Infants of mothers with early remitted clinical depression and mothers with no postpartum depression: Adaptive functioning in the second year of life.

Whether and how remitted clinical depression in postpartum motherhood contributes to poor infant adaptive functioning is inconclusive. The present longitudinal study examines adaptive functioning in infants of mothers diagnosed as clinically depressed at 5 months but remitted at 15 and 24 months. Fifty-five U. S. mothers with early, remitted clinical depression and 132 mothers without postpartum depression completed the Vineland Adaptive Behavior Scales about their infants at 15 and 24 months. Between groups, mothers were equivalent in age, ethnicity, marital status, and receptive vocabulary (a proxy for verbal intelligence), and infants were equivalent in age and distribution of gender. Controlling for maternal education and parity, mothers with early, remitted clinical depression and mothers with no postpartum depression rated their infants similarly on communication, daily living skills, and socialization. Mothers with early, remitted clinical depression rated their infants poorer in motor skills. Girls were rated more advanced than boys in communication at 24 months and daily living skills at 15 and 24 months. Rated infant adaptive behavior skills increased from 15 to 24 months. With exceptions, adaptive functioning in infants may be robust to early, remitted maternal depression, and adaptive functioning presents a domain to promote positive development in this otherwise vulnerable population.

Si la depresión clínica remitida en la maternidad del período de postparto contribuye y cómo contribuye al débil funcionamiento de adaptación del infante es algo inconcluso. El presente estudio longitudinal examina el funcionamiento de adaptación en infantes de madres clínicamente deprimidas a los 5 meses, pero remitidas a los 15 y 24 meses. Cincuenta y cinco madres con una temprana depresión clínica remitida y 132 madres sin depresión en el período de postparto en los Estados Unidos completaron las Escalas Vineland del Comportamiento de Adaptación acerca de sus infantes de 15 y 24 meses de edad. Entre los grupos, las madres presentaban equivalencia en cuanto a la edad, la etnicidad, el estado marital, así como el vocabulario receptivo (un reemplazo para la inteligencia verbal), y los infantes presentaban equivalencia en edad y género. Con los factores de educación y paridad controlados, las madres con temprana depresión clínica remitida y las madres sin depresión en el período de postparto evaluaron a sus infantes similarmente en cuanto a la comunicación, las habilidades del diario vivir y la socialización. Las madres con temprana depresión clínica remitida evaluaron a sus infantes más pobremente en cuanto a habilidades motoras. A las niñas se les evaluó como más avanzadas que los varones en la comunicación a los 24 meses y en las habilidades del diario vivir a los 15 y 24 meses. Las evaluadas habilidades del comportamiento de adaptación de los infantes aumentaron de los 15 a los 24 meses. Con excepciones, el funcionamiento de adaptación en los infantes pudiera ser robusto en relación con la temprana depresión materna remitida, y el funcionamiento de adaptación presenta un dominio para promover el positivo desarrollo en este grupo de población que, de lo contrario, es vulnerable.

Enhancing early parenting in the community: Preliminary results from a learning collaborative approach to scale up Attachment and Biobehavioral Catch-up.

Attachment and Biobehavioral Catch-up (ABC) is a promising home-visiting intervention promoting sensitive caregiving and secure parent-child attachment in families with young children. The goal of this study was to examine a learning collaborative approach to disseminating ABC in a community setting. Training outcomes (e.g., trainee completion, satisfaction, effectiveness of training methods) and intervention outcomes (e.g., parent behavior, parent beliefs, child socioemotional development) were examined. Eighteen practitioners participated in the ABC learning collaborative; 13 completed training. Quantitative and qualitative measures indicated that trainees were satisfied with their experience and valued the unique collaboration opportunities offered by the learning collaborative. In addition, trainees served 67 families in the community, 37 of whom completed all sessions of ABC. The study was conducted in the United States. Racial demographics of the children in the sample included: 56.7% White, 22.4% Black/African-American, 17.9% Bi- or Multi-racial, and 3.0% unknown. Regarding ethnicity, 80.6% were Non-Hispanic/Latino, 10.4% were Hispanic/Latino, and 9.0% were unknown. Caregivers who completed ABC showed more sensitive parenting behavior and reported positive changes in their perceived self-efficacy and their beliefs around infant crying. Children who received ABC showed increased socioemotional functioning. Results demonstrate successful dissemination of ABC in the community using a learning collaborative approach.

El Alcance de Afectividad y Bio-comportamiento (ABC) es una prometedora intervención de visita a casa que promueve el cuidado sensible y una relación progenitor-niño segura en familias con niños pequeños. El propósito de este estudio fue examinar un acercamiento de aprendizaje colaborativo para diseminar el ABC en un escenario comunitario. Se examinaron los resultados de entrenamiento (v.g. que el entrenado completó el proceso, satisfacción, efectividad de los métodos de entrenamiento) y los resultados de intervención (v.g. comportamiento del progenitor, creencias del progenitor, desarrollo socioemocional del niño). Dieciocho profesionales en la práctica participaron en el proceso de aprendizaje colaborativo; 13 completaron el entrenamiento, Las medidas cuantitativas y cualitativas indicaron que quienes se entrenaban estaban satisfechos con su experiencia y valoraron las oportunidades de colaboración que el proceso de aprendizaje colaborativo ofrecía de manera única. Adicionalmente, quienes se entrenaban les sirvieron a 67 familias en la comunidad, 37 de las cuales completaron todas las sesiones del ABC. El estudio se llevó a cabo en los Estados Unidos. Los perfiles demográficos raciales de los niños incluyen: 56.7% de raza blanca, 22.4% de raza negra o Afroamericanos, 17.9% birraciales o multirraciales, con un 3.0% cuya raza se desconoce. En cuanto a la etnicidad, 80.6% no eran hispanos o latinos, 10.4% eran hispanos o latinos, con un 9.0% cuya etnicidad se desconoce. Los cuidadores que completaron el ABC mostraron una conducta de crianza más sensible y reportaron cambios positivos en cuanto a su percepción de auto efectividad y su creencia acerca del llanto del infante. Los niños que recibieron el ABC mostraron un aumento en su funcionamiento socioemocional. Los resultados demuestran una exitosa diseminación del ABC en la comunidad usando un acercamiento de aprendizaje colaborativo.

L'attachement et le rattrapage bio-comportemental (en anglais Attachment and Biobehavioral Catch-up, soit ABC) est une intervention prometteuse de visite à domicile promouvant des soins sensibles et un attachement parent-enfant sécure chez les familles avec de jeunes enfants. Le but de cette étude est d'examiner une approche collaborative d'apprentissage à la dissémination de l'ABC dans le contexte d'une communauté. Les résultats de la formation (par exemple le fait de terminer le stage, la satisfaction, l'efficacité des méthodes de formation) et les résultats de l'intervention (par exemple le comportement du parent, les croyances parentales, le développement socio-émotionnel de l'enfant) ont été examinés. Dix-huit praticiens ont participé à la collaboration d'apprentissage ABC; 13 ont terminé la formation. Les mesures quantitatives and qualitatives ont indiqué que les stagiaires étaient satisfaits de leur expérience et avaient apprécié la chance d'une collaboration unique offerte par la collaboration d'apprentissage. De plus les stagiaires ont aidé 67 familles dans la communauté, 37 d'entre elles ayant terminé toutes les séances de l'ABC. L'étude a été faite aux Etats-Unis d'Amérique. Les données démographiques raciales des enfants dans l'échantillon ont inclus: 56,7% blancs, 22,4% noirs américains, 17,9% métisses ou multi-ethniques, et 3,0% de race inconnue. Concernant l'ethnicité, 80,6% était Non-Hispaniques/Non-Latinos, 10,4% étaient Hispaniques/Latinos et 9,0% étaient d'une ethnicité inconnue. Les personnes prenant soin des enfants qui ont complété l'ABC ont fait preuve d'un comportement de parentage plus sensible et fait état de changements positifs dans leur auto-efficacité perçue et leurs croyances concernant les pleurs des bébés. Les enfants ayant reçu l'ABC ont démontré un fonctionnement socio-émotionnel plus élevé. Les résultats démontrent une dissémination réussie de l'ABC dans une communauté en utilisant une approche collaborative d'apprentissage.

Parental sensitivity, family alliance and infants' vagal tone: Influences of early family interactions on physiological emotion regulation.

In this study, we investigated the influence of parental sensitivity and family alliance on infants' vagal tone, considered as a physiological indicator of emotion regulation. Studies on mother-infant interactions have shown that vagal tone can be influenced by the quality of the interaction, such as interacting with a sensitive mother. To date, no study has investigated the influence of paternal sensitivity or family alliance on infants' vagal tone. We hypothesized that maternal sensitivity, paternal sensitivity, and family alliance would be associated with infants' vagal tone during dyadic and triadic interactions. We also explored if family alliance would act as a moderator on the association between parental sensitivity and vagal tone and if the sensitivity of both parents would act as a moderator on the association between family alliance and vagal tone. This study took place in Switzerland and included 82 families with their 3-4-month-old infants. Results showed that maternal sensitivity and family alliance were associated with infants' vagal tone, but paternal sensitivity was not. We found no significant moderation effect. However, result tendencies suggested that the contribution of paternal sensitivity to infants' emotion regulation could be influenced by family alliance, whereas maternal sensitivity and family alliance have a unique contribution.

En este estudio, investigamos la influencia de la sensibilidad del progenitor y la alianza de familia sobre el tono vagal del infante, considerado como un indicador fisiológico de regulación de la emoción. Los estudios acerca de las interacciones madre-infante han demostrado que el tono vagal puede ser influido por la calidad de la interacción, tal como el interactuar con una mamá sensible. Hasta hoy, ningún estudio ha investigado la influencia de la sensibilidad paterna o la alianza de familia sobre el tono vagal del infante. Nuestra hipótesis es que la sensibilidad materna, la sensibilidad paterna y la alianza de familia estaban asociadas con el tono vagal del infante durante las interacciones diádicas y triádicas. También exploramos si la alianza de familia actuaba como moderadora en la asociación entre la sensibilidad paterna y el tono vagal y si la sensibilidad de ambos progenitores actuaba como moderadora en la asociación entre la alianza de familia y el tono vagal. Este estudio se llevó a cabo en Suiza e incluyó a 82 familias con sus infantes de 3-4 meses de edad. Los resultados muestran que la sensibilidad materna y la alianza de familia estaban asociadas con el tono vagal del infante, pero que la sensibilidad paterna no lo estaba. No encontramos ningún efecto de moderación significativo. Sin embargo, las tendencias del resultado sugieren que la contribución de la sensibilidad paterna a la regulación de la emoción puede ser influida por la alianza de familia, mientras que la sensibilidad materna y la alianza de familia tienen una contribución particularmente única.

Dans cette étude nous nous sommes penchés sur l'influence de la sensibilité paternelle et de l'alliance de la famille sur le tonus vagal des nourrissons, considéré comme étant un indicateur physiologique de la régulation de l'émotion. Les études sur les interactions mère-nourrisson ont montré que le tonus vagal peut être influencé par la qualité de l'interaction, comme l'interaction avec une mère sensible. Jusqu'à présent aucune étude n'a porté sur l'influence de la sensibilité paternelle ou l'alliance familiale sur le tonus vagal des nourrissons. Nous avons fait l'hypothèse que la sensibilité maternelle, la sensibilité paternelle, et l'alliance familiale peuvent être liées au tonus vagal des nourrissons durant les interactions dyadiques et triadiques. Nous avons également exploré si l'alliance familiale pourrait agir comme modératrice sur le lien entre la sensibilité parentale et le tonus vagal et si la sensibilité des deux parents pourrait agir comme modérateur du lien entre l'alliance familiale et le tonus vagal. Cette étude s'est faite en Suisse et a inclus 82 familles avec des bébés de 3-4 mois. Les résultats ont montré que la sensibilité maternelle et l'alliance familiale étaient liées au tonus vagal des bébés mais la sensibilité de l'était pas. Nous n'avons trouvé aucun effet de modération important. Cependant les tendances des résultats ont suggéré que la contribution de la sensibilité paternelle à la régulation de l'émotion des nourrissons pourrait être influencée par l'alliance familiale alors que la sensibilité maternelle et l'alliance familiale a une contribution unique.

Parent-Child Relationship Scale (P-CRS): A valid and clinically sensitive tool for assessing the parent-child relationship.

The present study measured the efficacy of the Parent-Child Relationship Scale (P-CRS) in assessing the relationship between parents and children. The aims of the study were to explore how the scale scores change in relation to age and sex of the children, evaluate its ability to capture relational difficulties, and investigating its usefulness to assess the parent-child relationship in the context of certain psychopathological conditions. A total of 322 clinicians rated 542 mother-child dyads (92% Italian, 8% other nationality). The clinical group was comprised of 267 children with confirmed clinical conditions. The control group was comprised of 275 children with typical development, rated by clinicians in their private offices after four to five evaluative sessions. Descriptive statistics were captured and ANOVAs and linear regression analyses were performed to investigate in both groups the efficacy of the scale in assessing the parent-child relationship. Finally, to test P-CRS accuracy, optimal cutoff scores for each subscale were computed using the ROC method. The findings provide evidence for the P-CRS ability to capture relational difficulties in both groups, showing its utility as screening tool. Thus, the results support that P-CRS can be used for exploring how different relationship patterns can occur in different clinical conditions.

El presente estudió midió la efectividad de la Escala de la Relación Progenitor-Niño (P-CRS) para evaluar la relación entre progenitores y niños. El propósito del estudio fue explorar cómo los puntajes de la escala cambian en relación con la edad y el sexo de los niños, evalúa su habilidad de captar las dificultades en la relación, e investiga su utilidad para evaluar la relación entre progenitor y niño dentro del contexto de ciertas condiciones sicopatológicas. Trescientos veintidós clínicos evaluaron 542 díadas madre-niño (92% italianas, 8 % otras nacionalidades). El grupo clínico estuvo compuesto de 267 niños con condiciones clínicas confirmadas. El grupo de control estuvo compuesto de 275 niños con un desarrollo típico, evaluados por los clínicos en sus oficinas privadas después de cuatro a cinco sesiones evaluativas. Se captaron estadísticas descriptivas y se llevaron a cabo análisis de variación (ANOVA) y análisis de regresión lineal, para investigar en ambos grupos la efectividad de la escala para evaluar la relación progenitor-niño. Finalmente, para demostrar la precisión de P-CRS, se calcularon los puntajes límites óptimos para cada subescala, usando el método ROC. Los resultados proveen evidencia de la habilidad de P-CRS de captar las dificultades de la relación en ambos grupos, demostrando su utilidad como herramienta de detección. De manera que los resultados apoyan el hecho de que P-CRS puede usarse para explorar cuán diferente los patrones de relación pueden ocurrir bajo diferentes condiciones clínicas.

Cette étude a mesuré l'efficacité de l'Echelle de Relation Parent-Enfant (Parent-Child Relationship Scale en anglais, soit P-CRS) en évaluant la relation entre les parents et les enfants. Les buts de l'étude étaient d'explorer comme les scores de l'échelle changement en relation à l'âge et au sexe des enfants, d'évaluer sa capacité à capturer les difficultés relationnelles, et de comprendre son utilité pour l'évaluation de la relation parent-enfant dans le contexte de certaines conditions psychopathologiques. 322 cliniciens ont évalué 542 dyades mère-enfant (92% Italiennes, 8% autre nationalité). Le groupe clinique comprenait 267 enfants avec des conditions cliniques confirmées. Le groupe de contrôle comprenait 275 enfants avec un développement typique, évalués par des cliniciens dans leurs cabinets médicaux après de trois à cinq sessions d'évaluation. Des statistiques descriptives ont été capturées et des ANOVA ainsi que des analyses de régression linéaire ont été faites afin d'établir chez les deux groupes l'efficacité de l'échelle à évaluer la relation parent-enfant. Enfin, pour tester la précision de l'a P-CRS, des scores limite optimaux pour chaque sous-échelle ont été calculés en utilisant la méthode ROC. Les résultats montrent la capacité de la P-CRS à capturer les difficultés relationnelles chez les deux groupes, montrant son utilité en tant qu'outil de dépistage. Par conséquent les résultats soutiennent que la P-CRS peut être utilisé pour explorer la manière dont des patterns de relation différents peuvent apparaître dans des conditions cliniques différentes.

Neurofibromatosis Type 1: Diagnostic Timelines in Children. / Cronología del diagnóstico de la neurofibromatosis tipo 1 en la infancia.

BACKGROUND AND OBJECTIVES: The neurofibromatosis 1 (NF1) diagnosis is challenging in young children without a family history of NF1. The aims of this study were to estimate diagnostic delays in children without a family history of NF1 and to examine the effects of using café au lait macules and skin fold freckling as a single diagnostic criterion. PATIENTS AND METHODS: Retrospective, descriptive, observational study of all patients diagnosed with NF1 before the age of 18 years who were seen at our hospital. The medical records of those included were reviewed to identify the date on which the diagnostic criteria of NF1 were objectified. The patients were categorized into 2 groups: those with a known parental history of NF1 and those without. Café au lait macules and skin fold freckling were assessed as a single diagnostic criterion, and genetic evidence was considered to confirm highly suspicious cases. RESULTS: We studied 108 patients younger than the age of 18 years with a diagnosis of NF1. Mean (SD) age at diagnosis was 3.94 (±3.8) years for the overall group, 1 year for patients with a parental history of NF1, and 4 years and 8 months for those without. Diagnosis was therefore delayed by 3 years and 8 months in patients without a family history. CONCLUSION: Skin lesions were the first clinical manifestation of NF1 in most patients. We believe that the National Institutes of Health's diagnostic criteria for NF1 should be updated to aid diagnosis in young children.

Building reflective capacity and improving well-being of early childhood professionals through an embedded cross-system model of infant early childhood mental health consultation.

Infant and Early Childhood Mental Health Consultation (IECMHC) aims to improve early childhood professionals' abilities to promote children's mental health through relationship building and collaboration. Using a longitudinal, matched-comparison group design, a 3-year pilot study of a cross-system, embedded model of IECMHC assessed teachers and home visitors in intervention and comparison programs in reflective capacity, burnout, and perceptions of children's behavior. A sample of 136 staff (n = 72 intervention group; n = 64 comparison group; 21% Black; 51% White; 28% Latina/Hispanic) participated in surveys over a 21-month implementation period. A subsample of staff (n = 26) participated in interviews that included a narrative measure of reflective capacity; and a smaller subsample of teachers only (n = 21) completed assessments of children. Staff in the intervention group significantly increased reflective capacity after 21 months. For the staff interview subsample, receiving the intervention predicted lower levels of burnout at 12-15 months post-baseline. Among teachers completing child assessments, those with higher reflective capacity rated children's behaviors more positively than teachers with lower reflective capacity. We conclude that this IECMHC model successfully improved reflective capacity in staff. Future research should investigate reflective capacity as a potential mechanism of change for IECMHC.

La Consulta de Salud Mental de la Infancia y la Temprana Niñez (IECMHC) se propone mejorar las habilidades de los profesionales de la temprana niñez para promover la salud mental de los niños por medio de establecer relaciones y de la colaboración. Usando un diseño longitudinal, de un grupo de comparación emparejado, un estudio experimental de tres años con un modelo incorporado de IECMHC a lo largo del sistema, evaluó a instructores y visitadores a casa en programas de intervención y comparación en cuanto a la capacidad de reflexión, el agotamiento, así como las percepciones del comportamiento de los niños. Un grupo muestra de 136 miembros del personal (n = 72 en el grupo de intervención; n = 64 en el grupo de comparación; 21% negros; 51% blancos; 28% hispano/latino) participó en entrevistas que incluían una medida narrativa de la capacidad de reflexión; y un más pequeño subgrupo muestra de instructores solamente (n = 21) completaron evaluaciones de los niños. Los miembros del personal en el grupo de intervención significativamente aumentaron la capacidad de reflexión después de 21 meses. Para la entrevista del personal en el subgrupo muestra, recibir la intervención predijo más bajos niveles de agotamiento a los 12 a 15 meses después del punto de partida. De los instructores que completaron las evaluaciones del niño, aquellos con más alta capacidad de reflexión evaluaron el comportamiento de los niños más positivamente que los instructores con una más baja capacidad de reflexión. Concluimos con que este modelo de IECMHC mejoré con éxito la capacidad de reflexión del personal. La investigación futura debe investigar la capacidad reflexión como un potencial mecanismo de cambio para IECMHC.

La consultation de Santé Mentale du Nourrisson et de la Petite Enfance (abrégé IECMHC en anglais) a pour but d'améliorer les compétences des professionnels de la petite enfance à promouvoir la santé mentale des enfants au travers de l'établissement de relations et de la collaboration. En utilisant une conception de groupe témoin apparié, longitudinale, une étude pilote de trois années d'un modèle inter-système et intégré de IECMHC a évalué des enseignants et des visiteurs à domicile dans des programmes d'intervention et de comparaison pour ce qui concerne la capacité de réflexion, le burnout et les perception du comportement des enfants. Un échantillon de 136 employés (n = 72 groupe d'intervention; n = 64 groupe de comparaison; 21% Noirs; 51% Blancs; 28% Hispaniques / Latinas) ont participé à des enquêtes sur une période de mise en place de 21 mois. Un sous-échantillon d'employés (n = 26) a participé à des entretiens qui ont inclus une mesure narrative de capacité de réflexion; et un plus petit sous-échantillon d'enseignants uniquement (n = 21) a rempli des évaluations des enfants. Les employés dans le groupe d'intervention ont fortement augmenté leur capacité de réflexion après 21 mois. Pour le sous-échantillon d'employés, le fait d'avoir reçu l'intervention a prédit des niveaux plus bas de burnout à 12-15 mois après référence. Des enseignants ayant rempli les évaluations des enfants, ceux avec la capacité de réflexion la plus élevées ont évalué les comportements des enfants de manière plus positive que les enseignants avec une capacité de réflexion moins élevée. Nous concluons que ce modèle IECMHC a amélioré avec succès la capacité de réflexion chez les employés. Des recherches futures devraient se pencher sur la capacité de réflexion comme mécanisme potentiel de changement pour l'IECMHC.

[Summary PAPPS Childhood and Adolescence 2022]. / Resumen PAPPS Infancia y Adolescencia 2022.

Two important topics about children and adolescents in our primary care activity are presented in this update document: tobacco smoking prevention in adolescence and prophylaxis with vitamin K to prevent the hemorrhagic disease of the newborn.

Moderate to Severe Psoriasis in Pediatric and Young Patients: The BIOBADADERM Registry Experience. / Psoriasis moderada-grave en pacientes pediátricos y jóvenes: experiencia en el registro BIOBADADERM.

Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Of the 3946 patients in the registry, 24 were aged 21 years or younger. They had mean age of 16.1 years on starting treatment. When the registry was started, they had a Psoriasis Area and Severity Index of 9.4 and 67% were being treated with a conventional systemic drug. Treatment was discontinued in 14 patients (58%) due to adverse events or a loss or lack of effectiveness. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs.

Adverse childhood experiences. Knowledge and use by pediatrics residents.

INTRODUCTION: Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life. OBJECTIVE: To identify the knowledge and the frequency pediatrics residents ask about ACEs with. METHODS: Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care children's hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected. RESULTS: 21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them. CONCLUSIONS: Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.

INTRODUCCIÓN: Las experiencias adversas en la infancia (EAI) se han relacionado con la adquisición de conductas de riesgo y el desarrollo de enfermedades crónicas y mentales, desde la adolescencia y en la vida adulta. OBJETIVO: Identificar el conocimiento y la frecuencia con la que médicos residentes de pediatría interrogan sobre las EAI. MÉTODOS: Mediante una encuesta en línea enviada a todos los médicos residentes del año académico 2017-2018 de un hospital pediátrico de tercer nivel, se recabaron variables demográficas, del conocimiento, uso, entrenamiento y barreras para interrogar sobre EAI. RESULTADOS: 21 % de los residentes respondió la encuesta, la mayoría fue del sexo femenino (70 %), menos de 5 % de los participantes estaba familiarizado con las EAI, 31 % interrogaba sobre ellas a los padres e hijos y 71 % consideró que tiene alguna barrera para interrogarlas. CONCLUSIONES: Los participantes de este estudio mostraron un conocimiento limitado sobre las EAI, lo que repercutió en la frecuencia con la que preguntaban al respecto a sus pacientes y padres; al menos la mitad tuvo la percepción que identificarlas está fuera del alcance del pediatra.

Mediation of Childhood Adversity and Health by Relationship Quality in Diverse Couples.

Individuals with economic disadvantage experience greater (a) adverse childhood experiences (ACE), (b) risk for low relationship quality and relationship dissolution, and (c) disparity in physical and mental health. Thus, a critical need exists to understand the connections between areas of disparity in family and relational health on physical and mental health for those most vulnerable to the deleterious effects. The researchers therefore tested a dyadic model for the mediation of ACE and health by relationship quality with data from 503 couples with economic disadvantage and a racial or ethnic minority background (76.9%). The data fit the proposed model and explained a majority of the variance in health, 82.3% of the variance in men's health and 56.5% in women's health-both large effects. Moreover, the significant indirect pathway between ACE and health through relationship quality contributed 98.05% and 57.40% of the total effects for men and women, respectively. Overall, a significant relationship existed between ACE, relationship quality, and health for men and women at the actor-level and the dyadic influence between members of a couple contributed to the overall model fit. Results add to support for the role of relationship quality as a dyadic social determinant of health disparities with implications for prevention and intervention.

Las personas desfavorecidas económicamente sufren más (a) experiencias adversas en la infancia (EAI), (b) riesgo de una baja calidad de las relaciones y de disolución de las relaciones, y (c) disparidad en la salud física y mental. En consecuencia, existe una necesidad imperiosa de comprender las conexiones entre las áreas de disparidad en la salud familiar y relacional, y la salud física y mental para aquellos más vulnerables a los efectos perjudiciales. Por lo tanto, los investigadores evaluaron un modelo diádico para la mediación de las EAI y la salud según la calidad de la relación con datos de 503 parejas desfavorecidas económicamente y un origen de minoría étnica o racial (76.9%). Los datos se adaptaron al modelo propuesto y explicaron una mayoría de la varianza en la salud, un 82.3% de la varianza en la salud de los hombres y un 56.5% en la salud de las mujeres, ambos grandes efectos. Además, la vía indirecta significativa entre las EAI y la salud mediante la calidad de la relación aportó un 98.05% y un 57.40% de los efectos totales para los hombres y las mujeres respectivamente. En general, existió una relación significativa entre las EAI, la calidad de la relación y la salud para los hombres y las mujeres a nivel del actor, y la influencia diádica entre los integrantes de una pareja contribuyó a la adaptación al modelo en general. Los resultados respaldan aún mas el rol de la calidad de la relación como determinante social diádico de disparidades en la salud con implicancias para la prevención y la intervención.

[Childhood and adolescence PAPPS summary 2020]. / RESUMEN PAPPS Infancia y Adolescencia 2020.

Four important topics about children and adolescents in our Primary Care activity are presented in this update document: support for breastfeeding, promotion of physical activity, prevention of child injuries due to traffic accidents, and screening for major depression.

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities.

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE-health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.

Las experiencias adversas de la infancia son fuentes interpersonales de distrés correlacionadas negativamente con la salud mental y física así como con estrategias desadaptativas de conflicto con la pareja íntima en la adultez. Las minorías étnicas y raciales económicamente vulnerables informan las mayores divergencias en la exposición a experiencias adversas de la infancia, así como en el distrés en la relación y en la salud. Sin embargo, se sabe poco acerca de las conexiones entre las experiencias adversas de la infancia, el distrés relacional y la salud. Por lo tanto, evaluamos un modelo teórico para el rol mediador del distrés relacional a fin de explicar la conexión entre la salud y las experiencias adversas de la infancia con una muestra (N = 96) de minorías raciales o étnicas (87%) predominantemente de bajos recursos. Aplicamos un modelo de ecuaciones estructurales utilizando regresión parcial por mínimos cuadrados con análisis de remuestreo (N = 500). El distrés relacional fortaleció la relación predictiva entre las experiencias adversas de la infancia y la salud, y justificó el 42% de la varianza en la salud. Los resultados ofrecen un respaldo preliminar del distrés de la relación como determinante social de divergencias en la salud con implicancias para una intervención interdisciplinaria en la salud.

Early life predictors of callous-unemotional and psychopathic traits.

Psychopathy is a disorder that occurs primarily in males. Offenders with psychopathic traits are responsible for a disproportionate amount of crime in society, particularly violent crime. Early childhood is a time when individual differences in empathy and guilt-key indicators of the construct of psychopathy-are first evident. A growing number of longitudinal studies have begun to investigate how factors in infancy and early childhood predict psychopathic-like traits in later childhood, adolescence, and adulthood. These studies have suggested that parenting styles during infancy (parental sensitivity, maternal harsh intrusion, commenting on the emotional state of the child) as well as attachment styles are predictive of later psychopathic-like traits. In addition, child characteristics such as temperament and the functioning of biological systems such as the autonomic nervous system and hypothalamic-pituitary-adrenal axis are predictive. Overall, studies have suggested that at least some of the origins of psychopathic traits are present in infancy and early childhood, which is consistent with the perspective of psychopathy as a neurodevelopmental disorder. A recent evolutionary-developmental model provides hypotheses regarding how psychopathy may develop and why it is more common in males than females. This model, and its implications for intervention, is discussed in the context of the longitudinal studies that have been conducted on psychopathy.

Attachment and Family Processes in Children's Psychological Adjustment in Middle Childhood.

This study examined the links between parent-child attachment, whole family interaction patterns, and child emotional adjustment and adaptability in a sample of 86 community families with children between the ages of 8 and 11 years. Family interactions were observed and coded with the System for Coding Interactions and Family Functioning (SCIFF; Lindahl, 2001). Both parents and each target child completed the appropriate form of the Behavior Assessment System for Children-2nd Edition (BASC-2; Reynolds & Kamphaus, 2004). Target children also completed the Children's Coping Strategies Questionnaire (CCSQ; Yunger, Corby, & Perry, 2005). Hierarchical multiple regressions indicated that Secure mother-child attachment was a robust predictor of children's emotional symptoms, but father-child attachment strategies were not significant independent predictors. Positive Affect in family interactions significantly increased the amount of variance accounted for in children's emotional symptoms. In addition, Family Cohesion and Positive Affect moderated the relationship between father-child attachment and children's emotional symptoms. When data from all BASC-2 informants (mother, father, child) were considered simultaneously and multidimensional constructs were modeled, mother-child security directly predicted children's adjustment and adaptive skills, but the influence of father-child security was fully mediated through positive family functioning. Results of the current study support the utility of considering dyadic attachment and family interaction patterns conjointly when conceptualizing and fostering positive emotional and behavioral outcomes in children.

Child Characteristics, Parent Education and Depressive Symptoms, and Marital Conflict Predicting Trajectories of Parenting Behavior from Childhood Through Early Adolescence in Taiwan.

The study examined how child and parent characteristics, and contextual sources of stress, such as marital conflict predict initial status and trajectories of parent involvement, support, and harsh control, over a 4-year period in families in Taiwan (n = 4,754). Based on Belsky's (1984) ecological model of parenting, three domains predicting parenting were tested, child characteristics (age cohort and gender), father and mother characteristics (education and depressive symptoms), and contextual sources of stress (marital conflict). The study followed two cohorts of children; the younger cohort was followed from first to fourth grade and the older cohort from fourth to seventh grade. Initially, fourth graders reported more parental involvement, support, and harsh control than first graders. However, involvement, support, and harsh control decreased across the 4 years for the older cohort as they transitioned to early adolescence. In the first year, girls reported more parental involvement and support and less harsh control than boys. Across the 4 years, involvement and support increased, and harsh control decreased for boys; whereas involvement stayed the same, support slightly decreased, and harsh control slightly increased for girls. Children whose parents were more educated reported more parent involvement, support, and harsh control in the first year. Children whose fathers were chronically depressed and whose parents were experiencing marital conflict reported decreasing parent involvement and support over the years.

MATERNAL INTERACTION QUALITY MODERATES EFFECTS OF PRENATAL MATERNAL EMOTIONAL SYMPTOMS ON GIRLS' INTERNALIZING PROBLEMS.

The role of mother-infant interaction quality is studied in the relation between prenatal maternal emotional symptoms and child behavioral problems. Healthy pregnant, Dutch women (N = 96, M = 31.6, SD = 3.3) were allocated to the "exposed group" (n = 46), consisting of mothers with high levels of prenatal feelings of anxiety and depression, or the "low-exposed group" (n = 50), consisting of mothers with normal levels of depressive or anxious symptoms during pregnancy. When the children (49 girls, 47 boys) were 23 to 60 months of age (M = 39.0, SD = 9.6), parents completed the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, ), and mother-child interaction quality during a home visit was rated using the Emotional Availability Scales. There were no differences in mother-child interaction quality between the prenatally exposed and low-exposed groups. Girls exposed to high prenatal emotional symptoms showed more internalizing problems, if maternal interaction quality was less optimal. No significant effects were found for boys.

[Rare location of arachnoid cysts. Extratemporal cysts]. / Quistes aracnoideos de localización infrecuente. Quistes extratemporales.

The therapeutic management of arachnoid cysts depends largely on its location. Almost 50% of arachnoid cysts are located in the temporal fossa-Sylvian fissure, whereas the other half is distributed in different locations, sometimes exceptional. Under the name of infrequent location arachnoid cysts, a description is presented of those composed of 2 sheets of arachnoid membrane, which are not located in the temporal fossa, and are primary or congenital.

Annular Lichenoid Dermatitis of Youth: A Report of 2 Cases and a Review of the Literature. / Dermatitis anular liquenoide de la infancia. Descripción de 2 casos y revisión de la literatura.

Annular lichenoid dermatitis of youth is a lichenoid dermatosis of unknown etiology. It mostly affects children and adolescents and has well-defined clinical and histological characteristics that permit a diagnosis. We present 2 new cases of annular lichenoid dermatitis of youth with classical clinical features in 2 girls, aged 2 and 4 years. The histologic findings, however, differed from those reported in the literature in that the lichenoid inflammatory infiltrate was located primarily at the top of the dermal papillae and not at the tips of the rete ridges. In both cases, the lesions regressed spontaneously without treatment.

Delimiting family in syntheses of research on childhood chronic conditions and family life.

Synthesis of family research presents unique challenges to investigators who must delimit what will be included as a family study in the proposed review. In this paper, the authors discuss the conceptual and pragmatic challenges of conducting systematic reviews of the literature on the intersection between family life and childhood chronic conditions. A proposed framework for delimiting the family domain of interest is presented. The framework addresses both topical salience and level of relevance and provides direction to future researchers, with the goal of supporting the overall quality of family research synthesis efforts. For users of synthesis studies, knowledge of how investigators conceptualize the boundaries of family research is important contextual information for understanding the limits and applicability of the results.

FATHERS' AND MOTHERS' REPRESENTATIONS OF THE INFANT: ASSOCIATIONS WITH PRENATAL RISK FACTORS.

Parents' representations of their infants consist of parents' subjective experiences of how they perceive their infants. They provide important information about the quality of the parent-infant relationship and are closely related to parenting behavior and infant attachment. Previous studies have shown that parents' representations emerge during pregnancy. However, little is known about prenatal (risk) factors that are related to parents' representations. In a prospective study, 308 mothers and 243 fathers were followed during pregnancy and postpartum. Prenatal risk factors were assessed with an adapted version of the Dunedin Family Services Indicator (T.G. Egan et al., ; R.C. Muir et al., ). At 26 weeks' gestation and 6 months' postpartum, parents' representations of their children were assessed with the Working Model of the Child Interview (C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan). Results showed stability between pre- and postnatal representations, with fathers having more disengaged representations than did mothers. In addition, prenatal risk factors of parenting problems were associated with the quality of parents' prenatal (only in mothers) and postnatal representations. This study provides valuable information concerning parents at risk of developing nonbalanced representations of their children. In clinical practice, these families could be monitored more intensively and may be supported in developing a more optimal parent-infant relationship.