Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis.

BACKGROUND: Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors. METHODS: Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation. RESULTS: Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment. CONCLUSIONS: CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.

Autonomic function and inflammation in pregnant women participating in a randomized controlled study of Mindfulness Based Childbirth and Parenting.

BACKGROUND: Pregnancy and childbirth are significant events in many women's lives, and the prevalence of depressive symptoms increases during this vulnerable period. Apart from well documented cognitive, affective, and somatic symptoms, stress and depression are associated with physiological changes, such as reduced heart-rate variability (HRV) and activation of the inflammatory response system. Mindfulness Based Interventions may potentially have an effect on both HRV, inflammatory biomarkers, and self-assessed mental health. Therefore, the aim of this study was to assess the effects of a Mindfulness Childbirth and Parenting (MBCP) intervention on HRV, serum inflammatory marker levels, through an RCT study design with an active control group. METHODS: This study is a sub-study of a larger RCT, where significant intervention effects were found on perinatal depression (PND) and perceived stress. Participants were recruited through eight maternity health clinics in Stockholm, Sweden. In this sub-study, we included altogether 80 women with increased risk for PND, and blood samples and HRV measures were available from 60 of the participants (26 in the intervention and 34 in the control group). RESULTS: Participants who received MBCP reported a significantly larger reduction in perceived stress and a significantly larger increase in mindfulness, compared to participants who received the active control treatment. However, in this sub-study, the intervention had no significant effect on PND, inflammatory serum markers or measures of HRV. CONCLUSIONS: No significant differences were found regarding changes in HRV measures and biomarkers of inflammation, larger studies may be needed in the future. TRIAL REGISTRATION: ClinicalTrials.gov ID:  NCT02441595 . Registered 12 May 2015 - Retrospectively registered.

Comparing the efficacy of mindfulness-based therapy and cognitive-behavioral therapy for depression in head-to-head randomized controlled trials: A systematic review and meta-analysis of equivalence.

BACKGROUND: While Cognitive Behavioral Therapy (CBT) is recommended as first-line treatment for depression, a significant minority do not show an adequate treatment response. Despite evidence for the efficacy of Mindfulness-Based Therapies (MBT) both in treating current depression and preventing relapse, it remains unknown whether MBT and CBT are equivalent in the treatment of current depression. METHODS: Five databases were searched for randomized controlled trials (RCTs) directly comparing MBT with CBT and including depression as primary or secondary outcome. RESULTS: When pooling the results of 30 independent RCTs with a total of 2750 participants, MBT and CBT were statistically significantly equivalent at both post-intervention (Hedges's g = -0.009; p < .001) and follow-up (g = -0.033; p = .001). Supplementary Bayesian analyses provided further support for the alternative hypothesis of no difference between MBT and CBT. When exploring possible sources of heterogeneity, the differences at follow-up were smaller between CBT and mindfulness-based cognitive therapy (MBCT) than between CBT and mindfulness-based stress-reduction (MBSR) (Slope = 0.37;p = .022). CONCLUSION: The currently available evidence suggests that that MBT and CBT are equally efficacious in treating current adult depression. It remains unclear whether the similar effects of the two intervention types are due to different mechanisms or common factors.

Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis.

Acceptance and mindfulness-based therapies have shown efficacy in the treatment of anxiety and depression. Arguably, acceptance and mindfulness-based therapies target core processes in anxiety and depression by increasing mindful attention, decentering, and acceptance. The present study identified randomized controlled trials of acceptance and mindfulness-based therapies for anxiety and depression. Specifically, we aimed to synthesize the indirect effect of the three putative mediators (i.e., mindful attention, decentering, acceptance) on anxiety and depression. Electronic searches yielded 4989 unique records, which were screened for eligibility by two independent raters, resulting in the identification of 33 eligible studies (30 independent trials). The overall pooled mediating effect of mindful attention, decentering, and acceptance was small to medium (r = 0.145, p < .001). Type of mediation analysis emerged as the only statistically significant moderator. Specifically, studies using correlation-based mediation approaches showed statistically significant mediating effects, while studies using causal time-lag analyses did not yield statistically significant mediating effects. Mediator specificity could not be established. In conclusion, putative mediators of acceptance and mindfulness-based therapies mediated treatment effects on anxiety and depression. Limitations in study number, designs, and statistical approaches employed restrict conclusions regarding specificity and causality.

Epidural Analgesia With or Without Oxytocin, but Not Oxytocin Alone, Administered During Birth Disturbs Infant Pre-feeding and Sucking Behaviors and Maternal Oxytocin Levels in Connection With a Breastfeed Two Days Later.

Aims This work aimed to study consequences of medical interventions in connection with birth on infant pre-feeding and feeding behaviors and on maternal oxytocin levels in connection with a breastfeed 2 days later. Materials and Methods Mothers and their full-term newborns (n = 41) were videotaped during a breastfeed 2 days after birth. Duration and quality of rooting [Infant Breastfeeding Assessment Tool (IBFAT)] were assessed. Maternal blood samples were collected, oxytocin levels were analyzed, and mean oxytocin level and variance were calculated. Data on medical interventions during birth, number of breastfeedings, and infant weight loss since birth were recorded. Data were analyzed using logistic regression models. Results The duration of infant rooting was significantly shorter when the mother had received epidural analgesia. The shorter the duration of infant rooting, the more often infants had breastfed and the greater was the infant weight loss since birth. Mothers with epidural analgesia with oxytocin had the lowest oxytocin mean levels in connection with a breastfeed. Oxytocin variance correlated positively with quality of rooting and correlated negatively with infant weight loss. In the control group alone, we found similar patterns of associations with oxytocin levels. Conclusion Epidural analgesia and epidural analgesia with oxytocin infusion in connection with birth negatively influenced infant rooting behavior and maternal mean oxytocin levels, respectively. Oxytocin infusion alone was without effect. The data also suggest that infants who suck well stimulate oxytocin release more efficiently, as expressed by a high oxytocin variance, leading to a better stimulation of milk production and consequently to a reduced infant weight loss 2 days after birth.

Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response.

BACKGROUND: The present study investigates possible predictors of treatment response in an Internet-delivered Mindfulness-Based Cognitive Therapy (iMBCT) intervention with therapist support. This iMBCT program, a fully online delivered intervention with asynchronous therapist support, has previously been shown to be efficacious in reducing symptoms of anxiety and depression in women treated for breast cancer and men treated for prostate cancer. METHODS: Eighty-two breast- and prostate cancer survivors experiencing psychological distress received 8 weeks of therapist-guided iMBCT. Primary outcomes were improvement in anxiety and depression scores from baseline to post-treatment and from baseline to six-months follow-up. Clinical predictors included levels of depression and anxiety at the time of screening and at baseline, as well as time since diagnosis. Demographic predictors included age and educational level. Therapy-related predictors included working alliance, self-compassion, and five facets of mindfulness. Mixed Linear Models were employed to test the prediction effects over time. RESULTS: Higher levels of baseline depression were associated with increased treatment response in anxiety at post-treatment, and lower levels of self-compassion were associated with increased treatment response in depression at post-treatment. None of the proposed predictors significantly predicted treatment response at six-months follow-up. CONCLUSION: The findings suggest that iMBCT can be provided for cancer survivors regardless of their age, educational level, and time since diagnosis (up to five years) and that therapeutic alliance is not crucial for treatment response. We did not identify characteristics predicting treatment response, although many factors were tested. Still, other characteristics may be predictors, and given the relatively small sample size and a large number of statistical tests, the results should be interpreted with caution.

Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning.

Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.

Los ensayos controlados al azar demuestran lo eficaz de de la sicoterapia progenitor-infante, pero su aplicabilidad y efectividad en el cuidado de la salud pública menos conocidas. Método: Estudio naturalista de evaluación de la Intervención Sicodinámica a Corto Plazo entre Infante y Progenitor en Centros de Salud Infantil (SPIPIC) en Estocolmo, Suecia. Se reclutaron 100 madres afligidas con infantes a través de enfermeras supervisadas. Seis terapeutas proveyeron 4.3 sesiones de terapia en promedio (SD = 3.3). Las sesiones típicamente incluyeron a las madres, a menudo con su bebé presente, mientras que los papás raramente asistieron a las sesiones. Se distribuyeron la Escala de Depresión Postnatal de Edimburgo (EPDS) y el Cuestionario de Edades y Estados: Socio-emocional (ASQ: SE) al punto de partida inicial básico, y a los tres y nueve meses después. Simultáneamente se recogió información de un grupo no clínico con el fin de proveer información de la norma. Resultados: Modelos de crecimiento de niveles múltiples basados en los puntajes de cuestionarios de las madres mostraron significativas bajas a lo largo del tiempo en ambas medidas. Nueve meses después del punto de partida inicial básico, el 50% logró un cambio confiable en la EPDS y 14% en el ASQ; SE. Los tamaños del efecto anterior y posterior (d) fueron 0,70 y 0.40 para la EPDS y el ASQ: SE, lo cual es comparable con resultados estudios controlados. Conclusiones: Los sicoterapeutas integrados con el cuidado de salud pública parecen lograr buenos resultados cuando apoyan a madres afligidas con intervenciones breves perinatalmente. La SPIPIC necesita ser comparada con otras modalidades y marcos de trabajo organizacionales.

Les essais contrôlés randomisés démontrent l'efficacité de la psychothérapie parent-nourrisson mais son application et son efficacité pour le soin de santé publique sont moins connues. Méthode: étude naturelle évaluant l'Intervention Psychodynamique Nourrisson-Parent à Court Terme dans des Centres de Santé de l'Enfant (SPIPIC) à Stockholm en Suède. Cent mères en détresse avec des nourrissons ont été recrutées par des infirmières supervisées. Six thérapeutes ont offerts 4,3 séances thérapeutiques en moyenne (SD = 3,3). Les séances ont typiquement inclus les mères, souvent avec le bébé présent, alors que les pères sont rarement venus aux séances. L'échelle de dépression postnatale d'Edinbourg (EPDS) et le ASQ: SE, questionnaire Etapes et Ages sur le développement socio-développemental et comportemental a été distribué au départ, à trois mois et à neuf mois plus tard. Des données d'un groupe non-clinique ont été collectées simultanément afin d'offrir des données de normes. Résultats: des modèles de croissance multiniveau sur les scores aux questionnaires des mères ont fait preuve de baisses importantes au fil du temps sur les deux mesures. Neuf mois après le départ, 50% ont fait preuve d'un changement important pour ce qui concerne l'EPDS et 14% pour ce qui concerne l'ASQ: SE. Les effets pré-post observés (d) étaient de 0,70 et 0,40 pour l'EPDS et l'ASQ: SE, comparable aux résultats d'études de contrôle. Conclusions: les psychothérapeutes intégrés avec un soin de santé publique semblent être parvenus à de bons résultats alors qu'ils soutenaient les mères en détresse avec de brèves interventions périnatales. Le SPIPIC doit être comparé à d'autres modalités et d'autres structures organisationnelles.

The nine stages of skin-to-skin: practical guidelines and insights from four countries.

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin-to-skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin-to-skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström's 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn's progression through Widström's 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period.

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents' perspectives.

A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.

El desarrollo emocional y social del niño depende de que los padres le brinden un apoyo óptimo. Muchos progenitores con aflicciones perinatales experimentan dificultades al aprender a dominar la crianza y buscan ayuda de profesionales dentro del cuidado de salud de primera instancia. En Estocolmo, se inició un proyecto clínico en el que sicoterapeutas sicodinámicos ofrecieron consultas a corto plazo en los Centros de Salud Infantil. Este estudio exploró cualitativamente las experiencias de aflicciones perinatales de los padres y las de recibir ayuda del cuerpo de enfermería y terapeutas del proyecto. Método: Se entrevistaron trece progenitores y sus respuestas se analizaron con un método hermenéutico. Resultados: Se concretaron tres temas principales: la accesibilidad a ayuda sicológica con detección de problemas emocionales, las experiencias de terapia en los Centros de Salud Infantil, así como las técnicas de los terapeutas. A los progenitores se les agrupó también en tres designados Tipos Ideales: el inseguro, el progenitor en crisis, el progenitor con problemas sicológicos a lo largo de la vida. Conclusión: los progenitores se enfrentaron con obstáculos al tratar de encontrar ayuda sicológica dentro del cuidado de salud de primera instancia; los sicoterapeutas con una perspectiva familiar integral y aquellos que podían oscilar entre fomentar la percepción y las intervenciones de apoyo fueron especialmente apreciados; se identificaron categorías de pacientes que se beneficiaron del fomento de la percepción y del apoyo, respectivamente.

Le développement émotionnel et social d'un enfant dépend du soutien optimal qu'offrent les parents. Beaucoup de parents avec une détresse périnatale font l'expérience de difficultés quant à la gestion du parentage et cherchent l'aide de professionnels au sein des soins de santé primaires. Un projet clinique a été lancé à Stockholm, en Suède, au sein duquel des psychothérapeutes psychodynamiques ont offert des consultations à court terme dans les Centres de Santé de l'Enfant. Cette étude a exploré de manière qualitative les expériences de détresse périnatale des parents et l'aide qu'ils ont reçue de la part des infirmières/infirmiers et des thérapeutes dans ce projet. Méthode: Treize parents ont passé un entretien, et leurs réponses ont été analysées au moyen d'une méthode herméneutique. Résultats : Trois thèmes principaux ont émergé, l'accès à l'aide psychologique et la détection de problèmes émotionnels, les expériences de thérapie au Centre de Santé de l'Enfant, et la technique des thérapeutes. Les parents ont aussi été regroupés en trois soi-disant Types Parfaits: les insécures, les parents en crise et les parents avec des problèmes psychologiques de longue haleine. Conclusion: Les parents ont fait l'expérience d'obstacles dans l'accès au soin psychologique au sein des soins de santé primaires. Les psychothérapeutes ayant une perspective familiale holistique et ceux qui sont arrivés à osciller entre une promotion de perspicacité et des interventions de soutien ont été généralement appréciés. Les catégories de patients qui ont respectivement bénéficié de perspicacité et de soutien ont été identifiées.

A plausible pathway of imprinted behaviors: Skin-to-skin actions of the newborn immediately after birth follow the order of fetal development and intrauterine training of movements.

We hypothesize that the competence of a newborn in the first hours after birth is the direct result of behavior training that begins during the first 12 weeks of fetal life. Correlation of Widström's 9 Instinctive Stages (behaviors of the full-term newborn during the first hours after birth) with the developmental movements during fetal life demonstrate that the fetus is invested in learning specific tasks, in a specific order, that are evolutionarily necessary for survival during the first hour and beyond.

Effects of a mindfulness based childbirth and parenting program on pregnant women's perceived stress and risk of perinatal depression-Results from a randomized controlled trial.

OBJECTIVES: The aim of this study was to test the efficacy of a Mindfulness-Based Childbirth and Parenting Program (MBCP) in reducing pregnant women's perceived stress and preventing perinatal depression compared to an active control condition. METHOD: First time pregnant women (n = 197) at risk of perinatal depression were randomized to MBCP or an active control treatment, which consisted of a Lamaze childbirth class. At baseline and post-intervention, participants filled out questionnaires on perceived stress, depressive symptoms, positive states of mind, and five facets of mindfulness. RESULTS: Compared to the active control treatment, MBCP significantly reduced perceived stress (p = 0.038, d = 0.30) and depressive symptoms (p = 0.004, d = 0.42), and increased positive states of mind (p = 0.005, d = 0.41) and self-reported mindfulness (p = 0.039, d = 0.30). Moreover, change in mindfulness possibly mediated the treatment effects of MBCP on stress, depression symptoms, and positive states of mind. The subscales "non-reactivity to inner experience" and "non-judging of experience" seemed to have the strongest mediating effects. LIMITATIONS: The outcomes were self-report questionnaires, the participants were not blinded to treatment condition and the condition was confounded by number of sessions. CONCLUSIONS: Our results suggest that MBCP is more effective in decreasing perceived stress and risk of perinatal depression compared to a Lamaze childbirth class. The results also contribute to our understanding of the underlying psychological mechanisms through which the reduction of stress and depression symptoms may operate. Thus, this study increases our knowledge about efficient intervention strategies to prevent perinatal depression and promote mental wellbeing among pregnant women.

Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial.

OBJECTIVE: Internet-delivered interventions may alleviate distress in cancer survivors with limited access to psychological face-to-face treatment. In collaboration with a group of cancer survivors, we developed and tested the efficacy of a therapist-assisted internet-delivered mindfulness-based cognitive therapy (iMBCT) program for anxiety and depression in cancer survivors. METHODS: A total of 1282 cancer survivors were screened for anxiety and depression during their routine oncology follow-up; eligible breast (n = 137) and prostate cancer (n = 13) survivors were randomized to iMBCT or care-as-usual (CAU) wait-list. Primary outcomes of anxiety and depression were assessed at baseline, 5 weeks, 10 weeks (post intervention), and 6 months. RESULTS: Significant effects were found for both anxiety (Cohen's d = 0.45; P = .017) and depressive symptoms (d = 0.42; P = .024) post intervention. The effects were maintained at follow-up for anxiety (d = 0.40; P = .029), but not for depressive symptoms (d = 0.28; P = .131). CONCLUSIONS: Our preliminary findings suggest iMBCT to be a helpful intervention for cancer survivors suffering from symptoms of anxiety. Further studies on the efficacy for symptoms of depression are needed.

Genetic risk factors for cancer-related cognitive impairment: a systematic review.

Background: Cancer-related cognitive impairment (CRCI) is a commonly reported complaint among non-CNS cancer patients. Even subtle CRCI may have detrimental effects on quality of life and identifying patients at increased risk for CRCI to improve survivorship care is important. In the present paper, we systematically reviewed available studies of possible genetic risk factors for developing CRCI. Methods: Keyword-based systematic searches were undertaken on 24 July 2018 in PubMed, Web of Science, The Cochrane Library, and CINAHL. Three authors independently evaluated full-texts of identified papers and excluded studies with registration of reasons. Seventeen studies reporting results from 14 independent samples were included for review. Two authors independently quality assessed the included studies. The review was preregistered with PROSPERO (CRD42018107689). Results: Ten studies investigated apolipoprotein E (APOE), with four studies reporting that carrying at least one risk allele (APOE4 (ε4)) was associated with CRCI, while six studies found no association. The remaining identified genetic risk variants associated with CRCI located in: COMT, four DNA repair genes, five oxidative stress genes, 22 genes related to breast cancer phenotype, and GNB3. No associations were found between CRCI and genes coding for interleukin-6 (IL6), tumor necrosis factor alpha (TNF), interleukin 1 beta (IL1B), and brain-derived neurotropic factor (BDNF). With the exception of APOE, the genetic risk factors had only been investigated in one or two studies each. Conclusions: Overall, the available evidence of possible genetic risk factors for CRCI is limited. While some research suggests a role for the ε4 allele, the literature is generally inconsistent, and the currently available evidence does not allow clear-cut conclusions regarding the role of genetic factors in the development of CRCI. Larger genetic studies and studies investigating additional genetic variants are needed to uncover genetic risk factors for CRCI.

Skin-to-skin contact the first hour after birth, underlying implications and clinical practice.

AIM: This paper integrates clinical expertise to earlier research about the behaviours of the healthy, alert, full-term infant placed skin-to-skin with the mother during the first hour after birth following a noninstrumental vaginal birth. METHOD: This state-of-the-art article forms a link within the knowledge-to-action cycle, integrating clinical observations and practice with evidence-based findings to guide clinicians in their work to implement safe uninterrupted skin-to-skin contact the first hours after birth. RESULTS: Strong scientific research exists about the importance of skin-to-skin in the first hour after birth. This unique time for both mother and infant, individually and in relation to each other, provides vital advantages to short- and long-term health, regulation and bonding. However, worldwide, clinical practice lags. A deeper understanding of the implications for clinical practice, through review of the scientific research, has been integrated with enhanced understanding of the infant's instinctive behaviour and maternal responses while in skin-to-skin contact. CONCLUSION: The first hour after birth is a sensitive period for both the infant and the mother. Through an enhanced understanding of the newborn infant's instinctive behaviour, practical, evidence-informed suggestions strive to overcome barriers and facilitate enablers of knowledge translation. This time must be protected by evidence-based routines of staff.

What is learned from Mindfulness Based Childbirth and Parenting Education? - Participants' experiences.

BACKGROUND: In the search for effective interventions aiming to prevent perinatal stress, depression and anxiety, we are evaluating a Mindfulness Based Childbirth and Parenting (MBCP) Program. In this study we explore the participants' experiences of the program. METHOD: This is a descriptive qualitative study with influences of phenomenology. The participants were expectant couples who participated in the program and the pregnant women had an increased risk of perinatal stress, anxiety and depression. Ten mothers and six fathers were interviewed in depth, at four to six months postpartum. Thematic analysis of the transcripts was conducted. RESULTS: The participants' descriptions show a variety in how motivated they were and how much value they ascribed to MBCP. Those who experienced that they benefitted from the intervention described that they did so at an intra-personal level-with deeper self-knowledge and self-compassion; and on an inter-personal level-being helpful in relationships. Furthermore, they perceived that what they had learned from MBCP was helpful during childbirth and early parenting. CONCLUSION: Our findings demonstrate that most of the parents experienced MBCP as a valuable preparation for the challenges they met when they went through the life-changing events of becoming parents. The phenomenon of participating in the intervention, integrating the teachings and embodying mindfulness seems to develop inner resources that foster the development of wisdom. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02441595, May 4, 2015.

Experience of perceived barriers and enablers of safe uninterrupted skin-to-skin contact during the first hour after birth in Uganda.

OBJECTIVE: To identify barriers and enablers to conducting safe uninterrupted skin-to-skin contact (SSC) in the first hour after birth in a low-resource setting and to evaluate how health care professionals coped with the identified barriers after completion of an intervention package. DESIGN AND SETTING: A qualitative method using focus-group and individual interviews with health professionals at a governmental hospital in Uganda. PARTICIPANTS: 81 health professionals. INTERVENTIONS: A 6-step intervention package including, amongst other things, showing a DVD on safe uninterrupted SSC following birth and discussing with the professionals what barriers and possibilities there were to changing practice to allow SSC for one hour. MEASUREMENTS AND FINDINGS: The thematic analysis of the intervention interviews yielded the following themes: Perceived barriers including medical events, psychosocial issues and standard midwifery practice; Pragmatic barriers including economic constraints in the hospital and community; Anticipated barriers by staff and families; Enabling events including staff involvement. Most of the barriers involving expenses were not solved. When the mother and infant had to move to the postnatal ward within one hour after birth, there were difficulties in keeping SSC during the transportation, but this obstacle was partly solved. A few mothers (i.e. depressed and/or adolescent) were considered to be unwilling to keep the infant skin-to-skin; this difficulty was not solved. Practising SSC led the participants to find advantages such as reduced work load and positive effects on pain during suturing. CONCLUSIONS: SSC following birth was shown to be applicable and accepted by the health professionals. The involvement of professionals had clinical implications, such as initiatives to broadcast the message of SSC by radio to the community and introduce SSC to women having a Caesarean section.

A hermeneutic study of integrating psychotherapist competence in postnatal child health care: nurses' perspectives.

BACKGROUND: There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses' conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm. METHODS: In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach. RESULTS: Four main themes crystallized; The nurses' conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses' conceptions of the psychotherapist's function. In a second step, an analysis that clustered the nurses' attitudes towards handling mental health problems yielded one last theme with three "Ideal types"; nurses who expressed "I don't want to", "I want to but I cannot", and "I want to and I can" (take care of families' emotional problems at the CHC). CONCLUSION: The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.

Patient involvement in the development of a psychosocial cancer rehabilitation intervention: evaluation of a shared working group with patients and researchers.

PLAIN ENGLISH SUMMARY: The aim of this paper is to present our experiences from a shared working group (SWG) with patient representatives and researchers. The SWG collaborated on developing a psychosocial cancer rehabilitation intervention for women treated for breast cancer and men treated for prostate cancer and on the planning of an effect study of this intervention.The SWG included five patient representatives (three women treated for breast cancer and two men treated for prostate cancer), four researchers and a research assistant. The SWG met four times during the year where the intervention was developed. Data material for the present evaluation study comprises meeting documents, transcriptions of interviews with two patient representatives and three researchers from the SWG, and the primary investigator's field notes.The collaboration between patient representatives and researchers informed both the intervention and the research planning and was rewarding for the involved participants. The well-structured organization of the collaboration had a positive impact on the outcome. In addition, clear goals and clarification of expectations were important. Challenges were encountered in keeping continuity between meetings and carrying out homework as intended. It was crucial for the collaboration that patient representatives had specific knowledge, interest and motivation for the project.Involving patient representatives in the research process heightened the relevancy of the research and the quality of its contents. The SWG gave patient representatives and researchers a better mutual understanding. Overall, the conclusion is that the benefits obtained by involving patient representatives exceeds the additional costs this involves. ABSTRACT: Background The aim of the paper is to present experiences of researchers collaborating with patients in a shared working group comprising patient representatives and researchers. Experiences are deduced from the evaluation of the work in the working group, which collaborated on developing a psychosocial cancer rehabilitation intervention for women treated for breast cancer and men treated for prostate cancer and the planning of a randomized controlled trial that investigates the effect of this intervention. Methods Five patient representatives (three women treated for breast cancer and two men treated for prostate cancer), four researchers and a research assistant participated in the shared working group. The shared working group met four times during the year the intervention was developed. Data material for the present evaluation study was collected from meeting documents, transcriptions of interviews with two patient representatives and three researchers from the shared working group, and the primary investigator's field notes. The data analysis was guided by Sandelowski's qualitative description strategy. Results The collaboration between patient representatives and researchers informed the intervention and the research planning and was rewarding for the involved participants. The well-structured organization of the collaboration had a positive impact on the outcome. Also, clear goals and clarification of expectations were important. Challenges were encountered in ensuring continuity between meetings and carrying out homework as intended. It was considered crucial for the collaboration to recruit patient representatives with specific knowledge, interest and motivation for the project. The direct costs related to the shared working group, including meals, transportation and salary for the research assistant, were small. However, the indirect costs in terms of time spent on planning patient-involving elements of, organizing meetings and evaluation were substantial and demanded a significant amount of extra work for the primary investigator. Conclusion Involving patients in the research process heightened the relevancy of the research and the quality of the research contents. The shared working group influenced both patient representatives and researchers and gave them a better mutual understanding. Overall, the conclusion is that the benefits obtained by involving patients exceed the additional costs related to patient involvement.

Weight loss and low age are associated with intensity of rooting behaviours in newborn infants.

AIM: Little is known about the developing breastfeeding behaviour of newborn infants. This study describes infants' prebreastfeeding behaviour during the second day of life and explores possible associations with infant characteristics. METHODS: We studied 13 mothers and healthy full-term infants after normal births. At 24-48 hours of life, the newborns were placed in skin-to-skin contact with their mothers for breastfeeding and were video-filmed. The order, frequency and duration of predefined infant prefeeding behaviours and suckling were coded and analysed using computer-based video software. RESULTS: Prefeeding behaviours occurred in the following order: rooting, hand to mouth movements, licking of the nipple and hand to breast to mouth movements. The infants started to suckle at a median of one to two minutes. Rooting was the most common behaviour, observed in 12 infants. The duration of rooting movements during the last minute before breastfeeding was inversely related to neonatal age (p ≤ 0.001) and positively related to neonatal weight loss (p = 0.02) after birth. CONCLUSION: Infants exhibited a distinct sequence of prefeeding behaviours during the second day of life, and our findings suggest that rooting movements were governed by mechanisms involved in the regulation of food intake and weight gain.

The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes.

OBJECTIVE: this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors. DESIGN: a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records. SETTING: data were recruited from antenatal health-care clinics in Halland, Sweden. PARTICIPANTS: a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42. MEASUREMENTS: five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States. FINDINGS: results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy. KEY CONCLUSIONS: this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth.