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2.
Int J Behav Med ; 2020 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-32215858

RESUMO

BACKGROUND: Health risk behaviors during adolescence may cluster into patterns that might be predicted by specific factors, among which HIV may have an important role. METHOD: In a cross-sectional study conducted between 2017 and 2018, clustering of HRB and its associated factors was investigated in rural Kenya among 588 adolescents (36% perinatally HIV infected; 28% perinatally HIV exposed but uninfected; and 36% HIV unexposed/uninfected). Latent class analysis of 22 behaviors followed by multinomial logistic regression were conducted. Four risk behavior classes were identified. RESULTS: No significant differences were found in behavioral class membership across the three HIV groups (p = 0.366). The risk of membership to the higher risk behavioral classes relative to class 1 (the substance and drug abstinent low risk takers) increased with older adolescent age (p = 0.047), increased among adolescent who experienced mental distress (p < 0.001), and those who felt unsafe in their neighborhood (p < 0.002). Better working memory (p = 0.0037) was found to be protective. CONCLUSION: The results highlight a need to include screening and interventions for internalizing mental health problems and deficits in executive functioning, as well as steps to involve family members and communities to address psychosocial risk factors in adolescents in Kenya.

3.
J Affect Disord ; 267: 315-324, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32217232

RESUMO

BACKGROUND: We utilised data from the 2015 Pelotas Birth Cohort, a large prospective cohort in southern Brazil, to examine the association of moderate and severe antenatal depression with child birth outcomes and explore interactions with sociodemographic characteristics. METHODS: Data was available for n = 3046 participants and their infants. We measured antenatal depression using the Edinburgh Postnatal Depression Scale (EPDS, ≥13 for moderate and ≥17 for severe depression). Outcome measures included gestational age, birth weight, length and head circumference, using the Intergrowth-21st standards. We controlled for known confounders including obstetric risk. RESULTS: We did not find differences in childbirth outcomes by maternal depression status for participants with at least moderate depression, although there was an increased risk for female offspring to be small for gestational age (SGA, OR 2.33[1.37,3.97]). For severe depression (EPDS≥17) we found an increased risk for lower APGAR scores (OR 1.63[1.02,2.60]) and being SGA (OR 1.77[1.06,2.97], with an increased risk for female offspring in particular to be in lower weight centiles (-10.71 [-16.83,-4.60]), to be SGA (OR 3.74[1.89, 7.44]) and in the lower 10th centile for length (OR 2.19[1.25,3.84]). LIMITATIONS: include the use of a maternal report questionnaire to ascertain depressive symptoms. CONCLUSIONS: In this recent large longitudinal cohort in Brazil we did not find independent effects of depression on adverse birth outcomes or interactions with sociodemographic characteristics. We found an increased risk of being SGA for female offspring of women with moderate and severe depression, in line with other research suggesting females may be more susceptible to antenatal disturbances. FUNDING: This work was supported by the Wellcome Trust, United Kingdom (095582), the Brazilian National Research Council (CNPq) and the Coordination for the Improvement of Higher Education Personnel (CAPES). EN was supported by the UK Economic and Social Research Council GCRF Postdoctoral Fellowship (ES/P009794/1).

5.
Trials ; 21(1): 25, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907018

RESUMO

BACKGROUND: The 2016 World Health Organization Antenatal Guidelines and the 2015 South African Maternal and Child Health Guidelines recommend one early antenatal ultrasound scan to establish gestational age and to detect multiple pregnancies and fetal abnormalities. Prior research indicates that ultrasound scan can also increase parental-fetal attachment. We aim to establish whether, compared to routine care, messages to promote parental attachment and healthy child development, conducted during one or two pregnancy ultrasound scans, improve early child development and growth, exclusive breastfeeding, parental-child interactions and prenatal and postnatal clinic attendance. METHODS: The effect of messages to sensitise mothers and fathers to fetal development will be tested in a three-armed randomised trial with 100 mothers and their partners from Soweto, Johannesburg in each arm. The primary outcome is child development at 6 months postnatally. Secondary outcomes include infant feeding, parental attachment and interaction, parental mental health and infant growth, assessed at 6 weeks and 6 months. Parents in Arm 1 receive a fetal ultrasound scan < 25 weeks during routine antenatal care at tertiary hospitals, and a second standard ultrasound scan at the research site within 2 weeks. Arm 2 participants receive the routine antenatal ultrasound scan and an additional ultrasound scan < 25 weeks at the research site, together with messages to promote parental attachment and healthy child development. Arm 3 participants receive the routine ultrasound scan and two additional ultrasound scans at the research site, < 25 weeks and < 36 weeks, together with messages to promote parental attachment and healthy child development. DISCUSSION: Evidence from high-income countries suggests that first-time prospective mothers and fathers enjoy seeing their fetus during ultrasound scan and that it is an emotional experience. A number of studies have found that ultrasound scan increases maternal attachment during pregnancy, a predictor of positive parent-infant interactions which, in turn, promotes healthy infant development. It is generally agreed that studies are needed which follow up parental-child behaviour and healthy child development postnatally, include fathers and examine the construct in a wider diversity of settings, especially in low and middle-income countries. Testing the added benefits of pregnancy ultrasound scan for child development is a gap that the proposed trial in South Africa seeks to address. TRIAL REGISTRATION: Pan African Clinical Trials Registry, PACTR201808107241133. Registered on 15 August 2018.

6.
World Neurosurg ; 133: 283-290, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505282

RESUMO

BACKGROUND: Traditional manual retraction to access deep-seated brain lesions has been associated with complications related to vascular compromise of cerebral tissue. Various techniques have been developed over time to minimize injury, such as self-sustaining retractors, neuronavigation, and endoscopic approaches. Recently, tubular retractors, such as the ViewSite Brain Access System (VBAS), have been developed to reduce mechanical damage from retraction by dispersing the force of the retractor radially over the parenchyma. Therefore, we sought to review the current literature to accurately assess the indications, benefits, and complications associated with use of VBAS retractors. METHODS: A literature search for English articles published between 2005 and 2019 was performed using the MEDLINE database archive with the search terminology "Vycor OR ViewSite OR Brain-Access-System NOT glass." The VBAS website was also examined. Only articles detailing neurosurgical procedures using the VBAS tubular retractor system alone, or in combination with other retractors, were included. Postoperative morbidity and mortality were analyzed to estimate complications linked to using the retractor. RESULTS: Twelve publications (106 patients) met the inclusion criteria. The VBAS retractor was used for tumor resections, hematoma evacuations, cyst removal, foreign body extractions, and lesion resection in toxoplasmosis and multiple sclerosis. These cases were subdivided into groups based on lesion location, size, and resection volume for further analysis. Gross total resection was achieved in 63% of tumor excisions, and subtotal resection was achieved in 37%. Hematoma evacuation was successful in all cases. There were 3 short-term postoperative complications linked to the retractor, with an overall complication rate of 2.8%. CONCLUSIONS: This report is the first formal assessment of the VBAS, highlighting technical considerations of the retractor from the surgeon's perspective, patient outcomes, and complications. The retractor is a safe and efficacious tubular retraction system that can be used for tumor biopsy and resection, colloid cyst removal, hematoma evacuation, and removal of foreign bodies. However, further randomized controlled trials are indicated to accurately assess complication rates and outcomes.


Assuntos
Neoplasias Encefálicas/cirurgia , Microcirurgia/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Instrumentos Cirúrgicos , Humanos
7.
J Child Psychol Psychiatry ; 61(1): 62-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31364169

RESUMO

BACKGROUND: This study evaluated whether clinical and economic outcomes from CBT for child anxiety disorders in the context of maternal anxiety disorders are improved by adding treatment focused on (a) maternal anxiety disorders or (b) mother-child interactions. METHODS: Two hundred and eleven children (7-12 years, 85% White British, 52% female) with a primary anxiety disorder, whose mothers also had a current anxiety disorder, were randomised to receive (a) child-focused CBT with nonspecific control interventions (CCBT+Con), (b) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (c) CCBT with an intervention targeting the mother-child interaction (CCBT+MCI). A cost-utility analysis from a societal perspective was conducted using mother/child combined quality-adjusted life years (QALYs). [Trial registration: https://doi.org/10.1186/isrctn19762288]. RESULTS: MCBT was associated with immediate reductions in maternal anxiety compared to the nonspecific control; however, after children had also received CCBT, maternal outcomes in the CCBT+MCI and CCBT+Con arms improved and CCBT+MCBT was no longer superior. Neither CCBT+MCBT nor CCBT+MCI conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post-treatment [primary outcome] (adj RR: 1.22 (95% CI: 0.88, 1.67), p = .23; adj RR: 1.21 (95% CI: 0.88, 1.65), p = .24, respectively) or global improvement ratings (adj RR: 1.25 (95% CI: 0.99, 1.57), p = .06; adj RR: 1.18 (95% CI: 0.93, 1.50), p = .17) or six and 12 months later. No significant differences between the groups were found on the main economic outcome measures (child/mother combined QALY mean difference: CCBT+MCBT vs. CCBT+Con: -0.04 (95% CI: -0.12, 0.04), p = .29; CCBT+MCI vs. CCBT+Con: 0.02 (95% CI: -0.05, -0.09), p = .54). CCBT+MCI was associated with nonsignificantly higher costs than CCBT (mean difference: £154 (95% CI: -£1,239, £1,547), p = .83) but, when taking into account sampling uncertainty, it may be cost-effective compared with CCBT alone. CONCLUSIONS: Good outcomes were achieved for children and their mothers across treatment arms. There was no evidence of significant clinical benefit from supplementing CCBT with either CBT for the maternal anxiety disorder or treatment focussed on mother-child interactions, but the addition of MCI (and not MCBT) may be cost-effective.

8.
Am J Epidemiol ; 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31667490

RESUMO

The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13 - 21) in rural Mpumalanga Province, South Africa during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and assessed mediation using inverse odds ratio weighting. Inference was calculated using the non-parametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared to those without (risk difference = 3.5 [95% CI 0.1, 7.0]). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6 [95% CI 0.0, 3.3]) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5 [95% CI -0.3, 3.3]). All mediators jointly explained two-thirds (indirect effect = 2.4 [95% CI 0.2, 4.5]) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health may reduce risk of acquiring HIV among AGYW.

9.
PLoS Med ; 16(8): e1002889, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31454346

RESUMO

BACKGROUND: Evidence on the association between breastfeeding and later childhood obesity and blood pressure (BP) is inconsistent, especially in HIV-prevalent areas where, until recently, HIV-infected women were discouraged from breastfeeding, but obesity is increasingly prevalent. METHODS AND FINDINGS: The Siyakhula cohort (2012-2014), a population-based prospective cohort study, collected data over 3 visits on HIV-negative children ages 7 to 11 years in rural South Africa. We used weight (body mass index [BMI]), fat, and BP as outcome variables and incorporated early life (including mother's age at delivery and HIV status) and current life factors (including maternal education and current BMI). Our primary exposure was breastfeeding duration. We dichotomized 3 outcome measures using pre-established thresholds for clinical interpretability: (1) overfat: ≥85th percentile of body fat; (2) overweight: >1 SD BMI z score; and (3) prehypertension: ≥90th percentile for systolic BP (SBP) or diastolic BP (DBP). We modelled each outcome using multivariable logistic regression, including stopping breastfeeding, then early life, and finally current life factors. Of 1,536 children (mean age = 9.3 years; 872 girls; 664 boys), 7% were overfat, 13.2% overweight, and 9.1% prehypertensive. Over half (60%) of the mothers reported continued breastfeeding for 12+ months. In multivariable analyses, continued breastfeeding between 6 and 11 months was associated with approximately halved odds of both being overfat (adjusted odds ratio [aOR] = 0.43, 95% confidence interval [CI] 0.21-0.91, P = 0.027) and overweight (aOR = 0.46, CI 0.26-0.82, P = 0.0083), but the association with prehypertension did not reach statistical significance (aOR = 0.72, CI 0.38-1.37, P = 0.32). Children with a mother who was currently obese were 5 times more likely (aOR = 5.02, CI 2.47-10.20, P < 0.001) to be overfat and over 4 times more likely to be overweight (aOR = 4.33, CI 2.65-7.09, P < 0.001) than children with normal weight mothers. Differences between HIV-exposed and unexposed children on any of the outcomes were minimal and not significant. The main study limitation was that duration of breastfeeding was based on maternal recall. CONCLUSIONS: To our knowledge, this is the first study examining and quantifying the association between breastfeeding and childhood obesity in an African setting with high HIV prevalence. We observed that breastfeeding was independently associated with reduced childhood obesity for both HIV-exposed and unexposed children, suggesting that promoting optimal nutrition throughout the life course, starting with continued breastfeeding, may be critical to tackling the growing obesity epidemic. In the era of widespread effective antiretroviral treatment for HIV-infected women for life, these data further support the recommendation of breastfeeding for all women.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Infecções por HIV/epidemiologia , Obesidade Pediátrica/epidemiologia , Pré-Hipertensão/epidemiologia , Criança , Feminino , Humanos , Masculino , Obesidade Pediátrica/etiologia , Pré-Hipertensão/etiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , África do Sul/epidemiologia
10.
J Affect Disord ; 256: 441-447, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31252237

RESUMO

BACKGROUND: This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. METHODS: We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. RESULTS: The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42). LIMITATIONS: Disrespect and abuse experiences during childbirth were self-reported. CONCLUSIONS: Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

11.
J Affect Disord ; 256: 364-372, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31207560

RESUMO

BACKGROUND: Depressive recurrence is highly prevalent and adds significantly to the burden of depressive disorder. Whilst some clinical predictors of recurrence have been clearly demonstrated (e.g. residual symptoms, previous episodes), the cognitive and psychological processes that may contribute to recurrence risk are less well established. In this study we examine whether cognitive flexibility deficits and rumination are related to recurrence in a remitted clinical sample. METHOD: We compared remitted patients with 2 or more previous depressive episodes (N = 69) to a matched group of healthy controls (N = 43). Cognitive flexibility was measured using the Internal Shift Task (IST) and a version of the Exogenous Cueing Task (ECT); rumination was assessed with the Ruminative Responses Scale. RESULTS: IST and ECT performance did not differ between remitted patients and controls. Remitted patients had higher levels of rumination than controls. Within the remitted patient group, faster disengagement from angry and happy faces on the ECT was predictive of shorter time to recurrence (hazard ratio for 1 standard deviation, (HRSD) = 0.563 [CI, 0.381-0.832], p = 0.004, (HRSD) = 0.561 [CI, 0.389-0.808], p = 0.002, respectively). Rumination predicted recurrence (HRSD = 1.526 [CI, 1.152-2.202]; p = 0.003) but was not related to emotional disengagement. LIMITATIONS: We had low power to detect small effects for the analysis within remitted patients. CONCLUSIONS: Whilst cognitive flexibility in remitted patients was not impaired relative to controls, rapid disengagement from emotional stimuli and rumination were independently associated with time to recurrence. Cognitive flexibility may be an important indicator of recurrence risk, and a target for interventions to reduce recurrence.

12.
Clin Neurol Neurosurg ; 180: 52-56, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30928808

RESUMO

OBJECTIVES: Intraventricular hemorrhage (IVH) remains a major complication of prematurity, affecting 20-25% of premature infants of very low birth weight. Preterm infants with IVH are at risk for developing significant complications, including posthemorrhagic hydrocephalus and seizures. Multiple studies have reported an association between the neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and outcomes after acute intracranial hemorrhage in adults. However, the prognostic value of the NLR in preterm infants, particularly those with IVH, has not been investigated previously. PATIENTS AND METHODS: This retrospective, observational cohort study included premature infants with IVH and a neonatal reservoir placed between January 2013 and January 2018. For each patient, peripheral blood and available cerebrospinal fluid laboratory results within 50 days of IVH diagnosis were averaged. NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Differences in NLR levels for patients with seizures or shunt placement were analyzed. RESULTS: Data for 13 surviving preterm infants (mean gestational age, 26.5 ± 3.0 weeks) were analyzed. The mean peripheral NLR (n = 13) was 1.6 ± 1.3 for all patients. Patients who experienced seizures had significantly higher peripheral blood NLR (p = 1.2 × 10-6, t-test) than those who did not, and an NLR > 3 correlated with seizure outcomes (p = 0.0035, Fisher's exact). Patients with sepsis or meningitis also had NLR values >3 (p = 0.01 and 0.005, respectively) but there was no correlation between the sepsis/meningitis and seizures patients. No significant correlation was found between NLR and the development of hydrocephalus. CONCLUSION: The development of seizures in preterm infants with IVH is known to significantly increase morbidity. In this study, higher peripheral blood NLR (>3) correlated with the development of seizures, independent of sepsis or meningitis. Further prospective validation of the role of NLR as a predictive marker for seizures in preterm infants is warranted.

13.
Lancet ; 393(10176): 1150-1163, 2019 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-30894271

RESUMO

When a child is diagnosed with a life-threatening condition, one of the most challenging tasks facing health-care professionals is how to communicate this to the child, and to their parents or caregivers. Evidence-based guidelines are urgently needed for all health-care settings, from tertiary referral centres in high-income countries to resource limited environments in low-income and middle-income countries, where rates of child mortality are high. We place this Review in the context of children's developing understanding of illness and death. We review the effect of communication on children's emotional, behavioural, and social functioning, as well as treatment adherence, disease progression, and wider family relationships. We consider the factors that influence the process of communication and the preferences of children, families, and health-care professionals about how to convey the diagnosis. Critically, the barriers and challenges to effective communication are explored. Finally, we outline principles for communicating with children, parents, and caregivers, generated from a workshop of international experts.


Assuntos
Comunicação , Pessoal de Saúde/ética , Pais/educação , Doente Terminal/psicologia , Adolescente , Criança , Pré-Escolar , Assistência à Saúde Culturalmente Competente/normas , Tomada de Decisões , Progressão da Doença , Prática Clínica Baseada em Evidências/métodos , Humanos , Pais/psicologia , Doente Terminal/estatística & dados numéricos , Cooperação e Adesão ao Tratamento
14.
Lancet ; 393(10176): 1164-1176, 2019 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-30894272

RESUMO

Many adults diagnosed with a life-threatening condition have children living at home; they and their partners face the dual challenge of coping with the diagnosis while trying to maintain a parenting role. Parents are often uncertain about how, when, and what to tell their children about the condition, and are fearful of the effect on their family. There is evidence that children are often aware that something is seriously wrong and want honest information. Health-care professionals have a key role in supporting and guiding parents and caregivers to communicate with their children about the diagnosis. However, the practical and emotional challenges of communicating with families are compounded by a scarcity of evidence-based guidelines. This Review considers children's awareness and understanding of their parents' condition, the effect of communication around parental life-threatening condition on their wellbeing, factors that influence communication, and the challenges to achieving effective communication. Children's and parents' preferences about communication are outlined. An expert workshop was convened to generate principles for health-care professionals, intended as practical guidance in the current absence of empirically derived guidelines.


Assuntos
Comunicação , Pessoal de Saúde/ética , Pais/psicologia , Doente Terminal/psicologia , Adaptação Psicológica/fisiologia , Adolescente , Adulto , Conscientização , Criança , Pré-Escolar , Tomada de Decisões , Emoções , Humanos , Relações Pais-Filho , Preferência do Paciente/psicologia
15.
J Epidemiol Community Health ; 73(5): 422-426, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30842239

RESUMO

BACKGROUND: Children in low-income and middle-income countries (LMICs) who remain in school have better health and employment outcomes. South Africa, like many LMICs, has a secondary school completion rate under 50%, leaving room for improvement if we can identify factors that affect educational attainment. This is the first longitudinal study to examine the effects of childhood mental health and cognitions on educational outcomes in LMIC. METHODS: Using the Strengths and Difficulties Questionnaire (SDQ) and Cognitive Triad Inventory for Children (CTI-C), we assessed the psychological functioning and cognition of children aged 10-12 in rural South Africa. We linked that data with measures of educational progress collected 5 years later and examined associations between educational progress and (1) behavioural and emotional problems and (2) cognitive interpretations, adjusting for possible confounders. RESULTS: Educational data were available for 443 individuals. 92% (n=408) of individuals had advanced three or fewer grades in 7 years. Having more positive cognitions (CTIC-C) was positively associated with progressing at least three grade levels (adjusted OR 1.43, 95% CI 1.14 to 1.79). There was no evidence for an association between emotional and behavioural problems (SDQ) and educational progress (OR 0.90, 95% CI 0.72 to 1.11). CONCLUSION: If children in LMICs can develop more positive perspectives, they may be able to stay in school longer. Cognitions can be modified, and future studies should test interventions that work to improve cognition in childhood, guided, for example, by principles of cognitive-behavioural therapy.

16.
Nat Commun ; 10(1): 511, 2019 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700709

RESUMO

It is unclear whether early child development is, like skeletal growth, similar across diverse regions with adequate health and nutrition. We prospectively assessed 1307 healthy, well-nourished 2-year-old children of educated mothers, enrolled in early pregnancy from urban areas without major socioeconomic or environmental constraints, in Brazil, India, Italy, Kenya and UK. We used a specially developed psychometric tool, WHO motor milestones and visual tests. Similarities across sites were measured using variance components analysis and standardised site differences (SSD). In 14 of the 16 domains, the percentage of total variance explained by between-site differences ranged from 1.3% (cognitive score) to 9.2% (behaviour score). Of the 80 SSD comparisons, only six were >±0.50 units of the pooled SD for the corresponding item. The sequence and timing of attainment of neurodevelopmental milestones and associated behaviours in early childhood are, therefore, likely innate and universal, as long as nutritional and health needs are met.


Assuntos
Comportamento , Desenvolvimento Infantil/fisiologia , Brasil , Pré-Escolar , Feminino , Humanos , Índia , Itália , Quênia , Masculino , Mães , Psicometria , Fatores Socioeconômicos
17.
J Behav Ther Exp Psychiatry ; 63: 28-35, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30639915

RESUMO

BACKGROUND AND OBJECTIVES: It has been suggested that impaired attentional control (AC) promotes the use of maladaptive emotional regulation strategies, such as rumination, with subsequent increase in risk of depression. METHOD: This study examined this hypothesis in a healthy community sample. Questionnaire measures of depression, anxiety, rumination and self-reported AC (shifting and focusing) were used, as well as an attention performance task (Attention Network Task; ANT). RESULTS: While self-report and performance measures of AC were not significantly related, both depression and rumination were associated with reduced self-reported AC. Depression was specifically associated with poorer attentional shifting. Depression and brooding were also associated with better performance on the conflict component of the ANT. Importantly, the relationships of ANT conflict and self-reported AC to depression were mediated by brooding. LIMITATIONS: The current study used a community sample, and it is unclear if results would generalise to a clinical population. All measures were taken concurrently and so it is not possible to confidently ascertain causality or direction of effects. CONCLUSIONS: These results are consistent with the suggestion that impaired AC, particularly a narrow and inflexible attentional focus, may increase risk of depression by promoting ruminative thinking. The results highlight the importance of considering both self-report and performance measures of AC, as well as different components of attentional performance.

18.
JAMA Netw Open ; 2(1): e186861, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30646198

RESUMO

Importance: Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited. Objective: To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression. Design, Setting, and Participants: This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018. Interventions: Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week. Main Outcomes and Measures: Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained). Results: A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis. Conclusions and Relevance: Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken. Trial Registration: ClinicalTrials.gov Identifier: NCT02148965.


Assuntos
Depressão Pós-Parto , Exercício/psicologia , Treinamento de Resistência/métodos , Adulto , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/fisiopatologia , Depressão Pós-Parto/prevenção & controle , Feminino , Idade Gestacional , Humanos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Gravidez , Gestantes/psicologia , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
19.
JAMA Psychiatry ; 76(3): 290-296, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30586134

RESUMO

Importance: Paternal depression during the postnatal period has been associated with adverse child outcomes. Family environment has been reported as a pathway for risk transmission from fathers to children. The influence of paternal depression during the postnatal period on offspring depression remains to be clarified. Objective: To investigate the association between paternal depression in the postnatal period and offspring depression and explore potential mediating and moderating factors that influence any association between paternal and offspring depression. Design, Setting, and Participants: This prospective study of a UK community-based birth cohort (the Avon Longitudinal Study of Parents and Children) of parents and their adolescent offspring investigated associations between paternal depression during the postnatal period and offspring depression at age 18 years. We tested a hypothesized moderator (ie, sex) and conducted path analysis to examine hypothesized mediators (ie, depression in the other parent, couple conflict, and paternal involvement and emotional problems, conduct problems, and hyperactivity in offspring at age 3.5 years) of the associations between both paternal and maternal depression and offspring depression. Data collection for the Avon Longitudinal Study of Parents and Children began in 1991 and is ongoing. Data analysis for this study was conducted from June 2015 to September 2018. Exposures: Depression symptoms in fathers at 8 weeks after the birth of their children. Main Outcomes and Measures: Offspring depression symptoms at age 18 years, using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Results: A total of 3176 father-offspring pairs were analyzed; of the children, 1764 were girls (55.5%) and 1412 (44.5%) were boys. Paternal mean (SD) age at delivery was 29.6 (9.6) years. The offspring of fathers who had depression during the postnatal period were at increased risk of experiencing depression symptoms at age 18 years (ß = 0.053 [95% CI, 0.02-0.09]). The association is mediated by maternal depression at 8 months after birth (ß = 0.011 [95% CI, 0.0008-0.02]; 21% [0.011/0.053]) and conduct problems at 42 months after birth (ß = 0.004; [95% CI , -0.00004 to 0.009]; 7.5% [0.004/0.053]). Couple conflict and paternal involvement do not mediate this association. The increased risk is seen in girls but not boys (interaction ß = 0.095; P = .01). Conclusions and Relevance: The association between paternal depression in the postnatal period and depression in girls at age 18 years is partially explained by maternal depression. Couple conflict and paternal involvement were not found to play a role in the risk of transmission; this contrasts with the role that couple conflict was found to play in the risk of childhood behavior problems. Conduct problems in childhood appear to be a pathway for risk transmission between paternal depression and subsequent depression in offspring at age 18 years.


Assuntos
Filho de Pais Incapacitados/psicologia , Depressão Pós-Parto/epidemiologia , Depressão/etiologia , Pai/psicologia , Mães/psicologia , Período Pós-Parto/psicologia , Adolescente , Filho de Pais Incapacitados/estatística & dados numéricos , Depressão/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores Sexuais , Reino Unido/epidemiologia
20.
Cereb Cortex ; 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-32129828

RESUMO

The perception of infant emotionality, one aspect of temperament, starts to form in infancy, yet the underlying mechanisms of how infant emotionality affects adult neural dynamics remain unclear. We used a social reward task with probabilistic visual and auditory feedback (infant laughter or crying) to train 47 nulliparous women to perceive the emotional style of six different infants. Using functional neuroimaging, we subsequently measured brain activity while participants were tested on the learned emotionality of the six infants. We characterized the elicited patterns of dynamic functional brain connectivity using Leading Eigenvector Dynamics Analysis and found significant activity in a brain network linking the orbitofrontal cortex with the amygdala and hippocampus, where the probability of occurrence significantly correlated with the valence of the learned infant emotional disposition. In other words, seeing infants with neutral face expressions after having interacted and learned their various degrees of positive and negative emotional dispositions proportionally increased the activity in a brain network previously shown to be involved in pleasure, emotion, and memory. These findings provide novel neuroimaging insights into how the perception of happy versus sad infant emotionality shapes adult brain networks.

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