Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: Systematic review and meta-analysis evidence available from India

The aim of the systematic review and meta-analysis is to determine the stress and stressors experienced by the parents of high-risk neonates admitted to the neonatal intensive care unit (NICU) in India. We included both quantitative and qualitative studies. The Joanna Briggs Institute Critical Appraisal Checklist and Critical Appraisal Skill Programme checklist were used to assess the quality of included studies. A systematic search was conducted in PubMed, EMBASE, SCOPUS, EBSCOhost, Web of Science, ProQuest, Microsoft Academic, DOAJ, Indian Citation Index, and J-Gate to identify relevant studies. Additionally, online hand searching was performed on Indian websites of relevant institutions, women and child health departments, repositories, registries, and paediatric journals. Twelve of the 21 quantitative studies found that maternal stress was higher than fathers due to the separation from their babies and the medical condition of the neonate. One qualitative study reported that financial burden, alterations in the parenting role, and concern over domestic issues are significant causes of fathers' stress. A meta-analysis of the included studies assessed the prevalence of maternal, paternal, and parental stress and reported that mothers experienced higher stress levels than fathers across all subscales. The most typical stressors for parents were changes in neonatal looks, behaviour, and altered parental roles. Beyond the immediate NICU care and interactions, other triggering factors of stress among parents must be considered to design multicomponent interventions in a local (Indian) context. Moreover, parental psychological support and regular counselling can be incorporated into the standard neonatal intensive care policy.

Nursing students' attitudes towards mental illness: A multi-national comparison

Accessible Summary What is known on the subject Health professionals, including nurses, are shown to have stigmatizing attitudes towards mental illness. For nursing students who are in their formative years of professional development, mental illness stigma can severely impact the care they provide. Little research has investigated multi-national comparisons of nursing students' attitudes towards mental illness. What this paper adds to existing knowledge This study shows that between countries, there were substantial differences amongst nursing students in stigmatizing attitudes towards mental illness. Cultural perspectives may explain some of these differences. What are the implications for practice Regardless of location, stigmatizing attitudes are present at varying levels. Each nation can take steps to reduce these by acknowledging the presence of stigmatizing attitudes amongst nurses, educating nurses regarding the negative impacts of stigma on patient outcomes, and decrease stigmatizing attitudes by facilitating opportunities for nurses (particularly student nurses) to have direct contact with people with lived experiences of mental illness.

ABSTRACT

INTRODUCTION: Stigmatizing attitudes perpetuated by nursing professionals are a pervasive problem for people experiencing mental health issues. This global issue has detrimental consequences; inhibiting one's life chances and help-seeking behaviours. To date, few studies have compared nursing students' attitudes towards mental illness from a multi-national perspective.

AIM

To compare undergraduate nursing students' attitudes towards mental illness across six countries: Australia, India, Jordan, Saudi Arabia, Taiwan and USA.

METHOD

In a cross-sectional design, data were collected from undergraduate nursing students (N = 426) using the Social Distance Scale. A one-way analysis of variance was used to compare differences between countries.

RESULTS

Nursing students' attitudes to mental illness differed between countries. Social Distance Scores were highest amongst nursing students from Jordan and Saudi Arabia. Students from Taiwan and India possessed moderate stigma scores. Social Distance Scores from the USA and Australia were lowest.

DISCUSSION

Clear differences in stigmatizing attitudes emerged between countries; these are discussed in relation to possible cultural influences.

IMPLICATIONS FOR PRACTICE

It is suggested that educating nurses, combined with direct contact with people with lived experiences of mental illness, can reduce stigmatizing attitudes regardless of country, location or educational institution.

Randomized Controlled Trial on the Effect of the Neonatal Nurse Navigator Program on Maternal Stress and Neonatal Cortisol Levels

OBJECTIVE

To assess the effect of the Neonatal Nurse Navigator Program (NNNP) compared to usual care on maternal stress and neonatal salivary cortisol level (SCL) in the NICU.

DESIGN

Randomized control trial.

SETTING

NICU in a tertiary health care hospital in Manipal, Udupi District, Karnataka, India.

PARTICIPANTS

Neonates between 34 and 36 weeks gestation and their mothers (N = 120 dyads).

METHODS

We used block randomization to assign dyads to the intervention or control group. We measured maternal stress using the Parental Stress Scale: Neonatal Intensive Care Unit, and we estimated neonatal stress by measuring SCLs within 24 hours of NICU admission and before discharge from the unit. We conducted a descriptive analysis on participant characteristics and reported maternal stress levels using means and standard deviations. We used the analysis of covariance change score test to determine the difference in maternal and neonatal stress levels between the intervention and control groups.

RESULTS

The NNNP group exhibited significantly lower maternal stress scores before discharge than the control group, and we observed reductions across all three subscales of the Parental Stress Scale: Neonatal Intensive Care Unit. Mean neonatal salivary cortisol levels were significantly lower in the interventional group than in the control group, F(1.117) = 24.03, 95% confidence interval [7.9, 18.6], p < .001.

CONCLUSION

Use of the NNNP reduced maternal stress SCLs in high-risk neonates by actively engaging mothers in the care of their neonates in the NICU. We recommend adoption of the NNNP model as a standard care policy in NICUs throughout India.

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews

BACKGROUND

To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use.

METHODS

Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria.

FINDINGS AND CONCLUSION

Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.

Australian and Indian nursing students' skills and attitudes surrounding mental illness: Preparing for a transnational nursing education collaboration

Cultural competence is a viewed as a necessary set of skills within nursing, and there is a need for student support in this area. This is particularly important in mental health care, with two skills considered crucial for providing quality care: therapeutic relationship skills and positive attitudes. With the objective of initiating an educational collaboration between two educational institutions, this study examined Australian and Indian undergraduate nursing student's perceived therapeutic relationship skills and stigma attitudes associated with mental illness. Participants were five hundred and fifty-five (n = 555) undergraduate nursing students from two different universities in Indian and Australia. The modified version of the Scale To Assess Therapeutic Relationship (STAR-C) and the Social Distance Scale (SDS) were both used to examine student's perceived therapeutic relationship skills and stigma attitudes. Australian nursing students indicated lower levels of stigma with lower levels of self-reported therapeutic relationships skills, as compared with the Indian nursing student cohort. However, Indian nursing students indicated higher levels of stigma with higher self-reported therapeutic relationship skills. The results of this study may reflect cultural differences and meanings attached to mental illness.

Cerebellar processing of sensory inputs primes motor cortex plasticity

Plasticity of the human primary motor cortex (M1) has a critical role in motor control and learning. The cerebellum facilitates these functions using sensory feedback. We investigated whether cerebellar processing of sensory afferent information influences the plasticity of the primary motor cortex (M1). Theta-burst stimulation protocols (TBS), both excitatory and inhibitory, were used to modulate the excitability of the posterior cerebellar cortex and to condition an ongoing M1 plasticity. M1 plasticity was subsequently induced in 2 different ways: by paired associative stimulation (PAS) involving sensory processing and TBS that exclusively involves intracortical circuits of M1. Cerebellar excitation attenuated the PAS-induced M1 plasticity, whereas cerebellar inhibition enhanced and prolonged it. Furthermore, cerebellar inhibition abolished the topography-specific response of PAS-induced M1 plasticity, with the effects spreading to adjacent motor maps. Conversely, cerebellar excitation had no effect on the TBS-induced M1 plasticity. This demonstrates the key role of the cerebellum in priming M1 plasticity, and we propose that it is likely to occur at the thalamic or olivo-dentate nuclear level by influencing the sensory processing. We suggest that such a cerebellar priming of M1 plasticity could shape the impending motor command by favoring or inhibiting the recruitment of several muscle representations.

Survival of Ornithobacterium rhinotracheale in sterilized poultry litter

Ornithobacterium rhinotracheale (ORT) has been associated with respiratory disease, increased mortality, retarded growth, and decreased egg production in chickens and turkeys. Surveillance of exposure to ORT infection in the field has shown that prevalence of the infection is higher during winter months. The ability of ORT to remain viable in the poultry litter was studied at different temperatures over time. Presterilized poultry litter was inoculated with 10(11) colony-forming units of ORT and kept at -12 C, 4 C, 22 C, 37 C, and 42 C. Reisolation and titration of ORT from litter was attempted at intervals. Results indicate that ORT survived for 1 day at 37 C, 6 days at 22 C, 40 days at 4 C, and at least 150 days at -12 C. ORT did not survive 24 hr at 42 C. The survival of ORT at lower temperatures may be associated with the higher incidence of ORT infection in poultry during winter months.