Duration Of Distress Research Articles

Biochemical analysis of catecholamine and cortisol for the evaluation of the fetal distress in third trimester stillbirths

BackgroundStress hormones like catecholamine and cortisol are thought to reflect the magnitude of physical stress in adults and were studied in relationship to the cause of death and agony time. Intrauterine distress, intrapartum events, and modes of delivery can affect the fetal endocrine stress response, as reflected by biochemical analyses. The aim of the present study was to evaluate the role of catecholamines and cortisol as markers of ante-mortem fetal distress. The role of cortisol as a marker of circadian timing of delivery was also assessed.MethodsA 2-year prospective cohort-comparison inclusion of stillbirths and newborns took place with collection of antemortem data, labor parameters, neonatal outcome, post-mortem data and blood samples. Stillbirths were classified as acute or chronic on the basis of a multidisciplinary evaluation. Heart blood of stillbirths and cord blood of newborns were analyzed by high pressure liquid chromatography (HPLC) for adrenaline and noradrenaline and by immunoassay for cortisol determination.ResultsFifteen stillbirths and 46 newborns, as a comparison group, delivered by spontaneous vaginal birth, elective, and emergency cesarean sections were included. Stillbirths’ main cause of death was cord thrombosis. Levels of adrenaline and noradrenaline (median: 14,188 pg/ml and 230.5 pg/ml, respectively) were significantly higher (p < 0.001) in stillbirths than in newborns and were also higher in acute compared to chronic distress. Cortisol levels were significantly higher (p < 0.05) in spontaneous vaginal delivery (median: 18.2 μg/dl) compared to elective cesarean sections (median: 3.8 μg/dl). No difference in cortisol concentrations was detected between newborns delivered at morning and at afternoon/evening.ConclusionOur results suggest that the biochemical measurement of adrenaline and noradrenaline levels might reflect a marked physical stress response during the process of death in stillbirths. On the contrary, the elevation of cortisol levels could mirror the elevation in maternal cortisol level during vaginal delivery. For the post-mortem evaluation of stillbirths, the analysis of CA levels could provide additional data on the duration of distress, useful to integrate the forensic diagnosis.

Répression des pleurs comme traumatismes relationnels précoces

What to make of very young children's crying remains largely misunderstood and this topic is often neglected during the training of early childhood professionals. Linking this omission to a form of infantile amnesia, we start with the hypothesis that for the very young, dissociation is a primitive adaptation strategy related to attunement with a dissociative state in the parent. These early dissociative states appear in infants’ maturing brains when the adult care-giver does not respond to the infants’ emotional needs during repeated critical periods of crying while the child's attachment system is activated. Thusly, when the adult's reaction to the very young child's crying is to repress it, a chronic traumatic prototypic situation occurs in which we can witness in the infant, a repeated absence of the ability to regulate the intensity and duration of distress. We shall see how the genesis of these early traumas can, from a phenomenological point of view, put the notion of dissociation into question. While no longer considering it as only a defensive action system, an alternative hypothesis would be to consider the dissociative phenomena as an expression of repetition of early experiences in pathological relationships. This phenomenological reflection invites an epistemological debate in order to put into dialectical perspective different theoretical fields referring to dissociative phenomena. In closing, we shall discuss the importance of exploring infantile crying with adults who suffer from dissociative disorders.

A focus on the burdens, boosters, and bonuses of the bearers of bad news in India

Objectives: This study was done to explore the experiences of physicians in India about being the messengers of bad news and management of psychosocial burdens associated with such consultations. Methods: Narrative data was collected from 27 physicians working in four teaching hospitals, using a semi-structured interview schedule. Constant comparison analytic procedures were used to examine physicians’ perceptions and behaviors related to their role as the bearers of bad news. Results: Physicians perceived that being a messenger of bad news was very challenging throughout the course of their careers, although their self-confidence increased over time. Two types of patient care contexts were identified based on the intensity and duration of distress experienced by the physicians. Treatment failure with children and young adults, patients’ inability to access care at the initial stages of the disease, and withdrawal of life-saving treatments due to financial constrains caused intense distress among physicians. Physicians used a number of strategies to cope with the burden of bearing bad news. Clinical bad news puts physicians at risk for burnout, and in some cases is an opportunity for growth. Conclusions: Clinical skill trainings should increase clinicians’ ability to assess and attend to the psychosocial impacts of delivering bad news as much as teaching them the procedures of conveying such information. More studies about the impacts of bad news disclosure on physicians working in societies or settings with inequitable access to health care will improve such training programs.

Age-specific associations between emotional responses to separation and cognitive performance in infancy.

Associations between emotional responses to maternal separation and cognitive performance were expected to change with cognitive development over the first year. In this longitudinal study of 39 infants, measures of separation and reunion distress at 2, 6, and 10 months were interleaved with measures of sensorimotor coordination at 4, 8, and 13 months. Separation distress at 2 months predicted lower sensorimotor scores, whereas separation distress at 6 and 10 months corresponded with higher scores. Duration of distress in reunion showed the same pattern of associations, when controlled for general emotionality Infants' positive engagement and physical touch with their mothers at 10 months predicted higher sensorimotor scores as well. Emotional responses and cognitive performance may be linked by individual differences in self-regulation and attentional engagement, as mediated by age-specific developmental issues.

‘Booboos’: the study of everyday pain among young children

Three- to 7-year olds were observed in their day cares to determine the prevalence and nature of incidents of everyday pain (e.g. bumps, cuts, and scrapes). An observational checklist was used to record information on the behavioral responses of child and caregiver. The checklist showed excellent interrater reliability and supported the validity of the pain measure used. No age or sex differences in the incidence or severity of everyday pain were found. However, girls engaged more often in distress responses and received more physical comfort from adult caregivers. It was concluded that girls have a vocal response style which elicits responses from adult caregivers. No significant effect of age was found on intensity or duration of distress or on adult response, but frequency of help-seeking behaviors was found to decrease with age. Limited effects of age may be due to the age range restriction of 28–81 months. Analyses of temperament indicated that less adaptive children were more agitated prior to a pain incident. Analysis of behavioral context demonstrated that larger groups of children display a higher level of activity and individuals in the group display higher levels of agitation. Personal control of the child during a pain incident decreased within larger groups and increased with a high level of activity. Finally, it was found that children who experienced ‘booboos’ most often also responded to them most strongly, suggesting that increased exposure to this type of pain may lead to sensitization, rather than desensitization.

Responses of Six-Month-Olds to the Distress of Their Peers

Observations of 12 pairs of 6-month-old infants interacting in a laboratory playroom in the presence of both mothers indicated that the estimated frequency, duration, and temporal distribution of one infant's distressed vocalizations were statistically independent of those of the peer. The absence of toys in the environment was a reliable predictor of the extent of an infant's distress, whereas the peer's estimated frequency and duration of distress and the infant's own gender and locomotor status were not. Infants watched their distressed peers during a majority of distress episodes and occasionally directed other behaviors to them but only rarely became distressed themselves. However, there were some indications in the pattern of distress in the trial when toys were absent that suggest one infant's distress had cumulative effects on the peer. Such cumulative effects would seem to be tempered by environmental conditions and the reactions of caregivers.