Implementation of Parenting Programs in Real-World Community Settings: A Scoping Review.

Implementing parenting programs in real-world community settings is fundamental to making effective programs widely available and consequently improving the lives of children and their families. Despite the literature acknowledging that the high-quality implementation of parenting programs is particularly challenging in real-world community settings, little is known about how the programs are implemented in these settings. This scoping review followed the methodological framework described by the Joanna Briggs Institute to map evidence on how evidence-based parenting programs have been implemented under real-world conditions. A systematic search of 12 scientific databases, gray literature, and the reference lists of the included studies identified 1918 records, of which 145 were included in the review. Fifty-three parenting programs were identified in studies documenting implementation in real-world community settings worldwide. Most studies included families in psychosocial risk engaged with family-support agencies. The qualitative synthesis identified several implementation outcomes, adaptations, barriers, and facilitators. Most studies reported a maximum of two implementation outcomes, mainly fidelity and acceptability. Providers frequently made adaptations, mainly to bring down barriers and to tailor the program to improve its fit. Findings highlight the need for a more detailed description of the implementation of programs, with greater consistency in terminology, operationalization, and measurement of implementation outcomes across studies. This will promote a more transparent, consistent, and accurate evaluation and reporting of implementation and increase the public health impact of parenting programs. Future studies should also assess the impact of adaptations and the cost-effectiveness and sustainability of programs in real-world community settings.

Correction: Implementation of evidence-based parenting programs under real-world conditions: Protocol for a scoping review.

[This corrects the article DOI: 10.1371/journal.pone.0256392.].

10ß-Hydroxyestra-1,4-diene-3,17-dione as potential antiproliferative agent: in vitro biological evaluation and in silico studies.

10ß-Hydroxyestra-1,4-diene-3,17-dione (HEDD) is a natural product described as having neuroprotective activity. However, the cytotoxic properties of this quinol are barely studied. Thus, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed in six cell lines (MCF-7, T47-D, LNCaP, HepaRG, Caco-2 and NHDF). Additionally, an in vitro estrogenicity assay and a cell viability analysis together with in silico molecular docking studies were carried out in order to understand the potential mechanism of cytotoxicity. Computational predictions of its pharmacokinetic and toxicity properties were also performed. Surprisingly, HEDD displayed marked cytotoxic activity, particularly against hormone-dependent cancer cells and the flow cytometry analysis revealed that HEDD markedly reduced the viability of hepatic cancer cells. Molecular docking studies suggested a high affinity towards the estrogen receptor α and 17ß-hydroxysteroid dehydrogenase type 1. Moreover, it was predicted that HEDD may have good oral bioavailability and a low maximum tolerated dose in humans.

Narrative Abilities and Episodic Memory in School-Aged Children Followed by Child Protective Services.

The ability to narrate routine familiar events develops gradually during middle childhood, in increasingly higher levels of coherence and temporal cohesion. Improvements in episodic memory are also observed, reflecting children's increasing ability to recall specific circumstances of past events and personal experiences. Even though several studies have evaluated children's narrative abilities and episodic memory, little information is available regarding the children exposed to risks that justify their referral to Child Protective Services (CPS). The current study analysed children's narrative abilities and episodic memory performance, according to the circumstances related to the referral to CPS. Event schema representation, narrative coherence, narrative temporal cohesion, and episodic memory concerning routine and specific personal events in family context were analysed in a sample of 56 school-aged children followed by the CPS in Portugal. Children referred to CPS due to disruptive behaviour presented higher episodic memory performance, compared to those exposed to domestic violence, neglect, and abuse. No significant differences were found between groups regarding narrative abilities related to familiar routine events. Results highlight the relevance of evaluating the adverse circumstances that lead to CPS referral, considering the levels of risk and danger involved, given its differential effects on children's episodic memory development.

An Evaluation of the Quality of Parent-Child Interactions in Vulnerable Families That Are Followed by Child Protective Services: A Latent Profile Analysis.

In the current study, an observational procedure, recorded in video, was used to evaluate the quality of parent-child interactions in a sample of vulnerable Portuguese families (n = 47) with school-aged children followed by Child Protective Services (CPS). The study sought to explore if the families presented different profiles of parent-child interaction quality, and to characterize such profiles in terms of discrete behaviors observed, parenting outcome variables, and families' sociodemographic and CPS referral characteristics. The parent-child dyads took part in a 15 minutes structured task and parents completed self-report measures (affection, parenting behaviors, and stress). Discrete behaviors of parents and children during interactions were coded with a micro-analytic coding procedure. The global dimensions of the parents' interactions were coded with a global rating system. A latent profile analysis, estimated with global dimensions, identified two subgroups, one subgroup in which parents displayed higher quality interactions (n = 12), and another subgroup in which parents displayed lower quality interactions (n = 35). Further analyses comparing the subgroups determined that the higher quality subgroup presented more positive behaviors, and the lower quality subgroup presented more negative behaviors during the interactions. No further differences or associations were found regarding the parenting outcome variables, and the families' sociodemographic and CPS referral characteristics. The findings are in line with prior studies, suggesting that vulnerable families may frequently present depleted parent-child interactions. However, given the small sample size, future studies should replicate the described procedures and analyses in larger sample sizes.

Implementation of evidence-based parenting programs under real-world conditions: Protocol for a scoping review.

Protecting children is recognized as a public health priority and supporting parents through the implementation of evidence-based programs is a well-known strategy to achieve this. However, researchers highlight that these programs remain insufficiently implemented in real-world contexts. A knowledge gap exists between the intended implementation of evidence-based parenting programs and their actual implementation on real-world dynamics. This scoping review aims to provide a comprehensive understanding of how evidence-based parenting programs have been implemented under real-world conditions by providing a map of available evidence and identifying knowledge gaps. The overall research question is: "How have evidence-based parenting programs been implemented under real-world conditions?". The proposed scoping review follows the framework originally described by Arksey and O'Malley, Levac and colleagues, and the Joanna Briggs Institute: (1) identifying the research questions; (2) identifying the relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; (6) consultation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will inform the search strategy. The results will be described in relation to the research questions and in the context of the purpose of the review. This scoping review will help to bridge the implementation gap between research evidence and its translation into practice.

New Estrone Oxime Derivatives: Synthesis, Cytotoxic Evaluation and Docking Studies.

The interest in the introduction of the oxime group in molecules aiming to improve their biological effects is increasing. This work aimed to develop new steroidal oximes of the estrane series with potential antitumor interest. For this, several oximes were synthesized by reaction of hydroxylamine with the 17-ketone of estrone derivatives. Then, their cytotoxicity was evaluated in six cell lines. An estrogenicity assay, a cell cycle distribution analysis and a fluorescence microscopy study with Hoechst 3358 staining were performed with the most promising compound. In addition, molecular docking studies against estrogen receptor α, steroid sulfatase, 17ß-hydroxysteroid dehydrogenase type 1 and ß-tubulin were also accomplished. The 2-nitroestrone oxime showed higher cytotoxicity than the parent compound on MCF-7 cancer cells. Furthermore, the oximes bearing halogen groups in A-ring evidenced selectivity for HepaRG cells. Remarkably, the Δ9,11-estrone oxime was the most cytotoxic and arrested LNCaP cells in the G2/M phase. Fluorescence microscopy studies showed the presence of condensed DNA typical of prophase and condensed and fragmented nuclei characteristic of apoptosis. However, this oxime promoted the proliferation of T47-D cells. Interestingly, molecular docking studies estimated a strong interaction between Δ9,11-estrone oxime and estrogen receptor α and ß-tubulin, which may account for the described effects.

Medication Evaluation in Portuguese Elderly Patients According to Beers, STOPP/START Criteria and EU(7)-PIM List - An Exploratory Study.

PURPOSE: The increase in drug prescription for the elderly raises the risk of the occurrence of potentially inappropriate medications (PIMs), thus increasing the incidence of drug-related problems. Likewise, potential prescribing omissions (PPOs) are also highly prevalent in the elderly. This study aimed at assessing the prevalence of PIMs in the elderly by using the EU(7)-PIM list, STOPP criteria version 2 and the Beers criteria version 2015, as well as the prevalence of PPOs by applying the START criteria version 2 in elderly nursing home residents and outpatients of the Eastern Central Region of Portugal. PATIENTS AND METHODS: A descriptive cross-sectional study was carried out in a sample of 90 Portuguese elderly people. Age, gender, diagnoses and medication history were collected from the patients' clinical records. The prevalence of PIMs and PPOs was measured according to each of the criteria applied. RESULTS: The patients' ages ranged from 65 to 103 years, with an average age of 84.15 years. In addition, the average number of medications prescribed was 7.6. The STOPP criteria identified 250 PIMs affecting 77 patients (85.5%), the EU(7)-PIM list detected 94 PIMs in 58 patients (64.4%) and the Beers criteria identified 69 PIMs in 51 patients (56.6%). Therefore, the STOPP criteria version 2 identified substantially more PIMs than the other two tools. Furthermore, by applying the START criteria 68 PPOs were detected in 52 patients (57.7%). CONCLUSION: A high prevalence of PIMs and PPOs was observed, suggesting the need to implement actions aimed at reducing the phenomenon and thus help to improve the quality of care provided in nursing homes. The variations in prevalence with the different tools suggest the need to carefully choose the tool for medication review in the elderly.

Family Functioning and Adolescent Internalizing and Externalizing Problems: Disentangling between-, and Within-Family Associations.

Adolescence is often a period of onset for internalizing and externalizing problems. At the same time, adolescent maturation and increasing autonomy from parents push for changes in family functioning. Even though theoretically expected links among the changes in family functioning and adolescent internalizing and externalizing problems exist, studies examining this link on the within-family level are lacking. This longitudinal, pre-registered, and open-science study, examined the within-family dynamic longitudinal associations among family functioning, and internalizing and externalizing problems. Greek adolescents (N = 480, Mage = 15.73, 47.9% girls, at Wave 1) completed self-report questionnaires, three times in 12 months. Random-Intercept Cross-Lagged Panel Models (RI-CLPM) were applied; such models explicitly disentangle between-family differences from within-family processes, thereby offering a more stringent examination of within-family hypotheses. Results showed that family functioning was not significantly associated with internalizing or externalizing problems, on the within-family level. Also, alternative standard Cross-Lagged Panel Models (CLPM) were applied; such models have been recently criticized for failing to explicitly disentangle between-family variance from within-family variance, but they have been the standard approach to investigating questions of temporal ordering. Results from these analyses offered evidence that adolescents with higher internalizing and externalizing problems compared to their peers, tended to be those who later experienced worse family functioning, but not vice versa. Implications for theory and practice are discussed.

Psychological intervention at a primary health care center: predictors of success.

BACKGROUND: Few studies in Portugal have attempted to assess the impact of psychological interventions in primary health care regarding the problems shared by clients, and which variables predicted the success of this intervention. The current study, therefore, aimed to identify predictors of success related to psychological intervention in a single primary health care center in the north of Portugal. METHOD: This was a retrospective study from secondary data, using the data from 1024 clients who attended the psychological consultation at a primary health care center over a period of 8 years. The success of the psychological consultation was defined according to the discharge made by the psychologist. The multiple logistic regression analysis was employed. RESULTS: The attendance of a greater number of consultations and the biweekly frequency of consultations significantly predicted the success of psychological intervention. Additionally, the success was associated with having a diagnosis or specific problem identified. CONCLUSIONS: These findings provide contributions to enrich the literature in this field, in particular, in Portuguese primary health care. We highlight the importance of investing in psychological services in primary health care centers.

Couples' relationship affects mothers' and fathers' anxiety and depression trajectories over the transition to parenthood.

BACKGROUND: The association between the couple relationship and the mothers' and fathers' psychological adjustment to the transition to parenthood has been examined in the literature. However, the direction of effects between these variables has not been extensively explored. This study aimed to assess the direction of effects between mothers' and fathers' positive and negative interactions and anxiety and depression symptoms trajectories over the transition to parenthood. METHODS: A sample of 129 couples (N = 258) completed self-report measures of positive and negative interactions, anxiety and depression symptoms at each trimester of pregnancy, at childbirth, and at 3- and 30-months postpartum. Dyadic growth curve models were performed using multilevel modeling. RESULTS: Whereas anxiety and depression showed no moderation effect on positive and negative interactions over time, negative interaction moderated depression from 3- to 30-months postpartum. Mothers and fathers with high negative interaction scores experienced a steeper increase in depression from 3- to 30-months postpartum. Additionally, gender moderated the effect of positive interaction on anxiety from 3- to 30-months postpartum. Fathers with low positive interaction scores experienced an increase in anxiety, whereas fathers with high positive interaction scores and mothers with high or low positive interaction scores did not experience changes in anxiety from 3- to 30-months postpartum. LIMITATIONS: Despite the longitudinal aspect of the models, a possible causal relationship need to be taken with caution. CONCLUSIONS: Our results suggest that mothers' and fathers' positive and negative interactions affect their anxiety and depression symptoms trajectories: negative interaction raises mothers' and fathers' depression symptoms and positive interaction prevents the increase of fathers' anxiety symptoms over the postpartum period.

Couples' psychological adjustment to twin parenthood: mode of conception (spontaneous versus assisted reproduction) and gender differences.

AIM: To examine whether mode of conception and gender are associated with parents' psychological adjustment across the transition to twin parenthood. BACKGROUND: There is limited knowledge on the psychological adjustment of couples to twin parenthood during pregnancy and early postpartum, especially for fathers. The available research suggests that first-time mothers of twins conceived by assisted reproduction techniques (ART) may experience lower psychosocial well-being than mothers of spontaneously conceived (SC) twins. METHODS: A total of 41 couples expecting twins, 25 of whom conceived spontaneously and 16 conceived by assisted reproduction techniques, completed measures of depressive and anxiety symptoms, marital relationship, attitudes to sex, and attitudes to pregnancy and the baby. FINDINGS: ART parents showed a decline in marital relationship quality, no changes in attitudes to pregnancy and the baby and no changes in attitudes to sex over the postpartum. In contrast, SC parents did not change their perception of the marital relationship, reported more positive attitudes to pregnancy and the baby, and more positive attitudes to sex over the postpartum. Compared with the other groups (SC mothers and fathers, ART fathers), ART mothers exhibited a higher increase in depressive and anxiety symptoms from pregnancy to postpartum and only anxiety symptoms exhibited a decline trend over the postpartum. These findings suggest that ART parents may experience more psychological difficulties during the transition to twin parenthood than SC parents. ART mothers, in particular, appear to be more at risk of high levels of postpartum depressive symptoms.

Steroidal Oximes: Useful Compounds with Antitumor Activities.

BACKGROUND: Steroids play an important role in life because they can regulate a variety of biological processes and have been widely used in medicine namely as antiinflammatory, anabolic, contraceptives and anticancer drugs. In recent years, there has been an increasing interest in the introduction of the oxime group in a large variety of molecules in order to increase their biological effects. This review highlights steroidal oximes with anticancer properties and their potential mechanisms of action, as well as data on their relative potencies reported in literature in the last few years. METHODS: To prepare this review, an extensive literature search was performed on three databases, PubMed, ISI Web of Knowledge and Science Direct, to generate a critical but comprehensive overview of the potential antitumor activities of steroidal oximes. The main keywords used for the search consisted of combinations of the following terms or their synonyms: steroidal oximes, anticancer activity and enzymatic inhibitory activity. The abstracts and full texts were evaluated for their clarity and scientific merit and to further help on the selection of other articles. RESULTS: Over the last decades the introduction of oxime groups in the steroid scaffold is originating molecules with relevant antitumor activities, as well as steroid sulfatase, aromatase, 17α-hydroxylase-17,20-lyase, 5α-reductase and 17ß-hydroxysteroid dehydrogenase type 1 inhibitory activities. As relevant examples, pregnenolone 20-oximes showed high activity as 17α-hydroxylase-17,20-lyase and 5α-reductase inhibitors and the introduction of an oxime group at C-6 in androstane series also led to relevant results as aromatase inhibitors. Interestingly, the introduction of this functional group frequently improves the bioactivity when compared with non-oxime analogous compounds, which can be due to extra interactions with biological targets. In addition, it has been observed that varying the position of the hydroximino group on the parent skeleton leads to remarkable changes in the antitumor activity. CONCLUSION: The recent advances in synthesis and in vitro bioactivity studies of steroidal oximes contributed to understand the potential interest of the introduction of this functional group in the steroidal nucleus in the development of anticancer molecules. Moreover, the cytotoxic/enzyme inhibitory activity usually depends on the position of the oxime group in different steroid scaffolds. However, despite the promising results, it is necessary to perform more in vitro and in vivo assays not only to better explore the mechanisms of action but also to confirm the potential effectiveness and safety of this interesting family of compounds in clinical practice.

Anxiety and depressive symptoms in women and men from early pregnancy to 30 months postpartum.

AIMS: The aims of this study were to analyse the changes in anxiety and depression symptoms from early pregnancy to 30 months postpartum according to gender and parity. METHOD: 129 couples (N = 258) recruited from an obstetrics unit completed self-report measures of anxiety and depression at each pregnancy trimester, childbirth, 3 and 30 months postpartum. Using multilevel modelling, piecewise dyadic growth curve models were performed, assessing time, gender and parity as predictors of anxiety and depression symptoms. RESULTS: Anxiety and depression symptoms decreased from the first trimester to 3 months postpartum and increased from 3 to 30 months postpartum, returning to the baseline levels in the overall sample. The symptoms were positively correlated within-dyad; in a given time point when a partner reported more symptoms, the other reported more symptoms as well. Changes in anxiety and depression symptoms over time were different according to gender and parity, especially from 3 to 30 months postpartum. Primiparous women revealed low stable symptoms, whereas multiparous women revealed the steepest symptoms increase (in comparison to primiparous men and women and multiparous men). CONCLUSIONS: This study corroborates the literature considering that the transition to parenthood can last until the child's age of 2 or 3 years. Results point out that the risk for anxiety and depression symptoms increasing over the postpartum period is greater for multiparous and lesser for primiparous women. Future studies should explore the factors that contribute to the high risk of symptoms increase over the postpartum period for multiparous women. Screening and intervention should target couples and not only women.

Amamentação e depressão pós-parto: revisão do estado de arte / Breastfeeding and postpartum depression: state of the art review

OBJETIVO: Revisar a literatura sobre a associação entre a amamentação e a depressão pós-parto. FONTES: Uma revisão da literatura encontrada na base de dados MEDLINE/Pub-Med. RESUMO DOS ACHADOS: A literatura mostra, de forma consistente, que a amamentação fornece uma ampla quantidade de benefícios tanto para a criança quanto para a mãe. Ainda são necessárias mais pesquisas sobre os benefícios psicológicos para a mãe. Alguns estudos apontam que a depressão na gravidez é um dos fatores que pode contribuir para a não amamentação. Outros estudos sugerem, também, uma associação entre amamentação e depressão pós-parto, não estando clara ainda a direção dessa associação. A amamentação pode promover processos hormonais que protegem as mães contra a depressão pós-parto por atenuar a resposta do cortisol ao estresse. E isso também pode reduzir o seu risco, por auxiliar na regulação dos padrões do sono e vigília da mãe e do filho, melhorando a autoeficácia e o envolvimento emocional da mãe com a criança, reduzindo as dificuldades de temperamento e promovendo uma melhor interação entre eles. CONCLUSÕES: A pesquisa aponta que a amamentação pode proteger as mães da depressão pós-parto e começa a esclarecer que processos biológicos e psicológicos podem explicar essa proteção. Contudo, ainda existem resultados ambíguos na literatura que poderão ser explicados pelas limitações metodológicas apresentadas por alguns estudos.

OBJECTIVE: To review the literature on the association between breastfeeding and postpartum depression. SOURCES: A review of literature found on MEDLINE/ PubMed database. SUMMARY OF FINDINGS: The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mother's selfefficacy and her emotional involvement with the child, reducing the child's temperamental difficulties, and promoting a better interaction between mother and child. CONCLUSIONS: Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.

Breastfeeding and postpartum depression: state of the art review.

OBJECTIVE: To review the literature on the association between breastfeeding and postpartum depression. SOURCES: A review of literature found on MEDLINE/PubMed database. SUMMARY OF FINDINGS: The literature consistently shows that breastfeeding provides a wide range of benefits for both the child and the mother. The psychological benefits for the mother are still in need of further research. Some studies point out that pregnancy depression is one of the factors that may contribute to breastfeeding failure. Others studies also suggest an association between breastfeeding and postpartum depression; the direction of this association is still unclear. Breastfeeding can promote hormonal processes that protect mothers against postpartum depression by attenuating cortisol response to stress. It can also reduce the risk of postpartum depression, by helping the regulation of sleep and wake patterns for mother and child, improving mother's self-efficacy and her emotional involvement with the child, reducing the child's temperamental difficulties, and promoting a better interaction between mother and child. CONCLUSIONS: Studies demonstrate that breastfeeding can protect mothers from postpartum depression, and are starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies.

[Abortion: legal, deontological and ethical framework]. / Abortamento: enquadramento legal, deontológico e perspectiva ética.

Pregnancy interruption before fetal viability limit is inherent to a multidisciplinary reflection, due to the conflicts involved. Portuguese laws have been altered along time in the way of women's health protection, allowing the needed information and support towards a free, informed and enlightened decision. Deontological determinants about health professionals towards abortion indicate the practice accordingly the law. Nevertheless, it is safeguarded their right to consciousness objection. Ethical discussion about abortion, in its different ways, includes the concern about the value of intrauterine human life, and also the respect for individual autonomy. Even though the debate about intrauterine human life moral status is viewed from different theories and points of view, it is concluded that different perspectives about this matter are acceptable, in an interpersonal diversity valorization point of view.