Stress level and quality of life following pediatric cataract surgery / Avaliação do nível de estresse e de qualidade de vida em crianças submetidas à cirurgia de catarata

ABSTRACT Purpose: To evaluate the quality of life and stress level related to visual function following pediatric cataract surgery in a Brazilian public hospital. Methods: This prospective study analyzed children aged 6-14 years old who underwent cataract surgery. The Childhood Stress Scale and Children's Visual Function Questionnaire (CVFQ) were used to assess stress levels and quality of life, respectively. Both instruments were applied by two psychologists before and after the surgery. Eye examination was performed by two ophthalmologists. Preoperative and postoperative data were compared. Results: In total, 23 children (32 eyes) were enrolled in the study, of which 9 had bilateral cataracts. The average age group at the time of surgery was 9.65 ± 2.26 (6-14) years old. One month after the surgery, the spherical equivalent was -0.90 ± 1.66D, and the corrected distance visual acuity was 0.13 ± 0.10 (0-0.3) LogMAR in bilateral cases and 0.50 ± 0.39 (0-1.3) LogMAR in unilateral cases (p<0.01). According to the Childhood Stress Scale, 77.7% of the bilateral cases and 57.1% of the unilateral cases had stable stress levels, and 34.7% of the children improved their stress level. The analysis of the CVFQ was based on scores for general health, general vision health, competence, personality, and treatment. After cataract surgery, 78.2% of the patients had improved or maintained CVFQ scores in the general health domain; 82.6%, general vision health; 95.6%, competence; 56.5%, personality; and 78.2%, treatment. Conclusion: Pediatric cataract surgery improves the visual function and the quality of life even in patients undergoing surgical procedures, without increasing the stress levels.

RESUMO Objetivo: Avaliar a qualidade de vida e o nível de estresse relacionada à função visual após a cirurgia de catarata pediátrica em um hospital público brasileiro. Métodos: Estudo prospectivo em crianças de seis a 14 anos submetidas à cirurgia de catarata. A Escala de Stresse Infantil e o Questionário de Função Visual em Crianças foram usados para avaliar o nível de estresse e a qualidade de vida, respectivamente. Ambos os instrumentos foram aplicados por duas psicólogas antes e após a cirurgia. O exame oftalmológico foi realizado por dois oftalmologistas. Os dados coletados no pré e pós-operatório foram comparados. Resultados: Vinte e três crianças (32 olhos) foram incluídas no estudo, nove delas apresentavam catarata bilateral. A média de idade na cirurgia foi de 9,65±2,26 (6 a 14) anos. Um mês após a cirurgia, o equivalente esférico foi de -0,90 ± 1,66D e a acuidade visual corrigida a distância foi de 0,13 ± 0,10 (0-0,3) LogMAR em casos bilaterais e 0,50 ± 0,39 (0-1,3) LogMAR em casos unilaterais (p<0.01). De acordo com a Escala de Stresse Infantil, 77,7% dos casos de catarata bilaterais, e 57,1% dos casos unilaterais mantiveram o nível de estresse e 34,7% das crianças melhoraram o nível de estresse. A análise do Questionário de Função Visual em Crianças foi baseada em pontuações para saúde geral, saúde geral da visão, competência, personalidade e tratamento. Após a cirurgia de catarata, 78,2% dos pacientes melhoraram ou mantiveram o escore do Questionário de Função Visual em Crianças na saúde geral, 82,6% na saúde geral da visão, 95,6% na competência, 56,5% na personalidade e 78,2% no tratamento. Conclusão: A cirurgia de catarata pediátrica melhora a função visual e a qualidade de vida em pacientes submetidos a procedimento cirúrgico, sem aumentar o nível de estresse.

Experiencias infantiles adversas y síndrome metabólico en adultos de una unidad de medicina familiar en Michoacán, México / Adverse childhood experiences and metabolic syndrome in adults in a family medicine unit Michoacán, Mexico

Introducción: las experiencias infantiles adversas (EIA) aumentan el riesgo de enfermedades metabólicas en la edad adulta; no obstante, esta relación ha sido poco estudiada en la población mexicana Objetivos: determinar la frecuencia de experiencias infantiles adversas (EIA) y su relación con el síndrome metabólico en personas mayores de 19 años de edad en una unidad de medicina familiar urbana en Michoacán, México. Metodología: se realizó un estudio observacional, retrospectivo, transversal y analítico en 127 participantes mayores de 19 años. Se evaluaron sus medidas antropométricas, y cuantificamos los niveles de glucosa en ayuno, triglicéridos y colesterol HDL en sangre. Aplicamos el cuestionario internacional de experiencias infantiles adversas (ACE-IQ). Utilizamos estadística descriptiva y la prueba de Chi cuadrada. Resultados: el 95% de la muestra reportó al menos una EIA, y la más frecuente fue la violencia doméstica. El 45% de los individuos presentaron síndrome metabólico. No se encontró asociación entre el síndrome metabólico ni los componentes con la exposición a las EIA. No obstante, observamos que el divorcio o pérdida de uno de los padres fue más frecuente en los participantes con síndrome metabólico (p = 0.03). Conclusiones: la frecuencia de EIA fue mucho más alta que lo previamente reportado, pero no se observó una asociación con el síndrome metabólico... (AU)

Introduction: Adverse childhood experiences (ACE) increase the risk of metabolic diseases in adulthood; however, this relationship has been scarcely studied in the Mexican population. Objective: To determine the frequency of adverse childhood experiences and their relationship to metabolic syndrome in an urban Primary Care Unit from Michoacán, México. Methods: An observational, retrospective, cross-sectional and analytical study was performed in 127 participants older than 19 years. Their anthropometric measurements were evaluated, and we quantified the blood levels of fasting glucose, triglycerides, and HDL cholesterol. The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was utilized. We used descriptive statistics and the Chi square test. Results: 95% of the sample reported at least one EIA, and the most frequent was domestic violence. 45% of individuals presented metabolic syndrome. No association was found between the metabolic syndrome or its components with the exposure to EIA. However, we observed that divorce or loss of one of the parents was more frequent in the participants with metabolic syndrome (p = 0.03). Conclusions: The frequency of EIA was much higher than previously reported, however, we did not observe an association of ACE with metabolic... (AU)

Experiências adversas na infância: um estudo com autores de agressão sexual / Experiencias infantiles adversas: un estudio con perpretadores de agresiones sexuales / Adverse childhood experiences: a study addressing the perpetrators of sexual violence

This study aimed to describe the Adverse Childhood Experiences (ACE) of perpetrators of sexual violence of children and adolescents and their relationship with the abusers' personal and situational factors (n = 30). Hence, a database composed of the transcripts of interviews was analyzed using content analysis, from which thematic categories emerged as proposed by the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Physical abuse was the most frequently reported (70%). Sexual abuse was reported by almost half of the sample, which presented an increased risk in the face of the death and/or divorce of parents (RR = 4.21) and emotional neglect (RR = 3.2). In addition, the participants with higher ACE-Scores abused children more recurrently and less frequently consumed alcohol or other drugs. The interpretation of the results in light of the literature reinforces the hypothesis that the consequences of adversities during childhood are associated with a higher likelihood of becoming a victim throughout life and manifesting risky behaviors, such as aggressive sexual behavior. Future studies are suggested to apply the ACE-IQ to larger samples and implement a post-test to contribute to more effective interventions to treat this population.

Este estudio tuvo como objetivo analizar las Experiencias Adversas en la Infancia por parte de los perpetradores de agresión de niños y niñas y la asociación con factores personales y situacionales identificados. (n = 30). Para ello, se utilizó el instrumento de cribado del Cuestionario Internacional de Experiencias Adversas en la Infancia (ACE-IQ) para el análisis de los datos. El maltrato físico fue reportado con mayor frecuencia (70%) y el abuso sexual fue mencionado por casi la mitad de la muestra, con su riesgo aumentado ante la muerte y/o divorcio de los padres (RR = 4,21) y negligencia emocional (RR = 3.2). Participantes con ACE-Scores más altos han agredido repetidamente a sus víctimas y con menos necesidad de consumir alcohol y/o otras drogas. Los resultados muestran que las consecuencias de la exposición a la adversidad en la infancia están asociadas no solo a la probabilidad de convertirse en víctima a lo largo de la vida, sino también a caminos de transitar permeados por conductas de riesgo y criminalidad. Se sugiere que más estudios puedan aplicar el ACE-IQ a muestras más grandes, con la realización de una prueba posterior, lo que puede contribuir a intervenciones más efectivas al servicio de esta población.

Este estudo objetivou descrever Experiências Adversas na Infância (EAI) relatadas por autores de agressão sexual de crianças e adolescentes e sua relação com fatores pessoais e situacionais identificados (n = 30). Para tanto, utilizou-se um banco de dados formado por transcrições de entrevistas previamente realizadas, cuja análise de conteúdo considerou categorias temáticas retiradas do Adverse Childhood Experiences International Questionnaire (ACE-IQ). O abuso físico foi o mais relatado (70%) e o abuso sexual mencionado por quase metade da amostra, tendo seu risco aumentado diante da morte e/ou separação dos pais (RR = 4.21) e negligência emocional (RR = 3.2). Participantes com maiores ACE-Scores agrediram de forma mais recorrente e com menor uso de álcool e/ou outras drogas. A interpretação dos resultados à luz da literatura da área reforça a hipótese de que as consequências da exposição à adversidade na infância estão relacionadas tanto à probabilidade de tornar-se vítima ao longo da vida quanto de vir a manifestar comportamentos de risco, como a conduta sexual agressiva. Estudos posteriores poderão aplicar o ACE-IQ diretamente e em amostras maiores, com a realização de pós-teste, o que favorecerá a promoção de intervenções mais eficazes no atendimento a essa população.

Echoes of early-life stress on suicidal behavior in individuals with substance use disorder / Ecos del estrés en la vida temprana en el comportamiento suicida en personas con trastorno por uso de sustancias

Introduction: Psychoactive substances abuse is considered a problematic social factor due its likelihood to cause harmful, self-destructive behaviors to the subjects and the overall society. Stress in an individual's early life may also be a contributing factor to substance abuse as well as suicide attempts. There is a lack of studies examining these factors in people with substance-use disorder. Aim: to identify the relationship between early-life stress and suicide attempts in drug-dependent adults. Methods: This is a predictive correlational study with a cross-sectional approach. The convenience sample consisted of 105 individuals treated at an outpatient unit for addiction treatment. The participants were assessed using the Mini-international Neuropsychiatric Interview, a Childhood Trauma Questionnaire to measure the severity of the different types of early life stress; the Beck Scale for Suicide Ideation was also used. The data were analyzed using descriptive and inferential statistics through univariate and multivariate logistic regression. Results: The analyzed sample included 33 (31.4%) individuals who attempted suicide and were significantly more likely to suffer from emotional, physical, or sexual abuse than those who had never attempted suicide (p <0,05). Conclusions: Different forms of early-life stress are related to attempted suicide in people with substance-use disorder. Further studies are needed to understand the effects of early-life stress on suicide attempts in drug-dependent people.

Introducción: El abuso de sustancias psicoactivas se considera un factor social problemático cuando se producen conductas autodestructivas perjudiciales para el sujeto y la sociedad. El estrés en la vida temprana de una persona también puede ser un factor que contribuya a las situaciones de abuso de sustancias, así como a los intentos de suicidio. Hay una falta de estudios que examinen estos factores en personas con trastorno por uso de sustancias. Objetivo: Identificar la relación entre estrés en la vida temprana y los intentos de suicidio en personas adultas con trastorno por uso de sustancias. Métodos: Estudio correlacional, predictivo, transversal. La muestra de conveniencia consistió en 105 personas tratadas en una unidad ambulatoria para el tratamiento de adicciones. Las personas se evaluaron por medio de la Mini-Entrevista Neuropsiquiátrica Internacional, el Cuestionario de Trauma Infantil para medir la gravedad de los diferentes tipos de estrés en la vida temprana y la Escala de Beck para Ideación Suicida. Los datos se analizaron mediante estadística descriptiva e inferencial mediante regresión logística univariante y multivariante. Resultados: De la muestra analizada, 33 (31,4%) habían intentado suicidarse y tenían una exposición significativamente mayor al abuso emocional, físico y sexual (p<0,05) en comparación con las personas que nunca habían intentado suicidarse. Conclusiones: Diferentes formas de estrés en la vida temprana están relacionadas con el intento de suicidio en personas con trastorno por consumo de sustancias. Se necesitan más estudios para comprender los efectos del estrés en la vida temprana sobre los intentos de suicidio en una persona con dependencia.

Introdução: O uso abusivo de substâncias psicoativas é considerado um fator social problemático quando ocorrem comportamentos autodestrutivos prejudiciais ao sujeito e à sociedade. O estresse no início da vida de um indivíduo também pode ser um fator que contribui para situações de abuso de substâncias, bem como tentativas de suicídio. Há uma falta de estudos examinando esses fatores em pessoas com transtorno por uso de substâncias. Objetivo: Identificar a relação entre o estresse no início da vida e as tentativas de suicídio em adultos com transtorno de uso de substâncias. Métodos: Estudo correlacional preditivo com abordagem transversal. A amostra por conveniência foi composta por 105 indivíduos atendidos em uma unidade ambulatorial para tratamento de dependências e foi avaliada por meio do Mini-International Neuropsychiatric Interview, do Childhood Trauma Questionnaire para medir a gravidade de diferentes tipos de estresse precoce e da Escala de Beck para Ideação Suicida. Os dados foram analisados por meio de estatística descritiva e inferencial por meio de regressão logística univariada e multivariada. Resultados: Da amostra analisada, 33 (31,4%) já haviam tentado suicídio e tiveram exposição significativamente maior a abusos emocionais, físicos e sexuais (p <0,05) em comparação com os participantes que nunca tentaram suicídio. Conclusões: Diferentes formas de estresse no início da vida estão relacionadas à tentativa de suicídio em indivíduos com transtorno por uso de substâncias . Mais estudos são necessários para compreender os efeitos do estresse precoce nas tentativas de suicídio de uma pessoa com dependência.

Resilience, adverse childhood experiences, and mental health in Health Science students during the COVID-19 pandemic / Resiliencia, eventos adversos en la infancia y salud mental en estudiantes de Ciencias para la Salud en la pandemia por COVID-19

Abstract Introduction A steady rise in mental problems has been observed in the university population, particularly in the area of health, related to the COVID-19 pandemic. Protective factors such as resilience and risk factors such as adverse events in childhood have been associated with mental health outcomes. Objective Describe psychiatric symptoms and their association with adverse childhood experiences and resilience in first-semester students in the three undergraduate programs of the Faculty of Health Sciences of the University of Caldas, Colombia in 2020. Method Descriptive, cross-sectional, correlational study, using a virtual survey including the SRQ (Self Reporting Questionnaire), Wagnild and Young's Resilience Scale and questions on adverse childhood experiences. Results A total of 108 students with a mean age of 19.6 years participated in the study. Affective symptoms were found in 6.4% of subjects. The most frequent level of resilience was medium, while the most commonly reported adverse event was child abuse. An association was found between being exposed to adverse childhood experiences and the presence of symptoms that compromise mental health and alter one of the domains of resilience. A link was also found between the presence of these symptoms and the alteration of domains of resilience. Discussion and conclusion It was possible to identify a risk of mental health disorders in students, and to establish an association between adverse events in childhood and resilience.

Resumen Introducción Se ha descrito un aumento progresivo de problemas mentales en la población universitaria, especialmente en el área de la salud, relacionado con la pandemia por COVID-19. Factores protectores como la resiliencia y factores de riesgo como eventos adversos en la infancia, se han relacionado con desenlaces en la salud mental. Objetivo Describir síntomas psiquiátricos y su asociación con eventos adversos en la infancia y resiliencia, en estudiantes de primer semestre de los tres programas de pregrado de la Facultad de Ciencias para la Salud de la Universidad de Caldas, Colombia en 2020. Método Estudio descriptivo, transversal, correlacional, mediante una encuesta virtual incluyendo el SRQ (Self Reporting Questionnaire), escala de resiliencia de Wagnild y Young y preguntas relacionadas con eventos adversos en la infancia. Resultados Participaron 108 estudiantes con edad media de 19.6 años. Hubo presencia de síntomas afectivos en 6.4%. El nivel de resiliencia más frecuentemente encontrado fue "medio" y el evento adverso en la infancia más comúnmente reportado fue el maltrato. Se demostró asociación entre haber estado expuesto a eventos adversos en la infancia tanto con presencia de síntomas que comprometen la salud mental como con afectación de uno de los dominios de resiliencia. Asimismo, hubo asociación entre presencia de dichos síntomas con afectación de los dominios de la resiliencia. Discusión y conclusión Se pudo identificar riesgo de alteraciones de la salud mental en los estudiantes, resaltando la asociación con eventos adversos en la infancia y la resiliencia.

Reliability and validity of the Chinese version of adverse childhood experiences international questionnaire in parents of preschool children / 北京大学学报(医学版)

OBJECTIVE@#To test the reliability and validity of the Chinese version of adverse childhood experiences international questionnaire (ACE-IQ) in Chinese parents of preschool children.@*METHODS@#The parents of preschool children in 6 kindergartens in Tongzhou District of Beijing were selected by stratified random cluster sampling, and the Chinese version of ACE-IQ after translation and adaptation was used for survey online. The collected data were randomly divided into two parts. One part of the data (n=602) was used for exploratory factor analysis (EFA), to screen items and evaluate structural validity, and then form the final Chinese version of ACE-IQ. The other part of the data (n=700) was used for confirmatory factor analysis (CFA), criterion validity analysis and reliability analysis. At the same time, experts investigation method was used to evaluate the content validity of the final Chinese version of ACE-IQ.@*RESULTS@#After deleting four items of collective violence, the Chinese version of ACE-IQ with twenty-five items indicated good structural, criterion and content validity. Analysis results showed that the Chinese version of ACE-IQ presented a seven-factor model dimension, namely emotional neglect, physical neglect, family dysfunction, family violence, emotional and physical abuse, sexual abuse and violence outside the home, and the total score of the binary version of ACE-IQ Chinese version was positively correlated with the total score of childhood trauma questionaire-28 item short form (CTQ-SF, r=0.354, P < 0.001) and the center for epidemiological studies depression scale (CES-D, r=0.313, P < 0.001) respectively. Results from five experts showed that the item-level content validity index (I-CVI) of 25 items was between 0.80 and 1.00, and the average of all I-CVIs on the scale (S-CVI/Ave) of the scale was 0.984. At the same time, the internal consistency (Cronbach's α coefficient) of the whole scale was 0.818, and the split-half reliability (Spearman-Brown coefficient) was 0.621, which demonstrated good reliability.@*CONCLUSION@#This study has formed a Chinese version of ACE-IQ with 25 items and 7 dimensions, which has good reliability and validity among the parents of preschool children in China. It can be used as an evaluation instrument for measuring the minimum threshold of the adverse childhood experiences in the parents of preschool children in the cultural background of China.

Adverse childhood experiences and psychopathology in adolescents from northern Chile: the moderating role of the attachment style

Abstract Background Identifying the underlying mechanisms through which adverse childhood experiences affect (ACEs) the mental health of adolescents is of paramount importance for disease prevention in later stages of life. Objective The present study examines the relationship between ACEs and psychopathology in adolescents from northern Chile and how attachment style (abandonment anxiety and intimacy avoidance) may moderate this relationship. A total of 154 schooled adolescents aged 12 to 17 (M = 15.08, SD = 1.64) completed a series of self-report questionnaires including the Adverse Childhood Experience Questionnaire (ACEs), Experiences in Close Relationships-Relationship Structures (ECR-RS), and Youth Self Report (YSR-18). Results The data analysis was carried out using SPSS version 25, which included descriptive analysis, one-way ANOVA, and Spearman correlation analysis. To address moderation analysis, the PROCESS macro extension version 4.1 was employed. In this process, the bootstrap method was applied to construct confidence intervals, and the pick-a-point approach was used to define the levels of the moderating variable. According to the results, 80.3% of the sample experienced one or more ACEs, and 16.4% reported experiencing at least three. Furthermore, the variables under study exhibited significant correlations with each other, except for intimacy avoidance, which showed no correlation with ACEs (rho = −0.10; p = 0.273). When considering abandonment anxiety as a moderating variable, the direct effect of ACEs on externalizing symptoms showed statistically significant changes (β = 0.60, p = 0.03). No other moderating effects were found according to the proposed models. Conclusion In childhood, the accumulation of ACEs is associated with the development of psychopathology in adolescents from northern Chile, specifically with the presence of internalizing and externalizing symptoms. These findings suggest that lower levels of abandonment anxiety could mitigate the effects of ACEs on adolescent psychopathology, while higher levels of abandonment anxiety could exacerbate these effects on psychopathology.

Scurvy and food selectivity in childhood: a case report

ABSTRACT Despite its rarity, symptomatic micronutrient deficiency remains a public health problem. Scurvy is the differential diagnosis for bleeding disorders and hematological and rheumatological diseases, especially in patients with eating disorders. However, it is unrelated to autism spectrum disorders or other neurodevelopmental disorders. A previously healthy 10-year-old boy living in São Paulo, Brazil, had a history of significant food selectivity unrelated to autism spectrum disorder, resulting in symptomatic ascorbic acid deficiency (scurvy). This resulted in pain and purpuric lesions on the lower limbs, gingival edema, bleeding during tooth brushing, asthenia, weakness, malaise, and sadness. Therefore, dietary anamnesis is important for routine monitoring of child growth and development. This process helps prevent nutritional deficiencies, facilitates early diagnosis of eating disorders, and enables multidisciplinary follow-up for these patients.

Could children exposed to intimate partner violence against their mother have more functional gastrointestinal disorders?

Abstract Objective: To analyze the association between child exposure to intimate partner violence (CEIPV) committed against their mother and functional gastrointestinal disorders (FGIDs) in school-age children. Methods: A prospective cohort study was carried out that evaluated 626 mother-child pairs living in a poor urban area in the Northeast of Brazil. The mothers were asked about their children's exposure to intimate partner violence. Holden's classification was used, which investigates ten types of CEIPV from prenatal care. The number of exposures, age of onset, and the perpetrator of the exposure were also verified. The FGIDs in children were identified from the mother's responses to the questionnaire about pediatric gastrointestinal symptoms, Roma III version parent-report, translated and cross-culturally adapted into Brazilian Portuguese. Results: FGIDs were more frequent among children exposed to violence than those not exposed (OR: 1.64; 95% CI: 1.04-2.58; p = 0.03). Likewise, in children who suffered four or more types of exposure (OR: 1.81; 95% CI: 1.10-2.96; p = 0.01), in which the exposure started in the first two years of life (OR: 1.93; 95% CI: 1.08-3.47; p = 0.02) and in those whose biological father was the perpetrator of the violence (OR; 1.62; 95% CI: 1, 05-2.48; p = 0.02). Conclusion: Corroborating the proposal of the biopsychosocial model, CEIPV increases the chance of occurrence of FGIDs in school-age children. Therefore, early identification and proposals for appropriate interventions are suggested both for the prevention of CEIPV and for the prevention and follow-up of FGIDs.

How adverse and benevolent childhood experiences influence depression and suicidal ideation in Chinese undergraduates: a latent class analysis

BACKGROUND@#There has been minimal research on the role of benevolent childhood experiences (BCEs) and how such events may offer protection from the insidious effects of adverse childhood experiences (ACEs) or later in life.@*OBJECTIVES@#This research aims to learn how BCEs and ACEs interact to affect adolescents' psychological distress.@*METHODS@#Cross-sectional survey was conducted in three cities (Xuzhou, Nanjing, and Wuhan) in China from March 2021 to May 2021. Latent class analysis (LCA) was used to classify the patterns of ACEs and BCEs. We adopted hierarchical multivariable regression to examine the influences of ACEs and BCEs on depression and suicidal ideation.@*RESULTS@#To explore the relationship between childhood experience and suicidal ideation and depression, LCA revealed three patterns of ACEs: (1) emotional abuse (10.57%); (2) high ACEs (0.55%); and (3) low ACEs classes (88.88%). Adolescents with emotional abuse (depression: OR = 3.82, 95%CI = 2.80-5.22, P < 0.001; suicidal ideation: OR = 5.766, 95%CI = 3.97-8.38, P < 0.001) and high ACEs class (suicidal ideation: OR = 5.93, 95%CI = 1.19-29.66, P < 0.05) had an increased risk of psychological distress (reference: low ACEs). LCA revealed four patterns of BCEs: (1) relationship support (14.54%); (2) low BCEs (4.85%); (3) high BCEs (55.34%); and (4) high quality of life classes (25.28%). Adolescents with a high quality of life (depression: OR = 0.09, 95%CI = 0.05-0.16, P < 0.001; suicidal ideation: OR = 0.22, 95%CI = 0.12-0.40, P < 0.001) and high BCEs (depression: OR = 0.05, 95%CI = 0.03-0.09, P < 0.001; suicidal ideation: OR = 0.15, 95%CI = 0.09-0.26, P < 0.001) protected the mental health of adolescents (reference: low BCEs).@*CONCLUSIONS@#High ACEs and emotional abuse classes were significantly associated with poorer mental health symptoms, including suicidal ideation and depression. In contrast, high BCEs and high quality of life classes were associated with better mental health. These findings point out that it is more necessary to identify and support victims of ACEs, and it is urgent to increase BCEs in early childhood.

Childhood trauma subtypes may influence the pattern of substance use and preferential substance in men with alcohol and/or crack-cocaine addiction

Objective: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. Methods: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. Results: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. Conclusions: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

Relationship between adverse childhood experiences and the physical and mental health in Mexican adults / Relación entre las experiencias adversas en la infancia y la salud física y mental en adultos mexicanos

Abstract Introduction Adverse childhood experiences (ACEs) are potentially traumatic events that people may experience during early life, including physical, psychological, and sexual abuse; neglect; and household dysfunction. Objective To evaluate the frequency of ACEs and their relationship with the mental and physical health of Mexican adults. Method 389 people between 18 and 65 years old were included in a cross-sectional study with an incidental sample and voluntary participation. Subjects responded to the ACEs questionnaire, the PHQ-9, the GAD-7, and the PHQ-15. Logistic regression models were used to evaluate the association between ACEs and adult health conditions. Results 75% reported at least one type of adversity, and 31.4% reported three or more. Reporting three or more ACEs was associated with an increased odds ratio for depression (OR = 5.04, 95% CI [2.38, 10.68]), anxiety (OR = 3.33, 95% CI [1.09, 6.99]), psychosomatic severity (OR = 4.58, 95% CI [2.53, 8.29]), obesity (OR = 2.08, 95% CI [1.21, 3.59]), and limitations due to physical or emotional discomfort (OR = 5.90, 95% CI [2.88, 12.09]). Higher anxiety was associated with sexual abuse (OR = 2.12 95% CI [.92, 4.85]) and witnessing violence (OR = 5.09, 95% CI [1.04, 24.77]). The probability of psychosomatic severity was higher if reported sexual abuse increased (OR = 1.94 95% CI [.06, 3.54]) and emotional neglect (OR = 1.84, 95% CI [1.02, 3.32]). Discussion and conclusion ACEs are associated to mental health difficulties and psychosomatic symptoms. The relationship between different types of adversity and health is confirmed.

Resumen Introducción Las experiencias adversas en la infancia (EAI) se refieren a la exposición durante la niñez a sucesos potencialmente perjudiciales para la salud. Estos incluyen: maltrato físico, psicológico, sexual y negligencia, así como algunas formas de disfunción familiar. Objetivo Examinar la frecuencia de las EAI y su relación con la salud mental y física de adultos en Ciudad Juárez. Método 389 personas de entre 18 y 65 años, en un estudio transversal con muestra incidental y participación voluntaria. Los instrumentos empleados fueron: PHQ-9 para depresión, GAD-7 para ansiedad y PHQ-15 para síntomas psicosomáticos. Resultados El 75% reportó al menos un tipo de adversidad y el 31.4% tres o más. Reportar 3+ EAI estuvo asociado con un incremento en Odds Ratio para depresión (OR = 5.04, 95% IC [2.38, 10.68]), ansiedad (OR = 3.33, 95% IC [1.09, 6.99]), severidad psicosomática (OR = 4.58, 95% IC [2.53, 8.29]), obesidad (OR = 2.08, 95% IC [1.21, 3.59]) y limitaciones por malestares físicos o emocionales (OR = 5.90, 95% IC [2.88, 12.09]). Una mayor ansiedad se asoció con abuso sexual (OR = 2.12 95% IC [.92, 4.85]) y haber sido testigo de violencia (OR = 5.09, 95% IC [1.04, 24.77]). Mayor riesgo de severidad psicosomática se presentó si se reportaba abuso sexual (OR = 1.94 95% IC [1.06, 3.54]) y negligencia (OR = 1.84, 95% IC = [1.02, .32]). Discusión y conclusión Las EAI están asociadas con dificultades de salud mental y psicosomatización. Se confirma relación entre los distintos tipos de adversidad y la salud.

Prevalence and factors associated with adverse early childhood experiences: a population-based study in Ceará, Brazil / Prevalência e fatores associados a experiências adversas na primeira infância: um estudo de base populacional no Ceará, Brasil

ABSTRACT Objective: To estimate the prevalence of adverse childhood experiences and identify associated factors. Methods: A population-based cross-sectional study comprised data from a sample of 3,200 households with 3,566 children under 6 years of age, representative of the state of Ceará, Brazil. A multistage sampling approach was used, with stratification among the state capital, Fortaleza, and the 28 countryside municipalities, in which 160 census tracts were randomly selected, each one with a cluster of 20 households. The outcome variable was structured based on adverse childhood experiences as suggested by the Center for Disease Control and Prevention, according to the number of situations to which the child was exposed: 0-2, 3-5, and 6-9. Ordinal logistic regression multivariate model was applied to assess associations. Results: Among the 3,566 children studied, 89.7% (95%CI 88.7-90.7) were exposed to at least one adverse experience, of which the most prevalent were neglect, and emotional/physical abuse. The main factors associated were maternal advanced age and smoking, paternal absence, low education level of the head of the family, food insecurity and lack of a social support network. Conclusion: The study found a high occurrence of adverse early childhood experiences, particularly among preschool children born to mothers of older age, solo, who smoke and in a situation of social and economic vulnerability, including food insecurity, who should be target of control and prevention measures.

RESUMO Objetivo: Estimar a prevalência de experiências adversas na infância e identificar fatores associados. Métodos: O estudo transversal de base populacional compreendeu os dados de uma amostra de 3.200 domicílios com 3.566 crianças menores de seis anos, representativa do estado do Ceará, Brasil. Foi utilizado um processo de amostragem multiestágio, com estratificação entre a capital do estado, Fortaleza, e os 28 municípios do interior, nos quais foram sorteados 160 setores censitários, cada qual com um conglomerado de 20 domicílios. A variável desfecho foi estruturada com base nas situações de experiências adversas na infância sugeridas pelo grupo Centers for Disease Control and Prevention, de acordo com o número de situações a que a criança foi exposta: 0-2, 3-5 e 6-9. O modelo multivariado de regressão logística ordinal foi utilizado para avaliar as associações. Resultados: Das 3.566 crianças estudadas, 89,7% (intervalo de confiança — IC95% 88,7-90,7) foram expostas a pelo menos uma experiência adversa, sendo as mais prevalentes negligência e abuso emocional/físico. Os principais fatores associados às experiências adversas na infância foram a idade materna mais elevada e o tabagismo materno, a ausência paterna, a baixa escolaridade do chefe da família, a insegurança alimentar e a falta de rede de apoio social. Conclusão: O estudo encontrou alta ocorrência de experiências adversas na primeira infância, principalmente entre crianças nascidas de mães de idade mais elevada e tabagistas, sem a presença paterna, e em situação de vulnerabilidade social e econômica, como a insegurança alimentar, que deve ser alvo prioritário de medidas de prevenção e controle.

Experiências adversas na infância, características sociodemográficas e sintomas de depressão em adolescentes de um município do Rio de Janeiro, Brasil / Adverse childhood experiences, sociodemographic characteristics, and depressive symptoms in adolescents in a municipality in Rio de Janeiro, Brazil / Experiencias adversas en la infancia, características sociodemográficas y síntomas de depresión entre adolescentes de un municipio de Río de Janeiro, Brasil

O objetivo foi identificar os padrões das experiências adversas na infância entre adolescentes escolares de um município do Rio de Janeiro, Brasil, segundo características sociodemográficas (sexo, cor da pele e estrato socioeconômico) e sintomas depressivos. Caracteriza-se por um desenho transversal com amostra de 1.117 adolescentes escolares de 13 a 19 anos do Município de São Gonçalo, Rio de Janeiro. A depressão foi avaliada pelo Inventário de Depressão Infantil e foram investigadas experiências adversas na infância. A análise envolveu análises bivariadas e análise de correspondência múltipla (ACM) das experiências adversas na infância, variáveis sociodemográficas (sexo, cor de pele e estrato socioeconômico) e sintomas depressivos. Os resultados mostram a organização de oito grupos composto por: meninas e adolescentes de estrato social mais baixo e experiências adversas na infância relacionadas ao ambiente; meninos, ser de estrato social mais alto e não ter vivido experiências adversas na infância; adolescentes com sintomas de depressão e experiências adversas na infância dirigidas fisicamente a eles/família; adolescentes de cor de pele branca, sem sintomas de depressão e que não vivenciaram experiências adversas na infância; adolescentes de cor de pele preta/parta/amarela/indígena que vivenciaram experiências adversas na família e na comunidade; adolescentes que perderam pai e mãe por morte, e falta de comida em casa; adolescentes que vivenciaram violência psicológica; e adolescentes que vivenciaram experiências sexuais envolvendo seus pais. Os achados alertam para a necessidade de olhar com atenção e o mais cedo possível para a exposição de experiências adversas na infância de forma a cuidar, intervir e mitigar os efeitos negativos no momento atual, no curso de vida e em gerações futuras.

The study aimed to identify patterns in adverse childhood experiences among teenage schoolchildren in a municipality (county) in Rio de Janeiro State, Brazil, according to sociodemographic characteristics (sex, skin color, and socioeconomic status) and depressive symptoms. It adopted a cross-sectional design with a sample of 1,117 teenage schoolchildren 13 to 19 years of age in São Gonçalo, Rio de Janeiro State. Depression was assessed with the Childhood Depression Inventory, and adverse childhood experiences were investigated. The study used bivariate analyses and multiple correspondence analysis (MCA) of adverse childhood experiences, sociodemographic variables (sex, skin color, socioeconomic status), and depressive symptoms. The results reveal the organization of eight groups: lower-income female children and adolescents and adverse childhood experiences related to the environment; boys, with higher socioeconomic status, and not having experienced adverse childhood experiences; adolescents with depressive symptoms and adverse childhood experiences against themselves or their families; white adolescents, with depressive symptoms, and that had not experienced adverse childhood experiences; black, brown, Asian-descendant, and indigenous adolescents that had adverse experiences in the family and community; adolescents that had lost their father and/or mother from death, and lack of food at home; adolescents that had experienced psychological violence; and adolescents with a history of sexual experiences involving their parents. The findings call attention to the need for close and early attention to exposure to adverse childhood experiences to care for these youngsters, intervene, and mitigate the negative effects both at present, over the course of life, and in future generations.

El objetivo fue identificar los patrones de experiencias adversas en la infancia entre adolescentes escolares de un municipio de Río de Janeiro, Brasil, según las características sociodemográficas (género, color de piel y estrato socioeconómico) y los síntomas depresivos. Se trató de un estudio transversal, realizado con 1.117 adolescentes escolares de entre 13 y 19 años de la ciudad de São Gonçalo, Río de Janeiro. La depresión se evaluó con el Inventario de Depresión Infantil, y se investigaron las experiências adversas na infância. Se realizó un análisis bivariante y un análisis de correspondencias múltiples (ACM) de las experiências adversas na infância, las variables sociodemográficas (género, color de la piel y estrato socioeconómico) y los síntomas depresivos. Los resultados muestran la organización de 8 grupos compuestos por: niñas y adolescentes de bajo estrato social y experiências adversas na infância relacionadas con el entorno; niños de más alto estrato social y que no han experimentado experiências adversas na infância; adolescentes con síntomas de depresión y experiências adversas na infância dirigidas físicamente a ellos/familia; adolescentes de color de la piel blanco, sin síntomas de depresión y que no experimentaron experiências adversas na infância; adolescentes negros/pardos/amarillos/indígenas que han vivido experiencias adversas en la familia y la comunidad; adolescentes que han perdido a sus padres, y la falta de alimentos en el hogar; adolescentes que han sufrido violencia psicológica; y adolescentes que han vivido experiencias sexuales con sus padres. Los hallazgos alertan sobre la necesidad de observar atentamente y lo antes posible la exposición a las experiências adversas na infância para atender, intervenir y mitigar los efectos negativos en el momento actual, en el curso de la vida y en las generaciones futuras.

Impacto presente y consecuencias futuras de la pandemia en la salud de niños, niñas y adolescentes / Current impact and future consequences of the pandemic on children's and adolescents' health

Existe abundante bibliografía relacionada con el impacto de la pandemia de la enfermedad por el coronavirus 2019 (COVID-19) en la salud mental y social de niños, niñas, adolescentes y jóvenes. Un altísimo porcentaje de esta población tuvo síntomas emocionales y el nivel de ansiedad, depresión y pensamientos suicidas aumentaron considerablemente. Los adultos responsables de generar una red de soporte sufrieron el impacto con síntomas emocionales, inseguridad laboral y económica. En muchos niños, sin un entorno contenedor, aumentó la exposición a experiencias adversas, por lo que la pandemia puede considerarse como una experiencia adversa en sí misma. Se revisó el efecto a futuro de estas experiencias desfavorables en la infancia y cómo, con adecuado soporte familiar y social, podría disminuirse la sensibilidad al estrés generando mecanismos de resiliencia.La responsabilidad como ciudadanos y profesionales de la salud es reflexionar, discutir y desarrollar estrategias para mitigar estos daños que pueden tener graves consecuencias en la salud mental y física durante la niñez y la adultez.

There is plenty bibliography about the impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental and social health of children, adolescents, and youth. A very high percentage of this population developed emotional symptoms and their levels of anxiety, depression, and suicidal ideatio increased considerably. The adults who were responsible for generating a support network were impacted and suffered emotional symptoms and job and economic uncertainty. In many children, without a supportive context, exposure to adverse experiences increased, so the pandemic may be considered an adverse experience itself. The future effect of such unfavorable experience on childhood and how family and social support may help to reduce stress through the development of resilience were reviewed. As citizens and health care providers, our responsibility is to reflect, discuss, and develop strategies to mitigate such damage that may have severe consequences on the mental and physical health of children and adults.

Adverse childhood experiences and delinquent behaviour: Predictors and mediating variables

ABSTRACT Background: Adverse childhood experiences (ACEs) have been identified as a risk factor for the development of mental health and behavioural outcomes throughout life, including delinquent behaviours. This article focuses on the relationship between ACEs and delinquent behaviour (DB), seeking to identify predictors and mediating variables. Methods: The quantitative study comprised 175 Portuguese adolescents, aged 12 and 17 years of age (M = 14.99, SD = 2.26). Results: ACEs and exposure to traumatic events (ETE) are predictive of DB. Antisocial traits (AT) was found to be mediating the relationship between ACEs and DB, as well as the relation between ETE and DB. Conclusion: The results indicate that it is necessary that professionals in health behaviour field prevent and intervene in ACEs and in ETE, both predictors of DB. The results of this study allow to understand the role of ACEs in DB and its mediating variables, which must be considered to mitigate the harmful impact of ACEs in DB.

Experiencias adversas en la infancia. Conocimiento y uso por médicos residentes de pediatría / Adverse childhood experiences. Knowledge and use by pediatrics residents

Resumen 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.

Abstract 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.

Classes of childhood adversities and their associations to the mental health of college undergraduates: a nationwide cross-sectional study

BACKGROUND@#Childhood adversities pose deleterious consequences on health and well-being, but limited studies explore whether unique patterns of adverse childhood experiences (ACEs) impact the mental health of emerging adults and the mediating role of current stressful events (CSEs). This study examined classes of ACEs and how they relate to CSEs, psychological distress, and subjective well-being among Eritrean College undergraduates.@*METHODS@#Cross-sectional data on ACEs, CSEs, symptoms of psychological distress, and subjective well-being were collected from a national sample of college students (N = 507). We identified ACE patterns using latent class analysis and further examined whether CSEs mediated the effects of ACE classes on psychological distress and subjective well-being.@*RESULTS@#86.4% of the sample experienced at least one ACE. Collective violence, domestic violence, and physical abuse were the most common ACEs. Three subgroups, low ACEs (66.3%), household violence (19.1%), and multiple ACEs (14.6%) were identified. We found that relative to low ACEs, household violence (β = 0.142, 95% CI 0.046, 0.248) and multiple ACEs (β = 0.501, 95% CI 0.357, 0.666) indirectly influenced psychological distress through CSEs, and CSEs mediated the relationships between household violence (β = -0.096, 95% CI -0.176, -0.033), multiple ACEs (β = -0.338, 95% CI -0.498, -0.210), and subjective well-being. However, there were nonsignificant relative direct effects of ACE patterns on both psychological distress and subjective well-being.@*CONCLUSIONS@#Experiencing multiple ACEs and household violence in conjunction with CSEs significantly predict psychological distress and subjective well-being. Contextual interventions for the early identification of ACEs and the management of CSEs may play a crucial role in the prevention of mental health problems.

Effect of adverse childhood experiences and DNA methylation on male sexual orientation / 中南大学学报(医学版)

The causes for male sexual orientation are complicated, which have not yet been clarified. Recent years have witnessed fruitful progress in the field of biology, while the impact of environment has received little attention. Adverse childhood experiences (ACEs), identified as a special environment in the early stage of development, can affect the individual phenotype by DNA methylation. Given the relationships among male sexual orientation, ACEs, and DNA methylation, as well as based on the existing theory, this article proposes the model "ACEs-DNA methylation-male sexual orientation"from the perspective of environment and epigenetics, aiming to provide a theoretical basis for future research.

Cross-cultural Adaptation of the Adverse Childhood Experiences International Questionnaire / Adaptação transcultural do Adverse Childhood Experiences International Questionnaire

ABSTRACT OBJECTIVE: To translate, adapt and validate the contents of the Adverse Childhood Experiences International Questionnaire to a Portuguese version, to be used in Brazil, named Questionário Internacional de Experiências Adversas na Infância. METHODS: This is a methodological study of cross-cultural adaptation of evaluation instruments presenting the results of semantic equivalence between the original instrument and the adapted version. The semantic equivalence of the instrument involved the following steps: 1) two translations and a synthesis of the translations; 2) two retranslations; 3) validation of contents by eight health workers; 4) synthesis of the retranslations; 5) pre-tests to assess acceptability, understanding and emotional impact of the questions; and, finally, 6) writing of the final version of the instrument. RESULTS: the adapted version proved to be easy to apply and to understand and achieved good semantic equivalence when compared to the original version. The psychometric properties of the instrument still need to be evaluated. Limitations and recommendations for improving the instrument and its use are presented. CONCLUSION: The process of cross-cultural adaptation of the Adverse Childhood Experiences International Questionnaire resulted in an adapted version to Brazilian Portuguese.

RESUMO OBJETIVO: Traduzir, adaptar e validar o conteúdo do Adverse Childhood Experiences International Questionnaire para uma versão em português, vigente no Brasil, nomeada como Questionário Internacional de Experiências Adversas na Infância. MÉTODOS: Trata-se de um estudo metodológico de adaptação transcultural de instrumentos de avaliação, em que são apresentados os resultados da equivalência semântica entre o instrumento original e a versão adaptada. A equivalência semântica do instrumento envolveu as seguintes etapas: 1) duas traduções e uma síntese das traduções; 2) duas retraduções; 3) validação de conteúdo realizado por oito profissionais da área da saúde; 4) síntese das retraduções; 5) pré-testes para avaliar a aceitabilidade, a compreensão e o impacto emocional das questões; e, por fim, 6) a elaboração da versão final do instrumento. RESULTADOS: A versão adaptada demonstrou ser de fácil aplicação e compreensão e obteve boa equivalência semântica quando comparada à original. As propriedades psicométricas do instrumento devem, ainda, ser avaliadas. Limitações e recomendações para a melhoria do instrumento e para a sua utilização são apresentadas. CONCLUSÃO: O processo de adaptação transcultural do Adverse Childhood Experiences International Questionnaire proporcionou uma versão adaptada para o português vigente no Brasil.