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1.
Global Health ; 16(1): 96, 2020 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-33036622

RESUMO

BACKGROUND: The outbreak of Coronavirus Disease is causing considerable acute risk to public health and might also have an unanticipated impact on the mental health of children and adolescents in the long run. This study collected data during the national lockdown period in China and aims to understand whether there is a clinically significant difference in anxiety, depression, and parental rearing style when comparing adolescents from Wuhan and other cities in China. This study also intends to examine whether gender, grade in school, single child status, online learning participation, parents' involvement in COVID-19 related work, and parents being quarantined or infected due to the disease would lead to clinically significant differences in anxiety and depression. Beyond that, this study explored the pathways among the different variables in order to better understand how these factors play a part in impacting adolescents' mental health condition. RESULTS: Results showed that there was a statistically significant difference in anxiety symptoms between participants who were from Wuhan compared to other urban areas, but not in depressive symptoms. In addition, participants' grade level, gender, relative being infected, and study online have direct positive predictive value for depressive and anxiety symptoms, whereas location and sibling status have indirect predictive value. Having relatives who participated in COVID-19 related work only had positive direct predictive value toward depression, but not anxiety. CONCLUSIONS: This study discovered several risk factors for adolescents' depression and anxiety during the pandemic. It also called for a greater awareness of Wuhan parents' mental wellbeing and recommended a systematic approach for mental health prevention and intervention.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus/psicologia , Depressão/epidemiologia , Pandemias , Pneumonia Viral/psicologia , População Urbana/estatística & dados numéricos , Adolescente , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Poder Familiar/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Fatores de Risco
2.
Cleve Clin J Med ; 87(10): 613-618, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004322

RESUMO

The COVID-19 pandemic has dramatically affected every aspect of daily life. Parents of adolescents, in particular, may be facing unique challenges in helping them navigate unexpected changes to their daily routine. This article discusses how adolescents may respond to stressful and traumatic situations and provides recommendations for clinicians who may be advising parents of adolescents or parenting their own children.


Assuntos
Comportamento do Adolescente , Infecções por Coronavirus , Educação não Profissionalizante , Pandemias , Poder Familiar , Pneumonia Viral , Resiliência Psicológica , Estresse Psicológico/prevenção & controle , Adolescente , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Humanos , Relações Pais-Filho , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia
3.
BMC Psychol ; 8(1): 107, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33076981

RESUMO

BACKGROUND: Professional support to enhance the early parent-infant relationship in the first months after birth is recommended, but little is known about the effect of universal interventions. The objective was to investigate the effect of health visitors' use of the Newborn Behavioral Observations system in new families. METHODS: A cluster-randomised study was conducted in four Danish municipalities. Health visitors' geographical districts constituted the units for randomisation (n = 17). In the intervention group, 1332 families received NBO from 3 weeks after birth; in the comparison group, 1234 received usual care. Self-administered questionnaires were collected at baseline one to two weeks after birth, and at follow-up three and nine months postpartum. The outcomes were change over time measured by The Karitane Parenting Confidence Scale (KPCS), The Major Depression Inventory (MDI), The Ages and Stages Questionnaire: social-emotional (ASQ:SE) and The Mother and Baby Interaction Scale (MABIC). Data were analysed with mixed-effects linear regression using the intention-to-treat approach. RESULTS: At baseline, no significant differences between the two groups were seen regarding maternal and infant factors. At follow-up three and nine months after birth, the change in maternal confidence and mood, infant's socio-emotional behaviour, and early parent-infant relationship moved in a slightly more positive direction in the intervention group than in the comparison group, though not statistically significant. The only significant effect was that the intervention mothers reported higher level of knowledge about infant's communication skills, response to cues, and how to sooth and establish a relation with the infant, compared to the comparison group. CONCLUSIONS: We found no effect of the NBO system delivered in a universal context to all families in a community setting. The only significant difference between groups was a higher maternal degree of knowledge regarding early parenting in the intervention group. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03070652 . Registrated February 22, 2017.


Assuntos
Técnicas de Observação do Comportamento , Poder Familiar/psicologia , Psicologia da Criança , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Relações Mãe-Filho/psicologia , Mães/psicologia
4.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32968030

RESUMO

OBJECTIVES: Adolescents often display heterogenous trajectories of alcohol use. Initiation and escalation of drinking may be important predictors of later harms, including alcohol use disorder (AUD). Previous conceptualizations of these trajectories lacked adjustment for known confounders of adolescent drinking, which we aimed to address by modeling dynamic changes in drinking throughout adolescence while adjusting for covariates. METHODS: Survey data from a longitudinal cohort of Australian adolescents (n = 1813) were used to model latent class alcohol use trajectories over 5 annual follow-ups (mean age = 13.9 until 17.8 years). Regression models were used to determine whether child, parent, and peer factors at baseline (mean age = 12.9 years) predicted trajectory membership and whether trajectories predicted self-reported symptoms of AUD at the final follow-up (mean age = 18.8 years). RESULTS: We identified 4 classes: abstaining (n = 352); late-onset moderate drinking (n = 503); early-onset moderate drinking (n = 663); and early-onset heavy drinking (n = 295). Having more alcohol-specific household rules reduced risk of early-onset heavy drinking compared with late-onset moderate drinking (relative risk ratio: 0.31; 99.5% confidence interval [CI]: 0.11-0.83), whereas having more substance-using peers increased this risk (relative risk ratio: 3.43; 99.5% CI: 2.10-5.62). Early-onset heavy drinking increased odds of meeting criteria for AUD in early adulthood (odds ratio: 7.68; 99.5% CI: 2.41-24.47). CONCLUSIONS: Our study provides evidence that parenting factors and peer influences in early adolescence should be considered to reduce risk of later alcohol-related harm. Early initiation and heavy alcohol use throughout adolescence are associated with increased risk of alcohol-related harm compared with recommended maximum levels of consumption (late-onset, moderate drinking).


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/etiologia , Consumo de Álcool por Menores/psicologia , Adolescente , Fatores Etários , Alcoolismo/diagnóstico , Austrália/epidemiologia , Intervalos de Confiança , Feminino , Humanos , Estudos Longitudinais , Masculino , Poder Familiar , Pais , Grupo Associado , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-32987641

RESUMO

The present study aimed to examine the effects of the Spanish confinement derived from the COVID-19 crisis on children and their families, accounting for child's age. A range of child negative (e.g., conduct problems) and positive outcomes (e.g., routine maintenance) were examined, along with a set of parent-related variables, including resilience, perceived distress, emotional problems, parenting distress and specific parenting practices (e.g., structured or avoidant parenting), which were modeled through path analysis to better understand child adjustment. Data were collected in April 2020, with information for the present study provided by 940 (89.6%) mothers, 102 (9.7%) fathers and 7 (0.7%) different caregivers, who informed on 1049 Spanish children (50.4% girls) aged 3 to 12 years (Mage = 7.29; SD = 2.39). The results suggested that, according to parents' information, most children did not show important changes in behavior, although some increasing rates were observed for both negative and positive outcomes. Child adjustment was influenced by a chain of effects, derived from parents' perceived distress and emotional response to the COVID-19 crisis, via parenting distress and specific parenting practices. While parenting distress in particular triggered child negative outcomes, specific parenting practices were more closely related to child positive outcomes. These findings may help to better inform, for potential future outbreaks, effective guidelines and prevention programs aimed at promoting the child's well-being in the family.


Assuntos
Comportamento Infantil , Infecções por Coronavirus/psicologia , Poder Familiar , Pais/psicologia , Pneumonia Viral/psicologia , Quarentena/psicologia , Betacoronavirus , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pandemias , Angústia Psicológica , Espanha
6.
Matern Child Health J ; 24(Suppl 2): 232-242, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32889682

RESUMO

INTRODUCTION: Expectant and parenting young people (young parents) need a range of supports but may have difficulty accessing existing resources. An optimally connected network of organizations can help young parents navigate access to available services. Community organizations participating in the Pathways to Success (Pathways) initiative sought to strengthen their network of support for young parents through social network analysis (SNA) undertaken within an action research framework. METHOD: Evaluators and community partners utilized a survey and analysis tool to map and describe the local network of service providers offering resources to young parents. Respondents were asked to characterize their relationship with all other organizations in the network. Following survey analysis, all participants were invited to discuss and interpret the results and plan the next actions to improve the network on behalf of young parents. RESULTS: Scores described the diversity of organizations in the network, density of connections across the community, degree to which the network was centralized or decentralized, which organizations were central or outliers, frequency of contact, levels of collaboration, and levels of trust. Findings were interpreted with survey participants and used by Pathways staff for action planning to improve their network. DISCUSSION: SNA clarified complex relationships and set service providers on a path toward optimizing their network. The usefulness of SNA to impact and improve a network approach to supporting young parents is discussed, including lessons learned from this project.


Assuntos
Poder Familiar , Gravidez na Adolescência , Rede Social , Apoio Social , Adolescente , Comportamento Cooperativo , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Gravidez
7.
Matern Child Health J ; 24(Suppl 2): 171-177, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32889683

RESUMO

INTRODUCTION: Expectant and parenting young people (young parents) require diverse services to support their health, educational success, and family functioning. Rarely can the needs of young parents be met by a single school or service provider. This case study examines how one large school district funded through the pathways to success initiative was able to facilitate systems change to increase young parents' access to and use of supportive services. METHODS: Data sources include a needs and resources assessment, quarterly reports documenting grantee effort, sustainability plans, social network analysis, and capstone interviews. All data sources were systematically reviewed to identify the existing context prior to the start of the initiative, the changes that resulted from the initiative, and efforts that could potentially be maintained beyond the grant period. RESULTS: The community context prior to Pathways implementation was one of disconnected services and missed opportunities. The full-time program coordinator hired by the district focused on systems-level change and facilitated connections between organizations. This greater connectivity contributed to increased collaboration with the goal of producing lasting benefits for young parents. DISCUSSION: Promoting sustainable connections and collaboration at the systems level can help dismantle barriers to service access and benefit young parents.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Poder Familiar/psicologia , Serviços de Saúde Escolar/organização & administração , Apoio Social , Adolescente , Feminino , Humanos , Avaliação de Programas e Projetos de Saúde , Instituições Acadêmicas , Rede Social
9.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 443-462, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886045

RESUMO

Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.


Assuntos
Filho de Pais Incapacitados/psicologia , Terapia Cognitivo-Comportamental , Governo , Transtornos Mentais/prevenção & controle , Transtornos Mentais/terapia , Pais/psicologia , Adolescente , Adulto , Áustria , Criança , Pré-Escolar , Suscetibilidade a Doenças , Alemanha , Humanos , Lactente , Transtornos Mentais/diagnóstico , Poder Familiar/psicologia
10.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 463-480, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886047

RESUMO

Mental Disorders and Parenting: Challenges and Opportunities for Adult Mental Health Services Parenting can be a key element in the psychiatric rehabilitation process, but it may come with many challenges for parents with mental health problems. Illness symptoms, together with social and sociocultural factors, can have adverse effects on family life or parenting behaviors and entail severe consequences for a child's psychosocial development. Bidirectional interactions can increase parental burden and thus worsen a parent's course of illness. This vicious circle can be broken by the provision of early and adequate support of mothers and fathers with mental health problems. Adult mental health services can make an important yet often underestimated contribution here. This article refers to parents' resources and needs and introduces both opportunities and challenges for adult mental health services when it comes to dealing with parenting needs. Mental health professionals are in a pivotal position for extending adequate support to clients on their parental needs. These professionals' skills and knowledge regarding parenting are essential for the successful implementation of family-focused practices in adult mental health services. Beyond the individual level, there is a need for policies and guidelines stipulating the integration of family and child perspectives in adult mental health services. In a broader view, a program from Finland shows how mental health professionals as well as peers can support parents and their families during the treatment process.


Assuntos
Filho de Pais Incapacitados/psicologia , Transtornos Mentais/terapia , Serviços de Saúde Mental , Poder Familiar/psicologia , Pais/psicologia , Adulto , Criança , Suscetibilidade a Doenças , Feminino , Humanos , Masculino , Transtornos Mentais/prevenção & controle , Transtornos Mentais/reabilitação
11.
Prax Kinderpsychol Kinderpsychiatr ; 69(5): 416-425, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32886051

RESUMO

Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention In Germany, networks and measures of early childhood intervention (ECI) have been implemented nationwide. By specifically targeting families with multiple psychosocial challenges, ECI contributes to the enhancement of families' parenting skills, in order to promote equal opportunities for all children to grow up healthy and safe. In many families supported by ECI measures at least one parent shows symptoms of a mental health disorder, which poses a major challenge to ECI practitioners. Nevertheless, there is a lack of valid scientific knowledge about the proportion of young families living with symptoms of mental disorders, the degree to which parents' psychic burdens affect care in ECI measures and about the cooperation of different care providing systems. The National Center for Early Prevention (NCEP) monitors and evaluates the scaling up of ECI networks and measures in Germany. The present article compiles results of different NCEP studies focusing on parents with mental illness in Early Childhood Intervention. Results are discussed with regard to their relevance for further improving the care systems.


Assuntos
Filho de Pais Incapacitados/psicologia , Transtornos Mentais/prevenção & controle , Pais/psicologia , Medicina Preventiva , Criança , Suscetibilidade a Doenças , Alemanha , Humanos , Transtornos Mentais/reabilitação , Saúde Mental , Poder Familiar/psicologia
12.
Matern Child Health J ; 24(Suppl 2): 125-131, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32737680

RESUMO

INTRODUCTION: New Heights is a voluntary school-based program that provides a well-defined system of supports for expectant and parenting students in Washington, DC, and was found to be effective at improving educational outcomes. This study explores the program elements and practices that, when used together, improved academic outcomes for New Heights participants and define a possible roadmap for service providers interested in replicating the program's success. METHODS: The study team collected data through site visits, key informant interviews, staff surveys, program observations, case files, and program materials. RESULTS: The core design and implementation elements of the New Heights program are (1) placing a trained staff member in the school to provide advocacy, case management, education, and in-kind incentives; (2) bringing community-based service providers into the school; (3) giving trained staff autonomy and a strong grounding in local context; and (4) using a highly collaborative process to hire and support school-based coordinators. DISCUSSION: Staff and funders interested in improving outcomes for young parents in school could use the experience of New Heights and the key practices that were critical to its success as a guide: (1) ensure that the program is well defined but can be tailored to the needs of schools and students, (2) engage community partners to bring services to participants, (3) hire and train the right staff who are committed to "do whatever it takes," (4) actively cultivate a culture of collaboration among program staff, and (5) develop buy-in with school staff and illustrate program value.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Poder Familiar , Gravidez na Adolescência , Desenvolvimento de Programas , Adolescente , District of Columbia , Feminino , Humanos , Gravidez , Instituições Acadêmicas , Apoio Social , Evasão Escolar
13.
Matern Child Health J ; 24(Suppl 2): 141-151, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32748287

RESUMO

OBJECTIVES: With funding from the Pregnancy Assistance Fund, the Maternal, Child, and Adolescent Health Division (MCAH) of California redesigned its existing Adolescent Family Life Program (AFLP) for expectant and parenting young women into a more intensive and structured intervention, AFLP with positive youth development (PYD). This paper presents key findings from a federally funded, rigorous implementation study of the two programs. METHODS: This implementation study collected data from 13 agencies from January 2016 through December 2017, including interviews with 69 case managers and 18 supervisors; focus groups with 130 program participants; surveys of 66 case managers and 1330 young women; and observations of 42 visits with program participants. The study combined qualitative and quantitative analysis methods. RESULTS: As designed, PYD was a much more structured and intensive program than AFLP. Case managers and supervisors saw value in the PYD model and new approach but needed more support and guidance than expected in order to deliver it with fidelity. MCAH provided additional trainings and technical assistance to address challenges. In practice, although staff noted differences in approach and content, the youth experience with the two programs was similar. CONCLUSIONS FOR PRACTICE: Integrating the PYD framework into case management systems may foster youth self-sufficiency and resiliency. However, the rigid structure of the program was often challenging to implement in practice. Organizations interested in implementing prescribed case management approaches should consider allowing opportunities for flexibility in implementation and providing more detailed preservice training to prepare staff for real-world implementation.


Assuntos
Mães/educação , Poder Familiar , Gravidez na Adolescência , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , California , Administração de Caso , Feminino , Humanos , Mães/psicologia , Gravidez
14.
Matern Child Health J ; 24(Suppl 2): 67-75, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32860585

RESUMO

Until recently, federal programs had not explicitly focused on improving the outcomes of highly vulnerable teen parents. Established in 2010, the Pregnancy Assistance Fund (PAF) aims to improve the health, social, educational, and economic outcomes for expectant and parenting teens and young adults, their children, and their families, through providing grants to states and tribes. This article introduces the Maternal and Child Health Journal supplement "Supporting Expectant and Parenting Teens: The Pregnancy Assistance Fund," which draws together the perspectives of researchers and practitioners to provide insights into serving expectant and parenting teens through the PAF program. The articles in the supplement include examples of programs that use different intervention strategies to support teen parents, with programs based in high school, college, and community settings in both urban and rural locations. Some of the articles provide rigorous evidence of what works to support teen parents. In addition, the articles demonstrate key lessons learned from implementation, including allowing some flexibility in implementation while clearly outlining core programmatic components, using partnerships to meet the multifaceted needs of young parents, hiring the right staff and providing extensive training, using strategies for engaging and recruiting teen parents, and planning for sustainability early. The studies use a range of qualitative and quantitative methods to evaluate programs to support teen parents, and three articles describe how to implement innovative and cost effective methods to evaluate these kinds of programs. By summarizing findings across the supplement, we increase understanding of what is known about serving expectant and parenting teens and point to next steps for future research.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Gravidez na Adolescência , Apoio Social , Seguridade Social , Adolescente , Feminino , Previsões , Humanos , Poder Familiar , Pais , Gravidez
15.
Matern Child Health J ; 24(Suppl 2): 163-170, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32860586

RESUMO

PURPOSE: The New Mexico Graduation Reality and Dual-role Skills (GRADS) program provides services for expectant and parenting students at high schools. The GRADS program has operated since 1989, serving more than 17,000 youth. This study summarizes the GRADS program model and program administrators' lessons learned from implementing this comprehensive, large-scale program. DESCRIPTION: The GRADS program is a multicomponent intervention that can include a classroom intervention, case management, linkages to child care and health care, and support for young fathers. The program aims to support expectant and parenting youth in finishing high school, delaying a repeat pregnancy, promoting health outcomes for their children, and preparing for college and career. This study presents program administrators' lessons learned to increase understanding of how to implement a statewide program to support expectant and parenting students. ASSESSMENT: During the 2010-2017 school years, the GRADS program operated in 26-31 sites each year, serving a total of 2691 parenting youth. Program administrators identified lessons learned from implementing the GRADS program during that period of expansion, including allowing variation across sites based on resources and needs, providing centralized implementation support, fostering buy-in from school and district leaders, and collecting consistent data to better understand participant outcomes. CONCLUSIONS: Although not based on a rigorous impact or implementation study, this article provides lessons learned from a statewide, school-based program that may be a promising way to serve a large number of expectant and parenting youth and help them overcome challenges for completing high school.


Assuntos
Cuidado do Lactente , Poder Familiar , Pais/educação , Estudantes , Adolescente , Feminino , Humanos , Recém-Nascido , New Mexico , Gravidez , Gravidez na Adolescência , Instituições Acadêmicas , Adulto Jovem
16.
Epidemiol Psychiatr Sci ; 29: e155, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32787989

RESUMO

AIMS: To investigate behavioural problems throughout childhood and adolescent, and its relationship with socioeconomic position (SEP) and early parenting environment. METHODS: Using data from the Millennium Cohort Study conducted in the UK, behavioural problems of 14 452 children were analysed using a growth curve model. The children were followed from birth to adolescence, and their behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ). The SDQ was sub-scaled into externalising and internalising problems. After assessing the general trajectory of children's behavioural problems, variables representing SEP and parenting environments were introduced to the model to analyse the association with children's outcomes. RESULTS: Overall, children's trajectories in externalising problems showed a decreasing trend while internalising problems increased as they aged. Household income and maternal education in early childhood were independently associated with children's behavioural problems, while the association for maternal occupation was significantly weaker. Positive early parenting environments attenuated the association between SEP and children's behavioural problems. Also, with regards to children's behavioural problems, positive parenting explained more variance between children compared to SEP. Favourable parent-child relationship buffered the income gradient in children's behavioural problems during early childhood, and although this buffering effect did not last until adolescence, those who had good parent-child relationships developed better outcomes regardless of their SEP. CONCLUSIONS: The results of the study emphasise the importance of a positive early parenting environment for improving and reducing the socioeconomic gap in children's behavioural problems and encourages policies to promote better parenting circumstances.


Assuntos
Transtornos do Comportamento Infantil/psicologia , Relações Pais-Filho , Poder Familiar , Comportamento Problema/psicologia , Classe Social , Meio Social , Adolescente , Criança , Estudos de Coortes , Feminino , Humanos , Renda , Controle Interno-Externo , Masculino , Inquéritos e Questionários , Reino Unido
17.
Pediatr Dent ; 42(4): 308-315, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32847671

RESUMO

Purpose: To investigate the association between parent-child interactions in the first grade, child resilience in the second grade, and dental caries incidence in the fourth grade of elementary school. Methods: The longitudinal data of 3,168 children from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study were analyzed. In 2015, caregivers of all first-grade public elementary school children in Adachi City, Tokyo, Japan, provided answers about their parenting behaviors. In the second grade, child resilience and oral health behaviors were measured. The incidence of dental caries in the fourth grade was assessed during mandatory dental checkups at school. Structural equation modeling was applied. Results: Parent-child interactions at the first-grade was associated with higher resilience of children in second grade (standardized coefficient [ß] equals 0.402; 95 percent confidence interval [95% CI] equals 0.357 to 0.446), which was associated with favorable oral health behavior in the same year (ß equals 0.236, 95% CI equals 0.159 to 0.313). Favorable oral health behavior was inversely associated with dental caries incidence in the fourth grade (ß equals -0.108, 95% CI equals -0.170 to -0.045). Conclusion: Parent-child interactions were associated with improved resilience and fewer incidents of dental caries in children.


Assuntos
Cárie Dentária , Cuidadores , Criança , Humanos , Incidência , Saúde Bucal , Poder Familiar , Instituições Acadêmicas
18.
Pediatrics ; 146(Suppl 1): S60-S65, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737234

RESUMO

Charlie Gard (August 4, 2016, to July 28, 2017) was an infant in the United Kingdom who was diagnosed with an encephalopathic form of mitochondrial DNA depletion syndrome caused by a mutation in the RRM2B gene. Charlie's parents raised £1.3 million (∼$1.6 million US) on a crowdfunding platform to travel to New York to pursue experimental nucleoside bypass treatment, which was being used to treat a myopathic form of mitochondrial DNA depletion syndrome caused by mutations in a different gene (TK2). The case made international headlines about what was in Charlie's best interest. In the medical ethics community, it raised the question of whether best interest serves as a guidance principle (a principle that provides substantive directions as to how decisions are to be made), an intervention principle (a principle specifying the conditions under which third parties are to intervene), both guidance and intervention, or neither. I show that the United Kingdom uses best interest as both guidance and intervention, and the United States uses best interest for neither. This explains why the decision to withdraw the ventilator without attempting nucleoside bypass treatment was the correct decision in the United Kingdom and why the opposite conclusion would have been reached in the United States.


Assuntos
Proteínas de Ciclo Celular/genética , Encefalomiopatias Mitocondriais/terapia , Defesa do Paciente/ética , Respiração Artificial/ética , Ribonucleotídeo Redutases/genética , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Crowdsourcing/economia , História do Século XXI , Humanos , Lactente , Masculino , Futilidade Médica/ética , Encefalomiopatias Mitocondriais/genética , Cidade de Nova Iorque , Poder Familiar , Defesa do Paciente/legislação & jurisprudência , Transferência de Pacientes/ética , Transferência de Pacientes/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Timidina Quinase/genética , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
19.
J Med Internet Res ; 22(9): e22002, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32857707

RESUMO

BACKGROUND: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. OBJECTIVE: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. METHODS: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included "COVID," "corona," and "pandemic." A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. RESULTS: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including "worried" (n=165, 19.9%), "risk" (n=143, 17.2%), "anxiety" (n=98, 11.8%), "concerns" (n=74, 8.8%), and "stress" (n=69, 8.3%). CONCLUSIONS: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.


Assuntos
Infecções por Coronavirus/epidemiologia , Internet , Saúde Mental/estatística & dados numéricos , Mães/psicologia , Poder Familiar/psicologia , Pneumonia Viral/epidemiologia , Período Pós-Parto/psicologia , Gravidez/psicologia , Estresse Psicológico/epidemiologia , Adulto , Ansiedade/epidemiologia , Austrália/epidemiologia , Criança , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Pandemias/prevenção & controle , Parto/psicologia , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Apoio Social
20.
Child Psychiatry Hum Dev ; 51(5): 671-682, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32749568

RESUMO

Research confirms that the mental health burdens following community-wide disasters are extensive, with pervasive impacts noted in individuals and families. It is clear that child disaster outcomes are worst among children of highly distressed caregivers, or those caregivers who experience their own negative mental health outcomes from the disaster. The current study used path analysis to examine concurrent patterns of parents' (n = 420) experience from a national sample during the early months of the U.S. COVID-19 pandemic. The results of a multi-group path analysis, organized by parent gender, indicate good fit to the data [X2(10) = 159.04, p < .01]. Results indicate significant linkages between parents' caregiver burden, mental health, and perceptions of children's stress; these in turn are significantly linked to child-parent closeness and conflict, indicating possible spillover effects for depressed parents and compensatory effects for anxious parents. The impact of millions of families sheltering in place during the COVID-19 pandemic for an undefined period of time may lead to unprecedented impacts on individuals' mental health with unknown impacts on child-parent relationships. These impacts may be heightened for families whose caregivers experience increased mental health symptoms, as was the case for fathers in the current sample.


Assuntos
Esgotamento Psicológico , Cuidadores/psicologia , Bem-Estar da Criança/psicologia , Infecções por Coronavirus , Saúde Mental/tendências , Pandemias , Relações Pais-Filho , Poder Familiar/psicologia , Pneumonia Viral , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , Betacoronavirus , Esgotamento Psicológico/etiologia , Esgotamento Psicológico/prevenção & controle , Esgotamento Psicológico/psicologia , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Depressão/diagnóstico , Depressão/etiologia , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Pais/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Angústia Psicológica , Isolamento Social/psicologia
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