Directed Attention in Normal and High‐Risk Pregnancy

Initial validation of the German version of the Attentional Function Index in a sample of haematological cancer survivors

OBJECTIVE

To date, no German instrument exists to assess subjective levels of cancer-related cognitive impairments (CRCI) in cancer survivors. We translated the validated Attentional Function Index (AFI) into German and explored its psychometric properties.

METHODS

The validation sample consisted of 1,111 haematological cancer survivors mainly recruited from two cancer registries. Factorial structure was explored using principal component analysis, internal consistency via Cronbach's α, construct validity through correlational analyses (Pearson's r) and associations of patient characteristics with the AFI score via regression analyses.

RESULTS

In line with the original version, we revealed three factors, that is "effective action" (seven items), "attentional lapses" (three items) and "interpersonal effectiveness" (three items). The overall reliability α was .91. Verifying construct validity, the AFI score correlated positively with cognitive functioning (r = .64, p ≤ .01) and global QoL (r = .44, p ≤ .01), but negatively with fatigue (r = -.60, p ≤ .01) and depressive symptomatology (r = -.6, p ≤ .01). Older age (β = .12, p < .001), higher comorbidity (β = -.07, p = .02) and being male patient (β = .07, p = .01) were significantly associated with the AFI scores, but effect sizes were small.

CONCLUSION

The German translation of the AFI shows good psychometric properties and thus may be reasonably applied to measure the subjective level of CRCI in German-speaking oncological populations.

ON BEING MOTHER AND PATIENT: DIALECTICAL STRUGGLES DURING MEDICALLY HIGH-RISK PREGNANCY

Medically high-risk pregnancy (MHRP) affects 3 to 10% (diagnosis-dependent) of pregnant women in the United States (National Institute of Child Health Development, 2015), threatening maternal and fetal well-being. Although mothers' prenatal distress and mother-infant attachment after birth have been quantitatively researched, little research has examined women's lived experiences of MHRP in the United States. We examined 16 women's experiences of MHRP during hospitalization at an urban, Northeastern U.S. hospital using an interpretive phenomenological approach. Our qualitative findings provide new understanding of how women expend tremendous energy simultaneously navigating new roles of mother and patient. While negotiating these roles, they experienced dialectical struggles and uncertainty relating to emotion management, locus of control, appraisals of self/others, and relational self. Women managed these conflicts within the contexts of their emerging maternal identity, patient-provider relationships, and social relationships. Women struggled as they managed emotion, determined their level of responsibility for fetal outcomes, appraised others and themselves, and worried about how they were perceived. This amplified distress and contributed to women's emotional exhaustion, sense of being overwhelmed, and stress burden. New explication of these energy-depleting dynamic processes underlying women's experiences of MHRP and their impact on the future mother-infant relationship is considered, and strategies for psychosocial support are identified.

Influences of Green Outdoors versus Indoors Environmental Settings on Psychological and Social Outcomes of Controlled Exercise

This study addressed a methodological gap by comparing psychological and social outcomes of exercise in green outdoors versus built indoors settings, whilst rigorously controlling exercise mode and intensity. The hypotheses were that greater improvements or more desirable values for directed attention, mood, perceived exertion, social interaction time, intention for future exercise behaviour and enjoyment would be associated with outdoors compared to indoors exercise. Following a baseline session, paired participants completed two conditions of 15 min of cycling on an ergometer placed outside in a natural environment and inside in a laboratory setting in a randomized, counter-balanced order. At pre- and post-exercise, directed attention was measured with the digit span backwards task, and mood was assessed with the Profile of Mood States. During the exercise session, visual and verbal interactions were recorded by means of experimenter observations. After each exercise session, participants provided self-reports of their enjoyment of the exercise, perceived exertion and intention for future exercise in the same environment. Social interaction time was significantly greater during outdoors exercise versus indoors; on average, participants engaged in three minutes more social interaction during exercise outdoors compared to indoors. Social interaction time significantly predicted intention for future exercise in the outdoors condition, but did not in the indoor condition. There was a significant time by condition interaction for directed attention. Scores worsened in the indoors condition, but improved in the outdoors condition. There was no statistically-significant time by condition interaction for mood and no significant difference between conditions for either perceived exertion or intention. Taken together, these findings show that exercise in a natural environment may promote directed attention and social interactions, which may positively influence future exercise intentions.

Effects of the Visual Exercise Environments on Cognitive Directed Attention, Energy Expenditure and Perceived Exertion

Green exercise research often reports psychological health outcomes without rigorously controlling exercise. This study examines effects of visual exercise environments on directed attention, perceived exertion and time to exhaustion, whilst measuring and controlling the exercise component. Participants completed three experimental conditions in a randomized counterbalanced order. Conditions varied by video content viewed (nature; built; control) during two consistently-ordered exercise bouts (Exercise 1: 60% VO2peakInt for 15-mins; Exercise 2: 85% VO2peakInt to voluntary exhaustion). In each condition, participants completed modified Backwards Digit Span tests (a measure of directed attention) pre- and post-Exercise 1. Energy expenditure, respiratory exchange ratio and perceived exertion were measured during both exercise bouts. Time to exhaustion in Exercise 2 was also recorded. There was a significant time by condition interaction for Backwards Digit Span scores (F2,22 = 6.267, p = 0.007). Scores significantly improved in the nature condition (p < 0.001) but did not in the built or control conditions. There were no significant differences between conditions for either perceived exertion or physiological measures during either Exercise 1 or Exercise 2, or for time to exhaustion in Exercise 2. This was the first study to demonstrate effects of controlled exercise conducted in different visual environments on post-exercise directed attention. Via psychological mechanisms alone, visual nature facilitates attention restoration during moderate-intensity exercise.

Cognitive reorganization during pregnancy and the postpartum period: an evolutionary perspective

Where the non-human animal research investigating reproduction-induced cognitive reorganization has focused on neural plasticity and adaptive advantage in response to the demands associated with pregnancy and parenting, human studies have primarily concentrated on pregnancy-induced memory decline. The current review updates Henry and Rendell's 2007 meta-analysis, and examines cognitive reorganization as the result of reproductive experience from an adaptationist perspective. Investigations of pregnancy-induced cognitive change in human females may benefit by focusing on areas, such as social cognition, where a cognitive advantage would serve a protective function, and by extending the study duration beyond pregnancy into the postpartum period.

The Attentional Function Index--a self-report cognitive measure

OBJECTIVE

Cognitive assessment in individuals with cancer requires both measured performance on neuropsychological tests and self-report of effectiveness in functioning. Few instruments are available to assess the perceived impact of cognitive alterations on daily functioning in individuals treated for cancer. In this study, we investigated the psychometric properties of a theoretically based instrument, and the Attentional Function Index (AFI), designed to measure perceived effectiveness in common activities requiring attention and working memory, particularly the ability to formulate plans, carry out tasks, and function effectively in daily life.

METHODS

Women (N=172), ages 27-86 years, completed the questionnaire before primary treatment for early stage breast cancer. Construct validity was established using exploratory principal component factor analysis with varimax rotation.

RESULTS

A 13-item instrument emerged with 3 subscales, namely effective action, attentional lapses, and interpersonal effectiveness, which explained 74.69% of total variance. The internal consistency coefficients (Cronbach's α) were 0.92 for the total instrument, and ranged from 0.80 to 0.92 for the 3 subscales. Further examination of validity indicated that the scores on the AFI (1) showed expected correlations with established measures of ability to concentrate, cognitive failures, states of confusion, and mental fatigue, and (2) could distinguish differences in perceived cognitive functioning between younger and older age groups. AFI scores were not significantly associated with years of education or presence of comorbid conditions.

CONCLUSION

The brief AFI has demonstrated usefulness for assessment of perceived cognitive functioning in populations with life-threatening and chronic illness, such as breast cancer.

The relationship between perceived stress and health-promoting behaviors in high-risk pregnancy

OBJECTIVE

The purpose of this study was to examine the relationship between maternal perceived stress and health-promoting self-care behaviors in women experiencing high-risk pregnancies.

DESIGN

Descriptive correlational.

SAMPLE

Women (N=69) who had a complication in pregnancy that required referral to a perinatologist at a tertiary care center and ere in the third trimester of pregnancy.

MEASURES

The Perceived Stress Scale is a 14-item scale measuring the extent to which one appraises life situations as stressful. Health-Promoting Lifestyle Profile II is a 52-item scale from which scores for an overall health promotion scale and 6 subscales (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, and stress management) are calculated.

RESULTS

There was a significant and negative relationship between perceived stress and health-promoting lifestyle. The relationships between perceived stress and spiritual growth, interpersonal relations, and stress management were significant and negative.

CONCLUSIONS

During a high-risk pregnancy, women who engage in more health-promoting behaviors may experience less stress; however, the causal relationship between stress and health promotion is not known. Nurses can offer stress management techniques and health-promoting self-care during this stressful time to encourage health in mother and neonate.