Estudo longitudinal de famílias / Longitudinal study of families / Estudio longitudinal de familias

Introdução: O desenvolvimento da família é influenciado por diversos fatores de sua organização interna e de ordem ambiental, social, cultural, econômica e política. Em contexto de pobreza os riscos são maiores. Fatores de proteção, como boa organização familiar e rede social de apoio podem diminuir as consequências negativas da pobreza. São escassas as pesquisas longitudinais sobre vulnerabilidade e resiliência nas famílias. Objetivo: Este artigo descreve o desenvolvimento de três famílias ao longo de 15 anos, estudadas por meio de entrevistas em casa, parte de uma coorte populacional de um bairro de Porto Alegre (RS). Buscaram-se associações entre a qualidade das relações nessas famílias e sua saúde física e mental, especialmente a do filho, foco da pesquisa. Métodos: Selecionaram-se no arquivo da pesquisa as três primeiras famílias (do total de 148) das quais se tinham os resultados completos das cinco visitas realizadas aos quatro meses e aos dois, quatro, nove e 15 anos de um filho. Realizou-se análise qualitativa dos registros em busca de categorias para compreender a vida e as relações interpessoais nas famílias. O estudo foi realizado em conjunto por duas pesquisadoras, médicas especialistas em desenvolvimento humano. As categorias identificadas na análise e estudadas nas cinco etapas foram: configuração familiar, situação socioeconômica, situações traumáticas, saúde física, saúde relacional e mental, evolução cognitiva e escolar do filho. Resultados: As três famílias, todas de classe C, com filhos sem problemas de saúde física, tiveram evolução suficientemente boa, apesar de todas enfrentarem múltiplos problemas, inclusive separações e mortes precoces. A relação com o sistema de saúde e escola era boa e similar para as três. A jovem com menos problemas de saúde mental foi aquela que sofreu perdas mais importantes: morte dos pais. Tinha uma estrutura familiar multigeracional sólida desde a primeira infância, com relações interpessoais predominantemente colaborativas e amorosas. Conclusões: O artigo busca avançar na compreensão da resiliência nas famílias em situações de vulnerabilidade. Concluímos que essas três famílias, uma delas mais que as outras, foram suficientemente saudáveis na tarefa de educar seus filhos sem desenvolverem problemas mentais graves. Propomos que o bom desenvolvimento se associa com a adequação e amorosidade dos cuidados com a etapa do ciclo vital, mesmo enfrentando situações problemáticas. Essas qualidades precisam estar associadas à estabilidade socioeconômica básica e a bons serviços de saúde e escola.

Introduction: Family development is influenced by it's internal organization and environmental factors, socioeconomic, cultural and political. In poor contexts there are more risks to development. Protection factors like good family organization and social network may decrease the risks. Longitudinal research about vulnerability and resilience in families is scarse. Objective: This article describes the development of three families over 15 years through interviews at home. The families were part of a populational cohort of a neighborhood in Porto Alegre (RS). We looked for links between the quality of relationships and the physical and mental health of these families, especially of the child focus of the research. Methods: We selected in the research archives the first three families (of a total of 148) for which we had full results of the five interviews at four months and two, four, nine and fifteen years of a child. We did a qualitative analysis of the records looking for parameters to understand the life and interpersonal relationships of these families. This study was done by two researchers, both experts in Human Development. The categories identified in the analysis of the five phases were: family structure, socioeconomic situation, traumatic experiences, physical, mental and relational health and cognitive evolution of the child. Results: All three families belonged to economical class C. The children were in good physical health and had sufficiently good general development, having faced multiple problems, including parental separation and early parental death. The relationship with the health and school systems was good in all of them. The youth with less mental health problems was the one who suffered the heaviest loss: early death of both parents. Her family had strong multigenerational ties since her early days, with predominant collaborative and loving relationships. Conclusions: This article aims to contribute to the comprehension of resilience in families in the context of vulnerability. We can say that these three families were healthy enough in the task of bringing up children without any serious mental health problem. We suggest that healthy development is associated with loving interfamily relationships adequate to each phase of development, notwithstanding dramatic events. This needs to be supported by basic economic stability and adequate school and health systems.

Introducción: El desarrollo de la familia es influenciado por su organización interna y factores ambientales, sociales, culturales, económicos y políticos. En contextos pobres los riesgos son mayores. Factores de protección como buena organización familiar y red social de apoyo pueden disminuir las consecuencias negativas de la pobreza. Son pocas las investigaciones longitudinales de vulnerabilidad y resiliencia de las familias. Objetivo: Este artículo describe el estudio del desarrollo de tres familias a lo largo de 15 años, a través de entrevistas en domicilio, parte de una cohorte poblacional de un barrio de Porto Alegre (RS). Se buscaron correlaciones entre la calidad de las relaciones de esas familias y su salud física y mental, especialmente la del hijo foco de la investigación. Métodos: Fueron seleccionadas en el archivo de la investigación las tres primeras familias (de un total de 148) de las cuales se tenían los resultados completos de las cinco visitas realizadas, a los 4 meses, y a los 2, 4, 9, y 15 años de un hijo. Fue realizado un análisis cualitativo de los registros en busca de categorías para comprender la vida y las relaciones interpersonales en las familias. El estudio fue hecho en conjunto por dos investigadoras, médicas especialistas en desarrollo humano. Las categorías identificadas en el análisis y estudiadas en las cinco etapas fueron: configuración familiar, situación socioeconómica, situaciones traumáticas, salud física, salud relacional y mental, evolución cognitiva y escolar del hijo. Resultados: Las tres familias, todas de clase C, con hijos sin problemas de salud física, tuvieron evolución suficientemente buena, a pesar de que todas enfrentaron múltiples problemas, incluso separaciones y muertes precoces. La relación con el sistema de salud y escuela era buena y similar para las tres. La joven con menos problemas de salud mental fue aquella que sufrió las mayores pérdidas: muerte de los padres. Tenía una estructura familiar multigeneracional sólida desde la primera infancia, con relaciones interpersonales predominantemente colaborativas y amorosas. Conclusiones: El artículo pretende avanzar en la comprensión de la resiliencia en las familias en situaciones de vulnerabilidad. Concluimos que esas tres familias, una de ellas más que las otras, fueron suficientemente saludables en la tarea de educar a sus hijos sin que desarrollaran problemas mentales graves. Proponemos que el buen desarrollo se asocia con el amor y adecuación de los cuidados a la etapa del ciclo vital, aun enfrentando situaciones problemáticas. Esas calidades necesitan estar asociadas a la estabilidad socioeconómica básica y buenos servicios de salud y escuela.

Dynamic networks of complex posttraumatic stress disorder and depression among college students with childhood trauma: insights from cross-sectional and cross-lagged panel network analysis.

Background and Objective: There is a current research gap regarding the symptom structure and underlying causal relationships between complex posttraumatic stress disorder (CPTSD) and depressive symptoms. This longitudinal study used a cross-sectional network and cross-lag panel network (CLPN) to examine how CPTSD and depression symptoms interact over time in Chinese college students with childhood trauma.Methods: From 18,933 college students who took part in 2 surveys 12 months apart, 4006 participants (mean age: 20.07 ± 2.04) who reported childhood trauma were screened. Within this sample, there were 2354 (58.8%) males and 1652 (41.2%) females.Results: In the one-year interval CLPN model, it was found that depressive symptoms may precede other symptoms. Specifically, negative emotions and negative self-evaluations are more likely to predict subsequent symptoms. Conversely, in CPTSD, symptoms related to fear and anxiety, such as avoidance, intrusion, and hyperarousal, are more frequently activated by other symptoms, including negative emotionsConclusions: This finding offers a novel perspective on the interplay between CPTSD and depression, extending the existing theory. From a clinical standpoint, the points of intervention for comorbidity between depression and CPTSD who have experienced childhood trauma differ across different stages.

This study used network analysis to examine the evolving symptom structure of complex posttraumatic stress disorder (CPTSD) and depression, as well as the relationships between symptoms, in a large-scale longitudinal study among college students who have experienced childhood trauma.Symptoms such as emotional dysregulation and negative self-concept serve as stable central symptoms of both CPTSD and depression.Depression, tends to activate other symptoms, whereas CPTSD, is more frequently predicted by other symptoms.

Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland.

Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (ß = 0.16), embitterment (ß = 0.06), cognitive reappraisal (ß = -0.41), and the presence of meaning in life (ß = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.

KEY FINDINGS: Older adults with and without probable CPTSD differ in terms of age, employment status, adverse childhood experiences, psychiatric comorbidities, well-being, and life satisfaction.Temporal (in-)stability: In older adults, probable CPTSD appears to be unstable over a 21-month period with around one-third of the participants showing a stable course.Treatment targets: The identified significant predictors anger, embitterment, cognitive reappraisal, and the presence of meaning in life beliefs are potential treatment targets.

Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish simple.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks. OBJECTIVE: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years. MATERIAL AND METHOD: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). RESULTS: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference. CONCLUSIONS: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample.

ANTECEDENTES: El trastorno de déficit de atención e hiperactividad (TDAH) constituye una condición crónica con riesgos asociados a largo plazo. OBJETIVO: Analizar el estado clínico, la ocupación y las dificultades de la vida diaria de dos cohortes de niños con diagnóstico de TDAH (2004 y 2009) después cinco y 10 años. MATERIAL Y MÉTODO: Estudio descriptivo y longitudinal de la base de datos WOMI correspondiente a Oviedo, Asturias, España. Se incluyeron niños detectados con TDAH por su pediatra de atención primaria. Se solicitó una entrevista telefónica voluntaria de seguimiento. Las variables de resultado fueron estado clínico y ocupacional al momento de la entrevista, síntomas de TDAH según SNAP-IV y Cuestionario de Fortalezas y Dificultades (SDQ). RESULTADOS: La muestra entrevistada estuvo formada por 95 sujetos, de los cuales 71 respondieron a los cuestionarios SNAP-IV y SDQ; 60.7 % de la muestra no recibía tratamiento en el momento del seguimiento, 4.7 % no tenía ninguna ocupación, 25.4 % mantenía síntomas globales de TDAH en nivel superior al punto de corte clínico y 66.2 % presentaba dificultades con interferencia moderada. CONCLUSIONES: Los síntomas del TDAH disminuyen conforme las personas crecen. Las comorbilidades de salud mental y el abandono académico no se confirmaron en la muestra.

Trends in child and adolescent mental health in Catalonia in the context of the COVID-19 pandemic during the 2020-2021 school year.

INTRODUCTION: The SARS-CoV-2 pandemic has had a great impact on the physical and psychological health of the population. The aim of this study was to evaluate child and adolescent mental health in a population cohort along the 2020-2021 school year. METHODS: This was a prospective longitudinal study of a cohort of children from 5-14 years of age in Catalonia, Spain, performed from September 2020 to July 2021. The participants were randomly selected and accompanied by their primary care paediatrician. Evaluation of risk of psychopathology was performed using the Strengths and Difficulties Questionnaire (SDQ) carried out by one of the legal guardians of the child. We also collected sociodemographic and health variables of the participants and their nuclear family. Data were collected by an online survey through the RedCap platform at the beginning of the academic year and at the end of each trimester (4 cuts). RESULTS: At the beginning of the school year, 9.8% of the patients were probable cases of psychopathology compared to 6.2% at the end of the year. The perception of the level of preoccupation of the children for their health and that of their family was related to presenting psychopathology, especially at the beginning of the year, with the perception of a good family atmosphere being always related to lower risk. No variable related to COVID-19 was associated with an altered SDQ result. CONCLUSIONS: Along the 2020-2021 school year, the percentage of children with a probability of presenting psychopathology decreased from 9.8% to 6.2%.

Longitudinal changes in brain structure and their relationship with subclinical psychiatric symptoms in parents who lost their only child in China.

BACKGROUND: Losing an only child (Shidu) is a grievous traumatic event that may affect brain structure, even if it does not lead to psychiatric disorders. However, longitudinal changes in brain structure and their relationship to subclinical psychiatric symptoms (SPS) have not been well investigated in Shidu parents without any psychiatric disorders (SDNP). OBJECTIVES: This study aimed to investigate cross-sectional and longitudinal changes in cortical thickness and surface area in SDNP, and to explore their relationship with SPS. METHODS: A total of 50 SDNP and 40 matched healthy controls (HC) were enrolled. All participants underwent structural MRI scans and clinical assessment at baseline and at the 5-year follow-up. Differences in brain structural phenotypes (cortical thickness, surface area, and their annual rate of change) between the SDNP and HC groups were compared using FreeSurfer. Correlations between significant brain structural phenotypes and SPS in the SDNP group were evaluated using multiple linear regressions. RESULTS: The SDNP group showed a smaller surface area in the left inferior parietal cortex than the HC group at baseline and follow-up. The SDNP group showed slower rates of cortical thinning and surface area loss in several brain regions than the HC group from baseline to follow-up. Moreover, slower rates of cortical thinning in the left insula, superior frontal cortex, and superior temporal cortex were associated with greater reductions in avoidance, depression, and trauma re-experiencing symptoms scores over time in the SDNP group, respectively. CONCLUSIONS: Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms. The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

This study focused on longitudinal changes in cortical thickness and surface area and their relationship with subclinical psychiatric symptoms in Shidu parents without any psychiatric disorders.Shidu trauma-induced structural abnormalities in the inferior parietal cortex may persist over time and be independent of the severity of psychiatric symptoms.The expansion of prefrontal, temporal, and insular cortex implicated in emotional regulation may contribute to improvements in psychiatric symptoms in Shidu parents.

Evolución de menores diagnosticados con trastorno de déficit de atención e hiperactividad. Estudio de seguimiento en una muestra española / Evolution of children diagnosed with attention deficit/hyperactivity disorder. Follow-up study in a Spanish sample

Resumen Antecedentes: El trastorno de déficit de atención e hiperactividad (TDAH) constituye una condición crónica con riesgos asociados a largo plazo. Objetivo: Analizar el estado clínico, la ocupación y las dificultades de la vida diaria de dos cohortes de niños con diagnóstico de TDAH (2004 y 2009) después cinco y 10 años. Material y método: Estudio descriptivo y longitudinal de la base de datos WOMI correspondiente a Oviedo, Asturias, España. Se incluyeron niños detectados con TDAH por su pediatra de atención primaria. Se solicitó una entrevista telefónica voluntaria de seguimiento. Las variables de resultado fueron estado clínico y ocupacional al momento de la entrevista, síntomas de TDAH según SNAP-IV y Cuestionario de Fortalezas y Dificultades (SDQ). Resultados: La muestra entrevistada estuvo formada por 95 sujetos, de los cuales 71 respondieron a los cuestionarios SNAP-IV y SDQ; 60.7 % de la muestra no recibía tratamiento en el momento del seguimiento, 4.7 % no tenía ninguna ocupación, 25.4 % mantenía síntomas globales de TDAH en nivel superior al punto de corte clínico y 66.2 % presentaba dificultades con interferencia moderada. Conclusiones: Los síntomas del TDAH disminuyen conforme las personas crecen. Las comorbilidades de salud mental y el abandono académico no se confirmaron en la muestra.

Abstract Background: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks. Objective: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years. Material and method: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ). Results: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference. Conclusions: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample.

Neuropsychological rehabilitation for post-COVID-19 syndrome: results of a clinical programme and six-month follow up.

INTRODUCTION: Patients with post-COVID-19 syndrome may present cognitive and emotional symptomatology. This study aims to analyse the results of an outpatient neuropsychological intervention programme for post-COVID-19 syndrome. METHOD: In June 2020 Institut Guttmann started an outpatient post-COVID-19 neurorehabilitation programme, including respiratory therapy, physiotherapy, and neuropsychological rehabilitation. Before and after the programme, the cognitive-emotional state of all participants is assessed. Six months after treatment, a follow-up assessment is administered (which includes a collection of information on various aspects of daily life). RESULTS: The sample analysed consisted of 123 patients (mean age: 51 years, SD: 12.41). Seventy-four per cent (n = 91) had cognitive impairment and underwent cognitive treatment (experimental group); the remaining 26% (n = 32) constituted the control group. After the intervention, the experimental group improved in working memory, verbal memory (learning, recall and recognition), verbal fluency and anxious-depressive symptomatology. The control group showed changes in immediate memory, verbal memory (learning and recognition) and depressive symptomatology, although the effect size in the latter two was smaller than in the experimental group. Six months after treatment, 44.9% of the patients were unable to perform their pre-COVID-19 work activity, and 81.2% reported difficulties in their activities of daily living. CONCLUSIONS: Neuropsychological rehabilitation is an effective tool to treat the cognitive-emotional deficits present in post-COVID-19 syndrome. However, months after the end of treatment, not all patients recover their pre-COVID-19 functional level.

Estudio longitudinal de la ansiedad escolar en niños chilenos de educación primaria / Longitudinal Study Of School Anxiety In Chilean Children In Primary Education

Resumen Desde la teoría tridimensional, la ansiedad escolar se define como un conjunto de síntomas que se emiten desde tres sistemas de respuesta. El objetivo de este estudio fue evaluar las respuestas de ansiedad escolar en estudiantes chilenos de educación primaria para determinar los posibles cambios a nivel temporal. Para ello, se contó con 155 niños de tres cursos distintos, a quienes se les evaluó el nivel de ansiedad escolar durante tres años consecutivos. El instrumento utilizado fue el Inventario de Ansiedad escolar para la educación primaria (IAEB), que mide la respuesta de ansiedad de tipo cognitiva, psicofisiológica y motora. Se realizaron análisis de varianza de medidas repetidas para determinar la estabilidad temporal. Los resultados indican que la media no mostró diferencias estadísticamente significativas y se mantuvo la ansiedad escolar en estos niños en el periodo de tres años. Se apoyó la posibilidad de que se presente como un síntoma estable de los estudiantes, más que responder a eventos puntuales del entorno.

Abstract Since the three-dimensional theory, school anxiety is defined as a set of symptoms arising from three response systems. The objective of this study was to evaluate school anxiety responses in Chilean primary school students, during three consecutive years, to determine possible changes over time. To this end, 155 children from three different courses were included; they were evaluated for their level of school anxiety for three consecutive years. The instrument used for this was the School Anxiety Inventory for Primary Education (IAEB), which measures the cognitive, psychophysiological and motor anxiety responses. Analysis of variance of repeated measures was performed to determine temporal stability. The results indicated that the mean did not show statistically significant differences, maintaining school anxiety in these children over the three-year period, supporting the possibility that it appears as a stable symptom of the students, rather than responding to specific events in the environment.

Estabilidad diagnóstica de niños con trastorno del espectro autista en la adolescencia (TEA). Funcionamiento ejecutivo, socio-adaptativo y conductual / Diagnostic stability of children with autism spectrum disorder in adolescence (ASD). Executive, socio-adaptive and behavioral functioning

Resumen Las características de individuos con trastornos del espectro Autista (TEA) persistente (TEA-P) o con TEA remitente (TEA-R) en el tiempo son poco conocidas. Este estudio longitudinal se planteó con tres objetivos: 1) determinar la tasa de persistencia/recuperación en la adolescencia de niños con diagnós tico TEA; 2) comparar el funcionamiento ejecutivo (FE), manifestaciones socio-adaptativas y conductuales de adolescentes TEA-P y TEA-R; y 3) identificar el porcentaje de individuos de los grupos TEA-P y TEA-R con puntuaciones normalizadas en FE y manifestaciones socio-adaptativas y conductuales en la infancia (T1) y en la adolescencia (T2). La muestra en el Tiempo 1 estuvo integrada por 45 niños con TEA (edad 7 a 11 años) de los que 32 mantenían el diagnóstico del trastorno 5 años después. Los padres y profesores cumplimentaron cuestionarios de FE, teoría de la mente (ToM), manifestaciones socio-adaptativas y conductuales en T1 y en T2. El grupo con TEA-P presentó significativamente más problemas y peor evolución en FE, características socio-adaptativas y conductuales que el grupo TEA-R. Los hallazgos destacan la variabilidad de la trayectoria evolutiva del TEA y la necesidad de realizar un seguimiento psicoeducativo y médico frecuente en este trastorno del neurodesarrollo.

Abstract The characteristics of individuals with persis tent ASD (ASD-P) and remittent ASD (ASD-R) are little known. This longitudinal study had threeobjectives1) To determine the persistence and recovery in children with autism spectrum disorder diagnosis in adolescence: 2) To compare executive functioning (EF), socio-adaptive and behavioral manifestations of ASD-P and ASD-R adolescents; and 3) to identify the percentage of normalized individuals in ADS-P and ADS-R groups in EF, socio-adaptive and behavioral manifestation in childhood and adolescence. The sample at T1 was comprised of 45 children with ASD (aged 7-11), maintaining 32 ASD diagnosis five years later. Parents and teachers completed questionnaires on EF, theory of mind, socio-adaptive and behavior difficulties, at both time points. The ASD-P group presented significantly more problems than group ASD-Rand showed worst evolution in EF, socio-adaptive and behavioral domains. Our findings highlight the variability of developmental trajectories of children with ASD.

[Relationship between physical activity during leisure time and progression of ankle-brachial index]. / Relación entre la actividad física en el tiempo libre y la progresión del índice tobillo-brazo.

OBJECTIVE: To study the relationship between physical activity during leisure time and progression of ankle-brachial index (ABI) in the Spanish general population. METHOD: Prospective, multicentre cohort study with 1941 subjects over 49 years of age, free of peripheral arterial disease at the time of recruitment of the cohort, were studied. Physical activity during leisure time variable was obtained using the VREM questionnaire. Peripheral arterial disease was considered to be an ankle-brachial index (ABI) <0.9. A multivariate logistic regression analysis was performed to evaluate the independent association between physical activity during leisure time and ABI. RESULTS: The mean age was 63.4 years and 54.6% were women. In the multivariate analysis, there was a positive relationship between physical activity during leisure time and ABI in patients with an energy consumption of more than 5000 MET in 14 days (odds ratio: 0.37; 95% confidence interval: 0.18-0.80). These specific activities doing sports or dancing, going shopping on foot, and cleaning the house for more than an hour a day showed a protective effect. In the group of subjects who maintained the physical activity during leisure time during the time of the research, a protective effect was observed with overall physical activity (MET) and going shopping on foot. CONCLUSIONS: In our research, PALT was favorably associated with ABI, in a sample of the Spanish general population that is very active and has a low-cardiovascular risk.

Associações entre práticas de gestão de pessoas e comportamento de apoio à mudança organizacional: um estudo longitudinal / Associations between people management practices and behavior in support of organizational change: a longitudinal study / Asociaciones entre las prácticas de gestión de personas y el comportamiento de apoyo al cambio organizacional: un estudio longitudinal

Esta pesquisa descreveu as associações entre a percepção das práticas de Gestão de Pessoas, e o comportamento de apoio à mudança dos servidores lotados na Secretaria de Gestão de Pessoas de um órgão público brasileiro. O estudo apresenta o desenho longitudinal, com três ondas de coletas de dados, entre 2016 e 2019 e descreve as alterações estruturais nas Políticas e Práticas de Gestão de Pessoas. Os resultados apontaram que a percepção de Políticas e Práticas de Gestão de Pessoas pode explicar o comportamento de apoio às mudanças em períodos críticos. Esse estudo contribui tanto para a academia quanto para a prática profissional, visto que apresenta as primeiras evidências de resultados de ações feitas pela área de Gestão de Pessoas utilizando critérios alternativos, como aumento de apoio à mudança e o reconhecimento das políticas e práticas implementadas.

This research investigated associations between the perception of people management practices and change-supportive behavior of public servants at the People Management Secretariat of a Brazilian public agency. The study is longitudinal, with three waves of data collection between 2016 and 2019, and describes the structural changes in people management policies and practices. The results showed that the perception of people management policies and practices can explain the behavior that supports change in critical periods. This study contributes both to academia and to practice with the first evidence of the results of actions taken by the people management area using alternative criteria, such as increased support for change and the recognition of implemented policies and practices.

Esta investigación describió las asociaciones entre la percepción de las políticas y prácticas de Gestión de Personas y el comportamiento de apoyo al cambio de los servidores asignados a la Secretaría de Gestión de Personas de un organismo público brasileño. El estudio presenta un diseño longitudinal, con tres oleadas de recolección de datos, entre 2016 y 2019, y describe los cambios estructurales en las Políticas y Prácticas de Gestión de Personas. Los resultados mostraron que la percepción de las Políticas y Prácticas de Gestión de Personas puede explicar el comportamiento de apoyo a los cambios en períodos críticos. Este estudio contribuye tanto a la academia como a la práctica profesional, ya que presenta la primera evidencia de los resultados de las acciones realizadas por el área de Gestión de Personas utilizando criterios alternativos, como un mayor apoyo al cambio y el reconocimiento de las políticas y prácticas implementadas.

Engajamento de professores da educação básica: um estudo longitudinal / Teachers engagement of basic education: a longitudinal study / Engajamiento de professores de la educación báscia: um estúdio longitudinal

O engajamento no trabalho é um fenômeno processual de elevado prazer do trabalhador com o que produz nas organizações. E, nas últimas décadas, várias pesquisas estudaram seu impacto no trabalho. Este estudo objetivou analisar a flutuação do engajamento ao longo de três etapas, com os mesmos participantes, avaliando as pressões exercidas em momentos de avaliações externas. A amostra constituiu-se de 133 professores da educação básica pública de Goiás. Utilizou-se do método Painel data para estimar os níveis de engajamento, considerando o contexto de pesquisa e a constância de dados em séries temporais. Os resultados evidenciam que o ambiente influencia os níveis de engajamento dos docentes, considerando que estas alterações podem comprometer a saúde docente, pois o desequilíbrio entre os aspectos positivos e negativos colaboram na sua instabilidade emocional. Logo, o artigo discute o contexto e as exigências de trabalho e aprofunda a compreensão sobre o desgaste da energia laboral dos docentes, em cada momento avaliado, contribuindo para possíveis tomadas de decisões.

Engagement at work is a processual phenomenon of high worker pleasure with what it produces in organizations. And, in recente decades, several studies have studied its impact on work. In the last decades several studies have studied their impact on work and organizations. This study aimed to analyze the fluctuation of engagement over three stages, with the same participants, evaluating the pressures exerted in moments of external evaluations. The sample consisted of 133 teachers from the public basic education of Goias. The Panel method was used to estimate the levels of engagement, considering the research context and the constancy of data in time series. The results show that the environment influences the levels of work engagement, considering that these changes can compromise teacher health, as the imbalance between positive and negative aspects collaborate in their emotional instability. Therefore, the article discusses the context and the work requirements and deepens the understanding about the wear and tear of the teachers' labor energy, at each evaluated moment, contributing to possible decision making.

El compromiso en el trabajo es un fenómeno procesal de alto placer del trabajador con lo que produce em las organizaciones. Y, em las últimas décadas, vários estudios han estudiado su impacto em el trabajo. Este estudio tuvo como objetivo analizar la fluctuación del compromiso a lo largo de tres etapas, con los mismos participantes, evaluando las presiones ejercidas en momentos de evaluaciones externas. La muestra se constituyó de 133 profesores de la educación básica pública de Goiás. Se utilizó del método Cuadro para estimar los niveles de compromiso, considerando el contexto de investigación y la constancia de datos en series temporales. Los resultados muestran que el entorno influye en los niveles de compromiso de los docentes, considerando que estos cambios pueden comprometer la salud del docente, ya que el desequilibrio entre aspectos positivos y negativos colabora en su inestabilidad emocional. Por tanto, el artículo discute el contexto y los requisitos laborales y profundiza la comprensión sobre el desgaste de la energía laboral de los docentes, en cada momento evaluado, contribuyendo a la posible toma de decisiones.

Relative effects of breastfeeding intention and practice on maternal responsiveness.

Our objective was to examine the differential effects of antenatal breastfeeding intention (BI) and breastfeeding practice (BP) on maternal postnatal responsiveness. We conducted a secondary analysis of longitudinal data from a subsample of 962 mother-infant dyads from a U.K.-based birth cohort study the Avon Longitudinal Study of Parents and Children. Exposures were BI and BPs measured at 32 weeks of gestation and 18 months' postpartum. The outcome was maternal responsiveness assessed at 12 months' postpartum. We used logistic regression analyses unadjusted and adjusted for confounders. Intention to breastfeed was associated with increased odds of postnatal maternal responsiveness independent of BP, adjusted odds ratio (OR) = 2.34, 95% CI [1.42, 3.86]. There was no evidence that BP was an independent predictor of maternal responsiveness, OR = 0.93, 95% CI [0.55, 1.57]. Life-course epidemiology analyses demonstrated that maternal responsiveness is most positive when both BI and BP are present. This is the first population-based study to provide evidence that BI during pregnancy is more strongly associated with maternal postnatal responsiveness than is BP. Further research is needed to understand the determinants of BI in pregnancy and its relationships with maternal responsiveness.

Propósito: nuestro objetivo fue examinar los efectos diferenciales de la intención antenatal de amamantar y la práctica de amamantar sobre la sensibilidad materna posnatal. Métodos: llevamos a cabo un análisis secundario de información longitudinal de un subgrupo muestra de 962 díadas madre-infante que eran parte de un estudio británico de cohorte de nacimiento, el Estudio Longitudinal Avon de Padres y Niños. Los aspectos de exposición fueron la intención de amamantar y las prácticas de amamantar según fueron medidas a las 32 semanas de gestación y 18 meses posparto. El resultado fue la sensibilidad materna evaluada a los 12 meses posparto. Usamos análisis de regresión logística sin ajustar y ajustados para factores de confusión. Resultados: se asoció la intención de amamantar con mayores probabilidades de sensibilidad materna posparto independiente de la práctica de amamantar (ajustada proporción de probabilidades (OR) 2.34, 95% CI 1.42, 3.86). No hubo evidencia de que la práctica de amamantar fuera un independiente factor de predicción de la sensibilidad materna (OR 0.93, 95% CI 0.55, 1.57). Los análisis epidemiológicos de curso vital demostraron que la más positiva sensibilidad materna se da cuando ambas, la intención de amamantar y la práctica de amamantar, están presentes. Conclusiones: este es el primer estudio con base en la población que aporta evidencia de que la intención de amamantar durante el embarazo está más fuertemente asociada con la sensibilidad materna posparto que la práctica de amamantar. Mayor investigación es necesaria para comprender los factores determinantes de la intención de amamantar durante el embarazo y sus relaciones con la sensibilidad materna.

But Notre objectif était d'examiner les effets différentiels de l'intention d'allaitement au sein avant la naissance et la pratique d'allaitement au sein sur la réaction maternelle postnatale. Méthodes Nous avons procédé à une analyse secondaire de données longitudinales à partir d'un sous-échantillon de 962 dyades mère-nourrisson d'une étude de cohorte de naissance britannique, l'Etude Longitudinale de Parents et d'Enfants de l'Avon. Les risques étaient l'intention d'allaitement au sein et les pratiques d'allaitement mesurées à 32 mois de grossesse et à 18 mois après la naissance. Le résultat était la réaction maternelle évaluée à 12 mois postpartum. Nous avons utilisé des analyses de régression logistique non ajustées et ajustées pour les facteurs de confusion. Résultats L'intention d'allaiter au sein était liée à des chances accrues de réaction maternelle postnatale sans lien à la pratique d'allaitement (rapport de cote ajusté (RCaj) 2,34, 95% CI 1,42, 3,86). On n'a trouvé aucune preuve que la pratique d'allaitement était un facteur de prédiction indépendant de la réaction maternelle (RCaj 0,93, 95% CI 0,55, 1,57). Les analyses d'épidémiologie du parcours ont démontré que la réaction maternelle est plus positive lorsque l'intention d'allaitement et la pratique d'allaitement sont présentes. Conclusions Voici la première étude sur une population qui présente des preuves que l'intention d'allaitement durant la grossesse est plus fortement liée à la réaction postnatale maternelle que la pratique d'allaitement. Des recherches plus approfondies sont nécessaires afin de comprendre les déterminants de l'intention de l'allaitement durant la grossesse et sa relation à la réaction maternelle.

Aspectos clínicos y de laboratorio en pacientes con diagnóstico tardío de SIDA / Clinical and laboratory findings in patients with late diagnosis of AIDS

RESUMEN Introducción: El retraso diagnóstico de la infección por SIDA constituye un problema de gran magnitud con importantes repercusiones para los propios infectados y para la sociedad en general. Objetivos: Caracterizar a los pacientes con diagnóstico tardío de infección por VIH y su evolución a los 6 meses del diagnóstico. Material y Métodos: Se realizó un estudio longitudinal de corte prospectivo que incluyó 248 casos con diagnóstico positivo de infección por VIH durante su ingreso o en la consulta de infectología del Instituto de Medicina Tropical "Pedro Kourí" desde enero de 2015 hasta diciembre de 2016, los que se dividieron en dos grupos de comparación, según diagnóstico tardío (n=79) o no (n=169) de la enfermedad. Resultados: La edad avanzada y el sexo masculino fueron factores relacionados con el diagnóstico tardío de la infección por VIH. La fiebre (31,7%) y los síntomas respiratorios (20,3%) fueron las formas más frecuentes de presentación, mientras que la neumonía por Pneumocystis jirovecii fue la enfermedad con más incidencia en el momento del diagnóstico. La mitad de los pacientes se encontraban con inmunodepresión severa en el momento del diagnóstico. Los pacientes con diagnóstico tardío mostraron una supervivencia significativamente menor a los 6 meses del diagnóstico en comparación con los pacientes con diagnóstico precoz. La carga viral y el nivel de linfocitos CD4 fueron parámetros de laboratorio con un alto valor predictivo de mortalidad. Conclusiones: El diagnóstico tardío de infección por VIH conlleva un alto riesgo de mortalidad, mayor en aquellos con afectación de la carga viral y el nivel de linfocitos T CD4+.

ABSTRACT Introduction: Late diagnosis of HIV is a major problem with important consequences for the people infected with this virus and the society in general. Objectives: To characterize patients with late diagnosis of HIV infection and their evolution six months after diagnosis. Material and Methods: We conducted a prospective longitudinal study which included 248 cases with positive diagnosis of HIV infection during admission at the Pedro Kourí Tropical Medicine Institute between January 2015 and December 2016. They were divided into two comparison groups which included patients with late diagnosis (n=79) and those with no late diagnosis (n=169) of the disease. Results: Advanced age and male sex were factors related to the late diagnosis of HIV infection. Fever (31.7%) and respiratory symptoms (20.3%) were the most frequent forms of presentation, whereas Pneumocystis jirovecii pneumonia was the disease with the highest incidence at the time of diagnosis. Half of the patients were found to have severe immunosuppression at the time of diagnosis. Patients with late diagnosis showed a significantly diminished survival six months after being diagnosed compared with those patients with early diagnosis. Viral load and CD4+ T count were laboratory parameters with a high predictive value of mortality. Conclusions: Late diagnosis of HIV leads to a high risk of mortality, which is higher in those with affectation of the viral load and low CD4+ T cell count.

Observing home-visiting quality across time: A longitudinal reliability study of the Home Visit Rating Scales.

Empirical examination of home-visiting quality over time is lacking in the research literature. To this end, this study examined the most recent edition of a widely used observational measure of home-visiting quality, the Home Visit Rating Scales (HOVRS), over four repeated assessments spanning an average of 6 months. Psychometric quality for the HOVRS Total and Home Visitor Practice Scales, including item ratings and calculated scores, across time was demonstrated. Stability indicators for the Family Engagement Scales varied, with superior reliability often indicated for individual ratings over the calculated score. The exploration of interrelationships among family demographics and change in HOVRS scores over time were largely insignificant. Interestingly, a decline in the Home Visitor Practice Scale significantly related to increased symptoms of maternal depression, possibly suggesting that home-visitors' focus shifted from children's needs to those of parents when mental health concerns were observed. Although this study is an examination of one program model and poses limited generalizability, it sets the stage for advancing the HOVRS and longitudinal measurement of home-visiting quality.

A la examinación empírica de la calidad de la visita a casa a través tiempo le hace falta literatura investigativa. Con este fin, este estudio examinó la más reciente edición de una ampliamente utilizada medida de la calidad de visita a casa, las Escalas de Evaluación de Visitas a Casa (HOVRS; Roggman et al., 2012) con respecto a cuatro evaluaciones repetidas durante un período promedio de seis meses. Se demostró la calidad sicométrica a través del tiempo para la Totalidad de HOVRS y las Escalas de Prácticas de Visitadores a Casa, incluyendo puntuación de categorías y puntajes calculados. Los indicadores de estabilidad para las Escalas de Participación de la Familia variaron, con una confiabilidad superior a menudo señalada para puntajes individuales sobre el puntaje calculado. La exploración de las interrelaciones entre los datos demográficos de la familia y el cambio en los puntajes de HOVRS a través del tiempo fue por la mayor parte insignificante. A manera de interés, una baja en la Escala de Práctica del Visitador a Casa se relacionó significativamente con el aumento de síntomas de depresión materna, posiblemente sugiriendo que el enfoque de los visitadores a casa cambió de las necesidades del niño a aquellas de los progenitores cuando se observaron preocupaciones de salud mental. Aunque este estudio representa una examinación del modelo de un programa y presenta una generalización limitada, el mismo sienta las bases para llevar adelante a HOVRS y las medidas longitudinales de la calidad de las visitas a casa.

L'examen empirique de la qualité de la visite à domicile au fil du temps n'aparaît pas dans les recherches. Pour y remédier, cette étude a examiné l'édition la plus récente d'une mesure d'observation de la qualité de la visite à domicile largement utilisée, les Echelles d'Evaluation de la Visite à Domicile (en anglais Home Visit Rating Scales, soit HOVRS; Roggman et al., 2012) au moyen de quatre évaluations répétées étalées sur une moyenne de six mois. La qualité psychométrique des HOVRS totales a été démontrée, y compris les évaluations des éléments et les scores calculés. Les indicateurs de stabilité pour les Echelles d'Engagement de la Famille ont varié, avec une fiabilité supérieure souvent indiquée pour les évaluations individuelles par rapport au score calculé. L'exploration de l'interdépendance existant entre la démographie familiale et le changement dans les scores HOVRS au fil du temps se sont avérés très négligeables. Non sans intérêt, un déclin dans l'Echelle de la Pratique du Visiteur à Domicile s'est avéré fortement lié à des symptômes accrus de dépression maternelle, suggérant peut-être que l'attention des visiteurs à domicile s'est déplacée des besoins des enfants à ceux des parents lorsque des inquiétudes sur la santé mentale ont été observées. Bien que cette étude ait été un examen d'un modèle de programme et pose une généralisabilité limitée, elle prépare le terrain de l'amélioration des HOVRS et de la mesure longitudinale de la qualité de la visite à domicile.

Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. / Registro Español de Artritis Psoriásica de Reciente Comienzo (estudio REAPSER). Objetivos y metodología.

AIMS: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.

EARLY REGULATION IN CHILDREN WHO ARE LATER DIAGNOSED WITH AUTISM SPECTRUM DISORDER. A LONGITUDINAL STUDY WITHIN THE DANISH NATIONAL BIRTH COHORT.

Studies have shown that children later diagnosed with autism spectrum disorders (ASD) in their first years of life might show symptoms in main developmental areas and that these signs might be sensed by the parents. The present study investigated in a large birth cohort if children later diagnosed with ASD had deviations at 6 and 18 months in areas such as the ability to self-regulate emotions, feeding, and sleeping. The study was based on prospective information collected from 76,322 mothers who participated in the Danish National Birth Cohort. When the children reached an average age of 11 years, 973 children with ASD and a control group of 300 children with intellectual disability (IDnoASD) were identified via Danish health registries. Associations were found between short periods of breast-feeding and the children later diagnosed with ASD and IDnoASD as well as associations at 18 months to deviations in regulation of emotions and activity. The similarities in these associations emphasize how difficult it is to distinguish between diagnoses early in life.

Intimidade impedida e estabelecida: acompanhando uma menina desde a primeira infância até a psicoterapia infantil / Intimacy thwarted and established: Following a girl from infancy to child psychotherapy / Intimidad impedida y establecida: siguiendo a una niña desde el inicio de la vida hasta la psicoterapia infantil / L'intimité entravé et établie: la suivie d'une petite fille depuis la première enfance jusqu'à la psychothérapie infantile

O artigo é baseado em um único estudo de caso de uma mãe e sua filha, dos 5 meses aos 7 anos e meio desta. Elas participaram de um ensaio clínico aleatório durante o tratamento psicanalítico mãe-criança, o que incluiu um estudo de acompanhamento após 4 anos e meio. A menina fazia, então, psicoterapia infantil dos 6 aos 7 anos e meio. A mistura de contextos levou em conta entrevistas de pesquisa, gravações em vídeo das interações da dupla, outras avaliações, e anotações das sessões terapêuticas. Isto permitiu aos autores estabelecerem ligações conceituais entre as observações feitas por eles durante o início da infância da criança e o tratamento de uma neurose durante o período de latência, marcada por ansiedade, compulsões e prepotência. Eles argumentam que características de rispidez e imediatismo no relacionamento mãe-criança impediram o desenvolvimento da intimidade da menina. Com o propósito de compreender como tais aspectos do relacionamento se internalizaram na criança, os autores combinam várias fontes de dados das duas. O valor heurístico de cada é logicamente limitado e, deste modo, os autores defendem que são necessários tanto o entendimento psicanalítico quanto a pesquisa empírica para chegar-se a um entendimento mais profundo das relações entre influência externa e desenvolvimento interno.

The paper is based on a single case study of a mother and her daughter, from 5 months to 7½ years. They participated in an rct on mother-infant psychoanalytic treatment, including a follow-up study at 4½ years. The girl was then in child psychotherapy from 6 to 7½ years. The mix of settings allowed for research interviews, video-recordings of the dyad's interactions, other assessments, and notes from therapeutic sessions. This enabled the authors to forge conceptual links between the observations they made during infancy and the treatment of a neurosis during latency, marked by anxiety, compulsions, and bossiness. They argue that the mother-infant relationship's brusque and speedy qualities thwarted the girl's development of intimacy. To understand how such components of the relationship became internalised in her, the authors combine their various data sources. The heuristic value of each are necessarily limited and therefore, the authors argue, both psychoanalytic understanding and empirical research are needed to gain a deeper understanding of the relations between external influence and internal development.

El artículo se basa en un único estudio de caso de una madre y su hija, desde los 5 meses hasta los 7 años y medio. Ellas participaron en un ensayo clínico aleatorio durante el tratamiento psicoanalítico madre-hija, lo que incluyó un estudio de seguimiento después de 4 años y medio. La niña recibió psicoterapia infantil desde los 6 hasta los 7 años y medio. La mezcla de los contextos tuvo en cuenta entrevistas de investigación, grabaciones en vídeo de las interacciones del dúo, otras evaluaciones, y notas de las sesiones terapéuticas. Esto permitió que los autores establecieran conexiones conceptuales entre las observaciones realizadas por ellos durante el inicio de la infancia de la niña y el tratamiento de una neurosis durante el período de latencia, marcada por ansiedad, compulsiones y prepotencia. Ellos argumentan que características de rispidez e inmediatismo en la relación madre-hija impidieron el desarrollo de la intimidad de la niña. Con el propósito de comprender como tales aspectos de la relación se internalizaron en la niña, los autores combinan varias fuentes de datos de ambas. El valor heurístico de cada uno es lógicamente limitado y, de esta forma, los autores defienden que son necesarias tanto la comprensión psicoanalítica como la investigación empírica para llegar a un conocimiento más profundo de las relaciones entre influencia externa y desarrollo interno.

Le document est basé sur une seule étude de cas d'une mère et sa fille, de 5 mois à 7 ans et demi. Elles ont participé à un ecr (essai randomisé contrôlé) sur le traitement psychanalytique mère-enfant, y compris une étude de suivi à 4 ans et demi. La jeune fille était alors en psychothérapie d'enfants de 6 à 7 ans et demi. Le mélange des paramètres des entretiens de recherche a permis les enregistrements vidéo des interactions des deux, d'autres évaluations et des notes provenant de séances thérapeutiques. Cela a donné aux auteurs la possibilité de forger des liens conceptuels entre les observations qu'ils ont faites pendant la petite enfance et le traitement d'une névrose au cours d'un état latent, marquée par l'anxiété, les compulsions et la tyrannie. Ils démontrent que la relation mère-enfant étant brusque et rapide compromettait le développement de l'intimité de la petite fille. Pour comprendre comment ces composantes de la relation se sont intériorisées, les auteurs combinent leurs différentes sources de données. La valeur heuristique de chacune est nécessairement limitée et les auteurs considèrent donc que la compréhension psychanalytique aussi bien que la recherche empirique sont nécessaires pour mieux comprendre les relations entre l'influence extérieure et le développement interne.

La construcción del "mundo de ficción" y de la trama narrativa en situaciones de juego simbólico en el hogar

Con la participación de niños de sectores medios de Argentina, se presenta un estudio longitudinal acerca de la construcción del mundo ficcional y de la trama narrativa en situaciones de juego. Investigaciones previas evidenciaron las relaciones entre el juego y las habilidades narrativas. Son escasos los estudios que analizaron los recursos que contribuyen a elaborar el mundo ficcional del juego, así como las características de su trama narrativa. Se analizaron 60 situaciones de juego simbólico en las que participaron 12 niños y sus madres cuando los primeros tenían 2.6 y 3.6 años. Los participantes emplean diversos recursos para la construcción del mundo ficcional. Se observaron variaciones longitudinales respecto del uso de enunciados metalúdicos, el tipo de mundo ficcional y la complejidad de la trama narrativa del juego.

The paper presents a longitudinal analysis of the construction of the fictional world and the narrative discourse in play situations registered in the homes of middle-income children from Argentina. Previous research has shown the relations between play and narrative abilities. There are few studies focused on the characteristics of the interaction and the language that contribute to the narrative represented in the play. Sixty play situations were analyzed and registered in the homes of 12 children when they were 2.6 and 3.6 years old respectively. The participants used several resources for the construction of the fictional world of the play. Longitudinal variations were observed regarding the use of metaplay utterances, the types of fictional worlds constructed and the complexity of the narratives.