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We examined interactions among genetic, biological, and ecological variables predicting externalizing behaviors in preschool and middle childhood. Specifically, we examined prediction of externalizing behaviors from birth complications and negative emotionality, each moderated by genetic risk for aggression and ecological risk factors of insensitive parenting and low family income. At ages 4 and 5 years, 170 twin pairs and 5 triplet sets (N = 355 children) were tested; 166 of those children were tested again at middle childhood (M = 7.9 years). Multilevel linear modeling results showed generally that children at high genetic risk for aggression or from low-income families were likely to have high scores on externalizing, but for children not at high risk, those with increased birth complications or more negative emotionality had high scores on externalizing. This study underscores the importance of considering biological variables as moderated by both genetic and ecological variables as they predict externalizing behaviors across early childhood.

Diabetes mellitus is a non-communicable disease that currently affects over 366 million people worldwide and its prevalence is likely to double by 2030. Therefore, the need to screen for diabetes mellitus has become an impetus. The objective of the study was to determine the prevalence of dysglycaemia and significance of familiar risk factors for diabetes mellitus among the study population. One hundred and thirty-two and 48 consecutive non-previously diagnosed DM and previously diagnosed DM patients respectively were recruited from the same clinic. An interviewer administered questionnaire was applied and blood samples were taken for blood glucose. The prevalence of dysglycaemia was 36.2% and only 40.6% of the diabetic patients who did fasting blood glucose had glycaemic control. Family history of Diabetes mellitus in the first generation was significantly associated with chance of developing diabetic mellitus in the study population. In conclusion, it is important physicians begin to be very proactive in the screening for blood glucose in order to detect them early and forestall complications that are associated with late diagnosis of diabetes mellitus.

To determine the usefulness of cumulative and additive risk models in predicting the healthy-related quality of life (HRQOL) of caregivers of youth with chronic gastrointestinal conditions. 203 caregivers (82.8% mothers; 77.3% white) of youth (M = 11.27 years; 44.3% female; 78.8% White) completed self-report questionnaires focused on potential environmental, child health, and family risk factors that could impact caregiver HRQOL. Cumulative risk models, evaluating overall combined risk level, as well as an additive risk model, exploring individual risk variables, were evaluated. Higher levels of cumulative risk were associated with poorer caregiver HRQOL after controlling for child and caregiver sex. A linear cumulative risk model was a better fit than a quadratic cumulative risk model for predicting caregiver HRQOL, while an additive model identified child HRQOL, child pain interference and family functioning as the most individually impactful risk variables. This study illustrates the usefulness of both additive and cumulative risk approaches in identifying caregivers at risk for poor HRQOL. Provision of appropriate referrals and interventions based on the caregiver’s risk factors can help protect caregiver quality of life and, in turn, benefit the care children with chronic conditions receive at home.

Child-to-parent violence (CPV) is a growing public health problem with consequences for perpetrators and families. Most research has focused on individual and family risk factors. However, little is known about its links with individual outcomes. The aim of this study was to analyze the relationships between CPV and psychological distress, suicidal ideation, and self-concept in school-aged adolescents, taking into account the gender perspective. A study was conducted with a sample of 8,115 adolescents, aged between 11 and 16 years (M = 13.34; SD = 1.04) from the State of Nuevo León, Mexico. A MANOVA 3 × 2 was performed to analyze the data. The results revealed that adolescents involved in CPV showed higher levels of psychological distress and suicidal ideation and lower levels of family and social self-concept. It was also observed that girls with higher levels of CPV scored the lowest levels of psychological distress and suicidal ideation, as well as the lowest levels of family self-concept. The findings highlight that adolescents and especially girls involved in CPV also report internal maladjustment outcomes. Finally, the results and their implications for research and intervention with adolescents involved in CPV are discussed.

Zusammenfassung. Der Einfluss der Familie in Bezug auf die Entstehung und Aufrechterhaltung der ADHS bei Kindern ist wissenschaftlich gut fundiert, jedoch hat sich die einschlägige Forschung weitgehend auf das elterliche Erziehungsverhalten oder die Qualität der Eltern-Kind-Beziehung konzentriert. Die Rolle der elterlichen Partnerschaft in betroffenen Familien wurde in der Literatur bislang vernachlässigt. Diese Übersichtsarbeit fasst den aktuellen Forschungsstand zu den Zusammenhängen von Partnerschaftsstörungen und kindlicher ADHS zusammen und diskutiert chronische Paarkonflikte als Risikofaktor für die Entwicklung von ADHS-Symptomen. Basierend auf dem gegenwärtigen Kenntnisstand wird ein integratives Modell postuliert, das von einer genetischen Vulnerabilität für die kindliche ADHS ausgeht, mit der Partnerschaftsstörungen interagieren. Es stellt dar, wie Partnerschaftsstörungen mit ihren möglichen direkten und indirekten Folgen für die Ätiologie, Aufrechterhaltung und/oder Verstärkung von kindlichen ADHS-Symptomen bedeutsam sein können, welche wiederum auf die Paarbeziehung zurückwirken. Das Review verdeutlicht die Wichtigkeit von Paarpräventionsprogrammen zur Vorbeugung von kindlichen Störungen sowie die angemessene Berücksichtigung von Partnerschaftskonflikten in der Diagnostik und Therapie von Familien mit ADHS-betroffenen Kindern.

Introduction Research has documented modest positive impacts of early childhood home visiting programs. However, understanding more about what home visitors do during visits and how much time they spend on specific topics may provide insight into the variability in effectiveness of services. Methods Outcome data were collected via parent survey at program enrollment and 12 months from 123 women in three MIECHV-funded home visiting models. Home visitors completed weekly home visit content and activity logs. Results Families received an average of 28 visits during the study (3.1 visits per month). Of ten content areas, the three most often discussed were early childhood development, physical care of children, and the parent–child-relationship. Multivariate regression models were used to explore the association of home visit dosage, home visit content and cumulative risk factors on parenting outcomes. Women whose visits were focused more on parenting topics reported lower parenting-related stress at follow-up compared to those whose visits had less parenting content. Additionally, higher-risk women who received greater numbers of home visits showed larger reductions in their attitudes about harsh punishment over time, compared to high-risk women with fewer home visits. Discussion Receiving home visits that emphasize parenting content may contribute to reduced parenting-related stress. For high-risk women in particular, receiving more visits overall may be important to achieving positive outcomes. Implications for practice include working to engage and retain high-risk families. Future home visiting research calls for improved methods for collecting data on content/activity during visits, the necessity for long-term follow-up, and testing for the effectiveness of varied and flexible visit schedules/content focus for women and families with trauma exposure.

The results of prevalence and prognostic significance of occupational, housing and family risk factors for myocardial infarction are presented. The significance of the analyzed risk factors for predicting development of myocardial infarction is established. The myocardial infarction (MI) have to do with global social and medical evidential problems. The MI morbidity results in significant economic and social damage. The loss of the gross domestic product as a result of MI mortality in able-bodied age prevails in the structure of economic damage in the Russian Federation and makes up to more than 49 billion rubles per year. In MI patients such risk factors as tense psychological relationships at work, duration of workday more than 8 hours are highly spread. This is especially true for tensed psychological relationships at work, which are 5.6 times more likely to be detected in patients with MI as compared with other groups of patients. The study demonstrated considerable prevalence and significant role of particular professional, housing and family risk factors in the MI development. It is proved that physical overloads, unsatisfactory housing conditions and lack of one's own housing are of highest prevalence and prognostic significance. The study data permits to prognosticate possibility of MI development and to implement preventive and curative measures prior to onset of disease resulting in decreasing of MI morbidity, various complications and mortality.

Object - To review the literatures on the causes of low birth weight. Method- On the Pub Med and Ichushi (Japan Medical Abstracts Society) websites, the literatures on the causes of low birth weight published between 1975 to 2011 were searched. Results- From among the 469 original articles retrieved, 65 articles containing any description of the cause of low birth weight were identified, of which the 32 articles well-structured in the format of scientific writing were selected and reviewed. Conclusion- The suspected causes of low birth weight from pre-pregnancy risks were classified into two categories- a) Family risk factors, b) Mother herself risk factors. Further large-scale follow-up studies from birth would be needed at the prefectural level.

Zusammenfassung. Im Rahmen der Aachener Frühgeborenennachsorge wurden N = 199 Frühgeborene (< 32 SSW und/oder < 1500 g) der Geburtsjahrgänge 2007 bis 2011 im Alter von korrigiert zwei Jahren entwicklungsneurologisch nachuntersucht und ihr MDI mit dem Bayley II ermittelt. Die Daten wurden retrospektiv analysiert, um herauszufinden, ob der Migrationshintergrund die kognitive Leistungsfähigkeit zum Untersuchungszeitpunkt beeinflusst. Es zeigten sich keine Unterschiede hinsichtlich des Geschlechts, medizinischer Komplikationen und der Inanspruchnahme von Therapie zwischen Kindern mit (42 %) und ohne (58 %) Migrationshintergrund. In Übereinstimmung mit der Literatur lag die gesamte Aachener Stichprobe mit einem mittleren MDI von 83,3 (SD 17,4) eine Standardabweichung unter dem Durchschnitt der Referenzpopulation. Kinder mit Migrationshintergrund lagen im kognitiven Outcome 10 Punkte unter Kindern ohne diesen, was entscheidend durch das Vorliegen familiärer Risikofaktoren bedingt wurde. Im regressionsanalytischen Modell hatten familiäre Risikofaktoren und das Geburtsgewicht den größten Einfluss auf den kognitiven Outcome; aber auch das Vorliegen eines Migrationshintergrundes leistete einen zusätzlichen Beitrag zur Vorhersage. Frühgeborene mit Migrationshintergrund sollten daher als besondere Risikogruppe erkannt werden, insbesondere wenn sie zusätzlich familiäre Risikofaktoren aufweisen, um sie frühzeitig differenzierter fördern zu können.

Controversy exists about the role of parent psychopathology in persistence and severity of attention deficit hyperactivity disorder (ADHD) symptoms in their children. Here we aimed to analyse the potential association between the severity of ADHD symptoms in children and the presence of psychiatric and ADHD symptoms in their biological parents. Seventy-three triads of children and their parents who were in active treatment for their diagnosed ADHD were evaluated in our Child and Adolescent Mental Health Centers. The mental health of the parents was also assessed. The general psychopathology of the parents was evaluated using the Symptom Checklist-90-R (SCL-90-R), and symptoms of hyperactivity were examined using the Adult ADHD Self-Report Scale (ASRS v.1.1). The severity of symptoms in children was assessed using the ADHD Rating Scale-IV (ADHD-RS-IV). Variables that could have affected the clinical development of ADHD such as sex, evolution time, age, academic level and the presence of comorbidities were controlled. The severity of the symptoms in children with ADHD was significantly related to the psychiatric history of their mother, the younger age of the child and the presence of a comorbid conduct disorder in the child. We discussed the importance of screening for parental psychopathology in clinical practice.

Emotional regulation has emerged as an important factor in understanding a wide spectrum of disorders, including substance abuse. This article reviews research on the role of emotion regulation in substance use disorders (SUD) and offers a new perspective on the rationale of family substance use as a risk predictor for children and adolescents. The implications for prevention and early intervention are of particular importance to adolescent SUD.

Objective: The purpose of this study was to establish, using a quasi-experimental design, whether 2 family risk factors, parental psychological dysfunction and nonsupportive parenting, during preadolescence could longitudinally predict elevated sympathetic nervous system (SNS) activity 9 years later, and to determine whether participation in an efficacious family centered prevention program could moderate these associations if they emerged. Method: Rural African American preadolescents (N 476) were assigned randomly to the Strong African American Families (SAAF) program or to a control condition. When youths were 11 years of age (M 11.2 years), primary caregivers provided data on their own depressive symptoms and self-esteem, and youths provided data on their receipt of nonsupportive parenting. When the youths were 20 years of age, indicators of SNS activity, the catecholamines epinephrine and norepinephrine, were assayed from their overnight urine voids. Results: Parental psychological dysfunction and nonsupportive parenting forecast elevated catecholamine levels for youths in the control condition, but not for those in the SAAF condition. Conclusions: The demonstration that a prevention program can induce reduction of catecholamine levels is important from both theoretical and public health perspectives, because it shows that the developmental progression from family risk factors to heightened sympathetic nervous system activity is not immutable.

Objective Efforts to promote early brain and child development (EBCD) include initiatives to support healthy parent–child relationships, tools to identify family social-emotional risk factors, and referrals to community programs to address family risk factors. We sought to examine if pediatricians perceive barriers to implementing these activities, and if they utilize resources to address those barriers. Methods Data were analyzed from 304 nontrainee pediatricians who practice general pediatrics and completed a 2013 American Academy of Pediatrics Periodic Survey. Sample weights were used to decrease nonresponse bias. Bivariate comparisons and multivariable regression analyses were conducted. Results At least half of the pediatricians agreed that barriers to promoting EBCD include: a lack of tools to promote healthy parent–child relationships, a lack of tools to assess the family environment for social-emotional risk factors, and a lack of local resources to address family risks. Endorsing a lack of tools to assess the family environment as a barrier was associated with using fewer screening tools and community resources. Endorsing a lack of local resources as a barrier was associated with using fewer community resources and fewer initiatives to promote parent–child relationships. Interest in pediatric mental health was associated with using more initiatives to promote healthy parent–child relationships, screening tools, and community resources. Conclusions Although the majority of pediatricians perceive barriers to promoting EBCD, few are routinely using available resources to address these barriers. Addressing pediatricians' perceived barriers and encouraging interest in pediatric mental health may increase resource utilization and enhance efforts to promote EBCD.

To determine the prevalence and personal and family risk factors for nocturnal enuresis (NE) among primary school children in Al-Mukalla City, Yemen, we conducted a cross-sectional survey using a self-administered, three-part structured questionnaire involving 832 school children aged 6 - 15 years between 2007 and 2008. We assessed participants′ socio-demographic factors, family characteristics and factors related to the presence of NE. The mean age of the children was 11.5 (±2.7) years. The overall prevalence of NE was 28.6%, with a predominance of girls, and the prevalence decreased with increasing age (P 0.002) and a higher number of siblings (P = 0.01). Our findings reveal a high prevalence of NE among children in Al-Mukalla City, Yemen, with a higher prevalence in girls than in boys compared with the other studies. Sleep pattern, stressful life events, family history of NE, large family size and more children in the household may act as a risk factor for NE.

This secondary data analysis examined the association of Head Start children's entry age and enrollment duration on children's dental, vision, and hearing health based on data from 60 local Head Start classrooms. Children were divided into three groups: One group of children entered Head Start at age three and maintained enrollment for one year (Group 1). The second group of children entered Head Start at age four and stayed one year (Group 2). The third group of children entered at age three and stayed in Head Start for two years (Group 3). Compared with Group 3, Group 1 had fewer dental problems and Group 2 had less identified hearing problems. Children's gender, ethnicity, and program characteristics and family risk factors were associated with health problems.

Context Recent years have produced many articles about women’s addiction and its risk factors and the consequences of substance use and misuse in the emotional, social, psychological, and economic domains of life. Family vulnerabilities are one of the most important variables contributing to addiction among women. Thus, the purpose of this article is to investigate areas of family life that lead to women’s taking up and maintaining drug and alcohol abuse. Evidence Acquisition A database search of PubMed, ScienceDirect, Springer, and Google Scholar was conducted using the following keywords: “women and addiction”, “women addiction and family”, “addiction”, “substance abuse” and “family”. For the first step, we chose studies that were conducted between 2000 and 2015, and for the second step, studies conducted before 2000. We categorized all search results into three main groups: processes related to family disturbances, factors related to parenting styles, and variables related to partners. Results Partners, parenting styles, and family disturbances are three main factors affecting children growing up in a family and their inclination toward addiction. Some of these pathways are complicated and indirect, and some are straightforward. Conclusions Future research should pay more attention to the mechanisms and pathways mediating or moderating the relationship between family risk factors and addiction in women. Clinicians and researchers should keep in mind these vulnerabilities and take into consideration factors special to processes related to addiction in women.

In this chapter, the most common and potent familial risk and protective factors for suicidal behavior will be reviewed, namely, family history of psychiatric disorder and suicidal behavior and exposure to family adversity, such as bereavement, divorce, or maltreatment. We then will discuss strategies for identification of families and youth at risk and extant and proposed preventive interventions that could attenuate the risk for youth suicidal behavior.

Recent evidence suggesting that adolescent suicidality has increased over the past decade has emphasized the importance of assessing contributory psychosocial risk factors. This present study has examined the association of family conflict and family cohesion with adolescent suicidality. Data was collected from a multisite sample of 195 adolescent primary care patients using the Family Environment Survey (FES) and the Scale for Suicidal Ideation (BSI). Results indicated that family cohesion was significantly and inversely associated with suicidality (r = −.3904, p < .001) and that family conflict was significantly and positively associated with suicidality (r = .3899, p < .001). All (100 %) of the adolescents with BSI scores indicative of elevated risk for suicidal behavior reported above-median levels of family conflict. Reports of suicidality were particularly elevated among adolescents who reported high family conflict and low family cohesion. These findings suggest that it may be important to assess suicidality among adolescents reporting high family conflict and low family cohesion.

The objective of the study was to evaluate whether mental health problems identified through screens administered in first grade are related to poorer academic achievement test scores in the fourth grade. The government of Chile uses brief teacher- and parent-completed measures [Teacher Observation of Classroom Adaptation-Revised (TOCA-RR) and Pediatric Symptom Checklist (PSC-Cl)] to screen for mental health problems in about one-fifth of the country's elementary schools. In fourth grade, students take the national achievement tests (SIMCE) of language, mathematics and science. This study examined whether mental health problems identified through either or both screens predicted achievement test scores after controlling for student and family risk factors. A total of 17,252 students had complete first grade teacher forms and these were matched with fourth grade SIMCE data for 11,185 students, 7,903 of whom also had complete parent form data from the first grade. Students at risk on either the TOCA-RR or the PSC-Cl or both performed significantly worse on all SIMCE subtests. Even after controlling for covariates and adjusting for missing data, students with mental health problems on one screen in first grade had fourth grade achievement scores that were 14-18 points (~1/3 SD) lower than students screened as not at risk. Students at risk on both screens had scores that were on average 33 points lower than students at risk on either screen. Mental health problems in first grade were one of the strongest predictors of lower achievement test scores 3 years later, supporting the premise that for children mental health matters in the real world.

O objetivo deste estudo retrospectivo foi levantar taxas de desistência e abandono do atendimento em uma clínica-escola de psicologia infantil e identificar fatores de risco sócio-demográficos, clínicos e familiares para ambos os desfechos. Dados de 258 crianças foram obtidos nos prontuários. Desistiram do atendimento logo após a entrevista inicial 16% das famílias. Entre as famílias não desistentes, 49% interromperam o atendimento antes da alta. Foram comparados, quanto aos fatores de risco, os grupos desistente e não desistente. Além disso, no grupo não desistente, os subgrupos abandono (clientes que compareceram ao menos uma vez antes de interromperem o tratamento) e alta clínica (clientes que persistiram até o final do atendimento) também foram comparados. Famílias desistentes apresentaram mais crianças nas séries iniciais, com menos problemas de comportamento. O abandono foi associado a menor recurso cognitivo e menor idade da criança, pai mais jovem e maior exposição da família a estresse psicossocial. This retrospective study aimed at investigating the rates of treatment nonattendance and dropout at a university-affiliated child guidance clinic and identifying socio demographic, clinical and family risk factors that contribute to them. We obtained archival data of 258 children. Sixteen percent of the families did not return after their intake interview. Among families that returned, forty-nine percent dropped out of treatment. Groups were compared with respect to risk factors for self-termination: nonattenders (clients who did not return after intake) versus attenders (clients who returned); dropouts (clients that attended at least one session before interrupting treatment) versus completers (clients that persisted until treatment conclusion). Children from nonnattender families attended earlier school grades and had less behavior problems. Children in the dropout group had lower scores in intelligence assessment, their fathers were younger and their families were more exposed to psychosocial stress, as compared to completers. El objetivo fue buscar tasas de retirada y abandono del tratamiento en una clínica-escuela de psicología para niños y identificar factores de riesgo demográficos, clínicos y ambientales para ambos los desenlaces. Se utilizaron datos de archivo de 258 niños. No llegaran a iniciar el tratamiento en seguida a la primera entrevista 16% de las familias. Entre las que retornaran, 49% terminaran el tratamiento prematuramente. Se compararan las familias que no regresaran después de la entrevista inicial con las familias que retornaran. Las familias que abandonaran el tratamiento empezado fueran comparadas con las que persistieran hasta el fin. En las familias que no iniciaran en tratamiento los niños tenían menos problemas de conducta y cursaban años iniciales en la escuela. En las familias que abandonaran, los niños eran más jóvenes, tuvieran peor desempeño en test cognitivo, el estatus educativo de los padres era menor y la familia estaba más expuesta a estrés psicosocial

This study described empirically derived profiles of parents' personal and social coping resources in a sample of 207 families of children diagnosed with autism spectrum disorder. Latent Profile Analysis identified four family profiles based on socieoeconomic risk, coping strategy utilization, family functioning, available social supports, and perceptions of family-centered support. During the time of children's transition to school, parents in the most disadvantaged group experienced the highest levels of parenting stress and depression, and their children had significantly lower adaptive behaviour scores and more parent-reported behavior problems than children in the other three groups. Results highlight the need for systematic surveillance of family risk factors so that supports can be provided to enhance both parental well-being and children's developmental health.

In the article there are main risk factors significantly influencing on an occurrence of frequent respiratory diseases in children of preschool age. Ranking of the ascertained risk factors according to the rate of their information value was done. The priority of family risk factors in the occurrence of frequent diseases in children of preschool age was shown .

This paper describes the use of seclusion in a child and adolescent inpatient unit, including precipitating events, management strategies, details of seclusion episodes and individual and family risk factors. Inpatient ward documentation of seclusion episodes, demographic data and measures of individual psychopathology and impairment, parent mental health, life events and family functioning were used to compare secluded, non-secluded and outpatient groups. Secluded individuals had elevated psychopathology compared with non-secluded inpatients and outpatients. Their families reported poorer parental mental health and family functioning and more recent stressful life events. The results indicate that seclusion is most common among high-risk inpatients.

We determined risk factors for influenza hospital admission in children aged We linked all singleton live births in Scotland from 2007 to 2015 to hospital administrative data and influenza laboratory reports. Cox proportional hazard models were used to identify birth and family risk factors for influenza admissions. There were 1115 influenza admissions among 424 048 children. 85.1% of admitted children were born at term and were not in a high-risk group. Presence of an older sibling was strongly associated with increased risk of influenza admission, particularly for children aged versus first-born child was 2.02 (95% CI 1.52–2.69). Maternal age Targeting vaccination programmes to high-risk children will not prevent the vast majority of influenza admissions. Parents of children aged

This retrospective study examined differences among three groups of urban males in the prevalence of various family risk factors occurring before age 11 and their independent contributions to subsequent deviance. The groups included: narcotic addicts; never-addicted peer controls who were associates of the addicts at age 11; and never-addicted community controls not associated with the addicts. Sixty-four percent of the addicts, compared to slightly under 40% of both control groups, reportedly experienced one or more family risk factors involving deviant behavior among family members and family disruption before age 11. While community controls differed from addicts on both family deviance and disruption in family structure, peer controls differed from addicts only on disruption of family structure. For the total sample, both family deviance and family disruption experienced before age 11 were significantly associated with crime severity level at age 11. Implications of these findings for future substance abuse research and intervention are discussed.

Examined whether adult mortality risk was related to adolescent behavioral problems, substance abuse, and adverse home upbringing conditions, and whether Ss with an adult criminal conviction were o ...

IntroductionDuring last 10 years, the number of non-suicidal self-injury patients (NSSI patients) in Department of Adolescent Psychiatry of Medical University in Łódź has doubled (from 20 to over 40%). According to DSM-5 criteria, NSSI are deliberate and superficial skin injuries. Such behaviours should be distinguished from suicidal behaviour disorder (SBD). However, the two display the high rate of co-occurrence.Material and methodThe study covered 1300 patients (12–19 years of age) hospitalized during last 6 years. The analysis included various variables, e.g. demographic, familial, problems related to school and to peer relations, and variables describing NSSI.Results and summaryThe analyzed group consisted of 60,4% girls and 39,6% boys. Out of 43% of patients who performed NSSIs, 45% also confirmed BDS. The patients with diagnosed mental retardation and with schizophrenic psychoses performed significantly fewer NSSIs. The instrumental motive was the most frequently declared reason of self-injury (76%). The reactive (65%), and the illness-related motives (only 15%) were less frequent. In comparison to patients without self-injuries, the NSSI patients significantly more frequently (P < 0.05) experienced physical violence, unreciprocated love, played truant and repeated grades. Conflicts, delinquency, divorce, and lack of a sense of support were significantly more frequent in the family systems of NSSI patients. They more often experienced loss of their parent before age 15 and had close relatives suffering from mental disorders.ConclusionsNSSI is a multi-dimensional issue that requires further research. Indicating potential risk factors allows for implementing efficient prophylactic, diagnostic and therapeutic actions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Objective: Although previous reports have found no birth-order influence on ADHD risk, the authors hypothesize that being the firstborn is a risk factor for developing ADHD. Method: They selected all of the currently treated ADHD outpatients (n = 748) from our database. Families with adopted sons, nonnuclear families, and families with only one child and with sons (affected or unaffected) younger than 6 or older than 18 years were excluded. A total of 181 families with 213 ADHD sons met the inclusion criteria. We used all siblings without a clinical diagnosis of ADHD and who had no contact with our service as our unaffected controls (n = 173). Results: The bivariate analysis showed that ADHD was associated with birth order and that firstborn children had nearly twice the ADHD risk of children with other birth orders. Conclusion: birth order can be an ADHD risk factor in clinical samples.

A SCREENING PROGRAM FOR COLORECTAL CANCER IN CHILEAN SUBJECTS AGED FIFTY YEARS OR MORE Background: Mortality from colorectal cancer (CCR) in Chile has nearly doubled over the past 15 years. International studies have shown that CCR screening programs based on Fecal Occult Blood Test (FOBT) reduce CCR mortality. Aim: To analyze the results from a CCR screening model in people over 50 years. Material and methods: Between 2007 and 2009, a prospective multicenter study was performed in seven major Chilean cities. FOBT using an immunological method, was measured in asymptomatic subjects aged 50 years or more, without risk factors. In patients with a positive FOBT, with symptoms or with family risk factors, a colonoscopy was indicated. Results: A total of 6348 subjects were assessed, FOBT was performed in 4938 of them, with a compliance of 77%. The result was positive in 9.6%. A total of 2359 colonoscopies were ordered, with an overall compliance of 50.1%. Of the 1184 colonoscopies performed, adenomas and high risk adenomas were found in 304 (26%) and 75 (6%) patients, respectively. Thirteen patients were diagnosed with stage I and II CCR. Three of these lesions were excised endoscopically and 10 surgically. The detection rate of polyps, high risk adenomas and cancer was 75, 12 and 2 per 1000 screened individuals, respectively. Conclusions: This program allowed the early detection of an important number of high risk colon lesions, and all patients with CCR were diagnosed at early stages. Normal 0 21 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;}

Due to the increased prevalence of psychosomatic presentations and the difficulty of managing such patients, this article summarizes the latest findings for identifying individual and family risk factors, and new trends in the evaluation and management of pediatric patients with psychosomatic illness.Up to 50% of patients in pediatric care will complain of medically unexplained symptoms with significant functional and emotional impairment. Such patients place heavy burdens on the healthcare system (frequent utilization of health resources and hospitalizations, specialist consultations, unnecessary investigations, and treatments). Somatoform disorders in pediatric care are associated with risks for psychiatric co-morbidity (anxiety and depressive disorders), family conflict, parent-perceived ill health, and school problems/absenteeism.Gaining expertise in addressing pediatric psychosomatic illness can make a great difference in patients' life and in physicians' professional satisfaction. Effective treatment approaches involve a multidisciplinary approach to consolidate care and facilitate communication, target the patient/family's understanding of the mind-body relationship and their acceptance of the bio-psycho-social formulation and treatment, and utilize functional rehabilitation and cognitive behavioral therapy for the individual and family and management guidance for schools.

Reviewing large-scale, population-based studies, this chapter summarizes three health outcomes for young children with Down syndrome: (1) adverse birth outcomes (e.g., prematurity, low birthweight); (2) in-patient hospitalizations; and (3) early mortality. Prematurity and low birthweight occur several times more often among newborns with (vs. without) Down syndrome, and account for 14–25% of all newborns with the syndrome. From 1/2 to 3/4 of these infants experience nonbirth hospitalizations within their first 3 years, most beginning during their first year. Those infants with congenital heart defects experience hospitalization more often, earlier, and for longer periods; respiratory problems constitute the main reason for hospitalizations among children with (and without) heart defects. Newborns with Down syndrome die before their first birthday from 4 to 24 times more often than other newborns; congenital heart defects, African American mothers, and prematurity are the major risk factors. Future studies need to identify child, parent, and family risk factors for early health outcomes, tie health outcomes to medical services, and determine the influence on early health of pollution and other environments. Better data and data-linkage are also needed. With an expanded research base, physicians will be able to provide more precise anticipatory guidance to parents, early interventionists, and others who care for young children with Down syndrome.

Studied contributions of maternal psychological distress, family stress load, maternal and family risk factors, and family coping strategies in predicting behavior problems in 441 inner-city black primary-grade children. Results indicated maternal psychological distress and high family stress load were associated with high child behavior problems. Family coping strategies offered no protection against risk, while coping with life difficulties by reframing them was detrimental to child behavioral adjustment. Active help-seeking strategies (i.e., family mobilization, acquiring social supports) served to moderate the effects of maternal psychological distress and family risk attributes for boys, but exacerbated the effects of dysfunctional maternal social and psychiatric histories for girls. Implications for understanding vulnerability and resilience in inner-city black children and recommendations for future research are discussed.

The family background characteristics of 756 male heroin users were examined to determine the effects of selected family risk factors on the timing of onset of emancipation and drug use, on pre-addiction incarcerations and on educational attainment. These risk factors included family size, birth order, socioeconomic status, family drug use, parental history of alcoholism, parental absence, and family history of incarceration. The two measures of age of emancipation were age on leaving school and age on leaving home. Age of onset of regular use was measured for the following drugs: tobacco, alcohol, marijuana and heroin. Incarceration measures included the occurrence of juvenile detention and the time spent in prison prior to first addiction. Educational attainment was a score on a California State achievement test. Larger family size, higher birth order, parental alcoholism and parental absence were found to have a cumulatively negative effect on how young the respondents were when they first left home and when they first used particular drugs regularly, on their level of tested academic achievement, and on their probability of juvenile detention. Implications for social policies designed to prevent drug abuse are discussed.

Rates of alcohol, tobacco, and marijuana use among runaway/homeless youth are substantially higher than found among American high school students. To understand the risk and protective factors associated with substance use, this study (1) assessed cigarette, alcohol, and marijuana use among a national sample of runaway/homeless youth, (2) identified risk/protective factors associated with lifetime substance use, and (3) examined risk/protective factors associated with six month frequency of substance use. Unduplicated cases (n = 11,841) from the 1997 Runaway/Homeless Youth Management Information System (RHY MIS) were analyzed. Results showed that substance use levels are greater than previously reported for this population. Predictors of cigarette, alcohol, and marijuana use and frequency were predominately individual youth risk factors and demographics rather than family risk factors. Providers in emergency youth shelters are in a prime position to assess substance use behaviors, as well as the associated risk factors. Provision of appropriate screening and referral to other services is essential to meet the needs of these youth.

OBJECTIVE To analyze the influence of family history of cardiovascular disease (CVD) on lipoprotein (a) (Lpa) values in obese children. SUBJECTS AND METHODS Lpa values were measured by a nephelometric technique in 837 prepubertal obese children (442 girls, 395 boys) aged 6-8 years. Lpa > 30 mg/dl were determined to be a risk factor for CVD after complete recording of dietary norms, family history of CVD and coronary risk in relatives aged less than 50 years old. RESULTS The obese children's group with BMI > 30 and with family history of CVD presented higher values of Lpa (32.07 +/- 1.2 mg/dl) in comparison to the less obese group with family history of CVD (27.19 +/- 0.8 mg/dl) (p < 0.01), and both of these groups had significantly higher Lpa values than the groups with no family history of CVD. CONCLUSIONS Childhood obesity with high BMI increases the risk of CVD when these children become adults in children with family risk factors for CVD.

Family factors have been proposed as important risk factors for the development of bulimia nervosa. We examined several family variables using a case-control design for their association with DSM-III-R normal-weight bulimia nervosa. We found no significant difference in parental age, mean number of siblings, or birth order in a sample of 25 subjects with bulimia nervosa compared to controls. This study does support these factors as important contributors to the development of bulimia nervosa.

Editor,—Little information is available on the aetiology of primary not transient congenital hypothyroidism due to thyroid malformations. Usually it is considered to be a sporadic disease; however, to date, there are no reliable studies to identify some possible family risk factors for the disease.1 2Therefore between April and September 1996, during therapeutic follow up of affected children, we examined the mothers of 19 consecutive infants with congenital hypothyroidism (group A) screened through our regional newborn screening program (Emilia-Romagna, Italy) and 17 age matched volunteer mothers of unaffected children …

ObjectivesTo determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in Santiago, Chile, as part of a national sample.Methodsubjects from 4 to 18 years of age were selected in an aleatory stratified multistage fashion. As part of a national sample, 10 counties in Santiago were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use.Resultsa sample of 792 children and adolescents was evaluated, obtaining 76.7% of participation. Using the most stringent impairment algorithm, the prevalence for any psychiatric disorders was 25.4%, being 20.7% in boys and 30.3% in girls, mainly explained by anxious and affective disorders. Prevalence was higher in the 4-11 years of age than in the 12-18 (31.9% and 18.2% respectively). This difference was mainly accounted for by disruptive disorders. Prevalence of anxious disorders was the highest, but less associated with impairment, while most of the children and adolescents with affective disorders were impaired.Conclusionsprevalence of psychiatric disorders in Santiago is high in this age group, and this study will be used for improving mental health services.

Parents of pediatric patients attending regional otologic medical clinics were given a questionnaire to document family risk factors predictive of poor appointment attendance, and to determine barriers which caused non-attendance of medical appointments. Family risk factors which affected clinic attendance were studied using univariate and multivariate analyses. Univariate analyses revealed all factors except patients' sex and family size to be correlated with attendance. However, multivariate analysis revealed that parental age (p less than 0.0153), ownership of car (p less than 0.0012), parental education (p less than 0.0048), and age of patient (p less than 0.0023) were major predictors of clinic attendance. Although ownership of a car was a major independent factor, it was highly correlated with parental age and parental education and only shown to be significant in the subset of patients not having access to public transportation. The identified parental factors which affect pediatric health care delivery underscores the importance of family centered case management in promoting the health care of children and casts doubt on the effectiveness of interventions which are solely centered on the patient or are designed to mitigate only one of these factors.

Aronen E. Family risk factors as predictors of psychological development in 10- and 11-year-olds - Family councelling in the prevention of mental disturbances.The purpose of this study was to determine whether the familiy risk diagnosis made during the first six months of a child's life accurately predicted the psychological development of a child at the age of 10-11 years, and whether family counselling provided for half of the families could prevent mental disturbances in children at this age. The study included 196+20 families and their children born between July 1, 1975 and June 30. 1976. Each family was visited 3-6 times during the child's first six months of life. Using data thus obtained the supervisory group divided the families into four risk groups which reflected the familie's circumstances with respect to the mental development of the child. There were 29 (17%) families in which the child's psychological development was considered to be at risk. After that the families were divided into counse...