La récidive du cancer pédiatrique: une étude sur l'expérience maternelle

A relapse in pediatric oncology is experienced by mothers as a critical and threatening event. The diagnosis of the disease relapse implies in a new beginning of the treatment and the potential of failure and child loss. This study aimed to understand the mother's experience of her child's treatment phase. In this qualitative design study, a 39-year old mother participated in a semi-structured interview regarding aspects of her child's treatment trajectory, the resonances in family relationships, and the confrontation of the possibility of death. A thematic content analysis was used to analyze the data. The results indicated themes related to the attribution of meaning to the experience, the perception of injuries in the relationship scope, and a constant threat of loss. Understanding the mother's experiences can favor the planning of psychological interventions that support the attribution of a new meaning to the sickness-health process, as well as provide a preparation for the family regarding end-of-life care.La recurrencia en oncología pediátrica es experimentada por las madres como un evento crítico y amenazante. El diagnóstico de la recurrencia de la enfermedad implica en recomenzar el tratamiento y enfrentar la posibilidad de fracaso terapéutico y la pérdida del hijo. Este estudio buscó comprender la experiencia materna de esa etapa de tratamiento del niño. En este estudio cualitativo, una madre de 39 años participó de una entrevista semiestructurada involucrando aspectos del recorrido terapéutico de su hijo, resonancias en las relaciones familiares y confronto con la posibilidad de muerte. Los datos fueron analizados mediante el análisis de contenido temático. Los resultados revelaron asuntos relacionados con la atribución de significado a la experiencia, percepciones de perjuicios en el ámbito relacional y la constante amenaza de la pérdida. Entender las experiencias maternas puede facilitar la planificación de las intervenciones psicológicas que ayudan la resignificación del proceso de salud-enfermedad y preparan a la familia para el cuidado en el final de la vida.La récidive en Oncologie Pédiatrique est expérimentée par les mères comme un événement critique et menaçant. Le diagnostic de la récidive implique la reprise du traitement et la possibilité de faire face à un échec thérapeutique et à la perte de leurs enfants. L'étude a été réalisée dans le but de comprendre l'expérience maternelle à cette étape du traitement de l'enfant. Dans cette étude qualitative, une mère de 39 ans a participé à un entretien semi-structuré qui couvrait les aspects des voies thérapeutiques de son enfant, leur impact dans les relations familiales et la possibilité faire face à la mort de l'enfant. Les résultats ont été analysés en utilisant une analyse de contenu thématique, et ont révélé des difficultés liés à l'attribution de sens à l'expérience, la perception de la récidive par la sphère familiale et la menace constante de la perte. Comprendre les expériences maternelles peut favoriser la planification des interventions psychosociales mises en place pour encadrer le processus santé-maladie et préparent la famille pour l'expérience de fin de vie.A recidiva em oncologia pediátrica é experienciada pelas mães como um evento crítico e ameaçador. O diagnóstico da recaída da doença implica a retomada do tratamento e o confronto com a possibilidade de fracasso terapêutico e perda do filho. Este estudo teve por objetivo compreender a experiência materna nessa fase do tratamento do filho. Neste estudo de abordagem qualitativa, uma mãe de 39 anos participou de uma entrevista semiestruturada envolvendo aspectos do percurso terapêutico de seu filho, ressonâncias nas relações familiares e confronto com a possibilidade de morte. Os dados foram analisados por meio da análise de conteúdo temática. Os resultados evidenciaram temáticas relacionadas à atribuição de sentido à experiência, percepção de prejuízos na esfera relacional e constante ameaça da perda. Compreender as vivências maternas pode favorecer o planejamento de intervenções psicológicas que auxiliam a ressignificação do processo saúde-doença e preparam a família para o cuidado no final de vida

Validation of the English version of the Mood Rhythm Instrument

Background: Disruption of biological rhythms has been linked to the pathophysiology of mental disorders. However, little is known regarding the rhythmicity of mood symptoms due to the lack of validated clinical questionnaires. A better understanding of the rhythmicity of mood symptoms can help identifying individuals whose severity of mood symptoms follows an altered circadian rhythm. The objective of this study was to validate the English version of the Mood Rhythm Instrument (MRhI), a self-reported measure of self-perceived rhythmicity of mood symptoms and behaviours, in a sample of the general population from Canada. Methods: After the translation process, the final English version of the Mood Rhythm Instrument (MRhI-English) was applied on participants recruited at McMaster University and St. Joseph’s Healthcare Hamilton campuses. Individuals were also asked to answer the Reduced Morningness-Eveningness Questionnaire (rMEQ). Results: Four hundred one individuals completed the English version of the MRhI and the rMEQ. The MRhI-English presented a Cronbach’s alpha of 0.75. The factorial analysis grouped the MRhI-15 items in 3 factors (cognitive, affective and somatic), with affective items having a lower frequency of self-reported 24-h peaks. Comparison between sexes showed that women reported a higher frequency of daily peaks in irritability, anxiety, sadness and talking to friends, while men exhibited peaks more frequently in problem-solving, sexual arousal and motivation to exercise. Conclusions: Our findings suggest that the English version of the MRhI displayed good internal consistency. Future directions will include the use of the MRhI instrument in individuals with mood disorders, aiming to provide a better understanding of the relationship between daily patterns of mood variability and mental health outcomes

EFEITOS DA EXPOSIÇÃO EXCESSIVA DE TELAS NO DESENVOLVIMENTO INFANTIL

Introduction: Childhood is a crucial period for brain development and the use of screens in this age group has been the subject of discussion by Pediatric Societies, considering the possible repercussions on child development. Objective: Understand the effects of screen use on child development. Methodology: This is a systematic review study, carried out on the Pubmed, BIREME, LILACS, SciELO and IBECS platforms. The following descriptors were used in Decs/MeSH: “DIGITAL DEVICES”, “CHILDREN”, “SCREEN TIME”, “DEVELOPMENT” with the Boolean operator “AND” and the filters: “full text”, “English”, “Portuguese” and “Spanish”, in the time frame from 2019 to 2023. Articles without correlation with the theme and outside the proposed period were excluded, thus, 16 articles constituted the final sample. Results: The results found demonstrate that screen time that exceeds the recommendations of the American Academy of Pediatrics (AAP) and the Brazilian Society of Pediatrics (SBP) is associated with speech delays, behavioral disorders and changes in sleep patterns. However, the results also demonstrate that some variables in screen use, such as: total screen time, age of exposure, type of content and supervision, when following recommendations determine benefits for child development. The AAP and SPB recommendations suggest that total screen time of up to 1 hour per day, the age for exposure to screens above 2 years old, with educational and age-adapted content and the monitoring of parents and caregivers as intermediaries. Conclusion: Therefore, The present study confirmed that excessive screen exposure directly interferes with healthy child development. Given this reality, it is necessary that the recommendations for the use of screens are followed.Introdução: A infância é o período crucial para o desenvolvimento cerebral e o uso de telas nessa faixa etária têm sido pauta de discussão pelas Sociedades de Pediatria, tendo em vista as possíveis repercussões no desenvolvimento infantil. Objetivo: Compreender os efeitos do uso de tela no desenvolvimento infantil. Metodologia: Trata-se de um estudo tipo revisão sistemática, realizado nas plataformas Pubmed, BIREME, LILACS ,SciELO e IBECS. Foram utilizados os seguintes descritores em Decs/MeSH: “DIGITAL DEVICES”, “CHILDREN”, “SCREEN TIME”, “ DEVELOPMENT” com o operador booleano “AND” e os filtros: “texto completo”, “inglês”, “português” e “espanhol” , no recorte temporal de 2019 a 2023. Foram excluídos os artigos sem correlação com o tema e fora do período proposto, assim, 16 artigos constituíram a amostra final. Resultados: Os resultados encontrados demonstram que o tempo de tela que excede as recomendações da Academia Americana de Pediatria (AAP) e da Sociedade Brasileira de Pediatria (SBP) ,está associado a atrasos na fala, distúrbios comportamentais e alterações no padrão do sono. No entanto, os resultados também demonstram que algumas variáveis no uso de tela como: tempo total de tela, idade da exposição, tipo de conteúdo e supervisão, quando seguem as recomendações determinam benefícios para o desenvolvimento infantil. As recomendações da AAP e SPB sugerem que tempo total de tela de até 1h por dia, a idade para exposição às telas acima dos 2 anos, com conteúdo educativo e adaptado à idade e o monitoramento de pais e cuidadores como intermediadores.Conclusão: Portanto, o presente estudo confirmou que a exposição excessiva das telas interfere diretamente no desenvolvimento infantil saudável. Diante dessa realidade torna-se necessário que as recomendações do uso de telas sejam seguida

Prospective assessment of daily patterns of mood-related symptoms

Background: The Mood Rhythm Instrument (MRI) is a new self-report questionnaire that aims to assess, the presence, and timing of daily patterns of mood-related symptoms. Here, we examined the reliability of the MRI against a prospective daily investigation over the course of 15 days. As a secondary aim, we examined whether the number of items with a perceived daily pattern correlated with severity of depressive symptoms and psychological well-being. Methods: Thirty-two participants recruited from the general population were asked to prospectively fill out a daily version of the MRI (MRI-d) for 15 days. On the 16th day, they filled out the MRI, the Beck Depression Inventory (BDI) and the World Health Organization 5-item well-being index (WHO-5). Results: The MRI showed high agreement with the MRI-d, which suggests that the MRI is a valid tool to assess daily patterns of mood symptoms. The number of mood symptoms perceived as having daily peaks correlated positively with BDI scores and negatively with WHO-5 scores. Conclusions: The MRI might be a valid tool to investigate the presence of daily patterns and the timing of mood-related factors.The MRI does not seem to be influenced by recall or recency biases. Future studies should test the usefulness of this new clinical instrument in individuals with mood disorders, as well as its ability to detect changes in the daily timing of mood symptoms before and after treatment

The revised mood rhythm instrument : a large multicultural psychometric study

Background: Recent studies with the mood rhythm instrument (MRhI) have shown that the presence of recurrent daily peaks in specific mood symptoms are significantly associated with increased risk of psychiatric disorders. Using a large sample collected in Brazil, Spain, and Canada, we aimed to analyze which MRhI items maintained good psychometric properties across cultures. As a secondary aim, we used network analysis to visualize the strength of the association between the MRhI items. Methods: Adults (n = 1275) between 18–60 years old from Spain (n = 458), Brazil (n = 415), and Canada (n = 401) completed the MRhI and the self-reporting questionnaire (SRQ-20). Psychometric analyses followed three steps: Factor analysis, item response theory, and network analysis. Results: The factor analysis indicated the retention of three factors that grouped the MRhI items into cognitive, somatic, and affective domains. The item response theory analysis suggested the exclusion of items that displayed a significant divergence in difficulty measures between countries. Finally, the network analysis revealed a structure where sleepiness plays a central role in connecting the three domains. These psychometric analyses enabled a psychometric-based refinement of the MRhI, where the 11 items with good properties across cultures were kept in a shorter, revised MRhI version (MRhI-r). Limitations: Participants were mainly university students and, as we did not conduct a formal clinical assessment, any potential correlations (beyond the validated SRQ) cannot be ascertained. Conclusions: The MRhI-r is a novel tool to investigate self-perceived rhythmicity of mood-related symptoms and behaviors, with good psychometric properties across multiple cultures

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

AimAmazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types.LocationAmazonia.TaxonAngiosperms (Magnoliids; Monocots; Eudicots).MethodsData for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran's eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny.ResultsIn the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R2 = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R2 = 28%). A greater number of lineages were significant indicators of geographic regions than forest types.Main ConclusionNumerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R$^{2}$ = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R$^{2}$ = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution