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Objective To examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample. Methods Our sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression. Results Infant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively). Conclusions Mothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.

There is limited research regarding the continuity, stability, and role of country of origin in preterm infant temperament across the first year of life. This prospective longitudinal study examined patterns of mean-level continuity and individual-differences stability of select scales of temperament at 6 and 12 months in preterm infants from three countries, Chile (n = 47), United Kingdom (n = 44), and United States (n = 50). Temperament was assessed with the Infant Behavior Questionnaire and observed using the Bayley Behavior Rating Scale. Continuity and stability across infant age, country effects, and interactions of country and age on preterm infant temperament were examined. Chilean mothers rated infants higher in soothability, duration of orienting, and orientation/engagement compared with mothers from the United Kingdom and/or United States. Continuity of temperament from 6 to 12 months varied by country: Chilean mothers reported increasing smiling and laughter and activity level from 6 to 12 months, and mothers from the United Kingdom reported decreasing smiling and laughter and increasing fear from 6 to 12 months. Infant temperament was stable in all three countries. Correlations evidenced low concordance between maternal reports and examiner observations of infant temperament at 12 months. However, among Chilean infants, higher maternal reported activity level was associated with higher examiner observed orientation/engagement score.Hay una limitada investigación acerca de la continuidad, la estabilidad y el papel del país de origen en el temperamento de infantes nacidos prematuramente a lo largo del primer año de vida. Este potencial estudio longitudinal examinó patrones de continuidad en el promedio de nivel y las diferencias individuales en cuanto a la estabilidad de selectas escalas de temperamento a los 6 y 12 meses en infantes prematuros de tres países, Chile (n = 47), Reino Unido (n = 44) y Estados Unidos (n = 50). El temperamento se evaluó con el Cuestionario de Comportamiento del Infante y el mismo se observó usando la Escala de Puntuación del Comportamiento de Bayley. Se examinaron la continuidad y la estabilidad a lo largo de la edad del infante, los efectos del país, así como las interacciones entre país y edad en el temperamento de los infantes prematuros. Las madres chilenas evaluaron a sus infantes con más altos puntajes en cuanto a posibilidad de tranquilizarlos, duración de orientarlos y la orientación/participación en comparación con madres del Reino Unidos y/o de Estados Unidos. La continuidad de temperamento de los 6 a 12 meses varió según el país: las madres chilenas reportaron aumento en la sonrisa y la risa, y el nivel de actividad de los 6 a 12 meses, y las madres del Reino Unido reportaron una disminución en la sonrisa y la risa, y un aumento en el temor de los 6 a 12 meses. El temperamento del infante fue estable en los tres países. Las correlaciones son evidencia de la concordancia entre los reportes maternos y las observaciones del examinador del temperamento del infante a los 12 meses. Sin embrago, entre los infantes chilenos, el más alto nivel de actividad reportado por las madres se asoció con un más alto puntaje del examinador en cuanto a la observada orientación/participación.Nous n'avons que des recherches limitées sur la continuité, la stabilité et le rôle du pays d'origine dans le tempérament du bébé prématuré au fil de la première année de la vie. Cette étude longitudinale prospective a examiné les modèles de continuité au niveau moyen et la stabilité des différences individuelles de certaines échelles de tempérament à 6 et à 12 mois chez les enfants prématurés de trois pays, le Chili (n = 47), le Royaume Uni (n = 44) et les Etats-Unis d'Amérique (n = 50). Le tempérament a été évalué au moyen du Questionnaire du Comportement du Nourrisson et observé en utilisant l'Echelle de Bailey d'Evaluation du Comportement du Nourrisson. La continuité et la stabilité au travers de l’âge du nourrisson, les effets du pays et les interactions du pays et de l’âge sur le tempérament du bébé prématuré ont été examinés. Les mères chiliennes ont évalué leurs bébés plus haut pour ce qui concernait la capacité à être calmé, la durée de l'orientation et l'orientation/l'engagement par comparaison aux mères du Royaume Uni et/ou des Etats-Unis. La continuité du tempérament de 6 à 12 mois a varié par pays: les mères chiliennes ont fait état de plus de sourires et de rires et d'un niveau d'activité plus élevé de 6 à 12 mois et les mères du Royaume Uni ont fait état d'une décroissance des sourires et des rires et d'une plus grande peur de 6 à 12 mois. Le tempérament du nourrisson était stable dans les trois pays. Les corrélations ont montré une concordance faible entre les rapports maternels et les observations de l'examinateur du tempérament du nourrisson à 12 mois. Cependant, chez les enfants chiliens, un niveau d'activité plus élevé rapporté par la mère était lié à un score d'orientation/d'engagement observé plus élevé de la part de l'examinateur.Multimodale Beurteilungen des Temperaments von Frühgeborenen im ersten Lebensjahr: Kontinuität, Stabilität und Moderation durch Herkunftsland und Säuglingsalter Es gibt nur wenige Untersuchungen zur Kontinuität, Stabilität und Rolle des Herkunftslandes beim Temperament von Frühgeborenen im ersten Lebensjahr. Diese prospektive Längsschnittstudie untersuchte 6 und 12 Monate nach der Geburt mithilfe ausgewählter Temperamentsskalen durchschnittliche Kontinuitätsmuster und individuelle Unterschiede in Stabilität bei Frühgeborenen aus drei Ländern: Chile (n = 47), Vereinigtes Königreich (n = 44) und Vereinigte Staaten (n = 50). Das Temperament wurde mit dem „Infant Behavior Questionnaire“ erfasst und mit der „Bayley Behavior Rating Scale“ beobachtet. Untersucht wurden Kontinuität und Stabilität über das Alter des Säuglings, Ländereffekte und Interaktionen zwischen Land und Alter im Effekt auf das Temperament des Frühgeborenen. Chilenische Mütter bewerteten ihre Säuglinge in den Bereichen Beruhigungsfähigkeit, Dauer der Orientierung und Orientierung/Engagement besser als Mütter aus dem Vereinigten Königreich und/oder den Vereinigten Staaten. Die Kontinuität des Temperaments im Alter von 6-12 Monaten variierte je nach Land: Chilenische Mütter berichteten zunehmendes Lächelnund Lachen und ein höheres Aktivitätsniveau im Zeitraum von 6 bis 12 Monaten, während Mütter aus dem Vereinigten Königreich abnehmendes Lächeln und Lachen und zunehmende Angst im Zeitraum von 6 bis 12 Monaten berichteten. Das Temperament des Säuglings war in allen drei Ländern stabil. Korrelationen zeigten im Alter von 12 Monaten eine geringe Übereinstimmung zwischen den Berichten der Mütter und den Beobachtungen der Untersuchenden zum kindlichen Temperament. Bei den chilenischen Säuglingen war jedoch ein höheres selbstberichtetes Aktivitätsniveau der Mutter mit einem höheren beobachteten Wert für Orientierung/Engagement assoziiert.タイトル 生後1年にわたる早産児の気質に関する多軸評価 出生国別および乳幼児の月齢別による気質の継続性 、安定性、および調整力 要旨 早産児の気質の生後1年間における継続性と安定性、および出生国の役割に関する研究は限られている。本研究では、3カ国の早産児を対象に、生後6～12カ月における気質の継続性と安定性のパターンを調べ、出生国別による調整力を検証した。チリ (47名) 、イギリス (44名) 、アメリカ (50名) から母親と早産児の母子を募集し、前向き縦断研究デザインを実施した。気質は6カ月時と12カ月時に乳児行動質問票によって評価され、12カ月時には行動評価尺度によって観察された。母親の気質に関する報告について、乳児の年齢による継続性と安定性、国による違い、国と乳児の年齢の交互作用が検討された。また, 母親が報告した気質と実験室で評価した12カ月時点の気質との相関を調べた.気質の選択尺度得点は国によって異なり、チリの母親と英国や米国の母親とは比較して違いがあると報告された。乳児の気質はどの国でもほぼ安定していたが、出生国と年齢が乳児の気質に交互作用を及ぼし、6-12ヶ月の気質の継続性は国によって異なることがわかった。結果は、文化的な観点で解釈される。.关于在出生后第一年早产儿气质中原籍国的连续性、稳定性和作用的研究有限。这项前瞻性纵向研究考察了来自智利 (n = 47)、英国 (n = 44) 和美国 (n = 50) 这三个国家的早产儿在 6 个月和 12 个月时气质量表的平均水平连续性和个体差异稳定性的模式。气质通过“婴儿行为问卷”进行评估, 并使用“贝利行为评定量表”进行观察。考察了婴儿年龄、原籍国以及原籍国与年龄相互作用的连续性和稳定性对早产儿气质的影响。与英国或美国的母亲相比, 智利母亲对婴儿的易安抚性、持续定向、定向或参与能力的评分更高。6-12个月的气质连续性因原籍国而异:智利母亲报告说, 6-12个月的微笑和大笑以及活动性水平有所增加;而英国母亲报告说, 6-12个月的微笑和大笑减少, 害怕增加。三个国家的婴儿气质都很稳定。相关性分析表明, 母亲的报告与检查员对12个月婴儿气质的观察之间的一致性较低。然而, 在智利婴儿中, 母亲报告的活动性水平越高, 检查员观察到的定向或参与能力得分越高。.التقييمات متعددة الوسائط لمزاج الخدج عبر السنة الأولى من العمر: الاستمرارية ، والاستقرار ، والاعتدال حسب بلد المنشأ وعمر الرضيع هناك أبحاث محدودة فيما يتعلق بالاستمرارية والاستقرار ودور البلد الأصلي في مزاج الخدج عبر السنة الأولى من العمر. تناولت هذه الدراسة الطولية الاستطلاعية أنماط معدل الاستمرارية والفروق الفردية في الاستقرار من خلال مقاييس مختارة للمزاج العام في عمر 6 و 12 شهرًا عند الخدج من ثلاثة بلدان ، تشيلي (العدد = 47) ، المملكة المتحدة (العدد = 44) ، والولايات المتحدة (العدد = 50). تم تقييم الحالة المزاجية باستخدام استبيان سلوك الرضع وملاحظتها باستخدام مقياس بايلي لتقييم السلوك. وتم فحص الاستمرارية والاستقرار عبر عمر الرضيع ، ودور البلد ، والتفاعلات بين البلد والعمر على مزاج الرضع الخدج. صنفت الأمهات التشيليات الأطفال الرضع بدرجة أعلى من حيث قابلية التسكين ومدة التوجيه والمشاركة مقارنة بالأمهات من المملكة المتحدة و / أو الولايات المتحدة. تفاوتت استمرارية الحالة المزاجية من 6 إلى 12 شهرًا حسب البلد: أبلغت الأمهات التشيليات عن زيادة الابتسام والضحك ومستوى النشاط من 6 إلى 12 شهرًا ، وأبلغت الأمهات من المملكة المتحدة عن انخفاض الابتسام والضحك وزيادة الخوف من 6 إلى 12 شهرًا. وكان مزاج الرضع مستقرًا في جميع البلدان الثلاثة. أثبتت الارتباطات توافقًا منخفضًا بين تقارير الأمهات وملاحظات القائم بالفحص لمزاج الرضيع في عمر 12 شهر. ومع ذلك ، بين الرضع التشيليين ، ارتبط مستوى النشاط الأعلى المبلغ عنه من قبل الأم مع أعلى درجة للتوجه / المشاركة الملحوظة من قبل القائم بالفحص.

Objective The objectives of this study were to examine differences in body mass index z-score (BMIZ) trajectory during early childhood among children with a younger sibling compared with those without and to test potential mediators. Methods This longitudinal cohort study included 6050 participants of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Focal children's weight, height, sibship status, screen time, active play time, family dinner frequency, and diet quality were assessed at 9 months, 24 months, preschool, and kindergarten when available. A piecewise linear regression model was used to examine the association between sibling birth and focal child's subsequent BMIZ trajectory to kindergarten. Mediation by screen time, active play time, family dinner frequency, and diet quality was tested. Results BMIZ trajectory was lower among children who had a new sibling join the family before kindergarten compared to children who did not have a new sibling join the family by kindergarten. The association was strongest when new sibship occurred when the focal child was 48 to 66 months (b = –0.026, P = .044). The association was not mediated by screen time, active play time, family dinner frequency, or diet quality. Conclusion Among a nationally representative cohort of US children, new sibship before kindergarten was associated with a lower BMIZ trajectory. Several common obesogenic risk factors did not explain the association.

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separate observational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.La temprana interacción infante-progenitor establece una fundación esencial para el bienestar de los niños pequeños, y la evidencia sobre el papel de protección de tempranas relaciones receptivas ha aumentado el interés en la efectiva detección y promoción de la salud de la relación en el cuidado pediátrico primario y los escenarios de visitas a casa. Reportamos los resultados de dos estudios experimentales que describen la confiabilidad y validez de la Temprana Detección de la Salud de la Relación (ERHS) implementada en dos contextos: un modelo innovador de promoción de la salud de la relación en el cuidado primario (Estudio 1) y un modelo de salud mental infantil de visitas a casa (Estudio 2). A lo largo de ambos, un profesional clínico entrenado evaluó ERHS siguiendo una observación de interacción en tiempo real (v.g. puntajes asignados “en el momento”). Se evaluó la confiabilidad por medio de una comparación entre los puntajes del profesional clínico y los subsecuentes puntajes de la misma interacción en video por un evaluador independiente. Adicionalmente, los datos del Estudio 2 permitieron la evaluación de la validez de los puntajes de ERHS. Los resultados de ambos estudios indicaron la confiabilidad de los puntajes ERHS “en el momento.” Es más, los puntajes del profesional clínico del Estudio 2 se asociaron con la depresión materna y los puntajes de la interacción niño-progenitor derivados de una tarea separada usando una medida bien validada basada en la investigación. Las discusiones subrayan el potencial de ERHS como una herramienta de detección, promoción y prevención que puede ser administrada factiblemente por los proveedores tanto en el cuidado primario como en los casos de visitas a casa.L'interaction précoce nourrisson-parent jette les bases essentielles du bien-être du jeune enfant et l’évidence concernant le rôle protecteur des relations précoces sécures a mené à un intérêt plus grand pour le dépistage efficace et la promotion de la santé relationnelle précoce dans les soins de santé primaire en pédiatrie ainsi que les contextes de visites à domicile. Nous rapportons ici les résultats de deux études pilotes faites aux Etats-Unis d'Amérique, qui décrivent la fiabilité et la validité d'un outil de dépistage de la santé relationnelle, le Dépistage Précoce de Santé Relationnelle (en anglais Early Relational Health Screen dont nous gardons l'abréviation ici, ERHS), mis en place dans deux contextes différents: un modèle innovateur de promotion de la santé relationnelle précoce en soin pédiatrique primaire (Etude 1) et un modèle de visite à domicile pour la santé mentale du nourrisson (Etude 2). Au travers de ces deux études un clinicien entraîné a évalué l'ERHS après une observation en temps réel de l'interaction (c'est-à-dire, des scores “sur le moment”). La fiabilité a été évaluée en comparant l'ERHS “sur le moment” au codage ultérieur de la même interaction à partir d'une vidéo, par un évaluateur indépendant. De plus les données de l'Etude 2 ont permis l’évaluation de la validité des scores ERHS “sur le moment.” Les résultats des deux études ont indiqué la fiabilité des scores ERHS “sur le moment.” De plus les scores “sur le moment” du clinicien de l'Etude 2 étaient liés à la dépression maternelle et aux scores d'interaction enfant-parent dérivés d'une tâche observationnelle séparée codée par des évaluateurs indépendants en utilisant une mesure basée sur les recherches différente et communément validée. La discussion met en lumière le potentiel de l'ERHS en tant qu'outil de dépistage, de promotion et de prévention qui peut être réalistement utilisé par les professionnels au sein des soins primaires pédiatriques et des contextes de visites à domicile.Ad-Hoc-Ratings auf dem „Early Relational Health Screen“: Eine Pilotstudie zur Anwendung bei Hausbesuchen und in der Primärversorgung Die frühe Eltern-Säugling-Interaktion bildet eine entscheidende Grundlage für das Wohlbefinden kleiner Kinder. Evidenzen für die protektive Rolle reaktionsfähiger früher Beziehungen haben das Interesse an effektivem Screening und einer Förderung der relationalen Gesundheit in der pädiatrischen Primärversorgung und bei Hausbesuchen erhöht. Wir berichten Ergebnisse aus zwei Pilotstudien, die die Reliabilität und Validität des „Early Relational Health Screen“ (ERHS) beschreiben. Das Instrument wurde in zwei Kontexten implementiert: ein innovatives Modell für die Förderung relationaler Gesundheit in der Primärversorgung (Studie 1) und ein Hausbesuchsmodell für psychische Gesundheit bei Säuglingen (Studie 2). Bei beiden Kontexten beurteilte ein ausgebildeter Kliniker nach Echtzeitbeobachtungen anhand des ERHS die Interaktion (d. h. „Ad-Hoc-Ratings“). Die Reliabilität wurde untersucht, indem das Rating des Klinikers mit einem Rating verglichen wurde, welches ein unabhängiger Gutachter nachträglich anhand eines Videos derselben Interaktion gemacht hatte. Darüber hinaus ermöglichten die Daten aus Studie 2 eine Beurteilung der Validität von ERHS-Ratings. Die Ergebnisse beider Studien zeigten, dass die ERHS-Ratings reliabel waren. Darüber hinaus waren die Ratings des Klinikers in der zweiten Studie mit mütterlicher Depression und Ratings einer Eltern-Kind-Interaktion assoziiert, die aus einer separaten Aufgabe stammten, bei der ein gut validiertes, forschungsbasiertes Maß verwendet wurde. Die Diskussion hebt das Potenzial des ERHS als Screening-, Förderungs- und Präventionsinstrument hervor, das innerhalb der Primärversorgung und in Hausbesuchssettings durchgeführt werden kann.早期関係性健康度スクリーニングのその場での評価。家庭訪問とプライマリーケアでの適用に関するパイロット研究 初期の乳幼児と親の相互作用は、幼い子どもが幸福になる重要な基盤となる。初期の応答性のある関係が保護的な役割を果たすというエビデンスにより、小児プライマリーケアや家庭訪問の場における関係性の健康度の効果的なスクリーニングと促進への関心が高まっている。本研究では, プライマリーケアにおける革新的な関係性の健康促進モデル (研究1) と, 乳幼児精神保健の家庭訪問モデル (研究2) の2つの状況で実施した早期関係性健康度スクリーニング (ERHS) の信頼性と妥当性について, 2つのパイロット研究から得られた知見を報告する。いずれの研究においても、訓練を受けた臨床家が、相互作用をリアルタイムで観察しながらERHSを評価した (すなわち、「その場」の評価をした) 。信頼性は、臨床家が評価した結果と、別の測定者が同じ相互作用をビデオで評価した結果を比較して査定した。さらに、研究2では、ERHSの評価の妥当性を査定した。両研究の結果から、「その場で」のERHS評価の信頼性が示された。さらに、研究2の臨床家による評価は、母親の抑うつ状態や、信頼度の高い研究に基づく測定法を用いる別の課題から得られた子ども-親相互作用の評価と関連していた。ERHSは、スクリーニング、促進、予防のツールとして、プライマリーケアや家庭訪問の提供者が無理なく実施できる可能性があることが示された。.婴儿与父母的早期互动为幼儿的幸福感提供了一个重要的基础, 并且有关响应式早期关系保护作用的证据增加了儿科初级保健和家访机构对有效筛查以及促进关系健康的兴趣。我们报告了两项试点研究的结果, 这些研究描述了在两种情况下实施早期关系健康筛查 (ERHS) 的可靠性和有效性:初级保健中促进关系健康的创新模式 (研究1) 和婴儿心理健康家访模式 (研究2) 。在这两项研究中, 经过培训的临床医生在实时观察互动后对ERHS进行评级 (即“即时”评级) 。通过将临床医生的评级与独立评估员对视频中相同互动的后续评级进行比较, 评估其可靠性。此外, 研究2的数据被用于评估ERHS评级的有效性。两项研究的结果均表明了“即时”ERHS评级的可靠性。此外, 研究2的临床医生评级与母亲抑郁以及儿童与父母互动评级 (来自一项单独任务, 使用经过充分验证并有研究基础的测量方法得到) 相关。讨论部分强调了ERHS作为筛查、促进和预防工具的潜力, 可由初级保健和家访机构的提供者进行管理。.التقييمات اللحظية على فحص الصحة العلائقية المبكرة: دراسة تجريبية للتطبيق في الزيارة المنزلية والرعاية الأولية يضع التفاعل المبكر بين الوالدين والرضع أساسًا مهماً لرفاهية الأطفال الصغار ، وقد أدت الأدلة المتعلقة بالدور الوقائي للعلاقات المبكرة المتجاوبة إلى زيادة الاهتمام بالفحص الفعال وتعزيز الصحة العلائقية في الرعاية الأولية للأطفال وسياقات الزيارة المنزلية. قمنا بالإبلاغ عن نتائج دراستين تجريبيتين تصفان موثوقية وصحة فحص الصحة العلائقية المبكرة (ERHS) المنفذة في سياقين: نموذج مبتكر لتعزيز الصحة العلائقية في الرعاية الأولية (الدراسة 1) ونموذج زيارة المنزل للصحة النفسية للرضع (دراسة 2). في كلتا الحالتين ، قام طبيب مدرب بتقييم الصحة العلائقية بعد الملاحظة في الوقت الفعلي للتفاعل (أي تقييمات “في الوقت الحالي”). تم تقييم الموثوقية من خلال مقارنة تقييمات الأطباء بالتقييمات اللاحقة لنفس التفاعل من الفيديو بواسطة مقيِّم مستقل. بالإضافة إلى ذلك ، سمحت بيانات الدراسة 2 بتقييم صحة التقييمات من (ERHS). أشارت نتائج الدراستين إلى موثوقية التقييمات اللحظية لفحص الصحة العلائقية المبكرة (ERHS). بالإضافة إلى ذلك ، ارتبطت تقييمات الأطباء في الدراسة 2 بالاكتئاب الأمومي وتقييمات تفاعل الطفل مع الوالدين المستمدة من مهمة منفصلة باستخدام مقياس قائم على البحث تم التحقق من صحته جيدًا. تسلط المناقشة الضوء على إمكانات ERHS كأداة للفحص والترويج والوقاية يمكن إدارتها بشكل عملي من قبل مقدمي الرعاية في سياقات الرعاية الأولية والزيارة المنزلية.

Objective To examine the main and interactive effects of the amount of daily television exposure and frequency of parent conversation during shared television viewing on parent ratings of curiosity at kindergarten, and to test for moderation by socioeconomic status (SES). Study design Sample included 5100 children from the Early Childhood Longitudinal Study, Birth Cohort. Hours of daily television exposure and frequency of parent screen-time conversation were assessed from a parent interview at preschool, and the outcome of early childhood curiosity was derived from a child behavior questionnaire at kindergarten. Multivariate linear regression examined the main and interactive effects of television exposure and parent screen-time conversation on kindergarten curiosity and tested for moderation by SES. Results In adjusted models, greater number of hours of daily television viewing at preschool was associated with lower curiosity at kindergarten (B = -0.14, p = .008). More frequent parent conversation during shared screen-time was associated with higher parent-reported curiosity at kindergarten with evidence of moderation by SES. The magnitude of association between frequency of parent conversation during television viewing and curiosity was greater for children from low SES environments, compared to children from high SES environments: (SES ≤ median): B = 0.29, p < .001; (SES > median): B = 0.11, p < .001. Conclusions Higher curiosity at kindergarten was associated with greater frequency of parent conversation during shared television viewing, with a greater magnitude of association in low-SES families. While the study could not include measures of television program content, digital media use and non-screen time conversation, our results suggest the importance of parent conversation to promote early childhood curiosity, especially for children with socioeconomic disadvantage.

Benzophenones are widely used as organic UV filters in many personal care products, especially sunscreen, to protect humans from UV radiation. The increasing use of benzophenone class UV filters has raised concerns about the potential effects on the aquatic environment. These organic UV filters are designed to absorb UV light. However, to date, studies have not considered the potential of UV light to potentiate the toxicity of benzophenones in aquatic organisms. In this study using zebrafish embryos, we assessed the median lethal concentration (LC50) and sub-lethal effects of benzophenone and oxybenzone either under natural levels of UV light or under laboratory light conditions. The LC50 value in zebrafish embryos under both light conditions of oxybenzone was lower when compared to benzophenone. Interestingly, UV light significantly decreased the LC50 values (increased toxicity) of both benzophenone and oxybenzone. The presence of UV light induced a significant increase in hydroxyl radical formation and this was reflected in both increased SOD activity and lipid peroxidation in oxybenzone treated groups. Exposure to either benzophenone or oxybenzone also delayed hatching between 60 and 96 hpf when comparing to the control group while UV exposure further delayed hatching only in oxybenzone-exposed embryos. The results demonstrate the importance of involving UV light in toxicity testing for UV filters and provide much-need information on the UV-induced toxicity of benzophenone and oxybenzone under ecologically realistic conditions.

Although the coronavirus disease 2019 pandemic has served as a flashlight, illuminating and unmasking deep socio-economic and health care divides in our country, the terrible events surrounding the horrific murder of Mr. George Floyd in Minneapolis has spawned even greater outrage. As we all know, Mr. Floyd’s death is not an isolated incident, as there have been a tragic string of such deaths in recent years that further reflect deep issues regarding racism and systemic underlying causes of injustice. Unfortunately, the country’s inability to fully address these systemic foundations of injustice persists.

BACKGROUND Although children’s curiosity is thought to be important for early learning, the association of curiosity with early academic achievement has not been tested. We hypothesized that greater curiosity would be associated with greater kindergarten academic achievement in reading and math. METHODS Sample included 6200 children in the Early Childhood Longitudinal Study, Birth Cohort. Measures at kindergarten included direct assessments of reading and math, and a parent-report behavioral questionnaire from which we derived measures of curiosity and effortful control. Multivariate linear regression examined associations of curiosity with kindergarten reading and math academic achievement, adjusting for effortful control and confounders. We also tested for moderation by effortful control, sex, and socioeconomic status (SES). RESULTS In adjusted models, greater curiosity was associated with greater kindergarten reading and math academic achievement: breading=0.11, p

Primary Subject area Medical Education Background Pediatric tracheostomy care is intimidating; regular and emergency care are critical skills. Tracheostomy care training is vital for pediatric patients who have multiple people involved in their care and are fully dependent on their tracheostomy tubes for breathing. An Alberta team is developing an informational tool, the “Tracheostomy Journey”, to help families and health care providers understand and communicate clearly about pediatric tracheostomy. A needs assessment identified consistent, universal, multimodal teaching and communication tools for families, trainees, and hospital and home care providers as a primary need. Consistency in training will also improve communication between caregivers and families. Objectives The main objective of this study was to develop shareable pediatric tracheostomy care and management teaching materials for health care professionals and families. The goals of such information are to ensure checks and balances, provide universal, consistent and cohesive teaching content to all caregivers, set expectations, and promote effective communication. Design/Methods A modified Delphi approach provided structured development of training modules using existing diverse teaching materials. Participants were asked to focus on safe, consistent pediatric tracheostomy care. Two components were to: 1) Update and consolidate basic hospital discharge checklists for families; 2) Formalize current unstructured emergency training while building new resources to teach families, staff, and trainees through goal-oriented simulations. Results We consolidated 7 Home Care tracheostomy care checklists and developed 24 simulations to teach specific care skills, incorporating input from multiple stakeholders to consolidate and unify content. Participants included primary care and subspecialty physicians (Respirology, Otolaryngology, Pediatric and Neonatal Intensive Care), home care, nursing, respiratory therapy, trainees, and families. The teaching materials emphasize inclusive, acceptable skill and confidence-building as well as mastery. Each module includes a scenario, preceptor script, and debriefing materials. Scripting is designed for future video adaptation, to allow review. Pilot evaluation with trainees included knowledge and confidence assessment before and after training, after training specifically addressed the question: “Do they address the goal?”. Conclusion Training materials were developed by an expert team via a modified Delphi process and met the intended goals of being accessible, acceptable, inclusive, and effective at teaching and consolidating the skills of those involved in pediatric tracheostomy care. These tools are ready to employ and are anticipated to improve teaching and communication for families and trainees caring for children with tracheostomy.

Objective To examine the association of gestational age with school readiness in kindergarten reading and math skills. We hypothesized that compared with infants born at 39-41 weeks, infants born at lower gestational ages would have poorer school readiness. Study design The study sample comprised 5250 children from the Early Childhood Longitudinal Study, Birth Cohort, assessed with specialized reading and math assessments at kindergarten. Poor school readiness was characterized by reading and math theta scores ≥1.5 SD below the sample mean. The aOR and 95% CI of poor school readiness were estimated using multivariate logistic regression, examining gestational age continuously and categorically (very preterm [VPT], moderate/late preterm [M/LPT], early term [ET], and term). Pairwise comparisons were performed to test for differences by gestational age category. Results There was an association between gestational age and poor school readiness for reading and math, with the suggestion of a threshold effect in children born at ≥32 weeks gestation. In adjusted models, in VPT infants, the aORs of poor school readiness in reading and math were 2.58 (95% CI, 1.29-5.15) and 3.38 (95% CI, 1.66-6.91), respectively. For infants born M/LPT and ET, the odds of poor school readiness in reading did not differ from those of children born full-term, however. Conclusions Compared with term infants, the highest odds of poor school readiness in reading and math were seen in VPT infants, with lower odds of poor school readiness in children born at ≥32 weeks gestation. Ongoing developmental surveillance before kindergarten is indicated for VPT infants.

Background Inflammatory bowel diseases (IBD) are a group of complex and multifactorial disorders with unknown etiology. Chronic intestinal inflammation develops against resident intestinal bacteria in genetically susceptible hosts. We hypothesized that host intestinal immunoglobulin (Ig) G can be used to identify bacteria involved in IBD pathogenesis. Results IgG-bound and -unbound microorganisms were collected from 32 pediatric terminal ileum aspirate washes during colonoscopy [non-IBD (n = 10), Crohn disease (n = 15), and ulcerative colitis (n = 7)], and composition was assessed using the Illumina MiSeq platform. In vitro analysis of invasive capacity was evaluated by fluorescence in situ hybridization and gentamicin invasion assay; immune activation was measured by qPCR. Despite considerable inter-individual variations, IgG binding favored specific and unique mucosa-associated species in pediatric IBD patients. Burkholderia cepacia, Flavonifractor plautii, and Rumminococcus sp. demonstrated increased IgG binding, while Pseudomonas ST29 demonstrated reduced IgG binding, in IBD. In vitro validation confirmed that B. cepacia, F. plautii, and Rumminococcus display invasive potential while Pseudomonas protogens did not. Conclusion Using IgG as a marker of pathobionts in larger patient cohorts to identify microbes and elucidate their role in IBD pathogenesis will potentially underpin new strategies to facilitate development of novel, targeted diagnostic, and therapeutic approaches. Interestingly, this method can be used beyond the scope of this manuscript to evaluate altered gut pathobionts in a number of diseases associated with altered microbiota including arthritis, obesity, diabetes mellitus, alcoholic liver disease, cirrhosis, metabolic syndrome, and carcinomas. Electronic supplementary material The online version of this article (10.1186/s40168-018-0604-3) contains supplementary material, which is available to authorized users.

BACKGROUND: Several studies support a role for gut microorganisms in the development of the common and severely debilitating chronic inflammatory bowel diseases (IBD), Crohn disease (CD) and ulcerative colitis (UC). To date, most studies have examined only samples from stool or inflamed areas, limiting the ability to differentiate between cause and effect. Our recent work examined the uninflamed terminal ileum (TI) in pediatric UC, and showed changes in diversity and composition of bacteria, suggesting that microbes proximal to diseased areas may drive inflammation distally. AIMS: As immunoglobulin (Ig)G is increased in IBD and has been shown to bind more selectively to pathogens than its counterpart, IgA, we hypothesized that IgG is formed in response to invasive microbes, and could be used to identify specific taxa involved in IBD pathogenesis. To test this, we isolated IgG-bound intestinal bacteria, identified by 16S rDNA sequencing, and tested their virulence in vitro. METHODS: TI luminal washes were collected during endoscopy of pediatric IBD patients and non-IBD controls. IgG bound (IgG+) and unbound (IgG-) bacteria were separated and collected using FACS and DNA was extracted for 16S rDNA sequencing (Ilumina MiSeq platform). Virulence of specific IgG-bound bacteria was tested in-vitro via gentamycin protection assay, microscopy and qPCR for markers of immune response. RESULTS: Species diversity and microbial composition were reduced in UC compared to non-IBD. Furthermore, the ratio of IgG+/IgG- bacteria increased in CD and UC patients by 2 and 1.5 fold, respectively. Although total abundance of Burkholderia cepacia, was comparable in IBD and non-IBD, there was a 2.5 and 4.1 fold increase in the ratio of IgG+/IgG- binding to B. cepacia in remission/mild or moderate/severe UC, respectively, compared to non-IBD. B. cepacia was previously identified in the ileum of IBD cohorts however, it is not typically recognized as an intestinal pathogen. B. cepacia displays pro-inflammatory effects and invasive potential in an in-vitro model, supporting its pathobiont potential and further supporting the use of IgG as a marker of pathobionts in IBD. CONCLUSIONS: We have demonstrated the ability of IgG-binding to selectively identify previously unrecognized mucosa-associated pathobionts, validated in-vitro. Elucidating the role of specific bacterial species in UC pathogenesis will underpin new strategies to improve our ability to direct therapies to those patients most likely to respond. FUNDING AGENCIES: CCCCCFA

Fetal alcohol spectrum disorders (FASDs) is an umbrella term that describes a variety of conditions characterized by a pattern of atypical facial features, growth restriction, structural physical abnormalities, and brain dysfunction resulting from prenatal alcohol exposure. Because the cognitive and behavioral phenotype of children with fetal alcohol spectrum disorders can be nonspecific, and overlap with the phenotype of other neurodevelopmental disorders, and because the majority of individuals with FASDs do not manifest dysmorphic craniofacial features, misdiagnosis and under-diagnosis of FASDs is common. To mitigate the long-term morbidities associated with fetal alcohol spectrum disorders, it is important to maintain a heightened index of suspicion for prenatal alcohol exposure and the possibility of an alcohol-related diagnosis in children at risk, as early diagnosis and recognition of the disabilities associated with FASDs can help optimize future outcomes.

Background: Menopause is the end of a women’s menstrual cycle and reproductive years. For some women the transition is without major problems; others struggle with various psychological and physical symptoms. Regular walking exercise can be an easy way to maintain physical and mental health. Previous focus groups revealed that women enjoy and want the social aspect of walking groups. Objectives: The goal of this study is to test use and effectiveness of a walking app platform specific for menopausal women that allows them to connect with each other to schedule walks in Edmonton, and track the effect of walking on their symptom changes. Methods: Women will be recruited from the Edmonton Menopause clinics and by word of mouth. Interested and consented women receive login information to use the app to schedule and sign-up for walks. Women will complete menopause-specific QOL and symptom questionnaires at their first login and will be prompted to complete them monthly thereafter. Women will also be asked to record their walking durations and intensities. Participating women will be invited to focus groups to discuss their experience using the app. Descriptive statistics will be applied to analyze data collected at the backend from questionnaires and surveys, and qualitative content analysis will be applied to analyze the audio-recorded focus groups. Results: A prototypic online application has been created including a user manual. Access is restricted and all potential participants will be screened after their first login by the research team prior to gaining full access. Women will then be able to use the app features for schedules and surveys. Data collected at the back end by the researchers will determine the use and effectiveness of the app and explore the impact of social walking on menopause symptom changes. Conclusion: This is the first social platform of this kind created specifically for menopausal women. Ultimately we hope that this platform will empower women to seek lifestyle changes such as walking exercises and connect with each other on the communality of menopause. Testing the use and effectiveness of the app will help us to improve and further develop the app.

Infants born preterm are at elevated risk for socioemotional difficulties; however, factors contributing to this risk are largely understudied. Within the present study, we explored infant sleep as a biosocial factor that may play a role in infant socioemotional development. Within a prospective longitudinal design, we examined parent-reported sleep patterns and observed parenting quality as predictors of infant-mother attachment in 171 infants born preterm. Using structural equation modeling, we examined main effect and moderator models linking infant sleep patterns and parenting with attachment security. Sleep patterns characterized by more daytime sleep and positive/responsive parenting predicted infant attachment security. Parent-reported nighttime sleep patterns were unrelated to attachment in this sample of infants born preterm. These results indicate that daytime sleep and parenting quality may be important for emerging attachment relationships in infants born preterm. Abstracts translated in Spanish, French, German, and Japanese can be found on the abstract page of each article on Wiley Online Library at

OBJECTIVE: To compare developmental outcomes of late preterm infants (34–36 weeks’ gestation) with infants born at early term (37–38 weeks’ gestation) and term (39–41 weeks’ gestation), from infancy through kindergarten. METHODS: Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form–Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. RESULTS: With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P < .0001). This association was not seen at 24 months, (P = .66) but reemerged at preschool. Late preterm infants demonstrated less optimal scores in preschool reading (P = .0006), preschool mathematics (P = .0014), and kindergarten reading (P = .0007) compared with infants born at term gestation. CONCLUSIONS: Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten.

The adverse effects of prenatal alcohol exposure constitute a continuum of disabilities (fetal alcohol spectrum disorders [FASD]). In 1996, the Institute of Medicine established diagnostic categories delineating the spectrum but not specifying clinical criteria by which diagnoses could be assigned. In 2005, the authors published practical guidelines operationalizing the Institute of Medicine categories, allowing for standardization of FASD diagnoses in clinical settings. The purpose of the current report is to present updated diagnostic guidelines based on a thorough review of the literature and the authors’ combined expertise based on the evaluation of >10 000 children for potential FASD in clinical settings and in epidemiologic studies in conjunction with National Institute on Alcohol Abuse and Alcoholism–funded studies, the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, and the Collaboration on FASD Prevalence. The guidelines were formulated through conference calls and meetings held at National Institute on Alcohol Abuse and Alcoholism offices in Rockville, MD. Specific areas addressed include the following: precise definition of documented prenatal alcohol exposure; neurobehavioral criteria for diagnosis of fetal alcohol syndrome, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorder; revised diagnostic criteria for alcohol-related birth defects; an updated comprehensive research dysmorphology scoring system; and a new lip/philtrum guide for the white population, incorporating a 45-degree view. The guidelines reflect consensus among a large and experienced cadre of FASD investigators in the fields of dysmorphology, epidemiology, neurology, psychology, developmental/behavioral pediatrics, and educational diagnostics. Their improved clarity and specificity will guide clinicians in accurate diagnosis of infants and children prenatally exposed to alcohol.

OBJECTIVE:Group B Streptococcus (GBS) is the leading cause of meningitis in young infants. We evaluated long-term outcomes among GBS meningitis survivors. We hypothesized that despite reduced mortality, GBS meningitis would remain a significant cause of morbidity among GBS survivors.METHODS:Ninety term and near-term infants diagnosed with GBS meningitis from 1998 through 2006 were identified from 2 children’s hospitals. Five died acutely, and 5 died at 6 months to 3 years of age. Forty-three survivors (54%; mean age 6.8, range 3–12 years) were consented for evaluation and underwent physical and neurologic examinations, hearing and vision screening, and standardized developmental assessments. Associations among presenting features, laboratory parameters, neurologic status at hospital discharge, and later developmental outcomes were explored by using descriptive statistics and logistic regression.RESULTS:Twenty-four of 43 (56%) children evaluated demonstrated age-appropriate development, 11 (25%) had mild-to-moderate impairment, and 8 (19%) had severe impairment. Admission features associated with death after hospital discharge or severe impairment included lethargy (P = .003), respiratory distress (P = .022), coma or semicoma (P = .022), seizures (P = .015), bulging fontanel (P = .034), leukopenia (P = .026), acidosis (P = .024), cerebrospinal fluid protein >300 mg/dL (P = .006), cerebrospinal fluid glucose CONCLUSIONS:Survivors of GBS meningitis continue to have substantial long-term morbidity, highlighting the need for ongoing developmental follow-up and prevention strategies such as maternal immunization.

Background: The differential susceptibility (DS) model suggests that temperamentally prone-to-distress infants may exhibit adverse outcomes in negative environments but optimal outcomes in positive environments.Thisstudyexploredtemperament,parenting,and36-monthcognitionandbehaviorinpreterm infants using the DS model. We hypothesized that temperamentally prone to distress preterm infants wouldexhibitmoreoptimalcognitionandfewerbehaviorproblemswhenearlyparentingwaspositive;and less optimal cognition and more behavior problems when early parenting was less positive. Methods: Participants included 109 preterm infants (gestation

Studies have demonstrated a strong relation between adult attachment security, using the Adult Attachment Interview (AAI), and infant security, using the Strange Situation Procedure (SSP). This suggests that a mother’s representations of attachment may influence the development of her infant’s attachment to her. This study both confirms and modifies that finding in a cohort of 47 first-time mothers and their infants. The AAIs were administered during the third trimester of pregnancy and the SSPs were performed when the infant was 14 months of age. The AAIs were classified using Crittenden’s Dynamic-Maturational Model (DMM) and the SSPs using both the DMM and also Main and Solomon’s ABC+D methods. There was a significant match of patterns for secure mothers and babies, but a tendency for inversion of insecure patterns of attachment, that is Type A mothers often had infants with a Type C pattern and vice versa. No significant relation was seen between the DMM adult and ABC+D infant patterns of attachment. A significant, but modest, association was found between the DMM and ABC+D infant SSP classifications. These findings may help guide treatment of insecure mother—infant dyads by individualizing interventions to include a focus on maternal representations of the infant and maternal responses to infant behavior.

We explored associations among preterm status (very preterm infant (VPI

The differential susceptibility (DS) model suggests that temperamentally prone-to-distress infants may exhibit adverse outcomes in negative environments but optimal outcomes in positive environments. This study explored temperament, parenting, and 36-month cognition and behavior in preterm infants using the DS model. We hypothesized that temperamentally prone to distress preterm infants would exhibit more optimal cognition and fewer behavior problems when early parenting was positive; and less optimal cognition and more behavior problems when early parenting was less positive.Participants included 109 preterm infants (gestation37 weeks) and their mothers. We assessed neonatal risk and basal vagal tone in the neonatal intensive care unit; infant temperament and parenting interactions at 9 months post-term; and child behavior and cognitive skills at 36 months post-term. Hierarchical regression analyses tested study hypotheses.Temperamentally prone-to-distress infants exhibited more externalizing problems if they experienced more critical parenting at 9 months (β = -.20, p 0.05) but fewer externalizing problems with more positive parenting. Similarly, variations in maternal positive affect (β = .25, p .01) and intrusive behaviors (β = .23, p .05) at 9 months predicted 36-month cognition at high but not at low levels of infant temperamental distress. Higher basal vagal tone predicted fewer externalizing problems (β = -.19, p .05).Early parenting behaviors relate to later behavior and development in preterm infants who are temperamentally prone to distress, and neonatal basal vagal tone predicts subsequent externalizing behaviors. These findings suggest that both biological reactivity and quality of caregiving are important predictors for later outcomes in preterm infants and may be considered as foci for developmental surveillance and interventions.

This prospective longitudinal study examined emerging effortful control skills at 24- and 36-months postterm in 172 children born preterm (