Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses / Interdisciplinary intervention for the primary prevention of dental caries in children under 18 months

Introducción: la caries es la enfermedad crónica más frecuente en la infancia. La presencia de caries en la dentición temporal es el principal factor de riesgo para desarrollar caries en la dentición definitiva. La mayoría de los factores de riesgo de la caries son modificables y pueden convertirse en elementos para la prevención y control de la enfermedad. Con el objetivo de reducir la incidencia de caries a la edad de 18 meses se diseña una intervención interdisciplinaria de prevención primaria dirigida a familias con niños que se visitan siguiendo el Protocol d’activitats preventives i de promoció de la salut a l’edat pediátrica (PAPPS). Material y métodos: ensayo clínico no aleatorizado, realizado en dos centros de asistencia primaria de Catalunya desde enero de 2019 hasta junio de 2022. En uno de los centros se diseñó e implementó una intervención educativa de prevención primaria de la caries con consejos y habilidades para las familias. En el otro centro se mantuvo el protocolo habitual de recomendaciones. Se evaluó y comparó la incidencia de caries en ambos grupos a la edad de 18 meses con un modelo de regresión logística estimado con el programa R. Resultados: la incidencia de caries a los 18 meses fue superior en los niños del grupo control (OR = 6,0; IC 95% 1,8-20,2), a pesar de que la valoración del riesgo de caries basada en el sistema llamado Caries Management by Risk Assessment (CAMBRA) indicó mayor riesgo de desarrollo de caries en los lactantes del grupo intervención. Conclusión: la intervención interdisciplinaria de prevención primaria de la caries incorporada en los programas de salud infantil reduce la incidencia de caries en los primeros años de vida. (AU)

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the goal of reducing the incidence of caries in children at age 18 months, we designed an interdisciplinary primary prevention intervention aimed at families with children who attended routine preventive visits within the PAPPS (“Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica”) child health programme. Methodology: non-randomized clinical trial carried out in two primary care centres in Catalonia between January 2019 and June 2022. In one of the centres, an educational intervention for the primary prevention of caries was designed and implemented to provide families with guidance and skills. In the other centre, patients received standard care. The incidence of caries was assessed and compared in both groups at age 18 months by means of a logistic regression model fitted with the R software. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI: 1.8-20.2), despite the fact that the caries risk assessment by means of the “Caries Management by Risk Assessment” (CAMBRA) protocol indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention integrated into the child health prevention and promotion programme achieved a reduction in the incidence of caries in early childhood. (AU)

The temporal dimension in the understanding of maternal sensitivity in caregiver-infant interactions: The 'Early Mother-Child Interaction Coding System'.

Caregiver-child interaction is known to play a central role in children's socioemotional development, yet the diversity of measures commonly used to evaluate it call into question the nature of the construct being assessed. Contingency within caregiver-child interactions has been identified as a key dyadic process that requires taking a temporal perspective to evaluating interactions. The Early Mother-Child Interaction Coding System is a psychometrically sound measure that sequentially code the flow of interactive and non-interactive behaviours within a caregiver-infant system. Its use of the framework of nonlinear dynamical systems (NDS) expands our understanding of contingent caregiver-infant dyadic behaviour.

The Temporal Dimension in Maternal Sensitivity Predicting Organized Attachment in Children.

This study analyzed Maternal Sensitivity in the interaction of mother-infant dyads to distinguish different dynamics associated with their attachment group membership - Insecure-Avoidant (A), Secure (B), or Insecure-Resistant (C), with no Disorganized traits - that they developed at 15 months. Participants were 26 eight-month old infants interacting with their mothers in a free-play setting. The analyses used sequential streams of infant actions and maternal responses, and state-space grids to study the temporal organization of the sequences. We examined appropriateness and promptness of the maternal response to infant behavior and a dynamic analysis of the interactive process. In Group B, when the antecedent behavior was infant social approach, the appropriateness of the maternal profile (sensitive vs. intrusive responses) was related to their children's subsequent security. However, how promptly mothers responded was not predictive. Conversely, when the antecedent behavior was infant play, how promptly the mothers responded was associated with securely attached children while mothers' profile of appropriate responses did not distinguish the subsequent quality of attachment. The indices derived from state-space grids were associated with attachment type and distinguished Group C from Groups B and A. However, results from analysis of a specific region of states, 'maternal interfering response to infant social approach,' showed significant discriminant function that correctly classified 78% of Group B, 73% of Group A, and 83% of Group C. Group B infants received less intrusive behavior than their counterparts, and when they did, it involved positive affection or playfulness. Finally, regarding attractors, although more Group B dyads showed multi-stability of coexisting attractors, than Groups A or C, the differences were not statistically significant.

Parental and Infant Gender Factors in Parent-Infant Interaction: State-Space Dynamic Analysis.

This study aimed to investigate the influence of parental gender on their interaction with their infants, considering, as well, the role of the infant's gender. The State Space Grid (SSG) method, a graphical tool based on the non-linear dynamic system (NDS) approach was used to analyze the interaction, in Free-Play setting, of 52 infants, aged 6 to 10 months, divided into two groups: half of the infants interacted with their fathers and half with their mothers. There were 50% boys in each group. MANOVA results showed no differential parenting of boys and girls. Additionally, mothers and fathers showed no differences in the Diversity of behavioral dyadic states nor in Predictability. However, differences associated with parent's gender were found in that the paternal dyads were more "active" than the maternal dyads: they were faster in the rates per second of behavioral events and transitions or change of state. In contrast, maternal dyads were more repetitive because, once they visited a certain dyadic state, they tend to be involved in more events. Results showed a significant discriminant function on the parental groups, fathers and mothers. Specifically, the content analyses carried out for the three NDS variables, that previously showed differences between groups, showed particular dyadic behavioral states associated with the rate of Transitions and the Events per Visit ratio. Thus, the transitions involving 'in-out' of 'Child Social Approach neutral - Sensitive Approach neutral' state and the repetitions of events in the dyadic state 'Child Play-Sensitive Approach neutral' distinguished fathers from mothers. The classification of dyads (with fathers and mothers) based on this discriminant function identified 73.10% (19/26) of the father-infant dyads and 88.5% (23/26) of the mother-infant dyads. The study of father-infant interaction using the SSG approach offers interesting possibilities because it characterizes and quantifies the actual moment-to-moment flow of parent-infant interactive dynamics. Our findings showed how observational methods applied to natural contexts offer new facets in father vs. mother interactive behavior with their infants that can inform further developments in this field.

Mother-Infant Verbal and Nonverbal Interaction as Predictor of Attachment: Nonlinear Dynamic Analyses.

This longitudinal study examined flexibility in early mother-infant interaction at the age of approximately 6 months (N=30) and whether flexibility indices predicted (in) secure child attachment at 15 months. Dyadic flexibility was measured using dynamic systems-based modelling of patterns during mother-child free play in terms of NDS variables derived from SSG: the propensity to change states (dynamic flexibility), number of states visited (diversity) and predictability (dispersion). Results showed significant discriminant functions on the attachment type groups, A, B & C, for the total grid, which included verbal and non-verbal, and for the reciprocal verbal region. Specifically, the prediction outcomes seem to work better in total grid for A-dyads and in the reciprocal verbal region for B and C-dyads. Diversity emerged as the most relevant index in dyadic flexibility: A-dyads showed the least diversity, distinguished them from B-dyads in the verbal regions, (both the reciprocal and non-reciprocal, 'child verbal-mother non-verbal' one), and, from C-dyads in the reciprocal non-verbal region. A-dyads showed remarkably low activity in the regions involving child verbal behavior, showing that children who became avoidant attached at 15 months of age, were mostly silent at approximately 6 months, when they interacted with their mothers. Findings in this study contribute to advancing conceptually informed measurement of dyadic interaction to provide a new perspective on maternal sensitivity and early markers of child insecure/secure attachment.

Intimate Partner Violence in Self-Identified Lesbians: A Systematic Review of Its Prevalence and Correlates.

This article presents the first systematic review on intimate partner violence (IPV) in self-identified lesbians in same-sex couples. Studies published from January 1990 to December 2013 were analyzed. Of the 687 studies reviewed, 59 were preselected, of which 14 studies were selected that met the inclusion and methodological quality criteria. A summary is presented of the characteristics of the studies, the participants, the prevalence of IPV victimization and perpetration, and its correlates. All the studies were carried out in the United States and used a nonprobabilistic sampling method. The majority of participants were White with a high educational level. The results indicate that all the forms of violence occur, but the most prevalent is emotional/psychological violence. The correlates positively associated with IPV are certain personality characteristics, fusion, previous IPV experience, a family history of violence, and alcohol consumption. This review finds significant limitations in the analyzed literature. Methodological recommendations are made for future studies.

Dose-effect on the mothers and babies attending the Programa de Apoyo Psicológico P/Materno-Infantil© / Efecto de la dosis de intervención del Programa de Apoyo Psicológico P/Materno Infantil© sobre las madres y sus bebés

Se analizan los efectos de la dosis de intervención del Programa de Apoyo Psicológico P/Materno Infantil© (Cerezo 1992). Es un Programa dirigido a toda la población, que apoya a los padres durante los primeros 18 meses de vida del bebé, cuyo objetivo es promover sistemas adaptativos protectores en los niños. Los efectos de la dosis de intervención se evalúan sobre las madres, en sus niveles de distrés o malestar psicológico informado por ellas, y sobre sus bebés, en el tipo de apego que desarrollan evaluado con la "Situación Extraña" de Ainsworth y colaboradores (1978). La muestra son 342 familias que acuden al Programa entre 2 y 4 visitas antes de la evaluación post-intervención. Los resultados indican que se requieren al menos 3 sesiones de intervención para que se produzcan descensos significativos de las puntuaciones que obtienen las madres en distrés entre la evaluación pre y post. La proporción de niños con apego seguro es mayor cuando la familia acude 3 ó 4 visitas que cuando acude 2. También, se observa que las madres de niños con apego inseguro tienen puntuaciones más altas en distrés, y en otros factores que afectan la parentalidad, que las madres de niños con apego seguro

This paper presents an analysis of the intervention dose-effect of the Parent Child Psychological Support Program© (Cerezo 1990) a program aimed at promoting protective adaptive system in children which is offered to all newborns in a given catchment area. The program offers support to parents during the first 18 months of the baby’s life. The program dose-effect is examined regarding the parents by examining the level of distress reported by them and with babies by examining the development of attachment using the Strange Situation test of Ainsworth et al. (1978). The study is based on 342 families who made between 2 and 4 visits to the Pro-gram before being evaluation post-intervention. The results indicate that at least 3 program sessions are required to produce a significant decrease in the distress scores for mothers, between pre and post evaluation. The pro-portion of children with secure attachment is greater when the family attends 3 or 4 times, compared to those who attend on 2 occasions. It was also noted that mothers of children with insecure attachment had higher scores on the maternal distress and other factors affecting parenting than mothers of children with secure attachment

Mother-infant interaction and quality of child's attachment: a nonlinear dynamical systems approach.

The traditional classification of infant attachment described three distinct types (Ainsworth et al. 1978): Secure (B), Insecure-avoidant (A), and Insecure-resistant (C). Research shows that the quality of infant attachment reflects the child's history of interaction with their primary caregiver and, therefore, maternal sensitivity and appropriateness of maternal responses during the first year of life has been found to predict infant attachment. In this study Nonlinear Dynamic Systems (NDS) approach was applied to broaden the study of maternal sensitivity into the overall temporal organization of mother-infant relationship exchanges. The study focuses on understanding the differences between secure and insecure attached children by applying NDS in two temporal scales: real time and a developmental scale, with the notions of 'flexibility' and 'self-organization', respectively. Infants, classified as securely or insecurely attached at 15 months, had free-play situations with their mothers, at 6 and 12 months of age, videotaped and coded in real time. Results showed that at 6 months dyads from the B group, compared to the non-B group, showed higher flexibility through several NDS indices derived from the State-Space Grid method (SSG). The dyads at 12 months did not show differences in those indices. Moreover, B group showed self-organization by decreasing the number of attractors, from 6 to 12 months of infant's age, in contrast with A and C groups that either showed less self-organization, by increasing the number of attractors, or stayed basically as they were at 6 months. Furthermore, the B group showed an increase in the proportion of attractors with higher values from time 1 to time 2, in contrast to the non-B groups. Findings provide some grounds for using a SSG approach to deepen the construct of maternal sensitivity in dyadic terms.

El efecto del optimismo no realista en la intención de uso del condón como método de prevención de embarazos no deseados y de enfermedades de transmisión sexual / The effect of unrealistic optimism in the intention of the use of the condom as method of prevention of non-wanted pregnancies and sexually transmitted diseases

El optimismo no realista (ONR) se produce cuando una persona estima que su probabilidad de ser víctima de un suceso desagradable o peligroso es menor que la de otros. Se trata de un sesgo cognitivo que puede comprometer la eficacia de los programas de promoción de la salud. Este artículo analiza la existencia del ONR en la intención de uso del condón como método de prevención de embarazos no deseados (END) y de enfermedades de transmisión sexual (ETS). Para ello, se ha utilizado una adaptación del cuestionario de Zakay (1996) y Fernández-Castro, Limonero, Rovira y Albaina (2002) en una muestra de 292 universitarios con más de 20 años (181 mujeres y 111 hombres). Nuestros resultados confirman la existencia del ONR en la intención del uso del condón, siendo mayor el sesgo ante las situaciones de END que ante las ETS. En concreto, los sujetos creen tener menos probabilidades que otros de sufrir un END tanto si no utilizan el condón como si, al utilizarlo, éste se rompe. También creen tener menos probabilidades que otros de contagiarse con una ETS cuando no usan el condón. El efecto del ONR es mayor en los hombres que en las mujeres (AU)

Unrealistic optimism (UO) occurs when a person considers that his or her probability to go through an unpleasant or dangerous event is lower than that in others. It is a cognitive bias that can endanger the effectiveness of health care programmes. This article explores the existence of UO related to the use of the condom in situations of non-wanted pregnancies (NWP) and sexually transmitted diseases (STD). We have used a modified version of the questionnaire designed by Zakay (1996) and later adjusted by Fernández-Castro, Limonero, Rovira y Albaina (2002) (2002) in a sample of 292 college students with more than 20 years old (181 women and 111 men). Our results confirm the existence of the UO in the use of the condom, finding a greater bias in NWP’s situations than in STD. Specifically, we found that study subjects believed they were less liable to go through a NWP if not using the condom (or if it tore) than other people. Regarding STD, they also believed that their probability of being infected without using the condom was lower than in others. Therefore, we found that men are more prone to UO than women (AU)

Nocturnal blood pressure and progression to end-stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4.

OBJECTIVE: The objective was to assess the role of office and ambulatory blood pressure (BP) on the development of end-stage renal disease (ESRD) in nondiabetic chronic renal failure. DESIGN AND METHOD: Seventy-nine patients [mean age 57 (standard deviation 11) years, 47 men, BMI 28 (4), office BP 151 (25)/92 (14) mmHg, estimated glomerular filtration rate 28 (14) ml/min per 1.73 m3] were included. The causes of renal disease were nephrosclerosis (n = 33), glomerulonephritis (n = 19), interstitial (n = 12) and others (n = 15). The average follow-up was 44 months (range 9-72 months). The primary outcome was a composite of death, from any cause, or the development of ESRD that require initiation of renal replacement therapy. In all patients, 24-h ambulatory BP monitoring and left ventricular mass assessment were performed at the beginning of the study. RESULTS: During the follow-up period, 41 (52%) patients progressed to ESRD. In addition, nine (11%) patients died, four before reaching ESRD. Then the combined endpoint rate, 45 patients, was 6.3/100 patients per year. In a multivariate Cox proportional hazard model, which includes age, sex, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker status and the estimated glomerular filtration rate, office BP still provided no further prognostic information on risk of the primary outcome. In addition, daytime ambulatory BP and the no-dipper status did not further discriminate in terms of predicting endpoint. Nocturnal SBP more than 130 mmHg was associated with a doubling of risk [heart rate 2.07 (95% confidence interval 1.01-4.25)] on top of the other significant factors. CONCLUSION: Glomerular filtration rate and nocturnal SBP values, but not nondipper pattern, were associated with risk to develop ESRD.

New mutation in female patient with renal variant of Fabry disease and HIV.

We describe the case of a 27-year-old woman with a family history of Anderson-Fabry disease (AFD). Urinary sediment presented microhematuria and 0.9 g/24 hours proteinuria. The alpha-galactosidase A measurement in fibroblasts showed partial deficit of the enzyme, which was compatible with being a carrier of the illness. Renal biopsy gave evidence of kidney lesions from Fabry disease. Genetic study revealed mutation C52Y or Cys52Tyr, which has not been previously described and had also been detected in the father of the patient. During follow-up, the presence of hypergammaglobulinemia revealed an underlying HIV disease. She is now awaiting enzymatic substitution treatment.

Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy.

Spontaneous remission is a well known characteristic of idiopathic membranous nephropathy, but contemporary studies describing predictors of remission and long-term outcomes are lacking. We conducted a retrospective, multicenter cohort study of 328 patients with nephrotic syndrome resulting from idiopathic membranous nephropathy that initially received conservative therapy. Spontaneous remission occurred in 104 (32%) patients: proteinuria progressively declined after diagnosis until remission of disease at 14.7 +/- 11.4 months. Although spontaneous remission was more frequent with lower levels of baseline proteinuria, it also frequently occurred in patients with massive proteinuria: 26% among those with baseline proteinuria 8 to 12 g/24 h and 22% among those with proteinuria >12 g/24 h. Baseline serum creatinine and proteinuria, treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, and a >50% decline of proteinuria from baseline during the first year of follow-up were significant independent predictors for spontaneous remission. Only six patients (5.7%) experienced a relapse of nephrotic syndrome. The incidence of death and ESRD were significantly lower among patients with spontaneous remission. In conclusion, spontaneous remission is common among patients with nephrotic syndrome resulting from membranous nephropathy and carries a favorable long-term outcome with a low incidence of relapse. A decrease in proteinuria >50% from baseline during the first year predicts spontaneous remission.

Proteger a la infancia: Apoyando y asistiendo a las familias / No disponible

Las investigaciones realizadas en las últimas décadas han permitido identificar los factores de riesgo y los procesos relevantes en ladinámica del maltrato infantil, subrayando la importancia de las actuaciones dirigidas a las familias con el objetivo de intervenir enlas relaciones familiares disfuncionales promoviendo el buen trato a la infancia.El presente trabajo se centra en el contexto familiar como objetivo de intervención, especialmente en su vertiente de contexto para ladetección temprana y la prevención. Se aborda el tema de las buenas prácticas parentales y el apoyo a familias en la crianza de sushijos como factores protectores.Se presenta el Servicio Especializado de Atención a la Familia e Infancia como ilustración de una actuación de intervención y losprogramas “Apoyo Personal y Familiar” (APF) y Programa de Apoyo Psicológico P/Materno Infantil © (PAPMI), como ilustracionesde programas de prevención evaluados, dirigidos al apoyo a los padres y a la promoción del buen trato a la infancia.Los datos subrayan la importancia de la prevención primaria especialmente en momentos de crisis económica en los que pueden aumentarlos factores que afectan negativamente a la interacción familiar (AU)

Research carried out in recent decades has identified risk factors and relevant processes in the dynamics of child abuse. Such researchhas highlighted the importance of assisting families, with a view to intervening in dysfunctional parent-child relations and promotingpositive parenting, especially for younger children. The present paper focuses on the family context as a target of intervention,especially in the area of early detection and prevention. We consider good parenting practices and support for families in child-rearingas protective factors. The “Servicio Especializado de Atención a la Familia e Infancia” programme is presented as an illustrationof intervention. Two evidence-based programmes are also presented as illustrations of prevention strategies: “Apoyo Personal y Familiar”(APF) and Parent Child Psychologycal Support Program (PCPS). The main goals of these programmes are to provide supportfor parents in their child-rearing and to promote children’s well-being. Our paper highlights the importance of primary preventionand family intervention, which are particularly relevant in times of economic crisis, because those factors affect family life and increasethe risk situation for children (AU)

Mother-infant interaction and children's socio-emotional development with high- and low-risk mothers.

Charting the dynamic character of mother-infant interaction requires using observational systems of sequential coding in real time. A longitudinal study was designed to approach maternal sensitivity in a more complex way using sequential analysis. The study was conducted with 20 high- and 20 low-risk mothers and their infants (aged: 3, 12 and 15 months) to examine the relation among mothers' risk status for physical abuse and their maternal interactive profiles, using micro-social sequential analyses, and the subsequent quality of attachment developed by their children at 15 months of age. Results showed significantly different timings in maternal responses in high- and low-risk groups, that the high-risk mothers were less sensitive: more intrusive and less discriminate regarding their infant's behavior. Significant differences between groups were also found after infant difficult behavior. High-risk mothers' infants were significantly more likely to develop insecure attachment. Sensitivity is proposed as a constellation of timings in early mother-infant interaction.

Efficacy and safety of 'rescue therapy' with mycophenolate mofetil in resistant primary glomerulonephritis--a multicenter study.

BACKGROUND: Studies of mycophenolate mofetil (MMF) in primary glomerulonephritis have varied in their inclusion criteria, regimen and follow-up compromising assessments of efficacy and optimal dose. METHOD: This multicentre study analysed the safety and efficacy of MMF monotherapy in a large cohort with primary glomerulonephritis that was resistant to other conventional therapies. A total of 98 patients with biopsy-proven primary glomerulonephritis resistant to other drugs received MMF monotherapy for 1 year. Primary outcome measures were urinary protein excretion and the number of patients with complete or partial remission of proteinuria. Secondary analyses were time to remission and changes in the slope of creatinine clearance. RESULTS: Fifty-four percent of the patients achieved either complete or partial remission of proteinuria with no significant differences between glomerulonephritis types. Median (range) dose of MMF was 2 g/day (1.5-2 g/day) Mean (SD) treatment time to remission was 141.5 (+/-61.1) days with no significant differences between glomerulonephritis types. Serum albumin increased (P<0.01), whereas proteinuria (P<0.01) serum LDL-cholesterol (P<0.01) and mean blood pressure (P<0.05) decreased post-treatment. No significant changes were observed in glomerular filtration rate (GFR), serum creatinine or slopes of GFR. The reduction of urinary protein excretion was significantly higher in patients with basal nephrotic proteinuria and preserved renal function; it did not arise from an increased dose of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, since, among responders, mean blood pressure significantly decreased and the number of anti-hypertensive drugs could be reduced. CONCLUSIONS: MMF monotherapy causes a moderate decrease in proteinuria in >50% of the patients who do not have other treatment options. The response to therapy is largely influenced by a preserved renal function and requires sustained MMF treatment.

La evaluación del abuso sexual infantil: comparación entre informes periciales en función del diagnóstico de abuso / The evaluation of child sexual abuse: comparison between expert reports depending on the diagnosis of abuse

El objetivo del presente trabajo es comparar las diferencias existentes entre informes psicológicos periciales que confirman el diagnóstico de abuso sexual infantil de los que no lo confirman. Los datos proceden de 61 informes sobre menores remitidos a un serviciopara el diagnóstico. Las variables se agruparon en: características de la familia, proceso de evaluación y consecuencias psicológicas. Los resultados muestran que hay más niños en el grupo de abuso que viven en familias con graves problemas de relación y/o drogodependenciasy que tienen sentimientos negativos hacia el presunto perpetrador, si bien en esta muestra en un porcentaje elevado de casos el perpetrador utiliza amenazas y/o agresiones. Además se da una alta probabilidad de que el abuso se confirme cuando es el niño el que informa y cuando muestra conducta sexualizada o conocimientos sexuales no apropiados a la edad

The aim of this study was to compare the characteristics of confirmed cases of child sexual abuse assessed by skilled professionals versus cases where abuse was not confirmed. The study examined data concerning 61 children who were referred for diagnosis toa specialized team of evaluators. The factors were grouped in three areas: family characteristics,assessment process and psychological impact. The results showed that in the confirmed cases the children were more likely to be in families with severe relation problems and/or drug addictions in one or both parents and reporting negative feelings toward the alleged perpetrator. Moreover, it was also more likely that in the confirmed cases, the victim was one to report the abuse and showed sexualized behavior or sexual knowledgeinappropriate for their age

Interacción temprana madre-hijo y factores que afectan negativamente a la parentalidad / Early mother-infant interaction and factors negatively affecting parenting

El modelo del procesamiento de información social contribuye a identificar los procesos psicológicos subyacentes al constructo de «sensibilidad» en interacción madre-hijo. Los estados emocionales negativos por inadecuada autorregulación materna ante los estresores afectan sus habilidades atencionales y estadios del procesamiento de las señales infantiles llevándola a actuaciones menos sensibles: respuestas inoportunas, asincrónicas, particularmente insatisfactorias cuando el bebé manifiesta quejas/ llanto porque no le proporcionan la autorregulación emocional necesaria. Este estudio microsocial explora perfiles interaccionales secuenciales de reacciones maternas a conductas infantiles positivas/neutras vs. difíciles y los compara en dos grupos de díadas, uno con madres con alto nivel de factores negativos para la parentalidad y otro con bajo nivel. Las circunstancias desfavorables de madres del grupo alto y sus efectos negativos sobre la interacción se observaron en ciertas reacciones que no discriminaban el antecedente infantil y particularmente tras los estados de arousal negativo del bebé cuando el papel regulador materno es más necesario

The social information-processing model contributes to identifying the psychological processes underlying the construct «sensitivity» in early mother-child interaction. Negative emotional states associated with inadequate self-regulation in coping with stressors affect the mother’s attention skills and the processing of the baby’s signals. This leads to less synchronous parental practices, particularly unsatisfactory when the baby is unhappy, or crying because the required self-regulation is not provided. This micro-social research studies the sequential profile of maternal reactions to the baby’s positive/neutral vs. difficult behaviours and compares them in two groups of dyads, one with mothers who reported high levels of distress and other negative factors for parenting and another group with low levels. The unfavourable circumstances of the high stress group and their negative effects on interaction were observed in some indiscriminate maternal responses and particularly as they reacted to their baby’s difficult behaviour, when the mother’s regulatory role is more necessary

[Early mother-infant interaction and factors negatively affecting parenting]. / Interacción temprana madre-hijo y factores que afectan negativamente a la parentalidad.

The social information-processing model contributes to identifying the psychological processes underlying the construct "sensitivity" in early mother-child interaction. Negative emotional states associated with inadequate self-regulation in coping with stressors affect the mother's attention skills and the processing of the baby's signals. This leads to less synchronous parental practices, particularly unsatisfactory when the baby is unhappy, or crying because the required self-regulation is not provided. This micro-social research studies the sequential profile of maternal reactions to the baby's positive/neutral vs. difficult behaviours and compares them in two groups of dyads, one with mothers who reported high levels of distress and other negative factors for parenting and another group with low levels. The unfavourable circumstances of the high stress group and their negative effects on interaction were observed in some indiscriminate maternal responses and particularly as they reacted to their baby's difficult behaviour, when the mother's regulatory role is more necessary.

Cambio y estabilidad en los factores que afectan negativamente a la parentabilidad / Change and stability of the factors that affected parenting negatively

En la prevención del maltrato infantil, un área de interés lo constituye el estudio de las variables relacionadas con los factores que afectan negativamente la parentalidad. El propósito de este estudio longitudinal fue detectar en un año las variables que predicen «cambio» (Aumento o disminución) y «no cambio» de esos factores, dentro del programa de prevención «Apoyo Psicológico Materno-Infantil». 520 madres y sus niños de 3 a 18 meses constituyeron el grupo del cual se obtuvo una muestra aleatoria de 85. Los resultados de los análisis discriminantes mostraron que se predice mejor la estabilidad que el cambio. La historia de disciplina punitiva de la madre, la baja satisfacción materna y la percepción de su bebé cuando tenía tres meses explicaban el mantenimiento elevado de dichos factores, mientras que la buena relación de pareja y el mayor nivel de participación en el programa explicaban el mantenimiento bajo en los mismos

In child maltreatment prevention field and parenting support, is very relevant the study of the variables related with the change or stability of those factors that affect parenting negatively. The purpose of this longitudinal study was to detect the predictors of change (increase or decrease) and no-change of those negative factors that affect parenting, in a period of a year, in the context of a preventive programme «Mother child psychosocial support». 520 mothers and their babies aged from 3 to 18 months old constituted the group from which a sample of 85 was randomly selected. The results showed that «no-change» is better predicted than change. Punitive discipline in mother's childhood, low maternal satisfaction and reporting something they don't like in their 3 month babies, predicted to maintenance of high score in the factors under study. Good marital relationship and more visits to the Program predicted the maintenance of low score in those factors

Improving child maltreatment detection systems: a large-scale case study involving health, social services, and school professionals.

OBJECTIVES: The purpose of this 5-year study was to improve detection in two consecutive phases: (a) To close the gap between the number of identified cases and the actual number of cases of child abuse by increasing detection; and (b) To increase the possibility of a broader spectrum of detection. METHOD: The Balearic Islands (one of the Autonomous Communities of Spain, with 161,287 children under 18 years old) was selected as the study area. Phase 1: front-line professionals (181) from all the health and social services agencies were trained in detection. Phase 2, school professionals (251) from all schools in the territory were also trained. The independent factor was the intervention provided to the professionals with training and support. A pre-post design was used over the area, divided in territories, in which the program was gradually implemented to provide within-territory and between-territories controls. RESULTS: Phase 1: Comparison before-after implementation of the program showed that detection was tripled in the Balearic Islands (from .58 to 1.77 per 1,000 children). An unplanned generalization effect was found, and post hoc analysis considering only the islands showed the expected increase. Phase 2: A subsequent increased detection rate was found in Child Protection Services cases 2.18 per 1,000. Of those new cases, 24.5% came from schools, after controlling for duplication. CONCLUSIONS: This detection system showed positive changes after training and supporting frontline health and social services professionals. However, these professionals only have occasional contacts with the child population. Therefore, to broaden the spectrum of detection and to reach more maltreated children, who are less likely to be visible to CPS, it is necessary to train and support school professionals because of the frequency of their contacts with children on an almost daily basis.