Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study

Objective: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). Methods: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. Results: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. Conclusions: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Objetivo: Nuestro objetivo es determinar la prevalencia de trastornos mentales en hermanos de casos con TDAH y cómo los factores de adversidad psicosocial se relacionan con esta psicopatología en un país de ingresos bajos-medios (Colombia). Métodos: Se evaluó a sujetos con TDAH diagnosticado según los criterios del DSM-5, uno de sus padres y uno de sus hermanos (edades, 8-19 anos). Mediante la escala de calificación del TDAH y un conjunto de otros instrumentos se evaluó la presencia de trastornos mentales y adversidad psicosocial. Resultados: Se evaluó a 74 tríos formados por el caso índice con TDAH, un hermano y uno de los padres. Se halló que un 24,3% de los hermanos participantes también cumplían los criterios de TDAH y otro 24,3%, otros trastornos psiquiátricos. El riesgo de que estos hermanos tuvieran TDAH aumentó aún más cuando uno de los padres informó antecedentes de TDAH. También, que el 28,3% de las familias se enfrentaron a altos niveles de adversidad psicosocial según sus puntuaciones en el Índice de Adversidad de Rutter. Conclusiones: Los hermanos de sujetos con TDAH mostraron un significativo riesgo de TDAH y otros trastornos mentales. Ese riesgo aumenta si uno de los padres reporta antecedentes de TDAH y también cuando se presentan 2 o más factores de adversidad psicosocial. Este estudio respalda la importancia de la detección temprana con el fin de disminuir el riesgo para otros hermanos.

Considerações fenomenológicas sobre a percepção de si da criança/adolescente convivendo com irmão com deficiência / Phenomenological considerations regarding the self-perception of children/adolescents living with siblings with disabilities

Resumo O objetivo deste artigo é compreender a percepção de si de crianças/adolescentes que convivem com o irmão com deficiência. Pesquisa qualitativa, com abordagem hermenêutico-fenomenológica e participação de 20 crianças e adolescentes que convivem com o irmão com deficiência em um município do estado do Rio Grande do Sul, Brasil. Utilizou-se entrevista fenomenológica, diário de campo e interpretação hermenêutica. Evidenciaram-se lacunas de cuidado, necessidade de atenção, compreensão por parte da família, visto a atenção ser ao irmão com deficiência. O medo e a angústia da morte dos avós, da morte do irmão com deficiência, a saudade dos avós após sua morte. Percebe-se que essas crianças/adolescentes convivem e questionam o nascimento e a existência do irmão. Desvelou-se, ao dar luz ao mundo vivido da criança/adolescente, lacunas e fragilidades na relação com os pais, na atenção à saúde e nas situações de vulnerabilidades vivenciadas pela criança/adolescente e a família. Dessa forma, é necessário atenção a essa população, considerando que convivem com irmãos com deficiência e apresentam diversas vulnerabilidades que precisam ser discutidas, visando elaborações de estratégias de cuidado inclusivas e eficientes.

Abstract The scope of this article was to understand the self-perception of children/adolescents who live with siblings with disabilities. It involved qualitative research, with a hermeneutic-phenomenological approach, with 20 children and adolescents who live with a disabled sibling from a municipality in the state of Rio Grande do Sul/Brazil. Phenomenological interviews, field diaries and hermeneutic interpretations were used. There were gaps in care, need for attention and understanding on the part of the family, due to the attention given to the disabled sibling. Also, the fear and anguish of the death of the grandparents, the death of the disabled sibling, the nostalgia of the grandparents after their death. It was shown that these children/adolescents live together and question the birth and existence of the sibling. By shining a light on the child/adolescent's life experience, gaps and weaknesses in the relationship with parents, in health care, in situations of vulnerabilities experienced by the child/adolescent and family were revealed. Thus, attention needs to be devoted to this population, considering that they live with siblings with disabilities, and have several vulnerabilities that need to be discussed, aiming at developing inclusive and efficient care strategies.

Experiences of siblings of children with chronic diseases revealed by the dramatic therapeutic play / Experiencias de hermanos de niños con enfermedades crónicas reveladas por eljuego terapéutico dramático / Vivências de irmãos de crianças com doenças crônicas reveladas pelo brinquedo terapêutico dramático

ABSTRACT Objective To understand, through dramatic therapeutic play, the experiences of siblings of children with chronic diseases. Method Phenomenological study, in the light of Heideggerian philosophical framework, conducted with 12 siblings of children with chronic diseases, aged between three and 11 years, accompanied in a public teaching hospital in the countryside of the state of São Paulo. The phenomenological interviews were audio-recorded and mediated by sessions of dramatic therapeutic play; later, interpreted from the Heideggerianphilosophical framework and thematic literature. Results The siblings demonstrated that they are affectively touched in the mode of sadness, longing and affection towards the sick child and, by the daily occupations imposed by the disease. Conclusion The dramatic therapeutic play enabled the siblings of children with chronic diseases to expose their experiences permeated by the limitations of the child's chronic disease. Instituting actions for the inclusion of the sibling during the nursing care of the child with chronic disease is urgent to improve its quality.

RESUMEN Objetivo Comprender, a través del juego dramático terapéutico, las experiencias de los hermanos de niños con enfermedades crónicas. Método Estudio fenomenológico, a la luz del referente filosófico heideggeriano, realizado con 12 hijos de niños con enfermedades crónicas, de edades comprendidas entre los tres y los 11 años, acompañados en el hospital público de enseñanza, en el interior del estado de São Paulo. Las entrevistas fenomenológicas fueron grabadas en audio y mediadas por sesiones de juego terapéutico dramático; luego, interpretada desde el marco filosófico heideggeriano y la literatura temática. Resultados Los hermanos demostraron que están tocados afectivamente en el modo de la tristeza, la añoranza y el afecto en relación con el niño enfermo y, por las ocupaciones diarias impuestas por la enfermedad. El brinco terapéutico dramático permitió que los hijos de los niños con enfermedades crónicas expusieran su vida a las limitaciones de la enfermedad crónica del niño. Conclusión Es urgente instituir medidas para la inclusión del hermano durante la asistencia de enfermera al niño con enfermedades crónicases urgente para mejorar su calidad.

RESUMO Objetivo Compreender por meio do brinquedo terapêutico dramático, vivências de irmãos de crianças com doenças crônicas. Método Estudo fenomenológico heideggeriano, realizado com 12 irmãos de crianças com doenças crônicas, com idades entre três e 11 anos, acompanhadas em hospital público de ensino, no interior do estado de São Paulo. As entrevistas fenomenológicas foram audiogravadas e mediadas por sessões de brinquedo terapêutico dramático; posteriormente, interpretadas a partir do referencial filosófico hedeggeriano e literatura temática. Resultados Os irmãos demonstraram que são tocados afetivamente no modo da tristeza, saudade e carinho em relação à criança doente e, pelas ocupações diárias impostas pela doença. Conclusão O brinquedo terapêutico dramático possibilitou que os irmãos de crianças com doenças crônicas expusessem suas vivências permeadas pelas limitações da doença crônica da criança. Instituir ações para a inclusão do irmão durante a assistência de enfermagem à criança com doença crônica faz-se urgente para melhoria da sua qualidade.

Do motivational cards really benefit sibling screening of primary open-angle glaucoma probands?

Purpose: To compare the impact of Sibling Motivational Card (SMC) and oral counseling in screening siblings of primary open?angle glaucoma (POAG) probands. Methods: Two hundred and thirty-four newly diagnosed POAG probands were randomized to receive either oral counseling or SMC to motivate their siblings for a glaucoma screening at a tertiary eye care hospital in South India from July 2015 and June 2017. A total of 116 probands were orally counseled with a standard template of dialogs about the importance of family screening to motivate their siblings for a screening. One hundred and eighteen probands were randomized to receive SMC, bearing the details of the proband, sibling, and a message stressing the importance of family screening, in addition to oral counseling. We assessed the response rate in each group. Additionally, we evaluated the prevalence of POAG in the siblings. Results: A total of 95 siblings of 234 POAG probands were screened. The mean age distribution was 53.33 ± 10.9 years (range 28–79 years). The male to female ratio was 3:4. The percentage of siblings screened was more in the oral counseling group (63.2%) than in the SMC group (36.8). About 43 (45%) siblings had some form of glaucoma, and 13.6% had POAG. An additional 22.1% were disk suspects, and 5.2% had ocular hypertension. Conclusion: SMC did not have an additional benefit over the standard oral counseling in promoting sibling screening. Our study stresses the importance of sibling screening in POAG probands. Targeting siblings of POAG probands with oral counseling may offer a relatively inexpensive way of detecting glaucoma

Phenotypic variations in ocular features among siblings with oculocutaneous albinism

Purpose: To assess the clinical profiles, presenting ocular features, and variations in the phenotypic features in siblings with oculocutaneous albinism (OCA). Methods: Electronic medical records of consecutive siblings diagnosed with albinism from January 2016 to December 2020 were reviewed to identify the affected siblings. The variations in their phenotypic characteristics were studied. Results: Significant variations were observed in the clinical features between the siblings (n = 42). A difference of >2 lines in visual acuity was observed in 50% (n = 21) of the sibling pairs. Compound hyperopic astigmatism was the commonest refractive error. The refractive status was different in 80.95% (n = 34) pairs. Although individually strabismus and abnormal head posture were observed in one?third and one?fourth of individual children, respectively, both siblings with similar strabismus were seen in only 16.67% (n = 7) and with a similar abnormal head posture in 13.33% (n = 5). Nystagmus was the most consistent finding across these siblings with a similar nature of horizontal jerk or pendular in 65% of sibling pairs. Conclusion: This study observed significant variations in phenotypic presentations among siblings with OCA. Such differences in clinical manifestations and severity would be helpful in appropriate counseling of these families as the need for rehabilitation services is likely to vary across siblings

A Case Study on Sibling Relational Problem: Its Clinical Significance in Managing A Dyslexic Adolescent with Mild Depressive Disorder (Kajian Kes Mengenai Masalah Perhubungan Adik Beradik: Kepentingan Klinikalnya dalam Pengurusan Remaja Disleksia yang Mengalami Kemurungan Ringan ) / Jurnal Sains Kesihatan Malaysia

@#The purpose of this case study was to see the impacts of managing sibling relational problem on mild depressive disorder. This approach was applied on a 15-year-old girl, who has dyslexia. She was found to have mild depression for one year that was precipitated by her poor relationship with her younger sibling. The intervention used in managing this case was adapted from the Siblings Are Special Module, a special programme that helps to alleviate anger and frustration that siblings had on each other. These 5 session interventions also included leisure activities that helped them to overcome their ongoing conflicts and were conducted over 3 months period. Parents were involved in the last 2 sessions in order to promote positive parenting. She showed a marked improvement in her psychological wellbeing and family relationship especially with her siblings at the end of the intervention. In conclusion, the intervention used to improve sibling relationship has shown to be effective in improving the mental health of the adolescents.^ien

"He is normal": phenomenological considerations of child/adolescent's perception of the disabled sibling / "Él es normal": consideraciones fenomenológicas de la percepción del niño/adolescente del hermano con discapacidad / "Ele é normal": considerações fenomenológicas da percepção da criança/adolescente do irmão com deficiência

ABSTRACT Objective: To understand the child/adolescent's perception of the disabled sibling. Method: Qualitative research, with a phenomenological approach, conducted between 2018 and 2019, in a municipality in the south of Brazil, with 20 children/adolescents who are siblings of people with disabilities, through a phenomenological interview. Respecting ethical precepts, hermeneutics was used for interpretation. Results: The child/adolescent perceives his/her disabled sibling as a normal person, given his/her behavior, way of being and intellectual capacity. Still, it understands him as a special being, who has limitations regarding learning, but does not see him as different, thus, unlinks the idea of disability associated with the disease/abnormality. Final considerations: The perception of the disabled sibling occurs within the perception of normality. The child identifies his sibling's lower learning capacitor a way that is unique to him, a fact that does not condition him to be seen as abnormal, defining his being-in-the-world as a special way of existing.

RESUMEN Objetivo: Comprender la percepción del niño/adolescente sobre el hermano con discapacidad. Método: Investigación cualitativa con enfoque fenomenológico, desarrollada, entre 2018 y 2019, en un municipio del sur de Brasil, con 20 niños/adolescentes hermanos de personas con discapacidad, a través de entrevista fenomenológica. Respetando los preceptos éticos. Para la interpretación se utilizó la hermenéutica. Resultados: El niño/adolescente percibe a su hermano discapacitado como una persona normal, dado su comportamiento, forma de ser y capacidad intelectual. Aun así, lo entiende como un ser especial, que tiene limitaciones en aprendizaje, pero no lo ve como diferente, desvinculando así la idea de discapacidad asociada a la enfermedad/anormalidad. Consideraciones finales: La percepción del hermano discapacitado se da dentro de la percepción de normalidad. El niño identifica la menor capacidad de aprender del hermano o una forma que le es propia, hecho que no lo condiciona a ser visto como anormal, definiendo su ser-en-el-mundo como una forma especial de existir.

RESUMO Objetivo: Compreender a percepção da criança/adolescente sobre o irmão com deficiência. Método: Pesquisa qualitativa com abordagem fenomenológica, desenvolvida entre 2018 e 2019,em um município ao sul do Brasil, com 20crianças/adolescentes irmãos de pessoas com deficiência, mediante entrevista fenomenológica.Respeitados os preceitos éticos, utilizou-se a hermenêutica para interpretação. Resultados: A criança/adolescente percebe seu irmão com deficiência como uma pessoa normal, diante de seu comportamento, modo de ser e capacidade intelectual. Ainda, o entende como um ser especial, que possui limitações em relação à aprendizagem, porém não o vê como diferente, desvinculando a ideia da deficiência associada à doença/anormalidade. Considerações finais: A percepção sobre o irmão com deficiência ocorre dentro da perceptiva de normalidade. A criança identifica a menor capacidade de aprendizagem do irmão ou um jeito que é só dele, fato que não o condiciona a ser visto como anormal, definindo seu ser-no-mundo como um modo especial de existir.

Visita à criança hospitalizada em terapia intensiva: vivências de irmãos reveladas por meio do brinquedo terapêutico dramático / Visita al niño hospitalizado en terapia intensiva: vivencias de hermanos revelado por el juego terapéutico dramático / Visiting a hospitalized child in intensive care: experiences of siblings revealed through the dramatic therapeutic play

Resumo Objetivo: compreender, por meio do brinquedo terapêutico dramático, o significado, para o irmão, de visitar a criança hospitalizada em terapia intensiva. Método: pesquisa qualitativa, modalidade fenomenológica, que utilizou o brinquedo terapêutico dramático para acessar às experiências dos irmãos. Foi realizada em Unidade de Terapia Intensiva Pediátrica do interior do estado de São Paulo, Brasil. Participaram das sessões de brinquedo terapêutico 11 irmãos menores de 10 anos, as quais foram analisadas à luz da Teoria do Amadurecimento. Resultados: os irmãos, tendo um lugar para brincar, dramatizaram situações, anteriormente, vividas, de seu cotidiano e da visita à criança hospitalizada. Ao viver, criativamente, revelaram que brincar é fazer a integração das experiências do "eu", favorecendo o continuar a ser diante da situação vivida. Conclusões e implicações para a prática: o Brinquedo Terapêutico Dramático compreendido à luz de um referencial teórico possibilitou que o irmão significasse a visita como uma experiência de integração do "eu", revelando emoções, desejos e preferências do cotidiano. Nesse sentido, o cuidado ao irmão da criança hospitalizada define-se pela oferta do brincar livre, para que ele demonstre o sentimento de continuar a ser em suas interações com o mundo, no qual o contexto hospitalar tornou parte da realidade.

Resumen Objeto: Comprender por medio del juego terapéutico dramático el significado, para el hermano, de la visita al niño hospitalizado en Terapia Intensiva Pediátrica. Método: Investigación cualitativa, modalidad fenomenológica, que utilizó el juego terapéutico dramático para comprender la experiencia del hermano. Se realizó en Unidad de Terapia Intensiva Pediátrica del interior del Estado de São Paulo, Brasil. Participaron de las sesiones de juego terapéutico 11 hermanos con menos de 10 años, quienes fueron analizados a la luz de la Teoría de la Maduración. Resultados: Los hermanos, al tener un lugar para jugar, dramatizaron situaciones anteriormente vividas, de su cotidiano y de la visita al niño hospitalizado. Al vivir de forma creativa, revelaron que jugar es permitir la integración de las experiencias del "yo", lo que favorece el concepto de seguir siendo, ante la situación vivida. Conclusiones e implicaciones para la práctica: El Juego Terapéutico Dramático comprendido a la luz de un referencial teórico hizo posible que el hermano entendiera la visita como una experiencia de integración del "yo", revelando emociones, deseos y preferencias cotidianas. En este sentido, el cuidado del hermano del niño hospitalizado se define por la oferta de juego libre, para que pueda demostrar su sentimiento de seguir siendo en sus interacciones con el mundo, en el que el contexto hospitalario se ha convertido en parte de la realidad.

Abstract Objective: to understand, by means of dramatic therapeutic play, the meaning, for the sibling, of visiting the child hospitalized in intensive care. Method: a qualitative research, phenomenological modality, which used the dramatic therapeutic play to access the siblings' experiences. It was carried out in a Pediatric Intensive Care Unit in the countryside of the State of São Paulo, Brazil. Eleven siblings under ten years of age participated in the therapeutic play sessions, which were analyzed in the light of the Theory of Maturation. Results: the siblings, having a place to play, dramatized previously lived situations, from their daily life and from the visit to the hospitalized child. By living creatively, they revealed that playing is to integrate the experiences of the "I", favoring the continuity of being in the face of the situation lived. Conclusions and implications for practice: the Dramatic Therapeutic Play understood in the light of a theoretical framework allowed the sibling to mean the visit as an experience of integration of the "I", revealing emotions, desires and preferences of daily life. In this sense, the care for the brother of the hospitalized child is defined by the offer of free play, so that he demonstrates the feeling of continuing to be in his interactions with the world, in which the hospital context has become part of reality.

Jovens com transtorno autista, suas mães e irmãos: vivências familiares e modelo bioecológico / Young people with autistic disorder, their mothers and siblings: family experiences and bioecological model

Resumo No modelo bioecológico, compreende-se o desenvolvimento a partir da interação entre o sujeito e os múltiplos contextos nos quais está inserido, considerando a dimensão temporal. Nessa direção, por meio de um estudo descritivo, objetivou-se analisar as concepções de jovens com transtorno autista, suas mães e seus irmãos acerca de suas vivências familiares. Para tanto, foram realizadas entrevistas com 12 mães, 17 irmãos e 2 jovens com autismo, sendo transcritas e analisadas a partir da técnica de análise de conteúdo. Os resultados evidenciaram que as atividades, a rede de apoio e as concepções descritas pelos participantes funcionam como fatores protetivos, mesmo diante de fatores de risco em seu desenvolvimento. O presente estudo suscita novas questões de pesquisa e elucida aspectos das vivências familiares importantes para delinear intervenções.

Abstract In the bioecological model, development is understood as the interaction between the subject and the multiple contexts in which it is inserted, taking into consideration the temporal dimension. In this direction, through a descriptive study, it was aimed to analyze the conceptions of young people with autism, their mothers and siblings about their family experiences. For that, interviews were conducted with 12 mothers, 17 siblings and 2 youngsters with autism, being transcribed and analyzed using the content analysis technique. The results have showed that the activities, support networks and conceptions described by the participants work as protective factors, even in the face of risk factors in their development. The present study raises new research questions and elucidates aspects of family experiences that are important to delineate interventions.

Perspectivas de adolescentes sobre a prática de cuidado dos irmãos: um estudo qualitativo / Perspectives of adolescents about their sibling caretaking: a qualitative study / Perspectivas de los adolescentes sobre la práctica de cuidado del hermano: un estudio cualitativo

Este estudo buscou investigar as perspectivas de adolescentes sobre a prática de cuidado dos irmãos. A amostra foi composta por seis adolescentes de ambos os sexos, com idades entre 11 e 19 anos. Os dados foram coletados por meio de entrevistas semiestruturadas e as informações foram submetidas à análise de conteúdo. Ressalta-se a importância das atividades desempenhadas pelos adolescentes no contexto familiar para o sustento financeiro da família. A percepção do cuidador sobre o cuidado dispensado aos irmãos abarcou aspectos positivos e negativos, sendo também considerada uma prática normal e rotineira. Dentre os pontos positivos, constatou-se transmitir algo de bom aos irmãos, os desafios e facilidades na realização de atividades de cuidado com os irmãos menores. A prática do cuidado pode contribuir para o sentimento de importância no contexto familiar, como também ser percebida como uma falha das mães no cumprimento de suas responsabilidades. As percepções negativas referiram-se à limitação dos tempos de lazer, à rotina estressante e à mediação de brigas entre os irmãos menores. Evidencia-se a importância de analisar o que essa prática representa para os adolescentes cuidadores, já que esta pode estar associada a sentimentos de desconforto, influenciar o bem-estar, bem como limitar a realização de atividades de lazer.(AU)

This study sought to investigate the perspectives of adolescents about their sibling caretaking. The sample consisted of six adolescents of both sexes, aged between 11 and 19 years old. The data were collected through semi-structured interviews and were submitted to content analysis. The importance of the activities performed by adolescents in the family context for the financial support of the family is emphasized. The caregiver's perception of the care given to siblings contained positive and negative aspects, and was also considered to be routine practice. Among the positives factors, it was found to transmit something good to the siblings, the challenges and facilities in carrying out care activities to younger siblings. The sibling caretaking practice can contribute to the feeling of importance in the family context, as well as being perceived as a failure of mothers in carrying out their responsibilities. Negative perceptions referred to the limitation of leisure time, the stressful routine and the mediation of fights between younger siblings. The importance of analyzing what this practice represents for young caregivers is evident, as it can be associated with uncomfortable feelings, influence well-being, as well as limit the performance of leisure activities.(AU)

Este estudio buscó investigar las perspectivas de los adolescentes sobre la práctica del cuidado de los hermanos. La muestra estuvo formada por seis adolescentes de ambos sexos, con edades comprendidas entre los 11 y los 19 años. La información se recopiló a través de entrevistas semiestructuradas y la información se sometió a análisis de contenido. Se enfatiza la importancia de las actividades que realizan los adolescentes en el contexto familiar para el apoyo financiero de la familia. La percepción del cuidador sobre el cuidado brindado a los hermanos contenía aspectos tanto positivos como negativos, y también se considera una práctica normal y rutinaria. Entre los puntos positivos, se encontró transmitir algo bueno a los hermanos, los desafíos y facilidades para realizar actividades de cuidado con los hermanos menores. La práctica del cuidado puede contribuir al sentimiento de importancia en el contexto familiar, además de ser percibida como un fracaso de las madres en el cumplimiento de sus responsabilidades. Las percepciones negativas se referían a la limitación del tiempo libre, la rutina estresante y la mediación de peleas entre hermanos menores. Es evidente la importancia de analizar lo que representa esta práctica para los cuidadores adolescentes, ya que puede asociarse a sentimientos de malestar, influir en el bienestar, así como limitar la realización de actividades de ocio.(AU)

Care among siblings and repercussions of generational transmission on the sibling group / Cuidado entre irmãos e repercussões da transmissão geracional na fratria / Cuidado entre hermanos y repercusiones de la transmisión generacional en la fratría

This research is part of a broader study concerning siblings and the family network. Its objective was to investigate care among siblings and the repercussions of generational transmission on the sibling group. It employed clinical-qualitative methodology, centered on preliminary clinical interviews with families during the family assessment period. Clinical data were gathered at the Applied Psychology Service of a private university in Rio de Janeiro. The 14 families who took part in the study had the following configurations: four married-couple families, four stepfamilies, three single-parent families and three separated-parent families. We observed that both reduced parental investment and excessive family-care workload made it difficult to establish a more health-promoting parent-child relationship, often leading to the parentification of one or more of the children, with the assignment of parental functions to them. Flaws in the psychic assimilation of elements of generational transmission also influence in the creation of sibling bonds, inhibiting the development of family ties of solidarity and the establishment of healthy care practices among siblings.

Este estudo faz parte de uma pesquisa mais ampla sobre fratrias e rede familiar. Teve-se como objetivo investigar o cuidado entre irmãos e repercussões da transmissão geracional na fratria. Utilizou-se metodologia clínico-qualitativa, centrada em entrevistas clínicas preliminares com famílias no período de avaliação familiar. Os dados clínicos foram coletados no Serviço de Psicologia Aplicada de uma universidade privada carioca. Participaram da pesquisa 14 famílias, com as seguintes configurações: quatro casadas, quatro recasadas, três monoparentais e três separadas. Constatou-se que tanto o reduzido investimento parental quanto a sobrecarga nos cuidados familiares dificultam o estabelecimento de uma relação parento-filial mais promotora de saúde, muitas vezes levando à parentalização de um ou mais filhos, com atribuição de funções parentais a eles. Falhas na apropriação psíquica de elementos da transmissão geracional também repercutem na constituição do vínculo fraterno, dificultando a construção de laços familiares solidários e o estabelecimento de práticas salutares de cuidado entre os irmãos.

Este estudio es parte de una investigación más amplia sobre fratrías y redes familiares. El objetivo fue investigar el cuidado entre hermanos y las repercusiones de la transmisión generacional en la fratría. Se utilizó metodología clínico-cualitativa, centrada en entrevistas clínicas preliminares a las familias durante el período de evaluación familiar. Los datos clínicos se recolectaron en el Servicio de Psicología Aplicada de una universidad privada en Rio de Janeiro. Catorce familias participaron en la investigación, con las siguientes configuraciones: cuatro casadas, cuatro vueltas a casar, tres monoparentales y tres separados. Se encontró que tanto la menor inversión de los padres como la sobrecarga por los cuidados con la familia dificultan el establecimiento de una relación entre padres e hijos que promueva la salud, lo que a menudo conduce a la crianza de uno o más hijos con atribución de las funciones parentales a ellos. Las fallas en la apropiación psíquica de elementos de transmisión generacional también inciden en la constitución de un vínculo fraterno, dificultando la construcción de lazos familiares solidarios y el establecimiento de prácticas de cuidado saludable entre los hermanos.

Does maternal tooth brushing-related sef-efficacy predict child's brushing adherence?

Background: Dental plaque is a root cause of dental caries. Effective plaque control in young children can be achieved with twice-daily assisted tooth brushing. Self-efficacy relates to one's confidence in performing a task. Self-efficacy is shown to facilitate the behavior change in treatments for lifestyle diseases. The influence of maternal self-efficacy in children's oral health behaviors is less studied. Aim: The aim of this study is to evaluate an association between maternal tooth brushing-related self-efficacy (MTBSE) and child's brushing adherence. Settings and Design: This cross-sectional study was conducted in schools and included 781 mother-child dyads with children between the age group of 2 and 6 years. Methods: Selected mothers were asked to complete the questionnaires on sociodemographic data, mother's oral health knowledge (MOHK), tooth-brushing practices, and MTBSE. Brushing adherence was evaluated as complete adherence if the child followed twice daily assisted brushing using the toothbrush and toothpaste. Statistical Analysis: Nonparametric tests were used to compare the variables. Binary logistic regression was used to evaluate the predictors of brushing adherence. Results: Complete brushing adherence (assisted brushing with toothbrush and toothpaste at least twice per day) was seen only in 26.9% children. More children with complete brushing adherence were single children (P < 0.001). Children with complete brushing adherence had mothers with significantly higher MTBSE (P < 0.001). The presence/absence of siblings, MOHK, and MTBSE were found to be strong and significant predictors of brushing adherence in children. Conclusions: MTBSE plays a significant role in complete adherence to toothbrushing in children aged 2–6 years.

Research progress of behaviors and brain imaging in siblings with autism spectrum disorders of prospective cohorts / 中华实用儿科临床杂志

Autism spectrum disorder (ASD) is a condition of severe neurodevelopmental disorders that develops in early childhood.Early identification and intervention are recognized as effective strategies for ASD.ASD siblings are the high-risk population of ASD.A cohort study of ASD siblings after birth and construction of a multi-center data sharing mechanism are effective ways to find behavioral and biological markers related to early diagnosis of ASD.This study reviews the early behavior and brain imaging findings of ASD siblings at home and abroad in prospective cohorts, thus exploring the potential value of brain imaging techniques in the early identification and diagnosis of ASD.

The being who being-in-the-world … becomes mother of a second child / El ser que siendo-en-el-mundo … Se convierte en madre de un segundo hijo / O ser que sendo-no-mundo … se torna mãe de um segundo filho

ABSTRACT Becoming mother of a second child, as a parental transition phenomenon, poses a challenge to reflection in Nursing. This theoretical study intends to present a reflection on the being who being-in-the-world becomes mother of a second child. It is based on Heideggerian phenomenology and nursing thought. The text is organized around two axes: Heidegger's conceptual contributions and nursing thought. The Heideggerian ontological dimension, aligned with the humanistic presuppositions of Nursing, contributes to unfold the meanings of life experiences and broaden possibilities of caring of the being who being-in-the-world… becomes mother of a second child. Concomitantly, the access to the experience of women who being-in-the-world become mother of a second child enables widening comprehension of this phenomenon, which will certainly impact nurses' being-present in their daily care.

RESUMEN Convertirse en madre de un segundo hijo, en tanto que fenómeno de transición a la parentalidad, se configura como un desafío a la reflexión de Enfermería. Este estudio teórico pretende presentar una reflexión sobre el ser que, siendo-en-el-mundo, se convierte en madre de un segundo hijo a la luz de la fenomenología heideggeriana y del pensamiento enfermero. El texto se organizó en torno a dos ejes: las contribuciones conceptuales de Heidegger y el pensamiento enfermero. Se identifica que la dimensión ontológica heideggeriana, junto con los presupuestos humanísticos de la Enfermería, contribuyen a desvelar los sentidos de lo vivido y a ampliar las posibilidades de cuidar al ser que, siendo-en-el-mundo… se convierte en madre de un segundo hijo. Concomitantemente, el acceso a la experiencia de la mujer que, siendo-en-el-mundo, se convierte en madre de un segundo hijo, permite abrir el horizonte de comprensión del fenómeno, lo que sin duda repercutirá en el modo de ser-presente de los enfermeros en sus cuidados diarios.

RESUMO Tornar-se mãe de um segundo filho, enquanto fenómeno de transição na parentalidade, configura-se como um desafio à reflexão em Enfermagem. Pretende-se neste estudo teórico apresentar uma reflexão sobre o ser que sendo-no-mundo se torna mãe de um segundo filho à luz da fenomenologia heideggeriana e do pensamento de enfermagem. O texto foi organizado em torno de dois eixos: os contributos conceptuais de Heidegger e o pensamento de enfermagem. Identifica-se que a dimensão ontológica heideggeriana, alinhada com os pressupostos humanísticos da Enfermagem, contribui para desvelar os sentidos do vivido e ampliar as possibilidades de cuidar do ser que sendo-no-mundo… se torna mãe de um segundo filho. Concomitantemente, o acesso à experiência da mulher que sendo-no-mundo se torna mãe de um segundo filho permite abrir o horizonte de compreensão face ao fenómeno, o que certamente terá impacto no modo de ser-presente do enfermeiro no quotidiano de cuidados.

Leucemia na infância e adolescência: repercussões psicossociais nos irmãos sadios, sob a ótica das mães / Leukemia in childhood and adolescence: psychosocial repercussion on healthy siblings, from a mother’s perspective / Leucemia en la niñez y adolescencia: repercusiones psicosociales en los hermanos sanos, por la óptica de las madres

O processo de adoecimento, tratamento e hospitalizações após o diagnóstico de câncer infantojuvenil pode causar impacto emocional, influenciar na dinâmica e rotina de toda a família. Diante desse cenário, a pesquisa objetivou compreender as possíveis mudanças nas relações dos irmãos sadios, no contexto familiar, social e escolar, sob a ótica das mães. A amostra foi composta por 15 mães de crianças e adolescentes diagnosticadas com leucemia, com ao menos um filho sadio. Os dados foram coletados por entrevista semiestruturada e, com base na teoria da análise de conteúdo proposta por Bardin (1977), foram encontradas quatro categorias: repercussões do adoecimento, relações familiares, relações sociais, vida acadêmica. Pôde-se observar que os irmãos saudáveis vivenciam, de modo singular, o adoecimento do irmão com leucemia. Apresentaram diversas formas de reagir e de se relacionar. Na maioria, isolaram-se, aproximaramse, revoltaram-se ou demonstraram fragilidade nas trocas interpessoais, deflagrando um pedido de ajuda e atenção.

TThe process of illness, treatment, and hospitalizations after the diagnosis of child-adolescent cancer may cause emotional impact, as well as influence the dynamics and routine of the entire family. Given this scenario, the research aimed to comprehend the possible changes in the relationships of healthy siblings, in the family, social, and school context, under the mother's perspective. The sample consisted of 15 mothers of children and adolescents diagnosed with leukemia, with at least one healthy child. The data were collected through a semi-structured interview and, based on the theory of Content Analysis, proposed by Bardin (1977), four categories were found: repercussions of illness, family relations, social relations, and academic life. It was possible to observe that the healthy siblings experience, in a singular way, the sibling’s illness with leukemia. They presented plenty of ways of reacting and relating with each other. Mostly, they isolated themselves, approached, revolted, or demonstrated fragility in interpersonal exchanges, triggering a call for help and attention.

El proceso de enfermedad, tratamiento y hospitalización después del diagnóstico de cáncer en la niñez y la adolescencia puede causar impacto emocional, influir en la dinámica y en la rutina de toda la familia. Ante este escenario, la investigación tuvo como objetivo comprender los posibles cambios en las relaciones de los hermanos sanos, en el contexto familiar, social y escolar, desde la óptica de las madres. La muestra fue compuesta por 15 madres de niños y adolescentes diagnosticados con leucemia, con por lo menos un hijo sano. Los datos fueron recolectados a través de una entrevista semiestructurada y, a partir de la teoría del Análisis de Contenido propuesta por Bardin (1977), se encontraron cuatro categorías: repercusiones de la enfermad, relaciones familiares, relaciones sociales y vida escolar. Se pudo observar, que los hermanos sanos experimentan de modo singular la enfermedad del hermano con leucemia. Los hermanos presentaron diversas formas de reaccionar y de relacionarse, en su mayoría, se aislaron, se acercaron, se rebelaron o demostraron fragilidad en los intercambios interpersonales, desencadenando un pedido de ayuda y atención.

How does mother's working status and number of siblings affect school age child trauma presenting to the emergency department

 Background: The aim of this study was to investigate the effects of mother working status and siblings on school-age child trauma admitted to the emergency department and to investigate school-age traumas.Methods: This prospective study was conducted with the approval of the ethics committee in the emergency department of a training and research hospital. All demographic data of the school-aged children (66 months-18 years) who applied to the emergency department, the location of the trauma, the mechanism of occurrence, the mother's working status, the presence and number of siblings, the duration of stay in the emergency department, clinical outcome and hospital service cost were recorded.Results: A total of 794 children were included in the study. 263(33.1%) were girls and 531(66.9%) were boys. Soft tissue trauma was the most common (94.3%). The place of the trauma was 62.7% out of school and 37.3% in school. When mother working conditions were analyzed, it was seen that 34.2% did not work. 97.1% of the children had one or more siblings. The most common trauma mechanism (65.6%) was collision and the second (60.6%) was falls. 99.1% of the patients were discharged. The length of stay in the emergency department of the Grade-schooler age group was higher than the Teen age group (p: 0,000). The length of stay in emergency department was higher in patients without siblings (p: 0.017). It was observed that those whose mothers did not work remained in the emergency room longer (p: 0,000). It was found that the ones whose mothers did not work mostly came with trauma mechanism as a result of falling (65.4%) (p: 0.044).Conclusions: Providing education for protection from accidents in schools and out of school to all people, especially children, parents and teachers, and making safe playgrounds with solid floors will minimize accident and injury rates and severity levels.

Severe aplastic anemia treated with unrelated cord blood combined with matched sibling allogeneic hematopoietic stem cell transplantation / 中国组织工程研究

BACKGROUND: Sibling matched allogeneic hematopoietic stem cell transplantation is still the first-line treatment for severe aplastic anemia. However, with the increase of patients’ age, the effect of transplantation decreases significantly. OBJECTIVE: To explore the efficacy and safety of unrelated cord blood combined with matched sibling hematopoietic stem cell transplantation in the treatment of severe aplastic anemia. METHODS: A total of four severe aplastic anemia patients who underwent unrelated cord blood combined with matched sibling hematopoietic stem cell transplantation in First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College from July 2017 to February 2018 were enrolled and their clinical data were used for retrospective analysis. RESULTS AND CONCLUSION: (1) All the four patients were male. The median age was 40 years old and the median time from diagnosis to transplantation was 2.5 months. Bone marrow and peripheral blood stem cells from a sibling donor as well as a unit of unrelated cord blood with HLA matching ≥ 4/6 were applied. (2) The median stem cells of total nucleated cells and CD34+ were 13.67×108/kg and 2.7×106/kg of the sibling donor, 2.1×107/kg and 1.21×105/kg of the unrelated cord blood, respectively. (3) The median implantation time of neutrophils and platelets was +10 days and +20 days, respectively. (4) After transplantation, one patient was sibling donor chimerism while that of another three patients was double donors. At the follow-up date, among the three cases of mixed chimerism from two donors, one was completely implanted with unrelated cord blood; one was completely implanted with sibling donor; the third case had mixed chimerism with sibling donor and recipient giving up treatment because of infection. (5) Only one patient developed grade II acute graft versus host disease. The incidence of III-IV acute graft versus host disease and chronic graft versus host disease was 0%. (6) Two-year post-transplant disease free survival and overall survival rates were both 75% and graft versus host disease-free and relapse-free survival was 100%. (7) The results show that sibling allogeneic hematopoietic stem cell transplantation combined with unrelated cord blood transfusion for the treatment of older patients with severe aplastic anemia has a low incidence of graft versus host disease and a positive effect, but the dynamics for the implantation of two kinds of donor stem cells is worthy of further study.

Rivalidade e solidariedade entres irmãos na clínica com famílias / Rivalry and solidarity between siblings in the clinic with families / Rivalidad y solidaridad entre hermanos en la clínica con famílias

Este estudo faz parte de uma pesquisa mais ampla sobre fratria e teve como objetivo investigar rivalidade e solidariedade nas relações entre irmãos no contexto da clínica com famílias. Ressalta-se que tanto a rivalidade quanto a solidariedade fraterna são elementos importantes a serem trabalhados no processo psicoterápico da família. Utilizou-se o método clínico-qualitativo de investigação, com base no material clínico coletado durante o período de avaliação familiar em serviço de psicologia aplicada de uma universidade privada. Para fins deste trabalho, ilustramos a discussão com vinhetas clínicas de três famílias, com as seguintes configurações familiares: uma casada, uma monoparental e uma recasada. Concluímos que a presença de rivalidade e solidariedade entre irmãos está relacionada ao manejo parental dos conflitos em diferentes tipos de configurações familiares (AU).

This study is part of a wider research on siblings and aimed to investigate rivalry and solidarity in sibling relations in the context of the clinic with families. It is emphasized that both rivalry and fraternal solidarity are important elements to be worked on in the family psychotherapeutic process. The clinical-qualitative method of investigation was used, based on the clinical material collected during the period of family evaluation in the service of internship psychology of a private university. For the purpose of this work, we illustrate the discussion with clinical vignettes of three families, with the following family configurations: one married, one single parent and one remarried. We conclude that the presence of rivalry and solidarity between siblings is related to parental handling of conflicts in different types of family configurations (AU).

Este estudio és parte de una investigación más amplia sobre fratería y tuvo como objetivo investigar rivalidad y solidaridad en las relaciones entre hermanos en el contexto de la clínica con familias. Se resalta que tanto la rivalidad como la solidaridad fraterna son elementos importantes a ser trabajados en el proceso psicoterápico de la familia. Se utilizó el método clínico-cualitativo de investigación, con base en el material clínico recogido durante el período de evaluación familiar en servicio de psicología aplicada de una universidad privada. Para fines de este trabajo, ilustramos la discusión con viñetas clínicas de tres familias, con las siguientes configuraciones familiares: una casada, una monoparental y una recasada. Concluimos que la presencia de rivalidad y solidaridad entre hermanos está relacionada al manejo parental de los conflictos en diferentes tipos de configuraciones familiares (AU)

Nutritional status of children under five year of age: a cross sectional study in rural area of Jhalawar, Rajasthan

Background: Adequate nutrition is essential in early childhood to ensure healthy growth and development, proper organ functions and a strong immunity. Accurate assessment of nutritional status of children is a requisite in appropriate planning and effective implementation of nutrition interventions. The objective of this study is to assess nutritional status of children under five year of age in rural area and to identify the socio-demographic factors associated with under nutrition.Methods: A cross sectional study was conducted among children aged six months to five years in rural area of Jhalawar, Rajasthan. Nutritional status of the children was assessed by measurement of mid upper arm circumference and information like birth order of children, birth weight and number of siblings was collected using a pre-coded and semi structured questionnaire.Results: Moderate under-nutrition was present in 16.8% children. Under-nutrition was present among 9.9% male and 24.2% female children. 38.1% children with birth weight less than 2.5 kg were under-nourished. Proportion of under-nutrition was 27.7% among children with number of siblings more than 2 while it was only 11.1% among those with 2 or less number of siblings.Conclusions: Gender, number of siblings and birth weight of children were significantly associated with nutrition status of children.

Relación entre afrontamiento y problemas externalizados e internalizados en hermanos de niños con autismo / Relation between coping and externalized and internalized problems in siblings of children with autism

Introducción: El trastorno del espectro autista es un problema del neurodesarrollo caracterizado por la presencia de dificultades en la comunicación social e interacción y en el comportamiento, el cual suele ser estereotipado y con intereses restringidos. El impacto que tiene la presencia de un niño con este trastorno en los hermanos, tiene diferentes matices. Objetivo: Identificar las estrategias de afrontamiento que utilizan los hermanos de niños con trastorno del espectro autista y analizar su relación con problemas externalizados e internalizados. Resultados: Participaron 23 niños (15 niños y 8 niñas) de 8 a 12 años de edad (edad promedio: 9.8; DE= 1,5). Se aplicó una ficha sociodemográfica para niños, la escala infantil de afrontamiento y el cuestionario de problemas internalizados y externalizados para niños. Los resultados indican que el factor disfuncional se utiliza con mucha frecuencia y que existen correlaciones positivas entre el afrontamiento disfuncional con problemas externalizados e internalizados y entre los factores centrado en la emoción y el evitativo con problemas internalizados. Conclusiones: En este grupo de hermanos de niños con trastorno del espectro autista, la correlación significativa entre el afrontamiento disfuncional y los problemas externalizados e internalizados, indica la necesidad de una evaluación profunda de posibles problemas de conducta y emocionales, la necesidad de aprender a responder de manera funcional ante las situaciones cotidianas, así como de una intervención para desarrollar estrategias de afrontamiento funcionales(AU)

Introduction: Autism Spectrum Disorder (ASD) is a neuro-developmental disorder characterized by the presence of difficulties in social communication, social interaction and behavior, which is usually stereotyped and with restricted interests. The impact of the presence of a child with ASD in the siblings has different connotations and it has been found that these children have more positive than negative aspects. Objective: To identify the coping strategies used by siblings of children with ASD, and analyze their relation with externalized and internalized problems. Results: Participants were 23 children (15 boys and 8 girls) from 8 to 12 years old (average age: 9.8, D.E = 1.5). A socio-demographic index card for children was used in addition to the Children Coping Scale and the Questionnaire on Internalized and Externalized Problems for Children (EIA and CPIEN, by its acronyms in Spanish, respectively). The results indicate that the dysfunctional factor is very frequently used and that there are positive correlations between dysfunctional coping with externalized and internalized problems, and also between the factors focused on emotion and the avoidance with internalized problems. Conclusions: In this group of siblings of children with Autism Spectrum Disorder, the significant correlation between disfunctional coping and externalized and internalized problems indicates the need of a deep assesment of possible behavioral and emotional problems, the need to learn how to respond in a functional way to daily life situations, as well as the need of an intervention to develop functional coping strategies(AU)