On executive functioning and childcare: The moderating role of parent-child interactions.

Childcare services are widely used by families and thereby exert an important influence on many young children. Yet, little research has examined whether childcare may impact the development of child executive functioning (EF), one of the pillars of cognitive development in early childhood. Furthermore, despite persisting hypotheses that childcare may be particularly beneficial for children who have less access to optimal developmental resources at home, research has yet to address the possibility that putative associations between childcare and EF may vary as a function of family factors. Among a sample of 180 mostly White middle-class families (91 girls), we examined if childcare participation in infancy was related to two aspects of EF (Delay and Conflict) at 3 years, and whether two aspects of maternal parenting behavior (sensitivity and autonomy support) moderated these associations. The results showed positive associations between participation in group-based childcare and Delay EF specifically among children of relatively less autonomy-supportive mothers. These findings suggest that out-of-home childcare services may play a protective role for children exposed to parenting that is less conducive to their executive development. RESEARCH HIGHLIGHTS: Little research has considered effects of childcare in infancy on executive functioning (EF). Long-standing hypothesis that childcare is more beneficial for children exposed to less sensitive and supportive parenting. We test interactions between maternal parenting and childcare participation in infancy in relation to EF at age 3 years. We find positive associations between participation in group-based childcare and Delay EF specifically among children of relatively less autonomy-supportive mothers.

Revisiting the childcare-attachment question: under what conditions is childcare participation associated with mother-child attachment security?

Decades have passed since the controversy regarding the putative risks of childcare for mother-child attachment broke out. Yet, some uncertainty remains, as relevant studies have produced inconsistent evidence. Some have proposed that those conflicting findings may be due to the fact that the effects of childcare are conditioned on parenting. Accordingly, this study examined whether relations between childcare participation and mother-child attachment vary according to maternal sensitivity and autonomy support. In this sample of 236 mother-child dyads, there was no indication of main effects of childcare participation on attachment. There were, however, some interactive effects, such that the children who showed the least secure attachment behaviors were those who did not attend childcare and had either less sensitive or less autonomy-supportive mothers. The findings suggest that the effects of childcare on mother-child attachment are best understood in light of the parenting children receive at home.

Vaccine Hesitancy Counseling-an Educational Intervention to Teach a Critical Skill to Preclinical Medical Students.

INTRODUCTION: There has been a recent rise in public perception that vaccines are unsafe, fostering vaccine hesitancy (VH). Few interventions have focused on teaching medical students' communication skills for counseling vaccine-hesitant patients. METHODS: Our educational intervention, designed for medical students, involved a self-study module followed by an interactive session on VH. Students practiced counseling vaccine-hesitant standardized patients (SPs). Faculty and SPs assessed student counseling skills. Students completed pre- and post-intervention surveys to assess attitudes and preparedness to counsel VH patients. RESULTS: Students showed a better ability to talk to parents about Human Papillomavirus (HPV) vaccine concerns and Measles Mumps Rubella (MMR)/autism-related issues than to address patients' concerns related to the Varicella Zoster Virus (VZV) vaccine.Students' surveys pre- and post-intervention revealed significant improvement in their vaccination knowledge and comfort with counseling vaccine-hesitant patients. Student counseling skills as part of an Objective Structured Clinical Exam (OSCE) showed 73% of students asked about immunization and elicited SP concerns, but only 36% counseled appropriately. CONCLUSIONS: In the face of emerging VH, physicians play a critical role in advising and influencing vaccination decisions. Therefore, it is a core responsibility of medical educators to train medical students on recommending vaccinations and responding effectively to vaccine-hesitant parents and patients. Our multifaceted interactive session provided preclinical students with knowledge and skills to improve communication skills with VH patients and parents and the need for ongoing practice of these VH counseling skills.

Do obstructive sleep apnea syndrome patients underestimate their daytime symptoms before continuous positive airway pressure treatment?

BACKGROUND: Daytime somnolence is an important feature of the obstructive sleep apnea (OSA) hypopnea syndrome and is usually subjectively assessed using the Epworth Sleepiness Scale (ESS). OBJECTIVE: To compare the scores of the ESS and different domains of the Quebec Sleep Questionnaire (QSQ) assessed before and after the first months of continuous positive airway pressure (CPAP) treatment, as well as retrospectively without treatment. METHODS: The ESS score and domain scores of the QSQ were obtained before and after a three-month period of CPAP treatment using a retrospective assessment of the pretreatment scores in 76 untreated OSA patients. RESULTS: Fifty-two patients completed the study. The ESS and QSQ scores significantly improved following CPAP therapy. Retrospective evaluation of the ESS score was significantly worse than pre- and post-treatment values (mean [± SD] pretreatment score 11.0±4.8; retrospective pretreatment score 13.5±5.1). Such differences were not observed in any domain of the QSQ, including the domain assessing hypersomnolence. CONCLUSION: OSA patients underestimated their sleepiness according to the most widely used instrument to assess hypersomnolence. This finding may not be observed with other methods used to assess OSA-related symptoms such as quality of life questionnaires.