Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

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.

Responsabilidade filial: quais as atitudes dos filhos sobre a institucionalização dos pais idosos? / Responsabilidad filial: ¿cuáles son las actitudes de los hijos sobre la institucionalización de los padres mayores? / Filial responsibility: what are the attitudes of adult child caregivers on the institutionalization of aged parents?

Resumo OBJETIVO Analisar as atitudes de responsabilidade filial sobre a institucionalização dos pais idosos. MÉTODOS Estudo qualitativo com amostra intencional de 100 filhos cuidadores de idosos de duas Unidades de Saúde de Porto Alegre/RS. As informações foram coletadas em 2014, por meio de entrevista semiestruturada. A análise baseou-se na análise temática. Foi utilizado o software NVIVO® versão 10. RESULTADOS Elaboraram-se duas categorias de acordo com as questões do protocolo: possibilidade de institucionalização dos pais idosos e expectativa de cuidado. CONSIDERAÇÕES FINAIS A maioria dos filhos cuidadores não considerou a institucionalização dos pais idosos, por julgarem ser um dever deles o cuidado aos pais, e considerarem a institucionalização como abandono. A maioria dos filhos cuidadores possuía expectativa de ser cuidada pelos filhos e percebeu a institucionalização como forma de receber este cuidado. Os resultados do estudo contribuem para o fortalecimento da rede formal e informal ao idoso e seu filho cuidador.

Resumen OBJETIVO Analizar las actitudes de responsabilidad filial sobre la institucionalización de los padres mayores. MÉTODOS Estudio cualitativo con muestra intencional de 100 hijos cuidadores de personas mayores de dos Unidades de Salud de Porto Alegre/RS. Las informaciones se recolectaron en 2014, por medio de entrevista semiestructurada. El análisis se basó en el análisis temático. Se utilizó el software NVIVO®, versión 10. RESULTADOS Se elaboraron dos categorías, según las cuestiones del protocolo: posibilidad de institucionalización de los padres mayores y expectativa del cuidado. CONSIDERACIONES FINALES La mayoría de los hijos cuidadores no consideró la institucionalización de los padres ancianos, por juzgar ser un deber de ellos el cuidado de los padres, y por considerar la institucionalización como abandono. La mayoría de los hijos cuidadores tenía la expectativa de ser cuidada por los hijos y pasó a ver a la institucionalización como una forma de recibir este cuidado. Los resultados del estudio contribuyen al fortalecimiento de la red formal e informal al anciano y su hijo cuidador.

Abstract OBJECTIVE To analyze attitudes of filial responsibility about the institutionalization of aged parents. METHODS A qualitative descriptive study with intentional sample of 100 caregivers of aged people from two Primary Health Care Units of Porto Alegre/Brazil. The information was collected in 2014, through a semi-structured interview. Thematic analysis was carried out. The NVIVO® software version 10 was used. RESULTS Two categories were elaborated according to the protocol questions: the possibility of institutionalization of the aged parents and expectation of care. FINAL CONSIDERATIONS Most adult child caregivers did not consider the institutionalization of aged parents in the reason of a duty they felt to take care of their parents, and the institutionalization was considered as abandonment. Most of the adult child caregivers had an expectation to be cared by their children and perceived the institutionalization as an alternative of receiving this care. The results of the study contribute to the strengthening of the formal and informal network for the aged and their adult child caregiver.

Skinfold thickness in normoglycemic offspring of patients with t2dm on graded exercise

It is uncertain if exercise can influence the occurrence of T2DM in offspring of diabetic parents. Therefore this study was designed to assess the effect of exercise on skinfold thickness of offspring of T2DM parents compared with those of non-diabetic parents. This study involved convenience sampling of 50 offspring of T2DM parents attending University College Hospital, Ibadan and 50 offspring of nondiabetic parents who were undergraduate students of the University of Ibadan, Nigeria. Participants were randomly assigned into four groups using convenience sampling method: 25 Normal-weight Offspring of Non-Diabetic Parents (NONDP), 25 Normal-weight Offspring of Diabetic Parents (NODP), 25 Overweight Offspring of Non-Diabetic Parents (OONDP) and 25 Overweight Offspring of Diabetic Parents (OODP). Each participant followed a protocol of graded exercise using the "Tummy trimmer" everyday spending 30-45 minutes daily for 24 weeks. 4 sites of skinfold thickness (supra-iliac, Biceps, Triceps and sub-scapula) were measured by skinfold caliper. Weight and Body Mass Index (BMI) were estimated using standard methods at baseline, 6 weeks, 12 weeks, 18 weeks and 24 weeks, respectively. Data were analyzed using descriptive statistic and repeated ANOVA with p-value at n less than 0.05. The results indicate that compared to baseline, there were reductions at the four sites of skinfold thickness measurements (supra-iliac, Biceps, Triceps and sub-scapular). At supra-iliac site, skinfold thickness in NONDPreductions was from 7.16 mm ± 2.02 to 6.60 mm ± 4.40. The reduction trend for supra-iliac, Biceps, triceps and subscapular skinfold sites in NONDP were 0.56 mm, 0.79 mm, 1.66 mm and 0.19 mm respectively. While the reduction trend for supra-iliac, Biceps, triceps and subscapular skinfold sites in OODP were 0.56 mm, 1.10 mm, 2.06 mm and 1.52 mm respectively. At subscapular site, the average skinfold thickness reduction trend was 0.19 mm in control group 1.53 mm in test group. Thus, graded exercise reduced skinfold thickness in all the groups. The clinical importance of this in prevention of DM among offspring of diabetic parents is quite promising

Obsessive-compulsive symptoms in children with first degree relatives diagnosed with obsessive-compulsive disorder

Objective: A first-degree relative affected by obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) in childhood is an important risk factor for developing the disorder in adulthood. The relationship between a family history of OCD and the presence of OCS and its correlates in childhood is not well established. Methods: A total of 66 children whose parents or siblings have been diagnosed with OCD were assessed for the presence of OCS and clinical correlates. Results: Three children (4.5%) were reported to have received an OCD diagnosis and another 26 (39.4%) were identified as having OCS. Children with OCS had higher rates of coercive behavior and came from families with lower socioeconomic status. Contamination/cleaning dimension symptoms in the proband were associated with OCS in the assessed children. Conclusion: OCS are frequent among family members of individuals with OCD and are associated with socioeconomic status, coercive behaviors and proband contamination/cleaning symptoms. Future longitudinal studies should test the risk of developing OCD in association with these characteristics.

Associação da posição socioeconômica e da depressão materna com a saúde das crianças: avaliação da PNAD 2008, Brasil / Associating socioeconomic position and maternal depression with the health of children: an evaluation of the 2008 Brazilian household survey

Resumo O estudo analisou a associação entre posição socioeconômica (renda), depressão materna e saúde da criança no Brasil, utilizando informações da Pesquisa Nacional por Amostra de Domicílios 2008 (PNAD/IBGE). A análise considerou o delineamento amostral da pesquisa e incluiu 46.874 indivíduos com idade até 9 anos. Modelos Poisson foram estimados para três desfechos de saúde da criança: saúde reportada pelos pais ou responsáveis, restrição das atividades habituais por motivo de saúde e episódios de acamamento nas duas semanas anteriores à entrevista. Os resultados apontaram associação entre a depressão da mãe e os três desfechos, mesmo após o ajuste para posição socioeconômica, características maternas (saúde autorreferida, idade, escolaridade e tabagismo), idade, sexo e cor da pele da criança, além de região geográfica, situação censitária e número de moradores do domicílio. Constatou-se ainda que a associação entre depressão materna e saúde da criança independe da posição socioeconômica. Assim, políticas de saúde pública que objetivem atenuar os efeitos adversos da depressão materna sobre a saúde da criança, precisam considerar também os estratos mais elevados de renda da sociedade.

Abstract The study analyzed the association between socioeconomic position (income), maternal depression and the health of children in Brazil, using information from the 2008 National Household Survey (PNAD/IBGE). The analysis considered the sampling design for the research and included 46,874 individuals up to the age of nine. The Poisson models were estimated for three health outcomes for children: health as reported by the parents or the responsible person, restrictions on habitual activities for health reasons and periods when they were confined to bed two weeks before the interviews in the study. The results showed an association between the mothers' depression and the three health outcomes, even after taking into account the following: socioeconomic position, maternal characteristics (health self-referral, age, level of education and smoking), age, gender, the child's race, geographical region, the situation as noted in the census and the number of residents in a household. It was found that there still exists an association between maternal depression and children's health irrespective of socioeconomic position. Therefore public policies that aim to reduce the adverse effects of maternal depression on the health of children need to also take into account the higher income segments of society.

Correlations between caregiver psychiatric symptoms and offspring psychopathology in a low-resource setting

Objective: Associations between parental/caregiver depression and adverse child outcomes are well established and have been described through one or more mechanisms: child psychopathology following exposure to a depressed caregiver, child psychopathology exacerbating a caregiver's depression, and caregiver and offspring depression sharing the same etiology. Data from low and middle-income countries is scarce. We examined correlations between common symptoms of mental disorders in caregivers and their offspring's psychopathology in a Brazilian sample. Methods: In this cross-sectional study, adult caregivers were screened for depression during routine home visits by community health workers as part of the Brazilian Family Health Strategy. Caregivers with suspected depression were assessed using the Zung Self-Rating Depression Scale and the Self-Reporting Questionnaire (SRQ-20). Children's symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Results: The sample included 68 primary caregivers and 110 children aged 6 to 15 years. Higher caregiver scores on the SRQ-20 correlated significantly with psychiatric symptoms in offspring. Conclusion: These results substantiate our hypothesis that child psychopathology correlates with caregivers' psychiatric symptoms. This paper adds to the growing literature on community mental health assessment and can help guide future strategies for reducing the burden of common mental disorders in caregivers and children alike in low and middle-income countries.

'We were our parents' ears and mouths': reflecting on the language brokering experiences of hearing children born to deaf parents

Background. Hearing children born to deaf parents, or children of deaf adults (CODAs), are often bicultural and bilingual members of the deaf and hearing communities. They are often expected to fulfil very adult roles, especially as the communication link between their deaf parents and the hearing society. Assuming adult roles may place CODAs in difficult situations, potentially affecting their wellbeing and development. In SA, little is known about CODAs and the dynamics of growing up hearing in deaf-parented homes. Objective. To reflect on the childhood experiences of language brokering in deaf-parented families. Methods. Two male and eight female participants (21 - 40 years), identified through purposive and snowball sampling, participated in this study. A phenomenological, qualitative approach was employed using semi-structured, open-ended interviews. Thematic analysis revealed inductive themes. Results. The findings indicate that the interviewed CODAs acted as language brokers and interpreters between their families and the hearing community from a very young age. As children, they were placed in demanding situations, for which they were not developmentally ready. CODAs found balancing the demands from both communities emotionally draining, especially at a young age. Conclusion. A multidisciplinary approach is suggested to address the mental health, wellbeing and development of young CODAs

The views and knowledge of parents of children with autism spectrum disorder on a range of treatments

Background. Autism spectrum disorder (ASD) is a neurodevelopmental disorder that appears before the age of 3 years. Symptoms reflect delayed or abnormal social interaction and communication skills, with restricted or repetitive behaviour warranting the need for early intensive treatment.Methods. The aim of the study was to investigate the knowledge and views of parents regarding treatments for their children, aged between 5 and 9 years old with ASD, in eThekwini Metropolitan Municipality, South Africa. An embedded mixed methods research design was utilised. Nonrandom purposive sampling was used to select 46 parents of children with ASD. A 42-item questionnaire was used and the data were interpreted using descriptive statistics and thematic analysis.Results. More than half of the parents (53%) were unfamiliar with or had only heard of treatments in question, while 13.4% had a practical understanding of the treatments. Of all the treatments, parents rated their knowledge of speech-language therapy (SLT) most highly. The majority (68%) stated that they had difficulties accessing ASD treatment facilities and healthcare professionals, and perceived treatments as being costly. Even so, 74% of parents reported that they had a good relationship with their healthcare professional.Conclusion. The above findings should be viewed as motivation for health professionals to share information regarding the range of ASD treatments. They can assist parents in accessing appropriate facilities, recommend treatments that are supported by research, and update their knowledge on advances in ASD treatment

Experiencias de haber crecido con un padre/madre con trastorno mental severo (TMS) / Experiences of growing up with a parent with serious mental illness (SMI)

Introduction: The experience of living with people who present a Severe Mental Disorder (SMD) is hard for the families, especially for children who have been less studied. This research was aimed to know how the experience of having lived with a parent with severe mental disorder influenced on childhood, adolescence and young adulthood of their children. Method: The experience of coexistence with a parent with SMD in 10 children (6 men and 4 women) aged between 18 and 29 years was analyzed through individual semi-structured interviews and a group interview. The sample was obtained by convenience and all participants lived at least two continuous years during their childhood with a parent who presented SMD. Regarding the diagnoses, four parents suffered schizophrenia and six, bipolar disorder. The study is qualitative, exploratory and of descriptive type. An analysis of content and thematic of the corpuses was performed. Results: Show that by coexisting with a parent with SMD have negative as well as positive consequences. Among the negative consequences the following can be mentioned: distressing feelings, family burden and the delay of stages in the vital cycle. On the other hand, the positive consequences are related to the development of strengths in the offspring. Conclusions: These findings may provide inputs to be focused on the work with children of people affected by SMD.

Introducción. La experiencia de vivir con personas que presentan un Trastorno Mental Severo (TMS) es difícil para las familias, en especial para los hijos quienes han sido poco estudiados. El objetivo de la investigación fue conocer cómo la experiencia de haber vivido con un padre o madre con un trastorno mental severo influyó en la infancia, adolescencia y adultez joven de sus hijos e hijas. Método. Se analizan las experiencias de convivencia con un padre/madre con TMS en 10 hijos (6 hombres y 4 mujeres) de entre 18 y 29 años, a través de entrevistas semiestructuradas individuales y una entrevista grupal. La muestra se obtuvo por conveniencia y todos los participantes vivieron al menos dos años seguidos durante su niñez con un padre o madre que presentaba un TMS. Respecto a los diagnósticos, cuatro progenitores tenían esquizofrenia y seis trastornos bipolares. El estudio es cualitativo, exploratorio, de tipo descriptivo. Se realizó un análisis de contenido y temático de los corpus. Resultados. Muestran que convivir con padre/madre con TMS tiene consecuencias negativas y positivas, entre las primeras están: sentimientos aflictivos, carga familiar y el retraso de etapas del ciclo vital, en tanto las segundas se refieren al desarrollo de fortalezas en los descendientes. Conclusiones. Estos hallazgos pueden entregar insumos para focalizar el trabajo con los hijos e hijas de personas con TMS.

Practices related to late-onset sepsis in very low-birth weight preterm infants / Práticas relacionadas à sepse tardia em prematuros de muito baixo peso

OBJECTIVE: To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS. METHODS: This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others. RESULTS: All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside. CONCLUSION: The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy. .

OBJETIVO: Conhecer as práticas relacionadas a sepse tardia (ST) nos centros da Rede Brasileira de Pesquisas Neonatais (RBPN) e propor estratégias para redução da ST. MÉTODOS: Estudo transversal, multicêntrico da RBPN, aprovado pelo CEP. Três questionários sobre higienização das mãos, cateteres vasculares e diagnóstico/tratamento da ST foram elaborados e enviados aos coordenadores de cada centro. O centro com a menor incidência de ST foi comparado aos demais. RESULTADOS: Todos os 16 centros responderam aos questionários. Quanto à higienização das mãos: 87% usam chlorhexidine ou álcool 70%; 100% álcool gel; almotolia/leito em 80% (50% dispõem de um dispensador para cada dois leitos); Treinamento prático ocorre em 100%, teórico em 70% dos centros e 37% treinam uma vez/ano. Cateteres: 94% têm protocolo para passagem, 75% grupo de inserção. Diagnóstico/tratamento: hemograma e hemocultura são usados em 100% dos centros; PCR em 87%; 75% usam escores hematológicos; oxacilina e aminoglicosídeo são usados como terapia empírica em 50% dos centros. Características do centro com menor incidência de ST: rigorosa higienização das mãos; grupos de inserção e manutenção de cateteres; uso de hemocultura, PCR e escores hematológicos para diagnóstico da ST; tratamento empírico com oxacilina e aminoglicosídeo. CONCLUSÕES: O conhecimento das práticas de cada centro permitiu identificar aspectos a serem aprimorados como estratégia para a redução da ST incluindo: uso de álcool gel, treinamento em higienização das mãos, implantação de grupos de cateteres e uso racional de antibióticos. .

Função respiratória em filhos de mães asmáticas / Respiratory function in children of asthmatic mothers

OBJETIVO: Avaliar a função pulmonar e as manifestações clínicas sugestivas de asma em filhos de mães com diagnóstico médico referido de asma. MÉTODOS: Estudo observacional transversal analítico aninhado a uma coorte de 4.757 parturientes. Foram avaliadas 86 crianças aos seis anos de idade, filhas de mães com diagnóstico médico de asma antes da gestação. Foram coletadas informações referentes a sintomatologias clínicas de atopias e doenças respiratórias, variáveis socioeconômicas e de exposição; tendo sido as crianças submetidas à espirometria. RESULTADOS: Foram encontrados 30,3% de alterações espirométricas, havendo predomínio do diagnóstico de asma nos que apresentaram padrão obstrutivo. Diagnóstico médico pregresso de asma ocorreu em 9,3% das crianças; contudo, o diagnóstico estabelecido a partir da presença e frequência dos sintomas de asma representou 18,6%. Das 86 crianças participantes, 37,2% tiveram um escore de cinco ou mais pontos no questionário ISAAC, estando isso associado à alteração do padrão espirométrico (p = 0,002). Após a regressão logística múltipla, maior escolaridade paterna, maior número de quartos no domicílio e o fato de a mãe não ter apresentado "chiado" durante a gestação foram estatisticamente significantes como fatores protetores para a presença de distúrbio ventilatório à espirometria. CONCLUSÕES: A frequência de alterações do teste espirométrico em filhos de mães asmáticas foi alta, com o padrão restritivo ocorrendo mais vezes que o obstrutivo. Houve uma maior ocorrência de exames obstrutivos naqueles que apresentavam sintomatologia clínica de asma, com uma frequência de diagnóstico clínico de asma superior à encontrada na literatura.

OBJECTIVE: To evaluate lung function and clinical manifestations suggestive of asthma in children of mothers with a reported medical diagnosis of asthma. METHODS: An observational cross-sectional analytical study nested in a cohort of 4,757 pregnant women. A total of 86 six-year-old children were evaluated, born to mothers with a medical diagnosis of asthma before pregnancy. Information was collected regarding clinical symptoms of atopy and respiratory diseases, as well as socioeconomic and exposure variables; the children were submitted to spirometry. RESULTS: Spirometric alterations were observed in 30.3% of cases, with a prevalence of asthma in those who had an obstructive pattern. 9.3% of the children had a previous medical diagnosis of asthma; however, the established diagnosis based on the presence and frequency of asthma symptoms was 18.6%. Of the 86 participating children, 37.2% had a score of five or more points in the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, which was associated with spirometry alterations (p = 0.002). After multiple logistic regression analysis, higher paternal education, higher number of bedrooms in the family's home, and mother who did not have "wheezing" episodes during pregnancy were statistically significant as protective factors for the presence of respiratory disorder detected by spirometry. CONCLUSIONS: The frequency of spirometry alterations in children of asthmatic mothers was high; the restrictive pattern was more often observed that the obstructive. There was a higher incidence of obstructive test results in those who presented clinical symptoms of asthma, with a higher frequency of clinical diagnosis of asthma than that found in the literature.

Riesgos psicosociales en los hijos de personas con trastornos de salud mental / Psychosocial risk in the offspring of mental health patients

El presente trabajo entrega una visión panorámica de las dificultades que puede tener el adulto con patología psiquiátrica en la interacción con sus hijos. Se analizan diversos estudios que sugieren la mayor prevalencia de enfermedades mentales en estos niños. Se concluye que los hijos de personas con patología psiquiátrica constituyen una población de riesgo elevado de padecer enfermedad psiquiátrica, ya sea por su dotación genética o por los riesgos psicosociales a los que pueden verse expuestos como consecuencia de la patología psiquiátrica del padre o madre. Las patologías psiquiátricas que presentan tienden a ser variadas y no necesariamente igual a la patología del progenitor. Se destaca el rol del psiquiatra de adultos para detectar situaciones de riesgo y activar los distintos agentes de salud al servicio de la prevención y protección del desarrollo saludable de los niños. Se motiva a considerar en los casos de patología psiquiátrica severa de los padres la necesidad de que el otro progenitor o la familia extendida puedan suplir las carencias en periodos de crisis.

This paper provides an overview of the difficulties that can have an adult with psychiatric illness in interaction with their children. We analyzed several studies that suggest a higher prevalence of mental illness in these children. We conclude that children of people with psychiatric disorders constitute a population at high risk of developing psychiatric illness, either by their genetic or psychosocial risks that may be exposed as a consequence of psychiatric illness of a parent. The psychiatric disorders that occur tend to be varied and not necessarily the parent’s pathology. It highlights the role of adult psychiatrist to detect hazardous situations and trigger various health workers in the service of prevention and protection of children’s healthy development. Are encouraged to consider in cases of severe psychiatric pathology parents the need for the other parent or extended family to fill gaps in periods of crisis.

Lifetime psychopathology among the offspring of Bipolar I parents

BACKGROUND: Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents. METHOD: This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5 + 2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated. RESULTS: Of the offspring studied, 71.4 percent had a lifetime diagnosis of at least one psychiatric disorder (28.6 percent with a mood disorder, 40 percent with a disruptive behavior disorder and 20 percent with an anxiety disorder). Pure mood disorders (11.4 percent) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1 percent). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4 percent). CONCLUSIONS: Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.

The prevalence of psychopathology in offspring of bipolar women from a Brazilian tertiary center / Prevalência de psicopatologia em filhos de mulheres bipolares de um centro terciário brasileiro

OBJECTIVE: No previous study has assessed the occurrence of psychopathology in offspring of bipolar women from South America. The objective of this study was to assess the prevalence of psychopathology in offspring of bipolar mothers from Brazil compared with two control groups. METHOD: Children and adolescents aged 6 to 18 years of bipolar disorders mothers (n = 43), mothers with other mild to moderate mental disorders (n = 53) and mothers without any psychiatric disorder (n = 53) were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, the Child Behavior Checklist and the Youth Self-Report. Raters were blind to the mothers' diagnoses, who were interviewed by means of the Structured Clinical Interview. RESULTS: Bipolar offspring had twice the chance of having one or more lifetime Axis I diagnoses [prevalence ratio = 2.11 (95 percent CI: 1.30-3.42) and p = 0.003] and 2.8 higher risk of having a lifetime anxiety disorder [prevalence ratio = 2.83 (95 percent CI: 1.39-5.78) e p = 0.004] than the offspring of mothers with no mental disorder. In addition, significantly higher scores on Child Behavior Checklist thought problems and Youth Self-Report social problems, as well as anxiety/depression and internalizing problems were observed. CONCLUSION: Our results confirm previous findings suggesting higher psychiatric problems in offspring of bipolar mothers and extend them to the Brazilian society

OBJETIVO: Considerando-se a inexistência de estudos avaliando a ocorrência de psicopatologia em filhos de mães bipolares na América do Sul, este se propõe a avaliar a prevalência de psicopatologia em filhos de mulheres bipolares comparado com dois grupos-controle. MÉTODO: Crianças e adolescentes de 6 a 18 anos de idade, filhos de mães com transtorno bipolar (n = 43), filhos de mães com outros transtornos psiquiátricos leve a moderados (n = 53) e filhos de mães sem nenhum diagnóstico psiquiátrico (n = 53) foram avaliados usando o Kiddie Schedule for Affective Disorders and Schizophrenia present and lifetime version, o Child Behavior Checklist e o Youth Self-Report por entrevistadores cegos ao diagnóstico das mães, as quais foram entrevistadas por meio do Structured Clinical Interview. RESULTADOS: Os filhos de mães bipolares tiveram duas vezes mais chance de ter um ou mais diagnósticos de Eixo I [Razão de Prevalência = 2,11 (95 por cento IC: 1,30-3,42) e p = 0,003] e 2,8 vezes maior risco de ter transtornos de ansiedade [Razão de prevalência = 2,83 (95 por cento IC: 1,39-5,78) e p = 0,004] ao longo da vida do que os filhos de mulheres sem transtorno mental, além de maiores escores na subescala de problemas de pensamento do Child Behavior Checklist e nas subescalas de problemas sociais, ansiedade/depressão e problemas de internalização do Youth Self-Report. CONCLUSÃO: Nossos resultados confirmam os achados prévios da literatura internacional que sugerem mais problemas psiquiátricos em filhos de mães bipolares e os estendem para a cultura brasileira

Blind parents: their experience in care for their children / Padres ciegos: experiencias sobre el cuidado de los hijos / Pais cegos: experiências sobre o cuidado dos seus filhos

This study reflects on the difficulties and strategies of blind parents to take care of their children. The situations were related to breastfeeding, bathing, feeding, domestic accidents and administering medication. They use touch, hearing, smelling and the support network, contributing to their autonomy.

Reflexiones sobre las dificultades y las estrategias que los padres ciegos usan cuando cuidan a sus hijos. Las situaciones se refieren a amamantar, bañar, alimentar, accidentes domésticos y dar remedios; también sobre el uso del tacto, la audición y el olfato. La importancia de la red social que contribuye para su autonomía.

Reflexões sobre dificuldades e estratégias de pais cegos, quando cuidam de seus filhos. As situações referiam-se a amamentar, banhar, alimentar, acidentes domésticos e dar remédio, e o tato, audição e olfato e a rede social contribuindo para sua autonomia.

Psychological problems in children of parents with mental illness: a comparative study from Lahore, Pakistan

Mental illness in parents and its link with adverse outcomes for children has been well reported in western literature, but there is a paucity of published studies from Pakistan on this issue. The aim of our study was to determine the prevalence of psychological problems in children of parents having mental illness and to compare it with children of parents without any diagnosed psychiatric problems in urban area of a developing country. A case control study was conducted from January to April 2008 in Lahore. Following informed consent, cases were recruited through interviewing psychiatric patients. Controls were children of parents with no diagnosed psychiatric illness and were recruited through a school. A structured questionnaire for demographic information, and Strengths and Difficulties Questionnaire [SDQ] were filled in by parents. Seventy- six parents were recruited to get a sample of 200 children. [100 cases, 100 controls]. The mean age of children was 9.7 years and 111[55.5%] were boys. Children of parents with psychiatric problems had almost two times higher rate of mental health problems compared to controls [55% versus 28%; P value <0.001]. Emotional difficulties [P=0.028] and conduct problems [P=0.025] were found to be statistically significant. Boys were more likely to be hyperactive and have conduct and social difficulties. Girls had higher rates of emotional problems. Children of parents with mental illness are at much higher risk of childhood psychiatric problems. Risk was higher for males than females. Majority of parents had not sought any help for their children difficulties

Prevalence of HIV among victims of sexual assaults who were mentally impaired childreen (5 to 18 years old) in the Mthatha Area of South Africa

Background: Protection of children has been identified as a priority in South Africa. Despite a commitment to uphold children's rights; much still needs to be done for the safety of mentally impaired children. Objective: To determine the prevalence of HIV among victims of sexual assault amongst mentally impaired children. Methods: This is a record review of attendees at the Sinawe Centre from 2001 to 2005. It is the only centre in the Mthatha area that provides care for sexually assaulted persons and it is affiliated to the Nelson Mandela Academic Hospital. All mentally impaired victims of sexual assault were recorded on the register. Results: During the study period, 1,268 individuals, of whom 32 were profoundly mentally impaired, attended the Sinawe Centre following sexual assault. Of these mentally impaired individuals, 28 (87.5%) were below the age of 18 years. Two were males while the rest were females, giving a male to female ratio of 1:15. A close relative was implicated in 29 (90.6%) of the cases. Among the victims were six (18.7%) epileptics who were on treatment. One was 13 years old and pregnant. Four were HIV positive on screening. Conclusion: Over 2of the sexual assault victims attending the Sinawe Centre were mentally impaired. Of these, 12.5% were HIV seropositive

Las ocupaciones de los hijos de padres con discapacidad / Occupations of children who have parents with disabilities

Se analizan las ocupaciones de los hijos e hijas que tienen un padre o madre con algún tipo de discapacidad y se establecen relaciones entre las ocupaciones de los hijos y la condición de su padre. El estudio se justifica por la ausencia de mayor información en la literatura de Terapia Ocupacional sobre este tema. Se utiliza un enfoque cualitativo de carácter Exploratorio, con una tendencia Explicativa. La metodología utilizada incorporó la realización de entrevistas a ocho participantes. Los contenidos de dichas entrevistas fueron transcritos y posteriormente analizados por los investigadores, quienes construyeron categorías para interpretar los hallazgos. Estas categorías fueron principalmente basadas en un marco conceptual ocupacional. Los resultados apuntan a que variadas ocupaciones son influidas por el factor discapacidad y que la realización de ocupaciones en común con los padres influye en la forma en que imaginan su futuro ocupacional en los aspectos productivos y de la crianza; en la forma en que desarrollan sus relaciones interpersonales y en la visión que tienen respecto de la discapacidad en tanto concepto y problemática social.

This paper analyses the occupations of children who have parents with disabilities and established relations between the occupations of their children and the condition of their parents. The study is justified in the absence of more detailed literature / information being available on the occupational therapy subject. The qualitative approach was characterized by an exploratory nature which provided guidance on the most effective way on how to approach the research. The methodology included, conducting interviews with eight children with parents with disabilities. The contents of these interviews were transcribed and then analyzed by the researchers who then constructed categories to interpret the findings. These categories were primarily based on a conceptual occupational framework. The results indicated that all occupations within the study were influenced by the disability factor of the parents and that this parental influencing factor also affected the way the children imagine their occupational future in the productive and parenting areas. The child(s) life perceptions are directly influenced by both the disability of the parents as well as the social interactions that a child with parents with disabilities would experience. This in turn determines how themselves develop their interpersonal relationship and the view of disability as a social construct.

Gender differences in aggressiveness in children and adolescents at risk for schizophrenia / Comportamentos agressivos em crianças e adolescentes com risco para esquizofrenia: diferenças entre gêneros

OBJECTIVE: This study aimed to investigate whether differences in aggression-related behavioral problems occur between boys and girls at high risk for schizophrenia living in the city of São Paulo, Brazil. METHOD: Using the Child Behavior Checklist, we compared the prevalence of behavioral problems between genders for the offspring (6-18 years) of mothers with diagnosis of schizophrenia and a comparison group of children born to women with no severe mental disorders recruited at the gynecology outpatient clinic of the same hospital. The Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition was applied for the evaluation of diagnostic status of mothers. RESULTS: Male children of women with schizophrenia had a lower prevalence of aggressive behavior compared to females (4 percent vs. 36 percent; p = 0.005), whereas no gender differences regarding aggression were detected in the comparison group (24 percent vs. 32 percent; p = 0.53). Logistic regression analyses showed that male gender and being a child of women with schizophrenia interacted so as to favor lower prevalence of aggressive behavior (p = 0.03). CONCLUSION: These findings reinforce the notion that behavioral gender differences related to schizophrenia are already detectable in childhood.

OBJETIVO: Investigar diferenças da ocorrência de comportamentos agressivos entre crianças e adolescentes do sexo masculino e feminino com risco genético para desenvolver esquizofrenia. MÉTODO: A prevalência de comportamentos agressivos foi medida utilizando o inventário de comportamentos para crianças e adolescentes, Child Behavior Checklist, e comparada entre os gêneros para o grupo de crianças filhas de mulheres com esquizofrenia e para um grupo de crianças filhas de mulheres atendidas no serviço de ginecologia do mesmo hospital. A entrevista clínica estruturada para DSM-IV (The Structured Clinical Interview for DSM-IV Axis I Disorders Patient Edition) foi utilizada para confirmar o diagnóstico materno. RESULTADOS: Os filhos de mulheres com esquizofrenia do sexo masculino apresentaram prevalência menor de comportamentos agressivos quando comparados às meninas (4 por cento x 36 por cento; p = 0,005), o que não ocorreu para o grupo comparativo (24 por cento x 32 por cento; p = 0,53). A análise de regressão logística mostrou que pertencer ao sexo masculino e ser filho de mulher com esquizofrenia interagiram de forma a favorecer menor prevalência de comportamentos agressivos (p = 0,03). CONCLUSÃO: Esses achados corroboram para a noção que as diferenças comportamentais entre os gêneros na esquizofrenia podem ser detectadas precocemente durante a infância.