Hospitalisation in high-risk pregnancy patients: is prenatal attachment affected?

Objective: To compare prenatal attachment in women hospitalised due to high-risk pregnancy with prenatal attachment in non-hospitalised patients. To describe the impact of social support, socio-demographic factors and the nature of the pregnancy on prenatal attachment, anxiety and depression. Study Design: An exploratory, cross-sectional and descriptive study utilising the Maternal Antenatal Attachment Scale, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The sample comprised 80 hospitalised and 88 non-hospitalised patients. Result: No difference in prenatal attachment was found between the two groups. The hospitalised group presented higher levels of depressive symptomatology and anxiety. Social support had a significant effect on the hospitalised group, improving attachment quality. Conclusion: Incorporation of members of the patient's support network may help to improve quality of prenatal attachment during hospitalisation. Detection and treatment of anxiety and/or depression in hospitalised patients is recommended given their impact on the mental health of mother and baby.

Predictive value of the Ages and Stages Questionnaire® for school performance and school intervention in late preterm- and term-born children.

BACKGROUND: The new health supervision guidelines emphasize the importance of surveillance or a formal developmental screening test at 4 years, one of the most used tests is Ages & Stages Questionnaire. Nevertheless, there is still not enough evidence whether these tools will be useful to predict future school performance (SP). OBJECTIVES: The objectives of this study were to evaluate the Ages & Stages Questionnaire 3rd edition 48-month interval (ASQ3-48) translated to Spanish for predicting the need for school intervention (SI) and poor SP at 8-9 years of age, in late preterm infants (LPIs) and term-born infants (Terms) and to compare the prevalence of SI and poor SP in the two groups. METHODS: Data were collected from a cohort of 75 LPIs and 58 Terms assessed with ASQ3-48 and with a further assessment of academic results at 8-9 years, through a standardized school test of the Education Department of Catalonia. SI data were obtained through a parent report. Area under the curve (AUC), sensitivity, specificity and predictive values were calculated, and logistic regression analysis was used. RESULTS: The prevalence of poor SP was 12.8%, without statistically significant differences between LPIs and Terms. LPIs had higher SI than Terms (29.3% vs. 10.3%, P = 0.001). AUC for poor SP was 0.73 and for receiving SI was 0.56 without differences between the two groups. The sensitivity of the ASQ3-48 for poor SP was 41%, for specificity 92%, and for receiving SI 14% and 89%, respectively. Poor SP was related to having positive screening in the ASQ3-48 (OR 6.5 [95% CI, 1.9-22.2]) while having received SI was related to late prematurity (OR 3.6 [95% CI, 1.3-9.6]). CONCLUSIONS: The ASQ3-48 shows acceptable predictive properties for poor SP but not for receiving SI. No differences were found in SP between LPI and Term cohorts, but LPIs are likelier to require SI.

Comparison between Ages & Stages Questionnaire and Bayley Scales, to predict cognitive delay in school age.

OBJECTIVE: To compare the predictive value of the Spanish Ages & Stages Questionnaire third edition adapted for Chilean population (ASQ-Cl) and the Bayley Scale of Infant and Toddler Development 3rd edition (Bayley-III) for cognitive delay at school age, and to identify the domain predictors. METHODOLOGY: Data were collected from 306 term and preterm children of medium-high socio-economic level enrolled in a prospective cohort study. Developmental outcomes at 8, 18 and 30 months were assessed via the ASQ-Cl and Bayley-III; at 6-8 years cognitive development was assessed using the Wechsler Intelligence Scale for Children (WISC-III). The area under the curve (AUC), sensitivity, specificity and predictive values were calculated, and logistic regression analysis was used. RESULTS: Of 227 children studied, 6.6% had cognitive delay. ASQ-Cl and Bayley-III generate equivalent AUC [0.77 and 0.80]. Sensitivity 67% and 53%; specificity of 72% and 88%, positive predictive value of 14% and 24%, negative predictive values of 97% and 96% respectively. Greater predictive validity was obtained at 30 months assessment. Deficit in the communication and gross motor skills and problem-solving domains of the ASQ-Cl and all the Bayley-III domains were significantly associated with cognitive delay. CONCLUSIONS: ASQ-Cl can be used to identify children at risk for cognitive delay at 6-8 years of age, being comparable with the Bayley-III. Some domains of ASQ-Cl and all domains of Bayley-III were significant predictors for cognitive delay. These results support the use of ASQ-Cl as a screening tool for developmental delay.

Reliability and agreement of ages and stages questionnaires®: Results in late preterm and term-born infants at 24 and 48 months.

AIM: To evaluate the reliability of the Ages and Stages Questionnaires (ASQ-3) 24 and 48 month intervals translated to Spanish by Brookes Publishing, and the agreement between both questionnaires, comparing late preterm (LPI) and term-born infants (terms). METHODS: Two cohort samples of healthy LPI and terms that were born in a private hospital in Barcelona, Spain. Internal consistency was analyzed by Cronbach's alpha scores and Pearson product- moment correlation between the domain scores and the overall score. The agreement was analyzed using Pearson's correlations between the two questionnaires, and the odds ratio (OR) for positive screening at 48 months, given a positive screen in 24 month assessment. RESULTS: A total of 473 evaluations were analyzed, representing 331 children. Cronbach's alpha scores for the motor domains on both intervals were low, but acceptable compared with the overall score; a strong positive correlation between the domain and overall score were obtained in the majority of the domains. The correlation between the 24 and 48 month total scores were positive, especially for LPI. Having at least 2 domains in the referral zone at 24 months was associated with an OR of 140 [95% CI 14.85; 3575.65] for positive screen at 48 months. CONCLUSION: The Spanish ASQ-3 24 and 48 month intervals appear to be a reliable for developmental screening and for the follow-up of children, especially for LPI. Having two or more domains in the referral zone at 24 months screening is a significant predictor of developmental delay risk at 48-month questionnaire.

Metacognition in schizophrenia disorders: Comparisons with community controls and bipolar disorder: Replication with a Spanish language Chilean sample.

Metacognition refers to the activities which allow for the availability of a sense of oneself and others in the moment. Research mostly in North America with English-speaking samples has suggested that metacognitive deficits are present in schizophrenia and are closely tied to negative symptoms. Thus, replication is needed in other cultures and groups. The present study accordingly sought to replicate these findings in a Spanish speaking sample from Chile. Metacognition and symptoms were assessed among 26 patients with schizophrenia, 26 with bipolar disorder and 36 community members without serious mental illness. ANCOVA controlling for age and education revealed that the schizophrenia group had greater levels of metacognitive deficits than the bipolar disorder and community control groups. Differences in metacognition between the clinical groups persisted after controlling for symptom levels. Spearman correlations revealed a unique pattern of associations of metacognition with negative and cognitive symptoms. Results largely support previous findings and provide added evidence of the metacognitive deficits present in schizophrenia and the link to outcome cross culturally. Implications for developing metacognitively oriented interventions are discussed.

Validation of the Chilean version of the Ages and Stages Questionnaire (ASQ-CL) in Community Health Settings.

OBJECTIVE: To validate the translated and cross culturally adapted Chilean version of the 8 and 18month Ages and Stages Questionnaire (ASQ-CL) in a community sample. PARTICIPANTS: Parents of 1572 term children (82.9%) and 324 children at risk for developmental delay (17.1%) were included. INSTRUMENT: ASQ-3rd edition translated and culturally adapted for Chilean urban population. MAIN MEASURES: 8 and 18months ASQ-CL reliability, validity and mean scores. Feasibility was assessed using qualitative methods in healthcare professionals and mothers. RESULTS: ASQ-CL mean scores were comparable to U.S. normative data. The overall total score and all domains were reliable (Cronbach alpha 0.66-0.85). Test-retest and inter-rater reliability were high (Pearson's r range 0.73-0.94; intraclass correlation r range 0.68-0.93). Early preterm infants were more likely to fail on several criteria. Qualitative methods confirmed ASQ-CL as a feasible tool in this Chilean urban community. CONCLUSIONS: ASQ-CL is a valid, reliable and feasible tool for assessing development in children at 8 and 18months in Chilean urban population.

Gestational age and developmental risk in moderately and late preterm and early term infants.

OBJECTIVES: The objective of this study was to evaluate the association between gestational age (GA) at birth and risk of developmental delay at 8 and 18 months of corrected postnatal age. METHODS: During 2008 to 2011, infants at a corrected postnatal age of 8 or 18 months attending health centers in Santiago, Chile, were recruited. Participants completed a form on biographical and demographic characteristics and the Chilean validated version of the Ages and Stages Questionnaires, Third Edition (ASQ). Logistic regression was used to detect the capacity of GA to predict scores < -2 SDs on the basis of the Chilean ASQ reference group, in at least 1 ASQ domain, adjusted by different control variables. RESULTS: A total of 1667 infants were included in the analysis. An inverse "dose response" relationship between developmental delay risk and GA at birth was found, both in the crude and adjusted models. Compared with those born full term, the odds ratio for developmental delay risk was 1.56 for those born early term (95% confidence interval [CI]: 1.19-2.06), 2.58 for infants born late preterm (95%CI: 1.66-4.01), and 3.01 for those born moderately preterm (95%CI: 1.59-5.71). CONCLUSIONS: An inverse dose-response relationship between GA and risk of developmental delay was found in the tested population. Future prospective studies and predictive models are needed to understand whether this higher developmental risk in moderately and late preterm infants is transient and modifiable or persists throughout life, allowing for better targeting of early-intervention strategies.

Validity of the ages and stages questionnaires in term and preterm infants.

BACKGROUND: This study assessed the concurrent validity of the parent-completed developmental screening measure Ages and Stages Questionnaires, Third Edition (ASQ-3) compared with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) in children born term, late preterm, or extremely preterm at 8, 18, or 30 months of corrected gestational ages (CGA). METHODS: Data were collected from 306 term and preterm children ages 8, 18, and 30 months' CGA recruited from an ambulatory well-child clinic in Santiago, Chile. Parents completed the ASQ-3 in their homes, and afterward a trained professional administered the Bayley-III in a clinic setting. On the ASQ-3, the presence of any domain screened <2 SDs below the mean area score was considered a positive screen (indicating failure or delay). A Bayley-III score less than ≤1 SD indicated mild or severe delay. RESULTS: ASQ-3 showed adequate psychometric properties (75% sensitivity and 81% specificity) and modest agreement with the Bayley-III (r = 0.56). Sensitivity, specificity, and correlations between measures improved with testing age and in children who were born extremely preterm. CONCLUSIONS: Considering its psychometric properties, the ASQ-3 can be recommended for routine use in screening low-risk children at 8, 18, and 30 months' CGA and is advisable to be included in follow-up programs for children with biological risk factors such as those born preterm.

A family outreach intervention for engaging young out-of-treatment drug users: pre- versus post-treatment comparison.

Only a small fraction of drug users worldwide enter treatment each year. We evaluated the efficacy of a systemic family outreach intervention (SFOI) for young, untreated drug users, using a quasi-experimental design in which the experimental group (EG) received SFOI and the control group (CG) received traditional outreach work (OW). Both pre- and post-treatment, we administered the Addiction Severity Index-6 (ASI-6), the Family Environment Scale (FES), and tests of parental practices and risky behavior. Post-treatment, there was a fivefold improvement on the ASI-6 and a significant worsening on the conflict sub-scale of the FES in the EG as compared with the CG. SFOI was more efficacious than OW in reducing drug use in the drug user's home environment. The increased conflict in the EG might be explained by parents' increased awareness of abnormal behaviors and implementation of strategies to protect their children.

Clima Social Escolar: una escala de evaluación -Escala de Clima Social Escolar, ECLIS / School Social Climate: An instrument of evaluation

El presente artículo describe el proceso de diseño, construcción y validación inicial de una Escala de Clima Social Escolar (ECLIS) que representa una herramienta para visualizar las variables que, a juicio de las autoras, a partir de la revisión de la literatura y de sus investigaciones en la realidad escolar chilena, dan cuenta de las características que en un corte transversal puede tener un determinado contexto escolar. Se describe el marco conceptual que sustenta esta Escala y las características psicométricas básicas de la versión definitiva. Se incluyen los criterios para el análisis y su interpretación.

This paper describes the design and initial validation of ECLIS, a School Social Climate Scale. This scale is a useful tool for evaluation of the main variables reported by research and the authors of the school social climate. Conceptual framework, basic psychometric characteristic and results of the experimental application in different samples of Chilean school students are reported. Criteria for analysis and interpretation of scores are included.

Validación chilena del cuestionario de evaluación de apego en el adulto CAMIR / Chilean validation of the questionnaire of attachment evaluation in the adult CAMIR

El objetivo de esta investigación fue examinar la confiabilidad y validez del instrumento de evaluación de apego en el adulto, “Cartes: Modèles Individuels de Relation (CAMIR)”, en la realidad sociocultural chilena. Este instrumento, basado en la teoría del apego, es un cuestionario de auto-reporte que evalúa los modelos operativos internos en adultos y otras escalas relacionadas al apego. Los participantes fueron 578 sujetos, 204 hombres y 374 mujeres, con edades entre 14 y 80 años. Los sujetos completaron el CAMIR y medidas de vínculo y sintomatología actual, a través del Parental Bonding Instrument (PBI) and Outcome Questionnaire OQ-45.2. A través del análisis estadístico de los resultados se evaluaron las características psicométricas del test y se analizó la posibilidad de generar normas locales para la prueba. Los resultados confirmaron que el CAMIR es un instrumento confiable y válido en la evaluación de los modelos internos de relación en adultos.

This study was designed to estimate the validity and reliability of the “Cartes: Modèles Individuels de Relation(CAMIR)”, in Chile. This inventory, based on attachment’s theory, it’s a auto-questionnaire evaluates the working models in adults and other scales relating to attachment. Participants were 578 individuals, 204 males and 374 females, 14 a 80 years old. Individuals completed the CAMIR and measures of bond and actual symptoms, with the Parental Bonding Instrument (PBI) and Outcome Questionnaire OQ-45.2. The general norms were obtained according to a statistical analysis of the resultsand to an evaluation of the psychometric characteristics of the test. The results confirmed that the psychometric characteristics of the CAMIR make it a reliable and valid tool to assess working models in adults.

Evaluación del apego en adolescentes y adultos: adaptación chilena del cuestionario de apego CAMIR / Attachment evaluation in adolescents and adults: the Chilean versión of the ``CAMIR`` attachment questionnaire

El cuestionario de apego en adultos, CAMIR de Pierrehumbert el al.(1996) evalúa el vínculo del apego en adultos. El presente artículo expone el proceso de adaptación del instrumento a la realidad social y cultural chilena y su aporte en la evaluación del apego en adolescentes. Además, se presenta el análisis estadístico de su aplicación en una muestra chilena, la cual evidencio propiedades psicométricas adecuadas para evaluar los modelos individuales de relación de adolescentes y adultos en el contexto chileno (AU)

The CAMIR attachment questionnaire in adults, by Pierrehumbert et al. (1996), evaluates attachment bonds in adults. This paper presents the adaptation process of the instrument to the Chilean social and cultural, reality, and its contribution to the assessment of adolescent attachment styles. The statistical analysis of its application to a Chilean sample, within the Chilean context, in also exposed (AU)

Religiosidad, conductas de riesgo y salud mental en adolescentes de Santiago de Chile / Religiousness, risk behaviors and mental health among adolescents from Santiago, Chile

El grado de religiosidad y observancia religiosa han sido estudiadas como elementos protectores para diversas conductas de salud. Este estudio analiza la relación entre grado de religiosidad y presencia de uso de sustancias químicas, otras conductas de riesgo auto y hetero-agresivas, en una muestra aleatoria de 252 adolescentes escolarizados en la Región Metropolitana de Santiago de Chile, en base a una aplicación del cuestionario ECRA-2, comparando entre sí los subgrupos auto-calificados como muy religiosos (n=57) con los nada religiosos (n=50). El grupo total tuvo una edad promedio de 17,7 (DS 1,54), de los cuales un 55,9 por ciento eran mujeres. En cuanto a adscripción religiosa, un 72,8 por ciento se identificaban como católicos, un 10,9 por ciento protestantes, un 4,7 por ciento de otra religión y un 11,7 por ciento sin religión. Un 22,6 por ciento se identificó como muy religioso, y un 19,8 por ciento como nada religioso. La comparación presentada contrasta los subgrupos auto-calificados como muy religiosos (n=57) con los nada religiosos (n=50). Un 12,5 por ciento de los adolescentes muy religiosos consumieron marihuana más frecuentemente que una vez al mes, en comparación a un 41,7 por ciento de aquellos que se consideraban nada religiosos (8,643; 2gl;p=0,013). Los adolescentes muy religiosos se sentían más frecuentemente tristes y nerviosos que los nada religiosos (22,7 por ciento vs 12,5 por ciento; X2=5,175;2 gl; p=0,075); informaban menor frecuencia de golpear a otros(p=0,05), menor participación en peleas grupales (p=0,03), menor frecuencia de robo en tiendas(p=0,08) y de copia en pruebas(p=0,002).

The degree of religiousness and religious observance have been studied as protective elements for various health behaviors. The present study assesses the relation between the degree of religiousness and the use of chemical substances and the presence of aggressive risk behaviors towards one self or others, in a randomly selected sample of 252 schooled adolescents from the Metropolitan Region of Santiago, Chile. An ECRA-2 questionnaire was used, and the subgroups self-rated as very religious (n=57) and as not religious at all (n=50) were compared. The total group mean age was 17,7 years (SD 1,54), and 55,9 percent were female. As for religious ascription, 72,8 percent identified themselves as Catholics, 10,9 percent as Protestants , 4,7 percent as other religion and 11,7 percent as without religion. Twenty-two point six percent (22,6 percent) rated themselves as very religious, and 19,8 percent as not religious at all. The present comparison contrasts the subgroups self-rated as very religious (n=57) and as not religious at all (n=50). Of the very religious adolescents, 12,5 percent consumed marijuana more frequently than once per month, as compared to 41,7 percent of those who considered themselves as not religious at all (8,643; 2gl; p=0,013). The very religious adolescents felt sad and nervous more commonly than the not religious at all (22,7 percent vs 12,5 percent; X2=5,175;2 gl; p=0,075); they reported a lower frequency of beating others (p=0,05), a lesser degree of participation in group fights (p=0,03), a lower frequency of shoplifting (p=0,08) and of cheating behaviors (p=0,002).