Assessing the Implementation of the Baby-Friendly Hospital Initiative in Hungary: A Cross-Sectional Study.

We assessed the prevalence of the "Ten Steps to Successful Breastfeeding" in Hungary and identified possible associations of the steps with breastfeeding. Our quantitative, cross-sectional research was conducted anonymously online in Hungary with a self-administered questionnaire in 2021. Targeted sampling was used, with biological motherhood and having at least one child no older than 60 months as inclusion criteria (n = 2008). The implementation of the "Ten Steps to Successful Breastfeeding" was analyzed separately for breastfeeding and non-breastfeeding mothers. A breastfeeding mother was defined as breastfeeding for at least six months. Descriptive statistics, χ2 test, and t-test were calculated with SPSSv25 (p < 0.05). No significant differences were found between breastfeeding and non-breastfeeding mothers in terms of supplementary feeding at the advice of a health professional (p = 0.624) and in terms of assistance with breastfeeding or suggested breastfeeding positions during hospitalization (p = 0.413). Significant differences were found for receiving breastfeeding-friendly recommendations by staff (p = 0.006), valuing breastfeeding (p < 0.001), skin-to-skin contact within 1 h (p = 0.002), receiving supplementary feeding (p < 0.001), rooming-in (p < 0.001), responsive feeding, recognizing hunger signs (p < 0.001), pacifier/bottle use (p < 0.001), and availability of breastfeeding support (p = 0.005). Significant differences were observed between breastfeeding and non-breastfeeding subsamples regarding the implementation of baby-friendly steps (p < 0.001). Breastfeeding mothers experienced the implementation of more baby-friendly steps and a higher rate of breastfeeding, while there was no significant difference in the duration of exclusive (p = 0.795) and partial breastfeeding (p = 0.250) based on the results. We concluded that exposure to the Baby-Friendly Hospital Initiative may be associated with increased 6-month breastfeeding but may not influence longer durations.

Calm Contact Technique Based on the Endocrinological Mechanism of Hypnosis-A Theoretical Proposal.

This paper proposes the "calm contact" technique: an imaginative scenario where someone is in gentle contact with a loved one where the essence of the experience is to enjoy safety and calmness in peaceful social contact. The theoretical background is outlined by combining the brain mechanisms of stress reactions and hypnosis. In addition to the ancient stress responses (flight or fight or freeze), there are oxytocin-based options at the human level: tend and befriend behavior and the state of calm and connection, which is not a stress reaction but a resting reaction. These social-based reactions could prevent the organism from the primitive freezing response. Some studies proved that "hypnosis" as a setting reduces cortisol levels and could raise oxytocin levels. The beneficial mechanisms of the "calm contact" technique are analyzed in relation to "social support" and the psychoaffective effects of central oxytocin. The subjective effects of the proposed technique are outlined based on reports of healthy volunteers. The "calm contact" technique could be an alternative or adjunct to the "safe place" technique, applying the recent findings of endocrinological brain mechanisms of hypnosis. Clinical implications and limitations are briefly summarized.

The Impact of Mode of Delivery and Postpartum Conditions on Breastfeeding: A Cross-Sectional Study.

Breast milk is the optimal and essential source of nutrients for babies. Many women, however, do not breastfeed or stop early after giving birth, often due to lack of support. For newborns delivered by caesarean section, there is often a delay, or no skin-to-skin contact after birth; thus, early breastfeeding is not achieved. Separation, complementary feeding or pacifier use also limits the mother's ability to breastfeed. A quantitative, cross-sectional study was conducted. Sociodemographic data, the mode of delivery and postpartum circumstances, information on breastfeeding, and the method and duration of feeding were collected (n = 2008). Two-thirds of children born by caesarean section did not have skin-to-skin contact after birth (p < 0.001). Lack of rooming-in placement increased the incidence of more frequent complementary feeding (p < 0.001) and shortened the duration of exclusive breastfeeding (p < 0.001). The duration of breastfeeding may also be negatively affected by scheduled feeding (p = 0.007) and pacifier utilization (p < 0.001). The mode of delivery and postpartum circumstances directly affecting the mother and the newborn can affect the feasibility of breastfeeding and the duration of exclusive and partial breastfeeding. For positive breastfeeding outcomes, skin-to-skin contact immediately after birth, rooming-in and unrestricted, demand breastfeeding, as well as the avoidance of the use of pacifiers, are recommended.

[Comparison of the feeding habits of breastfeeding and non-breastfeeding mothers and the sociodemographic factors influencing breastfeeding]. / A szoptató és a nem szoptató gyermekágyas anyák táplálkozási szokásainak összehasonlítása, valamint az anyatejes táplálást befolyásoló szociodemográfiai tényezok.

INTRODUCTION: Breastfeeding is the most ideal form of infant feeding, the biological norm that affects the mother's nutrition as well as certain sociodemographic factors. OBJECTIVE: The aim of this research is to compare the nutritional habits of breastfeeding and non-breastfeeding mothers during the postpartum period, and to further examine the correlations of sociodemographic factors with breast milk feeding. METHOD: Our quantitative, cross-sectional study was conducted between 26. 03. 2021 and 18. 07. 2021. During the non-random, targeted, expert sample selection, the target group included those biological mothers who raised at least one child born alive after the 37th gestational week in their own care. Exclusion criteria included adoption, pregnancy with the first child, inadequate completion of the mandatory questions, and reports of a congenital and/or acquired physical or mental illness that makes breastfeeding impossible. 2008 people met the inclusion and exclusion criteria. The survey was carried out anonymously via a self-filled questionnaire online. The statistical analysis was performed using the IBM SPSS 25 program, the significance level was determined at p<0.05. RESULTS: There was a significant difference between the group of breastfeeding mothers and non-breastfeeding mothers in terms of age (p<0.001), place of residence (p<0.001), marital status (p<0.001), education (p<0.001), income status (p<0.001), the number of children (p = 0.005), the method of delivery (p = 0.018), how many children completed the questionnaire (p = 0.021). Varied nutrition was characteristic in a significantly higher proportion during the postpartum period among breastfeeding mothers (p = 0.006). There was a relationship between the two groups in terms of energy intake (p = 0.002) and daily vitamin/mineral/trace element intake (p = 0.044). CONCLUSION: During the period of childbirth, breastfeeding mothers pay more attention to their nutrition than non-breastfeeding mothers. Breastfeeding can be significantly influenced by certain sociodemographic factors. Orv Hetil. 2023; 164(43): 1693-1700.

LC3-associated phagocytosis promotes glial degradation of axon debris after injury in Drosophila models.

Glial engulfment of neuron-derived debris after trauma, during development, and in neurodegenerative diseases supports nervous system functions. However, mechanisms governing the efficiency of debris degradation in glia have remained largely unexplored. Here we show that LC3-associated phagocytosis (LAP), an engulfment pathway assisted by certain autophagy factors, promotes glial phagosome maturation in the Drosophila wing nerve. A LAP-specific subset of autophagy-related genes is required in glia for axon debris clearance, encoding members of the Atg8a (LC3) conjugation system and the Vps34 lipid kinase complex including UVRAG and Rubicon. Phagosomal Rubicon and Atg16 WD40 domain-dependent conjugation of Atg8a mediate proper breakdown of internalized axon fragments, and Rubicon overexpression in glia accelerates debris elimination. Finally, LAP promotes survival following traumatic brain injury. Our results reveal a role of glial LAP in the clearance of neuronal debris in vivo, with potential implications for the recovery of the injured nervous system.

Current Practices, Experiences, and Views in Clinical Hypnosis: Findings of an International Survey.

An online survey of 691 clinicians who use hypnosis was conducted in 31 countries to gain a broad real-world picture of current practices, views, and experiences in clinical hypnosis. Among 36 common clinical uses, stress reduction, wellbeing and self-esteem-enhancement, surgery preparations, anxiety interventions, mindfulness facilitation, and labor and childbirth applications were the most frequently rated as highly effective (each by ≥70% of raters) in the clinicians' own experience. Adverse hypnosis-associated effects had been encountered by 55% of clinicians but were generally short-lived and very rarely judged as serious. The most common hypnosis approaches used were Ericksonian (71%), hypnotic relaxation therapy (55%), and traditional hypnosis (50%). Almost all respondents reported regularly using other therapeutic modalities alongside hypnosis. Among a range of client variables potentially affecting therapy, most clinicians rated hypnotist-client rapport (88%) and client motivation (75%) as very or extremely important factors for successful hypnotherapy. The majority of respondents had conducted hypnosis treatment via teletherapy, and 54% of those estimated it to be as effective as in-person treatment.

Natural and synthetic oxytocin during childbirth and breastfeeding / A természetes és a szintetikus oxitocin szüléskor és szoptatáskor

The aim of this study is to provide an overview about the role of oxytocin in childbirth and breastfeeding, based on the review of studies on oxytocin. It highlights the relationship between physiological (peripheral) effects and central, psycho-affective effects. It also summarizes the known consequences of various interventions that modify the natural (endogenous) oxytocin action during childbirth and breastfeeding. Suggestions are made on how to support the endogenous oxytocin system by as few interventions as possible.

Electrodermal Orienting Response During Active-Alert Hypnosis: Do Verbal Suggestions Influence Automatic Attentional Processes?

This study explored the influence of suggestions on differences in electrodermal laterality of the skin conductance orienting response (SCR). Thirty-two participants were randomly assigned to either permitting or excluding suggestions. During the dream task in the permitting condition the suggestion was: "You are aware of your surroundings and any distractions that might disturb your dream," while in the excluding condition the wording was: "No outside stimulus will disturb your sleep." Participants were presented with 12 standards and 2 deviant computer-generated tones during active-alert hypnosis and musical control conditions in a mixed within-between design. High hypnotizables produced higher SCRs after permissive compared to excluding suggestions during hypnosis, while low hypnotizables did the same in the control condition. Study limitations include some loss of data due to equipment failure and relative homogeneity of sample, therefore results cannot be considered definitive.

Altered States of Consciousness during Exercise, Active-Alert Hypnosis, and Everyday Waking State.

This retrospective study was a nonrandomized comparison of exercisers' (runners and participants of a spinning class) states of consciousness with subjects of active-alert hypnosis (AAH) and students in a class (control). Three hundred and seventy-five participants completed the Phenomenology of Consciousness Inventory (PCI). Runners, spinners, and participants of AAH scored higher on the altered experience and altered state of awareness dimensions of the PCI than the control group. Runners scored higher than participants of AAH and the control condition on the rationality dimension, and spinners scored higher than participants in the AAH condition. The AAH group scored lowest on the self-awareness dimension. On the volitional control dimension, the spinning and control groups scored significantly higher than the runner and AAH groups. The results suggest that exercise may lead to states of consciousness similar to AAH and thus increase responsiveness to a coach's training suggestions.

Guidelines for the Assessment of Efficacy of Clinical Hypnosis Applications.

Research on the efficacy of hypnosis applications continues to grow, but there remain major gaps between the science and clinical practice. One challenge has been a lack of consensus on which applications of hypnosis are efficacious based on research evidence. In 2018, 6 major hypnosis organizations collaborated to form the Task Force for Establishing Efficacy Standards for Clinical Hypnosis. This paper describes a Guideline for the Assessment of Efficacy of Clinical Hypnosis Applications developed by the Task Force, which makes 10 specific recommendations. The guideline is intended to be a tool for those who want to assess the quality of existing evidence on the efficacy of clinical hypnosis for any particular indication. The paper also discusses methodological issues in the interpretation and implementation of these guidelines. Future papers will report on the other products of the Hypnosis Efficacy Task Force, such as best practice recommendations for outcomes research in hypnosis and an international survey of researchers and clinicians on current practice and attitudes about hypnosis.

A pilot study of trained ICU doulas providing early psychological support to critically ill patients.

BACKGROUND: Over a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor. In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed. METHODS: Adult critically ill patients were recruited for this single-arm, prospective pilot study. These ICU patients received a positive suggestion intervention daily during their ICU stay in parallel with their medical treatment. The intervention was designed to be delivered over a minimum of two sessions. Feasibility was defined as intervention delivery on ≥ 70% of ICU days after patient enrollment. As a secondary analysis, psychometric questionnaires were compared to those of a historic control cohort of patients receiving standard care in the ICU using adjusted linear regression models. RESULTS: Of the 97 patients who received the intervention and were alive at the end of their ICU course, 54 were excluded from analyses mostly for having received only one session because of a short ICU length of stay of < 2 days, transitioning to comfort care or not wanting to answer the study questionnaires. Forty-three patients who completed 2 or more sessions of the positive therapeutic suggestion intervention provided by two trained ICU doulas received it for a median of 4 days (IQR 3, 5), with each session lasting for a median of 20 min (IQR 14, 25). The intervention was delivered on 71% of days, meeting our pre-determined feasibility goal. Compared to historical controls (N = 299), patients receiving the intervention had higher severity of illness and longer length of stay. When adjusted for baseline differences, patients both with and without mechanical ventilation who received the intervention scored lower on the Hospital Anxiety and Depression Scale (HADS)-Depression subscale. The intervention was also associated with reduced HADS-Anxiety subscale among ventilated patients. CONCLUSIONS: Positive therapeutic suggestion delivered by ICU doulas is feasible in the ICU setting. A randomized trial is warranted to better delineate the role that positive suggestion and ICU doulas may play in ongoing interprofessional efforts to humanize critical care medicine. The study was registered on clinicaltrials.gov (NCT03736954) on 03/14/2018 prior to the first patient enrollment https://clinicaltrials.gov/ct2/show/NCT03736954?cond=ICU+Doulas+Providing+Psychological+Support&draw=2&rank=1 .

Possible Mechanisms of Hypnosis from an Interactional Perspective.

In this paper, utilizing the interactional research paradigm developed by Éva Bányai, we discuss the hypnotic relationship from the viewpoint of interactional synchrony. Based on our three decades of empirical studies of an interactional paradigm, we propose the analogy between hypnosis and mother-child interaction. Hypnosis is considered as a potential corrective/reparative possibility when the real childhood experiences appear to be unfavourable. Possible neuroanatomical and neurochemical mechanisms are also suggested in the right hemispheric orbitofrontal cortex and central oxytocin system.

System of Psychological Support Based on Positive Suggestions to the Critically Ill Using ICU Doulas.

Surviving critical illness often creates a lasting psychological impact, including depression, anxiety, and post-traumatic stress. Memories of frightening and delusional experiences are the largest potentially modifiable risk factor, but currently, there is no proven intervention to improve these inciting factors. Psychological support based on positive suggestion is a psychotherapeutic approach that can be provided even to patients in altered cognitive states and is therefore a viable psychotherapy intervention throughout the ICU stay. Traditional ICU care team members have limited time and training to provide such psychological support to patients. Doulas are trained supportive companions who have been effectively used to provide patient advocacy and emotional support in other clinical settings and may address this need. Our aim was to train and implement a psychological support based on positive suggestion program for the critically ill using doulas, and measure acceptance of this intervention through stakeholder feedback. METHODS: Doula training included three objectives: an introduction to ICU practice structure and policies; education about fundamental aspects of critical care conditions and procedures; and didactic and hands-on learning experiences in effective use of psychological support based on positive suggestion in the critically ill. Doulas were evaluated at the end of their training and during subsequent clinical activities using competency-based assessments as well as through survey-based questions and interviews with key stakeholders. RESULTS: The ICU doulas performed psychological support based on positive suggestion on 43 critically ill patients in the ICU setting. Stakeholder feedback from nurses, patients, and patient families was positive. The majority (28/32) of surveyed bedside ICU nurses reported that the doulas' involvement was helpful for both patients and nurses alike. All interviewed family members offered positive comments about the ICU doula presence and of the 40 patients who recalled the intervention 37 found it comforting. CONCLUSIONS: Our program successfully trained two doulas to work effectively in the ICU setting performing patient-centered psychological support based on positive suggestion interventions. Their training improved their skill sets and was reported as beneficial by patients, families, and critical care nursing. This training program offers a proof of concept that could be applied in other medical centers, bringing doulas more commonly into the ICU practice to help humanize the experience for patients, families, and medical teams.

Stress and Fear: Clinical Implications for Providers and Patients (in the Time of COVID-19 and Beyond).

In light of the coronavirus disease 2019 pandemic, we explore the role of stress, fear, and the impact of positive and negative emotions on health and disease. We then introduce strategies to help mitigate stress within the health care team, and provide a rationale for their efficacy. Additionally, we identify strategies to optimize patient care and explain their heightened importance in today's environment.

Phenomenological Experiences during Active-Alert Hypnosis: Comparison of Hypnotist and Subject.

There has been increasing clinical interest in active-alert hypnosis (AAH). However, relatively few studies have been devoted to studying its properties systematically. The present study compared the subjective experiences of subjects (31) and hypnotists (5) during AAH, using Pekala's Phenomenology of Consciousness Inventory (PCI), the Dyadic Interactional Harmony (DIH) scale and the Archaic Involvement Measure (AIM). Results demonstrated similarities between the experiences of subjects and hypnotists. The only significant difference between the subjects' and the hypnotists' experiences was shown by the PCI, which highlighted the differences stemming from the different roles of hypnotist and subject during the AAH. The study suggests it may be important to examine subjective descriptors in the exploration of personal experiences in studies of AAH.

Person- and job-specific factors of intuitive decision-making in clinical practice: results of a sample survey among Hungarian physicians and nurses.

Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person- and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of 'emergency' (necessity of making instantaneous decisions in unforeseeable situations) and 'complexity' (necessity of considering multiple perceptual and diagnostic aspects of patients' health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of 'high likelihood of emergency' or 'high complexity' increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs' propensity for IDM. Additionally, we performed content analysis of participants' free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job- and person-specific factors and HCPs' propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

Gene-sex interaction in Hypercompetitive Attitude suggests beneficial effect of the DRD4 7-repeat allele in adaptation.

Twin studies provide evidence for the heritability of social attitudes, e.g. competitiveness, however, there are no psychogenetic association results linking competitive attitudes to genetic polymorphisms. Candidate gene studies report association with competitiveness-related phenotypes, risk taking for example was linked with the 7-repeat allele of the dopamine D4 receptor gene. This polymorphism has been studied extensively with novelty seeking and certain psychiatric disorders, as it plays a crucial role in molecular genetic mechanisms driving behavioral responses to the environment, especially modulating behavior through the reward circuitry. In the present study, we examined association of the DRD4 48-bp VNTR and competitiveness using self-report data from 399 non-related Caucasians. We found an interesting gene-sex interaction: 7-carrier males were more hypercompetitive as compared to non-carriers, while 7-carrier females were less hypercompetitive as compared to non-carriers. This finding remained significant after Bonferroni correction for multiple testing. Interestingly, among females we observed a significant positive correlation between hypercompetitiveness and mood characteristic variables, however, no such relationship could be detected in males. In 7-carrier females the association of hypercompetitiveness and anxiety or depression was more robust as compared to non-carrier females. These results highlight the importance of cultural influences in interpreting gene-sex interaction effects. Our results underlies interaction between genes and the environment; suggesting that the 7-repeat allele plays an important role in adaptivity, enabling sex-specific behavior to social expectations.

Obimon: An open-source device enabling group measurement of electrodermal activity.

Electrodermal activity (EDA) provides the means to gauge the activity of the sympathetic nervous system. Assessment of EDA for research purposes requires measurement systems that are sensitive to small changes in arousal in the full measurement range, collecting, storing, and monitoring data. The objective behind designing a new open-source device was to be able to measure EDA simultaneously on many subjects, monitoring their activity in real time remotely and collecting high precision data suitable for analyses. To assure feasibility of simultaneous measurements on multiple subjects, the devices must be compact and wearable, without compromising data quality. Experiments were carried out using synchronized devices in group and single subject environments. Validity of EDA measurements of Obimon was demonstrated compared to a reference system (Nexus) during a breathing exercise, a short movie, and while exposed to loud computer-generated tones, using Pearson correlation, Passing-Bablok regression, and Bland-Altman analysis. Seamless management of several Obimons and real-time visualization of EDA via Android phone/tablet application from a large number of participants was demonstrated. Based on analyses of the data collected, we conclude that the Obimon device presented here is a valid and feasible tool for collecting EDA in single or multisubject environments.

Assessing fear of childbirth and its predictors among Hungarian pregnant women using Wijma Delivery Expectancy/Experience Questionnaire subscales.

This study aimed to assess fear of childbirth (FOB) among Hungarian pregnant women and determine predictors based on WDEQ-A subscales. This cross-sectional study was conducted among 423 healthy pregnant women during their third trimester. A socio-demographic and obstetrics characteristics, the Hungarian version of WDEQ-A, Beck Depression Inventory-Short Form and Beck Anxiety Inventory were used. The analysis was performed using multivariate linear regression. Among four WDEQ-A subscales, Fear (19%) and Lack of positive emotion (13%) obtained the largest and smallest percentages of cases with severe FOB. The nulliparous obtained significantly higher mean score in subscales Isolation and Lack of positive emotion compared to the multiparous. Anxiety was the most common predictor for all subscales in both groups. In the nulliparous group, significant predictors included economic hardship for Moment of birth, being a housewife for Fear, and wanted pregnancy for Lack of positive emotion. In the multiparous women, the strongest significant predictors were being married, previous elective caesarean section and being a housewife for subscales Isolation, Moment of birth, and Fear, respectively. Assessing FOB using WDEQ-A among Hungarian women revealed different mean scores and predisposing factors for each subscale. The topic should be further explored relative to its constituent factors.