The role of parents in the care for adolescents suffering from emotional and behavioral problems.

Background: Parents play an important role in the psychosocial care of their children. Previous research has primarily examined their role in care entry, whereas evidence on their role in other stages of the care process is scarce and lacking particularly in regard to the perspective of care providers. Our aim was therefore to examine how psychosocial care providers perceive the role of parents in the process of psychosocial care for adolescents. Methods: We used data from 25 semi-structured interviews with psychosocial care providers on the roles of parents in the care process. We analyzed data using consensual qualitative research and thematic analysis. Results: Four main themes were identified: (1) parents as a source of adolescents' problems; (2) parents trying to escape from responsibility for adolescents with problems; (3) parents as an active part of the care for adolescents; and (4) parents as a barrier to effective care. Conclusion: Psychosocial care providers should specifically address the role of the parents in psychosocial care to improve outcomes. Specific interventions are needed to support the involvement of parents in care, as their role is important. Moreover, professionals can be better trained in working with multi-problem families also to resolve some of the negative perceptions of these parents.

The Association of Family-Related Adversity With Fighting in Adolescents: Does Hopelessness Mediate This Association?

Objectives: To explore the association of family-related adversities with physical fighting, and whether this association is mediated by hopelessness. Methods: The sample consisted of 3712 Slovak adolescents (mean age: 13.9, 50.7% girls). Participants answered questions regarding experienced family-related adversities, involvement in physical fighting in the last 12 months and the Hopelessness Questionnaire. First, the association of family adversities in general with fighting and of each of family-related adversity separately was assessed using linear regression models and second, mediation was assessed using the a*b product method with bootstrapped 95% confidence intervals Results: Adolescents who had experienced at least one family adversity reported more frequent fighting. Similarly, each of reported family adversities (death of a parent, substance abuse problems of a parent, conflicts/physical fights, divorce) was associated with more frequent fighting among adolescents. The mediation effect of hopelessness was found in each association of family-related adversity with fighting. Conclusion: These findings suggest that interventions to support adolescents who had experienced family adversities could among other things be directed at better coping with hopelessness.

Crisis in the Family and Positive Youth Development: The Role of Family Functioning.

The family is a very important institution that provides relationships and contexts in which adolescents are included and where the trajectory of positive development can be activated. A family crisis can affect family functioning and endanger adolescent development. Therefore, we aimed to explore the association of crisis in the family with positive youth development (PYD), and further, whether adolescent-perceived family functioning mediates or moderates this relation. The sample consisted of Slovak adolescents (N = 341, 44% boys, mean age = 13.16) who completed questionnaires that included questions on family crisis and joint family activities, the Alabama parenting questionnaire and the Very Short PYD questionnaire in the baseline measurement of the Care4Youth cohort study. We found a positive association of perceived positive parenting (B = 0.51; p < 0.001) and family activities (B = 0.50; p < 0.001) with PYD, whereas crisis in the family (B = -0.42; p = 0.01) and perceived poor supervision (B = -0.30; p < 0.001) were negatively associated with PYD. Using serial mediation model, we found following pathway which connected crisis in the family with PYD: crisis in the family → perceived poor parental supervision → joint family activities → PYD. This implies that family interventions and counselling to support parenting skills, especially parental supervision and family activities, to those with the signs of an ongoing family crisis may help to counteract the negative effect of the family crisis on PYD.

Dynamic neuroendocrine changes in critically ill patients with polytrauma.

OBJECTIVE: Acute multiple-trauma induces activation of neuroendocrine system. Nonthyroidal illness syndrome (NTIS) is considered to be associated with adverse outcome in intensive care unit (ICU) patients. This study was aimed to assess dynamic changes of neuroendocrine hormones in patients with polytrauma and their association with the polytrauma score (PTS). METHODS: Blood samples from 24 critically ill patients with polytrauma were obtained on 1st, 2nd, 3rd and 7th day after admission to ICU for analysis of thyroid-stimulating hormone (TSH), total triiodothyronine (T3); free triiodothyronine (fT3), total thyroxine (T4), free thyroxine (fT4), growth hormone (GH), prolactin (PRL) and procalcitonin levels. RESULTS: Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16±5 points on average at the admission to ICU. All patients had normal baseline TSH, T4, fT4, but low T3, and fT3 levels were found in 20% and 33% ICU patients, respectively. On the 7th day after admission to ICU TSH had tendency to increase (p=0.07) and fT4 significantly decreased (p=0.03). The PRL level significantly increased on the 3rd day after admission as compared to 1st day (p=0.04). PTS positively correlated with fT3 (r=0.582, p=0.004) and negatively with fT4 (r=-0.422, p=0.04) at the 1st day in ICU. CONCLUSION: Critical illness in patients with polytrauma leaded to trauma severity-dependent alterations of the thyroid axis response early after injury. Our findings suggest that detection of dynamic hormonal response is more appropriate than single measurement. However supplemental therapy for NTIS should be used after more detailed studies are completed.