[Screening for heart disease in kids and adolescents (Prevencar Program)]. / Screening de cardiopatías en niños y adolescentes (Prevencar Program).

OBJECTIVE: The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. DESIGN: The study was carried out for one year using multistage sampling. SITE: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. PARTICIPANTS: Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. INTERVENTIONS: Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. MAIN MEASUREMENTS: Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. RESULTS: Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. CONCLUSIONS: The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.

[Motivations for alcohol consumption in schooled adolescents: analysis of discussion groups]. / Motivaciones para el consumo de alcohol en adolescentes escolarizados: análisis de grupos de discusión.

OBJECTIVE: To find out the motivations of adolescents for alcohol consumption. DESIGN: Qualitative methodology with discussion groups. PARTICIPANTS AND CONTEXT: 131 adolescents (15-17 years old) enrolled in nine schools in Tarragona (Spain). METHOD: Systematic coding strategy, adapted to focus groups. Educational centers were selected through a stratified purposive sampling by educational levels (segmentation criterion) and ownership of the center (public or private). Participants within the educational levels were randomly selected for the groups. Content analysis was conducted using an open and flexible coding strategy. RESULTS: Motivations for alcohol consumption were identified, revolving around six fundamental dimensions: a) seeking fun and new sensations, b) alleviating discomfort, c) consumption due to social contagion and group pressure, d) consumption as a rite of passage into adulthood, e) environmental availability of alcohol, and f) low perception of risk. This motivation varied according to the adolescent's gender. In girls, drinking behavior appeared related to overcoming negative emotional states, while for boys, belonging to the peer group took precedence: drinking reinforces hegemonic masculinity and ensures complicity among peers. Adolescents considered that the information they receive from educational centers is sufficient, but it does not motivate change. CONCLUSIONS: Public health strategies focused on preventing alcohol consumption in adolescents should incorporate their motivations to achieve greater efficiency, paying due attention to sex/gender variables.

[Impact of gender violence on girls and adolescents]. / Impacto de la violencia de género en las niñas y las adolescentes.

Gender is an important determinant of health. Its relationship with inequality and violence allows us to consider being a woman as a risk factor for health. Girls and teenager girls are not exempt from this circumstance, which conditions their lives from before birth and can determine their health status throughout life. It can vary according to social contexts, as various factors intersect with gender, adding risk and vulnerability to being a woman. Gender-based violence is often identified as a problem for adult women; however, the experience of discriminatory gender-based violence is constructed throughout women's lives, producing serious individual and social consequences from childhood. Accepting this violence as a «private or domestic matter¼ often prevents seeing the true dimension of the problem, its consequences, and the need to address it as a global issue.

Development of a Questionnaire on Knowledge, Habits, and Attitudes on Sexually Transmitted Infections in Teenagers and Young Adults.

Communication with teenagers who are significantly affected by sexually transmitted infections (STIs) is essential for the sake of prevention. The aim of this study is to develop a specific questionnaire for surveying the degree of knowledge, behavior, and attitudes of current teenagers and young adults on STIs to come up with the proper training tools. We conducted the study following the Delphi method, a 2-round critical assessment score (from 1 to 9) of all domains and items. Only domains and items with median scores ≥8 were selected. A total of 8 panelists were involved in this survey. After establishing a median score ≥8, a total of 14 domains and 40 items were eventually selected. This is the first questionnaire ever conducted to study the knowledge, habits, and attitudes of contemporary teenagers and young adults on STIs, and stands as a valuable tool for future training on STI prevention in teenagers and young adults.

Development of a Questionnaire on Knowledge, Habits, and Attitudes on Sexually Transmitted Infections in Teenagers and Young Adults. / [Artículo traducido] Generación de un cuestionario sobre conocimientos, hábitos y actitudes sobre infecciones de transmisión sexual en adolescentes y adultos jóvenes.

Communication with teenagers who are significantly affected by sexually transmitted infections (STIs) is essential for the sake of prevention. The aim of this study is to develop a specific questionnaire for surveying the degree of knowledge, behavior, and attitudes of current teenagers and young adults on STIs to come up with the proper training tools. We conducted the study following the Delphi method, a 2-round critical assessment score (from 1 to 9) of all domains and items. Only domains and items with median scores ≥8 were selected. A total of 8 panelists were involved in this survey. After establishing a median score ≥8, a total of 14 domains and 40 items were eventually selected. This is the first questionnaire ever conducted to study the knowledge, habits, and attitudes of contemporary teenagers and young adults on STIs, and stands as a valuable tool for future training on STI prevention in teenagers and young adults.

Spanish Version of Teenagers' Quality of Life (T-QoL) for Adolescents with Skin Diseases: Translation, Cultural Adaptation and Validation. / [Artículo Traducido] Traducción, adaptación cultural y validación de la versión española del Teenagers' Quality of Life (T-QoL): cuestionario para adolescentes con enfermedades de la piel.

BACKGROUND: Teenagers' Quality of Life (T-QoL) is an age-specific measure to assess QoL of teenagers suffering from different skin diseases. A validated Spanish language version is lacking. We present the translation, cultural adaptation and validation of the T-QoL into Spanish. METHODS: A prospective study with 133 patients (between 12 and 19 years old), attended at the dermatology department of Toledo University Hospital, Spain (September 2019-May 2020), was carried out for the validation study. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were used for the translation and cultural adaptation. We evaluated the convergent validity with the Dermatology Life Quality Index (DLQI), the Children's Dermatology Life Quality Index (CDLQI) and with a Global Question (GQ) on self-assessed disease severity. We also analysed internal consistency and reliability of the T-QoL tool and confirmed its structure with a factor analysis. RESULTS: Global T-QoL scores significantly correlated with the DLQI and the CDLQI (r = 0.75) and with the GQ (r = 0.63). The confirmatory factor analysis showed optimal fit for the bi-factor model and an adequate fit for the correlated three-factor model. Reliability indicators were high (Cronbach's α = 0.89; Guttman's Lambda 6 index = 0.91; Omega ω = 0.91) and test-retest showed a high stability (ICC = 0.85). The results were consistent with those found by the authors of the original test. CONCLUSION: Our Spanish version of the T-QoL tool is valid and reliable to assess QoL of Spanish-speaking adolescents with skin diseases.

Spanish Version of Teenagers' Quality of Life (T-QoL) for Adolescents with Skin Diseases: Translation, Cultural Adaptation and Validation.

BACKGROUND: Teenagers' Quality of Life (T-QoL) is an age-specific measure to assess QoL of teenagers suffering from different skin diseases. A validated Spanish language version is lacking. We present the translation, cultural adaptation and validation of the T-QoL into Spanish. METHODS: A prospective study with 133 patients (between 12 and 19 years old), attended at the dermatology department of Toledo University Hospital, Spain (September 2019-May 2020), was carried out for the validation study. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were used for the translation and cultural adaptation. We evaluated the convergent validity with the Dermatology Life Quality Index (DLQI), the Children's Dermatology Life Quality Index (CDLQI) and with a Global Question (GQ) on self-assessed disease severity. We also analysed internal consistency and reliability of the T-QoL tool and confirmed its structure with a factor analysis. RESULTS: Global T-QoL scores significantly correlated with the DLQI and the CDLQI (r=0.75) and with the GQ (r=0.63). The confirmatory factor analysis showed optimal fit for the bi-factor model and an adequate fit for the correlated three-factor model. Reliability indicators were high (Cronbach's α=0.89; Guttman's Lambda 6 index=0.91; Omega ω=0.91) and test-retest showed a high stability (ICC=0.85). The results were consistent with those found by the authors of the original test. CONCLUSION: Our Spanish version of the T-QoL tool is valid and reliable to assess QoL of Spanish-speaking adolescents with skin diseases.

Directive clinique no 423 : Interventions chirurgicales et thérapeutiques esthétiques génitales féminines.

OBJECTIF: Fournir aux chirurgiens et autres fournisseurs de soins canadiens qui réalisent des interventions chirurgicales ou thérapeutiques esthétiques génitales féminines, et tout praticien demandeur, des directives fondées sur des données probantes en réponse à l'augmentation des demandes et de la disponibilité des interventions chirurgicales et thérapeutiques vaginales et vulvaires sortant du cadre traditionnel de la reconstruction avec indication médicale. POPULATION CIBLE: Les femmes de tous âges qui consultent pour subir une intervention chirurgicale ou thérapeutique esthétique génitale. BéNéFICES, RISQUES ET COûTS: Les professionnels de la santé qui prodiguent des soins aux femmes jouent un rôle important en renseignant les femmes sur leur anatomie et en les aidant à prendre conscience des variations individuelles. La plupart des femmes qui demandent une intervention chirurgicale ou thérapeutique esthétique génitale féminine ont des organes génitaux normaux, et jusqu'à 87 % d'entre elles sont rassurées par des conseils. À l'heure actuelle, étant donné le manque de données probantes cliniques et scientifiques rigoureuses sur l'efficacité et l'innocuité à court et à long terme, il n'y a aucune base pour se prononcer en faveur des interventions chirurgicales ou thérapeutiques esthétiques génitales féminines sans indication médicale. Les interventions chirurgicales ou thérapeutiques esthétiques génitales féminines sont généralement réalisées dans le secteur privé, où les coûts sont assumés par la patiente. DONNéES PROBANTES: La littérature publiée a été rassemblée par des recherches dans les bases de données Medline, Scopus et Cochrane Library au moyen de termes et mots clés pertinents et validés. Les termes de recherche sélectionnés se composaient de mots clés sur les interventions chirurgicales ou thérapeutiques esthétiques génitales féminines (labiaplasty, surgery, vaginal laser therapy, laser vaginal tightening, vaginal laser, vaginal rejuvenation, vaginal relaxation syndrome, hymenoplasty, vaginal cosmetic procedures) combinés à female genital counselling, consent, satisfaction, follow-up, adolescent et body dysmorphic or body dysmorphia. La recherche a été limitée aux articles publiés après 2012 afin de mettre à jour la documentation depuis la dernière directive à ce sujet. Les résultats ont été restreints aux revues systématiques, aux essais cliniques randomisés et aux études observationnelles. Les études ont été limitées à celles menées chez l'humain seulement, et aucune restriction linguistique n'a été appliquée. La recherche a été effectuée le 20 mai 2020 et mise à jour le 10 novembre 2020. MéTHODES DE VALIDATION: Les auteures ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Gynécologues, fournisseurs de soins primaires, chirurgiens réalisant des interventions chirurgicales et/ou thérapeutiques esthétiques génitales féminines. RECOMMANDATIONS.

Adapting a Coparenting-Focused Prevention Program for Latinx Adolescent Parents in a School Context.

The current study utilized a three-step cultural adaptation process to adapt a universal-coparenting program for Latinx adolescent parents in a school-based setting. First, focus groups were conducted with adolescent parents (n = 13; 100% Latinx; 69% female), their parents (n = 17; 94% Latinx; 82% female), and school staff (n = 7; 71% White; 100% female) to identify unique needs faced by this population. Second, the program was adapted to include new lesson modules (e.g., coparenting with grandparents, coparenting after breakups) and structural reformatting to fit a school schedule. Third, selected lessons from the adapted program were piloted in four schools with 32 Latinx adolescent parents (97% Latinx; 78% female). Lesson evaluation surveys and focus group data assessed the feasibility and acceptability of the service delivery method and content to show the program was well received. However, implementation challenges emerged when attempting to provide services to adolescent fathers and Spanish-speaking adolescents. This manuscript provides an example of how to use this cultural adaptation process to tailor prevention programs, highlights a new prevention program that can serve as a resource for adolescent parents, and provides several recommendations for working with Latinx adolescent parents.

El presente estudio utilizó un proceso de adaptación cultural de tres pasos para adaptar un programa de cocrianza universal para padres adolescentes latinos en un entorno escolar. En primer lugar, se realizaron grupos de análisis con padres adolescentes (n = 13; el 100 % latinos; el 69 % mujeres), sus padres (n = 17; el 94 % latinos; el 82 % mujeres), y el personal escolar (n = 7; el 71 % blancos; el 100 % mujeres) para identificar las necesidades únicas que enfrenta esta población. En segundo lugar, el programa se adaptó para incluir módulos de enseñanza nuevos (p. ej.: la cocrianza con los abuelos, la cocrianza después de las separaciones) y para modificar el formato estructural de manera que se ajustara al horario escolar. En tercer lugar, se hicieron pruebas piloto de lecciones elegidas del programa adaptado en cuatro escuelas con 32 padres adolescentes latinos (el 97 % latinos; el 78 % mujeres). Se utilizaron encuestas de evaluación de las lecciones y datos de los grupos de análisis para evaluar la viabilidad y la aceptabilidad del método de prestación del servicio y del contenido a fin de demostrar que el programa fue bien recibido. Sin embargo, los desafíos de la implementación surgieron a la hora de prestar servicios a los padres adolescentes y a los adolescentes que hablan español. Este manuscrito brinda un ejemplo de cómo usar este proceso de adaptación cultural para adaptar programas de prevención, destaca un nuevo programa de prevención que puede servir como recurso para padres adolescentes y ofrece varias recomendaciones para trabajar con padres adolescentes latinos.

The Intergenerational Impact of Adverse Childhood Experiences on Hispanic Families: The Mediational Roles of Parental Depression and Parent-Adolescent Communication.

Parental exposure to adverse childhood experiences (ACEs) has been documented as a strong risk factor for subsequent externalizing behaviors in their youth. Although studies have investigated ACEs and their intergenerational association with youth externalizing behaviors, this association has not been investigated in Hispanic families. Additionally, substantial gaps in the literature exist explaining the mechanisms by which this association occurs. The purpose of this study was to examine whether parent-adolescent communication and parental depressive symptomatology explain the relationship between parent's ACE score and adolescent externalizing behaviors. This secondary data analysis utilized baseline data from an ongoing randomized controlled trial evaluating the relative effectiveness of an online parenting intervention for Hispanic adolescents. The sample consisted of 456 parents and their adolescents between the ages of 12-16. Using path modeling, parental depressive symptomatology and parent-adolescent communication were simultaneously examined as mechanisms that may explain the intergenerational relationship between parental exposure to ACEs and externalizing behaviors in Hispanic youth. Parental depressive symptomatology and parent-adolescent communication both significantly mediated the association between parental exposure to ACEs and adolescent externalizing behaviors. Understanding the mechanisms explaining the intergenerational association between parental exposure to ACEs and adolescent externalizing behaviors may aid future research examining problematic behaviors in Hispanic youth.

La exposición de los padres a las experiencias adversas de la niñez se ha documentado como un factor de riesgo potenciador de comportamientos posteriores de exteriorización en sus hijos. Aunque existen estudios donde se han investigado las experiencias adversas de la niñez y su asociación intergeneracional con las conductas de exteriorización de los jóvenes, esta asociación no se ha investigado en familias hispanas. Además, existen vacíos considerables en la bibliografía sobre la explicación de los mecanismos por los cuales ocurre esta asociación. El propósito de este estudio es analizar si la comunicación entre padres y adolescentes y la sintomatología depresiva de los padres explican la relación entre el puntaje de las experiencias adversas de la niñez de los padres y las conductas de exteriorización de los adolescentes. En este análisis de datos secundarios se utilizaron datos basales de un ensayo controlado aleatorizado en curso que evalúa la eficacia relativa de una intervención virtual sobre la crianza para adolescentes hispanos. La muestra consistió en 456 padres y sus adolescentes de entre 12 y 16 años. Utilizando un modelo de pautas, se analizaron simultáneamente la sintomatología depresiva de los padres y la comunicación entre los padres y los adolescentes como mecanismos que pueden explicar la relación intergeneracional entre la exposición de los padres a experiencias adversas en la niñez y las conductas de exteriorización en los jóvenes hispanos. La sintomatología depresiva de los padres y la comunicación entre los padres y los adolescentes mediaron significativamente la asociación entre la exposición de los padres a experiencias adversas en la niñez y las conductas de exteriorización de los adolescentes. La comprensión de los mecanismos que explican la asociación intergeneracional entre la exposición de los padres a experiencias adversas en la niñez y las conductas de exteriorización de los adolescentes puede ayudar a investigaciones futuras que analicen las conductas problemáticas de los jóvenes hispanos.

Therapist Adherence to Two Treatments for Adolescent Suicide Risk: Association to Outcomes and Role of Therapeutic Alliance.

In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.

En la investigación sobre psicoterapia, la adhesión se refiere al grado en el cual los terapeutas brindan un tratamiento según lo previsto. Este estudio analizó si la adhesión del terapeuta a dos tratamientos estandarizados diferentes estuvo asociada con mejores resultados en los pacientes y si la asociación estuvo moderada por la alianza terapéutica. La muestra del estudio incluyó 320 videograbaciones de sesiones de terapia de 118 casos en un ensayo aleatorizado controlado donde se comparó la terapia familiar basada en el apego (TFBA) con la terapia de apoyo no directiva optimizada por la familia (TAND-OF). Se eligieron grabaciones de las etapas iniciales, intermedias y finales del tratamiento. El instrumento de medición de la adhesión consistió en 24 ítems que representaban intervenciones esenciales del terapeuta de ambos tratamientos. Un grupo de calificadores capacitados codificaron las grabaciones de ambas terapias. El autoinforme de alianza de los adolescentes se midió en la cuarta sesión. La adhesión a la TFBA estuvo asociada con un aumento considerable de la cohesión familiar en la mitad del tratamiento, pero no después del tratamiento. La adhesión a la TAND-OF estuvo asociada considerablemente con un aumento de la ideación suicida después del tratamiento. Utilizando la alianza terapéutica como moderadora, la adhesión a la TFBA estuvo asociada considerablemente con una reducción de la ideación suicida, el conflicto familiar y una mayor satisfacción del paciente después del tratamiento. La alianza no afectó positivamente la asociación de la adhesión a la TAND-OF con los resultados. Los resultados sugieren que la adhesión a las intervenciones de TFBA puede asociarse mejor con los resultados del tratamiento cuando los adolescentes sienten una alianza fuerte con su terapeuta. Se analizan las implicancias para futuras investigaciones y para la capacitación de los terapeutas.

Parent immigration stress predicts youth externalizing behavior trajectories among Latino families in an emerging immigrant context.

According to ecodevelopmental and social learning models, Latino immigrant parents experience considerable stress associated with the immigration process, and such immigration-related stress is theorized to influence behavioral outcomes among their youth. Using a three-year longitudinal design among 217 Latino immigrant families in western Oregon, we assessed whether parents' (94% mothers, Mage  = 36.2 years) experience of immigration-related stress influenced the trajectory of their adolescents' (43% female, Mage = 13.4 years) externalizing behaviors. Controlling for covariates (gender, acculturation, age at migration, and gender), results showed that youth exhibited a normative downward trajectory for externalizing behaviors, and parents' experience of immigration stress significantly and negatively predicted this trajectory. Findings suggest that parents' experience of immigration stress may disrupt a normative trajectory of declining externalizing behaviors among Latino immigrant adolescents.

De acuerdo con los modelos de ecodesarrollo y de aprendizaje social, los padres inmigrantes latinos sufren bastante estrés asociado con el proceso de inmigración, y se cree que este estrés relacionado con la inmigración influye en los resultados conductuales entre sus hijos adolescentes. Utilizando un diseño longitudinal de tres años entre 217 familias de inmigrantes latinos del oeste de Oregon, evaluamos si el estrés sufrido por los padres debido a la inmigración (el 94 % madres, edad promedio = 36.2 años) influyó en la trayectoria de las conductas de exteriorización de sus hijos adolescentes (el 43 % de sexo femenino, edad promedio = 13.4 años). Teniendo en cuenta las covariables (el género, la aculturación, la edad al momento de la migración), los resultados indicaron que los adolescentes demostraron una trayectoria normativa descendente para las conductas de exteriorización, y que el estrés sufrido por los padres debido a la inmigración predijo significativamente y negativamente esta trayectoria. Los resultados indican que el estrés sufrido por los padres debido a la inmigración puede alterar una trayectoria normativa de disminución de las conductas de exteriorización entre los hijos adolescentes de inmigrantes latinos.

Family profiles based on family life satisfaction in dual-earner households with adolescent children in Chile.

Research has stressed the importance of the family domain for the individual's well-being, but the heterogeneity/homogeneity of satisfaction with family life between and within families have not previously assessed. This study identifies family profiles based on the level of family life satisfaction in mother-father-adolescent triads and determines whether profiles differ in terms of the three family members' perceived family support, importance assigned to the family, both parents' work-life balance and mental health, and the household's economic situation. The sample was composed of 303 families of different-sex dual-earner parents with one child aged between 10 and 17 years, from Temuco, Chile. A Latent Profile Analysis was used to identify three profiles: Families with low family satisfaction (17.80%), Families with medium family satisfaction (68.14%), and Families with high family satisfaction (14.06%). Profiles also differed in the three family members' perceived family support and importance assigned to the family, both parents' work-life balance and mental health, and in the household's income. Mothers, fathers, and adolescents in these profiles also differed from one another in these variables. The main variable related to the family members' satisfaction with family life was the parents' mental health problems. Family life satisfaction in dual-earner couples with adolescent children is heterogenous, and these profiles draw attention to indicators of parent-child well-being. Families with lower levels of family satisfaction require particular attention in research and interventions, as these families may report a lower household income, and the parents may experience higher rates of depression, anxiety, and stress, and diverging levels of work-life balance.

Las investigaciones han acentuado la importancia del ámbito familiar para el bienestar de las personas, pero la heterogeneidad/homogeneidad de la satisfacción con la vida familiar entre las familias y dentro de estas no se ha evaluado previamente. En este estudio se reconocen los perfiles familiares basados en el nivel de satisfacción con la vida familiar en triadas madre-padre-adolescente, y se determina si los perfiles difieren desde el punto de vista del apoyo familiar percibido por los tres miembros de la familia, la importancia asignada a la familia, el equilibrio entre el trabajo y la vida, la salud mental de ambos padres, y la situación económica del hogar. La muestra estuvo conformada por 303 familias de padres de distinto sexo que aportaban ingresos con un niño de entre 10 y 17 años de Temuco, Chile. Se usó un análisis de perfiles latentes para identificar tres perfiles: familias con una satisfacción familiar baja (17.80 %), familias con una satisfacción familiar media (68.14 %) y familias con una satisfacción familiar alta (14.06 %). Los perfiles también difirieron en el apoyo familiar percibido por los tres miembros de la familia y la importancia asignada a la familia, el equilibrio entre el trabajo y la vida, la salud mental de ambos padres, y los ingresos del hogar. Las madres, los padres y los adolescentes de estos perfiles también se diferenciaron unos de otros en estas variables. La principal variable relacionada con la satisfacción de los miembros de la familia con la vida familiar fue los problemas de salud mental de los padres. La satisfacción con la vida familiar en las parejas donde tanto el padre como la madre aportan ingresos y tienen hijos adolescentes es heterogénea, y esos perfiles dirigen la atención hacia los indicadores del bienestar de los padres y los hijos. Las familias con niveles bajos de satisfacción familiar necesitan que se les preste particular atención en las investigaciones y en las intervenciones, ya que estas familias pueden informar ingresos más bajos en el hogar y los padres pueden sufrir índices más altos de depresión, ansiedad y estrés, y tener diferentes niveles de equilibrio entre la vida y el trabajo.

Toward tailored care for families with multiple problems: A quasi-experimental study on effective elements of care.

Several effective interventions have been developed for families with multiple problems (FMP), but knowledge is lacking as to which specific practice and program elements of these interventions deliver positive outcomes. The aim of this study is to assess the degree to which practice and program elements (contents of and structure in which care is provided) contribute to the effectiveness of interventions for FMP in general and for subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. We performed a quasi-experimental study on the effectiveness of practice and program elements provided in attested FMP interventions. Using self-report questionnaires, we measured primary (child's internalizing and externalizing problems) and secondary (parental stress and social contacts) outcomes at the beginning, end, and three months thereafter. By means of Latent Profile Analysis, we identified groups of families receiving similar combinations of practice elements ("profiles"), and we calculated propensity scores. Next, we assessed how practice element profiles and program elements affected improvement in outcomes, and whether these effects were moderated by subgroup characteristics. We found three practice element profiles (explorative/supportive, action-oriented, and their combination), which were equally effective. Regarding program elements, effects were enhanced by more frequent telephone contact between visits and more frequent intervision. Effectiveness of practice and program elements varied for specific FMP subgroups. Variations in the content of care for FMP do not affect its effectiveness, but variations in the structure of the care do. This finding can help to further improve effective interventions.

Se han desarrollado varias intervenciones eficaces para familias multiproblemáticas, pero se sabe poco acerca de qué elementos específicos de la práctica y de los programas de estas intervenciones producen resultados positivos. El objetivo de este estudio es evaluar el grado en el cual los elementos de la práctica y de los programas (los contenidos de la asistencia y la estructura en la cual se presta) contribuyen a la eficacia de las intervenciones para familias multiproblemáticas en general, y para subgrupos de padres o hijos con problemas psiquiátricos, discapacidades intelectuales o consumo de sustancias. Realizamos un estudio cuasiexperimental sobre la eficacia de los elementos de la práctica y de los programas proporcionados en intervenciones certificadas para familias multiproblemáticas. Utilizando cuestionarios de autoinforme, medimos los resultados primarios (los problemas de interiorización y de exteriorización de los niños) y secundarios (estrés de los padres y contactos sociales) al comienzo, al final y tres meses a partir de entonces. Por medio del análisis de perfiles latentes, identificamos grupos de familias que recibían combinaciones similares de elementos de la práctica ("perfiles") y calculamos los puntajes de propensión. Después, evaluamos cómo los perfiles de los elementos de la práctica y los elementos del programa afectaron las mejoras en los resultados, y si estos efectos estuvieron moderados por las características de los subgrupos. Encontramos tres perfiles de elementos de la práctica (exploratorio/comprensivo, orientado a la acción y su combinación) que fueron igualmente eficaces. Con respecto a los elementos de los programas, los efectos mejoraron con el contacto telefónico más frecuente entre visitas y una intervisión más frecuente. La eficacia de los elementos de la práctica y de los programas varió según los subgrupos específicos de familias multiproblemáticas. Las variaciones en el contenido de la asistencia para las familias multiproblemáticas no afectan su eficacia, pero las variaciones en la estructura de la asistencia, sí. Estos resultados pueden ayudar a mejorar aún más las intervenciones eficaces.

[Impact of pelvic floor educational sessions on teenage girls]. / Impact de sessions d'éducation périnéale chez des adolescentes.

INTRODUCTION: Our objective was to evaluate the impact of pelvic floor educational sessions on teenage girls about their general knowledge of pelvic floor disorders (PFD) and the anatomy of the pelvic floor. MATERIAL: Educational sessions were offered to teenage girls from middle and high schools in the city of Caen. Each session included pelvic floor anatomy, urinary and digestive physiology as well as situations that favor PFD. At the beginning and end of the session, the participants received a questionnaire on their knowledge and questions concerning their satisfaction were asked at the end of the session. A questionnaire was sent at 2 months to assess the changes in their urinary and digestive habits as well as the dissemination of information to those around them. RESULTS: One hundred and five teenage girls, average age 15, participated in these sessions; 61% responded at 2 months. The educational sessions have significantly improved knowledge about the pelvic floor. After the sessions, 92% and 52% reported having changed their urinary and defecatory habits. Participants found the sessions very useful and all participants recommended these sessions to a friend. CONCLUSION: Pelvic floor educational sessions improve the knowledge of teenage girls and limit behaviors that favor PFD. Teenage satisfaction is important and the dissemination of information is high. A pelvic floor educational program in schools could help limit risky behaviors for the pelvic floor.

[Pelvic floor disorders: What do adolescents and young women know? A literature review]. / Troubles pelvi-périnéaux : quelles connaissances en ont les adolescentes et les jeunes femmes ? Une revue de la littérature.

AIM: To assess the knowledge of adolescent girls and young women on pelvic-perineal disorders (PPD). METHOD: We searched on PubMed, Cochrane Library, Kinédoc and Semantic Scholar databases using the MeSH keywords: "knowledge" "awareness" "surveys" "young women" "pelvic floor" "adolescent" "teenager" "athletic injury" "urinary incontinence". The articles had to have been published within the last 15 years, written in French or English, and deal with the state of knowledge of adolescents and young women concerning the perineal sphere using questionnaires. RESULTS: A total of 8 studies were included in the review, 5 cross-sectional studies and 3 intervention studies. The knowledge of adolescent girls and young women interviewed about the anatomy of the pelvic floor, its function, and risk factors for PPD was low. The majority of the participants wanted more information about the pelvic floor. Two studies that conducted an educational intervention showed a significant improvement in knowledge. CONCLUSION: Knowledge of pelvic-perineal disorders and pelvic floor function is poor in adolescent girls and young women. To better assess them, it would be necessary to validate a questionnaire containing all the items about knowledge.

Establishing percentiles for blood pressure based on absolute height for children and adolescents.

BACKGROUND: Evaluating blood pressure (BP) is one element for diagnosing and preventing disease in student populations. The objectives of this research were to (a) identify the range of height for measuring BP adjusted for student populations and (b) propose percentiles for evaluating BP based on height. METHODS: A cross-sectional study was carried out with 3,013 students. Weight, height, and diastolic (DBP) and systolic (SBP) blood pressure were evaluated. Body Mass Index (BMI) was calculated. Height ranges of 5 and 10 cm were generated. RESULTS: R2 values for height ranges of 5 cm consisted of [normotensive: DBP (R2 = 10 to 13%) and SBP (R2 = 14 to 20%), and for hypertensive: DBP (R2 = 0.07 to 15%) and for SBP (R2 = 29 to 32%)]. For height ranges of 10 cm, values included: [normotensive: DBP (R2 = 10 to 15%), and SBP (R2 = 15 to 21%) and for hypertensive: DBP (R2 = 0.07 to 16%) and SBP (R2 = 29 to 35%)]. For 5 cm height ranges, diferences occurred between both sexes for DBP (in 5 height ranges from 123 to 148 cm and 158 to 168 cm) and for the SBP (in 6 height ranges from 128 to 148 cm and from 158 to 168 cm). In the 10 cm categories, diferences appeared in DBP (from 138 to 148 cm) and in the SBP (from 158 to 168 cm). CONCLUSIONS: Height is a determinant for evaluating blood pressure, and height ranges of 10 cm are more suitable for children and adolescents. The proposed percentiles based on height ranges allowed assessment of the DBP and SBP suggest their use in epidemiological and educational contexts.

Joint Physical Custody and Adolescents' Life Satisfaction in 37 North American and European Countries.

Joint physical custody, a parental care arrangement in which a child lives with each parent about equally after separation or divorce, is an increasingly common phenomenon in many Western countries. Although attention from family scholars, practitioners, and law professionals is growing, there are hardly any numbers on the prevalence of joint physical custody (JPC). Moreover, studies using large-scale representative data on the effects of JPC for children's well-being are still rare. The data for this study come from Health Behaviour in School-Aged Children (HBSC), a representative cross-national survey of adolescents in 37 European and North American countries that was conducted in 2002, 2006, and 2010 and included information on students at the ages of 11, 13, and 15 years (N = 92,886). First, results revealed that symmetrical JPC after family dissolution is still very rare in the majority of countries (5% or less), but reaches 10-20% in some countries. Second, adolescents' life satisfaction in nonintact families is higher in symmetric JPC arrangements than in asymmetric care arrangements. However, after controlling for children and family characteristics, the differences disappear. Thus, it is not the symmetric JPC arrangement that induces adolescents' higher life satisfaction, but rather the children and family characteristics that are associated with the choice of such a custody arrangement by separated or divorced parents.

La custodia física conjunta, un acuerdo de cuidado parental por medio del cual un niño vive con cada padre más o menos por igual después de la separación o el divorcio, es un fenómeno cada vez más común en muchos países occidentales. Aunque la atención por parte de los investigadores familiares, los profesionales de la salud y los abogados está aumentando, hay muy pocas cifras sobre el predominio de la custodia física conjunta. Además, los estudios que utilizan datos representativos a gran escala sobre los efectos de la custodia física conjunta para el bienestar de los niños todavía son escasos. Los datos para este estudio provienen del Estudio sobre las conductas saludables de los jóvenes escolarizados (Health Behaviour in School-Aged Children, HBSC), una encuesta transnacional representativa de adolescentes en 37 países europeos y norteamericanos que se realizó en 2002, 2006 y 2010 e incluyó información sobre alumnos a las edades de 11, 13, y 15 años (N=92,886). En primer lugar, los resultados revelaron que la custodia física conjunta simétrica después de la división familiar aun es muy rara en la mayoría de los países (5 % o menos), pero llega a entre el 10 y el 20 % en algunos países. En segundo lugar, la satisfacción con la vida de los adolescentes en familias no intactas es mayor en los acuerdos de custodia física conjunta simétrica que en los acuerdos de cuidado asimétrico. Sin embargo, después de tener en cuenta las características de los niños y las familias, las diferencias desaparecen. Por lo tanto, no es el acuerdo de custodia física conjunta simétrica lo que causa una mayor satisfacción con la vida en los adolescentes, sino las características de los niños y las familias que están asociadas con la elección de dicho acuerdo de custodia por parte de los padres separados o divorciados.

Burden and Treatment Satisfaction among Caregivers of Adolescents with Borderline Personality Disorder.

Despite the fact that family involvement is encouraged in early interventions for borderline personality disorder (BPD), there is a limited knowledge on the experience of caring for adolescents with BPD. This is an exploratory retrospective study nested within a randomized controlled trial that compared mentalization-based treatment (MBT) in groups to treatment as usual for adolescents with BPD. Caregivers received six MBT-Parents sessions or standard care over one year. Three months after end of treatment (EOT), 75 caregivers (35 in MBT, 40 in TAU) filled out the Burden Assessment Scale, and 71 (34 in MBT, 37 in TAU) the Family Satisfaction Survey. The adolescents filled out the Borderline Personality Features Scale for Children at baseline and after twelve months at EOT. We tested whether caregiver demographics, adolescents' severity of BPD, treatment and adolescents' dropout from treatment predicted levels of caregiver burden and satisfaction with treatment. The caregivers reported high levels of burden on the BAS (M = 40.3, SD = 12.2). Our study suggests that higher BPD severity at EOT among the adolescents predicted caregiver burden (p = .03), whereas higher baseline BPD severity predicted satisfaction with treatment (p = .04) and that biological mothers could be more burdened than other types of caregivers but also might be more satisfied with treatment. Treatment and adolescents' dropout from treatment were not related to caregiver burden or satisfaction with treatment. To help inform future research and to devise appropriate interventions for caregivers and adolescents with BPD, it is important to identify possible predictors of caregiver burden. The results of this initial exploratory study indicate that caregivers (and particularly biological mothers) of adolescents with more severe levels of BPD could be particularly vulnerable toward feelings of burden and therefore are in need of support.

A pesar del hecho de que se recomienda la participación familiar en las primeras intervenciones para el trastorno límite de la personalidad (TLP), se sabe muy poco sobre la experiencia de cuidar a adolescentes con TLP. El presente es un estudio retrospectivo exploratorio enmarcado en un ensayo controlado aleatorizado que compara el tratamiento basado en la mentalización (TBM) en grupos con el tratamiento habitual (TH) para adolescentes con TLP. Los cuidadores recibieron seis sesiones de TBM para padres o la atención normal durante un año. Tres meses después del final del tratamiento, 75 cuidadores (35 en TBM, 40 en TH) completaron la Escala de Evaluación del Agobio (Burden Assessment Scale), y 71 (34 en TBM, 37 en TH) la Encuesta de Satisfacción Familiar (Family Satisfaction Survey). Los adolescentes completaron la Escala de Características de la Personalidad Límite para Niños (Borderline Personality Features Scale for Children) en el momento basal y después de doce meses al final del tratamiento. Evaluamos si las características demográficas de los cuidadores, la intensidad del TLP de los adolescentes, el tratamiento y la deserción del tratamiento por parte de los adolescentes predijeron niveles de agobio en los cuidadores y de satisfacción con el tratamiento. Los cuidadores informaron niveles altos de agobio en la Escala de Evaluación del Agobio (M = 40.3, DT= 12.2). Nuestro estudio indica que una mayor intensidad del TLP al final del tratamiento entre los adolescentes predijo el agobio del cuidador (p = .03), mientras que una mayor intensidad del TLP en el momento basal predijo la satisfacción con el tratamiento (p = .04), y que las madres biológicas podrían estar más agobiadas que otros tipos de cuidadores, pero también podrían estar más satisfechas con el tratamiento. El tratamiento y la deserción del tratamiento por parte de los adolescentes no estuvieron relacionados con el agobio del cuidador ni con la satisfacción con el tratamiento. Con el fin de contribuir a ampliar futuras investigaciones y de idear intervenciones adecuadas para cuidadores y adolescentes con TLP, es importante reconocer posibles predictores del agobio del cuidador. Los resultados de este estudio exploratorio inicial indican que los cuidadores (y particularmente las madres biológicas) de los adolescentes con niveles más intensos de TLP podrían ser particularmente vulnerables hacia sentimientos de agobio y, por lo tanto, necesitan apoyo.

Interparental Relationship Adjustment, Parenting, and Offspring's Cigarette Smoking at the 10-Year Follow-up.

Familial influences on children's cigarette smoking have been established, yet little is known about whether these influences in childhood relate to offspring's smoking behavior in adolescence. Drawing on prior work showing that children's emotional and behavioral problems (i.e., internalizing and externalizing behavior problems) are influenced by both interparental and parent-child relationships, we examined whether children's emotional and behavioral problems would further predict their smoking behavior in adolescence. Two hundred and twenty-one families were followed from early childhood (Mage  = 4.05 years) to the 10-year follow-up. Interparental relationship adjustment and disagreement, dysfunctional parenting, and children's emotional and behavioral problems were reported by both mothers and fathers. Adolescents' self-reported cigarette smoking status was assessed along with other demographic variables. Using structural equation modeling, the hypothesis was only supported based on mothers' reports, suggesting that early couple relationship adjustment and parenting relate to children's emotional and behavioral problems, which associate with smoking behavior in adolescence. When the hypothesized model was tested with emotional and behavioral problems separately, only behavioral problems were related to adolescent smoking for both parents. Findings from this study support models of family environment and children's behavioral problems, providing evidence of the long-term links with adolescent cigarette smoking behaviors. Further family-focused research and preventive work, for instance, testing the combination of partner support and parent training, are needed.

Se han establecido las influencias familiares en el consumo de cigarrillos de los niños, sin embargo, se sabe poco acerca de si estas influencias en la niñez se relacionan con la conducta de consumo de cigarrillos de los niños en la adolescencia. Teniendo en cuenta trabajos anteriores que demuestran que los problemas conductuales y emocionales de los niños (p. ej.: los problemas de conductas de exteriorización e interiorización) están influenciados tanto por las relaciones interparentales como por las relaciones entre padres e hijos, analizamos si los problemas emocionales y conductuales de los niños predecirían, además, su conducta de consumo de cigarrillos en la adolescencia. Se siguió a doscientas veintiuna familias desde la primera infancia (edad promedio = 4.05 años) hasta el control a los diez años. Tanto las madres como los padres informaron adaptación y desacuerdo en las relaciones interparentales, crianza disfuncional y problemas conductuales y emocionales de los niños. Se evaluó la situación de consumo de cigarrillos autoinformada por los adolescentes junto con otras variables demográficas. Utilizando modelos de ecuaciones estructurales, se respaldó la hipótesis solo sobre la base de los informes de las madres, lo cual sugiere que la adaptación temprana en la relación de pareja y la crianza se relacionan con los problemas emocionales y conductuales de los niños, los cuales se asocian con la conducta de fumar en la adolescencia. Cuando el modelo hipotetizado se probó con problemas conductuales y emocionales por separado, solo los problemas conductuales se relacionaron con el consumo de cigarrillos de los adolescentes para ambos padres. Los hallazgos de este estudio respaldan los modelos de entorno familiar y los problemas conductuales de los niños, ya que ofrecen indicios de los vínculos a largo plazo con las conductas de consumo de cigarrillos en los adolescentes. Se necesitan más investigaciones centradas en la familia y trabajos preventivos, por ejemplo, la evaluación de la combinación de apoyo para padres y de capacitaciones para padres.