RESUMEN
OBJECTIVES: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. METHODS: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. CONCLUSIONS: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.
Asunto(s)
Trastorno Bipolar , Hijo de Padres Discapacitados , Autocontrol , Adolescente , Humanos , Niño , Trastorno Bipolar/psicología , Padres/psicología , Hijo de Padres Discapacitados/psicología , AgresiónRESUMEN
Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)
Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)
Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Práctica Profesional , Niño , Cuidadores , Ecología , Acogimiento , Desarrollo Humano , Dolor , Relaciones Padres-Hijo , Conducta Paterna , Privación Paterna , Juego e Implementos de Juego , Pobreza , Psicología , Psicología Social , Seguridad , Atención , Relaciones entre Hermanos , Sueño , Ajuste Social , Cambio Social , Condiciones Sociales , Medio Social , Justicia Social , Problemas Sociales , Apoyo Social , Sociología , Deportes , Violencia , Síndrome del Niño Maltratado , Mujeres , Trabajo Infantil , Adopción , Divorcio , Familia , Niño Abandonado , Maltrato a los Niños , Defensa del Niño , Desarrollo Infantil , Niño Institucionalizado , Crianza del Niño , Niño no Deseado , Protección a la Infancia , Características de la Residencia , Composición Familiar , Salud , Higiene , Hijo de Padres Discapacitados , Responsabilidad Legal , Hambre , Desórdenes Civiles , Responsabilidad Parental , Entrevista , Violencia Doméstica , Diversidad Cultural , Vida , Víctimas de Crimen , Trastornos Relacionados con Alcohol , Afecto , Cultura , Autonomía Personal , Instrucciones , Mecanismos de Defensa , Hijos Adultos , Trastornos de Estrés Traumático , Investigación Cualitativa , Amigos , Menores , Desarrollo del Adolescente , Violaciones de los Derechos Humanos , Dieta , Alcoholismo , Empatía , Salud del Niño Institucionalizado , Conflicto Familiar , Relaciones Familiares , Consumidores de Drogas , Trastornos Químicamente Inducidos , Personas Esclavizadas , Teoría Fundamentada , Abuelos , Trauma Psicológico , Niño Adoptado , Niño Acogido , Libertad , Experiencias Adversas de la Infancia , Separación Familiar , Distrés Psicológico , Derecho a la Salud , Abuso Emocional , Libertad de Religión , Interacción Social , Factores Sociodemográficos , Vulnerabilidad Social , Ciudadanía , Apoyo Familiar , Tareas del Hogar , Derechos Humanos , Individualidad , Institucionalización , Celos , Actividades Recreativas , Soledad , Amor , Mala Praxis , Privación Materna , Trastornos Mentales , Motivación , Apego a ObjetosRESUMEN
OBJECTIVES: Whether parental age, i.e., paternal or maternal, at childbirth is associated with the risk of bipolar disorder (BD) in offspring remains unclear. We conducted a meta-analysis of observational studies to address this gap. METHODS: PubMed, PsycINFO, Embase, and Web of Science were searched up to June 2021. Studies investigating the associations between parental age at childbirth (exposure) and the risk of BD in offspring (outcome) were eligible for inclusion in our study. Paternal and maternal age were examined separately. Odds ratio (OR) was used as the effect size index. Data were pooled through random-effects meta-analyses. RESULTS: Seven studies involving 3,183,539 participants and 23,253 individuals with BD were included in our meta-analyses. Meta-analyses indicated an increased risk of BD in the offspring of the older paternal age groups (35-44 years old [k = 5; OR = 1.09; 95% CI 1.05, 1.14; p < 0.0001] and ≥45 years old [k = 5; OR = 1.44; 95% CI 1.19, 1.14; p = 0.0001]) in comparison with the reference category (25-34 years old). Meta-analysis also indicated an increased risk of BD in the offspring of the older maternal age group (≥40 years old [k = 3; OR = 1.20; 95% CI 1.10, 1.31; p < 0.0001]) in comparison with the reference category (20-29 years old). CONCLUSIONS: Advanced paternal and maternal age were both associated with an increased risk of BD in offspring. Further studies are needed to investigate the mechanisms behind this association.
Asunto(s)
Trastorno Bipolar , Hijo de Padres Discapacitados , Adulto , Trastorno Bipolar/epidemiología , Padre , Humanos , Masculino , Persona de Mediana Edad , Estudios Observacionales como Asunto , Padres , Factores de Riesgo , Adulto JovenRESUMEN
Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear. OBJECTIVE: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders. METHODS: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate). RESULTS: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption. CONCLUSION: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use.
Asunto(s)
Trastorno Bipolar , Hijo de Padres Discapacitados , Trastornos Mentales , Adulto , Trastorno Bipolar/epidemiología , Estudios de Cohortes , Humanos , Trastornos Mentales/epidemiología , Estudios ProspectivosRESUMEN
INTRODUCTION: Neonatal hyperthyroidism is a disease that can cause mortality and sequelae. To date, there is no clinical series of cases that allows us to know the local reality of this condition. OBJECTIVE: to charac terize the children of mothers with Graves' disease (GD) from a clinical and biochemical point of view. SUBJECTS AND METHOD: A prospective follow-up of all newborns (NB) of mothers with history of GD was performed in two public hospitals in Santiago, during 5 years. Clinical and laboratory variables of mother-child pairs and thyroid-stimulating hormone receptor antibodies (TRAbs) le vels were analyzed looking for associations between these variables and the development of neonatal hyperthyroidism. RESULTS: Seventy-six mother-child pairs were included (0.2% of all deliveries). Five neonates (6.6%) presented biochemical hyperthyroidism, and 3 of them developed clinical disease and required treatment. All 5 NBs who developed hyperthyroidism had mothers with positive or indeterminate TRAbs. No child of TRAbs-negative mothers developed the disease. TRAbs could be determined in only 65% of the mothers and 72% of the NBs. There was a significant correlation bet ween maternal TRAbs titers (p < 0.03), neonatal TRAbs titers (p < 0.008), and neonatal TSH between days 2-6 (p < 0.006), with the subsequent development of hyperthyroidism. All cases of neonatal hyperthyroidism were transient. There was no mortality in our series. CONCLUSIONS: This is the first national case series of children of mothers with GD. Maternal and neonatal TRAbs and TSH between days 2-6 of life were predictors of neonatal hyperthyroidism.
Asunto(s)
Enfermedades Fetales/sangre , Enfermedad de Graves/sangre , Hipertiroidismo/diagnóstico , Complicaciones del Embarazo/epidemiología , Efectos Tardíos de la Exposición Prenatal/terapia , Tirotoxicosis , Biomarcadores/sangre , Hijo de Padres Discapacitados , Femenino , Enfermedades Fetales/etiología , Enfermedades Fetales/inmunología , Enfermedad de Graves/complicaciones , Humanos , Hipertiroidismo/sangre , Hipertiroidismo/congénito , Recién Nacido , Enfermedades del Recién Nacido , Madres , Embarazo , Efectos Tardíos de la Exposición Prenatal/sangre , Estudios Prospectivos , Pruebas de Función de la Tiroides , TirotropinaRESUMEN
INTRODUCTION: Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life. OBJECTIVE: To identify the knowledge and the frequency pediatrics residents ask about ACEs with. METHODS: Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care children's hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected. RESULTS: 21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them. CONCLUSIONS: Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.
INTRODUCCIÓN: Las experiencias adversas en la infancia (EAI) se han relacionado con la adquisición de conductas de riesgo y el desarrollo de enfermedades crónicas y mentales, desde la adolescencia y en la vida adulta. OBJETIVO: Identificar el conocimiento y la frecuencia con la que médicos residentes de pediatría interrogan sobre las EAI. MÉTODOS: Mediante una encuesta en línea enviada a todos los médicos residentes del año académico 2017-2018 de un hospital pediátrico de tercer nivel, se recabaron variables demográficas, del conocimiento, uso, entrenamiento y barreras para interrogar sobre EAI. RESULTADOS: 21 % de los residentes respondió la encuesta, la mayoría fue del sexo femenino (70 %), menos de 5 % de los participantes estaba familiarizado con las EAI, 31 % interrogaba sobre ellas a los padres e hijos y 71 % consideró que tiene alguna barrera para interrogarlas. CONCLUSIONES: Los participantes de este estudio mostraron un conocimiento limitado sobre las EAI, lo que repercutió en la frecuencia con la que preguntaban al respecto a sus pacientes y padres; al menos la mitad tuvo la percepción que identificarlas está fuera del alcance del pediatra.
Asunto(s)
Experiencias Adversas de la Infancia/psicología , Maltrato a los Niños/diagnóstico , Competencia Clínica , Internado y Residencia/estadística & datos numéricos , Pediatría , Adolescente , Adulto , Niño , Abuso Sexual Infantil/diagnóstico , Hijo de Padres Discapacitados , Violencia Doméstica , Abuso Emocional , Femenino , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/diagnóstico , México , Padres , Abuso FísicoRESUMEN
OBJECTIVE: To report vigilance attention outcomes from a cluster randomized controlled trial of early childhood development caregiver training for perinatally HIV-exposed/uninfected preschool-age children in rural Uganda. The Early Childhood Vigilance Test (ECVT) provides a webcam recording of proportion of time a child views an animation periodically moving across a computer screen. STUDY DESIGN: Sixty mothers/caregivers received biweekly year-long training sessions of the Mediational Intervention for Sensitizing Caregivers (MISC), and 59 mothers received biweekly training about nutrition, hygiene, and health care. Children were tested for attention at baseline, 6 months, and 12 months with the ECVT, in terms of proportion of time spent viewing a 6-minute animation of animals greeting the child and moving across the computer monitor screen. Time viewing the animation were scored by trained observers using ProCoder program for webcam scoring of proportion of time the child faced the animation. Mixed-effects modeling was used to compare ECVT outcomes for the 2 intervention groups. RESULTS: Unadjusted and adjusted (for age, sex, height, and ECVT at baseline) group differences on ECVT significantly favored the MISC arm at 6 months (P = .03; 95% CI (0.01, 0.11), effect size = 0.46) but not at 12 months. Both groups made significant gains in sustained attention across the year-long intervention (P = .021) with no significant interaction effects between time and treatment arms or sex. CONCLUSIONS: Caregiver early childhood development training enhanced attention in at-risk Ugandan children, which can be foundational to improved working memory and learning, and perhaps related to previous language benefits reported for this cohort. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00889395.
Asunto(s)
Cuidadores/educación , Desarrollo Infantil , Infecciones por VIH/psicología , Cuidadores/psicología , Hijo de Padres Discapacitados/psicología , Preescolar , Análisis por Conglomerados , Cognición , Educación en Salud/métodos , Humanos , Población Rural , UgandaRESUMEN
Resumen Introducción: Las experiencias adversas en la infancia (EAI) se han relacionado con la adquisición de conductas de riesgo y el desarrollo de enfermedades crónicas y mentales, desde la adolescencia y en la vida adulta. Objetivo: Identificar el conocimiento y la frecuencia con la que médicos residentes de pediatría interrogan sobre las EAI. Métodos: Mediante una encuesta en línea enviada a todos los médicos residentes del año académico 2017-2018 de un hospital pediátrico de tercer nivel, se recabaron variables demográficas, del conocimiento, uso, entrenamiento y barreras para interrogar sobre EAI. Resultados: 21 % de los residentes respondió la encuesta, la mayoría fue del sexo femenino (70 %), menos de 5 % de los participantes estaba familiarizado con las EAI, 31 % interrogaba sobre ellas a los padres e hijos y 71 % consideró que tiene alguna barrera para interrogarlas. Conclusiones: Los participantes de este estudio mostraron un conocimiento limitado sobre las EAI, lo que repercutió en la frecuencia con la que preguntaban al respecto a sus pacientes y padres; al menos la mitad tuvo la percepción que identificarlas está fuera del alcance del pediatra.
Abstract Introduction: Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life. Objective: To identify the knowledge and the frequency pediatrics residents ask about ACEs with. Methods: Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care childrens hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected. Results: 21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them. Conclusions: Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Pediatría , Maltrato a los Niños/diagnóstico , Competencia Clínica , Experiencias Adversas de la Infancia , Internado y Residencia/estadística & datos numéricos , Padres , Abuso Sexual Infantil/diagnóstico , Hijo de Padres Discapacitados , Violencia Doméstica , Encuestas de Atención de la Salud/estadística & datos numéricos , Abuso Físico , Abuso Emocional , Trastornos Mentales/diagnóstico , MéxicoRESUMEN
CONTEXT: Several cross-sectional studies have assessed the association of lead exposure with type 2 diabetes and cardiometabolic risk factors in adults; however, studies of such associations in childhood are rare. OBJECTIVE: We assessed the prospective associations of prenatal exposure to lead with type 2 diabetes and cardiometabolic risk factors in children. DESIGN: The Early Life Exposure in Mexico to Environmental Toxicants is a birth cohort study of pregnant women and their offspring. SETTING: Public hospitals in Mexico City. PATIENTS OR OTHER PARTICIPANTS: Women were recruited during pregnancy; their offspring were recruited for a follow-up visit at age 10 to 18 years (n = 369). MAIN OUTCOME MEASURES: We measured fasting serum markers of type 2 diabetes and cardiometabolic risk factors in children, including fasting glucose, insulin, and lipids. The index of insulin resistance was calculated. RESULTS: The geometric mean of maternal blood lead levels (BLLs) during pregnancy was 4.3 µg/dL (95% confidence interval [CI]): 4.0-4.6 µg/dL) in the entire sample. In boys, those with maternal BLLs ≥ 5 µg/dL (compared with those with BLLs < 5 µg/dL) had significantly lower z scores for total cholesterol (ß = -0.41, 95% CI: -0.71, -0.12), high-density lipoprotein cholesterol (ß = -0.32, 95% CI: -0.59, -0.05), and low-density lipoprotein cholesterol (ß = -0.52, 95% CI: -0.81, -0.22), adjusting for covariates. No associations were detected in girls. CONCLUSIONS: In our study, we found that higher prenatal exposure to lead was associated with lower levels of cholesterol in children following a sex-specific pattern. Further studies with a larger sample size that examine whether sex is a potential modifier are needed to confirm our findings.
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Enfermedades Cardiovasculares/etiología , Hijo de Padres Discapacitados , Diabetes Mellitus Tipo 2 , Intoxicación por Plomo , Enfermedades Metabólicas/etiología , Embarazo en Diabéticas , Efectos Tardíos de la Exposición Prenatal/epidemiología , Adolescente , Adulto , Enfermedades Cardiovasculares/epidemiología , Niño , Hijo de Padres Discapacitados/estadística & datos numéricos , Estudios de Cohortes , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Plomo/análisis , Plomo/sangre , Plomo/toxicidad , Masculino , Enfermedades Metabólicas/epidemiología , México/epidemiología , Embarazo , Efectos Tardíos de la Exposición Prenatal/sangre , Factores de Riesgo , Adulto JovenRESUMEN
Pediatric Bipolar Disorder (PBD) is a highly heritable condition responsible for 18% of all pediatric mental health hospitalizations. Despite the heritability of this disorder, few studies have assessed potential differences in the clinical manifestation of PBD among patients with a clear parental history of BD. Additionally, while recent studies suggest that attentional deficits are a potential endophenotypic marker of PBD, it is unclear whether heritability is a relevant contributor to these symptoms. In order to address this gap, the present study assessed 61 youth with PBD (6-17 years old), corresponding to 27 offspring of BD patients, and 31 PBD patients without a parental history of the disorder. All standardized assessments, including the K-SADS-PL-W were performed by trained child and adolescent psychiatrists. We performed a logistic multivariate model using the variables of ADHD, rapid cycling, and lifetime psychosis. Rates of ADHD comorbidity were significantly higher among PBD patients who had a parent with BD. Furthermore, PBD patients who had a parent with BD showed a trend toward significance of earlier symptom onset. PBD offspring did not show increased rates of suicide attempts, rapid cycling, or psychosis. Given these findings, it appears that PBD patients who have a parent with BD may represent a distinct endophenotype of the disorder. Future longitudinal and larger studies are required to confirm our findings.
Asunto(s)
Trastorno Bipolar/genética , Trastorno Bipolar/psicología , Hijo de Padres Discapacitados/psicología , Padres/psicología , Intento de Suicidio/psicología , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/genética , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno Bipolar/diagnóstico , Niño , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Intento de Suicidio/tendenciasRESUMEN
OBJECTIVE: To analyze attitudes of filial responsibility about the institutionalization of aged parents. METHODS: A qualitative descriptive study with intentional sample of 100 caregivers of aged people from two Primary Health Care Units of Porto Alegre/Brazil. The information was collected in 2014, through a semi-structured interview. Thematic analysis was carried out. The NVIVO® software version 10 was used. RESULTS: Two categories were elaborated according to the protocol questions: the possibility of institutionalization of the aged parents and expectation of care. FINAL CONSIDERATIONS: Most adult child caregivers did not consider the institutionalization of aged parents in the reason of a duty they felt to take care of their parents, and the institutionalization was considered as abandonment. Most of the adult child caregivers had an expectation to be cared by their children and perceived the institutionalization as an alternative of receiving this care. The results of the study contribute to the strengthening of the formal and informal network for the aged and their adult child caregiver.
Asunto(s)
Hijos Adultos/psicología , Actitud , Institucionalización , Padres , Anciano , Cuidadores/psicología , Hijo de Padres Discapacitados/psicología , Toma de Decisiones , Relaciones Familiares , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Responsabilidad SocialRESUMEN
BACKGROUND: Maternal depression is associated with impairments in child behavioural and emotional development, although the effect of exposure to maternal depression until adolescence is underexplored in most studies. This longitudinal study examined the association between maternal depressive symptoms trajectories and offspring socioemotional competences at age 11. METHODS: We included 3,437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Maternal depressive symptoms were assessed during the follow-up waves. Adolescent socioemotional competences were peer relationship problems and prosocial behaviour, both assessed by Strengths and Difficulties Questionnaire (SDQ), and Locus of Control (LoC), assessed by Nowick-Strickland Internal-External Scale. We used multivariate linear and logistic regression models to examine the effects of maternal depression trajectories on offspring's socioemotional competences, adjusting for potential confounding variables. RESULTS: We identified five trajectories of maternal depressive symptoms: a "low" trajectory (32.6%), a "moderate low" (42.2%), a "increasing" (11.1%), a "decreasing" (9.2%), and a "high-chronic" trajectory (4.9%). Adolescents whose mothers had persistent depressive symptoms, either intermediate or high, had greater levels of peer relationship problems and lower levels of prosocial behaviour than those whose mothers had low depressive symptoms. These differences were not explained by socioeconomic, maternal, and child characteristics. Maternal depressive symptoms during offspring's life was not a predictor of LoC orientation. LIMITATIONS: Nearly 20% of original cohort were not included in the analysis due to missing data. Adolescent's socioemotional competences were ascertained by maternal report. CONCLUSION: Our study extended the evidences of the negative impact of severe and recurrent maternal depression on offspring's socioemotional competences until early adolescence.
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Hijo de Padres Discapacitados/psicología , Depresión/psicología , Madres/psicología , Adulto , Brasil/epidemiología , Niño , Hijo de Padres Discapacitados/estadística & datos numéricos , Depresión/epidemiología , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , MasculinoRESUMEN
Siblings of children with autism spectrum disorders (ASD) present greater susceptibility to developmental problems, in comparison with siblings of typically developing children. The greater prevalence of mental health disorders among parents of children with ASD increases younger siblings' vulnerability to emotional problems. The aim of this study is to compare the interaction between carers and babies aged 2 to 26 months (M = 11.7, SD = 6.9) who are siblings of children with ASD (ASD dyads) with the interaction of dyads of siblings of typically developing children (TD dyads). The protocol of Clinical Indicators of Risk for Child Development and the Coding Interactive Behaviour measures were used to evaluate interaction. ASD dyads presented higher scores of constriction in their interaction, P = .024, with babies presenting higher scores of withdrawal behavior, P = .003, and carers presenting higher scores of depressive mood, P = .008, when compared to TD dyads. The ASD dyads have interactive impairments more frequently than do the TD dyads.
Trasfondo: Los hermanos de niños con trastornos dentro de la gama del autismo (ASD) presentan una mayor susceptibilidad a problemas del desarrollo, en comparación con los hermanos de niños que se desarrollan de una manera típica. La mayor prevalencia de trastornos de salud mental entre padres de niños con ASD aumenta la vulnerabilidad de los hermanos más jóvenes a problemas emocionales. El objetivo de este estudio es comparar la interacción entre cuidadores y bebés de edad entre 2 y 26 meses (Media: 11.7 meses/ SD: 6.9) hermanos de niños con ASD (díadas ASD), con las interacción de díadas de hermanos de niños que se desarrollan típicamente (díadas TD). Método: Para evaluar la interacción se usó el protocolo de los Indicadores Clínicos de Riesgo para el Desarrollo del Niño y la Codificación Interactiva de Conducta. Resultados: Las díadas ASD presentaron puntuaciones más altas de constricción en su interacción (p = 0.024), con los bebés que presentaron más altas puntuaciones de conducta de despego (p = 0.003) y los cuidadores que presentaron más altas puntuaciones de estados de ánimo depresivos (p = 0.008) cuando se les comparó con las díadas TD. Conclusiones: Las díadas ASD tienen impedimentos interactivos más frecuentemente que las díadas TD.
Contexte: Les frères et sÅurs d'enfants avec des troubles du spectre autistique (TSA) présentent une plus grande susceptibilité à des problèmes comportementaux, comparés aux frères et sÅurs d'enfants se développant typiquement. La plus grande prévalence de troubles de santé mentale avec les parents d'enfants avec TSA augmente la vulnérabilité aux problèmes émotionnels des jeunes frères ou sÅurs. Le but de cette étude est de comparer l'interaction entre les parents ou personnes prenant soin des enfants et les bébés âgés de 2 à 26 mois (Moyenne: 11, 7 mois/ DS: 6,9), frères et sÅurs d'enfants avec des TSA (dyades-TSA), avec l'interaction de dyades de frères et sÅurs d'enfants se développant typiquement (dyades-DT). Méthode: Le protocole d'Indicateurs Cliniques de Risque pour le Développement de l'Enfant et le Codage des Comportements Interactifs ont été utilisés pour évaluer l'interaction. Résultats: les dyades TSA ont présenté des scores plus élevés de constriction (p = 0,024) de leur interaction avec les bébés présentant des scores de comportement de retrait (p = 0,003) et les personnes prenant soin des enfants ont présenté des scores plus élevés d'humeur dépressive (p = 0,008) quand comparées aux dyades-DT. Conclusions: Les dyades-TSA ont des insuffisances interactives plus fréquemment que les dyades-DT.
Asunto(s)
Trastorno del Espectro Autista , Desarrollo Infantil , Relaciones Familiares/psicología , Padres/psicología , Hermanos/psicología , Adulto , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/psicología , Brasil/epidemiología , Niño , Hijo de Padres Discapacitados , Femenino , Humanos , Lactante , Masculino , Prevalencia , Problema de Conducta/psicologíaRESUMEN
PURPOSE: US Hispanics are more likely to be diagnosed with advanced cancer as parents than their non-Hispanic white counterparts but little is known about Hispanic parents' willingness to discuss a terminal cancer diagnosis with dependent children, potentially resulting in suboptimal child coping. Therefore, we investigated Hispanic mothers' willingness to communicate with dependent children about her actual or hypothetical advanced cancer diagnosis. METHODS: Two focus groups (n = 6 participants) and three one-on-one interviews (n = 3) were conducted in either Spanish or English among adult, Mexican-American mothers with a current cancer diagnosis of any stage residing in US-Mexico border communities. Participants reported their perceived concerns, parenting challenges, and openness to discussing an incurable cancer diagnosis with a dependent child. Audio files were transcribed into English and qualitatively coded using content analysis. RESULTS: Participants, most with breast cancer, ranged in age from 25 to 47. Five had considered the possibility of their own death from advanced cancer and three had previously discussed this with their children. While many expected their children would carry on well without them, seven expressed concern for the emotional/spiritual well-being of their children. Mothers anticipated physical and time-based parenting challenges but wanted the opportunity to focus on themselves and their children in advance of death. All but one would be willing to discuss an advance cancer diagnosis with dependent children; four expressed the value of doing so or the potential harm of abdicating this responsibility. CONCLUSIONS: If faced with an advanced cancer diagnosis, Mexican-American mothers are open to communicating with dependent children.
Asunto(s)
Hijo de Padres Discapacitados , Hispánicos o Latinos , Madres , Neoplasias , Relaciones Padres-Hijo , Enfermo Terminal , Adaptación Psicológica/fisiología , Adolescente , Adulto , Niño , Hijo de Padres Discapacitados/psicología , Hijo de Padres Discapacitados/estadística & datos numéricos , Preescolar , Progresión de la Enfermedad , Emociones , Femenino , Grupos Focales , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , México/etnología , Persona de Mediana Edad , Madres/psicología , Madres/estadística & datos numéricos , Neoplasias/diagnóstico , Neoplasias/etnología , Neoplasias/patología , Cuidados Paliativos/psicología , Cuidados Paliativos/estadística & datos numéricos , Relaciones Padres-Hijo/etnología , Proyectos Piloto , Investigación Cualitativa , VoliciónRESUMEN
OBJECTIVE: Little is known about the impact of the home environment on biomarkers of obesity, such as adipokines, in children. In this study, we examined the relationship of maternal depressive symptoms and potentially protective social factors, including maternal support and the home learning environment, with body mass index and adipokines. METHODS: Data were obtained from 326 Mexican American participants from the Center for the Health Assessment of Mothers and Children of Salinas cohort. Plasma adipokine levels were assessed in 326 children by enzyme-linked immunoassay at birth or ages 5, 9, or 14 years. Maternal depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale when children were 1, 3.5, 7, and 9 years old; social support was assessed by the Duke-University of North Carolina Questionnaire at ages 1 and 5 years; and home learning environment by the Home Observation for the Measurement of the Environment (HOME) at ages of 6 months and 1, 2, 3.5, 7, 9, and 10.5 years. RESULTS: Age was significantly associated with adiponectin (B = -5.0, SE = 0.2) and leptin (B = 0.01, SE = 0.003) levels. Individual time point analyses identified significant positive associations of HOME scores in childhood with adiponectin at ages 9 years (HOME score; age 3.5 years: B = 0.9, p = .04) and 14 years (HOME score; age 7 years: B = 0.6, p = .02, age 9 years: B = 0.6, p = .05, age 10.5 years: B = 0.5, p = .04). We observed significant relationships of maternal depressive symptoms at age 9 years with adiponectin and body mass index z-score at age 14 years (B = -0.2, p = .003 and B = 0.02, p = .002, resp.), which were confirmed in longitudinal models. CONCLUSIONS: This study adds new evidence that adverse and protective aspects of the home environment could lead to altered obesity status in children.
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Adiponectina/sangre , Hijo de Padres Discapacitados/estadística & datos numéricos , Depresión/etnología , Familia , Americanos Mexicanos/estadística & datos numéricos , Obesidad Infantil/etnología , Medio Social , Apoyo Social , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Leptina/sangre , Estudios Longitudinales , MasculinoRESUMEN
This article estimates the proportion of children (17 and younger) exposed to an adult with an alcohol problem or alcohol use disorder (AUD) in San Juan, Puerto Rico. Data are from a household random sample of 1,510 individuals 18-64 years of age. A total of 20.9% of children in sample households were exposed to an adult with an alcohol problem, and 5.7% were exposed to an adult with DSM-5 AUD. These considerable proportions suggest that alcohol treatment and family support programs should include help for adults in the family, and special support for exposed children in the household.
Asunto(s)
Trastornos Relacionados con Alcohol/epidemiología , Salud de la Familia , Apoyo Social , Adolescente , Adulto , Niño , Hijo de Padres Discapacitados/psicología , Humanos , Persona de Mediana Edad , Puerto Rico , Adulto JovenRESUMEN
INTRODUCTION: Injuries during childhood, which mostly consist of falls, burns, drowning, poisonings and car crashes, are among the main causes of death among children and young adults in several countries. OBJECTIVES: To investigate the association between maternal depression and the incidence of injuries during childhood. METHODS: In 2004, children who were born in the municipality of Pelotas, Brazil, were enrolled in a population-based birth cohort, with evaluations at birth and at 3, 12, 24 and 48 months of age. Maternal depression during pregnancy was evaluated at the time of delivery. At 12 and 24 months post partum, the Edinburgh Postnatal Depression Scale (EPDS) was used. The injuries incidence rates at ages of 24-48 months and the crude and adjusted IRRs were calculated with 95% CI through Poisson's regression. RESULTS: A total of 3533 children were analysed. The incidence of injuries was higher among children whose mothers presented depressive symptoms during pregnancy and at 12 and 24 months compared with those whose mothers did not present any symptoms. In the adjusted analysis, the IRR among girls whose mothers presented depressive symptoms during pregnancy and EPDS ≥13 at 12 and 24 months was 1.31 (1.15-1.50); and, among boys, 1.18 (1.03-1.36). INTERPRETATION: Maternal depression is associated with higher incidence of injuries between 24 and 48 months of age, in both sexes.
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Hijo de Padres Discapacitados/estadística & datos numéricos , Depresión Posparto/epidemiología , Madres/psicología , Heridas y Lesiones/epidemiología , Adaptación Psicológica , Brasil/epidemiología , Preescolar , Estudios de Cohortes , Depresión Posparto/complicaciones , Femenino , Humanos , Incidencia , Masculino , Factores de Riesgo , Factores Socioeconómicos , Heridas y Lesiones/etiologíaRESUMEN
This study examined the associations among maternal depression, mothers' emotional and material investment in their child, and children's cognitive functioning. Middle-class Chilean mothers and children (N = 875; 52% males) were studied when children were 1, 5, 10, and 16 years (1991-2007). Results indicated that highly depressed mothers provided less emotional and material support to their child across all ages, which related to children's lower IQ. Children with lower mental abilities at age 1 received less learning-material support at age 5, which led to mothers' higher depression at child age 10. Mothers' low support was more strongly linked to maternal depression as children got older. Findings elucidate the dynamic and enduring effects of depression on mothers' parenting and children's development.
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Desarrollo del Adolescente/fisiología , Desarrollo Infantil/fisiología , Hijo de Padres Discapacitados/psicología , Trastorno Depresivo/psicología , Emociones/fisiología , Inteligencia/fisiología , Conducta Materna/psicología , Madres/psicología , Responsabilidad Parental/psicología , Adolescente , Adulto , Niño , Preescolar , Chile , Femenino , Humanos , Lactante , Estudios Longitudinales , MasculinoRESUMEN
BACKGROUND: Longitudinal studies of children with disruptive disorders (DDs) have shown high rates of antisocial personality disorder (ASPD) and substance use in adulthood, but few have examined the contribution of parental disorders. We examine child-/adulthood outcomes of DDs in offspring, whose biological parents did not have a history of ASPD, bipolar disorder, or substance use disorders. METHOD: Offspring (Nâ¯=â¯267) of parents with or without major depression (MDD), but no ASPD or bipolar disorders were followed longitudinally over 33 years, and associations between DDs and psychiatric and functional outcomes were tested. RESULTS: Eighty-nine (33%) offspring had a DD. Those with, compared to without DDs, had higher rates of MDD (adjusted odds ratio, AORâ¯=â¯3.42, pâ¯<â¯0.0001), bipolar disorder (AORâ¯=â¯3.10, pâ¯=â¯0.03), and substance use disorders (AORâ¯=â¯5.69, pâ¯<â¯0.0001) by age 18, as well as poorer school performance and global functioning. DDs continued to predict MDD and substance use outcomes in adulthood, even after accounting for presence of the corresponding disorder in childhood (MDD: hazards ratio, HRâ¯=â¯3.25, pâ¯<â¯0.0001; SUD, HRâ¯=â¯2.52, pâ¯<â¯0.0001). Associations were similar among the offspring of parents with and without major depression. DDs did not predict adulthood ASPD in either group. LIMITATIONS: Associations are largely accounted for by conduct disorder (CD), as there were few offspring with ADHD, and oppositional defiant disorder (ODD) was not diagnosed at the time this study began. CONCLUSION: If there is no familial risk for ASPD, bipolar disorder or substance use, childhood DDs do not lead to ASPD in adulthood; however, the children still have poorer prognosis into midlife. Early treatment of children with DD, particularly CD, while carefully considering familial risk for these disorders, may help mitigate later adversity.
Asunto(s)
Hijo de Padres Discapacitados/psicología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Adolescente , Adulto , Trastorno de Personalidad Antisocial/epidemiología , Trastorno Bipolar/epidemiología , Estudios de Casos y Controles , Niño , Trastorno de la Conducta/epidemiología , Trastorno Depresivo Mayor/epidemiología , Femenino , Humanos , Masculino , Oportunidad Relativa , Trastornos Relacionados con Sustancias/epidemiología , Adulto JovenRESUMEN
The present study aimed to verify the association between maternal depression and emotional and behavioral problems in school children in Pelotas, Southern Brazil, considering that maternal depression increases children's vulnerability for developing psychiatric disorders. This is a cross-sectional study with a school-based sample conducted between August 2015 and November 2016 and it is part of a major project entitled 'Healthy Childhood in Context: A Multidisciplinary Investigation'. Schoolchildren aged between 7 and 8 years and one of their respective parents or a primary caregiver were included in the study. Maternal depression was assessed using the Mini International Neuropsychiatric Interview (MINI). The presence of emotional and behavioral problems in children was verified by the Strengths and Difficulties Questionnaire (SDQ) - parents version. Children of depressed mothers exhibited higher mean scores in all SDQ domains and in the total score when compared to children of non-depressed mothers. Lower socio-economic status was also associated with higher SDQ scores. Our results showed the effects of both maternal depression and poverty on children emotional and behavioral problems, which evidence the need for child mental health preventive care, and free quality assistance for both mothers and their children.