RESUMO
PURPOSE: Associations between prenatal earthquake exposure and children's mental health remain unclear. Moreover, there is a paucity of research using quasi-experimental statistical techniques to diminish potential selection bias. Thus, this study aimed to explore the impact of prenatal exposure to the Chilean earthquake of 2010 on children's behavioural and emotional problems between 1½ and 3 years old using propensity score matching. METHODS: Participants included 1549 families from the Encuesta Longitudinal de la Primera Infancia cohort in Chile. Maternal reports using the Child Behaviour Checklist (CBCL) were used to assess behavioural and emotional problems between 1½ and 3 years old. Information on prenatal earthquake exposure was collected via maternal report. The Kernel matching estimator was used to compare the average treatment effects of children who were exposed to the earthquake compared to those who were not. RESULTS: Five of the seven CBCL outcomes were statistically significant after matching and adjustment for multiple testing, suggesting greater difficulties for exposed children which included emotional reactivity, anxious/depressed, sleep problems, attention problems, and aggression (mean difference of 0.69, 0.87, 0.73, 0.85, 3.51, respectively). The magnitude of the effect was small to medium. CONCLUSION: Findings contribute to the potential causal inferences between prenatal earthquake exposure and increased behavioural and emotional problems in early childhood. Results suggest that in utero experiences may have long-term consequences for infants' well-being, supporting the need for specific interventions in pregnancy after natural disasters.
Assuntos
Transtornos do Comportamento Infantil , Terremotos , Lactente , Feminino , Gravidez , Criança , Humanos , Pré-Escolar , Chile , Ansiedade , Transtornos do Comportamento Infantil/psicologia , AgressãoRESUMO
BACKGROUND: Given the support for the numerous benefits of breastfeeding, a better understanding of social and health determinants is necessary, particularly in under-researched populations. We examined determinants of breastfeeding initiation and duration using a national cohort of Chilean mothers. METHODS: Participants included 13 738 families enrolled in the Encuesta Longitudinal de la Primera Infancia cohort. Data were collected in 2010 and 2012. Families from all regions of the country were considered. Breastfeeding information was collected via maternal report and standardised assessments were used to collect information on maternal IQ and personality. Logistic and linear regressions were used to identify predictors of breastfeeding initiation and duration. RESULTS: Breastfeeding was initiated by 95.2% of mothers. Variation in duration of breastfeeding was large, ranging from 1 to 48 months (M = 11.74; SD = 8.74). Maternal IQ, low-risk prenatal behaviours, conditions at birth and the presence of a partner were relevant predictors of both initiation and duration of breastfeeding, whereas personality and contextual/socioeconomic factors were relevant only for breastfeeding duration. Differences between regions were observed. Rates of caesarean deliveries are alarmingly high and triple that of the global WHO recommendations, at 45% of deliveries in Chile, which are implicated in both initiation and duration. CONCLUSIONS: Breastfeeding rates exceed Chilean target goals although vary by region. Global targets now need to be focused on. Social and health determinants are implicated in both initiation and duration of breastfeeding. These findings suggest important targets for policy development and breastfeeding initiatives in Chile, particularly concerning the reduction of surgical deliveries.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/estatística & dados numéricos , Determinantes Sociais da Saúde , Adulto , Alimentação com Mamadeira/estatística & dados numéricos , Chile , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Masculino , Transtornos Mentais/psicologia , Gravidez , População Rural , Fatores Socioeconômicos , Fatores de Tempo , População UrbanaRESUMO
IMPORTANCE: Potential effects of breast feeding on children's behaviour remains an elusive debate given inherent methodological challenges. Propensity score matching affords benefits by ensuring greater equivalence on observable social and health determinants, helping to reduce bias between groups. OBJECTIVES: We examined whether the duration of breast feeding had an impact on children's externalising and internalising behaviours. STUDY DESIGN: A cohort study (Encuesta Longitudinal de la Primera Infancia cohort) that included 3037 Chilean families who were enrolled in 2010. Follow-up data was collected in 2012. SETTING: General community. PARTICIPANTS: Population-based sample. Eligibility criteria: children born full-term with complete data on matching variables. Matching variables included: healthcare system as a proxy of income, presence of a partner/spouse in the household, maternal age, educational level, IQ, working status, type of work, diagnosis of prenatal depression by a healthcare professional, smoking during pregnancy, delivery type, child sex, weight at birth, incubation following delivery, and child age. EXPOSURE: Duration of breast feeding. MAIN OUTCOMES AND MEASURES: Externalising and internalising problems assessed using the Child Behaviour Checklist. RESULTS: Matched results revealed benefits of any breast feeding, up to 6 months, on emotional reactivity and somatic complaints (mean difference of -1.00, 95% CI, -1.84 to -0.16 and -1.02, 95% CI, -1.76 to -0.28, respectively). Children breast fed between 7 and 12 months also had reduced scores on emotional reactivity, in addition to attention problems (mean difference of -0.86, 95% CI, -1.66 to -0.06 and -0.50, 95% CI, -0.93 to -0.07, respectively). No benefits were observed for children breast fed 13 months or more. CONCLUSION: Reduced internalising difficulties and inattention were found in children breast fed up to a year, suggesting that breast feeding may have beneficial impacts on these areas of development. The magnitude of effect was modest. Extended durations of breast feeding did not appear to offer any benefits.