Moderate prematurity, socioeconomic status, and neurodevelopment in early childhood:A life course perspective

Sociale achterstand versterkt negatieve effecten van vroeggeboorte op ontwikkeling en gedrag Wereldwijd wordt 1 op de 10 kinderen te vroeg geboren, namelijk vóór een zwangerschapsduur van 37 weken. Verreweg de meeste van deze vroeggeboortes vinden plaats bij een zwangerschapsduur tussen 32 en 37 weken: ‘matig’ tot ‘laat’ te vroeg geboren. Uit onderzoek is gebleken dat matige vroeggeboorte samenhangt met het vaker voorkomen van ontwikkelings- en gedragsproblemen. Echter, dat zou ook een gevolg kunnen zijn van een lage sociaaleconomische status (SES), want vroeggeboortes komen meer voor bij een lage SES. Tevens is lage SES een risicofactor voor ontwikkelingsachterstand en gedragsmatige en emotionele problemen. Bevindingen uit dit proefschrift laten zien dat matige vroeggeboorte en lage SES elk afzonderlijk bijdragen aan ontwikkelings- en gedragsproblemen, leidend tot substantieel hogere risico’s bij aanwezigheid van beide factoren. Bovendien kwamen gedragsmatige problemen vaak gelijktijdig voor met ontwikkelingsachterstand. De bevindingen tonen aan dat er meer aandacht nodig is voor ontwikkelings- en gedragsproblemen bij matig te vroeg geboren kinderen met een lage SES. Nader onderzoek zal moeten uitwijzen op welke wijze vroegtijdige interventies ondersteuning zouden kunnen bieden aan deze kinderen, want het is niet bekend of vroegtijdige interventies zich meer zouden moeten richten op het stimuleren van sociaal-emotionele en cognitieve vaardigheden van het kind of bijvoorbeeld op het verbeteren van ouder-kind-interacties. Ten slotte worden in dit proefschrift mechanismen besproken waardoor matige vroeggeboorte en lage SES zouden kunnen leiden tot ontwikkelings- en gedragsproblemen en waardoor dergelijke problemen gevolgen zouden kunnen hebben voor de gezondheid op de lange termijn

Group Cognitive Behavioural Analysis System of Psychotherapy (CBASP) for persistently depressed outpatients:a retrospective chart review

BACKGROUND: Cognitive behavioural analysis system of psychotherapy (CBASP) is an effective individual treatment for persistent depressive disorder (PDD), but evidence on group treatment (Group-CBASP) is limited. Our aim was to review the effect of Group-CBASP on self-report depression severity in outpatients with PDD, overall and by age of depression-onset. METHODS: A retrospective chart review study (November 2011-March 2017) in 54 patients with PDD (29 late-onset, 25 early-onset). Patients were previously treated by pharmacotherapy (92.6%), psychotherapy (98.1%) and/or electroconvulsive therapy (11.1%). Group-CBASP involved 24 weekly sessions during 6 months, followed by individual appointments over 6 months. The Inventory of Depressive Symptoms -self rating(IDS-SR) was used at baseline and after 3, 6, 9 and 12 months, computing mean differences and response rates. RESULTS: The mean IDS-SR score decreased significantly from 39.83 at baseline to 33.78 at 6 months: a decrease from severe to moderate depression after 24 weeks of Group-CBASP, with a medium effect size (Cohen's d = .49). At 12 months, the mean IDS-SR score was 32.81, indicating moderate symptom levels remained. At 6 and 12 months, mean IDS-SR scores were similar among late- versus early-onset patients, but at 12 months response rates were higher among late-onset patients. LIMITATIONS: Although results of our study provide valuable input for future prospective studies, limitations were the use of a retrospective design and the small group size. CONCLUSION: Group-CBASP offered to an outpatient population with PDD was associated with clinically relevant decrease in self-reported symptom severity, and with sustained response particularly in patients with late onset of depression. PRACTITIONER POINTS: Group-CBASP seems to be a good alternative for CBASP in individual setting. Patients with late age of depression-onset seem to benefit more from Group-CBASP. This study shows that clinical relevant effects of Group-CBASP, followed by individual contacts, remain at least for 6 months. Research on personalizing treatment strategies is needed to improve patient assignment for Group-CBASP

Higher rates of behavioural and emotional problems at preschool age in children born moderately preterm

Objective To compare preschool children born moderately preterm (MP; 32-35 weeks' gestation) and children born at term (38-41 weeks' gestation) regarding the occurrence of behavioural and emotional problems, overall, for separate types of problems and by gender. Design Prospective cohort study consisting of a community-based sample of MP and a random sample of term-born children in 13 Preventive Child Healthcare centres throughout the Netherlands. Patients 995 MP and 577 term-born children just under age 4 were included. Main outcome measures Behavioural and emotional problems were measured using the Child Behavior Checklist 1.5-5 years. Seven syndrome scales, internalising, externalising and total problems were determined. Higher scores indicate worse outcomes. Results MP children had higher scores on all syndrome scales, internalising, externalising and total problems than term-born controls. The mean difference on total problems was 4.04 (95% CI 2.08 to 6.00). Prevalence rates of elevated externalising problem scores were highest in boys (10.5%) and internalising problems were highest in girls (9.9%). MP children were at greater risk for somatic complaints (OR 1.92, 95% CI 1.09 to 3.38), internalising (OR 2.40, 95% CI 1.48 to 3.87), externalising (OR 1.69, 95% CI 1.07 to 2.67) and total problems (OR 1.84, 95% CI 1.12 to 3.00). Conclusions Moderate preterm birth affects all domains of behavioural and emotional problems, particularly for girls. MP children should be targeted for the prevention of mental health problems as they have a great impact on developmental and social competencies at school and in the community

外国語を教えるということ(SOLAC発足10周年記念特別寄稿エッセー)

Contains fulltext : 153048.pdf (publisher's version ) (Closed access)BACKGROUND: To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema. METHODS: Cross-sectional study in a population of lymphedema patients (n = 200), undergoing treatment in a Dutch lymphedema-specialized hospital. The second-level categories of the ICF were used to collect information on patients' problems in daily functioning. RESULTS: The mean age of the study group was 56 years (22-84). In total 78.5% of the patients were female. The most frequent mentioned items were: In the Body Functions component: muscle power and mobility of joints, in the Activities and Participation component: doing housework, and changing and maintaining a body position, in the Environmental Factors: Health professionals, who can act as both facilitators and barriers. Interestingly, patients assessed their health more positively than health professionals do. CONCLUSION: By using the ICF, a considerable part of the broad spectrum of problems in functioning of lymphedema patients was reported

"... and How Are the Kids?" Psychoeducation for Adult Patients With Depressive and/or Anxiety Disorders:A Pilot Study

Depressive and anxiety disorders are highly prevalent and form a substantial burden for individuals and their family members. A recent study showed that approximately two-thirds of the children of patients with severe depressive and/or anxiety disorders develop one of these disorders themselves before 35 years of age. In the Netherlands, various preventive interventions are available for children of parents with mental illnesses. However, the actual reach of interventions is small

Development of aggression subtypes from childhood to adolescence:a group-based multi-trajectory modelling perspective

The persistence of elevated subtypes of aggression beginning in childhood have been associated with long-term maladaptive outcomes. Yet it remains unclear to what extent there are clusters of individuals following similar developmental trajectories across forms (i.e., physical and indirect) and functions (i.e., proactive and reactive) of aggression. We aimed to identify groups of children with distinct profiles of the joint development of forms and functions of aggression and to identify risk factors for group membership. A sample of 787 children was followed from birth to adolescence. Parent and teacher reports, and standardised assessments were used to measure two forms and two functions of aggressive behaviour, between six and 13 years of age along with preceding child, maternal, and family-level risk-factors. Analyses were conducted using a group-based multi-trajectory modelling approach. Five trajectory groups emerged: non-aggressors, low-stable, moderate-engagers, high-desisting, and high-chronic. Coercive parenting increased membership risk in the moderate-engagers and high-chronic groups. Lower maternal IQ increased membership risk in both high-desisting and high-chronic groups, whereas maternal depression increased membership risk in the high-desisting group only. Never being breastfed increased membership risk in the moderate-engagers group. Boys were at greater risk for belonging to groups displaying elevated aggression. Individuals with chronic aggression problems use all subtypes of aggression. Risk factors suggest that prevention programs should start early in life and target mothers with lower IQ. Strategies to deal with maternal depression and enhance positive parenting while replacing coercive parenting tactics should be highlighted in programming efforts