Maternal Distress and Adolescent Mental Health in Poor Chinese Single-Mother Families: Filial Responsibilities-Risks or Buffers?

Single motherhood and poverty have a significant, negative impact on mothers and their children. When their mothers experience maternal distress, adolescent children have to take up more instrumental and emotional filial responsibilities to comfort their mother and adapt to related changes. Based on 325 mother-child dyads of Chinese single-mother families experiencing economic disadvantage, this study examined the relationship between maternal distress and adolescent mental health problems (indexed by anxiety and depression) and the moderating roles of instrumental and emotional filial responsibilities. Results indicated that maternal distress was positively associated with anxiety and depression in adolescent children. In addition, instrumental filial responsibility intensified the associations of maternal distress with adolescent anxiety and depression. Moreover, the moderating role of emotional filial responsibility in the predictive relationship between maternal distress and adolescent anxiety was different in boys and girls. Adolescent girls with more emotional filial responsibility reported higher adolescent anxiety than did those who shouldered less emotional filial responsibility when their mother exhibited more distress, whereas the relationship between maternal distress and adolescent anxiety was stable in boys, regardless of emotional filial responsibility. In short, the present study showed that parentification was likely to occur in poor Chinese single-mother families, and adolescent children who took up a more caregiving role in the family exhibited poorer mental health. Family counselling and tangible support for single-mother families experiencing economic disadvantage are urged.

Poder, norma e ideário na lei da alienação parental / Power, norm and ideology in the law of parental alienation / Poder, norma e ideología en la ley de alienación parental

A recomendação ética do psicólogo para intervir criticamente sobre a demanda vai de encontro com a tarefa de diagnosticar atos de Alienação Parental e, num sentido amplo, com a judicialização das relações privadas. A genealogia de Foucault consiste num método capaz de lançar luz sobre as práticas de poder na base dos discursos relacionados ao tema da alienação parental. O eufemismo pedagógico empregado para designar as sanções da lei tem como finalidade estratégica o convencimento a respeito de supostos benefícios da tutela sobre as famílias, ao mesmo tempo em que lhes são atribuídas alguma patologia disfuncional. Numa perspectiva crítica, a assimetria de gêneros corresponde às relações de poder presentes no problema da alienação parental. Por fim, a inversão dos critérios de identificação da alienação parental revela o distanciamento entre o ideal normativo e a realidade da ruptura conjugal e familiar, apontando para a importância de práticas de cuidado e assistência em vez de judicativas e punitivas.(AU)

The psychologist's ethical recommendation to critically intervene on the demand goes against the task of diagnosing acts of Parental Alienation (AP) and, in a broad sense, with the judicialization of private relations. Foucault's genealogy consists of a method able to shed on the power practices on the basis of discourses related to the theme of Parental Alienation. The pedagogical euphemism used to designate the sanctions of the law has the strategic purpose of convincing about the supposed benefits of guardianship over families, while attributing some dysfunctional pathology to them. From a critical perspective, gender asymmetry corresponds to the power relations present in the Parental Alienation problem. Finally, the inversion of the Parental Alienation's identification criteria reveals the gap between the normative ideal and the reality of marital and family disruption, pointing to the importance of care and assistance practices instead of judicative and punitive ones.(AU)

La recomendación ética del psicólogo de intervenir críticamente sobre la demanda va en contra de la tarea de diagnosticar actos de Alienación Parental (AP) y, en un sentido amplio, con la judicialización de las relaciones privadas. La genealogía de Foucault consiste en un método capaz de arrojar luz sobre las prácticas del poder a partir de discursos relacionados con el tema de la Alienación Parental. El eufemismo pedagógico que se utiliza para designar las sanciones de la ley tiene el propósito estratégico de convencer sobre los supuestos beneficios de la tutela sobre las familias, atribuyéndoles alguna patología disfuncional. Desde una perspectiva crítica, la asimetría de género corresponde a las relaciones de poder presentes en el problema de la Alienación Parental. Finalmente, la inversión de los criterios de identificación de la Alienación Parental revela la brecha entre el ideal normativo y la realidad de la ruptura conyugal y familiar, señalando la importancia de las prácticas de cuidado y asistencia en lugar de las judicativas y punitivas.(AU)

Domestic violence against women in the brazilian media: study of social representations / Violencia doméstica contra las mujeres en los medios de comunicación brasileños: estudio de representaciones sociales / Violência doméstica contra as mulheres na mídia brasileira: estudo de representações sociais

This study examined the content published by the newspaper Folha de São Paulo regarding domestic violence before and after Law 11340/06, commonly known as Maria da Penha Law, came into force. A retrospective and comparative documentary research analyzed 3408 news reports published between 1994 and 2018. Divided into two corpora, '12 years before' and '12 years after' the Law, the material was analyzed using the IRaMuTeQ software and Descending Hierarchical Classification. The first corpus included news reports on cases involving celebrities and little about ordinary people. It also covered the feminist struggle to reduce domestic violence, focusing on specialized police stations and shelters. The second corpus included reports on the achievements generated by the Law and its challenges, pointing out the need to regard the law as more than a punitive instrument, addressing its preventive and care spheres. Problematizing how the media discloses such law is paramount, since the content divulged affects the construction of social representations.(AU)

Este artículo tuvo por objetivo identificar el contenido de la violencia doméstica transmitido en el periódico Folha de S. Paulo antes y después de la Ley 11.340/2006 (Ley Maria da Penha). La investigación fue de carácter documental retrospectivo y comparativa, realizada a partir de 3.408 noticias difundidas entre 1994 y 2018. El material se dividió en dos corpus: 12 años antes y 12 años después de la Ley, y se analizó con el software IRaMuTeQ. En el primer corpus, los medios informaron casos de celebridades y poco sobre la gente común. También abordaron la lucha feminista para reducir la violencia doméstica. Como no existe una legislación específica, la atención se centró en estaciones de policía especializadas y refugios. En el segundo corpus, se observaron los logros generados por la Ley y sus desafíos. Se identificó la necesidad de mirar la Ley desde un punto de vista no solo punitivo, sino también abordando las esferas preventivas y de asistencia. Se enfatiza la importancia de problematizar la difusión de la Ley en los medios, ya que los contenidos generalizados afectan la construcción de las representaciones sociales.(AU)

Este artigo pretende identificar o conteúdo sobre violência doméstica difundido no jornal Folha de S. Paulo antes e depois da Lei 11340/06 (Maria da Penha). A pesquisa foi documental, retrospectiva e comparativa; com 3408 reportagens entre 1994 e 2018. O material foi dividido em dois corpora: 12 anos antes e 12 anos depois da lei, e analisado com software IRaMuTeQ. No primeiro corpus, a mídia divulgava casos de celebridades e pouco acerca de pessoas do cotidiano. Também trouxe a luta feminista para diminuir a violência doméstica. Em virtude da então inexistência de uma legislação específica, os destaques eram as delegacias especializadas e as casas abrigo. No segundo corpus, observou-se as conquistas geradas pela lei e seus desafios. Identificou-se a necessidade de olhar para a lei por um viés não apenas punitivista, abordando as esferas preventivas e assistenciais. Destaca-se a importância de problematizar a difusão da lei na mídia, visto que os conteúdos perpassados afetam a construção de representações sociais.(AU)

Infancias y colecho en la Argentina: factores sociodemográficos, socioeconómicos y de salud familiar / Bedsharing and childhood: socio-demographic, socio-economic and family health factors / Co-leito na infância: fatores sócio-demográficos, socioeconômicos e de saúde familiar

Resumen (analítico) Se caracteriza el fenómeno del colecho en términos sociodemográficos, socioeconómicos y en relación con las vulnerabilidades específicas de los hogares, tales como la violencia intrafamiliar y los consumos nocivos. A través de la Encuesta de la Deuda Social Argentina y un análisis multivariado cuantitativo, se abordan los siguientes interrogantes: ¿el colecho es una práctica asociada únicamente a los bebés?, ¿resulta más frecuente en contextos de pobreza o se trata de una práctica que atraviesa a diferentes infancias? Se concluye que el colecho no es un fenómeno exclusivo de los y las bebés; que en la adolescencia es más regresivo para las mujeres y que el factor socio-económico remite a un «colecho forzoso¼ que se especifica en interacción con el hacinamiento, la monoparentalidad, los consumos nocivos y la violencia intrafamiliar.

Abstract (analytical) This paper analyses the phenomenon of bed-sharing in terms of sociodemographic and socioeconomic variables, but also considers specific vulnerabilities like domestic violence and addictions. It is worth examining whether this practice is associated only with babies, or else if vulnerable contexts also have an impact on children's and adolescent's co-sleeping. The information was obtained through Social Debts in Argentina Survey, and this quantitative research concludes that in this country not only early years bed-share, the phenomenon impairs teenage girls more often and that the socio-economic factor plays a decisive role. For this reason, we propose the term "forced-bed-sharing", which refers to when co-sleeping is intensified by variables like overcrowding, single-parent family type, addictions and domestic violence.

Resumo (analítico) O artigo caracteriza o fenómeno do coleito considerando variáveis sócio demográficas e socioeconómicas, mas também vulnerabilidades específicas como a violência doméstica ou vícios. Neste contexto, perguntamo-nos: associa-se só aos bebés? Tem mais frequência em condições de vulnerabilidade? Esta prática tem um impacto ou motivações diferentes em relação ás características das crianças? A informação foi obtida através do Questionário da Dívida Social Argentina, e o desenho de pesquisa quantitativo conclui que não é somente um fenómeno exclusivo da primeira infância, na adolescência é mais frequente em meninas e que o fator socioeconómico é decisivo. Por isso, propomos o termo "coleito forçoso", que refere a quando a regularidade da cama compartilhada se intensifica por variáveis como a superlotação, o tipo de família monoparental, vícios e violência doméstica.

Getting Better or Getting Worse? A Population-Based Study on Trends in Self-Rated Health among Single Mothers in Germany between 1994 and 2018.

BACKGROUND: While numerous studies suggest that single motherhood is associated with socioeconomic disadvantages and poor health, few studies have analyzed how these conditions have evolved over time. Addressing this gap, we examined the temporal development of self-rated health (SRH) among single compared to partnered mothers, and the role of socioeconomic factors that may have influenced this trend. METHODS: We used representative longitudinal data from the German Socioeconomic Panel Survey (G-SOEP) between 1994 and 2018, consisting of 83,843 women with children, aged 30-49 years (13,664 single and 70,179 partnered mothers). Time trends in SRH and socioeconomic factors were analyzed by means of logistic regression analyses. We applied the Karlson-Holm-Breen (KHB) method for decomposing the total time effect into direct and indirect parts via socioeconomic mediators. RESULTS: The predicted probabilities of good SRH decreased in single mothers from 57.0% to 48.4%, while they increased in partnered mothers from 54.8% to 61.3%. Similarly, predicted probabilities of poor SRH rose from 15.0% to 22.7% in single mothers while decreasing slightly from 12.0% to 11.4% in partnered mothers. Moreover, socioeconomic factors worsened over time for single mothers, while they mostly improved for partnered mothers. Decomposing the time trend revealed that the deterioration of single mothers' health was partly explained by the worsening of socioeconomic disadvantages, of which the decline in full-time employment, the rise in low incomes, and in unemployment contributed most. CONCLUSIONS: The alarming rise in socioeconomic and health disadvantages among single mothers in Germany shows that action is needed to counter this trend.

An application of the Biobehavioral Family Model: Examining the impact of maternal depression on child asthma mediated by insecure attachment and child depression.

OBJECTIVE: Child asthma disparities are prevalent in socio-economically stressed single-parent families. Stress impacts childhood asthma mediated by immune and autonomic pathways, but specific family stress pathways are not well established. This study tests the hypothesis, derived from a version of the Biobehavioral Family Model, that single parent maternal depression impacts child asthma mediated by insecure attachment and child depression. METHODS: In a cross-sectional study, children with asthma (age 7-17 years old) from a socio-economically disadvantaged population and their single parent mothers (N = 202) were assessed for depression and attachment security. Child asthma disease activity was assessed by symptom report and lung function tests. Structural equation modeling (SEM) was used to test a model in which caregiver depression impacts child asthma disease activity mediated by insecure attachment and child depression. RESULTS: SEM results indicated that maternal depression statistically predicted child depression (ß = 0.21, p < 0.01) and insecure mother-child attachment (ß = 0.17, p < 0.05). In addition, insecure attachment statistically predicted child depression (ß = 0.50, p < 0.001). Child depression mediated the adverse effects of maternal depression and insecure attachment on child asthma disease activity (ß = 0.43, p < 0.01). There was no direct effect of insecure attachment on child asthma. CONCLUSION: In single-parent families, maternal depression may impact child asthma disease activity, mediated serially by insecure attachment and child depression. Longitudinal and/or intervention studies are needed to establish a causal effect. These findings suggest that caregiver depression and parent-child relationships may be important targets for family intervention. These interventions may help improve child asthma outcomes and reduce health disparities.

Social Determinants Do Not Determine Me.

The following is the winning submission from the fifth annual Section on Pediatric Trainees Monthly Feature essay competition. For this year's competition, we asked trainees to reflect on and share how their unique identity, or identities, informs their advocacy work on behalf of children and families. We asked writers to consider how their personal histories and backgrounds, including sex, sexual orientation, race, ethnicity, religion, geographic area, and life experiences improve equity in pediatric health care. We were impressed by the broad variety of important topics addressed in the pieces submitted by trainees from around the country. The winning essay by Dr Haleigh Prather highlights her experiences as a Hispanic woman raised by a single, working-class mother; the obstacles that she faced in her life and how she surmounted them; and how her strength and resilience shaped her approach to health care delivery. In this piece, she underscores how the lessons learned by trainees from challenges in their own lives promote advocacy for the health and welfare of patients.

Decomposing the Decline of Cash Assistance in the United States, 1993 to 2016.

Cash assistance allocations from Temporary Assistance for Needy Families (TANF) and its predecessor program fell from $34.3 billion to $7.4 billion in real value from 1993 to 2016, a 78% decrease. Some investigations of TANF point to favorable labor market changes as the source of the decline, whereas others point to declining benefit levels and barriers to benefit receipt. This study introduces a framework to decompose the decline of TANF cash assistance into changes in need for cash assistance, the participation rate among those meeting income-based eligibility standards, and benefit levels among those receiving cash support. Using the U.S. Current Population Survey, I find that declining participation explains 52% of the decline in TANF cash assistance from 1993 onward, whereas declining need explains 21%, and declining benefit levels explain 27%. The study then applies reweighting techniques to measure the extent to which compositional changes in the population, such as rising employment rates among single mothers, can explain changes in need, participation, and benefit levels. The results suggest that compositional changes explain only 22% of the decline of TANF cash assistance, confirming that the majority of the decline is due to reduced participation and benefit levels rather than reduced demand for cash support. Adding the noncompositional share of the decline in TANF back to observed levels of cash spending in 2016 would result in nearly $20 billion in additional transfers, more than the minimum amount necessary to lift all single-mother households out of poverty.

Association of maternal depression, family composition and poverty with maternal care and physical health of children in the first year of life / Associação da depressão materna, composição da família e pobreza com os cuidados maternos e a saúde física de crianças no primeiro ano de vida

INTRODUCTION: The child's overall health depends on several factors, including the quality of the environment in which it lives and the care it receives. Child well-being early in life has an impact on its future and future generations' health. OBJECTIVE: Analyze the association of maternal depression, family composition, and socioeconomic conditions with the indicator of maternal care and physical health of children. METHODS: Retrospective cohort that analyzed data from 120 children during their first year of life. A Health and Maternal Care Indicator (ISCM) was created, aggregating information on growth, breastfeeding, vaccination, prophylaxis of iron deficiency anemia, illnesses, and accidents. The socioeconomic and health conditions were obtained through a structured interview. The Edinburgh Postnatal Depression Scale assessed maternal depression. Quasipoisson Regression examined the association between the ICSM and the predictors. The initial model considered p<0.25 in the univariate analysis and p<0.05 in the final model. RESULTS: The mothers were adults (83.3%), studied for an average of 10 years, and 36% had depressive symptoms. About 37% of the families were single-parent female, 59% were from Class C1-C2 of ABEP, and 12% received the "Bolsa Família" benefit. ISCM was 8% lower in children whose mothers were depressed (p = 0.04) or had no partner (p = 0.03), and was 14% higher in families receiving Bolsa Família (p = 0.02) in relation to their peers. CONCLUSION: Maternal depression and female single-parent family arrangements negatively impacted child health and care, while the conditional cash transfer program represented a protective factor.

INTRODUÇÃO: A saúde integral da criança depende de vários fatores, entre eles a qualidade do ambiente em que vive e dos cuidados que recebe. O bem-estar da criança no início da vida tem impacto na sua saúde futura e das próximas gerações. OBJETIVO: Analisar a associação da depressão materna, composição da família e condições socioeconômicas com o indicador de cuidados maternos e saúde física de crianças. MÉTODO: Coorte retrospectiva que analisou dados de 120 crianças no primeiro ano de vida. Foi criado um Indicador de Saúde e Cuidados Maternos (ISCM), agregando informações sobre crescimento, aleitamento materno, vacinação, profilaxia de anemia ferropriva, adoecimentos e acidentes. A condição socioeconômica e de saúde foram obtidas por entrevista estruturada. A depressão materna foi avaliada pela Edinburgh Postnatal Depression Scale. A associação entre o ICSM e os preditores foi examinada pela Regressão de Quasipoisson. O modelo inicial foi composto por variáveis com p<0,25 na análise univariada e p<0,05 no modelo final. RESULTADOS: As mães eram adultas (83,3%), estudaram, em média, por 10 anos e 36% delas apresentaram sintomas depressivos. Cerca de 37% das famílias eram do tipo monoparental feminino, 59% eram da Classe C1-C2 da ABEP e 12% recebiam o benefício "Bolsa Família". O ISCM foi 8% menor nas crianças cujas mães eram deprimidas (p=0,04) ou não tinham companheiro (p=0,03), e foi 14% maior nas famílias que recebiam o Bolsa família (p=0,02) em relação aos seus pares. CONCLUSÃO: A depressão materna e o arranjo familiar monoparental feminino impactaram negativamente a saúde e os cuidados com a criança, enquanto o programa de transferência condicionada de renda representou um fator de proteção.

Association of Long-Term Trajectories of Neighborhood Socioeconomic Status With Weight Change in Older Adults.

Importance: Studying long-term changes in neighborhood socioeconomic status (SES) may help to better understand the associations between neighborhood exposure and weight outcomes and provide evidence supporting neighborhood interventions. Little previous research has been done to examine associations between neighborhood SES and weight loss, a risk factor associated with poor health outcomes in the older population. Objective: To determine whether improvements in neighborhood SES are associated with reduced likelihoods of excessive weight gain and excessive weight loss and whether declines are associated with increased likelihoods of these weight outcomes. Design, Study, and Participants: This cohort study was conducted using data from the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health study (1995-2006). The analysis included a cohort of 126 179 adults (aged 50-71 years) whose neighborhoods at baseline (1995-1996) were the same as at follow-up (2004-2006). All analyses were performed from December 2018 through December 2020. Exposures: Living in a neighborhood that experienced 1 of 8 neighborhood SES trajectories defined based on a national neighborhood SES index created using data from the US Census and American Community Survey. The 8 trajectory groups, in which high, or H, indicated rankings at or above the sample median of a specific year and low, or L, indicated rankings below the median, were HHH (ie, high in 1990 to high in 2000 to high in 2010), or stable high; HLL, or early decline; HHL, or late decline; HLH, or transient decline; LLL, or stable low; LHH, or early improvement; LLH, or late improvement; and LHL, or transient improvement. Main Outcomes and Measures: Excessive weight gain and loss were defined as gaining or losing 10% or more of baseline weight. Results: Among 126 179 adults, 76 225 (60.4%) were men and the mean (SD) age was 62.1 (5.3) years. Improvements in neighborhood SES were associated with lower likelihoods of excessive weight gain and weight loss over follow-up, while declines in neighborhood SES were associated with higher likelihoods of excessive weight gain and weight loss. Compared with the stable low group, the risk was significantly reduced for excessive weight gain in the early improvement group (odds ratio [OR], 0.87; 95% CI, 0.79-0.95) and for excessive weight loss in the late improvement group (OR, 0.89; 95% CI, 0.80-1.00). Compared with the stable high group, the risk of excessive weight gain was significantly increased for the early decline group (OR, 1.19; 95% CI, 1.08-1.31) and late decline group (OR, 1.13; 95% CI, 1.04-1.24) and for excessive weight loss in the early decline group (OR, 1.15; 95% CI, 1.02-1.28). The increases in likelihood were greater when the improvement or decline in neighborhood SES occurred early in the study period (ie, 1990-2000) and was substantiated throughout the follow-up (ie, the early decline and early improvement groups). Overall, we found a linear association between changes in neighborhood SES and weight outcomes, in which every 5 percentile decline in neighborhood SES was associated with a 1.2% to 2.4% increase in the risk of excessive weight gain or loss (excessive weight gain: OR, 1.01; 95% CI, 1.00-1.02 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; excessive weight loss: OR, 1.02; 95% CI, 1.01-1.03 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; P for- trend < .0001). Conclusions and Relevance: These findings suggest that changing neighborhood environment was associated with changes in weight status in older adults.

Family Well-being in Grandparent- Versus Parent-Headed Households.

BACKGROUND AND OBJECTIVES: Little is known about the 2% of US children being raised by their grandparents. We sought to characterize and compare grandparent- and parent-headed households with respect to adverse childhood experiences (ACEs), child temperament, attention-deficit/hyperactivity disorder (ADHD), and caregiver aggravation and coping. METHODS: Using a combined data set of children ages 3 to 17 from the 2016, 2017, and 2018 National Survey of Children's Health, we applied survey regression procedures, adjusted for sociodemographic confounders, to compare grandparent- and parent-headed households on composite and single-item outcome measures of ACEs; ADHD; preschool inattention and restlessness; child temperament; and caregiver aggravation, coping, support, and interactions with children. RESULTS: Among 80 646 households (2407 grandparent-headed, 78 239 parent-headed), children in grandparent-headed households experienced more ACEs (ß = 1.22, 95% confidence interval [CI]: 1.07 to 1.38). Preschool-aged and school-aged children in grandparent-headed households were more likely to have ADHD (adjusted odds ratio = 4.29, 95% CI: 2.22 to 8.28; adjusted odds ratio = 1.72, 95% CI: 1.34 to 2.20). School-aged children in these households had poorer temperament (ßadj = .25, 95% CI: -0.63 to 1.14), and their caregivers experienced greater aggravation (ßadj = .29, 95% CI: 0.08 to 0.49). However, these differences were not detected after excluding children with ADHD from the sample. No differences were noted between grandparent- and parent-headed households for caregiver coping, emotional support, or interactions with children. CONCLUSIONS: Despite caring for children with greater developmental problems and poorer temperaments, grandparent caregivers seem to cope with parenting about as well as parents.

[Gender, food and nutrition security and vulnerability: the Thousand Women Program in focus]. / Gênero, segurança alimentar e nutricional e vulnerabilidade: o Programa das Mulheres Mil em foco.

Gender inequality is revealed in the issues of education, income and access to Food and Nutrition Security. In Brazil, the National Women Thousand Program aims to intensify the process of regional and institutional development by improving the access of women in situations of social vulnerability to education and the world of work. The objective is to analyze the contribution of the Programa Nacional Mulheres Mil's to reduce vulnerability to food insecurity of households headed by woman. A semi-structured questionnaire was applied to 384 participants, which contained the demographic and socioeconomic variables as well as the Brazilian Food Insecurity Scale. It was observed that, although there was no change in the Food Security situation, there were significant differences in relation to income, especially among women in situation of food insecurity, varying from 20.5% to 46% the number of participants with an income range higher than one minimum wage. The advance in the identified income was not enough to intervene in Food Insecurity. Further research should be carried out in order to deepen the understanding of the relationships between income, education and food and nutritional security, especially from the point of view of actions directed at the female gender.

A desigualdade de gênero se revela nas questões de educação, renda e acesso a Segurança Alimentar e Nutricional. No Brasil, o Programa Nacional Mulheres Mil tem como objetivo intensificar o processo de desenvolvimento regional e institucional, pela melhoria do acesso de mulheres em situação de vulnerabilidade social à educação e ao mundo do trabalho. O objetivo é analisar a contribuição do Programa para redução da vulnerabilidade à insegurança alimentar dos domicílios chefiado por mulheres. Aplicou-se um questionário semiestruturado para 384 participantes contendo as variáveis demográficas e socioeconômicas e a Escala Brasileira de Insegurança Alimentar. Constataram-se diferenças significativas em relação à renda, especialmente, entre aquelas em situação de insegurança alimentar, variando o número de participantes da faixa de renda superior a um salário mínimo. O avanço na renda não foi suficiente para intervir na Insegurança Alimentar. Mais pesquisas devem ser realizadas com objetivo de aprofundar a compreensão das relações entre renda, educação e Segurança Alimentar e Nutricional, sobretudo sob a ótica das ações direcionadas ao gênero feminino.

Gênero, segurança alimentar e nutricional e vulnerabilidade: o Programa das Mulheres Mil em foco / Gender, food and nutrition security and vulnerability: the Thousand Women Program in focus

Resumo A desigualdade de gênero se revela nas questões de educação, renda e acesso a Segurança Alimentar e Nutricional. No Brasil, o Programa Nacional Mulheres Mil tem como objetivo intensificar o processo de desenvolvimento regional e institucional, pela melhoria do acesso de mulheres em situação de vulnerabilidade social à educação e ao mundo do trabalho. O objetivo é analisar a contribuição do Programa para redução da vulnerabilidade à insegurança alimentar dos domicílios chefiado por mulheres. Aplicou-se um questionário semiestruturado para 384 participantes contendo as variáveis demográficas e socioeconômicas e a Escala Brasileira de Insegurança Alimentar. Constataram-se diferenças significativas em relação à renda, especialmente, entre aquelas em situação de insegurança alimentar, variando o número de participantes da faixa de renda superior a um salário mínimo. O avanço na renda não foi suficiente para intervir na Insegurança Alimentar. Mais pesquisas devem ser realizadas com objetivo de aprofundar a compreensão das relações entre renda, educação e Segurança Alimentar e Nutricional, sobretudo sob a ótica das ações direcionadas ao gênero feminino.

Abstract Gender inequality is revealed in the issues of education, income and access to Food and Nutrition Security. In Brazil, the National Women Thousand Program aims to intensify the process of regional and institutional development by improving the access of women in situations of social vulnerability to education and the world of work. The objective is to analyze the contribution of the Programa Nacional Mulheres Mil's to reduce vulnerability to food insecurity of households headed by woman. A semi-structured questionnaire was applied to 384 participants, which contained the demographic and socioeconomic variables as well as the Brazilian Food Insecurity Scale. It was observed that, although there was no change in the Food Security situation, there were significant differences in relation to income, especially among women in situation of food insecurity, varying from 20.5% to 46% the number of participants with an income range higher than one minimum wage. The advance in the identified income was not enough to intervene in Food Insecurity. Further research should be carried out in order to deepen the understanding of the relationships between income, education and food and nutritional security, especially from the point of view of actions directed at the female gender.

Reliability of the American Community Survey Estimates of Risk-Adjusted Readmission Rankings for Hospitals Before and After Peer Group Stratification.

Importance: Since the transition to the American Community Survey, data uncertainty has complicated its use for policy making and research, despite the ongoing need to identify disparities in health care outcomes. The US Centers for Medicare & Medicaid Services' new, stratified payment adjustment method for its Hospital Readmissions Reduction Program may be able to reduce the reliance on data linkages to socioeconomic survey estimates. Objective: To determine whether there are differences in the reliability of socioeconomically risk-adjusted hospital readmission rates among hospitals that serve a disproportionate share of low-income populations after stratifying hospitals into peer group-based classification groups. Design, Setting, and Participants: This cross-sectional study uses data from the 2014 New York State Health Cost and Utilization Project State Inpatient Database for 96 278 hospital admissions for acute myocardial infarction, pneumonia, and congestive heart failure. The analysis included patients aged 18 years and older who were not transferred to another hospital, who were discharged alive, who did not leave the hospital against medical advice, and who were discharged before December 2014. Main Outcomes and Measures: The main outcomes were 30-day hospital readmissions after acute myocardial infarction, pneumonia, and congestive heart failure assessed using hierarchical logistic regression. Results: The mean (SD) age of the patients was 69.6 (16.0) years for the safety-net hospitals and 74.9 (14.7) years for the non-safety-net hospitals; 9382 (48.8%) and 7003 (48.5%) patients, respectively, were female. For safety net designations, 20% (3 of 15) of all evaluations concealed and distorted differences in risk, with factors such as poverty failing to identify similar risk of acute myocardial infarction readmission until unreliable estimates were excluded from the analysis (OR, 1.23 [95% CI, 1.00-1.52], P = .02; vs OR, 1.17 [95% CI, 0.94-1.46], P = .15). By comparison, 2 of the 60 models (3%) for the peer group-based classification altered the association between socioeconomic status and readmission risk, concealing similarities in congestive heart failure readmission when adjusted using high school completion rates (OR, 1.27 [95% CI 1.02-1.58], P = .04; vs OR, 1.23 [95% CI, 0.98-1.53], P = .06) and distorting similarities in pneumonia readmissions when accounting for the proportion of lone-parent families (OR, 1.27 [95% CI, 0.98-1.66], P = .07; vs OR, 1.35 [95% CI, 1.02-1.80], P = .04) between the lowest and highest socioeconomic status hospitals in quartile 1. Conclusions and Relevance: There was greater precision in socioeconomic adjusted readmission estimates when hospitals were stratified into the new payment adjustment criteria compared with safety net designations. A contributing factor for improved reliability of American Community Survey estimates under the new payment criteria was the merging of patients from low-income neighborhoods with greater homogeneity in survey estimates into groupings similar to those for higher-income patients, whose neighborhoods often exhibit greater estimate variability. Additional efforts are needed to explore the effect of measurement error on American Community Survey-adjusted readmissions using the new peer group-based classification methods.

Mental health among single mothers in Cyprus: a cross-sectional descriptive correlational study.

BACKGROUND: International literature reveals that single mothers experience increased levels of chronic stress, which is mainly due to economic hardship and reduced levels of social support. Eventually this leads to psychological distress. While most of the studies commonly identify that mental health disorders are common among single mothers compared to their married counterparts, the magnitude of the problem might be even larger since diagnosis-specific tools may mask important levels of distress of milder intensity. This study aims to assess the level of mental distress experienced by single mothers as measured by the GHQ-28, and how it is influenced by socioeconomic factors, as well as the level of perceived social support. METHODS: Between January and March 2012, Greek speaking single mothers who reside in Cyprus were recruited by either personal conduct through Single Mothers' Association (SMA), or by using snowball sampling technic. Mental distress was assessed with the General Health Questionnaire (GHQ-28) and perceived social support with the Social Provision Scale (SPS). All scales were completed anonymously and voluntarily by 316 single mothers. Univariable and multivariable associations with socio-demographic characteristics were investigated using chi-square tests and in multivariable backward stepwise logistic regression models respectively. Odds ratio of psychological distress across decreasing levels of social support were estimated in logistic regression models. . RESULTS: As many as 44.6% of the sample appeared to experience psychological distress (GHQ-28 total score ≥ 5). Strong associations with all health assessment tools were observed with variables relating to the lowest monthly family income, the presence of economic difficulties, the higher educational level, the age group 35-44 years and pre-existing illness. Social support as perceived by the mothers displayed a strong negative independent association with psychological distress, even after adjusting confounders. CONCLUSION: This study highlights that single mothers are very likely to experience poor psychological well-being. With a steady rise in the proportion of single-parent families headed by a mother, these findings highlight a significant issue that would adversely affect many women and consequently their children and the community. It also emphasizes the necessity for interventions and strategies at community level in order to support this vulnerable population group.

A risk calculator to predict adult attention-deficit/hyperactivity disorder: generation and external validation in three birth cohorts and one clinical sample.

AIM: Few personalised medicine investigations have been conducted for mental health. We aimed to generate and validate a risk tool that predicts adult attention-deficit/hyperactivity disorder (ADHD). METHODS: Using logistic regression models, we generated a risk tool in a representative population cohort (ALSPAC - UK, 5113 participants, followed from birth to age 17) using childhood clinical and sociodemographic data with internal validation. Predictors included sex, socioeconomic status, single-parent family, ADHD symptoms, comorbid disruptive disorders, childhood maltreatment, ADHD symptoms, depressive symptoms, mother's depression and intelligence quotient. The outcome was defined as a categorical diagnosis of ADHD in young adulthood without requiring age at onset criteria. We also tested Machine Learning approaches for developing the risk models: Random Forest, Stochastic Gradient Boosting and Artificial Neural Network. The risk tool was externally validated in the E-Risk cohort (UK, 2040 participants, birth to age 18), the 1993 Pelotas Birth Cohort (Brazil, 3911 participants, birth to age 18) and the MTA clinical sample (USA, 476 children with ADHD and 241 controls followed for 16 years from a minimum of 8 and a maximum of 26 years old). RESULTS: The overall prevalence of adult ADHD ranged from 8.1 to 12% in the population-based samples, and was 28.6% in the clinical sample. The internal performance of the model in the generating sample was good, with an area under the curve (AUC) for predicting adult ADHD of 0.82 (95% confidence interval (CI) 0.79-0.83). Calibration plots showed good agreement between predicted and observed event frequencies from 0 to 60% probability. In the UK birth cohort test sample, the AUC was 0.75 (95% CI 0.71-0.78). In the Brazilian birth cohort test sample, the AUC was significantly lower -0.57 (95% CI 0.54-0.60). In the clinical trial test sample, the AUC was 0.76 (95% CI 0.73-0.80). The risk model did not predict adult anxiety or major depressive disorder. Machine Learning approaches did not outperform logistic regression models. An open-source and free risk calculator was generated for clinical use and is available online at https://ufrgs.br/prodah/adhd-calculator/. CONCLUSIONS: The risk tool based on childhood characteristics specifically predicts adult ADHD in European and North-American population-based and clinical samples with comparable discrimination to commonly used clinical tools in internal medicine and higher than most previous attempts for mental and neurological disorders. However, its use in middle-income settings requires caution.

Father departure and children's mental health: How does timing matter?

Father's permanent departure from the household in childhood has the potential to affect child mental health. The event is non-random, and a major limitation in most previous studies is lack of adequate control for unobserved confounders. Using five waves of data spanning ages 3 to 14 from the Millennium Cohort Study, a UK-wide nationally representative longitudinal study, this paper uses fixed effect models to examine the effect of paternal absence on children's mental health (i.e. externalising and internalising problems) in a sample of 6245 children. Heterogeneity of effects are examined by gender and maternal education. A novel aspect is to examine how the timing of departure matters, and to assess whether there are developmental periods that are especially sensitive to paternal departure, and whether effects are temporary or enduring. We find that paternal departure has a negative effect on child mental health, particularly on internalising symptoms. Striking gender differences emerge in examining effects by timing and duration. There are no short-term effects of departure in early childhood, and only weak evidence of females showing an increase in internalising symptoms in the medium-term. Paternal departure in later childhood, on the other hand, is associated with an increase in internalising problems in both males and females, and increased externalising symptoms for males only. We do not find maternal education to be a protective factor.

Cultural factors influencing teenage pregnancy in Jamaica.

A literature review was undertaken to identify key factors associated with teenage pregnancy in Jamaica. Using the PEN-3 cultural model, we first categorised these factors to develop a theoretical taxonomy that can be used to help health intervention planners to understand and address the phenomenon. Next, we examined the validity of this initial taxonomy by comparing it with cultural factors identified in semi-structured focus group discussions with Jamaican teenage mothers. Cultural factors identified in the initial literature review - such as parental interaction and control, the intergenerational transmission of teenage pregnancy and experiences of sexual abuse - were largely confirmed and built upon. Results highlight promising opportunities for health communication among young women in Jamaica with a focus on self-efficacy, resilience and positive cultural factors.