes from a longitudinal study of heterosexual dating couples (N = 180). Both individuals in the relationship independently graphed changes in commitment to wed their partner and reported reasons for each change monthly for eight consecutive months. Frequency and intensity of decreased interaction, relational uncertainty, and alternative partners were measured across periods of stability (increased or stable levels of commitment to wed) and declining commitment (decreased commitment to wed that was at least one month in duration). Hierarchical linear models revealed that more frequent reports of these characteristics were associated with declining commitment rather than stability. Using survival analyses, intensity of each characteristic predicted breakup versus declining commitment. Implications for relationship processes are discussed.

Expressing negative emotions to children: Mothers' aversion sensitivity and children's adjustment.

Research is unclear about when expressing negative emotions to children performs valuable socialization and regulatory functions and when, instead, it undermines children's adjustment. In this study, we isolated 1 kind of negative expression to test the aversion sensitivity hypothesis: that rapid increases in mothers' negativity as a function of increases in the aversiveness of children's behavior are uniquely problematic for children. During multiple assessments of a divorcing sample over 2 years (N = 284), 12-min interactions between mothers and their 4- to 11-year-old children were recorded. Forty-seven observed child behaviors were ranked from low to high aversive. Within-dyad changes demonstrated that mothers' general negativity-their tendency to express negative emotion at high rates-was unrelated to children's adjustment. In contrast, mothers' aversion-focused negativity-their tendency to increase negative emotional expression rapidly as the aversiveness of children's behavior increased-predicted children's poor social competence, poor emotion regulation, and externalizing behavior problems at the next assessment. The findings suggest that negative expression that reflects mothers' affective sensitivity to aversive child behavior may promote interaction patterns and adaptations in children that are particularly likely to place children at risk for adjustment problems. (PsycINFO Database Record

Consequences of Dating for Post-Divorce Maternal Well-Being.

Repartnering has been linked to health benefits for mothers, yet few studies have examined relationship quality in this context. According to the divorce-stress-adaptation perspective, relationship quality may influence the relationship between maternal well-being and dating after divorce. The current study examines the consequences of dating, relationship quality, and dating transitions (breaking up and dating new partners) on maternal well-being (negative affect and life satisfaction). Using monthly surveys completed by mothers over a two-year period after filing for divorce, we examined changes in intercepts and slopes of dating status and transitions for maternal well-being while also testing the effects of relationship quality. Mothers entering high-quality relationships were likely to report boosts in well-being at relationship initiation compared to single mothers and mothers entering low-quality relationships. Mothers entering lower-quality relationships were likely to report lower levels of well-being than single mothers. Dating transitions were associated with increases in well-being. Implications for maternal adjustment are discussed.

Demographic and occupational predictors of neck pain in pilots: analysis and multinational comparison.

OBJECTIVE: This study aimed to elucidate the overall risk and demographic/occupational predictors of neck pain among professional aviators. METHODS: There were 413 surveys characterizing the severity and character of neck pain symptoms that were administered to a multinational cohort of pilots representing 3 separate airframe types. All results were compared to a nonaviator control group. Univariate and multivariate regression analyses were performed to elucidate independent predictors of occupationally related neck pain. RESULTS: Of the surveys, 92% were completed and returned. Multivariate analysis reveals that the pilot profession is independently predictive of increased occupational neck pain symptoms (OR 1.94, 95% CI 3.72, 1.01). High performance airframes, cargo/passenger airframes, and increasing age were also independent predictors of increased neck pain scores (OR = 3.91, 95% CI 7.10, 2.15; OR = 3.22, 95% CI 5.83, 1.77; OR = 4.00, 95% CI 7.43, 2.15, respectively). CONCLUSIONS: Our broad, multinational/multi-airframe analysis reveals that the pilot profession, most notably high performance and long-haul cargo/passenger airframes, display an increased risk of neck pain symptoms.

Spine-related disability following combat injury.

Spine-related disability for military personnel injured in combat is not known. The goal of this study was to characterize spine-related disability in a cohort of soldiers wounded in recent military operations. The authors reviewed the U.S. Army Physical Evaluation Board database medical discharge records of 450 wounded soldiers for long-term disability causing a medical discharge from active duty service. Fourteen percent of the cohort had at least one spine-related disability resulting in medical discharge from the military. For the 54 unfitting conditions attributed to back pain, 33% had no precipitating injury. Eighteen soldiers had a spinal cord injury, 10 of which were complete. The average percent disability for back pain was 11%, and the average disability for a spinal cord injury was 77%. Twenty-one percent of the soldiers with spine-related disability also had disability attributed to psychological conditions. Spine-related disability is common after combat injury, though not all spine disability is directly related to an actual injury. Spinal cord injury with persistent neurological dysfunction results in higher permanent disability.

Mothers' depressive symptoms predict both increased and reduced negative reactivity: aversion sensitivity and the regulation of emotion.

This study examined whether, as mothers' depressive symptoms increase, their expressions of negative emotion to children increasingly reflect aversion sensitivity and motivation to minimize ongoing stress or discomfort. In multiple interactions over 2 years, negative affect expressed by 319 mothers and their children was observed across variations in mothers' depressive symptoms, the aversiveness of children's immediate behavior, and observed differences in children's general negative reactivity. As expected, depressive symptoms predicted reduced maternal negative reactivity when child behavior was low in aversiveness, particularly with children who were high in negative reactivity. Depressive symptoms predicted high negative reactivity and steep increases in negative reactivity as the aversiveness of child behavior increased, particularly when high and continued aversiveness from the child was expected (i.e., children were high in negative reactivity). The findings are consistent with the proposal that deficits in parenting competence as depressive symptoms increase reflect aversion sensitivity and motivation to avoid conflict and suppress children's aversive behavior.

Patterns of intimate partner violence in a large, epidemiological sample of divorcing couples.

In many jurisdictions divorcing couples are court-ordered to participate in divorce mediation to resolve parenting plan disputes prior to a court allowing a case to proceed to trial. Historically, a significant number (40-80%) of these divorcing couples enter this highly stressful legal process having experienced violence and abuse within the relationship (Pearson, 1997). Several researchers have developed typologies that describe couple-level patterns of Intimate Partner Violence and Abuse (IPV/A) behaviors; one research team suggested their typology could apply specifically to such divorcing people (Kelly & Johnson, 2008). In this context, identification and accurate classification of IPV/A can lead to better decisions as long-term, difficult to modify custody orders concerning the children are made during divorce mediation. Accurate identification and classification of IPV/A can also assist clinical researchers designing specialized interventions for couples and individuals experiencing IPV/A, mental health practitioners who may treat these families, and custody evaluators who may make recommendations to the courts. The current study includes a large epidemiological sample of divorcing couples and provides a robust statistical solution with five distinct categories of IPV/A. Two of the five categories were similar to those proposed by Johnson (2006c). The current study also provides descriptions and frequencies of each type of IPV/A, and discusses implications for court personnel, researchers and practitioners.

Parent-child acculturation discrepancy, perceived parental knowledge, peer deviance, and adolescent delinquency in Chinese immigrant families.

Parent-child acculturation discrepancy has been considered a risk factor for child maladjustment. The current study examined parent-child acculturation discrepancy as an ongoing risk factor for delinquency, through the mediating pathway of parental knowledge of the child's daily experiences relating to contact with deviant peers. Participants were drawn from a longitudinal project with 4 years between data collection waves: 201 Chinese immigrant families participated at Wave 1 (123 girls and 78 boys) and 183 families (110 girls and 73 boys) participated at Wave 2. Based on the absolute difference in acculturation levels (tested separately for Chinese and American orientations) between adolescents and parents, one parent in each family was assigned to the "more discrepant" group of parent-child dyads, and the other parent was assigned to the "less discrepant" group of parent-child dyads. To explore possible within-family variations, the mediating pathways were tested separately among the more and less discrepant groups. Structural equation modeling showed that the proposed mediating pathways were significant only among the more discrepant parent-adolescent dyads in American orientation. Among these dyads, a high level of parent-child acculturation discrepancy is related to adolescent perceptions of less parental knowledge, which is related to adolescents having more contact with deviant peers, which in turn leads to more adolescent delinquency. This mediating pathway is significant concurrently, within early and middle adolescence, and longitudinally, from early to middle adolescence. These findings illuminate some of the dynamics in the more culturally discrepant parent-child dyad in a family and highlight the importance of examining parent-child acculturation discrepancy within family systems.

"My child and I are a package deal": balancing adult and child concerns in repartnering after divorce.

Parents who repartner after divorce must decide how to balance the potentially competing demands of their own desire for adult companionship and romance with the needs of their children for parental attention and affection. In this study, the authors assessed individual differences in divorced custodial mothers' orientation toward repartnering, characterizing it as a continuum, ranging from more child focused to more adult focused. Mothers who are more adult focused tend to be older, more educated, more likely to be employed outside the home, and exiting marriages of longer duration. In addition, using longitudinal data from in-home interviews, mothers who are more adult focused reported having lower rapport with their children, spending less time in joint activities with their children, and their children in turn reported lower rapport with their mothers. Levels of adult-focused orientation are relatively stable over time but increase when mothers become involved or interested in new partners. Using longitudinal diary data over a 2-year period, the authors demonstrated that mothers who are more child focused engage in more active management of emergent relationships in repartnered families and that adult-focused and child-focused mothers respond to different concerns. Whereas all mothers become more active in managing emergent relationships when both partner and child are resisting one another, mothers with greater child focus respond more to concerns of the child, and mothers with greater adult focus respond more to the concerns of the partner. Implications for intervention with divorced families are discussed.

Prophylaxis against deep-vein thrombosis following trauma: a prospective, randomized comparison of mechanical and pharmacologic prophylaxis.

BACKGROUND: Deep-vein thrombosis following skeletal trauma is an important yet poorly studied issue. The purpose of the present study was to evaluate the efficacy of two different strategies for prophylaxis against deep-vein thrombosis and pulmonary embolus following blunt skeletal trauma. METHODS: Two hundred and twenty-four inpatients were enrolled in a prospective, randomized study investigating venous thromboembolic disease following trauma. Two hundred patients completed the study, which compared two different regimens of prophylaxis. The patients in Group A received enoxaparin (30 mg, administered subcutaneously twice a day) starting twenty-four to forty-eight hours after blunt trauma. The patients in Group B were managed with pulsatile foot pumps at the time of admission combined with enoxaparin on a delayed basis. All patients were screened with magnetic resonance venography and ultrasonography before discharge. RESULTS: There were ninety-seven patients in Group A and 103 patients in Group B. Twenty-two patients (including thirteen in Group A and nine in Group B) had development of deep-vein thrombosis, with two (both in Group A) also having development of pulmonary embolism. The prevalence of deep-vein thrombosis was 11% for the whole series, 13.4% for Group A, and 8.7% for Group B; the difference between Groups A and B was not significant. There were eleven large or occlusive clots (prevalence, 11.3%) in Group A, compared with only three (prevalence, 2.9%) in Group B (p = 0.025). The prevalence of pulmonary embolism was 2.1% in Group A and 0% in Group B. Wound complications occurred in twenty-one patients in Group A, compared with twenty patients in Group B. Patients who had development of deep-vein thrombosis during the inpatient portion of the study required a mean of 7.4 units of blood during hospitalization, compared with 3.9 units of blood for those who did not (p < 0.05). CONCLUSIONS: Our results indicate that early mechanical prophylaxis with foot pumps and the addition of enoxaparin on a delayed basis is a very successful strategy for prophylaxis against venous thromboembolic disease following serious musculoskeletal injury. The prevalence of large or occlusive deep-vein thromboses among patients who had been managed with this protocol was significantly less than that among patients who had been managed with enoxaparin alone.

Nutrition knowledge is associated with greater weight loss in obese and overweight low-income mothers.

OBJECTIVE: To examine if greater nutrition knowledge vs gains in knowledge promote more successful weight loss in low-income, overweight and obese mothers with young children. DESIGN: A convenience sample of mothers and their children were measured for height and weight; mothers completed demographic and nutrition knowledge questionnaires pre- and post-intervention. SUBJECTS/SETTING: Participants (N=141) were recruited from government and public health clinics and elementary schools. Inclusion criteria for mothers were: family income <200% federal poverty level; overweight/obese; and Hispanic, African-American, or white race/ethnicity. INTERVENTION: Eight weekly weight-loss classes emphasizing diet, physical activity, and behavior modification based on Social Cognitive Theory were administered to mothers. MAIN OUTCOME MEASURES: Improvements in maternal nutrition knowledge and weight loss. STATISTICAL ANALYSES PERFORMED: Paired-samples t tests, repeated measures analysis of variance, analysis of covariance, Pearson correlations, and chi(2) statistics. RESULTS: Nutrition knowledge of mothers increased in all areas. Participants with weight loss > or =2.27 kg (responders) had greater knowledge than those who did not; however, the actual net gain was similar for those who lost and did not lose weight. Weight gainers only improved in two areas on the test, whereas weight-loss responders increased knowledge in all six. Responders appeared more cognizant of diet, weight loss, and health information. CONCLUSIONS: Weight-management programs should include a strong component of nutrition education to alleviate knowledge inequalities and promote more effective weight control. In low-income mothers, greater initial knowledge may be more predictive of weight loss than gains in knowledge during an intervention.

Noninvasive measurement of compartment syndrome.

This study compared the effectiveness of a commercially available invasive intracompartmental pressure measuring device with an investigational noninvasive hardness measuring device in 75 patients undergoing examination for possible compartment syndrome. Legs, forearms, thighs, and arms were tested. Pressure values and hardness ratios were compared to one another as continuous variables and to the clinical diagnosis of compartment syndrome as discrete variables. The compartment with the highest pressure reading within a limb diagnosed with compartment syndrome was compared to limbs without compartment syndrome. Due to the low specificity of the noninvasive measurement of hardness compared to the invasive pressure measurement (0.82 versus 0.96), this study does not support the use of the hardness monitor in the diagnosis of compartment syndrome.

Six-year follow-up of preventive interventions for children of divorce: a randomized controlled trial.

CONTEXT: Compared with their peers with nondivorced parents, adolescents with divorced parents are more likely to have mental health problems, drop out of school, and become pregnant. The long-term effects of intervention programs for this population are unknown. OBJECTIVE: To evaluate the long-term effectiveness of 2 programs designed to prevent mental health problems in children with divorced parents. DESIGN AND SETTING: Six-year follow-up of a randomized controlled trial of 2 intervention programs (mother program: 11 group and 2 individual sessions; mother plus child program: mother program and 11 group sessions for children) and a control condition (books on postdivorce adjustment), which was conducted in a large metropolitan US city from April 1998 through March 2000. PARTICIPANTS: A total of 218 families (91% of the original sample) with adolescents aged between 15 and 19 years were reinterviewed. MAIN OUTCOME MEASURES: Externalizing and internalizing problems, diagnosed mental disorders, drug and alcohol use, and number of sexual partners. RESULTS: Eleven percent of adolescents in the mother plus child program (95% confidence interval [CI], 3.8%-18.2%) had a 1-year prevalence of diagnosed mental disorder compared with 23.5% (95% CI, 13.8%-33.2%) of adolescents in the control program (P =.007). Adolescents in the mother plus child program had fewer sexual partners (mean [SE], 0.68 [0.16]) compared with adolescents in the control program (1.65 [0.37]; P =.01). Adolescents with higher initial mental health problems whose families were in the mother plus child program had lower externalizing problems (P =.007) and fewer symptoms of mental disorder (P =.02) compared with those in the control program. Compared with controls, adolescents whose mothers participated in the mother program and who had higher initial mental health problems had lower levels of externalizing problems (P<.001); fewer symptoms of mental disorder (P =.005); and less alcohol (P =.005), marijuana (P =.02), and other drug use (P =.01). CONCLUSIONS: In adolescents of divorced parents, the mother program and the mother plus child program reduced symptoms of mental disorder; rates of diagnoses of mental disorder; levels of externalizing problems; marijuana, alcohol, and other drug use; and number of sexual partners.