RESUMEN
Emotion-focused parenting interventions have only rarely been evaluated systematically in Europe. This study investigates the effectiveness of "Tuning in to Kids" (TIK) from Australia delivered online in a randomized controlled trial. TIK is a six-week emotion-focused group parenting program that has shown to improve many aspects of parent emotion socialization as well as child problem behavior in several different countries across cultures. Parents (N = 141) of children between 3 and 6 years of age were included in the study and randomly assigned to an intervention and wait-list control group. The intervention was delivered online due to the worldwide COVID-19 pandemic in spring 2021 (intervention group) and one year later (control group) in Switzerland. Parents' beliefs about emotions, their reported reactions to the child's negative emotions, family emotional climate, and child behavior (internalizing and externalizing) improved after the intervention and stayed better until the 6 months follow-up in the intervention group, but not in the wait-list controls. Adherence to the program was very high. This study shows that parent emotion socialization practice is changeable with small effects even on child behavior and even after online delivery. This possibly makes Tuning in to Kids a promising emotion-focused parenting intervention when delivered online as an interactive group webinar.
Asunto(s)
Responsabilidad Parental , Socialización , Niño , Humanos , Conducta Infantil/psicología , Emociones , Pandemias , Responsabilidad Parental/psicología , PreescolarRESUMEN
Home-visiting programs have gained increasing importance in family-centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home-visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long-term ZEPPELIN study, a randomized controlled trial with 251 participating at-risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity-weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.
Asunto(s)
Intervención Educativa Precoz/métodos , Familia/psicología , Visita Domiciliaria , Desarrollo del Lenguaje , Conducta Materna/psicología , Adulto , Femenino , Humanos , Estudios Longitudinales , Sistemas de Apoyo Psicosocial , AutoimagenRESUMEN
In adults, reporting low and high maternal care in childhood, we compared DNA methylation in two stress-associated genes (two target sequences in the oxytocin receptor gene, OXTR; one in the brain-derived neurotrophic factor gene, BDNF) in peripheral whole blood, in a cross-sectional study (University of Basel, Switzerland) during 2007-2008. We recruited 89 participants scoring < 27 (n = 47, 36 women) or > 33 (n = 42, 35 women) on the maternal care subscale of the Parental Bonding Instrument (PBI) at a previous assessment of a larger group (N = 709, range PBI maternal care = 0-36, age range = 19-66 years; median 24 years). 85 participants gave blood for DNA methylation analyses (Sequenom(R) EpiTYPER, San Diego, CA) and cell count (Sysmex PocH-100i™, Kobe, Japan). Mixed model statistical analysis showed greater DNA methylation in the low versus high maternal care group, in the BDNF target sequence [Likelihood-Ratio (1) = 4.47; p = 0.035] and in one OXTR target sequence Likelihood-Ratio (1) = 4.33; p = 0.037], but not the second OXTR target sequence [Likelihood-Ratio (1) < 0.001; p = 0.995). Mediation analyses indicated that differential blood cell count did not explain associations between low maternal care and BDNF (estimate = -0.005, 95% CI = -0.025 to 0.015; p = 0.626) or OXTR DNA methylation (estimate = -0.015, 95% CI = -0.038 to 0.008; p = 0.192). Hence, low maternal care in childhood was associated with greater DNA methylation in an OXTR and a BDNF target sequence in blood cells in adulthood. Although the study has limitations (cross-sectional, a wide age range, only three target sequences in two genes studied, small effects, uncertain relevance of changes in blood cells to gene methylation in brain), the findings may indicate components of the epiphenotype from early life stress.
Asunto(s)
Factor Neurotrófico Derivado del Encéfalo/genética , Metilación de ADN/genética , Conducta Materna , Receptores de Oxitocina/genética , Estrés Psicológico/genética , Adulto , Anciano , Estudios Transversales , Epigénesis Genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
BACKGROUND: The dramatic rise in chronically ill patients on permanent disability benefits threatens the sustainability of social security in high-income countries. Social insurance organizations have started to invest in promising, but costly return to work (RTW) coordination programmes. The benefit, however, remains uncertain. We conducted a systematic review to determine the long-term effectiveness of RTW coordination compared to usual practice in patients at risk for long-term disability. METHODS AND FINDINGS: Eligible trials enrolled employees on work absence for at least 4 weeks and randomly assigned them to RTW coordination or to usual practice. We searched 5 databases (to April 2, 2012). Two investigators performed standardised eligibility assessment, study appraisal and data extraction independently and in duplicate. The GRADE framework guided our assessment of confidence in the meta-analytic estimates. We identified 9 trials from 7 countries, 8 focusing on musculoskeletal, and 1 on mental complaints. Most trials followed participants for 12 months or less. No trial assessed permanent disability. Moderate quality evidence suggests a benefit of RTW coordination on proportion at work at end of follow-up (risk ratio = 1.08, 95% CI = 1.03 to 1.13; absolute effect = 5 in 100 additional individuals returning to work, 95% CI = 2 to 8), overall function (mean difference [MD] on a 0 to 100 scale = 5.2, 95% CI = 2.4 to 8.0; minimal important difference [MID] = 10), physical function (MD = 5.3, 95% CI = 1.4 to 9.1; MID = 8.4), mental function (MD = 3.1, 95% CI = 0.7 to 5.6; MID = 7.3) and pain (MD = 6.1, 95% CI = 3.1 to 9.2; MID = 10). CONCLUSIONS: Moderate quality evidence suggests that RTW coordination results in small relative, but likely important absolute benefits in the likelihood of disabled or sick-listed patients returning to work, and associated small improvements in function and pain. Future research should explore whether the limited effects persist, and whether the programmes are cost effective in the long term.
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Personas con Discapacidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Reinserción al Trabajo , Enfermedad Crónica , Análisis Costo-Beneficio , Países Desarrollados , Humanos , Seguridad SocialRESUMEN
Twenty-five panic disorder (PD) patients, 19 social phobics (SP), and 20 healthy controls (HC) sat quietly for 15 min, rating their anxiety and dyspnea every 30s while respiratory, cardiovascular, and electrodermal responses were recorded. No panic attacks were reported. For self-reported anxiety and dyspnea, within-subject variability over time was higher in PD than in SP or HC. In PD within-subject correlations across 30-s epochs were significant for (a) self-reported anxiety versus dyspnea, end-tidal pCO2, minute volume, duty cycle, skin conductance level, and interbeat interval, and for (b) dyspnea versus end-tidal pCO2, minute volume, tidal volume, and inspiratory flow rate. Several positive or negative correlations were greater in PD than in other groups. Thus in PD, experienced anxiety and dyspnea are temporally unstable but are correlated with each other and with fluctuations in respiratory and autonomic variables, even in the absence of panic attacks.