Parent training for 842 families experiencing disruptive child behavior across 19 Danish community sites: A benchmark effectiveness study.

Interactional processes between child and parents, in particular harsh and coercive parenting practices, have been established as important factors maintaining and shaping the developmental trajectory of disruptive child behavior. The Incredible Years Parent Training (IYPT) is a well-established evidence-based program targeting negative parent-child interactions in families with children exhibiting high levels of disruptive behaviors. There are, however, few studies investigating the effectiveness of the IYPT when implemented in established practice settings independently from research environments. Also, very little evidence exists for the program's effectiveness for school-aged children. The IYPT was administered to consecutive groups of parents (N = 842) across 19 Danish community sites during the period from 2012 to 2019. Pre and post data were collected using the Eyberg Child Behavior Inventory (ECBI). By means of a benchmark approach, the effectiveness of the intervention was compared with that of two European effectiveness randomized controlled trials. Large effect sizes were seen from pre to post for both parent-reported number of problematic disruptive child behaviors (ECBI Problem subscale; d = 1.51, p = 0.000, 95% CI [9.06-10.01]) and frequency of these behaviors (ECBI Intensity subscale; d = 1.15, p = 0.000, 95% CI [29.33-32.73]). Treatment effects found in this study are comparable to or larger than those found in previous effectiveness studies and show the IYPT to be an effective intervention when implemented across a range of different community settings in a large community sample of children across an age span of 2 to 12 years.

Randomized controlled trial of the Marriage Checkup: Stress outcomes.

Several couple interventions targeting relationship distress also show beneficial effects on individual mental health. Yet, strikingly few studies report effects on perceived stress. This study examined the effects of a brief couple intervention, the Marriage Checkup (MC), on perceived stress. We randomly assigned 231 couples to receive two MCs (Weeks 7 and 51) or to a waitlist control. Survey data were collected at seven time points over 2 years and analyzed using multilevel models. We found no significant between-group treatment effects on average stress at any time point. However, women, but not men, in the intervention group experienced decreased stress after the second MC (d = -0.23) and more women in the intervention group (26.5%) compared with the control group (14.9%) experienced reliable improvements in stress after the second MC. Overall, the MC did not result in main effects on stress but caused temporary reliable change in terms of stress relief for women.

A randomized controlled trial of a 5-year marriage checkup booster session for a subsample of responder couples.

This study examined maintenance and booster effects of a brief couple intervention, the Marriage Checkup (MC), across 5 years. A subsample of 63 couples who benefitted from two previous MCs (responder couples), were randomly assigned to a third MC or control. Before randomization (at 4-years-9-months), the responder sample had maintained small to medium effects on two measures of relationship functioning. After randomization, we found no significant between-group effects. Yet, within-group analyses revealed that while control couples showed flat trajectories in all outcomes after the 4-year-9-months baseline, couples receiving a third MC (at Year 5) reported small to medium improvements in three measures of relationship functioning and maintained follow-up effect in one measure. Findings indicate that couples who initially improved from the MC can maintain some of their improvements over long periods. The potential of boosting such improvements with recurrent MCs is a relevant target for further investigation in larger samples.

Association between loneliness, self-esteem and outcome of life satisfaction in Norwegian adolescents aged 15-21.

AIMS: Adolescence is an important developmental stage for understanding the role of perceived loneliness and self-esteem on life satisfaction. This study investigated the association between loneliness, self-esteem and the outcome of life satisfaction, as well as potential interaction effects in association with life satisfaction, in a sample of Norwegian adolescents. METHODS: The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. Data were collected in September 2016. The participants reported scores on the five-item Satisfaction with Life Scale, the 10-item Rosenberg Self-Esteem Scale and one item assessing loneliness. Control variables included sex, age, perceived family economy, parents' education, place of birth and perceived bullying. The data were analysed with descriptive and multiple linear regression analysis. RESULTS: A significant negative and moderately strong association was found between loneliness and life satisfaction, where the association was stronger for girls than for boys. Self-esteem showed a significant positive and strong association with life satisfaction; however, no significant interaction effect was found. CONCLUSIONS: The findings show the significant role of both loneliness and self-esteem in association with adolescents' perception of life satisfaction. The findings support promoting self-esteem, belongingness and social integration in all daily life contexts for adolescents to support their life satisfaction.

The role of perceived loneliness and sociodemographic factors in association with subjective mental and physical health and well-being in Norwegian adolescents.

AIMS: Adolescence is a particularly salient period for understanding the role of perceived loneliness for subjective health and well-being. This study investigated sociodemographic differences (sex, age, self-reported socio-economic status (SES)) in loneliness and associations between sociodemographic factors, loneliness and self-rated health (SRH), subjective health symptoms, symptoms of depression/anxiety and mental well-being (MWB) in a sample of Norwegian adolescents. METHODS: The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. The participants reported scores on an 11-item scale assessing subjective health complaints (SHC), one item each assessing SRH and loneliness, the 10-item version of the Hopkins Symptom Checklist and the seven-item version of the Warwick-Edinburgh Mental Well-Being Scale. SES was assessed using perceived family economy and parents' education. Data were analysed with descriptive, comparative and multiple linear regression analyses. RESULTS: The multivariate results showed that boys scored significantly higher on MWB than girls did, whereas girls scored significantly higher on loneliness, depression/anxiety and SHC. Perceptions of poorer family finances were significantly associated with higher levels of SHC and depression/anxiety, lower levels of MWB and more negative SRH. Loneliness showed significant positive associations with depression/anxiety and SHC, and significant negative associations with MWB and SRH. A significant moderation effect of sex by loneliness was found in association with depression/anxiety, with stronger associations for girls. CONCLUSIONS: The findings in this study support the significant roles of sex, perceptions of family finances and loneliness in association with adolescent's subjective mental and physical health and well-being, especially mental health.

Fungal diversity driven by bark features affects phorophyte preference in epiphytic orchids from southern China.

Epiphytic orchids exhibit varying degrees of phorophyte tree specificity. We performed a pilot study to investigate why epiphytic orchids prefer or avoid certain trees. We selected two orchid species, Panisea uniflora and Bulbophyllum odoratissimum co-occurring in a forest habitat in southern China, where they showed a specific association with Quercus yiwuensis and Pistacia weinmannifolia trees, respectively. We analysed a number of environmental factors potentially influencing the relationship between orchids and trees. Difference in bark features, such as water holding capacity and pH were recorded between Q. yiwuensis and P. weinmannifolia, which could influence both orchid seed germination and fungal diversity on the two phorophytes. Morphological and molecular culture-based methods, combined with metabarcoding analyses, were used to assess fungal communities associated with studied orchids and trees. A total of 162 fungal species in 74 genera were isolated from bark samples. Only two genera, Acremonium and Verticillium, were shared by the two phorophyte species. Metabarcoding analysis confirmed the presence of significantly different fungal communities on the investigated tree and orchid species, with considerable similarity between each orchid species and its host tree, suggesting that the orchid-host tree association is influenced by the fungal communities of the host tree bark.

Temporal turnover in mycorrhizal interactions: a proof of concept with orchids.

Temporal turnover events in biotic interactions involving plants are rarely assessed, although such changes might afford a considerable acclimation potential to the plant. This could enable fairly rapid responses to short-term fluctuations in growth conditions as well as lasting responses to long-term climatic trends. Here, we present a classification of temporal turnover encompassing 11 possible scenarios. Using orchid mycorrhiza as a study model, we show that temporal changes are common, and discuss under which conditions temporal turnover of fungal symbiont is expected. We provide six research questions and identify technical challenges that we deem most important for future studies. Finally, we discuss how the same framework can be applied to other types of biotic interactions.

Partial mycoheterotrophy is common among chlorophyllous plants with Paris-type arbuscular mycorrhiza.

BACKGROUND AND AIMS: An arbuscular mycorrhiza is a mutualistic symbiosis with plants as carbon providers for fungi. However, achlorophyllous arbuscular mycorrhizal species are known to obtain carbon from fungi, i.e. they are mycoheterotrophic. These species all have the Paris type of arbuscular mycorrhiza. Recently, two chlorophyllous Paris-type species proved to be partially mycoheterotrophic. In this study, we explore the frequency of this condition and its association with Paris-type arbuscular mycorrhiza. METHODS: We searched for evidence of mycoheterotrophy in all currently published 13C, 2H and 15N stable isotope abundance patterns suited for calculations of enrichment factors, i.e. isotopic differences between neighbouring Paris- and Arum-type species. We found suitable data for 135 plant species classified into the two arbuscular mycorrhizal morphotypes. KEY RESULTS: About half of the chlorophyllous Paris-type species tested were significantly enriched in 13C and often also enriched in 2H and 15N, compared with co-occurring Arum-type species. Based on a two-source linear mixing model, the carbon gain from the fungal source ranged between 7 and 93 % with ferns > horsetails > seed plants. The seed plants represented 13 families, many without a previous record of mycoheterotrophy. The 13C-enriched chlorophyllous Paris-type species were exclusively herbaceous perennials, with a majority of them thriving on shady forest ground. CONCLUSIONS: Significant carbon acquisition from fungi appears quite common and widespread among Paris-type species, this arbuscular mycorrhizal morphotype probably being a pre-condition for developing varying degrees of mycoheterotrophy.

The prevalence of intimate partner violence among couples signing up for universally offered parent preparation.

BACKGROUND: Intimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and the unborn child. Nevertheless, IPV is seldom addressed in the context of parent preparation. AIM: This study aimed to map the prevalence, direction, and severity of IPV in a sample of expectant couples signing up for universally-offered parent preparation. METHOD: A total of 1726 Danish couples expecting their first child provided data on physical and psychological IPV by completing the Family Maltreatment measure during the second trimester of pregnancy. RESULTS: In 18.5% of the couples, at least one partner reported psychological or physical IPV acts during the past year. In more than 8% of couples, one or both partners reported acts and impacts above the ICD-11 threshold for clinically-significant IPV (CS-IPV) during the past year (3.6% physical CS-IPV, 5.3% psychological CS-IPV, and 0.8% both physical and psychological CS-IPV). Among couples with physical IPV below the clinical threshold, pregnant-woman-to-partner (50%) and bidirectional (38.2%) IPV were more common than partner-to-pregnant-woman IPV (11.8%). Among couples with physical CS-IPV, pregnant-woman-to-partner (36.1%), partner-to-pregnant-women (29.1%) and bidirectional (34.4%) forms were equally common. Among couples with psychological IPV, pregnant-woman-to-partner (54.9%) and partner-to-pregnant-woman (39.6%) IPV were more common than bidirectional IPV (5.5%). DISCUSSION: The prevalence of violence was markedly higher in this study compared with previous reports from the Nordic region and highlights a previous oversight of a substantial and clinically significant level of pregnant-woman-to-partner IPV-as well as the reverse. Data from this study call for IPV to be addressed in universally offered parent preparation programs.

Ovarian cancer suspicion, urgent referral and time to diagnosis in Danish general practice: a population-based study.

BACKGROUND: Ovarian cancer (OC) survival rates are lower in Denmark than in countries with similar health care. Prolonged time to diagnosis could be a contributing factor. The Danish cancer patient pathway (CPP) for OC was introduced in 2009. It provides GPs with fast access to diagnostic work-up. OBJECTIVE: To investigate cancer suspicion and pathway use among GPs and to explore the association between these factors and the diagnostic intervals (DIs). METHODS: We conducted a national population-based cohort study using questionnaires and national registers. RESULTS: Of the 313 women with participating GPs, 91% presented with symptoms within 1 year of diagnosis, 61% presented vague non-specific symptoms and 62% were diagnosed with late-stage disease. Cancer was suspected in 39%, and 36% were referred to a CPP. Comorbidity [prevalence ratio (PR): 0.53, 95% confidence interval (CI): 0.29-0.98] and no cancer suspicion (PR: 0.35, 95% CI: 0.20-0.60) were associated with no referral to a CPP. The median DI was 36 days. Long DIs were associated with no cancer suspicion (median DI: 59 versus 20 days) and no referral to a CPP (median DI: 42 versus 23 days). CONCLUSIONS: Nine in ten patients attended general practice with symptoms before diagnosis. Two-thirds initially presented with vague non-specific symptoms were less likely to be referred to a CPP and had longer DIs than women suspected of cancer. These findings underline the importance of supplementing the CPP with additional accelerated diagnostic routes.

The Relationship Between Positive Mental Health Literacy and Mental Well-Being Among Adolescents: Implications for School Health Services.

Mental health education is a central part of school nurses' practice. Mental health literacy is an asset for health that educational initiatives can strengthen, and a significant determinant of mental health. This study was intended to examine the relationship between positive mental health literacy (PMeHL) and mental well-being to discuss its implications for school health services' mental health education. The relationship was assessed using a multiple linear regression model controlling for relevant covariates. Data were derived from a cross-sectional school-based survey including 1,888 adolescents aged 15-21 years (response rate 97.3%). A weak gender difference was found in PMeHL. The regression model accounted for 41% of the variance in adolescents' mental well-being; PMeHL was a significant explanatory variable of mental well-being. Accordingly, the current study found support for including PMeHL, or knowledge of how to obtain and maintain good mental health, as an integral component of school health services' mental health education among adolescents.

Relationship Help-Seeking in a Danish Population Sample.

Empirically supported couple interventions often transfer from the US to several other parts of the world yet we have little data on their final reach. This study investigated relationship help-seeking in a random population sample of 1,371 individuals living with a partner in Denmark, a European high income - high divorce country. Only a small fraction of respondents had ever sought couple education (3%) or counseling/therapy (7%) with their partner. Among respondents experiencing a severe relationship crisis, individual types of help-seeking were the most prevalent. Both women (38.9%) and men (27.8%) with a recent relationship crisis sought information online, and mostly women (19.4%) also sought individual therapy. Findings can inform strategies for increasing the reach of couples in new cultural contexts.

Life satisfaction in association with self-efficacy and stressor experience in adolescents - self-efficacy as a potential moderator.

AIM: This paper reports associations among socio-demographic variables, stressor experience, self-efficacy and life satisfaction among Norwegian adolescents aged 15-21 years and the potential moderating role of self-efficacy on the association between stressor experience and life satisfaction. METHODS: The cross-sectional school-based survey study involved 1816 upper-secondary school students from Mid-Norway. Data were analysed with independent samples t test, Pearson's product moment correlation and multiple linear regression analysis. RESULTS: Bivariate results showed that boys scored higher than girls on life satisfaction and self-efficacy, whereas girls scored higher than boys on all stressor domains. Multiple linear regression analysis showed that life satisfaction declined weakly with age, whereas stronger family economy and having parents who work full-time associated with higher life satisfaction. Stress with teacher interaction, peer pressure, home life, school attendance, school-leisure conflict and school performance were all negatively associated with life satisfaction, whereas self-efficacy associated positively and strongly with life satisfaction. Self-efficacy moderated the association between both interpersonal and school-related stressors and life satisfaction. CONCLUSION: The results provide support for the unique role of stressor experience and self-efficacy in association with adolescents' life satisfaction as well as self-efficacy as a stress moderator in relation to life satisfaction.

How Danish dentists and dental hygienists handle their role in child abuse and neglect matters.

OBJECTIVE: The objective of this study was to identify how the dental team perceives its role in safeguarding children, to identify barriers to referral to social services, to compare data with data previously reported from Denmark, and to assess if increased focus on safeguarding children has had an effect on how the dental team handles its responsibility to refer to social services. MATERIAL AND METHODS: The study is based on a Danish version of a questionnaire previously used in Scotland and Denmark. The questionnaire was sent to a random sample of the Danish dental team. RESULTS: The number of returned questionnaires was 964 (67.0%) with valid data. Of these, 40.8% had had a suspicion of child abuse or neglect and 50.0% had referred their concern to social services. Frequently reported barriers to referral were uncertainty about observations, signs, and symptoms of abuse and neglect, and uncertainty about referral procedures. A total of 84 (8.9%) of the respondents had received both undergraduate and postgraduate training on the topic, and 64.4% of the respondents found that the dental staff could recognize signs and symptoms of abuse and neglect. CONCLUSION: Findings suggest a continuous need for a focus on the awareness and training of the Danish dental staff on the important topic of child abuse and neglect.

Checking up on Couples-A Meta-Analysis of the Effect of Assessment and Feedback on Marital Functioning and Individual Mental Health in Couples.

The primary aim of the current meta-analysis was to investigate the overall effect of a relationship checkup (RC), a couple-oriented assessment, and feedback intervention. Systematic literature searches revealed 12 eligible randomized trials published between 1995 and 2015. Results showed significant overall pre-post effect of an RC on marital functioning (Hedge's g = 0.20) and individual mental health (g = 0.44). The between-group controlled effect size was significant at postassessment (g = 0.23) and up to six-month follow-up (g = 0.23). Characteristics of the RC format, therapist-guided versus self-directed, or the study samples, distressed versus healthy, did not moderate the overall effect of the RC. Thus, our results suggest an RC to improve couples' marital functioning up to six-month follow-up, while the effect on individual mental health and repeated delivery of a RC awaits further research.

A randomized controlled trial of the Marriage Checkup adapted for private practice.

OBJECTIVE: This study examined the effectiveness of the Marriage Checkup (MC), adapted for independent practice. METHOD: A total of 233 couples were recruited from 2 metropolitan areas of Denmark and randomized to the MC adapted for independent practice (MC-P, n = 116) or a waitlist condition (WL, n = 117). Self-report measures of relationship health were obtained online at 3 (WL) or 6 (MC-P) time points across 54 weeks. MC-P couples received 2 checkups (Week 7 and 51). WL couples received tickets to a movie night (Week 10). Data were analyzed using multilevel growth models. RESULTS: Following the first checkup, small intervention effects were found on 3 of 4 outcome measures. Between the checkups, the effects on 2 of 3 measures first leveled off then reappeared. Following the second checkup, intervention effects in the small to medium range were found on all 4 measures including the Brief Marital Satisfaction Inventory (Cohen's d = 0.48), the Couple Satisfaction Index (d = 0.20), the Responsiveness and Attention Scale (d = 0.43), and the Intimate Safety Questionnaire (d = 0.21). CONCLUSIONS: Couples receiving 2 annual checkups across 54 weeks experienced small to medium effects on relationship health when compared to controls. These are the first and preliminary results on a model for conducting regular relationship health checkups in a real-world therapeutic setting. Future studies are needed to investigate the comparative and long-term effects of this approach. (PsycINFO Database Record

Germination and seedling establishment in orchids: a complex of requirements.

BACKGROUND: Seedling recruitment is essential to the sustainability of any plant population. Due to the minute nature of seeds and early-stage seedlings, orchid germination in situ was for a long time practically impossible to observe, creating an obstacle towards understanding seedling site requirements and fluctuations in orchid populations. The introduction of seed packet techniques for sowing and retrieval in natural sites has brought with it important insights, but many aspects of orchid seed and germination biology remain largely unexplored. KEY CONSIDERATIONS: The germination niche for orchids is extremely complex, because it is defined by requirements not only for seed lodging and germination, but also for presence of a fungal host and its substrate. A mycobiont that the seedling can parasitize is considered an essential element, and a great diversity of Basidiomycota and Ascomycota have now been identified for their role in orchid seed germination, with fungi identifiable as imperfect Rhizoctonia species predominating. Specificity patterns vary from orchid species employing a single fungal lineage to species associating individually with a limited selection of distantly related fungi. A suitable organic carbon source for the mycobiont constitutes another key requirement. Orchid germination also relies on factors that generally influence the success of plant seeds, both abiotic, such as light/shade, moisture, substrate chemistry and texture, and biotic, such as competitors and antagonists. Complexity is furthermore increased when these factors influence seeds/seedling, fungi and fungal substrate differentially. CONCLUSIONS: A better understanding of germination and seedling establishment is needed for conservation of orchid populations. Due to the obligate association with a mycobiont, the germination niches in orchid species are extremely complex and varied. Microsites suitable for germination can be small and transient, and direct observation is difficult. An experimental approach using several levels of environmental manipulation/control is recommended.

The mediational role of panic self-efficacy in cognitive behavioral therapy for panic disorder: a systematic review and meta-analysis.

Cognitive models of panic disorder (PD) with or without agoraphobia have stressed the role of catastrophic beliefs of bodily symptoms as a central mediating variable of the efficacy of cognitive behavioral therapy (CBT). Perceived ability to cope with or control panic attacks, panic self-efficacy, has also been proposed to play a key role in therapeutic change; however, this cognitive factor has received much less attention in research. The aim of the present review is to evaluate panic self-efficacy as a mediator of therapeutic outcome in CBT for PD using descriptive and meta-analytic procedures. We performed systematic literature searches, and included and evaluated 33 studies according to four criteria for establishing mediation. Twenty-eight studies, including nine randomized waitlist-controlled studies, showed strong support for CBT improving panic self-efficacy (criterion 1); ten showed an association between change in panic self-efficacy and change in outcome during therapy (criterion 2); three tested, and one established formal statistical mediation of panic self-efficacy (criterion 3); while four tested and three found change in panic self-efficacy occurring before the reduction of panic severity (criterion 4). Although none of the studies fulfilled all of the four criteria, results provide some support for panic self-efficacy as a mediator of outcome in CBT for PD, generally on par with catastrophic beliefs in the reviewed studies.

Composition of Cypripedium calceolus (Orchidaceae) seeds analyzed by attenuated total reflectance IR spectroscopy: in search of understanding longevity in the ground.

PREMISE OF THE STUDY: Orchid seeds are minute and covered with a thin coat, yet they often have a long life after dispersal. They are notorious for low and irregular germination, in nature as well as in vitro. Since orchids are often rare species of conservational and commercial interest, reproduction by seeds is an important concern. The purpose of this study was to learn more about the resilience of these highly specialized seeds and stimulatory processes toward germination. • METHODS: We studied testa and embryos of Cypripedium calceolus to identify natural components in intact seeds and the impact of 7 yr in soil in its natural habitat. We also analyzed the effects of Ca(OCl)2, used technically to enhance germination for cultivation in vitro. For the first time with this kind of plant material, we used attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, an ideal method for minute sample sizes and surface selectivity. Thus, we could link treatments with changes in seed surface chemistry. • KEY RESULTS: A lignin-like polymer is an essential testa component that undergoes degradation by soil or hypochlorite processes. In both cases, we found a build-up of CaCO3 on the testa, which could interact with lignin to enhance germination. Very minor changes occurred in embryo reserve nutrient content after a long sojourn underground, which supports their continued viability. • CONCLUSIONS: We suggest that degradation of lignin and enrichment of the testa surface with CaCO3 are important stimulants of germination both in the habitat and during laboratory sowing.