The Association between Prematurity, Antibiotic Consumption, and Mother-Infant Attachment in the First Year of Life.

Antibiotics have individual and public-health drawbacks. Nevertheless, mother-infant attachment quality and maternal sensitivity are associated with antibiotic use. Ambivalent-attached infants are more likely to consume antibiotics than other infants. Conceivably, the emotional over-externalization of ambivalent-attached infants and maternal anxiety when infants are ill raise concerns in healthcare professionals, leading to antibiotic over-prescriptions. However, because infants prematurely born, particularly those with less than 32 weeks of gestation, are under more accurate health vigilance, the impact of infant and maternal behavior on antibiotic prescription may vanish in this sample. To test this hypothesis, we performed a longitudinal study to compare antibiotic use and the quality of mother-infant attachment in three groups: 86 infants born at full-term, 44 moderate-to-late preterm infants (32-36 gestation weeks), and 58 very-to-extreme preterm infants (<32 gestation weeks). Infants' attachment was observed with the Ainsworth Strange Situation's experimental paradigm at 12 months of corrected age. Findings indicate that infant attachment strategy is associated with antibiotics uptake, but results vary across samples. The proportion of infants that used antibiotics is highest among ambivalent-attached infants in the full-term sample but highest among avoidant-attached infants in the very-to-extreme premature sample. Moreover, higher infant gestational age and lower maternal sensitivity determine higher antibiotic use.

Antibiotic Consumption, Illness, and Maternal Sensitivity in Infants with a Disorganized Attachment.

Prior research found an association between mother-infant attachment and antibiotic use. Ambivalent-attached infants are more likely to take antibiotics than other infants, and their mothers tend to be less sensitive to their needs than most. This finding is important because it shows the association between psychological processes, early relationships, and health outcomes. We aim to learn about children with high-risk attachment relationships, such as disorganized-attached infants. This study compares antibiotic use, infant-mother interactive behavior, and health indicators according to infant attachment patterns (including disorganized attachment). For this purpose, we observed mothers-infants' interactive behavior in free play at nine months and infants' attachment in the Ainsworth Strange Situation at twelve months. Participants included 77 girls and 104 boys (full-term and preterm) and their mothers. Paradoxically, mothers of disorganized-attached infants reported that their children were ill only 1.56 times on average, but 61% of their children used antibiotics in the first nine months. The other mothers reported that their children were sick 5.73 times on average, but only 54% of their children used antibiotics in the same period. Infants with disorganized attachment had mothers who were more literate and less sensitive. These results add to a body of research that shows that early high-risk relationships affect children's lives at multiple levels.

Maternal sensitivity and mother-infant attachment are associated with antibiotic uptake in infancy.

Attachment security has been associated with health status and symptom reporting. In this longitudinal study, we investigated the association between antibiotics uptake by infants at 9-months and mother-infant attachment at 12-months. Logistic regression analyses indicated that lower maternal sensitivity was associated with increased odds of antibiotic uptake. Furthermore, 89.7% of insecure-ambivalent infants consumed antibiotics, which contrasted with 32.5% of avoidant infants and 21.5% of secure infants. This study suggests that maternal behavior and mother-infant attachment impact on antibiotic consumption, which is worrying because antibiotics may lead to several health problems later in life and antibiotic-resistance.

Lupus miliaris disseminatus faciei: a case report.

UNLABELLED: A 33-year-old man presented to our clinic with asymptomatic red-brown, dome-shaped papules, distributed bilaterally on the central area of the face (forehead, lower portions of the eyelids, nasolabial folds, and perioral areas) these had evolved over a period of about 1 year. A skin biopsy, taken from a lesion on the forehead, revealed an epithelioid cell granuloma with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. The chest X-ray and the results of the laboratory studies were within normal limits; the Mantoux test was negative. The patient was treated with minocycline 100 mg/day for 4 months. There was significant clinical improvement, but papular lesions remained on the forehead. Later on, treatment with systemic steroids for 7 months resulted in the resolution of most lesions. COMMENT: Lupus miliaris disseminatus faciei (LMDF) is an uncommon, chronic, inflammatory dermatosis characterized by red-to-yellow or yellow-brown papules of the central face, particularly on and around the eyelids. Originally, LMDF was considered to be a variant of lupus vulgaris or a tuberculid because of the histology, but there has been no evidence to date supporting a link to tuberculosis. Some authors consider LMDF to be a granulomatous forms of rosacea. However, our case supports the concept that it is a distinct entity.

The effects of parental sensitivity and involvement in caregiving on mother-infant and father-infant attachment in a Portuguese sample.

In the present longitudinal study, we investigated attachment quality in Portuguese mother-infant and in father-infant dyads, and evaluated whether attachment quality was related to parental sensitivity during parent-infant social interaction or to the amount of time each parent spent with the infant during play and in routine caregiving activities (e.g., feeding, bathing, play). The sample consisted of 82 healthy full-term infants (30 girls, 53 boys, 48 first born), and their mothers and fathers from mostly middle-class households. To assess parental sensitivity, mothers and fathers were independently observed during free play interactions with their infants when infants were 9 and 15 months old. The videotaped interactions were scored by masked coders using the Crittenden's CARE-Index. When infants were 12 and 18 months old, mother-infant and father-infant dyads were videotaped during an adaptation of Ainsworth's Strange Situation. Parents also described their level of involvement in infant caregiving activities using a Portuguese version of the McBride and Mills Parent Responsibility Scale. Mothers were rated as being more sensitive than fathers during parent-infant free play at both 9 and 15 months. There also was a higher prevalence of secure attachment in mother-infant versus father-infant dyads at both 12 and 18 months. Attachment security was predicted by the amount of time mothers and fathers were involved in caregiving and play with the infant, and with parents' behavior during parent-infant free play.

Interação e linguagem dirigida a crianças de quinze meses / Interaction et langage adressé aux enfants de quinze mois / Interacción y lenguaje dirigido a niños de 15 meses / Interaction and language directed at children aged 15 months

Neste estudo são comparadas a interação e a linguagem dirigida aos filhos(as) pelos pais e mães, para analisar as diferenças e semelhanças entre as díades. Para o efeito, foram videogravadas durante uma situação de brincadeira livre 80 díades - 40 crianças (25 meninas e 15 meninos) de 15 meses em interação com os respetivos pai e mãe. Os resultados revelam que não há diferenças significativas na forma de os pais e as mães interagirem com seus filhos e filhas. Contudo, observam-se diferenças na linguagem dirigida às crianças por pais e mães, em particular em comportamentos de nomeação e avaliação positiva. Para além das diferenças são de sublinhar correlação positiva quer na interação, quer na comunicação de pais que coabitam.

Cet étude compare l'interaction et la communication de père-enfant et de mère-enfant pour analyser les différences et les similitudes entre les dyades. Dans ce but, 80 dyades ont été filmées dans une situation de jeu libre - 40 enfants âgés de quinze mois en interaction à la fois avec son père et sa mère (25 garçons et 15 filles). Les résultats révèlent qu'il n'y a pas de différences significatives dans l'interaction des parents avec leurs enfants. Cependant, en ce qui concerne la communication, des différences ont été observées dans le langage adressé aux enfants par les parents, en particulier, dans les énoncés ciblant des noms et d'évaluation positive. Au-delà des différences, nous soulignons la corrélation positive trouvée soit dans l'interaction soit dans la communication entre des parents qui cohabitent.

En este estudio se comparan la interacción y la comunicación entre padre-hijo(a) y madre-hijo(a) con el objetivo de analizar las diferencias y similitudes entre las díadas. Para esto, se grabaron en vídeo durante una situación de juego libre 80 díadas con 40 niños de 15 meses en interacción con sus respectivos padre y madre. Los resultados revelan que no hay diferencias significativas en la manera en que los padres y las madres interactúan con sus hijos e hijas. Sin embargo, se observan diferencias en el lenguaje que los padres dirigen a los niños, en particular en comportamientos de nombrar y valoración positiva. Más que las diferencias, es notable la correlación positiva, ya sea en la interacción, ya sea en la comunicación de padres que cohabitan.

In this study we compare maternal and paternal interaction and speech directed to their children, in order to analyze differences and similitudes between the dyads. For that purpose, 80 dyads were taped in a free play situation ­ forty 15 months old children (25 girls, 15 boys) interacting with their parents. Results demonstrate no significant differences regarding the way mothers and fathers interact with their sons and daughters. However, differences in mothers versus fathers' style of communication toward their children were found, particularly naming and positive evaluation behaviors. Although differences were found, we underline positive correlation in interaction and communication of cohabiting parents.

Momentos de interação em que as emoções se apre(e)ndem: estudo exploratório sobre a prestação materna e infantil em jogo livre / Interactional moments where emotions can be (re)learned: An exploratory study of mother and infant responses in free play situations / Affectif moments de interaction: Exploratoire étudie de la interaction maman-bébé / Instantes de interacción en que se adquieren las emociones: Estudio exploratorio acerca del desempeño materno e infantil en el juego libre

Numa amostra com 99 díades mãe-filho (sem condições evidentes de risco), tendo os bebês entre 3 e 6 meses, analisamos breves sequências de jogo livre. Pretendíamos estudar a interacção mãe-filho num registo próximo do dia a dia. Para o efeito, avaliamos: a expressão facial, expressão vocal, posicionamento e manipulação, expressão afetiva, reciprocidade, directividade e jogo proporcionados pelas mães. Nos bebês observamos as respostas faciais, vocais, afectivas, a capacidade de responder reciprocamente e comportamento em jogo. Os resultados indicam que os comportamentos maternos muito sensíveis e adequados e os seus opostos - muito desajustados - são minoritários. De fato, a maioria das mães combina sensibilidade com alguma intrusão. A generalidade das crianças apresenta receptividade às solicitações maternas, mas não são raros os comportamentos difíceis e de resistência. A sensibilidade materna e a cooperação infantil apresentaram uma forte associação. Por fim, verificamos que os comportamentos maternos e infantis foram afectados pelo sexo da criança, pela educação e pelas idades maternas e o nível socioeconômico das famílias.

In this study, the authors investigate mother-child interaction in free play. Brief sequences of interaction were analyzed in a sample of 99 mother-infant dyads (with no evidence of risk). The infants' ages ranged between 3 and 6 months old. Mothers' facial and vocal expression, positioning and handling, affective expression, reciprocity, directiveness and appropriateness of play were assessed. In addition, infants were observed concerning to facial, vocal and affective responses, the ability to respond reciprocally and the quality of play presented. Results showed that highly sensitive and adequate maternal behavior and its opposite - highly insensitive and inadequate - are relatively uncommon. Moreover, a great number of mothers combined sensitivity with some level of intrusion. Infants presented, in general, receptivity to mother turns, but moment's resistance and difficult behaviors were found in many cases. These findings suggest a strong association between maternal sensitivity and infant cooperation. Results were affected by several variables like: infant's sex, mother's level of education, mother's age and family social economical status.

Dans un échantillon de 99 paires maman et bébé (sans être dans les conditions de risque), avec des enfantes entre 3 et 6 mois, nous avons analysé de brèves séquences du jeux libre. On voudrait étudier l'interaction maman et bébé justement comme ça se passe pendant la journée. A cet effet, on a évalué: l'expression facial, la vocalisation, la manipulation de la mère sur le bébé, l'expression des affects, la réciprocité, la directivité et les jeux proportionnés par les mères. Dans les bébés on a observé les réponses faciales, vocales et affectives, la capacité de répondre avec réciprocité et le type d'interaction dans le jeu. Les résultats montre que les comportements maternels, qui sont trop sensibles et adéquats, bien comme, lesquelles trop désajustés, sont en minorité. En fait, la majorité des mères fait une combinaison entre sensibilité et intrusion. La généralité des enfants présent réceptivité aux sollicitations de leurs mères mais ils ne sont pas rares les comportements difficiles et de résistance. La sensibilité maternelle et la coopération enfantine on présenté une forte association. Finalement, on a vérifié que les comportements maternels et enfantines on été affecté par le sexe de l'enfant, l'éducation, les ages maternels et le niveaux socio-économique des familles.

En una muestra de 99 parejas madre-hijo (sin riesgo evidente), teniendo los bebés entre 3 y 6 meses, analizamos breves sequencias de juego libre. Pretendíamos estudiar la interacción madre-hijo en un registro que se asemejase a su dia a dia. Para ello evaluamos: la expresividad facial y oral, la postura y la manipulación, la afectividad y reciprocidad, la capacidad de dirigir y la capacidad lúdica proporcionadas por las madres. En los bebés analizamos la expresividad facial, oral y afectiva, la capacidad de respuesta recíproca y su comportamiento durante el juego. Los resultados indican que tanto las actitudes maternales muy sensibles y adecuadas como sus opuestas - muy inadecuadas, son minoritarias. De hecho, la mayoría de las madres combina la sensibilidad con algún grado de intrusismo. La mayoría de los bebés es receptiva a las actitudes maternas, pero no son infrecuentes los comportamientos difíciles y rebeldes. La sensibilidad materna y la cooperación infantil mostraron una fuerte asociación. Finalmente, verificamos que las actitudes maternas e infantiles dependieron del sexo del niño, de la educación, de la edad materna y del nivel sócio-económico de las famílias.