Mobile applications providing guidance about decreased fetal movement: Review and content analysis.

BACKGROUND: Maternal perception of decreased fetal movement has clinical significance as a predictor of pregnancies at risk of adverse outcomes, including stillbirth. Increasingly, women are using mobile applications ("apps") to access information during the antenatal period. Little is known about how apps intended for use during pregnancy guide women to address fetal movement concerns. OBJECTIVE: To explore information about decreased fetal movement provided through mobile apps intended for use during pregnancy. METHODS: A systematic review framework was applied to the search, screening, and assessment of mobile apps. A sample of apps were downloaded in December 2016 that met inclusion criteria for accessibility, reach, relevance and quality. Data extraction was performed independently by two reviewers in January 2017. A quantitative and qualitative approach was taken to analyse data and present results. FINDINGS: All 24 apps in the sample mentioned decreased fetal movement, but few explicitly link decreased fetal movement to stillbirth or other specific adverse outcomes. There is substantial variability in guidance for fetal movement monitoring. One-quarter of apps recommend consumption of food or drink to stimulate fetal movement, two-thirds of apps recommend "kick counting", and one-third offer a kick "counter". CONCLUSION: This review is the first to assess information about decreased fetal movement available in mobile apps intended for download by pregnant women. Across the sample, this review identifies a lack of evidence-based clinical advice to guide women experiencing decreased fetal movement. As an antenatal education tool used by millions of women, accurate content about fetal movement is essential.

Up close: family therapy challenges and innovations around the world.

Family therapists from 10 different countries (China, India, Israel including Palestinian citizens, Japan, Mexico, Peru, Spain, Turkey, Uganda, and the United Kingdom) describe systemic therapy in their contexts and current innovative work and challenges. They highlight the importance of family therapy continuing to cut across disciplines, the power of systems ideas in widely diverse settings and institutions (such as courts, HIV projects, working with people forced into exile), extensive new mental health initiatives (such as in Turkey and India), as well as the range of family therapy journals available (four alone in Spain). Many family therapy groups are collaborating across organizations (especially in Asia) and the article presents other ideas for connections such as a clearing house to inexpensively translate family therapy articles into other languages.

Optimising patient management before and after surgery.

Enhanced recovery involves the implementation of several evidence-based interventions concurrently in pathways of care for surgery, rather than individually, to ensure they have a greater impact on patient outcomes. This article explains the enhanced recovery pathway and discusses some of its benefits.

Teaching and learning with therapists who work with street children and their families.

Providing training for people working with some of the most marginalized families in Guatemala and Peru meant establishing credibility as a facilitator; entering organizations as a learner; cocreating training agendas; and working in a format that paralleled a strength-based, resilience focus in therapy. Strategies used for different phases of the work are detailed: multiple ways to gather information, shadowing staff, delivering topics on demand, and creating learning environments with a focus on families as teachers. Key processes included moving in and out of the role of facilitator and participant, entering into the trainings from different vantage points within the organizations, and designing activities with an eye to how they would impact work relationships of staff and clients.

Transparency and self-disclosure in family therapy: dangers and possibilities.

Therapy is a paid intimate relationship that thrusts clients and therapists into navigating personal and professional boundaries. When, where, why, and how is it appropriate and ethical for family therapists to be transparent, and when is it damaging? Theorists take varied stances from Haley's position of tight boundaries around therapist disclosure--whether in treatment or training--to the narrative viewpoint that therapists should be transparent about models of therapy, personal values, and life experiences that inform their practice and beliefs. However, these positions are not research based, and theorists who support disclosure offer few guidelines other than general statements. This article examines the history of ideas about disclosure in six major family therapy models, and the dangers and possibilities of transparency. It looks at the research on self-disclosure in individual therapy and whether and how it could apply to family therapy. Guidelines are proposed that take into account the multiple social identities of therapists and clients, and issues of safety and transparency.

Maternal depression and child behaviour problems. Randomised placebo-controlled trial of a cognitive-behavioural group intervention.

BACKGROUND: Despite the frequently reported association between maternal depression and childhood psychopathological disorder, few studies have attempted to intervene with both conditions. AIMS: To evaluate the effect of group cognitive-behavioural therapy (CBT) on child behaviour problems and maternal depression in a group of women with young children. METHOD: An assessor-masked, randomised placebo-controlled trial compared three treatments: CBT for depression and parenting skills enhancement; a mothers' support group; and no intervention. An epidemiological (general population) sample was recruited. RESULTS: Analysis showed no significant difference between the groups. Within-group comparison suggested that at the end of treatment and at 6-month and 12-month follow-up, child problems and maternal depression had improved significantly in the CBT group. CONCLUSIONS: There was no statistically significant difference between groups. Both contact interventions seemed to provide some benefits to mothers with depression, with a possibly improved outcome resulting from CBT for children with behavioural problems. The results must be treated with caution.

Expressed emotion, attributions and depression in mothers of children with problem behaviour.

BACKGROUND: This was an initial study seeking to examine the relationship between Expressed Emotion (EE), spontaneous causal attributions and depression in mothers of children referred for problem behaviour. METHOD: Sixty-one mothers were interviewed using the Camberwell Family Interview (CFI). The CFI was coded for maternal EE and spontaneous causal attributions regarding the child's behaviour. Self-report measures of child problem behaviour and maternal depressive symptoms were also completed. RESULTS: Consistent with previous research, high EE mothers, compared to low EE mothers, were more likely to make attributions thatjudged the cause of problem behaviour to be personal to and controllable by the child and also made more 'child-blaming' attributions than low EE mothers. Mothers' scores on the Beck Depression Inventory were found to be associated with 'child-blaming' attributions and higher levels of EE. Regression analyses did not support the hypothesised role of attributions as a mediator between depression and EE but did identify EE as a potential mediator in the relationship between maternal depressed mood and ratings of child problem behaviour. CONCLUSIONS: These results indicate the relevance of both EE and attributions in mothers of children with problem behaviour and suggest that maternal depressed mood is an important factor which is related to both of these.

Maternal expressed emotion, attributions and depression and entry into therapy for children with behaviour problems.

OBJECTIVES: Maternal expressed emotion (EE), attributions, depression and parenting stress in mothers of children with behaviour problems referred for therapy were tested for associations with entry to therapy. METHOD: In all, 57 mothers were assessed prior to first appointment using the Camberwell Family Interview coded for EE and attributions (LACS), and completed the Beck Depression Inventory (BDI) and Parenting Stress Index (PSI). RESULTS: Mothers who did not attend scored higher on EE dimensions of critical comments, hostility or emotional over-involvement, BDI or PSI. CONCLUSIONS: Some of the most distressed families referred may not attend, and need a different approach to engagement.