Time 1 Research Articles

Intrapartum cardiotocography: an exploratory analysis of interpretational variation

Our aim was to evaluate the intra- and inter-operator agreement in cardiotocography (CTG) traces analysis using the 2015 FIGO classification guidelines, and whether the educational background and the knowledge of anamnestic data can influence the interpretation of CTG traces. A retrospective interpretation of 73 intrapartum CTGs at time 0 (T0) for a first blind interpretation and at time 1 (T1) two months later with additional anamnestic pregnancy information was made by eight different operators (four obstetricians and four midwives with different years of work experience). The intra-observer agreement demonstrates that midwifes are more concordant than obstetricians with a mean of 77.05% versus a mean of 65.75%. There is moderate inter-observer agreement in classifying a CTG trace as ‘normal’; on the contrary, there is no consensus on the ‘suspect’ and ‘pathological’ classification category. IMPACT STATEMENT What is already known on this subject? Interpretation of intrapartum CTG is affected by significant subjective variables with relevant intra- and inter-observer lack of optimal agreement, especially in case of abnormal o pathologic findings. What do the results of this study add? Clinical data seem to play a role in interpretation of suspicious and pathological traces while they do not affect the rate of agreement for normal traces. Midwives tend to be less influenced by anamnestic data in visual CTG interpretation. Instead, obstetricians tend to be more focussed on clinical data and clinical setting that, as a consequence, tend to have great impact on CTG trace interpretation. What are the implications of these findings for clinical practice and/or further research? Cooperation among obstetricians and between obstetricians and midwives should be encouraged in order to optimise CTG reading and improve maternal and neonatal outcomes. Regarding the influence of clinical parameters in classification of intrapartum CTG traces, especially in case of abnormal CTG traces, it should be conceivable to improve medical skills in CTG blind interpretation and further investigate which clinical parameters are mainly related with an augmented risk of foetal asphyxia and adverse neonatal outcomes.

Exploring the prospective role of relationships and psychological distress in postpartum risk of intergenerational continuity of child maltreatment

Objectives: This prospective longitudinal study aimed to explore the role of family relationships (romantic satisfaction and mother-infant bonding) and psychological distress in the associations between four child maltreatment (CM) subtypes (sexual, physical, and emotional abuse, neglect) and early child abuse potential in young mothers.Methods: A sample of 85 pregnant mothers (18-29 years old) was recruited to complete an online survey at Time 1 (T1); 57 mothers participated at T2 (3 months postpartum). The survey documented experiences of CM, prenatal romantic satisfaction, postnatal psychological distress, mother-infant bonding, and child abuse potential using validated questionnaires.Results: Four sequential mediation models were tested, one for each CM subtype. Results show that a maternal history of CM (all subtypes) was indirectly associated with heightened child abuse potential three months postpartum. All CM subtypes were negatively related to prenatal romantic satisfaction, which was in turn negatively associated with postnatal psychological distress. Postnatal psychological distress was related to lower mother-infant bonding which, in turn, was related to increased child abuse potential. The complete sequential model was significant for physical, sexual, and emotional abuse, while a partial sequence was identified with neglect.Implications: Our results are consistent with theoretical models and empirical findings demonstrating the importance of relational factors and mental health in the intergenerational continuity of CM. While our findings await replication, they emphasize the need to intervene early - during the perinatal period - on mental health and family relationships to interrupt intergenerational cycles of CM in at-risk families.

Adolescent social emotional skills, resilience and behavioral problems during the COVID-19 pandemic: A longitudinal study in three European countries.

ObjectivesThe consequences of long-lasting restrictions related to the COVID-19 pandemic have become a topical question in the latest research. The present study aims to analyze longitudinal changes in adolescents’ social emotional skills, resilience, and behavioral problems. Moreover, the study addresses the impact of adolescents’ social emotional learning on changes in their resilience and behavioral problems over the course of seven months of the pandemic.MethodsThe Time 1 (T1) and Time 2 (T2) measuring points were in October 2020 and May 2021, characterized by high mortality rates and strict restrictions in Europe. For all three countries combined, 512 questionnaires were answered by both adolescents (aged 11-13 and 14-16 years) and their parents. The SSIS-SEL and SDQ student self-report and parent forms were used to evaluate adolescents’ social emotional skills and behavioral problems. The CD-RISC-10 scale was administered to adolescents to measure their self-reported resilience. Several multilevel models were fitted to investigate the changes in adolescents’ social emotional skills, resilience, and behavioral problems, controlling for age and gender. Correlation analysis was carried out to investigate how changes in the adolescents’ social emotional skills were associated with changes in their resilience and mental health adjustment.ResultsComparing T1 and T2 evaluations, adolescents claim they have more behavioral problems, have less social emotional skills, and are less prosocial than perceived by their parents, and this result applies across all countries and age groups. Both informants agree that COVID-19 had a negative impact, reporting an increment in the mean internalizing and externalizing difficulties scores and reductions in social emotional skills, prosocial behavior, and resilience scores. However, these changes are not very conspicuous, and most of them are not significant. Correlation analysis shows that changes in adolescents’ social emotional skills are negatively and significantly related to changes in internalized and externalized problems and positively and significantly related to changes in prosocial behavior and resilience. This implies that adolescents who experienced larger development in social emotional learning also experienced more increase in resilience and prosocial behavior and a decrease in difficulties.ConclusionDue to its longitudinal design, sample size, and multi-informant approach, this study adds to a deeper understanding of the pandemic’s consequences on adolescents’ mental health.

Cannabis use and workplace cannabis availability, perceptions and policies among Canadian workers: a comparison before and after the legalisation of non-medical cannabis

ObjectivesLittle data exist examining the impact of non-medical (recreational) cannabis legalisation among a working population. The objective was to compare cannabis use patterns and workplace risk perceptions, cannabis availability and...

A bidirectional examination of mental health symptoms and perceptions of leader support: Which comes first?

ABSTRACT Leader support for psychological health (LSPH) has been identified as an important factor in the prediction of mental health symptoms among warfighters. Although research has examined the relationship between LSPH and mental health symptoms, the extent to which this relationship is bidirectional has been underexplored. Consequently, the present study examined the longitudinal relationships between perceived LSPH and mental health symptoms (depression and PTSD) among military personnel over a 5-month period. We found that perceived LSPH at Time 1 (T1) was associated with fewer mental health symptoms at Time 2 (T2); however, mental health symptoms at T1 were also associated with lower perceptions of LSPH at T2. The results differed slightly based on the type of symptoms experienced, but the relationships between perceived LSPH and symptoms did not vary based on whether soldiers had been exposed to combat. However, it is important to note that the overall sample had low combat experience. Despite this, these findings may suggest that the assumption that leader support can enhance soldier mental health may fail to consider that the symptoms themselves may also affect how leaders are perceived. Therefore, organizations such as the military should consider both directions to optimally understand the relationship between leaders and subordinate mental health.

Prospective mental health effects of intimate partner stalking among women veterans.

Women veterans are disproportionately affected by intimate partner violence (IPV). Within the civilian literature, intimate partner stalking (IPS) is a common, uniquely deleterious form of IPV; the present study seeks to prospectively examine the psychological effects of IPS among women veterans. Women veterans (n = 266) were recruited using the KnowledgePanel, a probability-based survey panel; participants completed surveys at time 1 (T1) and at time 2 (T2) follow-up 18 months later. Women responded to questionnaires assessing IPV and IPS experiences, and symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. At T1, 54.5% of women reported lifetime IPV, of whom 64.1% reported IPS; at T2, 49.2% reported past-year IPV, of whom 7.6% experienced past-year IPS. Bivariately, women in the T1 IPS group reported higher T2 PTSD, depression, and anxiety symptoms than the T1 IPV only and no IPV groups. In a multivariate model, there remained indirect effects of T1 IPS on T2 PTSD symptoms, when other forms of violence (i.e., T1 and T2 IPV, MST, IPS) were controlled. When added to models including other forms of IPV, women who experienced IPS reported increased risk for PTSD symptoms, which predicted heightened PTSD symptoms over time. Providers treating women veterans should assess for experiences of IPS as an additional form of IPV and address PTSD to prevent the development of subsequent comorbid psychopathology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Angular Kinematics and Critical Power of Younger and Older Cyclists during the 3-Min All-Out Test

This study aimed to determine differences in angular kinematics and critical power between younger and older cyclists during the 3-min all-out test. Younger (n = 15, 21.8 ± 2.4y) and older (n = 15, 53.3 ± 6.6 y) Category 1 or 2 riders completed maximal aerobic testing and a 3-min all-out test on separate days using their own bicycle on a cycle ergometer. Eight retroreflective markers determined right side sagittal plane angular kinematics during the 3-min all-out test. Younger cyclists displayed higher VO2max, VO2 @ VEbp, HRmax, Power @ VO2max and Critical Power (p < 0.05) than older cyclists. Cadence decreased over time for the combined group (time 1 (T1) = 87.3 ± 4.5 rpm, time 2 (T2) = 83.7 ± 4.6 rpm, and time 3 (T3) = 83.6 ± 5.0 rpm) where T1 was significantly higher than T2 and T3 (p < 0.001), but there were no differences between age groups. Ankle (T1 > T2 > T3, p < 0.026) and foot ranges of motion (T1, T2 > T3, p < 0.01) decreased over time for both age groups. Additionally, younger cyclists had larger ankle and foot ranges of motion (ROM) compared to older cyclists (p = 0.036 and p = 0.032, respectively). Age related differences in physiological measures occurred as expected, although the skill level of the cyclists may explain their similar cadence. Smaller ankle and foot ROM may be strategies to assist force and power generation, particularly in older cyclists as they attempt to overcome aging related physiological declines. With smaller ROM, older cyclists may aim to strengthen ankle musculature and deemphasize high cadence to maintain force generation and critical power.

Cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma undergoing standard chemotherapy: a longitudinal feasibility study

PurposeCancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer and its treatment. This study assessed the feasibility of collecting longitudinal data on cognition in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent via self-report, neuropsychological assessment, peripheral markers of inflammation, and neuroimaging. An exploration and description of patterns of cancer-related cognitive impairment over the course of treatment and recovery was also undertaken and will be reported separately.MethodsEligible participants completed repeated measures of cognition including self-report and neuropsychological assessment, and correlates of cognition including blood cell–based inflammatory markers, and neuroimaging at three pre-specified timepoints, time 1 (T1) — pre-treatment (treatment naïve), time 2 (T2) — mid-treatment, and time 3 (T3) — 6 to 8 weeks post-completion of treatment.Results30/33 eligible patients (91%, 95% CI: 76%, 97%) were recruited over 10 months. The recruitment rate was 3 patients/month (95% CI: 2.0, 4.3 patients/month). Reasons for declining included feeling overwhelmed and rapid treatment commencement. Mean age was 57 years (SD = 17 years) and 16/30 (53%) were male. Most patients (20/30, 67%) had diffuse large B cell lymphoma or Hodgkin lymphoma (4/30, 13%). The neuroimaging sub-study was optional, 11/30 participants (37%) were eligible to take part, and all agreed. The remaining 19 participants were ineligible as their diagnostic PET/CT scan was completed prior. Retention and compliance with all assessments were 89 to 100% at all timepoints. Only one participant was withdrawn due to disease progression.ConclusionsFindings from this study including excellent recruitment, retention, and compliance rates demonstrate it is feasible to longitudinally assess cognition in people with newly diagnosed aggressive lymphoma during their initial treatment and recovery to inform the development of future research to improve patient experiences and cognitive outcomes.Trial registration.Australian New Zealand Clinical Trials Registry ACTRN12619001649101.

Effects of parental support and coach-initiated motivational climate on young athletes’ psychosocial behaviors and well-being

This study examined the effect of coach-initiated motivational climate and parental support on intrinsic motivation, enjoyment of sport participation, subjective vitality, sport-related violence, and academic achievement of youth soccer players. The second purpose was to examine if intrinsic motivation mediates the impact of coach-initiated climate and parental support on the above endogenous variables. Two measurements Time 1 (T1) and Time 2 (T2) were conducted. In T1, 494 young soccer male athletes completed surveys of coach-created motivational climate, parental praise and understanding, intrinsic motivation, sport-related violence, vitality, sport enjoyment and Grade Point Average (GPA). After five months, 188 of those soccer athletes responded again to the same surveys (T2). In both measurements the findings suggest that perceived coach-initiated empowering climate and parental praise and understanding have indirect effects on sport-related violence, GPA, vitality and sport enjoyment through intrinsic motivation in sport.

Predictors of latent class trajectories of depressive symptoms in Latina mothers.

Guided by the Family Stress Model (FSM) for minority families, the present study examined culture-specific (i.e., stress responses to anti-immigration actions and news, home-school dissonance) and general (i.e., financial strain, social support) risk and promotive factors as longitudinal predictors of Latina mothers' depressive symptom trajectories. Participants included 271 Latina mothers of early adolescents living in a new immigrant area in the southeast part of the United States, followed prospectively across four time points spanning 2 years. Mothers reported on their depressive symptoms at all four time points; risk and promotive factors were measured at Time 1 (T1). Latent class growth curve models identified three classes of mothers based on their depressive symptom trajectories. Roughly half of mothers reported low and decreasing symptoms, a third indicated moderate and increasing symptoms, and 10% displayed high and increasing symptoms. As expected, higher levels of stress responses to anti-immigration actions and news, home-school dissonance, and financial strain predicted membership in increasing symptom classes, whereas higher social support predicted membership in the decreasing symptom class. By adapting prevention and intervention efforts to the unique cultural and social contexts experienced by Latina mothers in new immigrant areas, practitioners may be better able to protect this segment of the population from experiencing depressive symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Exploration of Adherence to the Immunosuppressive Medication in Kidney Transplant Recipients Based on Theory of Planned Behavior.

To investigate adherence to immunosuppressive medication (IM) in kidney transplant recipients (KTRs) and analyze the associated factors using the Theory of Planned Behavior (TPB). Data were collected at Time1 (T1) and 3 months later (T2). T1: the elements of the TPB, past behavior, beliefs about medicines, perceived social support were measured. T2: IM adherence was measured. Structural equation modeling was applied to analyze the associated factors of medication adherence. A total of 246 KTRs were included. The average IM adherence score of KTRs' was 4.86 (SD = 1.63). Of the recipients, 39.43% had one aspect of non-adherence to IM. The model could explain 28.7% of the variance in adherence to IM (R2 = .287, p = .006). TPB is a useful tool for understanding adherence to IM in KTRs. Caregivers can provide effective interventions during follow-up, which should focus on improving medication beliefs as well as provision of other external support especially from outside.

Aging with Disability Symptoms and Ability to Participate in, and Satisfaction with, Social Participation among Persons Aged 45-64.

Pain, fatigue, and depression, considered aging with disability (AwD) symptoms, are known to be substantially higher among middle-aged adults with long-term disability compared to their age peers. Participation has been recognized as an important component of health. This cohort survey study reports findings on the relationship between AwD symptoms and ability to participate in, and satisfaction with participation in, social roles and activities using PROMIS measures. Data were collected at three time points from individuals aged 45–64 with an average of two decades of disability duration and primarily living in the state of Missouri, USA. This study reports on Time 1 (T1) and Time 3 (T3), pre- and post-COVID-19 pandemic declaration, respectively. Multiple regressions using both individual AwD symptoms and a composite measure demonstrated that having more pain, fatigue, and depression was associated with worse participation outcomes. Lower physical function scores were also related to lower participation scores, as was being female and living with others, and having more income reduced participation. Better physical health and identifying as African American/Black were associated with higher participation scores. Our findings suggest that AwD symptoms, along with other sociodemographic and health factors, play a substantial role in the social participation outcomes for persons aging with disability and remain consistent over time.

How do physical and emotional abuse affect depression and problematic behaviors in adolescents? The roles of emotional regulation and anger

BackgroundRates of physical and emotional abuse are high among Chinese adolescents and elicit distinct psychopathologies. However, it remains unclear whether physical and emotional abuse relate to depression and behavior problems similarly or differently. In addition, few studies have examined if they share underlying mechanisms in adolescents. ObjectiveThis study used longitudinal data to examine the mechanisms underlying the effect of physical and emotional abuse on depression and problematic behaviors through emotional regulation and anger in Chinese adolescents. Participants and settingsParticipants were 1689 adolescents (with age ranging from 12 to 17 years) from junior and senior high schools in Zhejiang Province, China. MethodsParticipants completed a childhood trauma questionnaire and an emotion regulation strategies questionnaire at time 1 (T1), and they completed an anger scale, a depression scale, and a problematic behaviors questionnaire one year later (T2). Structural equation modeling was used to examine the research hypotheses. ResultsPhysical abuse had direct positive effects on problematic behaviors but not on depression. However, emotional abuse had direct effects on depression and problematic behaviors, and indirect effects on both psychopathologies through expressive suppression and anger. ConclusionsPhysical and emotional abuse had distinct effects and influencing mechanisms on adolescents' externalizing and internalizing problems. Compared with physical abuse, emotional abuse elicited more harms and subsequent psychopathologies.

Avoidance/emotion-focused coping mediates the relationship between distress tolerance and problematic Internet use in a representative sample of adolescents in Taiwan: One-year follow-up.

Based on the theoretical frameworks of the Theory of Triadic Influence (TTI), this longitudinal study was designed to examine the mediating role of avoidance/emotion-focused coping in the relationship between distress tolerance and problematic Internet use (PIU) in a large representative sample of senior high school students in Taiwan. Through a 1-year follow-up design, 2170 participants were recruited from high schools throughout Taiwan using both stratified and cluster sampling in time 1 (T1), and 1832 students were followed-up 1 year later (T2). Structure equation modeling and bootstrap analyses results showed that after controlling for PIU measured at T1, PIU (T2) was significantly predicted by distress tolerance (T1) and fully mediated through avoidance/emotion-focused coping (T2). The results not only support the TTI framework, but can also serve as a reference to help educational agencies and mental health organizations create policies and design programs that will help in the prevention of PIU among adolescents. The mediating role of avoidance/emotion-focused coping in the relationship between distress tolerance and PIU was discussed.

Comparative study of photoplethysmographic waveforms with application of antihypertensive medication in hypertensive patients.

BackgroundMultiple studies have been published using a pulse oximeter's photoplethysmographic (PPG) capability to detect tissue perfusion. However, the origin of the PPG signal is still debatable.AimA comparative study was performed of PPG waveforms in hypertensive patients before and after treatment with antihypertensive medication. The aim of this study was to observe the changes of PPG waveforms before and after lowering blood pressure in hypertensive patients and then to detect the relationship between blood pressure and PPG waveforms.MethodsThe PPG waveforms of 60 patients with hypertension were collected. After administration of the antihypertensive medication nitroglycerin, PPG waveforms were collected again. The changes of the T3 (time3): This phase occurred between Marker 3 and Marker 4 (this phase occurs mid‐diastolic) angle, before and after the antihypertensive medication treatment, were compared. The statistical analyses of two related groups were performed using the Paired t‐test.ResultsThe blood perfusion waveforms of hypertensive patients before and after antihypertensive medication administration were differently indicated with the tilt angle T3. The slope angle of the T3 phase waveform increased significantly when the blood pressure dropped to normal (−41.9 ± 16.2° vs. −25.6 ± 21.9°, p < .0001), and the tilt angle of some patients was similar to that of adults with normal blood pressure.ConclusionIn patients with hypertension, the tilt angle of the PPG waveform in the T3 phase increased significantly after administration of the antihypertensive medication nitroglycerin. It is worth to conduct deeper research about the relationship between hypertension and the blood perfusion of microcirculation in the diastolic period.

Predictors of Word and Text Reading Fluency of Deaf Children in Bilingual Deaf Education Programmes

Reading continues to be a challenging task for most deaf children. Bimodal bilingual education creates a supportive environment that stimulates deaf children’s learning through the use of sign language. However, it is still unclear how exposure to sign language might contribute to improving reading ability. Here, we investigate the relative contribution of several cognitive and linguistic variables to the development of word and text reading fluency in deaf children in bimodal bilingual education programmes. The participants of this study were 62 school-aged (8 to 10 years old at the start of the 3-year study) deaf children who took part in bilingual education (using Dutch and Sign Language of The Netherlands) and 40 age-matched hearing children. We assessed vocabulary knowledge in speech and sign, phonological awareness in speech and sign, receptive fingerspelling ability, and short-term memory at time 1 (T1). At times 2 (T2) and 3 (T3), we assessed word and text reading fluency. We found that (1) speech-based vocabulary strongly predicted word and text reading at T2 and T3, (2) fingerspelling ability was a strong predictor of word and text reading fluency at T2 and T3, (3) speech-based phonological awareness predicted word reading accuracy at T2 and T3 but did not predict text reading fluency, and (4) fingerspelling and STM predicted word reading latency at T2 while sign-based phonological awareness predicted this outcome measure at T3. These results suggest that fingerspelling may have an important function in facilitating the construction of orthographical/phonological representations of printed words for deaf children and strengthening word decoding and recognition abilities.

Focus on and venting of negative emotion mediates the 18-year bi-directional relations between major depressive disorder and generalized anxiety disorder diagnoses

BackgroundMyriad emotion regulation and coping theories have proposed that avoidant/emotion-oriented coping is a cause and consequence of anxiety and depression. However, few studies have investigated potential mechanisms underlying the prospective anxiety-depression disorder relation. The current study examined various coping strategies (i.e., denial, focus on and venting of emotion (FOAVE), and behavioral disengagement) as potential longitudinal mediators between generalized anxiety disorder (GAD) and major depressive disorder (MDD). MethodsIn a nationally representative sample of adults (N = 3,294), MDD and GAD were assessed at Time 1 (T1) and Time 3 (T3) (Composite International Diagnostic Interview – Short-Form), and avoidant coping strategies (denial, behavioral disengagement, and FOAVE) were measured at Time 2 (T2) (Coping Questionnaire). Assessments occurred over 18 years, each spaced approximately 9 years apart. Structural equation modeling mediation analyses examined whether T1 MDD predicted T3 GAD (and vice versa), and if T2 avoidant coping mediated these relations, above and beyond baseline comorbidity. ResultsFOAVE mediated the T1 MDD–T3 GAD association, and vice versa. Presence of T1 MDD and GAD predicted more T2 FOAVE, and greater T2 FOAVE forecasted T3 MDD and GAD, accounting for 16–21% of the longitudinal MDD-GAD relations. However, behavioral disengagement and denial did not mediate the prospective MDD-GAD relations. Also, T1 MDD and GAD forecasted greater T2 behavioral disengagement. ConclusionsThe use of FOAVE, may be a mechanism by which MDD earlier in life may lead to GAD 18 years later, and vice versa. Theoretical and potential clinical implications are discussed.

The Perceived Risk of Being Infected with COVID-19 at Work, Communication, and Employee Health: A Longitudinal Application of the Job Demands–Resources Model

The perceived risk of being infected at work (PRIW) with COVID-19 represents a potential risk factor for workers during the current COVID-19 pandemic. In line with the job demands–resources (JD-R) model in the context of safety at work, in this longitudinal study we propose that PRIW can be conceptualized as a job demand (JD), whereas communication (i.e., the exchange of good-quality information across team members) can be conceived of as a job resource (JR). Accordingly, we hypothesize that PRIW at Time 1 (T1) would positively predict psychophysical strain at Time 2 (i.e., four months later), and that communication at T1 would negatively predict psychophysical strain at T2. Overall, 297 workers participated in the study. The hypothesized relationships were tested using multiple regression analysis. The results support our predictions: PRIW positively predicted psychophysical strain over time, whereas communication negatively predicted psychophysical strain over time. The results did not change after controlling for age, gender, and type of contract. Overall, this study suggests that PRIW and communication might be conceived of as a risk and a protective factor for work-related stress, respectively. Hence, to promote more sustainable working conditions, interventions should help organizations to promote an adequate balance between JDs and JRs related to COVID-19.

EVALUATION OF PALATAL VOLUME IN CHILDREN WITH CLEFT LIP AND PALATE: A COMPARISON OF TWO SURGICAL PROTOCOL

Objective: Compare the palatal volume in children with unilateral cleft lip and palate before and after two surgicalprotocols. Material and Methods: Retrospective data collection was performed in a specialized hospital. Thesample comprised 120 digitized dental models divided into, Group 1 (G1) – participants submitted to cheiloplastyat 3 months (Millard technique) and one-step palatoplasty at 12 months (von Langenbeck technique); Group 2(G2) – participants submitted to cheiloplasty (Millard technique) and hard palate closure (Hans Pichler technique)at 3 months and soft palate closure at 12 months (Sommerlad technique). The dental models were evaluatedat Time 1 (T1): before primary plastic surgeries, Time 2 (T2): 1st post-surgical phase, and Time 3 (T3): 2ndpost-surgical phase. The volume was measured through stereophotogrammetry system software. Parametric andnon-parametric statistical tests were applied (alpha = 5%). Results: The intragroup analysis revealed that G1 had astatistically significant increase in volume at T2 followed by a reduction at T3 (p=0.003); G2 showed a statisticallysignificant increase of dental arch volume between T1 and T2 (p=0.001). There was no statistically significantdifference in the intergroup and gender analyses (p&gt;0.05). Conclusion: The surgical protocol influenced thepalatal volume of children with unilateral cleft lip and palate. This study suggested that two-step palatoplastyprotocol has a tendency to be more appropriate.KEYWORDSCleft lip; Cleft palate; Dental arch; Imaging; Three-dimensional.

The effects of Expressing Writing on Palliative Care healthcare professionals: a qualitative study.

Expressive Writing (EW) is a useful tool for taking care of the person globally, and literature shows that self-care and self-awareness improve the coping skills of health professionals, positively increasing personal and professional satisfaction and reducing the negative aspects related to the profession, such as burnout. The objective of the research is to analyze the writings produced by healthcare professionals belonging to palliative care in a previous quantitative study to identify any changes between two sessions. It is a longitudinal qualitative research with an interpretative phenomenological methodology of analysis of documents written by professionals. The study included 50 expressive writings: 25 at Time 0 (T0) and 25 at Time 1 (T1). The analysis sample is composed of 25 professionals. All participants completed an Expressive Writing protocol homogeneous in procedure, mandate, and timing. The study revealed a variation in contents from T0 to T1 highlighting both professional and intimate growth of the professionals. The practitioner appears more aware of working together to achieve a goal. Writing evolve as more spontaneous. Attention is focused on the relationship with the patient as an engine of personal and professional growth. The satisfaction is linked to the management of a complex case in its entirety. The investigated instrument resulted in a beneficial change in the healthcare professionals involved. Writing helps to find strategies to take care of the other, improves communication, favors the sharing of experience with the other, increasing the awareness of limitations and strengths.