Motivational interviewing for maternal Immunizations: Intervention development

Background and ObjectiveVaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context.MethodsDesign of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations (“You’re due for two vaccines today”) combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components.ResultsInterview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff.ConclusionsMI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff.     

Salience in a social landscape: electrophysiological effects of task-irrelevant and infrequent vocal change

In a dynamically changing social environment, humans have to face the challenge of prioritizing stimuli that compete for attention. In the context of social communication, the voice is the most important sound category. However, the existing studies do not directly address whether and how the salience of an unexpected vocal change in an auditory sequence influences the orientation of attention. In this study, frequent tones were interspersed with task-relevant infrequent tones and task-irrelevant infrequent vocal sounds (neutral, happy and angry vocalizations). Eighteen healthy college students were asked to count infrequent tones. A combined event-related potential (ERP) and EEG time–frequency approach was used, with the focus on the P3 component and on the early auditory evoked gamma band response, respectively. A spatial-temporal principal component analysis was used to disentangle potentially overlapping ERP components. Although no condition differences were observed in the 210–310 ms window, larger positive responses were observed for emotional than neutral vocalizations in the 310–410 ms window. Furthermore, the phase synchronization of the early auditory evoked gamma oscillation was enhanced for happy vocalizations. These findings support the idea that the brain prioritizes the processing of emotional stimuli, by devoting more attentional resources to salient social signals even when they are not task-relevant.     

Effects of Terrorist Charges and Threatening Conduct on Mock Jurors’ Decisions

Terror management theory posits that fear of death influences judgments in criminal cases. A between-subjects study examined the influence of mortality and terrorism salience in the context of life-threatening versus non-threatening criminal conduct on mock jurors’ emotions and judgments of convictions by 485 jury-eligible Australian citizens. Mortality salience did not impact upon mock jurors’ judgments, indicating that exposure to a criminal trial mitigated the effect. The participants reported more negative emotions with a suspect charged with a terrorism than non-terrorism crime, independently of criminal conduct. Mock jurors were more likely to convict a suspected terrorist (66.4%) than a defendant charged with murder when the criminal conduct entailed throwing a paint bomb (54.0%). When the actus reus was life-threatening, they were more likely to convict a defendant charged with intent to murder (81.5%) than with a terrorist crime (69.7%). The findings indicated that jurors can be influenced by numerous factors at court, including fear of death.     

“In Praise of My Doctor”— Frieda Fromm-Reichmann

This article reviews the chapter on Edith Jacobson and Otto Kernberg in Greenberg and Mitchell's (1983) classic volume. It summarizes both their mostly accurate overview of the proposals of these two psychoanalytic contributors, and points to some misunderstanding of them in Greenberg and Mitchell's critique. The article then clarifies Otto Kernberg's present views, and proposes a concept of human motivation that includes both its neurobiological basis and the secondary symbolic level of organization of experience and motivation. This proposal includes a reformulation of the origin of Freud's dual drive system, and stresses the concept of unconscious intrapsychic conflict as a core aspect of psychoanalytic theory.     

动机性访谈对妊娠期高血压孕妇血压控制与妊娠结局的影响研究

目的观察动机性访谈对妊娠期高血压孕妇血压及妊娠结局的影响。方法 2011年1月至2014年6月在青岛市平度市张舍卫生院妇产科,采用单纯随机抽样的方法将70例妊娠期高血压孕妇随机分为观察组和对照组。对照组常规处理,观察组给予动机性访谈干预措施,观察两组孕妇干预前后的血压情况及妊娠结局。结果干预前两组血压指标比较差异无统计学意义(P>0.05)。观察组孕妇剖宫产、胎儿宫内窘迫、妊娠高血压的发生比率低于对照组,差异有统计学意义(P<0.05)。结论两组患者治疗后患者的血压、血清肌酐、尿素氮水平和尿微量白蛋白与治疗前比较均显著下降,均明显改善,组内比较,差异有统计学意义(均P<0.05),治疗后组间比较,观察组显著低于对照组,差异有统计学意义(均P<0.05)。