A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Experiences and needs of carers of Aboriginal children with a disability: a qualitative study.

BACKGROUND: Australian parents/carers of a person with a disability experience higher rates of depression, more financial stress, and are twice as likely to be in poor physical health than the general population. Aboriginal and Torres Strait Islander peoples experience worse health, social and economic outcomes than other Australians, and those with a disability face 'double disadvantage'. This study aimed to better understand the experiences and needs of parents/carers/families of Aboriginal children with a disability. METHODS: Semi-structured in-depth interviews were conducted with parents or primary carers of Aboriginal children aged zero-eight with disability. Interviews were analysed using thematic analysis. RESULTS: Nineteen women (sixteen mothers and three grandmothers) were interviewed. More than half were lone carers (without a partner or spouse). Participants described their experiences, including challenges and facilitators, to providing and accessing care, impacts on their health and wellbeing, and associated economic and non-economic costs of caregiving. Financial strain and social isolation was particularly prominent for lone carers. CONCLUSIONS: Tailoring services to the needs of carers of Aboriginal children with a disability means supporting kinship caregiving, facilitating engagement with other Aboriginal families, and streamlining services and systems to mitigate costs. The experiences described by our participants depict an intersection of race, socio-economic status, gender, disability, and caregiving. Services and funding initiatives should incorporate such intersecting determinants in planning and delivery of holistic care.

The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers.

BACKGROUND: Work stress and family composition have been separately linked with later-life mortality among working women, but it is not known how combinations of these exposures impact mortality, particularly when exposure is assessed cumulatively over the life course. We tested whether, among US women, lifelong work stress and lifelong family circumstances would jointly predict mortality risk. PROCEDURES: We studied formerly working mothers in the US Health and Retirement Study (HRS) born 1924-1957 (n = 7352). We used sequence analysis to determine five prototypical trajectories of marriage and parenthood in our sample. Using detailed information on occupation and industry of each woman's longest-held job, we assigned each respondent a score for job control and job demands. We calculated age-standardized mortality rates by combined job demands, job control, and family status, then modeled hazard ratios for death based on family constellation, job control tertiles, and their combination. RESULTS: Married women who had children later in life had the lowest mortality risks (93/1000). The highest-risk family clusters were characterized by spells of single motherhood (132/1000). Generally, we observed linear relationships between job control and mortality hazard within each family trajectory. But while mortality risk was high for all long-term single mothers, we did not observe a job control-mortality gradient in this group. The highest-mortality subgroup was previously married women who became single mothers later in life and had low job control (HR 1.91, 95% CI 1.38,2.63). PRACTICAL IMPLICATIONS: Studies of associations between psychosocial work characteristics and health might consider heterogeneity of effects by family circumstances. Worksite interventions simultaneously considering both work and family characteristics may be most effective in reducing health risks.

[Emotional childhood parentification and mental disorders in adulthood]. / Parentifizierung in der Kindheit und psychische Störungen im Erwachsenenalter.

BACKGROUND: Emotional parentification is considered harmful to a child's development. METHOD: A total of about 975 patients were examined at a Department of Psychosomatic Medicine and in the practices of general practitioners with regard to childhood adversities. RESULTS: Emotional parentification is a risk factor for 2 symptom groups: the patients with depression and the patients with somatoform pain. While the occurrence of depression is mainly predicted by maternal emotional parentification, paternal influences are also relevant in regard to the development of somatoform pain. CONCLUSION: Emotional parentification is an important risk factor for the occurrence of psychological and somatoform complaints in adulthood. This is especially apparent in combination with further risk factors, such as low reported values for love, sexual abuse, or being raised without a father.

The lived experience of pregnancy complications in single older women.

PURPOSE: To explore the lived experience of single older women (35 years or older at time of birth) who experienced complications in their planned pregnancy. DESIGN AND METHODS: Phenomenology, using semistructured interviews with 11 women between the ages of 35 to 48 years. RESULTS: Six themes emerged: (a) motherhood now or never, (b) the known and unknown, (c) importance of support, (d) the stigma of single motherhood, (e) changing priorities, and (f) long-term concerns for themselves and child/children. CLINICAL IMPLICATIONS: Nurses who work with pregnant women should understand as much as possible about the issues affecting older single women who choose pregnancy; this offers the best opportunity to provide comprehensive care. These women can be at increased risk for many pregnancy complications, and should receive counseling about their risks for both fetal and maternal complications. Nurses should also conduct a thorough psychosocial assessment to determine what support systems are in place and what resources are available if complications arise. In the intrapartum and postpartum settings, nurses can offer not only appropriate physical caregiving but also a supportive and caring attitude with women in this circumstance. Helping women maintain a sense of control by helping them to participate in their care planning is essential.

Modeling the interplay of multilevel risk factors for future academic and behavior problems: a person-centered approach.

This study identified profiles of 13 risk factors across child, family, school, and neighborhood domains in a diverse sample of children in kindergarten from four US locations (n = 750; 45% minority). It then examined the relation of those early risk profiles to externalizing problems, school failure, and low academic achievement in Grade 5. A person-centered approach, latent class analysis, revealed four unique risk profiles, which varied considerably across urban African American, urban White, and rural White children. Profiles characterized by several risks that cut across multiple domains conferred the highest risk for negative outcomes. Compared to a variable-centered approach, such as a cumulative risk index, these findings provide a more nuanced understanding of the early precursors to negative outcomes. For example, results suggested that urban children in single-parent homes that have few other risk factors (i.e., show at least average parenting warmth and consistency and report relatively low stress and high social support) are at quite low risk for externalizing problems, but at relatively high risk for poor grades and low academic achievement. These findings provide important information for refining and targeting preventive interventions to groups of children who share particular constellations of risk factors.

[Prevention of child neglect by outreach care of family midwives]. / Prävention von Kindesvernachlässigung durch aufsuchende Arbeit von Familienhebammen.

The service of freelance family midwives was field-tested in the project "outreach care for mothers and their children--network family midwives" in the years 2002-2006 in Lower Saxony in three municipalities. The data of 590 cared for women and their children were evaluated. The clientele, that has been defined as target group--e.g., underage pregnant women and mothers, single pregnant women and mothers, pregnant women and mothers in difficult social and psychosocial life situations, pregnant women and mothers with a migratory background--could be reached by the family midwives. In 80% of the cared for women and their children an improvement of the initial situation was achieved. In all tackled problem areas positive changes were achieved, however to a varying degree. The greatest successes were observed in reducing mental overload and fears, improvement of knowledge, appropriate nursing care of the child, improvement of the mother-child relationship, and improvement of the health situation. The positive results with respect to achieving the target group, the results of care and the referral of clients to regular support structures was a consequence of the good mutual trust between client and family midwife as well as the intense cooperation between the family midwives and a social workers (coordinator) who was released from work by one youth welfare office.

[Medical-social aspects pregnancy, labor and puerperium in patients the solitary mother home in Karwowo near Szczecin]. / Medyczno-spoleczne aspekty przebiegu ciazy, porodu i pologu u pacjentek--pensjonariuszek domu samotnej matki w Karwowie kolo Szczecina.

PURPOSE: Solitary maternity is a significant problem of modern times requiring socio-economic and psychological, as well as perinatological studies. The twentieth anniversary of the Maternity Home managed by the Benedictine Samaritan Sisters motivated the present study. MATERIAL AND METHODS: Hospital discharge summaries of 429 women (group DSM) who lived at the Maternity Home between 26 July 1983 and 26 February 2002 were analyzed. This documentation was supplemented with hospital data on 177 women who gave birth at two Szczecin hospitals and on 13 who left the Home before delivery. RESULTS: Residents of the Home came from all regions of Poland and from urban and rural societies. They were between 14 and 43 years of age (mean 22.6 +/- 5.7). 87.4% of them were single and 63.7% were primipara. 50.4% of them failed to complete primary education while 3.4% had university-level education. 6% were mentally and/or psychologically handicapped and 42.7% had no profession. The major causes of admission into the Home were: desire to hide the pregnancy, family conflicts, homelessness, difficult material situation, mental or physical disability, violence or alcoholism in the family. The control group comprised 400 women (group K) who gave birth at the Department of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin. 51.5% of them were primipara. The mean age in this group was 27.4 +/- 5.4 (17-44). 71.3% were married. The Majority had secondary (41.9%) or university (32.5%) education. Most of them worked as artisans, teachers or economists. Neurological or psychiatric diseases dominated in group DSM but otherwise no severe disease at all could be disclosed. Satisfactory prenatal care was provided to 33.1% of DSM patients and to 78% of group K. No prenatal care was provided to 9.5% of DSM patients and to 1.7% of group K. EPH gestosis was more often observed in DSM patients and imminent abortion, premature birth, PROM, urinary tract infection, and anaemia were more frequent in controls. More DSM patients had no treatment during pregnancy than controls. The use of tocolytics was significantly more frequent in DSM patients. Antibiotics and drugs accelerating maturation of the respiratory system were applied with similar frequency in both groups. Frequency of immature and mature births was similar in both groups. 84.2% of DSM patients and 68.8% of controls had natural delivery. Cesarian section was twice more frequent in group K. Immediate indications dominated in both groups (74.1% in DSM; 57.4% in K). No medication was used during delivery in 30% of patients. DSM patients more often required strong analgesics. Antibiotics and agents increasing uterine tension more often were used in K patients. Deliveries in both groups were usually without complications. Female genital tract injury was more frequent in DSM patients (20.9% in DSM; 14.8% in K). Delivery duration was similar in both groups, but the second part of delivery was longer in K primipara. Mean neonatal weight in the 1000-2500 g range was similar in both groups but was significantly higher in controls for 2501-4000 g neonates. The difference for newborns weighing more than 4000 g was not significant. There were no neonates weighing less than 1000 g. The clinical condition of newborns measured with the Apgar scale was worse in the DSM group after the 1st min, as well as after the 3rd and 5th min and the difference in each case was significant. Puerperium was usually uncomplicated. However, urinary tract infection was more frequent in DSM patients and anaemia was more frequent in controls. The duration of hospitalisation was similar in both groups (mean = 6 days). 120 of 177 DSM mothers left hospital together with their children, as compared to 99.3% in the control group. 87 children of mothers from the Maternity Home were offered for adoption. CONCLUSION: By studying unwed maternity it was observed that a holistic approach is the only way to disclose all the problems which are often unusually complex and concealed but which determine the normal development of an individual in the society. Analysis of the factors involved may help in attaining goals that serve the good of the society.

Deviancy training and association with deviant peers in young children: ocurrence and contribution to early-onset conduct problems.

The relationships of deviant talk and role taking during peer interaction, association with deviant peers, and growth in overt and covert conduct problems during kindergarten and first grade were examined in a community sample of 267 boys and girls. At entry to kindergarten, high levels of overt and covert conduct problems predicted association with deviant peers, and deviant peer association predicted deviant talk and role taking during peer interaction during kindergarten. Association with deviant peers, and deviant talk and role taking predicted growth in overt and covert conduct problems on the playground, in the classroom, and at home during kindergarten and first grade. Peer processes associated with growth in conduct problems that escalate rapidly during late childhood and adolescence appear to occur in earlier childhood. These peer processes may play a central role in the evolution of conduct problems to include covert as well as overt forms.

Could parenting stress and lack of support/confidence function as mediating mechanisms between certain environmental factors and the development of autoimmunity in children?: a study within ABIS.

Despite extensive research, the etiology of type 1 diabetes is still to a large extent unknown. We would like to propose psychoimmunology as one possible pathway. Psychological mechanisms are directly linked to hormonal and nervous signals, which increase the need for insulin and affect the immune system. Disparate factors of social, environmental, and medical character have been associated with the onset of type 1 diabetes or with the autoimmune process leading to the disease-for instance, parental age, maternal infections, delivery mood, need for neonatal intensive care, and low socioeconomic status. Our results, based on the analyses of 4337 nonselected newborn children and their mothers, show that all these risk factors were also associated with psychological mechanisms (defined as lack of social support/confidence and high parenting stress). These results support the hypothesis of psychological mechanisms as mediating variables between a number of disparate risk factors and the development of type 1 diabetes.

Maternal resources, parenting, and dietary patterns among rural African American children in single-parent families.

A correlation study was designed to test the hypothesis that maternal education, perceived family resources, and the importance of family routines would be related to children's dietary patterns. Additionally, the study examined the hypothesis that dietary patterns would be associated with children's cognitive and physical abilities. The sample for this study included 159 African American single-mother families with a 6- to 9-year-old child living in rural areas, most of whom lived in poverty. Children's eating patterns were assessed using a self-report questionnaire administered to the mother in an interview format. Children's cognitive ability was measured by several subscales from the Woodcock Johnson Psycho-Educational Instrument and the Harter Perceived Competence Scale for children. For male children, the mother's higher education was related to more adequate eating patterns at home, and more perceived family resources were related to the likelihood of taking vitamin supplements. For female children, greater milk intake was positively related to cognitive outcomes, including applied problem, passage comprehension, calculation, synonym identification, antonym identification, and quantitative concept scores. Milk intake was clearly related to more optimal cognitive development. The results of this study support the literature related to the importance of nutrition for cognitive and physical abilities in children.

Family structure and psychosocial correlates among urban African-American adolescent males.

Substance use and delinquency, psychological well-being, and social support were compared across 5 family constellations among 254 urban African-American adolescent males. Single-mother, stepparent, both parents, mother with extended family, and extended family only households were studied. The only differences found were that youth living in single-mother households reported more parental support than other youth. Relationships with father and male role models were also studied and related to several psychosocial outcomes. The results challenge the assumptions that single African-American mothers are alone in providing support to their sons and that fathers' absence results in no significant relationship.

Women and health: power through perseverance.

Health among the world's women is becoming more precarious as people are thrown into mad competition for scarce global resources. Patriarchal institutions continue to dominate the quest for power over earth, self, and others. This paper discusses five major issues related to women's health status today. Each issue raises questions for nurses to ponder as we try to address the widespread prejudice against women and health. Finally, the paper points to avenues that are being opened in nursing to address women's health concerns.

Stress, coping, and adjustment in mothers and young adolescents in single- and two-parent families.

Compared stress, coping, and psychological adjustment in single (divorced or separated) and married mothers and their young adolescent children. Single mothers reported more daily hassles related to economic, family, and personal health problems, and more symptoms of depression, anxiety, and psychoticism. Single mothers also reported using more coping strategies related to accepting responsibility and positive reappraisal. After controlling for level of family income, differences in family hassles and coping strategies remained significant. The two groups did not differ on subtypes of symptoms after controlling for income, but single mothers still reported more total psychological symptoms. No differences were found between children in these two family constellations on maternal reports of emotional/behavioral problems or on children's self-reported emotional/behavioral problems, stressful events, or coping. Implications of these findings for adjustment to life in single-parent families are discussed.

The single parent family and the child's mental health.

The prevalence of psychiatric and psychosomatic disorders in a 1 year birth cohort from northern Finland followed up until 19 years was examined on the basis of hospital records and national registers for subsidies for chronically sick children. Psychiatric disorders were found to occur with higher frequency in children of single parent families, especially those lacking a father during the child's whole life. Childhood enuresis was most frequent in the children who had experienced the divorce of their parents. Discriminant function analysis was used to establish the explanatory value of the family constellation for both psychiatric disorders and enuresis. The other significant explanatory variables for psychiatric disorders were school performance, place of residence and the child's height at 1 year of age, with poor school performance, high population density and short stature increasing the risk. The other significant variables increasing the risk of enuresis were psychiatric disorders, poor school performance, juvenile smoking and small size of dwelling. Disabled children had psychiatric disorders 9 times as frequently as non-disabled ones.