Effectiveness of online group cognitive behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study

Objective: To evaluate the effectiveness of online group cognitive behavioral therapy (CBT) based on the CAMALEO TOC manual in the treatment of adolescents with obsessive-compulsive disorder (OCD). Methods: This is a quasi-experimental study with a single-group pretest-posttest intervention. Over a 12-week period, 11 adolescents aged 11 to 17 years with OCD participated in weekly online group CBT sessions based on the CAMALEO TOC manual. We used several assessment tools, including the Children's Yale-Brown Obsessive-Compulsive Scale to assess the severity of OCD symptoms, the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer-Rated to measure family accommodation, the Children's Depression Inventory to assess depression symptoms, the Revised Children's Manifest Anxiety Scale to assess anxiety, and the Multidimensional Students' Life Satisfaction Scale to measure satisfaction with life. Results: OCD symptoms decreased significantly (d = -1.55) after online group CBT, and a strong effect size (d = -1.03) was found for family accommodation. After controlling for variables (e.g., engagement in psychotherapeutic treatment, medication use, or psychiatric comorbidities), no significant differences were found for OCD symptoms and family accommodation scores. In addition, there was insufficient evidence to support the effectiveness of online group CBT in reducing symptoms of depression or anxiety or improving overall quality of life. Conclusion: Our study demonstrates the feasibility of short-term online group CBT as an effective therapeutic approach for adolescents with OCD.

The Influence of Social Class on Family Participation in Children's Education: A Case Study / La Influencia de la Clase Social Sobre la Participación Familiar en la Educación de los Niños: Un Estudio de Caso

Abstract Parental involvement in children's education is commonly accepted as beneficial. However, family social class plays a crucial role in the efficacy of homework help. In a comparative case study, a low-income immigrant family from Mexico and a middle-income family in Los Angeles were observed helping their children with math homework and were asked questions about goals, tutoring strategies, and beliefs about learning. Qualitative analysis focused on two effective teaching methods: scaffolding and productive struggle. The low-income mother with little formal education provided direct help rather than a scaffold, and disapproved of hard problems. However, an older sibling with more education than her mother used scaffolding and believed that difficult problems aid learning. In these respects, she resembled the college-educated middle-income mother. The sister exemplifies how older siblings in immigrant families provide bridges to educational achievement for younger siblings. We suggest effective ways for schools to involve parents who lacked educational opportunity themselves to participate in the education of their children.

Resumen La participación de los padres en la educación de sus niños es establecida como beneficiosa. Sin embargo, la clase social de la familia tiene una fuerte influencia sobre la eficacia de su ayuda con las tareas. En un estudio de caso comparativo, una familia inmigrante de México, de bajos ingresos, y una familia de Los Ángeles, de medianos ingresos, fueron observadas ayudando a sus niñas con deberes en matemáticas. Además, el investigador hizo preguntas sobre metas, estrategias de enseñanza y creencias sobre el aprendizaje. El análisis cualitativo se centró en dos métodos efectivos de enseñanza: proporcionar el aprendizaje de manera de andamio y estimular la lucha productiva. La madre de ingresos bajos proporcionó apoyo directo a su hija en lugar de proporcionar un andamio, y ella desaprobó los problemas difíciles; sin embargo, una hermana mayor con más educación que la madre proporcionó un andamio y creyó que los problemas difíciles ayudan al aprendizaje. En estos aspectos, la hermana mayor era similar a la madre de ingresos medios con educación universitaria. La hermana demuestra cómo hermanos mayores en las familias inmigrantes proporcionan puentes al éxito educativo para los hermanos menores. Sugerimos modos efectivos para que las escuelas puedan alentar a los padres con falta de oportunidades educativas a participar en la educación de sus hijos.

Envolvimentos no trabalho e na família: estudo de caso com mães trabalhadoras na função pública / Work and family involvements: case study with working mothers in the civil service

Neste estudo, abordamos os desafios da conciliação trabalho-família em três mulheres com diferentes jornadas de trabalho (parcial, integral e extensa) na função pública. Para isso, utilizou-se um guia para a avaliação das mudanças, dificuldades, estratégias e ajustes realizados desde o nascimento das crianças. Foram conduzidas entrevistas semiestruturadas, utilizando-se análise de conteúdo para interpretação dos dados. As participantes eram casadas, na faixa etária dos 30 anos, com filhos em idade pré-escolar e residiam no interior paulista. As jornadas variavam entre 25 a 55 horas por semana. A partir da análise das entrevistas, foram construídas seis categorias: qualidade de vida, casamento e filhos, trabalho, ajustes e estratégias, suportes sociais e jornada de trabalho. A gestão do tempo na conciliação trabalho-família pode ser estressante e cansativa, especialmente para aquelas que são recém-mães. No entanto, novas adaptações e os apoios familiar e organizacional contribuem para que o desempenho dos papéis profissionais e familiares seja satisfatório.

In this study, we address the challenges of work-family reconciliation in three women with different working hours (partial, full and extensive) in the civil service. For this, we used a guide for the assessment of changes, difficulties, strategies and adjustments made since the birth of children. Semi-structured interviews were conducted using content analysis for data interpretation. The participants were married, aged 30 years, with preschool children and resided in São Paulo. Journeys ranged from 25 to 55 hours per week. From the analysis of the interviews, six categories were built: quality of life, marriage and children, work, adjustments and strategies, social support and working hours. Time management in work-family reconciliation can be stressful and tiring, especially for new mothers. However, new adaptations and family and organizational support contribute to the satisfactory performance of professional and family roles.

Participación familiar en la prevención de complicaciones en pacientes con diabetes tipo 2: cuidados intensivos hospital general milagro, 2019 / Family participation in the prevention of complications in patients with type 2 diabetes: intensive care hospital general milagro, 2019

La diabetes tipo 2 es una enfermedad relevante debido al aumento de su prevalencia en mayores de 50 años. Objetivo: Determinar la participación familiar en la prevención de complicaciones de pacientes con diabetes tipo 2 que ingresan en la Unidad de Cuidados Intensivos - Hospital General IESS Mila-gro, enero a junio del 2019. Metodología: tuvo un enfoque cuantitativo, descriptivo-deductivo, no experimental de corte transversal. Se diseñó un formulario con 13 preguntas que responde a los objetivos del estudio. Del universo de 210 pacientes ingresados se tomó una muestra conformada por 68 pacientes con sus respectivos familiares, seleccionada mediante muestreo no probabilístico, de los cuales el 64.7% pertenecen a género masculino, siendo las edades más afectadas los de 61 a 80 años, que viven en la zona rural (33.82%). Resultados: demostraron que el desconocimiento de los familiares sobre la enfermedad y sus complicaciones es uno de los factores más relevantes, con el 85.29%; el tiempo de evolución de la enfermedad es de seis a ocho años (52.94%); la participación en la administración de medicamentos es mayoritariamente proporcionada por su cónyuge (38,24%); la situación laboral es la limitante principal en el cuidado del paciente (55.88%), siendo el nivel de de-pendencia moderada-severa el principal problema (44.12%); el incumplimiento de las indicaciones médicas representada por el 54.41%, presentando la hiperglicemia (44.12%), y la nefropatía (65.45%), la hipertensión (43.75%) como las complicaciones más relevantes; el índice de mortalidad es de 27.94%. Conclusión: Se encontró que la participación familiar in-fluye de manera significativa en el cuida-do de estos pacientes, ya que permiten prevenir las complicaciones por diabetes tipo 2, como parte de las estrategias de salud pública para enfrentar las enfermedades crónicas no transmisibles(AU)

Type 2 diabetes is a relevant disease due to the increase in its pre-valence in people over 50 years of age. Objective: To determine the family partici-pation in the prevention of complications in patients with type 2 diabetes admitted to the Intensive Care Unit - General Hos-pital IESS Milagro, January to June 2019. Methodology: it had a quantitative, des-criptive-deductive, non-experimental cross-sectional approach. A form with 13 questions in order to answers the objec-tives of the study, was designed. From the universe of 210 admitted patients, a sample was made up of 68 patients with their respective relatives, selected by means of non-probability sampling, of which 64.7% belong to the male gender, the most affected ages being those be-tween 61 and 80 years of age, who live in the rural area (33.82%). Results: they showed that the ignorance of the relatives about the disease and its complications is one of the most relevant factors, with 85.29%. The evolution time of the disease is six to eight years (52.94%). Your spou-se (38.24%), mostly provides participa-tion in the administration of medications. The labor situation is the main limitation in patient care (55.88%), with the level of moderate-severe dependency being the main problem (44.12%); non-complian-ce with medical indications represented by 54.41%, presenting hyperglycemia (44.12%), and kidney disease (65.45%), hypertension (43.75%) as the most rele-vant complications; the mortality rate is 27.94%. Conclusion: It was found that family participation significantly influences the care of these patients, since they allow preventing complications from type 2 diabetes, as part of public health strate-gies to deal with chronic non-communicable diseases(AU)

Desarrollo de lenguaje en niños con implante coclear en centro terciario de salud: serie clínica / Language development in children with cochlear implant at a tertiary health care center: clinical series

Resumen Introducción: Desde la década de los 90, los implantes cocleares han progresado desde aplicaciones experimentales a un uso clínico estandarizado en niños con pérdida auditiva severa y profunda. Las investigaciones han producido cambios en la tecnología de los implantes y ha dado lugar a la expansión de los candidatos a implante para incluir a los niños menores de 2 años de edad. El objetivo principal de la implantación coclear pediátrica es facilitar el desarrollo del lenguaje hablado. A pesar de los avances en la tecnología de implantes y los cambios en el manejo de la pérdida auditiva, los resultados de lenguaje en niños son todavía muy variables, participando de este proceso tanto el tratamiento oportuno, la red familiar y nivel socioeconómico entre algunos de ellos. Objetivo: Describir resultados de niños menores 6 años sometidos a cirugía de implante coclear en un centro terciario de salud. Material y método: Estudio longitudinal de cohorte retrospectivo, análisis a 99 pacientes implantados en centro terciario de salud desde inicio programa en 1994 a 2015. Resultados: 99 pacientes, 57% hombres 43% mujeres, edad promedio implantación 16,3 meses. 54,8% casos origen congénito no especificado o prematurez. En 74,4% se objetivó presencia de lenguaje auditivo verbal. El nivel socioeconómico (NSE) mostró asociación con no desarrollo de lenguaje (p =0,009) evidenciando que pacientes de bajo NSE 20% no desarrolla lenguaje. La variable discapacidad asociada (p <0,001) y la variable NSE (p =0,036) se asociaron de manera independiente a lenguaje de señas o no desarrollo de lenguaje oral. Conclusión: Los implantes cocleares ofrecen una opción en la rehabilitación auditiva en hipoacusia sensorio neural profunda, para candidatos de todo el espectro de edad, sin embargo los resultados dependen en gran medida del entorno en el que se utilizan los implantes cocleares.

ABSTRACT Introduction: Since the 90s, cochlear implantation has progressed from experimental to standard clinical practice for children with severe and profound hearing loss. Research has produced changes in implant technology and has led to the expansion of implant candidacy to include children younger than 2 years of age. The primary goal of pediatric cochlear implantation is to facilitate spoken language development. Despite the advances in implant technology and the changes to the management of hearing loss, language outcomes for children are still highly variable, participating in this process both timely treatment, the family network and socio economic level among others. Aim: describe outcomes of patients younger than 6 years undergoing cochlear implant surgery in a tertiary care center. Material and method: retrospective longitudinal cohort study, 99 patients implanted in a tertiary health center since the program's inception in 1994 to 2015 was analyzed. Results: 99 patients, 57 % men 43 % women, average age of implantation 16.3 months. 54.8 % of cases were congenital or prematurity. In 74.4 % they had auditory verbal language. Socioeconomic status (SES) showed association with the lack of language development (p =0.009) demonstrating that low SES patients (20%) do not develop language. The disability associated variable (p <0.001) and the SES variable (p =0.036) were independently associated with sign language or no oral language development. Conclusions: Cochlear implants offer an option for hearing rehabilitation in profound hearing loss, for candidates of all ages, however the results depend largely on the environment in which cochlear implants are used.

Patient's Cognitive Function and Attitudes towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. MATERIALS AND METHODS: A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea andwere asked to express their preferences forfamily involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment). RESULTS: Both patients and family caregivers preferred greater family dominance in treatment decision makingwith the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted κ=0.32, κ=0.26, and κ=0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment. CONCLUSION: Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.

Aspects cliniques de la maladie de Stargardt: cas d'une atteinte familiale / NA

La maladie de Stargardt est la plus connue des dystrophies maculaires juvéniles. Encore appelé fundus flavimaculatus, elle est une dystrophie maculaire héréditaire qui se transmet souvent sur un mode autosomique récessif et rarement sur un mode autosomique dominant. Elle est typiquement caractérisée par une déficience de la vision centrale, qui se manifeste autour de la première et ou de la deuxième décennie de la vie. Nous présentons les cas de deux frères et une soeur atteints de la maladie. La présentation, le diagnostic et les modalités thérapeutiques sont discutés.

Stargardt's disease is the best known of juvenile macular dystrophies. Also called fundus flavimaculatus, it is an inherited macular dystrophy that is often transmitted in an autosomal recessive fashion and rarely in an autosomal dominant mode. It is typically characterized by a deficiency of central vision, which manifests itself around the first and / or second decade of life. We present the cases of two brothers and one sister with the disease. Presentation, diagnosis and therapeutic modalities are discussed.

Involving Family Members in Diabetes Treatment / 임상당뇨병

The family plays a very important role in diabetes treatment and self-management for diabetic patients. To facilitate more effective diabetes self-management, diabetes educators should involve family members in the treatment process. Diabetes educators need to teach families about the disease and how to manage diabetes, as well as listen to and identify diabetes-related emotional issues and address inappropriate emotions or irrational beliefs. Diabetes educators should lead families to have realistic expectations and behavioral goals, and provide effective support without pushing or controlling patients.

O momento da avaliação na intervenção precoce: o envolvimento da família estudo das qualidades psicométricas do ASQ-2 dos 30 aos 60 meses / The moment of assessment in early intervention: study of parental involvement of psychometric properties of ASQ-2 from 30 to 60 months

A relação entre pais e profissionais de saúde e de educação é fundamental para o desenvolvimento da criança. Esta se torna ainda mais essencial em crianças que apresentam risco de desenvolvimento. Essa mesma relação é valorizada numa abordagem centrada na família tendo implicações significativas nas práticas nos diferentes contextos e na sua aplicabilidade, exigindo que os profissionais assumam novos papéis e que aprendam novas competências no trabalho com as famílias. Estas competências concretizam-se nos primeiros contactos com a família desde o momento da avaliação até à efetiva prestação de serviços. A realização deste estudo surgiu da necessidade constatada de envolver os pais desde o primeiro momento do processo em intervenção precoce através de um instrumento formal e de simples aplicação. O ASQ-2 é constituído por 19 questionários divididos por diferentes idades entre os quatro e os 60 meses. Cada questionário é composto por 30 itens divididos pelas áreas de desenvolvimento comunicação, motricidade global, motricidade fina, resolução de problemas e pessoal-social. Este trabalho constitui a análise dos questionários dos 30 aos 60 meses para observar as qualidades psicométricas do ASQ, tendo sido aplicados a uma amostra de conveniência de 127 famílias do distrito de Braga. Foi possível verificar que o ASQ-2 traduzido apresenta resultados atraentes o que significa que poderá vir a ser utilizado pela população portuguesa de pais e profissionais (de saúde e de educação) que pretendam concretizar as suas dúvidas através de um instrumento formal de rastreio e de monitorização do desenvolvimento da criança.

The relationship between parents and health and education professionals is fundamental to the development of the child. This becomes even more important in children who are at risk. This relationship is valued in a family-centered approach and there are significant implications for practice in different contexts, requiring professionals to take on new roles and learn new skills in working with families. These skills come to the foreground during the first contacts with the family beginning at the time of assessment through to the effective provision of services. This study arose due to the perception that parents needed to be involved from the very beginning of the process in Early Intervention, by means of a formal instrument and simple application. The ASQ-2 is composed of 19 different questionnaires organized according to age intervals from 4 to 60 months. Each questionnaire comprises 30 items grouped according to the developmental areas of communication, gross motor, fine motor, problem solving and personal-social. This study presents the analysis of questionnaires from 30 to 60 months to observe the psychometric properties of the ASQ applied to a convenience sample of 127 households in the district of Braga. We concluded that the ASQ-2 presents attractive results suggesting that it could be used by the Portuguese population of parents and professionals (health and education) who wish to answer some questions using a formal screening and monitoring of child development instrument.