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1.
Sci Adv ; 8(40): eabn4316, 2022 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-36206331

RESUMO

Hypotheses concerning the biologic embedding of early adversity via developmental neuroplasticity mechanisms have been proposed on the basis of experimental studies in animals. However, no studies have demonstrated a causal link between early adversity and neural development in humans. Here, we present evidence from a randomized controlled trial linking psychosocial deprivation in early childhood to changes in cortical development from childhood to adolescence using longitudinal data from the Bucharest Early Intervention Project. Changes in cortical structure due to randomization to foster care were most pronounced in the lateral and medial prefrontal cortex and in white matter tracts connecting the prefrontal and parietal cortex. Demonstrating the causal impact of exposure to deprivation on the development of neural structure highlights the importance of early placement into family-based care to mitigate lasting neurodevelopmental consequences associated with early-life deprivation.


Assuntos
Produtos Biológicos , Substância Branca , Adolescente , Encéfalo , Criança , Criança Institucionalizada/psicologia , Pré-Escolar , Cuidados no Lar de Adoção/psicologia , Humanos , Carência Psicossocial
2.
Proc Natl Acad Sci U S A ; 119(38): e2119318119, 2022 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-36095188

RESUMO

This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred, those who had been randomized to high-quality foster care had significantly higher IQ scores (9 points, 0.6 SD) than those randomized to care as usual. Mediation analyses provide evidence that the causal effect of the intervention on cognitive ability in early adulthood could be explained, in part, by higher-quality caregiving and attachment security. These findings indicate that early investment in family care as an alternative to institutional care leads to sustained gains in cognitive ability. Fostering caregiving relationships is a likely mechanism of the intervention. In addition, exploratory analyses indicate that stable placements throughout childhood are associated with the greatest long-term gains in cognitive ability. Whether early interventions for infants and young children lead to lasting change has significant implications for decisions to invest in programs aimed at improving children's developmental outcomes.


Assuntos
Criança Institucionalizada , Cognição , Intervenção Educacional Precoce , Cuidados no Lar de Adoção , Carência Psicossocial , Criança Institucionalizada/psicologia , Pré-Escolar , Cuidados no Lar de Adoção/psicologia , Humanos , Lactente , Testes de Inteligência
3.
Eur J Psychotraumatol ; 13(1): 2029042, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35222839

RESUMO

Background: Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role. Objective: Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru. Methods: In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data. Results: Major themes included 1) how participants' home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged. The participant statement 'In my country they torture your body but in Australia they kill your mind.' conveyed these three key themes in our analysis. Conclusion: Our findings suggest that moral injury may be one of the processes by which mandatory immigration detention can cause harm. Although refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one's moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health.


Antecedentes: La detención de inmigrantes está asociada con resultados perjudiciales en la salud mental, pero se conoce poco acerca de los procesos psicológicos subyacentes. El daño moral y la experiencia de transgredir las creencias morales pueden desempeñar un rol importante.Objetivos: Nuestro objetivo fue explorar las evaluaciones de daño moral y los resultados asociados a la salud mental relacionados con la detención de inmigrantes en Nauru.Métodos: En este estudio retrospectivo, realizamos entrevistas en profundidad a 13 individuos que habían solicitado refugio en Australia y, debido a que llegaron en barco, habían sido transferidos a centros de detención de inmigrantes en Nauru. En el momento del estudio, se encontraban viviendo en Australia tras un traslado médico. Utilizamos un análisis temático reflexivo para desarrollar temas a partir de los datos.Resultados: Los temas principales incluyeron 1) cómo la experiencia del país de origen de los participantes y la expectativa de obtener protección los llevaron a buscar seguridad en Australia; 2) cómo experimentaron la privación, la falta de acción, la violencia, la deshumanización posterior a su llegada, con el gobierno australiano visto como la fuerza impulsora detrás de estas experiencias; y 3) cómo estas experiencias los llevaron a sentirse irreparablemente dañados. La declaración de los participantes 'En mi país torturan tu cuerpo, pero en Australia matan tu mente', transmitió estos tres temas en nuestro análisis.Conclusiones: Nuestros hallazgos sugieren que el daño moral puede ser uno de los mecanismos por los cuales la detención migratoria obligatoria puede causar daño. Sin embargo, los refugiados retornados de la detención en alta mar a Australia pueden beneficiarse de las intervenciones que se enfocan específicamente en el daño moral, se necesitan pasos colectivos para disminuir el deterioro de la salud mental de los refugiados. Nuestros resultados resaltan el impacto potencialmente deletéreo en la salud mental de experimentar múltiples transgresiones sutiles y sustanciales de los marcos morales de uno. Los diseñadores de políticas públicas deberían incorporar consideraciones relacionadas al daño moral para prevenir la erosión de la salud mental de los refugiados.


Assuntos
Campos de Refugiados , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Austrália , Feminino , Humanos , Masculino , Micronésia , Pessoa de Meia-Idade , Carência Psicossocial , Pesquisa Qualitativa , Estudos Retrospectivos
4.
Rev. Asoc. Esp. Neuropsiquiatr ; 42(141): 141-158, ene.-jun. 2022.
Artigo em Espanhol | IBECS | ID: ibc-210458

RESUMO

El presente trabajo analiza el tratamiento que la normativa penal y penitenciaria española ofrece a las personas con problemas de salud mental (o con discapacidad psicosocial) que son acusadas de un delito y entran en contacto con el medio penitenciario. El análisis revela que este colectivo es víctima de una discriminación y un maltrato institucional cuya erradicación exige cambios relevantes en la legislación, las políticas públicas y la mentalidad social, a la luz de la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Estos cambios se orientan a cuatro objetivos básicos: 1) evitar situaciones de desatención que aboquen a las personas con problemas de salud mental a entrar en el ciclo delictivo; 2) potenciar su desviación del medio penitenciario hacia respuestas más resocializadoras; 3) garantizar que quienes entren en prisión puedan ejercer sus derechos en igualdad de condiciones que todas las personas internas; 4) erradicar prejuicios y estereotipos promoviendo la formación de profesionales y la toma de conciencia por parte de la sociedad de la situación de desventaja de este colectivo. (AU)


This paper analyzes the treatment that Spanish penal and penitentiary regulations offer to people with mental health problems (or with psychosocial disabilities) who are accused of a crime and come into contact with the penitentiary environment. The analysis reveals that this group is the victim of discrimination and institutional abuse, whose eradication requires significant changes in legislation, public policies and social mentality, in the light of the International Convention on the Rights of Persons with Disabilities. These changes are aimed at four basic objectives: 1) to avoid situations of neglect that lead people with mental health problems to enter the criminal cycle; 2) to enhance their diversion from the prison environment towards more resocializing responses; 3) to ensure that those who have to enter prison can exercise their rights on an equal basis with other inmates; 4) to eradicate prejudices and stereotypes by promoting the training of professionals and raising the awareness of society regarding the situation of disadvantage in this group. (AU)


Assuntos
Humanos , Prisões/normas , Saúde Mental/normas , Espanha , Carência Psicossocial , Medidas de Segurança
5.
Emotion ; 22(2): 318-330, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34766790

RESUMO

Autonomic nervous system reactivity has been posited to be a mechanism contributing to social and emotional problems among children exposed to early adversity. Leveraging data from the Bucharest Early Intervention Project, a longitudinal randomized controlled trial of foster care versus institutional care of abandoned children in Romania, we assessed whether altered sympathetic reactivity to peer rejection feedback in early adolescence mediated the relation between early institutional rearing and peer problems in later adolescence. We also assessed whether adolescent friendship quality or randomized placement in foster care early in life moderated these associations. Participants include 68 institutionalized children randomized to care as usual, 68 institutionalized children randomized to foster care, and 135 never-institutionalized children. At age 12, participants reported friendship quality with respect to a best friend and completed a social rejection task while electrocardiogram and impedance cardiography were recorded. Sympathetic nervous system reactivity to rejection feedback was assessed using preejection period (PEP). At ages 12 and 16, peer problems were reported by parents. Mediation analysis revealed that less PEP reactivity to social rejection at age 12 partially mediated the association between early institutionalization and greater peer problems at age 16. Further moderated mediation analysis revealed that this indirect effect was evidenced among previously institutionalized youths with low, but not high, quality friendships. We did not observe foster care intervention effects. These findings suggest that altered sympathetic reactivity to social rejection might be a mechanism linking early institutionalization to social difficulties into adolescence, however, positive adolescent friendships may buffer these effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Amigos , Carência Psicossocial , Adolescente , Sistema Nervoso Autônomo , Criança , Criança Institucionalizada/psicologia , Humanos
6.
Rev. Investig. Salud. Univ. Boyacá ; 8(2): 131-146, 20211201.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1369469

RESUMO

Introducción: El estrés laboral es una enfermedad peligrosa que altera el estado psicológico de la persona, porque genera reacciones y respuestas de tipo emocional, cognitivo, fisiológico y del comportamiento frente a situaciones con alta demanda laboral que sobrepasa los recursos personales y del trabajo. Se considera una problemática de tipo social y económica asociada con factores de riesgo psicosocial y con desencadenantes. Por ello, es fundamental su detección precoz, para evitar sus secuelas y para emplear estilos de afrontamiento. Objetivo: Analizar los referentes teóricos del estrés laboral, teniendo en cuenta sus principales causas, consecuencias y estrategias de prevención en el ámbito laboral. Metodología: Revisión documental disponible en las bases de datos Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Biblioteca Digital, Elsevier, Redalyc, Dialnet, SciELO y Science Direct, de estudios publicados entre 2015 y 2020 que incluyeran conceptos de estrés laboral, causas, consecuencias y estrategias de prevención. Se revisaron 60 artículos, y para seleccionar la información se aplicó búsqueda, organización, categorización y análisis de 5554 documentos electrónicos. Se excluyeron 6 estudios relacionados con temas específicos del síndrome de burnout. Conclusiones: El estrés es una problemática prevalente en el contexto organizacional que se genera por múltiples factores asociados con las condiciones laborales y personales y origina en el individuo consecuencias fisiológicas y mentales que afectan su desempeño y productividad. De ahí que sea necesario incentivar una cultura preventiva que fomente la salud de los colaboradores.


Introduction: The labor stress is dangerous disease that alters the psychological state of the person, by generating emotional, cognitive, physiological and behavioral reactions and responses to situa-tions with high work demand that exceeds personal and work resources. It is considered as a social and economic problem associated with psychosocial risk factors and triggers, which, it is essential to attach importance to its early detection and thus avoid its consequences, as well as the use of coping styles. Objective: To analyze the theoretical references of work stress, considering the main causes, conse-quences and prevention strategies in the workplace. Methodology: Documentary review available in the databases Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Bibliotheca Digital, Elsevier, Redalyc, Dialnet, SciELO and Science Direct. Inclusion criteria: works published between 2015 and 2020 that include concepts of work stress, causes, consequences and prevention strategies. 60 articles were reviewed to select the information, a search, organization, categorization and analysis of 5554 electronic documents were applied, 6 studies related to specific topics of Burnout syndrome were excluded. Conclusions: Stress is a prevalent problem in the organizational context that is generated by multiple factors associated with the work and personal conditions, originating in the individual consequences of physiological and mental type affecting the performance and the productivity, being necessary to stimulate a preventive culture that promotes the health of the collaborators.


Introdução: O estresse relacionado ao trabalho é uma doença perigosa que altera o estado psicoló-gico da pessoa, pois gera reações emocionais, cognitivas, fisiológicas, comportamentais e respostas a situações com altas exigências de trabalho que excedem os recursos pessoais e de trabalho. É conside-rado um problema social e econômico associados a fatores de risco psicossociais e desencadeadores. É, portanto, essencial detectá-lo cedo, para evitar suas consequências e usar estilos de enfrentamento. Objetivo: Analisar as referências teóricas do estresse relacionado ao trabalho, levando em conta suas principais causas, consequências e estratégias de prevenção no local de trabalho. Metodologia: revisão documental disponível nas bases de dados Epistemonikos, ProQuest, Frontiers in Psychology, Academy, Digital Library, Elsevier, Redalyc, Dialnet, SciELO e Science Direct, de estudos publicados entre 2015 e 2020 que incluíam conceitos de estresse relacionado ao trabalho, causas, consequências e estratégias de prevenção. Sessenta artigos foram revisados, e para selecionar as informações, foi aplicada uma pesquisa onde foram organizados, categorizados e analisados 5554 documentos eletrônicos. Foram excluídos seis estudos relacionados a questões específicas da Síndro-me de Burnout. Conclusões: O estresse é um problema predominante no contexto organizacional que é gerado por múltiplos fatores associados às condições de trabalho e pessoais, e causa consequências fisiológicas e mentais no indivíduo que afetam seu desempenho e produtividade. Portanto, é necessário incentivar uma cultura preventiva que promova a saúde dos funcionários.Palavras-chave: estresse ocupacional; psicossocial; saúde ocupacional; trabalhadores.


Assuntos
Estresse Ocupacional , Carência Psicossocial , Saúde do Trabalhador , Categorias de Trabalhadores
7.
Ann Glob Health ; 87(1): 57, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34249619

RESUMO

Globally, 10-20% of children and adolescents experience mental health conditions, but most of them do not receive the appropriate care when it is needed. The COVID-19 deaths and prevention measures, such as the lockdowns, economic downturns, and school closures, have affected many communities physically, mentally, and economically and significantly impacted the already-neglected children and adolescents' mental health. As a result, evidence has shown that many children and adolescents are experiencing psychological effects such as depression and anxiety without adequate support. The consequences of not addressing the mental health conditions in children and adolescents extend through adulthood and restrict them from reaching their full potential. The effects of COVID-19 on children and adolescents' mental health highlight the urgent need for multisectoral home-grown solutions to provide early diagnosis and treatment and educate caregivers on home-based interventions and community outreach initiatives to address children and adolescents' mental health challenges during this pandemic and beyond.


Assuntos
COVID-19 , Serviços Comunitários de Saúde Mental , Intervenção Médica Precoce/organização & administração , Transtornos Mentais , Quarentena/psicologia , Adolescente , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Controle de Doenças Transmissíveis/métodos , Serviços Comunitários de Saúde Mental/métodos , Serviços Comunitários de Saúde Mental/tendências , Educação à Distância , Saúde Global , Necessidades e Demandas de Serviços de Saúde , Humanos , Colaboração Intersetorial , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Saúde Mental/tendências , Carência Psicossocial , Ruanda/epidemiologia , SARS-CoV-2
8.
Health Qual Life Outcomes ; 19(1): 167, 2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34147118

RESUMO

BACKGROUND: Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). METHODS: We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). RESULTS: Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70-0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94-0.96; p < 0.001). CONCLUSIONS: Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.


Assuntos
Atenção à Saúde/normas , Pesquisas sobre Atenção à Saúde/instrumentação , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/psicologia , Carência Psicossocial , Estudos Retrospectivos , Meio Social , Fatores Socioeconômicos , Centros de Atenção Terciária , Utah/epidemiologia
9.
PLoS One ; 16(4): e0249836, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33872319

RESUMO

BACKGROUND: HIV-HCV coinfected individuals are often more deprived than the general population. However, deprivation is difficult to measure, often relying on aggregate data which does not capture individual heterogeneity. We developed an individual-level deprivation index for HIV-HCV co-infected persons that encapsulated social, material, and lifestyle factors. METHODS: We estimated an individual-level deprivation index with data from the Canadian Coinfection Cohort, a national prospective cohort study. We used a predetermined process to select 9 out of 19 dichotomous variables at baseline visit to include in the deprivation model: income >$1500/month; education >high school; employment; identifying as gay or bisexual; Indigenous status; injection drug use in last 6 months; injection drug use ever; past incarceration, and past psychiatric hospitalization. We fitted an item response theory model with: severity parameters (how likely an item was reported), discriminatory parameters, (how well a variable distinguished index levels), and an individual parameter (the index). We considered two models: a simple one with no provincial variation and a hierarchical model by province. The Widely Applicable Information Criterion (WAIC) was used to compare the fitted models. To showcase a potential utility of the proposed index, we evaluated with logistic regression the association of the index with non-attendance to a second clinic visit (as a proxy for disengagement) and using WAIC compared it to a model containing all the individual parameters that compose the index as covariates. RESULTS: We analyzed 1547 complete cases of 1842 enrolled participants. According to the WAIC the hierarchical model provided a better fit when compared to the model that does not consider the individual's province. Values of the index were similarly distributed across the provinces. Overall, past incarceration, education, and unemployment had the highest discriminatory parameters. However, in each province different components of the index were associated with being deprived reflecting local epidemiology. For example, Saskatchewan had the highest severity parameter for Indigenous status while Quebec the lowest. For the secondary analysis, 457 (30%) failed to attend a second visit. A one-unit increase in the index was associated with 17% increased odds (95% credible interval, 2% to 34%) of not attending a second visit. The model with just the index performed better than the model with all the components as covariates in terms of WAIC. CONCLUSION: We estimated an individual-level deprivation index in the Canadian Coinfection cohort. The index identified deprivation profiles across different provinces. This index and the methodology used may be useful in studying health and treatment outcomes that are influenced by social disparities in co-infected Canadians. The methodological approach described can be used in other studies with similar characteristics.


Assuntos
Coinfecção/psicologia , Infecções por HIV/psicologia , Hepatite C/psicologia , Carência Psicossocial , Canadá , Coinfecção/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hepatite C/complicações , Hepatite C/epidemiologia , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
10.
Int J Equity Health ; 20(1): 83, 2021 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743718

RESUMO

BACKGROUND: There are inequalities in breastfeeding initiation and continuation rates, whereby socio-economically disadvantaged mothers are least likely to breastfeed. Breastfeeding peer support (BPS) interventions are recommended as a solution, and in the UK non-profit organisations are commissioned to deliver BPS services in areas of socio-economic deprivation. BPS interventions have a mixed evidence base, offering limited knowledge about the interaction between context and intervention and how this affects women's experiences. METHODS: This interpretive study used a case study methodology to explore how and why two BPS services developed their services in socio-economically deprived contexts. Methods aimed to generate holistic understanding of BPS service development. Data collected across both cases comprised; observation (n = 1), and semi-structured interviews with: mothers who had (n = 10) and had not (n = 9) engaged with the BPS services, peer supporters (PSs) (n = 9), community health professionals (n = 5), infant feeding co-ordinators (n = 2), non-profit organisation managers (n = 3), and public health commissioners (n = 2). Inductive grounded theory analytic techniques of open coding and constant comparisons, followed by cross case comparisons, were used to analyse the data. RESULTS: The over-arching theme - 'the transcending influence of society' - offers insights into the underlying context and drivers impacting service development. It reflects how funding and data sharing arrangements determined service operation and the peer's access to women. Four underpinning themes explain how: peer supporters were resourceful in adapting their services ('adapting and modifying the support'); BPS organisations worked to enable women's access to supportive breastfeeding environments, but did not necessarily focus service development on the needs of women living in areas of deprivation ('supporting women's journeys to access'); the BPS-professional connections for supporting access and how BPS could result in more supportive community environments ('embedding within healthcare practice'); and how management practices precluded meaningful use of data to provide context led service development ('ways of using knowledge'). CONCLUSIONS: Findings suggest that while PSs are commissioned to focus on those most in need, there is limited discussion, collection, or use of knowledge about women's lives to develop needs-led service delivery. The key recommendation is the development of a social ecological tool to facilitate the use and application of contextual knowledge.


Assuntos
Aleitamento Materno , Cuidado Pós-Natal/métodos , Áreas de Pobreza , Carência Psicossocial , Apoio Social , Adolescente , Criança , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Lactente , Entrevistas como Assunto , Pobreza , Gravidez , Pesquisa Qualitativa
11.
Hum Brain Mapp ; 42(8): 2445-2460, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33739544

RESUMO

While stress may be a potential mechanism by which childhood threat and deprivation influence mental health, few studies have considered specific stress-related white matter pathways, such as the stria terminalis (ST) and medial forebrain bundle (MFB). Our goal was to examine the relationships between childhood adversity and ST and MFB structural integrity and whether these pathways may provide a link between childhood adversity and affective symptoms and disorders. Participants were young adults (n = 100) with a full distribution of maltreatment history and affective symptom severity. Threat was determined by measures of childhood abuse and repeated traumatic events. Socioeconomic deprivation (SED) was determined by a measure of childhood socioeconomic status (parental education). Participants underwent diffusion spectrum imaging. Human Connectome Project data was used to perform ST and MFB tractography; these tracts were used as ROIs to extract generalized fractional anisotropy (gFA) from each participant. Childhood threat was associated with ST gFA, such that greater threat was associated with less ST gFA. SED was also associated with ST gFA, however, conversely to threat, greater SED was associated with greater ST gFA. Additionally, threat was negatively associated with MFB gFA, and MFB gFA was negatively associated with post-traumatic stress symptoms. Our results suggest that childhood threat and deprivation have opposing influences on ST structural integrity, providing new evidence that the context of childhood adversity may have an important influence on its neurobiological effects, even on the same structure. Further, the MFB may provide a novel link between childhood threat and affective symptoms.


Assuntos
Experiências Adversas da Infância , Sintomas Afetivos/patologia , Feixe Prosencefálico Mediano/patologia , Estresse Psicológico/patologia , Substância Branca/patologia , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis , Sintomas Afetivos/diagnóstico por imagem , Imagem de Tensor de Difusão , Feminino , Fórnice/diagnóstico por imagem , Fórnice/patologia , Humanos , Masculino , Feixe Prosencefálico Mediano/diagnóstico por imagem , Carência Psicossocial , Núcleos Septais/diagnóstico por imagem , Núcleos Septais/patologia , Fatores Socioeconômicos , Estresse Psicológico/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto Jovem
13.
Dev Psychopathol ; 33(1): 18-28, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-31896375

RESUMO

Adverse developmental outcomes for some children following institutional care are well established. Removal from institutional care and placement into families can promote recovery. However, little is known about how positive outcomes are sustained across adolescence among children with histories of severe deprivation. The present study examined the caregiving conditions that are associated with attaining and maintaining competent functioning (i.e., outcomes within typical levels) from middle childhood to adolescence following exposure to early institutional care. The participants included children with and without a history of institutional care who had competence assessed at ages 8, 12, and 16 years across seven domains: family relationships, peer relationships, academic performance, physical health, mental health, substance use (ages 12 and 16 years only), and risk-taking behavior. The participants were grouped based on whether they were always versus not always competent and never versus ever competent at ages 8 through 16 years. Adolescents with a history of institutional care were less likely to be consistently competent than those who were family reared. Among those who were exposed to early institutional rearing, maintaining competent functioning from 8 to 16 years was associated with spending less time in institutions and receiving higher-quality caregiving early in life. Ensuring high quality early caregiving may promote competent functioning following early deprivation.


Assuntos
Criança Institucionalizada , Carência Psicossocial , Adolescente , Criança , Cuidados no Lar de Adoção , Humanos
14.
Arch Dis Child ; 106(4): 392-393, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32341013

RESUMO

Acute appendicitis is the most common surgical emergency in childhood. Perforation of the appendix conveys a worse outcome.This case-control study investigated the relationship between deprivation and appendiceal perforation in children in the West of Scotland.All children undergoing acute appendicectomy over a 2-year period were identified. Basic demographics including Scottish Index of Multiple Deprivation (SIMD) rank and clinical features including time to presentation and surgical findings were recorded. Associations were investigated using multivariable analysis.304 patients (62% male) underwent appendicectomy. Mean age was 10.4 years (SD ±3.5). Mean time from symptom onset to presentation was 2.3 days (SD ±2.5). Perforation rate was 44.41%.Perforation was associated with lower age (p=0.004, OR -0.10, 95% CI -0.17 to -0.33), increased time to presentation (p=0.044, OR 0.14, 95% CI 0.004 to 0.27) and SIMD tertile (p=0.027, OR 0.63, 95% CI 0.07 to 1.20). SIMD tertile was not associated with delayed presentation.Worsening deprivation independently predicts perforation, but this relationship is not mediated through a delay in presentation.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Doença Aguda , Adolescente , Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico , Apendicite/epidemiologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Carência Psicossocial , Escócia/epidemiologia , Tempo para o Tratamento/tendências
15.
Psychol Med ; 51(15): 2675-2684, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-32419675

RESUMO

BACKGROUND: Institutional deprivation in early childhood is associated with neuropsychological deficits in adolescence. Using 20-year follow-up data from a unique natural experiment - the large-scale adoption of children exposed to extreme deprivation in Romanian institutions in the 1980s -we examined, for the first time, whether such deficits are still present in adulthood and whether they are associated with deprivation-related symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). METHODS: Adult neuropsychological functioning was assessed across five domains (inhibitory control, emotion recognition, decision-making, prospective memory and IQ) in 70 previously institutionalized adoptees (mean age = 25.3, 50% female) and 22 non-deprived UK adoptees (comparison group, mean age = 24.6, 41% female). ADHD and ASD symptoms were assessed using parent-completed questionnaires. RESULTS: Early institutionalization was associated with impaired performance on all tasks in adulthood. Prospective memory deficits persisted after controlling for IQ. ADHD and ASD symptoms were positively correlated. After controlling for ASD symptoms, ADHD symptoms remained associated with deficits in IQ, prospective memory, proactive inhibition, decision-making quality and emotion recognition. ASD symptoms were not independently associated with neuropsychological deficits when accounting for their overlap with ADHD symptoms. Multiple regression analysis revealed that the link between childhood deprivation and adult ADHD symptoms was statistically explained by deprivation-related differences in adult IQ and prospective memory. CONCLUSIONS: These results represent some of the most compelling evidence to date of the enduring power of early, time-limited childhood adversity to impair long-term neuropsychological functioning across the lifespan - effects that are linked specifically to deprivation-related adult ADHD symptoms.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtornos da Memória/psicologia , Carência Psicossocial , Adulto , Criança Adotada , Feminino , Seguimentos , Humanos , Inteligência , Masculino , Testes Neuropsicológicos , Romênia/etnologia , Reino Unido , Adulto Jovem
16.
Diabet Med ; 38(3): e14445, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33128811

RESUMO

AIMS: Intensive glycaemic control is associated with substantial health benefits in people with type 1 diabetes. We sought to examine clinical and demographic factors associated with meeting glycaemic targets in type 1 diabetes. METHODS: We conducted a cross-sectional analysis of 4594 individuals with type 1 diabetes. The primary outcome of the study was assessing factors associated with meeting HbA1c targets. Secondary endpoints included factors associated with continuous subcutaneous insulin infusion (CSII) use and persistent C-peptide secretion. RESULTS: Socioeconomic deprivation was strongly associated with a lower likelihood of achieving an HbA1c <58 mmol/mol (7.5%) (20% in the most deprived quintile vs. 40% in the least deprived, p < 0.001). In multivariate analysis, absence of smoking history (OR 3.06, p < 0.001), flash monitoring (OR 1.49, p < 0.001), CSII (1.43, p = 0.022) and longer diabetes duration (OR 1.02 per year, p = 0.004) were independently associated with achieving HbA1c <58 mmol/mol (7.5%), whereas increasing age (OR 0.99 per year, p = 0.004) and C-peptide <50 pM (OR 0.58, p < 0.001) were associated with a lower likelihood of meeting this target. Low C-peptide (<50 pM) was less likely in men (OR 0.55, p < 0.001) and never smokers (0.44, p < 0.001) in multivariate analysis. CONCLUSIONS: Lower levels of deprivation, non-smoking, higher C-peptide, technology use, lower BMI and male gender were all associated with a higher likelihood of meeting HbA1c targets. Access to proven diabetes treatments is lower in the most deprived individuals. Urgent efforts are required to provide treatments which are effective across the socioeconomic gradient.


Assuntos
Peptídeo C/sangue , Diabetes Mellitus Tipo 1 , Controle Glicêmico , Carência Psicossocial , Fumar/epidemiologia , Adulto , Atitude Frente aos Computadores , Glicemia/análise , Glicemia/metabolismo , Automonitorização da Glicemia , Estudos Transversais , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Controle Glicêmico/métodos , Controle Glicêmico/psicologia , Controle Glicêmico/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Fumar/sangue , Fumar/psicologia , Fatores Socioeconômicos , Tecnologia/estatística & dados numéricos , Reino Unido/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-33215715

RESUMO

BACKGROUND: Adolescence has been proposed to be a period of heightened sensitivity to environmental influence. If true, adolescence may present a window of opportunity for recovery for children exposed to early-life adversity. Recent evidence supports adolescent recalibration of stress response systems following early-life adversity. However, it is unknown whether similar recovery occurs in other domains of functioning in adolescence. METHODS: We use data from the Bucharest Early Intervention Project - a randomized controlled trial of foster care for children raised in psychosocially depriving institutions - to examine the associations of the caregiving environment with reward processing, executive functioning, and internalizing and externalizing psychopathology at ages 8, 12, and 16 years, and evaluate whether these associations change across development. RESULTS: Higher quality caregiving in adolescence was associated with greater reward responsivity and lower levels of internalizing and externalizing symptoms, after covarying for the early-life caregiving environment. The associations of caregiving with executive function and internalizing and externalizing symptoms varied by age and were strongest at age 16 relative to ages 8 and 12 years. This heightened sensitivity to caregiving in adolescence was observed in both children with and without exposure to early psychosocial neglect. CONCLUSIONS: Adolescence may be a period of heightened sensitivity to the caregiving environment, at least for some domains of functioning. For children who experience early psychosocial deprivation, this developmental period may be a window of opportunity for recovery of some functions. Albeit correlational, these findings suggest that it may be possible to reverse or remediate some of the lasting effects of early-life adversity with interventions that target caregiving during adolescence.


Assuntos
Experiências Adversas da Infância , Adolescente , Criança , Criança Institucionalizada , Cuidados no Lar de Adoção , Humanos , Psicopatologia , Carência Psicossocial
18.
J Neurodev Disord ; 12(1): 36, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33327936

RESUMO

BACKGROUND: The quality of early caregiving experiences is a known contributor to the quality of the language experiences young children receive. What is unknown is whether, and if so, how psychosocial deprivation early in life is associated with long-lasting receptive language outcomes. METHODS: Two prospective longitudinal studies examining early psychosocial deprivation/neglect in different contexts (i.e., deprivation due to institutional care or deprivation experienced by children residing within US families) and receptive language as assessed via the Peabody Picture Vocabulary Test (PPVT) were used to assess the magnitude of these associations. First, 129 participants from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care in Romania, completed a receptive language assessment at age 18 years. Second, from the USA, 3342 participants from the Fragile Families and Child Wellbeing Study were assessed from infancy until middle childhood. RESULTS: Children exposed to early institutional care, on average, had lower receptive language scores than their never institutionalized counterparts in late adolescence. While randomization to an early foster care intervention had no long-lasting association with PPVT scores, the duration of childhood exposure to institutional care was negatively associated with receptive language. Psychosocial deprivation in US families was also negatively associated with receptive language longitudinally, and this association remained statistically significant even after accounting for measures of socioeconomic status. CONCLUSION: Experiences of psychosocial deprivation may have long-lasting consequences for receptive language ability, extending to age 18 years. Psychosocial deprivation is an important prospective predictor of poorer receptive language. TRIAL REGISTRATION: Bucharest Early Intervention Project ClinicalTrials.gov Identifier: NCT00747396.


Assuntos
Idioma , Carência Psicossocial , Adolescente , Criança , Pré-Escolar , Cuidados no Lar de Adoção , Humanos , Desenvolvimento da Linguagem , Estudos Prospectivos , Romênia
19.
J Consult Clin Psychol ; 88(12): 1079-1090, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33370132

RESUMO

OBJECTIVE: Early psychosocial deprivation is associated with increased risk for psychopathology, yet few studies have examined outcomes in adolescents. METHOD: At baseline (M age 22 months), 136 children from Bucharest, Romania, living in large institutions, were randomized into foster care (FCG) or to care as usual (CAUG). Caregivers completed psychiatric interviews regarding their children (52 FCG; 51 CAUG) at age 16 years (M = 16.67 years; SD = 0.78) to assess past year diagnoses and symptom counts. In addition, never-institutionalized community comparison children (n = 47) were included. RESULTS: Ever-institutionalized children had higher rates of meeting criteria for any psychiatric disorder and higher symptom counts of internalizing, externalizing, attention-deficit/hyperactivity, and substance use disorders compared to never-institutionalized children (ps < .05). Using intent-to-treat analyses, we found that children in the CAUG had more than twice the rate of psychiatric disorders than children in the FCG (OR = 2.48, 95% CI [1.12, 5.48]). Furthermore, children in foster care who remained in their original placement did not significantly differ in their rates of psychiatric disorders compared to never-institutionalized children. CONCLUSIONS: There are many ways children can be separated from parents, including placement into institutional care. The current findings indicate that such placements are associated with significant risks for psychopathology. Moreover, we provide causal evidence for the long-lasting positive effect of foster care in reducing the risk of psychopathology in adolescence, especially among those in stable placements. These results provide strong evidence that early and stable placements into quality foster care may mitigate risk for psychopathology following severe early psychosocial deprivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Criança Institucionalizada/psicologia , Cuidados no Lar de Adoção/psicologia , Transtornos Mentais/epidemiologia , Adolescente , Feminino , Seguimentos , Humanos , Masculino , Psicopatologia , Carência Psicossocial , Romênia/epidemiologia
20.
J Immunol Res ; 2020: 8375096, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33354578

RESUMO

Recently, the novel coronavirus epidemic occurred in China and spread worldwide to become a global pandemic. COVID-19 is a fatal viral infection causing death, particularly in aged individuals, due to impaired immunity. To date, no intervention is available to prevent COVID-19 and its manifestations. Physical exercise training generally has health benefits, and it assists in the prevention of several chronic diseases. Therefore, this review is aimed at exploring the role of physical exercise training in the face of COVID-19 in older adults and elderly individuals. From this point of view, this review suggests that physical exercise training plays a key role in promoting immune system regulation, delaying immunity dysfunction, reducing circulatory inflammation markers, and preventing sarcopenia and thus could prevent the risk of acquiring COVID-19 infection and reduce the complications of recommended self-isolation in older adults and elderly individuals. Additionally, immunity biomarkers were optimistically demonstrated in older adults following physical exercise training, thereby reducing mortality and morbidity rates. Finally, in accordance with recommendations to stay home and perform self-isolation to prevent the spread of COVID-19, all populations are strongly recommended to practice regular home exercise training at home to promote immune system functioning.


Assuntos
Exercício Físico/fisiologia , Exercício Físico/psicologia , Funcionamento Psicossocial , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Idoso Fragilizado/psicologia , Humanos , Imunidade Celular/imunologia , Isolamento de Pacientes , Carência Psicossocial , SARS-CoV-2 , Sarcopenia/prevenção & controle
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