Maternal early-pregnancy vitamin d status is associated with maternal depressive symptoms in the amsterdam born children and their development cohort

Objective To examine low maternal vitamin D status as a potential risk factor for high levels of depressive symptoms in a pregnant population. Methods In the Amsterdam Born Children and Their Development cohort, maternal serum vitamin D (n = 4236) was measured during early pregnancy (median, 13 weeks) and labeled "deficient" (≤29.9 nM), "insufficient" (30-49.9 nM), "sufficient" (50-79.9 nM), and "normal" (≥80 nM). Maternal depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale at 16-week gestation. The association of vitamin D status with high levels of depressive symptoms (Center for Epidemiological Studies Depression score ≥16) was assessed by multivariate logistic regression (final sample, 4101). Results Overall, 23% of women had vitamin D deficiency, and 21% of women had vitamin D insufficiency. Women with high levels of depressive symptoms (28%) had lower vitamin D concentrations than women with low levels of depressive symptoms (p < .001). After adjustment for constitutional factors, life-style and psychosocial covariates, and sociodemographic factors, vitamin D deficiency (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.13-1.95) and insufficiency (OR, 1.44; 95% CI, 1.12-1.85) were significantly associated with high levels of depressive symptoms. Additional analyses revealed a linear trend, with an OR of 1.05 (95% CI, 1.02-1.08) for each 10-nM decrease in vitamin D status. Conclusions In this study, low early-pregnancy vitamin D status was associated with elevated depressive symptoms in pregnancy. Further research, using a randomized controlled design, would be required to confirm the causality of this association and the potential benefits of higher vitamin D intake for psychosocial health.     

Symptom profile and asthma control in school-aged children.

BACKGROUND: Children with poorly controlled asthma are at high risk of airway remodeling, sleep disruption, school absenteeism, and limited participation in activities. OBJECTIVE: To determine asthma prevalence and characterize disease severity and burden in school-aged children. METHOD: A case-finding study was conducted via a multiple-choice questionnaire and asthma algorithm. Items used for analysis include physician diagnosis of asthma, symptom severity, and health care utilization. The chi2 test was used to determine the significance of differences among cases. Logistic regression was used to evaluate the association of patient factors and asthma indicators. RESULTS: Of the 5,417 children surveyed, 1,341 (25%) were classified as being at risk of asthma. Of these asthma cases, 55% were positive by diagnosis and algorithm (active), 10% were positive per algorithm alone (suspected), and 35% were positive per diagnosis alone (nonactive). Only 14% of all asthma cases reported experiencing no respiratory symptoms (< 1% active, 2% suspected, and 40% nonactive) compared with 75% of noncases. Also, 75% of noncases reported never missing school compared with 19%, 33%, and 54% of active, suspected, and nonactive asthma cases. African American race, Medicaid enrollment, and male sex were independent predictors of asthma risk. Similarly, African American race, Medicaid enrollment, age, and persistent asthma were independent predictors of emergency department use among asthma cases. DISCUSSION: Prevalence of active symptoms suggestive of poor asthma control was extremely high among urban, minority children enrolled in Arkansas' largest public school district. Poor asthma control greatly affects quality of life, including school attendance and performance. Interventions should raise expectations and emphasize the importance of achieving asthma control.     

Sleep disturbance and daytime symptoms in wheezing school-aged children

The aim of the study was to investigate whether wheezing is associated with disturbed sleep and increased daytime symptoms in school-aged children. A random sample of 1234 children, aged 6-14 years, participated in a respiratory health study in the region of Antwerp. The International Study of Asthma and Allergies in Childhood questionnaire and a separate sleep questionnaire were completed. In the children who wheezed in the last 12 months, sleep quality was more frequently disturbed due to nocturnal awakenings and restless sleep compared with children who did not wheeze. Daytime sleepiness and tiredness were more common in wheezing than in non-wheezing children. After adjusting for possible confounders a positive association was found between wheeze and: difficulties falling asleep [odds ratio (OR) = 2.0], restless sleep (OR = 5.0), daytime sleepiness (OR = 3.8) and daytime tiredness (OR = 5.1). Chronic cough (OR = 2.4), snoring (OR = 2.0), chronic rhinitis (OR = 2.6) and eczema (OR = 3.3) were associated with disturbed sleep. Chronic cough (OR = 2.5) and rhinitis (OR = 4.1) were related to daytime tiredness. Chronic rhinitis was an important risk factor for snoring (OR = 1.9). In wheezing school-aged children, decreased quality of sleep and increased daytime tiredness and sleepiness were more often reported. Upper airway symptoms were related to the sleep disturbances.     

Maternal depression, assessment methods, and physical symptoms affect estimates of depressive symptomatology among children with cancer.

Investigated the incidence of depressive symptoms and their covariates in a sample of 99 children undergoing treatment for cancer and their mothers. Although the prevalence of depressive symptoms falling within the clinical range was low (7 to 8%), classification of these children was highly dependent upon the informant and instrument used. Interrater reliabilities did not differ from chance levels. Separate multiple regression analyses of the mother's and nurse's ratings of the child's level of depression, the child's self-report on the Child Depression Inventory, and the mother's responses to the Child Behavior Checklist depression scales revealed different statistical models for each method of assessment. However, increased severity of the mother's self-report of depressive symptoms on the Beck Depression Inventory, which was predicted by low perceived social support and hospitalization of her child, was associated with higher levels of child depression on all child- and parent-report measures. Parental adjustment, sociodemographic, and medical factors as well as methods of assessment must be addressed by models explaining the etiology of depressive symptoms among pediatric oncology patients.     

Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour

Hardly any research has examined the link between postpartum anxiety disorder and maternal bonding. This study examined if postpartum anxiety disorder and maternal bonding are related in the postpartum period. Thereby, subclinical depressive symptoms and specific aspects of an anxious symptomatology were also taken into consideration. The German sample of N?=?78 mother–infant dyads is composed of n?=?30 mothers with postpartum anxiety disorders but without major or minor depression according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and n?=?48 healthy mothers. Subjects were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M?=?4.1 months. Moreover, mothers filled out the Postpartum Bonding Questionnaire-16. The Anxiety Cognitions Questionnaire, the Body Sensations Questionnaire and the Mobility Inventory were chosen to assess different aspects of anxious symptomatology. To control for concurrent subclinical depressive symptoms, we used the German Edinburgh-Postnatal-Depression Scale. Mothers with postpartum anxiety disorder reported significantly lower bonding than healthy mothers. However, in a linear regression analysis, concurrent subclinical depressive symptoms and avoidance of anxiety-related situations in company explained 27 % of the overall variance in maternal bonding. The perceived lower bonding of mothers with anxiety disorder could be due to aspects of a concurrent subclinical depressive symptomatology. This notion emphasizes the need to target even mild depressive symptoms in the treatment of postpartum anxiety disorders. The outcomes also underline that the severity of anxious symptomatology, reflected by avoidance behaviour in company, puts the mother–infant bond at risk.     

Maternal age and depressive symptoms in a low‐income sample

In this study, depressive symptoms of 2,011 European‐American, African‐American, and Latina low‐income mothers at approximately 14 months after birth of the child were examined. Maternal age was used as a predictor of depressive symptoms. Overall, 31.9% of mothers were classified as depressed using the Center for Epidemiological Studies Depression Scale. Younger mothers tended to have more depressive symptoms among European‐American mothers only. Latina mothers had fewer depressive symptoms than African‐American and European‐American mothers. Number of children 5 years and under in the home was positively related to depressive symptoms. In addition, mothers with higher levels of self‐mastery reported fewer symptoms of depression. Implications for preventing maternal depressive symptoms are discussed. © 2008 Wiley Periodicals, Inc.     

Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma.

BACKGROUND: Improving asthma knowledge and self-management is a common focus of asthma educational programs, but most programs have had little influence on morbidity outcomes. We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care. OBJECTIVE: To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk, school-aged children with asthma. METHODS: We enrolled 119 children aged 5 to 12 years from low-income, urban areas in and around San Francisco, CA, and San Jose, CA. Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were randomized to participate in the disease management intervention or to receive their usual care (control group). Patients were evaluated for clinical and quality-of-life outcomes at weeks 8, 32, and 52 of the study. RESULTS: Compared with controls, the intervention group had significant improvements in the physical domain (P = .04 and P = .01 at 32 and 52 weeks, respectively) and social activity domain (P = .02 and P = .05 at 32 and 52 weeks, respectively) of asthma quality of life on the Child Health Survey for Asthma and child (P = .02 at 8 weeks) and parent (P = .04 and .004 at 32 and 52 weeks, respectively) asthma self-management knowledge. There were no significant differences between groups on clinical outcome variables. CONCLUSIONS: A multicomponent educational, behavioral, and medical intervention targeted at high-risk, inner-city children with asthma can improve asthma knowledge and quality of life.     

Impact of depressive symptoms on adult asthma outcomes.

BACKGROUND: Psychological disorders, including depression, are common in adults with asthma. Although depression is treatable, its impact on longitudinal asthma outcomes is not clear. OBJECTIVE: To elucidate the impact of depressive symptoms on patient-centered outcomes and emergency health care use in adults with asthma. METHODS: We conducted a prospective cohort study of 743 adults with asthma who were recruited after hospitalization for asthma. Depressive symptoms were defined as having a score of 16 or more on the Center for Epidemiologic Studies Depression Scale. We examined the impact of depressive symptoms on patient-centered outcomes (validated severity-of-asthma score, Marks Asthma Quality of Life Questionnaire, and 12-Item Short-Form Health Survey physical component summary score) and on future emergency health care use for asthma ascertained from computerized databases. RESULTS: The prevalence of depressive symptoms was 18% (95% confidence interval [CI], 15%-21%) among adults with asthma. Depressive symptoms were associated with greater severity-of-asthma scores after controlling for age, sex, race/ ethnicity, educational attainment, and cigarette smoking (mean score increment, 2.6 points; 95% CI, 1.8-3.4 points). Furthermore, depressive symptoms were associated with poorer asthma-specific quality of life (mean score increment, 19.9 points; 95% CI, 17.7-22.1 points) and poorer physical health status (mean score decrement, 3.7 points; 95% CI, 1.5-5.8 points). Depressive symptoms were associated with a greater longitudinal risk of hospitalization for asthma (hazard ratio, 1.34; 95% CI, 0.98-1.84). After controlling for differences in preventive care for asthma, the relationship was stronger (hazard ratio, 1.45; 95% CI, 1.05-2.0). CONCLUSION: Depressive symptoms are common in adults with asthma and are associated with poorer health outcomes, including greater asthma severity and risk of hospitalization for asthma.     

Stability and individual change in depressive symptoms among mothers raising young children with ASD: maternal and child correlates

Mothers raising children with Autism Spectrum Disorders (ASD) evidence elevated depressive symptoms, but symptom stability has not been examined. Mothers (N=143) of toddlers with ASD (77% boys) were enrolled and assessed when their children were 18 to 33 months old and followed annually for 2 years. Multilevel modeling revealed no significant change in group depressive symptom level, which was in the moderately elevated range (Intercept=13.67; SE=.96). In contrast, there was significant individual variation in change over time. Child problem behaviors and delayed competence, maternal anxiety symptoms and angry/hostile mood, low parenting efficacy and social supports, and coping styles were associated with depression severity. Only maternal anxiety and parenting efficacy predicted individual change. Many mothers do not appear to adapt, supporting the need for early intervention for maternal well-being. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–11, 2009.     

全程护理干预模式对雾化治疗的学龄期哮喘患儿生命体征和临床症状的影响

目的：探讨及研究全程护理干预模式对雾化治疗的学龄期哮喘患儿生命体征和临床症状的影响及治疗效果。方法：选取112例2015年8月至2016年2月来我院诊治的学龄期哮喘患儿为研究对象,随机分为全程护理干预组(A组,n=56)和常规护理干预组(A组,n=56)。患者均采用氧驱动雾化吸入治疗后,A组患者给予全程护理干预,B组患者给予传统常规护理干预,观察比较两组患者干预前后生命体征、护理后症状评分及护理工作满意度等情况。结果：A组患者在全程护理干预模式背景下,症状得到改善,生命体征以及日间和夜间症状评分均优于传统常规护理组(P<0.05);A组满意率为98.3%相较于B组满意率83.4%,两者满意度差异大(P<0.05)。结论：采用全程护理模式干预氧驱动雾化吸入治疗的学龄期哮喘儿童,可改善患儿生命体征和临床症状,全程护理干预模式值得在相关临床活动中应用与推广。     

Effects of prenatal depressive symptoms on maternal and infant cortisol reactivity

Prenatal depression is associated with adverse offspring outcomes, and the prevailing mechanistic theory to account for mood-associated effects implicates alterations of the maternal and foetal hypothalamic-pituitary adrenal (HPA) axes. Recent research suggests that depression may be associated with a failure to attenuate cortisol reactivity during early pregnancy. The aim of the current study is to investigate whether this effect continues into mid and late gestation. A further aim is to test whether maternal prenatal cortisol reactivity directly predicts infant cortisol reactivity. One hundred three pregnant women were recruited during either the second or third trimester. Depressive symptoms were assessed by self-report, and maternal salivary cortisol responses to a stressor (infant distress film) were measured. Approximately 2 months after birth, mothers (n?=?88) reported postnatal depression and infant salivary cortisol responses to inoculation were measured. Prenatal depression was not associated with cortisol reactivity to acute stress in mid and late pregnancy. Similarly, neither prenatal depression nor maternal prenatal cortisol reactivity predicted infant cortisol reactivity to inoculation at 2 months. If the effects of prenatal depression on foetal and infant development are mediated by alterations of the maternal and foetal HPA axes, then early pregnancy may be a particularly vulnerable period. Alternatively, changes to HPA reactivity may not be as central to this association as previously thought.     

Behavioral correlates of maternal depressive symptomatology in conduct-disorder children

We contrasted two predictive models of the impact of maternal depressive symptomatology on child behavior in a study of 51 mothers and their conduct-disorder children. Relations between global measures of maternal distress and child adjustment and observational measures of mother-child interaction were examined. Children of distressed mothers were more maladjusted than children of nondistressed mothers, when maladjustment was measured on the basis of a global rating, but "better" adjusted when measured on the basis of interactional measures. Measures of maternal indiscriminate responding to the child may account for these findings. Results suggest that (a) although conduct-disorder children are generally more maladjusted when their mothers are distressed, they display this maladjustment in a selective fashion, and (b) maternal distress acts as an adverse contextual factor that maintains mother-child interactional difficulties by disrupting the attentional and monitoring skills required for contingent responding.     

The influence of parent-child relatedness on depressive symptoms in children with asthma: tests of moderator and mediator models

OBJECTIVE: To examine the influence of parent-child relationship quality on the association between illness-related functional status and depressive symptoms in children with asthma. METHODS: Questionnaire data were collected from the child, caregiver, and physician. Fifty-five children with asthma (8-17 years of age), their caregivers, and physicians participated. RESULTS: Regression analyses suggest that patterns of mother-child relatedness (secure vs. insecure) mediate the relationship between functional status and depressive symptoms. CONCLUSIONS: The parent-child relationship may be an important pathway by which illness influences symptoms of depression in children with asthma. This study suggests that impaired functional status does not directly contribute to symptoms of depression, but rather influences the parent-child relationship in ways that may promote the development of depressive symptoms in the child.     

Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome

BACKGROUND: The goal was to study the effects of social support during pregnancy on maternal depressive symptoms, quality of life and pregnancy outcomes. METHODS: Eight hundred ninety-six women were prospectively studied in the first trimester of pregnancy and following completion of the pregnancy. The sample was divided into quartiles yielding groups of low, medium and high social support based on perceived social support. RESULTS: Pregnant women with low support reported increased depressive symptoms and reduced quality of life. The effects of social support on pregnancy outcomes were particularly pronounced in women who had smoked during pregnancy, with significant main effects of social support in a two-way analysis of variance (smoking status and social support) for child body length (F = 4.26, P = 0.04; 50.43 +/- 2.81 cm with low support versus 51.76 +/- 2.31 cm with high support) and birthweight (F = 11.35, P = 0.001; 3175 +/- 453 g with low support versus 3571 +/- 409 g with high support). In smokers, pregnancy complications occurred more frequently when given low support {34 versus 10.3% with high support, chi(2) = 5.49, P = 0.019; relative risk (RR) = 3.3 [95% confidence interval (95% CI) = 1.1-10.2]}, and the proportion of preterm deliveries was greater given low support (10.0 versus 0% with high support, chi(2) = 3.84, P = 0.05, odds ratio = 8.1). CONCLUSIONS: Lack of social support constitutes an important risk factor for maternal well-being during pregnancy and has adverse effects on pregnancy outcomes.     

Emotion-related abilities and depressive symptoms in Latina mothers and their children

This study examined the abilities of 40 Latina mothers and their 6- to 11-year-old children (20 girls, 20 boys) to recognize and produce emotion expressions and how these abilities differed as a function of maternal depressive symptoms. The results indicated that depressively symptomatic mothers were less accurate at recognizing basic emotions (e.g., happy, sad, etc.) and some mixed emotions (e.g., scared/ok combinations) than nonsymptomatic mothers, but there were no group differences for emotion production. In contrast, children of symptomatic mothers posed fewer recognizable sad expressions than their peers. Error pattern analyses also revealed that children of symptomatic mothers were more likely to mistakenly recognize happiness and to avoid posing sadness (across all basic emotions). Children's ability to pose emotions was related to their mothers' emotion production, and this was not moderated by maternal depressive symptoms. The discussion focuses on the possible interpersonal consequences of these biases and deficits in the emotion-related abilities of symptomatic mothers and their children and on the need to conduct research on the familial and cultural processes that might underlie these findings.