Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program.

Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother-child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent-Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant-parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with relatively less adversity.

Las madres con trastornos por abuso de sustancias (SUDs) típicamente tienen historias de trauma y dificultades sicosociales que conducen al débil funcionamiento socio-emocional y relaciones madre-niño trastornadas. Este estudio de 12 meses exploró asociaciones entre circunstancias adversas de familia y servicios (de dirección de caso, terapéuticos, basados en la comunidad) que recibieron 57 madres con SUDs y sus infantes (menos de 24 meses de edad) con cambios en el funcionamiento socio-emocional. Todas las madres fueron inscritas en un programa de dirección de caso con base en la relación (Programa de Asistencia al Progenitor y Niño - PCAP) que enfatizaba la conexión de las madres con adecuados servicios comunitarios. Un subgrupo de madres recibió además una intervención sicoterapéutica con enfoque en el trauma (Sicoterapia de Infante-Progenitor - IPP). Las díadas en ambos grupos de tratamiento mejoraron en el funcionamiento socio-emocional en términos generales tal como se les evaluó por medio de la Escala Funcional de Evaluación Emocional (FEAS). Un análisis de regresión que combinó los grupos muestras reveló que los mejorados puntajes en FEAS habían sido pronosticados significativamente por el número de servicios comunitarios recibidos, pero no por las horas del programa de dirección de caso PCAP (no se incluyó la IPP en este análisis). Se asociaron las circunstancias más adversas con un menor mejoramiento en el funcionamiento socio-emocional en los niños; pero entre las madres, el nivel del trauma no predijo los puntajes FEAS. También encontramos un efecto moderador del trauma: las díadas con más adversidad relativamente mostraron significativamente mayor asociación de servicios comunitarios recibidos con mejoras en los puntajes FEAS que aquellas con menor adversidad relativamente. Palabras claves: Salud mental infantil, trastornos maternos por abuso de sustancias, trauma, servicios comunitarios, Sicoterapia de Infante-Progenitor.

Les mères ayant des troubles liés à la toxicomanie (TLT) ont typiquement des passés de trauma et des difficultés psychosociales qui mènent à un mauvais fonctionnement socio-émotionnel et à des relations mère-enfant perturbées. Cette étude de 12 mois a exploré les liens de circonstances familiales adverses et les services (gestion des cas, services thérapeutiques, et services au niveau de la communauté) reçus par 57 mères ayant des TLT et leurs bébés (moins de 24 mois) avec des changements dans le fonctionnement socio-émotionnel. Toutes les mères ont été inscrites dans un programme de gestion de cas basé sur la relation (Programme d'Assistance Parent-Enfant) mettant l'accent sur la référence des mères aux services communautaires appropriés. Un sous-groupe de mères a en plus reçu une intervention psychothérapeutique centrée sur le trauma (Psychothérapie Bébé-Parent). Les dyades des deux groupes de traitement se sont améliorées dans le fonctionnement socio-émotionnel général, évalué par l'Echelle d'Evaluation Emotionnelle Fonctionnelle (Functional Emotional Assessment Scale, soir FEAS). Une analyse de régression d'échantillons combinés a révélé que les scores FEAS améliorés étaient fortement prédits par le nombre de services communautaires reçus mais pas par les heures de gestion de cas FCAP (l'IPP n'a pas été inclue dans cette analyse). Plus de circonstances adverses était lié à moins d'amélioration dans le fonctionnement socio-émotionnel chez les enfants. Mais chez les mères le niveau de trauma ne prédisait pas les scores FEAS. Nous avons aussi découvert un effet modérateur du trauma: les dyades avec relativement plus d'adversité faisaient preuve d'une association bien plus élevée avec les services communautaires reçus avec une amélioration dans les scores FEAS que les dyades avec relativement moins d'adversité. Mots clés: Santé Mentale du Nourrisson, Troubles Liés à la Toxicomanie Maternelle, Trauma, Service Communautaires, Psychothérapie Bébé-Parent.

The Effects of Early Postpartum Depression on Infant Temperament.

Research linking postpartum depression (PPD) with negative child outcomes has predominantly examined PPD at six weeks postpartum or later, and has not controlled for depression during pregnancy. The present study examined associations between PPD at three weeks postpartum and temperament in 6-month-old infants in a sample of women who were not depressed during pregnancy. Depression was assessed at three weeks and six months postpartum using the Postpartum Depression Screening Scale (PDSS). Observed and maternal report of infant temperament was assessed when infants were 6-months-old. PPD symptoms significantly predicted observed temperament behaviour and marginally explained maternal report of infant temperament. Symptoms of PPD at three weeks postpartum were a stronger predictor than at six months. Findings suggest that early depressive symptoms may be particularly problematic, and have implications for early assessment and treatment of PPD even in women who were not depressed during pregnancy or are otherwise considered low risk.

Real-Time Three-Dimensional Echocardiography of the Left Ventricle-Pediatric Percentiles and Head-to-Head Comparison of Different Contour-Finding Algorithms: A Multicenter Study.

BACKGROUND: Real-time three-dimensional echocardiography (RT3DE) is a promising method for accurate assessment of left ventricular (LV) volumes and function, however, pediatric reference values are scarce. The aim of the study was to establish pediatric percentiles in a large population and to compare the inherent influence of different evaluation software on the resulting measurements. METHODS: In a multicenter prospective-design study, 497 healthy children (ages 1 day to 219 months) underwent RT3DE imaging of the LV (ie33, Philips, Andover, MA). Volume analysis was performed using QLab 9.0 (Philips) and TomTec 4DLV2.7 (vendor-independent; testing high (TomTec75) and low (TomTec30) contour-finding activity). Reference percentiles were computed using Cole's LMS method. In 22 subjects, cardiovascular magnetic resonance imaging (CMR) was used as the reference. RESULTS: A total of 370/497 (74.4%) of the subjects provided adequate data sets. LV volumes had a significant association with age, body size, and gender; therefore, sex-specific percentiles were indexed to body surface area. Intra- and interobserver variability for both workstations was good (relative bias ± SD for end-diastolic volume [EDV] in %: intraobserver: QLab = -0.8 ± 2.4; TomTec30 = -0.7 ± 7.2; TomTec75 = -1.9 ± 6.7; interobserver: QLab = 2.4 ± 7.5; TomTec30 = 1.2 ± 5.1; TomTec75 = 1.3 ± 4.5). Intervendor agreement between QLab and TomTec30 showed larger bias and wider limits of agreement (bias: QLab vs TomTec30: end-systolic volume [ESV] = 0.8% ± 23.6%; EDV = -2.2% ± 17.0%) with notable individual differences in small children. QLab and TomTec underestimated CMR values, with the highest agreement between CMR and QLab. CONCLUSIONS: RT3DE allows reproducible noninvasive assessment of LV volumes and function. However, intertechnique variability is relevant. Therefore, our software-specific percentiles, based on a large pediatric population, serve as a reference for both commonly used quantification programs.

Long-term follow-up of former world-class swimmers: evaluation of cardiovascular function.

There is some evidence that long-term high-intensity endurance training might be associated with deterioration in cardiac function and might impose a potential risk for cardiovascular events. Thus, the intention was to retrospectively evaluate the cardiac status in former endurance athletes, particularly right ventricular (RV) dimension and function, to reveal potential cardiac damage. A group of 12 former world-class swimmers (45 ± 1.5 years) was examined 24.9 ± 4.3 years after cessation of high-intensity endurance training. They underwent history taking, physical examination, ECG, exercise testing and echocardiography. Furthermore, functional and echocardiography data that were also available from former evaluations were included in the analysis. There was a significant decline in exercise capacity. LV function was normal with a decrease in septal thickness to 9.1 ± 1.3 (p < 0.05) and LV diastolic diameter to 48.9 ± 5.6 (p < 0.05). Still, there was a remaining septal hypertrophy. RV function was 55.3 ± 4.2% and there were normal RV dimensions adjusted for body surface area. 25 years after the cessation of endurance training there was a normal RV and LV function with a normalization of almost all diameters, still there was a mild LV hypertrophy in some athletes. Consequently, no relevant long-term cardiac remodeling after intensive endurance training was depicted in this group of athletes.