Improving Maternal Depression Screening in the Neonatal Intensive Care Unit.

PURPOSE: To examine whether self-perceived benefits of mental health treatment differed between mothers of babies in the neonatal intensive care unit with and without a positive screen for depression based on their Edinburgh Postnatal Depression score. STUDY DESIGN AND METHODS: Mothers were recruited in person pre-COVID-19 pandemic, and via phone call and online advertisement during the pandemic. Mothers completed a 10-item depression scale and whether they believed they would benefit from mental health treatment. A chi-square test determined the difference in perceived benefit between mothers who screened positively for depression and those who did not. RESULTS: This secondary analysis included 205 mothers, with an average age of 29. Of the 68 mothers who screened positively for depression, 12 believed that would not benefit from mental health intervention. Of the 137 who screened negatively for depression, 18 believed they would benefit from mental health intervention. Mothers who screened negatively for depression were significantly less likely to believe they would benefit from mental health intervention. CLINICAL IMPLICATIONS: Depression screening scales offer guidance on which mothers to flag for follow-up, but neither on how a mother will respond nor how to effectively approach a mother about her mental health. Nurses can improve identification and follow-up of depressed mothers in the neonatal intensive care unit by asking mothers about their perceived need for mental health treatment.

Conserving the evolutionary history of birds.

In the midst of the sixth mass extinction, limited resources are forcing conservationists to prioritize which species and places will receive conservation action. Evolutionary distinctiveness measures the isolation of a species on its phylogenetic tree. Combining a species' evolutionary distinctiveness with its globally endangered status creates an EDGE score. We use EDGE scores to prioritize the places and species that should be managed to conserve bird evolutionary history. We analyzed all birds in all countries and important bird areas. We examined parrots, raptors, and seabirds in depth because these groups are especially threatened and relatively speciose. The three focal groups had greater median threatened evolutionary history than other taxa, making them important for conserving bird evolutionary history. Australia, Brazil, Indonesia, Madagascar, New Zealand, and the Philippines were especially critical countries for bird conservation because they had the most threatened evolutionary history for endemic birds and are important for parrots, raptors, and seabirds. Increased enforcement of international agreements for the conservation of parrots, raptors, and seabirds is needed because these agreements protect hundreds of millions of years of threatened bird evolutionary history. Decisive action is required to conserve the evolutionary history of birds into the Anthropocene.

En medio de la sexta extinción masiva, los recursos limitados están obligando a los conservacionistas a priorizar cuáles especies y lugares recibirán acciones de conservación. La peculiaridad evolutiva mide el aislamiento de una especie con respecto a su árbol filogenético. La combinación entre la peculiaridad evolutiva de una especie y su estado de conservación mundial genera un puntaje EDGE. Usamos estos puntajes para priorizar los lugares y especies que se deben gestionar para conservar la historia evolutiva ornitológica. Analizamos todas las especies de aves en todos los países y áreas de importancia ornitológica. Estudiamos a profundidad a los psitácidos, rapaces, y aves marinas por el nivel de amenaza que enfrentan estos grupos y porque cuentan con muchas especies. Estos tres grupos tuvieron una mayor mediana de historia evolutiva amenazada que los demás taxones, por lo que son de suma importancia para la conservación de la historia evolutiva ornitológica. Australia, Brasil, Indonesia, Madagascar, Nueva Zelanda y las Filipinas fueron países particularmente críticos para la conservación de las aves pues cuentan con la mayor historia evolutiva amenazada de aves endémicas y son localidades importantes para nuestros tres grupos focales. Se requiere de un incremento en la aplicación de los acuerdos internaciones para la conservación de los psitácidos, rapaces y aves marinas ya que estos acuerdos protegen cientos de millones de años de historia evolutiva ornitológica. Se necesitan acciones decisivas para conservar la historia evolutiva de las aves en el Antropoceno.

Examining the Structure of Distress Tolerance: Are Behavioral and Self-Report Indicators Assessing the Same Construct?

Distress tolerance, or the ability to tolerate physically and emotionally aversive experiences, is a target of psychological intervention in contextual behavioral science. It has been conceptualized as a self-reported ability, as well as a behavioral tendency, and operationalized with a wide variability of questionnaires and behavioral tasks. The current study aimed to investigate whether behavioral tasks and self-report assessments of distress tolerance measure the same underlying dimension, two correlated dimensions, or whether method factors accounted for covariation above and beyond a general content dimension. A university student sample (N = 288) completed behavioral tasks associated with distress tolerance and self-report distress tolerance measures. Confirmatory factor analysis indicated that behavioral and self-report assessments of distress tolerance do not comprise a single dimension of distress tolerance, or two correlated dimensions of self-report or behavioral distress tolerance. Results also failed to support a bifactor conceptualization with a general distress tolerance dimension and domain-specific method dimensions for behavioral and self-report assessments. Findings suggest that more precision and attention to contextual factors are required in the operationalization and conceptualization of distress tolerance.

A Randomized Controlled Trial of Listening Visits for Mothers of Hospitalized Newborns.

BACKGROUND: Emotional distress is frequently experienced by mothers whose newborns are hospitalized in a neonatal intensive care unit (NICU). Among these women, there is a critical need for emotional support conveniently delivered at the newborn's point of care by a trusted and medically knowledgeable professional: a NICU nurse. One promising way to enhance in situ delivery of emotional care is to have a NICU nurse provide Listening Visits (LVs), a brief support intervention developed expressly for delivery by nurses to depressed postpartum women. OBJECTIVES: This trial assessed the feasibility of having NICU nurses deliver LVs to emotionally distressed mothers of hospitalized newborns and compared depression outcomes in a small sample of participants randomized to LVs or usual care (UC). METHODS: In this pilot randomized controlled trial, emotionally distressed mothers of hospitalized newborns were randomized to receive up to six LVs from a NICU nurse or UC from a NICU social worker. To assess change in depression symptoms, women were invited to complete the Inventory of Depression and Anxiety Symptoms-General Depression Scale at enrollment and 4 and 8 weeks post-enrollment. RESULTS: Depression symptoms declined over time for both groups, with no difference between the two groups. A post hoc analysis of reliable change found higher rates of improvement at the 4-week assessment among recipients of LVs than UC. DISCUSSION: NICU nurses successfully implemented LVs during this trial. Depression symptom scores did not significantly differ in the two groups posttreatment or at follow-up. Nevertheless, post hoc analyses indicated comparatively higher rates of clinical improvement immediately after LVs, suggesting the intervention can reduce maternal depression early on when women are most distressed.

Telehealth Listening Visits for emotionally distressed mothers of hospitalized newborns: Proof-of-concept.

Problem: Newborn admission to the neonatal intensive care unit (NICU) is stressful. Yet in clinical practice, at best, NICU mothers are screened for depression and if indicated, referred to a mental-health specialist. At worst, no action is taken. Listening Visits, an empirically supported nurse-delivered intervention addressing emotional distress, can be conveniently provided by a NICU nurse. Prompted by the need to minimize face-to-face contacts during the pandemic, the primary purpose of this small pilot trial was to assess the feasibility of having nurses provide Listening Visits to NICU mothers over Zoom. Secondarily, we assessed pre-to post-Listening Visits depression symptom scores as a preliminary evaluation of the effectiveness of this type of support. Materials and methods: Nine NICU mothers with mildly to moderately severe depression symptoms received up to six Listening Visits sessions from a NICU nurse via Zoom. Participants completed the Inventory Depression and Anxiety Symptoms-General Depression scale (IDAS-GD) at study entry and 4- and 8-weeks post enrollment. They completed the Client Satisfaction Questionnaire (CSQ) at the 8-week assessment. Results: Using an intent-to-treat approach, the effect of time from the mixed model analysis of IDAS-GD was statistically significant (F(2,26) = 10.50, p < 0.001), indicating improvement in IDAS-GD scores from baseline to follow-up. The average CSQ score was high (M = 29.0, SD = 3.3), with 75% of participants rating the quality of help they received as "excellent". Discussion: In this pilot trial, we learned it is feasible to provide Listening Visits over Zoom, that this mode of delivery is associated with a significant decrease in depression symptom scores, and that women value this approach. Clinical trial registration: [https://clinicaltrials.gov/], identifier [#201805961].

Antipredator behaviors in urban settings: Ecological experimentation powered by citizen science.

Animal behaviors are often modified in urban settings due to changes in species assemblages and interactions. The ability of prey to respond to a predator is a critical behavior, but urban populations may experience altered predation pressure, food supplementation, and other human-mediated disturbances that modify their responsiveness to predation risk and promote habituation.Citizen-science programs generally focus on the collection and analysis of observational data (e.g., bird checklists), but there has been increasing interest in the engagement of citizen scientists for ecological experimentation.Our goal was to implement a behavioral experiment in which citizen scientists recorded antipredator behaviors in wild birds occupying urban areas. In North America, increasing populations of Accipiter hawks have colonized suburban and urban areas and regularly prey upon birds that frequent backyard bird feeders. This scenario, of an increasingly common avian predator hunting birds near human dwellings, offers a unique opportunity to characterize antipredator behaviors within urban passerines.For two winters, we engaged citizen scientists in Chicago, IL, USA to deploy a playback experiment and record antipredator behaviors in backyard birds. If backyard birds maintained their antipredator behaviors, we hypothesized that birds would decrease foraging behaviors and increase vigilance in response to a predator cue (hawk playback) but that these responses would be mediated by flock size, presence of sentinel species, body size, tree cover, and amount of surrounding urban area.Using a randomized control-treatment design, citizen scientists at 15 sites recorded behaviors from 3891 individual birds representing 22 species. Birds were more vigilant and foraged less during the playback of a hawk call, and these responses were strongest for individuals within larger flocks and weakest in larger-bodied birds. We did not find effects of sentinel species, tree cover, or urbanization.By deploying a behavioral experiment, we found that backyard birds inhabiting urban landscapes largely maintained antipredator behaviors of increased vigilance and decreased foraging in response to predator cues. Experimentation in citizen science poses challenges (e.g., observation bias, sample size limitations, and reduced complexity in protocol design), but unlike programs focused solely on observational data, experimentation allows researchers to disentangle the complex factors underlying animal behavior and species interactions.

Lessons Learned Recruiting and Retaining Pregnant and Postpartum Individuals in Digital Trials: Viewpoint.

In an increasingly connected world and in the midst of a global pandemic, digital trials offer numerous advantages over traditional trials that rely on physical study sites. Digital trials have the potential to improve access to research and clinical treatments for the most vulnerable and minoritized, including pregnant and postpartum individuals. However, digital trials are underutilized in maternal and child health research, and there is limited evidence to inform the design and conduct of digital trials. Our research collaborative, consisting of 5 research teams in the U.S. and Australia, aimed to address this gap. We collaborated to share lessons learned from our experiences recruiting and retaining pregnant and postpartum individuals in digital trials of social and behavioral interventions. We first discuss the promise of digital trials in improving participation in research during the perinatal period, as well as the unique challenges they pose. Second, we present lessons learned from 12 completed and ongoing digital trials that have used platforms such as Ovia, Facebook, and Instagram for recruitment. Our trials evaluated interventions for breastfeeding, prenatal and postpartum depression, insomnia, decision making, and chronic pain. We focus on challenges and lessons learned in 3 key areas: (1) rapid recruitment of large samples with a diversity of minoritized identities, (2) retention of study participants in longitudinal studies, and (3) prevention of fraudulent enrollment. We offer concrete strategies that we pilot-tested to address these challenges. Strategies presented in this commentary can be incorporated, as well as formally evaluated, in future studies.

Eagles enter rotor-swept zones of wind turbines at rates that vary per turbine.

There is increasing pressure on wind energy facilities to manage or mitigate for wildlife collisions. However, little information exists regarding spatial and temporal variation in collision rates, meaning that mitigation is most often a blanket prescription. To address this knowledge gap, we evaluated variation among turbines and months in an aspect of collision risk-probability of entry by an eagle into a rotor-swept zone (hereafter, "probability of entry"). We examined 10,222 eagle flight paths identified and recorded by an automated bird monitoring system at a wind energy facility in Wyoming, USA. Probabilities of entry per turbine-month combination were 4.03 times greater in some months than others, ranging 0.15 to 0.62. The overall probability of entry for the riskiest turbine (i.e., the one with the greatest probability of entry) was 2.39 times greater than the least-risky turbine. Our methodology describes large variation across turbines and months in the probability of entry. If subsequently combined with information on other sources of variation (i.e., weather, topography), this approach can identify risky versus safe situations for eagles under which cost of management, curtailment prescriptions, and collision risk can be simultaneously minimized.

Listening Visits for maternal depression: a meta-analysis.

Listening Visits are a non-directive counseling intervention delivered by nurses to depressed postpartum women. In 2007, Listening Visits were listed as a recommended treatment in British national guidelines. They were removed from the guideline update, due to the small effect size drawn from a meta-analysis of five clinical trials with depressed and non-depressed postpartum women. The purpose of this meta-analysis is to provide an estimate of the true population effect of Listening Visits as a treatment for maternal depression compared to control conditions. A meta-analytic review was conducted of studies published before October 2020. Inclusion criteria required that the study was a pragmatic or randomized trial of Listening Visits delivered by non-mental health specialists to mothers with elevated symptoms of maternal depression. Post-treatment depression rates for the treatment and control groups were extracted from eligible studies. Six studies met eligibility criteria which included 703 participants. Analyses of observed effect sizes corrected for study artifacts revealed an estimate of 0.66 (95% CI: 0.32, 0.99) with high heterogeneity (Q = 17.95, p = 0.003, I2 = 72.14). After removing outliers and addressing heterogeneity across observed effect sizes, the meta-analytic estimate across four methodologically similar studies and 651 participants was 0.43 (95% CI: 0.24, 0.62). The moderate effect size for Listening Visits, considered together with the advantages afforded by how, where, and who provides this treatment, supports Listening Visits as a first-line intervention in a stepped care approach for mothers with mild to moderately severe depression symptoms.

Perinatal anxiety and depressive symptoms and perception of child behavior and temperament in early motherhood.

The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother-child interactions as well as inform interventions for women and their families.

Spaced radiology: encouraging durable memory using spaced testing in pediatric radiology.

Applied memory research in the field of cognitive and educational psychology has generated a large body of data to support the use of spacing and testing to promote long-term or durable memory. Despite the consensus of this scientific community, most learners, including radiology residents, do not utilize these tools for learning new information. We present a discussion of these parallel and synergistic learning techniques and their incorporation into a software platform, called Spaced Radiology, which we created for teaching radiology residents. Specifically, this software uses these evidence-based strategies to teach pediatric radiology through a flashcard deck system.

Prey abundance and urbanization influence the establishment of avian predators in a metropolitan landscape.

Urbanization causes the simplification of natural habitats, resulting in animal communities dominated by exotic species with few top predators. In recent years, however, many predators such as hawks, and in the US coyotes and cougars, have become increasingly common in urban environments. Hawks in the Accipiter genus, especially, are recovering from widespread population declines and are increasingly common in urbanizing landscapes. Our goal was to identify factors that determine the occupancy, colonization and persistence of Accipiter hawks in a major metropolitan area. Through a novel combination of citizen science and advanced remote sensing, we quantified how urban features facilitate the dynamics and long-term establishment of Accipiter hawks. Based on data from Project FeederWatch, we quantified 21 years (1996-2016) of changes in the spatio-temporal dynamics of Accipiter hawks in Chicago, IL, USA. Using a multi-season occupancy model, we estimated Cooper's (Accipiter cooperii) and sharp-shinned (A. striatus) hawk occupancy dynamics as a function of tree canopy cover, impervious surface cover and prey availability. In the late 1990s, hawks occupied 26% of sites around Chicago, but after two decades, their occupancy fluctuated close to 67% of sites and they colonized increasingly urbanized areas. Once established, hawks persisted in areas with high levels of impervious surfaces as long as those areas supported high abundances of prey birds. Urban areas represent increasingly habitable environments for recovering predators, and understanding the precise urban features that drive colonization and persistence is important for wildlife conservation in an urbanizing world.

Preconception Health Risk Factors in Women with and without a History of Military Service.

INTRODUCTION: Given the increasing number of women service members and veterans of childbearing age, it is important to understand the preconception risks in this potentially vulnerable population. This study compared the prevalence of modifiable preconception risk factors among women with and without a history of service. METHODS: Analyses included data from the 2013 and 2014 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Preconception risk factors included health behaviors, chronic conditions, and mental health among women of childbearing age. Multivariate logistic regressions were used to compare the adjusted prevalence of each outcome among women with and without a history of service. Interaction terms assessed variation by age and history of service. RESULTS: Compared with women without a history of service, women with a history of service reported higher prevalence of insufficient sleep (49.6% vs. 36.3%; p < .001) and diagnosed depression (26.5% vs. 21.6%; p < .01). Women with a history of service were overall less likely to have obesity (19.8% vs. 26.5%; p < .001). Age-stratified results suggested that, compared with women without a history of service, women with a history of service were more likely to smoke in the 25 to 34 age group and reported comparable levels of obesity in the 35 to 44 age group. CONCLUSIONS: Women with a history of service demonstrated a preconception health profile that differs from women without a history of service. It is critical that providers are aware of their patients' military status and potential associated risks.

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017.

The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.

Wind patterns as a potential driver in the evolution and maintenance of a North American migratory suture zone.

Suture zones are areas where range contact zones and hybrid zones of multiple taxa are clustered. Migratory divides, contact zones between divergent populations that breed adjacent to one another but use different migratory routes, are a particular case of suture zones. Although multiple hypotheses for both the formation and maintenance of migratory divides have been suggested, quantitative tests are scarce. Here, we tested whether a novel factor, prevailing winds, was sufficient to explain both the evolution and maintenance of the Cordilleran migratory divide using individual-based models. Empirical observations of eastern birds suggest a circuitous migratory route across Canada before heading south. Western breeders, however, travel south along the Pacific coast to their wintering grounds. We modeled the effect of wind on bird migratory flights by allowing them to float at elevation using spatially explicit modeled wind data. Modeled eastern birds had easterly mean trajectories, whereas western breeders showed significantly more southern trajectories. We also determined that a mean airspeed of 18.5 m s(-1) would be necessary to eliminate this difference in trajectory, a speed that is achieved by waterfowl and shorebirds, but is faster than songbird flight speeds. These results lend support for the potential importance of wind in shaping the phylogeographic history of North American songbirds.

Differences in successful treatment completion among pregnant and non-pregnant American women.

The present study explores characteristics of successful substance abuse treatment completion of pregnant women through an analysis of retrospective outcomes data. Women without prior treatment admissions, aged 18-44, and not in methadone maintenance therapy were included (N = 678,782). Chi-square tests analyzed significant differences; logistic regression provided predictive probabilities; odds ratios (OR) and risk differences with 95 % confidence intervals represent the effect sizes and clinically meaningful differences. Pregnant women were less likely to successfully complete treatment than non-pregnant women (χ (2) = 321.33, df = 1, p < 0.0001), though the difference was not clinically meaningful (risk difference = 4.75, 95 % confidence interval (CI) = 4.23-5.26). Aside from criminal justice agencies, "other community agencies" refer the greatest percentage of pregnant women to treatment (risk difference = 6.37, 95 % CI = 5.89-6.84). Pregnant women successfully complete treatment more than non-pregnant women in only non-intensive outpatient settings (χ (2) = 10,182.48, df = 7, p < 0.0001). Further attention to referral source and treatment setting for pregnant women may improve successful treatment completion by targeting needs of pregnant women. Referring to non-intensive outpatient and residential hospital treatment settings may help to ameliorate prenatal substance abuse treatment contingent on the primary problem substance.

Partner support and maternal depression in the context of the Iowa floods.

A systematic investigation of the role of prenatal partner support in perinatal maternal depression was conducted. Separate facets of partner support were examined (i.e., received support and support adequacy) and a multidimensional model of support was applied to investigate the effects of distinct types of support (i.e., informational, physical comfort, emotional/esteem, and tangible support). Both main and stress-buffering models of partner support were tested in the context of prenatal maternal stress resulting from exposure to a natural disaster. Questionnaire data were analyzed from 145 partnered women using growth curve analytic techniques. Results indicate that received support interacts with maternal flood stress during pregnancy to weaken the association between stress and trajectories of maternal depression from pregnancy to 30 months postpartum. Support adequacy did not interact with stress, but was associated with levels of depressive symptoms controlling for maternal stress and received support. Results demonstrate the distinct roles of various facets and types of support for a more refined explanatory model of prenatal partner support and perinatal maternal depression. Results inform both main effect and stress buffering models of partner support as they apply to the etiology of perinatal maternal depression, and highlight the importance of promoting partner support during pregnancy that matches support preferences.

Depression and anxiety symptoms in mothers of newborns hospitalized on the neonatal intensive care unit.

BACKGROUND: Mothers of infants hospitalized in the neonatal intensive care unit (NICU) are at risk for clinically significant levels of depression and anxiety symptoms; however, the maternal/infant characteristics that predict risk have been difficult to determine. Previous studies have conceptualized depression and anxiety symptoms separately, ignoring their comorbidity. Moreover, risk factors for these symptoms have not been assessed together in one study sample. OBJECTIVES: The primary aim of this study was to determine whether a diagnostic classification approach or a common factor model better explained the pattern of symptoms reported by NICU mothers, including depression, generalized anxiety, panic, and trauma. A secondary aim was to assess risk factors of aversive emotional states in NICU mothers based on the supported conceptual model. METHOD: In this cross-sectional study, a nonprobability convenience sample of 200 NICU mothers completed questionnaires assessing maternal demographic and infant health characteristics, as well as maternal depression and anxiety symptoms. Structural equation modeling was used to test a diagnostic classification model and a common factor model of aversive emotional states and the risk factors of aversive emotional states in mothers in the NICU. RESULTS: Maximum likelihood estimates indicated that examining symptoms of depression and anxiety disorders as separate diagnostic classifications did not fit the data well, whereas examining the common factor of negative emotionality rendered an adequate fit to the data and identified a history of depression, infant illness, and infant prematurity as significant risk factors. DISCUSSION: This study supports a multidimensional view of depression and should guide both clinical practice and future research with NICU mothers.