The way children experience a medical visit lays the groundwork for their health education and fosters trust and comfort in healthcare relationships. This study employed a retrospective and narrative-based design to analyze how children perceived their experiences of visits to their doctor, how they describe their emotions, and how they portray the different relationships within the doctor-caregiver-patient triad. Three hundred fifty students (50.75% female, 8-13 years, Mage = 10.5, SD = 5.93, 77.95% from primary school) completed a booklet comprising different narrative activities. The booklet underwent quantitative content analysis according to gender and school level. Children reported that the doctors primarily addressed their caregivers when asking for and delivering health-related information, while their role was mostly passive. Meeting with friendly doctors and being in a welcoming environment were associated with a positive medical experience, while negative emotions and encounters with unsympathetic practitioners contributed to negative experiences. Most respondents wanted to talk privately with their doctors at their next visit. Some examples and practices are discussed to enable healthcare practitioners to create an environment where children are heard and valued, and their involvement during consultation processes is enhanced.

A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman’s correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother’s MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children.

Previous research suggested that during the COVID-19 pandemic, mental distress did not affect all people equally. This longitudinal study aims to examine joint trajectories of depressive, anxiety, and stress symptoms in a sample of Italian adults during the pandemic, and to identify psychosocial predictors of distress states. We analyzed four-wave panel data from 3,931 adults who had received assessments of depressive, anxiety and stress symptoms between April 2020 and May 2021. Trajectories of individual psychological distress were identified by Latent Class Growth Analysis (LCGA) with parallel processes, and multinomial regression models were conducted to identify baseline predictors. Parallel process LCGA identified three joint trajectory classes for depression, anxiety and stress symptoms. Most individuals (54%) showed a resilient trajectory. However, two subgroups showed vulnerable joint trajectories for depression, anxiety and stress. Expressive suppression, intolerance to uncertainty, and fear of COVID-19 were risk characteristics associated with vulnerable trajectories for mental health distress. Moreover, vulnerability to mental health distress was higher in females, younger age groups and those unemployed during the first lockdown. Findings support the fact that group heterogeneity could be detected in the trajectories of mental health distress during the pandemic and it may help to identify subgroups at risk of worsening states.

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals’ distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak.

Although establishing an affective tie with a child during perinatality is considered one of the most important maternal tasks, little is still known about the mediators of the association between maternal antenatal and postnatal bonding with the infant. This prospective study addresses this gap by evaluating a community sample of 110 Italian women to assess whether maternal pre- and postnatal bonds with the infant are mediated by parental reflective functioning (PRF), as assessed at the third trimester of pregnancy and three months postpartum. Controlling for confounding variables, the hierarchical regression analyses show the maternal prenatal quality of attachment to the fetus as the main predictor of maternal postnatal attachment to the child (β = 0.315; t = 0.2.86; p = 0.005). The mediation analyses show that mothers' PRF (b = 0.245; SE = 0.119; 95% CI = 0.071, 0.531) explains 39% of the relationship between maternal pre- and postnatal bonding with the child. The findings of this study contribute to research on the association between prenatal and mother-to-infant bonding by additionally investigating the importance of taking into account maternal PRF as a mediating variable. This provides support for the clinical utility of interventions focused on maternal PRF.

BACKGROUND:A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women's mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women's psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women's psychological distress.METHODS:This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty.RESULTS:No significant changes were found in women's psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress.CONCLUSIONS:Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.

The Covid19 pandemic raised concerns regarding millions of children’s mental health. For schools, the real challenge has been how to manage the situation in terms of education and development. The present investigation was carried out to evaluate a school re-entry program that supported teachers and students with activities aimed at processing emotions and lockdown experiences in their classrooms. Results show that the program was well perceived and was associated with a consequent reduction in children’s state anxiety and negative emotions. We conclude that a school re-entry program can play an important role in fostering resilience and development during a crisis.

Ten nurses with basic airway management experience were formally trained to use a classic laryngeal mask airway (LMA) and a Laerdal Pocket Facemask (LPFM) for oxygen enriched expired air ventilation (EEAV). They then used both of these devices for EEAV in a randomised fashion in 100 anaesthetised ASA I/II patients for elective surgery. EEAV was considered successful if the patient's arterial oxygen saturation was maintained above 93% on room air for 3 min. EEAV success rates for the LMA and LPFM were 95% and 51% respectively (P=0.03). There was no apparent learning curve for either apparatus. Mean time in seconds (s) for first successful ventilation from picking up the apparatus was 26.8s and 15.1s, for the LMA and LPFM respectively (P<0.005). Although the LMA took significantly longer time to insert, it proved to be more successful and easier to use than the LPFM for EEAV.

Obesity is a widespread and broadly consequential health condition associated with numerous medical complications that could increase mortality rates. As personality concerned individual’s patterns of feeling, behavior, and thinking, it may help in understanding how people with obesity differ from people with normal-weight status in their typical weight-relevant behavior. So far, studies about personality and BMI associations have mainly focused on broad personality traits. The main purpose of this study was to explore the personality and health associations among a clinical group composed of 46 outpatients with overweight/obesity (mean age = 55.83; SD = 12.84) in comparison to a healthy control group that included 46 subjects (mean age = 54.96; SD = 12.60). Both the clinical and control groups were composed of 14 males and 32 females. Several personality and psychopathological aspects were assessed with the Personality Assessment Inventory (PAI). The results of the analysis of variance of aligned rank transformed (ART) showed that patients with overweight/obesity reported higher scores for Somatic Complaints, Depression, and Borderline Features than the control group. Logistic regression highlighted specifically that the subscales of the Borderline Features assessing the Negative Relationship contributed to the increased risk of belonging to the clinical group. For the purpose of this study, the role of gender was considered. The present findings highlight the importance of focusing on assessing personality functioning in the health context and on specific characteristics of interpersonal relationships to promote more tailored treatments.

Although recent research has provided empirical support for the codevelopment of group interaction (defined as development in a common direction of perceptions of group relationships), no studies have yet investigated the "causes" of codevelopment among group members in the long term. The aim of the current study is to examine how the perceptions of an individual group member, and other group members, regarding group relationships influence each other over the course of treatment. We analyzed group data from 168 adult obese patients who participated in (1 of 20) 12-session therapy groups for weight management. Group relationships were measured by the Group Questionnaire (Krogel et al., 2013), which was administered to group members in early, middle and late group sessions. The longitudinal version of the group actor-partner interdependence model was used to analyze the influence among members. Results showed that there is no mutual influence in the codevelopment of both positive bonding and negative relationship. However, positive bonding of other group members in the middle of the group influenced positive bonding of the individual group member in the late group session. Moreover, individual group member negative relationships in early and middle sessions influenced other group member negative relationships in middle and late sessions. Finally, there was evidence of mutual influence in the codevelopment of positive working early in the group. The findings show that the process of influence among members is complex with regard to the specific dimension of the group relationship assessed and the time spent in group treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parental factors contribute to ADHD, partly in an etiological way and partly as moderators and mediators of child outcomes and treatment effects. An important aspect of parenting seems to be parental reflective functioning (PRF), defined as the parent's capacity to reflect upon his own and his child's internal mental experience. The studies on parenting factors linked to ADHD have not extensively investigated the role of PRF. Recent findings on interventions have begun to consider mentalization to promote empathy and emotion regulation in parents, but empirical studies assessing PRF are still scarce. The aim of this cross-sectional study was to compare specific familial and parental functioning characteristic between parents of children with attention deficit/hyperactivity disorder (ADHD) and parents of controls without ADHD. A clinical sample of 41 children with ADHD aged 8-11 years and their parents was compared with a matched, non-clinical sample of 40 children. Three aspects of parental functioning were investigated: parental symptomatology, parental alliances and PRF; children's differences in strength and difficulty profiles were also assessed. The results showed that families of children with ADHD had lower socioeconomic status, and both mothers and fathers of the same families reported higher scores for depression and lower PRF than did the control group; only mothers showed lower parental alliance. Logistic regression highlighted the fact that several of these familial and parental factors contributed to the increased risk of belonging to the clinical group, specifically both mothers' and fathers' depressive symptoms and lower PRF. These data represent new findings with potentially meaningful clinical implications for both assessment and intervention.

BACKGROUND/OBJECTIVE:In recent decades, the prevalence of childhood obesity has increased, with the major implications for public health. However, the factors that contribute to obesity in children are still poorly understood. The present study aimed to investigate the role of parental reflective functioning (PRF) in childhood obesity. METHOD:In a cross-sectional design, 120 sets of parents of 60 children (n = 30 with obesity, age range 6-11) were recruited by local paediatricians. Parents completed the Parental Reflective Functioning Questionnaire. Children's and parents' weight (assessed by BMI), as well as their socio-economic status (SES), were assessed to explore the contribution of PRF in the prediction of children's weight, controlling for parents' weight and SES. RESULTS:t-test showed significant differences with medium effect sizes in BMI, SES and PRF between parents of children with and without obesity. The best model resulted from hierarchical multiple regression analyses and showed that mothers' PRF predicted children's BMI above and beyond the prediction by parents' BMI and SES. CONCLUSIONS:Low maternal PRF could be an important target for intervention strategies, highlighting the need to consider parental responses to children's emotions in the treatment of childhood obesity, particularly in parents with low SES and high BMI.

Research on parental reflective functioning (PRF)—defined as parents’ capacity to comprehend the developing mind of their child, reflect upon it, and hold in mind the inner life of the child—has mostly involved mothers of infants and young children, and rarely fathers and parents of school-aged children. The present study sought to extend research on PRF by examining aspects of the construct that are still scarcely explored, such as the role of gender and attachment; to investigate whether there were differences between mothers’ and fathers’ PRF and whether there were differences in PRF related to the gender and age of the child; and, finally, to assess the association between PRF and each parent’s attachment style. The Parental Reflective Functioning Questionnaire (PRFQ) and the Attachment Style Questionnaire (ASQ) were administered to a community sample of mothers and fathers of 385 children aged 3–10 years. A multi-group factor analysis supported the hypothesized three-factor model among both fathers and mothers. Univariate and multivariate analyses of variance showed that mothers had higher levels of interest and curiosity in their children’s mental states than fathers. Parents of daughters showed higher pre-mentalizing modes than parents of sons. Parents of preschool children showed less nonmentalizing modes than parents of children aged 8–10. Correlations between PRFQ and ASQ showed that both mothers’ and fathers’ interest in thinking about their child’s internal experience and in taking the child’s perspective were correlated with higher levels of secure attachment style. Research implications are discussed.

Intrapersonal split alliances were defined as discrepancies in how group members perceived their positive bonding relationships with the group leader, the other group members, and the group-as-a-whole, and were related to group members' outcome. Participants were 168 patients (116 women and 52 men) diagnosed as overweight or obese who participated in 1 of 20, 12-session, therapy groups for weight management. Group members completed the Outcome Questionnaire-45 (OQ-45, Lambert et al., 2004) pre- and posttreatment and the Group Questionnaire (GQ, Krogel et al., 2013) at early, middle and late group sessions. Early, middle, and late ratings were aggregated because bond scores were consistent across time. Two-level (members within groups), polynomial regressions and response surface analyses were used to examine congruency and discrepancy in ratings of Positive Bonding Relationships to the leader, group members, and group-as-a-whole. When the discrepancy between positive bonding relationships with the leader and positive bonding relationships with the group members increased, and when the discrepancy between positive bonding relationships with the group members and positive bonding relationships with the group-as-a-whole increased, there was less symptom improvement. The findings show that, like interpersonal split alliances, intrapersonal split alliances are harmful for treatment progress and need to be recognized and addressed by the group leader.

1 Research on parental reflective functioning (PRF)—defined as parents‘ capacity to comprehend the developing mind 2 of their child, reflect upon it, and hold in mind the inner life of the child—has mostly involved mothers of infants 3 and young children, and rarely fathers and parents of school-aged children. The present study sought to extend 4 research on PRF by examining aspects of the construct that are still scarcely explored, such as the role of gender and 5 attachment; to investigate whether there were differences between mothers‘ and fathers‘ PRF and whether there 6 were differences in PRF related to the gender and age of the child; and, finally, to assess the association between 7 PRF and each parent‘s attachment style. The Parental Reflective Functioning Questionnaire (PRFQ) and the 8 Attachment Style Questionnaire (ASQ) were administered to a community sample of mothers and fathers of 385 9 children aged 3–10 years. A multi-group factor analysis supported the hypothesized three-factor model among both 10 fathers and mothers. Univariate and multivariate analyses of variance showed that mothers had higher levels of 11 interest and curiosity in their children‘s mental states than fathers. Parents of daughters showed higher pre12 mentalizing modes than parents of sons. Parents of preschool children showed less nonmentalizing modes than 13 parents of children aged 8–10. Correlations between PRFQ and ASQ showed that both mothers‘ and fathers‘ interest 14 in thinking about their child‘s internal experience and in taking the child‘s perspective were correlated with higher 15 levels of secure attachment style. Research implications are discussed. 16 17

Presently there is a lack of evidence regarding the impact of gender composition of mixed-gender weight management therapy groups on members' posttreatment outcomes. As such, the current study tested the association between the gender composition of mixed-gender narrative therapy groups for weight management and members' posttreatment outcomes. Specifically, we examined the variability in group members' adjusted posttreatment psychological (Outcome Questionnaire-45 [OQ-45]) and obesity-related (Obesity Related Well-Being [ORWELL 97]) symptoms as a function of the quadratic proportion of female members in a group, and the interaction between group member gender and the quadratic proportion of female group members. Pre-and posttreatment OQ-45 and ORWELL 97 data was collected from 32 men and 67 women participating in 15 short-term weight-management therapy groups. Results indicated that the quadratic proportion of female group members was significantly related to adjusted posttreatment OQ-45 scores, such that group members reported fewer psychological symptoms at posttreatment in more proportionally balanced groups of men and women. This relationship was not significant for adjusted posttreatment ORWELL 97 scores. Additionally, in an exploratory analysis we found a significant interaction between group member gender, the proportion of female group members, and group members' adjusted posttreatment OQ-45 scores, indicating that the relationship between gender composition and adjusted posttreatment OQ-45 scores was stronger for men than women. These preliminary findings suggest that the gender composition of weight management groups is an important factor in group members' posttreatment psychological outcomes.

L’articolo esplora la maternita interiore, cioe quella ‘atmosfera materna’ che si instaura durante la gravidanza e determina nuovi eventi mentali e trasformazioni nei processi di organizzazione del se. Gli autori ricordano le concettualizzazioni della «preoccupazione materna primaria» (Winni- cott) come stato regressivo che costituisce il preludio alla comprensione empatica del neonato, della «trasparenza psichica» (Bydlowski) come costruzione di un grembo psichico che accogliera il bambino della «costellazione materna» (Stern) come nuova organizzazione mentale che accompagna ogni maternita dell’«attaccamento prenatale» come costrutto psicologico capace di interferire con la relazione primaria e lo sviluppo del bambino. Il concetto di maternita interiore costituisce una sorta di mappa utile a definire il mondo della relazione madre-bambino in tutte le sue diverse articolazioni. Vengono individuate come disfunzionalita nella formazione della maternita interiore condizioni cliniche estreme, come ad esempio il diniego di gravidanza, spesso strettamente collegato con l’infanticidio. La descrizione di un caso clinico esemplifica come un funzionamento mentale fondato rigidamente sul diniego abbia determinato in una giovane donna la totale inconsapevolezza della gravidanza e la mancata costruzione della maternita interiore e di qualsiasi traccia di attaccamento prenatale verso il bambino.

We compared each individual group member's attachment fit with the attachment of the other group members. Participants were 201 members of 20 therapy groups who sought treatment because they were overweight or obese. Group members completed the Attachment Style Questionnaire before commencing treatment and the Group Questionnaire at three points during group treatment. Multilevel polynomial regression followed by response surface analysis was used to examine how the attachment anxiety and avoidance of the individual group member and the aggregated attachment anxiety and avoidance of the group members were related to individual group members' perceptions of the positive bonding, positive working relationships, and negative relationships in the group. The findings suggested that attachment heterogeneity in group is related to the perception of members' stronger bonding relationships and lower negative relationships. In addition, positive bonding can be increased when a patient high in attachment avoidance is added to a group whose patients are low in attachment avoidance; however, group members reported weaker negative relationships when their attachment anxiety or avoidance became increasingly higher or lower than other group members' attachment anxiety or avoidance.