The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor.

Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.

'In the shower crying but we came back in the following day and did it all again'. Distress and resilience in care home staff during the COVID-19 pandemic- A qualitative interview study.

BACKGROUND: Care homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them. METHODS: Semi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis. RESULTS: Interview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued. CONCLUSIONS: This paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges.

Use of psychoacoustic spectrum warping, decision template fusion, and neighborhood component analysis in newborn cry diagnostic systems.

Dealing with newborns' health is a delicate matter since they cannot express needs, and crying does not reflect their condition. Although newborn cries have been studied for various purposes, there is no prior research on distinguishing a certain pathology from other pathologies so far. Here, an unsophisticated framework is proposed for the study of septic newborns amid a collective of other pathologies. The cry was analyzed with music inspired and speech processing inspired features. Furthermore, neighborhood component analysis (NCA) feature selection was employed with two goals: (i) Exploring how the elements of each feature set contributed to classification outcome; (ii) investigating to what extent the feature space could be compacted. The attained results showed success of both experiments introduced in this study, with 88.66% for the decision template fusion (DTF) technique and a consistent enhancement in comparison to all feature sets in terms of accuracy and 86.22% for the NCA feature selection method by drastically downsizing the feature space from 86 elements to only 6 elements. The achieved results showed great potential for identifying a certain pathology from other pathologies that may have similar effects on the cry patterns as well as proving the success of the proposed framework.

Evaluation of measurement errors in the Patient-Oriented Eczema Measure (POEM) outcome.

BACKGROUND: The Patient-Oriented Eczema Measure (POEM) is the recommended core outcome instrument for atopic dermatitis (AD) symptoms. POEM is reported by recalling the presence/absence of seven symptoms in the last 7 days. OBJECTIVE: To evaluate measurement errors in POEM recordings due to imperfect recall. METHODS: Using data from a clinical trial of 247 AD patients aged 12-65 years, we analysed the reported POEM score (r-POEM) and the POEM derived from the corresponding daily scores for the same seven symptoms without weekly recall (d-POEM). We quantified recall error by comparing the r-POEM and d-POEM for 777 patient-weeks collected from 207 patients, and estimated two components of recall error: (1) recall bias due to systematic errors in measurements and (2) recall noise due to random errors in measurements, using a bespoke statistical model. RESULTS: POEM scores have a relatively low recall bias, but a high recall noise. Recall bias was estimated at 1.2 points lower for the r-POEM on average than the d-POEM, with a recall noise of 5.7 points. For example, a patient with a recall-free POEM of 11 (moderate) could report their POEM score anywhere from 5 to 14 (with 95% probability) because of recall error. Model estimates suggested that patients tend to recall itch and dryness more often than experienced (positive bias of less than 1 day), but less often for the other symptoms (bleeding, cracking, flaking, oozing/weeping and sleep disturbance; negative bias ranging 1-4 days). CONCLUSIONS: In this clinical trial data set, we found that patients tended to slightly underestimate their symptoms when reporting POEM, with significant variation in how well they were able to recall the frequency of their symptoms every time they reported POEM. A large recall noise should be taken into consideration when interpreting POEM scores.

When crying turns to hitting: Examining maternal responses to negative affect.

Physical aggression in toddlerhood is empirically linked to anger and often conceptualized as a byproduct of frustration and related negative affect. Further, parenting is the major environmental construct implicated in the development of aggressive behaviors. Given parents' role as "external regulators," parents' responses to their toddlers' negative affect may serve to escalate or de-escalate their toddlers' affective experience, thereby impacting the likelihood of subsequent aggression. In the present study, we examined whether parents' negative affect, harsh, soothing, and distracting responses to their toddlers' negative affect mediated the relation between toddlers' negative affect and their aggressive behavior in brief conflict episodes. During a laboratory visit, a community sample of 69 mother-toddler dyads was observed in a structured interaction task. We found that child negative affect is associated with subsequent aggressive behavior by way of maternal harsh responses to negative affect. Negative emotional expression, soothing, and distraction neither facilitated or hindered children's escalation from negative affect to aggression. Our findings support a dyadic intervention in which patterns of coercive parent-child interactions are targets for prevention and intervention of toddler aggression.

Sleep SAAF Responsive Parenting Intervention for Black Mothers Impacts Response to Infant Crying: A Randomized Clinical Trial.

OBJECTIVE: Many parents use food to soothe their infant, regardless of infant hunger, which can increase risk for rapid weight gain. Interventions promoting alternative soothing strategies may help parents respond more appropriately to crying. This secondary analysis aimed to examine effects of the Sleep SAAF (Strong African American Families) responsive parenting (RP) intervention on maternal responses to infant crying and to explore moderating effects of infant negativity. METHODS: Primiparous Black mothers (n = 212) were randomized to an RP or safety control intervention, delivered during home visits at 3 and 8 weeks postpartum. Parents were empowered to first use non-food soothing strategies (eg, white noise, swaddling) when responding to crying. Mothers completed the Babies Need Soothing questionnaire at 8 and 16 weeks, and the Infant Behavior Questionnaire at 16 weeks. Data were analyzed using linear or logistic regression. RESULTS: RP mothers were significantly more likely than controls to use shushing/white noise to soothe their infant at 8 (OR = 4.9, 95% CI: 2.2-10.6) and 16 weeks (OR = 4.8, 95% CI: 2.2-10.5), to go for a walk in stroller/ride in car at 8 weeks (OR = 2.3, 95% CI: 1.2-4.6), and to swing/rock/bounce their infant at 16 weeks (OR = 5.5, 95% CI: 1.2-25.7). RP mothers also reported significantly more frequent use of deep breathing, exercising, and bathing/showering than controls when frustrated with crying. Infant negativity moderated some intervention effects such that the RP intervention was more effective at increasing use of some soothing practices among mothers with less negative infants. CONCLUSIONS: An RP intervention positively impacted first-time Black mothers' responses to infant crying.

Golden tears: A cross-country study of crying in the Olympics.

This article studies tears of joy by exploring data on the behavior of gold medalists of all 450 individual events at the 2012 and 2016 Summer Olympic Games at the end of the medalists' respective competitions and during the medal ceremonies. We find that women cry more than men, older athletes cry more than younger athletes, athletes from the host country cry more at the end of the competition, and athletes cry more when they receive information on their victory immediately after completing their task. When looking at the socioeconomic characteristics of athletes' countries, we find that men from countries with larger female labor force participation rates cry more than men from countries with lower female labor force participation, and athletes from countries with higher religious fractionalization cry less than those from countries with lower fractionalization. Finally, we find no relationship between the wealth of a country and the propensity of its athletes of any gender to cry. We discuss possible mechanisms that drive our results and suggest future directions for observational studies on emotions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Childminder knowledge of shaken baby syndrome and the role played by childminders in prevention: An observational study in France.

BACKGROUND: Shaken baby syndrome (SBS) triggers negative short- and long-term outcomes. In France, registered childminders are the principal source of daycare. They may encounter SBS imparted by caregivers or simply excessive infant crying. The aim of the study was to explore childminder knowledge on SBS, the source of information, the responses to infant crying, how childminders perceived their roles in terms of caregiver SBS prevention, and the factors associated with a good knowledge of SBS. METHODS: The participants were registered childminders working in the French department of Gironde who had email accounts. This observational study employed an anonymous online questionnaire distributed by the maternal and child health services unit of the Gironde department over 5 weeks from 16 September 2021. Data on childminder characteristics, knowledge on SBS, responses to infant crying, and perceptions of their roles in SBS prevention were collected. The knowledge score ranged from 0 (all wrong answers) to 30 (all correct answers). RESULTS: A total of 779 registered childminders participated; 43.9 % had learnt about SBS during their initial training and 75 % before (other training) or after initial training. The median knowledge score was 19/30 (interquartile range [16; 21]). A higher educational level, previous other professional experience, training on SBS, and responsibility for few children were associated with higher scores. Ten reported that they did not advise caregivers who complained of infant crying. CONCLUSION: Childminders require training on SBS and SBS prevention.

Sensitive responsiveness and multiple caregiving networks among Mbendjele BaYaka hunter-gatherers: Potential implications for psychological development and well-being.

Attachment theory postulates that there is a particular style of caregiving that, because of its interaction with our evolved psychology, is most likely to result in healthy psychological development. Attachment research has been criticized because most studies have been conducted with Western populations. Critics argue this has (a) overemphasized the importance of sensitive responsive caregiving and (b) limited our understanding of multiple nonmaternal caregiving (allomothering). Here, we analyze the extent of sensitive responsiveness and structural properties of allomothering networks among Mbendjele hunter-gatherers who reside in the Republic of Congo. Humans lived as hunter-gatherers for the majority of our evolutionary history, thus studying contemporary hunter-gatherers can offer insight into the caregiving children may be psychologically adapted to. Based on 12-hr focal follows of 18 children (0-4 years old; 10 male), we constructed caregiving networks across the domains of responding to crying, physical contact, interactive care, and proximity. Crying was virtually always responded to rapidly via comforting and never via scolding. Children received physical contact and care for the majority of the day. Allomothering accounted for 40%-50% of caregiving in each domain. While allomaternal networks were large, they were highly concentrated-the majority of a child's allocare was provided by just a few caregivers. Due to high caregiver:child ratios, "sharing" of caregivers was limited-a child typically had several allomothers who directed a majority of their allomaternal effort to him/her. These findings add to our understanding of the level and sources of sensitive responsive caregiving that children may be evolutionarily primed to expect. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Breastfeeding on the Newborn's Comfort and Pain Levels During Heel Blood Collection.

This research was planned to determine the effect of breastfeeding on newborns' behavioral pain and comfort scores during heel blood collection. A pretest/posttest experimental-control group design was used. The research was conducted between August 2021 and June 2022. A total of 50 newborns, including 25 in each of the experimental and control groups, were included in the study. An Infant Descriptive Information Form, the COMFORTneo Behaviour Scale, the NIPS-Neonatal Infant Pain Scale, and the LATCH Breastfeeding Diagnosis and Assessment Tool were used in the study. The comfort behaviors and pain scores of infants in the experimental and control groups were evaluated during the heel blood collection process. The comparison of the comfort behaviors (comfort, pain, and distress), differences between pretest-posttest scores on the NIPPS pain score, and crying duration of the newborns in the experimental and control groups indicated a significant difference (p 0.05). The intra-group differences between the mean pretest and posttest scores of both the intervention and control groups were found to be statistically significant (p 0.05). Breastfeeding is an important nursing intervention for reducing procedural pain in newborns. The breastfeeding method reduces pain and distress and increases comfort for newborns during the heel blood collection process.

Breastfeeding is an important nursing intervention for reducing procedural pain in newborns.The breastfeeding method reduces the pain and distress of the newborn during the heel blood collection process and increases comfort.Neonatal nurses can diversify the effectiveness of non-pharmacological methods in painful interventions by evaluating them with appropriate tools.

Music Therapy During Basic Daily Care in Critically Ill Children: A Randomized Crossover Clinical Trial.

OBJECTIVE: To assess whether music therapy (MT) is effective to reduce pain during daily personal hygiene care (DPHC), a procedure performed in all patients in a pediatric intensive care unit. METHODS: Fifty critically ill children were enrolled in a crossover controlled clinical trial with random ordering of the intervention, that is, passive MT, and standard conditions, and blind assessment of pain on film recordings. The primary outcome was variation of the Face Legs Activity Cry Consolability (FLACC) score (range, 0-10) comparing before and during DPHC. Secondary outcomes were changes in heart rate, respiratory rate, and mean arterial blood pressure, and administration of analgesic or sedative drugs during DPHC. Mixed-effects linear model analysis was used to assess effect size (95% CI). RESULTS: The median (Q25-Q75) age and weight of the patients were 3.5 years (1.0-7.6 years) and 15.0 kg (10.0-26.8 kg). Consecutive DPHC were assessed on days 3 (2-5) and 4 (3-7) of hospitalization. In standard conditions, FLACC score was 0.0 (0.0-3.0) at baseline and 3.0 (1.0-5.5) during DPHC. With MT, these values were, respectively, 0.0 (0.0-1.0) and 2.0 (0.5-4.0). Rates of FLACC scores of >4 during DPHC, which indicates severe pain, were 42% in standard conditions and 17% with MT (P = .013). Mixed-effects model analysis found smaller increases in FLACC scores (-0.54 [-1.08 to -0.01]; P = .04) and heart rate (-9.00; [-14.53; -3.40]; P = .001) with MT. CONCLUSIONS: MT is effective to improve analgesia in critically ill children exposed to DPHC. TRIAL REGISTRATION: This study was recorded (April 16, 2019) before patient recruitment on the National Library of Medicine registry (NCT03916835; https://clinicaltrials.gov/ct2/show/NCT03916835).

Infantile colic.

Infant colic is characterized by excessive and often inconsolable crying in an otherwise healthy and well-fed infant. Infant crying follows a developmental pattern, starting to increase around 2 weeks of age (corrected for gestational age at birth), peaking at 5 to 6 weeks, and trailing down by about 12 weeks. There is also a circadian component in that infants cry more in the evening than at other times. Infant colic can be thought of as an amplified version of the maturational, circadian-influenced behavior of infant crying. There is substantial evidence for an association between infant colic and migraine. Children with migraine are more likely to have been colicky as infants, and in a prospective, population-based study, young adults with migraine without aura were more than twice as likely to have been colicky as infants. Mothers with migraine are more likely to have infants with colic, particularly those mothers with higher headache frequency. Clinicians should be aware of these associations in order to be able to counsel appropriately pregnant women with migraine about the possibility of having an infant with colic (and its time-limited nature), and to help make an accurate diagnosis of migraine in children and adolescents presenting with recurrent headaches.

A Scene Adaption Framework for Infant Cry Detection in Obstetrics.

Infant cry provides useful clinical insights for caregivers to make appropriate medical decisions, such as in obstetrics. However, robust infant cry detection in real clinical settings (e.g. obstetrics) is still challenging due to the limited training data in this scenario. In this paper, we propose a scene adaption framework (SAF) including two different learning stages that can quickly adapt the cry detection model to a new environment. The first stage uses the acoustic principle that mixture sources in audio signals are approximately additive to imitate the sounds in clinical settings using public datasets. The second stage utilizes mutual learning to mine the shared characteristics of infant cry between the clinical setting and public dataset to adapt the scene in an unsupervised manner. The clinical trial was conducted in Obstetrics, where the crying audios from 200 infants were collected. The experimented four classifiers used for infant cry detection have nearly 30% improvement on the F1-score by using SAF, which achieves similar performance as the supervised learning based on the target setting. SAF is demonstrated to be an effective plug- and-play tool for improving infant cry detection in new clinical settings. Our code is available at https://github.com/contactless-healthcare/Scene-Adaption-for-Infant-Cry-Detection.

Multi-modal analysis of infant cry types characterization: Acoustics, body language and brain signals.

BACKGROUND: Infant crying is the first attempt babies use to communicate during their initial months of life. A misunderstanding of the cry message can compromise infant care and future neurodevelopmental process. METHODS: An exploratory study collecting multimodal data (i.e., crying, electroencephalography (EEG), near-infrared spectroscopy (NIRS), facial expressions, and body movements) from 38 healthy full-term newborns was conducted. Cry types were defined based on different conditions (i.e., hunger, sleepiness, fussiness, need to burp, and distress). Statistical analysis, Machine Learning (ML), and Deep Learning (DL) techniques were used to identify relevant features for cry type classification and to evaluate a robust DL algorithm named Acoustic MultiStage Interpreter (AMSI). RESULTS: Significant differences were found across cry types based on acoustics, EEG, NIRS, facial expressions, and body movements. Acoustics and body language were identified as the most relevant ML features to support the cause of crying. The DL AMSI algorithm achieved an accuracy rate of 92%. CONCLUSIONS: This study set a precedent for cry analysis research by highlighting the complexity of newborn cry expression and strengthening the potential use of infant cry analysis as an objective, reliable, accessible, and non-invasive tool for cry interpretation, improving the infant-parent relationship and ensuring family well-being.

Spontaneous infant crying modulates vagal activity in real time.

Porges' polyvagal theory (1991) proposes that the activity of the vagal nerve modulates moment-by-moment changes in adaptive behavior during stress. However, most work, including research with infants, has only examined vagal changes at low temporal resolutions, averaging 30+ s across phases of structured stressor paradigms. Thus, the true timescale of vagal regulation-and the extent to which it can be observed during unprompted crying-is unknown. The current study utilized a recently validated method to calculate respiratory sinus arrhythmia (RSA) dynamically at a high resolution of 5 Hz (updated every 200 ms) in a home-based infant study. Using an event-related analysis, we calculated the relative change in RSA around the onset of naturally occurring unprompted instances of n = 41 infants' 180 crying events. As predicted, RSA significantly decreased after the onset of crying compared to non-crying chance changes in RSA. Decreasing trends in RSA were driven by infants with higher pre-cry RSA values, infants rated lower in Negative Affectivity, and those rated both high and low in Orienting by their mothers. Our results display the timescale of RSA in spontaneous and naturalistic episodes of infant crying and that these dynamic RSA patterns are aligned with real-time levels of RSA and also caregiver-reported temperament.

Effectiveness of different bathing methods on physiological indexes and behavioral status of preterm infants: a systematic review and meta-analysis.

BACKGROUND: Bath is an external stimulus for preterm infants. Currently, three methods are used for preterm infants to bath. It is important to choose the best way for them. The objective of this meta-analysis is to evaluate the effectiveness of different bath methods on physiological indexes and behavioral status of preterm infants. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO(CRD42022377657). PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Sino Med, China National Knowledge Internet (CNKI) and Wan-Fang database were systematically searched for randomized controlled trials on the effects of different bath methods for preterm infants. The retrieval time was from the establishment of the database to February 2023. According to the inclusion and exclusion criteria, the literature was screened, quality evaluated and the data was extracted. Reman Version 5.4 was used for meta-analysis and Stata 16.0 software for publication bias Egger's test. RESULTS: A total of 11 RCTs with 828 preterm infants were included. The results of meta-analysis showed that the body temperature and oxygen saturation of preterm infants in the sponge bath group were lower than those in conventional tub bath group (SMD = -0.34; 95%CI -0.56 to -0.12; I2 = 0; p < 0.01), (MD = -0.39; 95%CI -0.76 to -0.02; I2 = 39%; p = 0.04), while the heart rates were higher than those in conventional tub bath group(MD = 5.90; 95%CI 0.44 to 11.35; I2 = 61%; p = 0.03). Preterm infant's body temperature and blood oxygen saturation of in swaddle bath group were higher than those in conventional tub bath group (MD = 0.18; 95%CI 0.05 to 0.30; I2 = 88%; p < 0.01), (MD = 1.11; 95%CI 0.07 to 2.16; I2 = 86%; p = 0.04), respiratory rates were more stable compared with infants in conventional tub bath group (MD = -2.73; 95%CI -3.43 to -2.03; I2 = 0; p < 0.01). The crying duration, stress and pain scores of preterm infants in swaddle bath group were lower than those in conventional tub bath group (SMD = -1.64; 95CI -2.47 to -0.82; I2 = 91%; p < 0.01), (SMD = -2.34; 95%CI -2.78 to -1.91; I2 = 0; p < 0.01), (SMD = -1.01; 95%CI -1.40 to -0.62; I2 = 49%; p < 0.01). Egger's test showed no publication bias in body temperature, respiratory rate, oxygen saturation, and crying duration. CONCLUSIONS: Swaddle bath is the best bathing method than conventional tub bath and sponge bath in maintaining the stability of preterm infant's body temperature, blood oxygen saturation and respiratory rate. In addition, swaddle bath also plays a role in reducing cry duration, stress scores, and pain levels of preterm infant compared with conventional tub bath and sponge bath. However, due to the important heterogeneity in some outcomes, future studies with larger sample size and more appropriately design are needed to conduct before recommendation. TRIAL REGISTRATION: Prospero CRD42022377657.

The Crying Need for a Better Response Assessment in Rectal Cancer.

OPINION STATEMENT: Since total neoadjuvant treatment achieves almost 30% pathologic complete response, organ preservation has been increasingly debated for good responders after neoadjuvant treatment for patients diagnosed with rectal cancer. Two organ preservation strategies are available: a watch and wait strategy and a local excision strategy including patients with a near clinical complete response. A major issue is the selection of patients according to the initial tumor staging or the response assessment. Despite modern imaging improvement, identifying complete response remains challenging. A better selection could be possible by radiomics analyses, exploiting numerous image features to feed data characterization algorithms. The subsequent step is to include baseline and/or pre-therapeutic MRI, PET-CT, and CT radiomics added to the patients' clinicopathological data, inside machine learning (ML) prediction models, with predictive or prognostic purposes. These models could be further improved by the addition of new biomarkers such as circulating tumor biomarkers, molecular profiling, or pathological immune biomarkers.