Serotonin transporter gene (SLC6A4) polymorphism and susceptibility to a home-visiting maternal-infant attachment intervention delivered by community health workers in South Africa: reanalysis of a randomized controlled trial

Background Clear recognition of the damaging effects of poverty on early childhood development has fueled an interest in interventions aimed at mitigating these harmful consequences. Psychosocial interventions aimed at alleviating the negative impacts of poverty on children are frequently shown to be of benefit, but effect sizes are typically small to moderate. However, averaging outcomes over an entire sample, as is typically done, could underestimate efficacy because weaker effects on less susceptible individuals would dilute estimation of effects on those more disposed to respond. This study investigates whether a genetic polymorphism of the serotonin transporter gene moderates susceptibility to a psychosocial intervention. Methods and findings We reanalyzed data from a randomized controlled trial of a home-visiting program delivered by community health workers in a black, isiXhosa-speaking population in Khayelitsha, South Africa. The intervention, designed to enhance maternal-infant attachment, began in the third trimester and continued until 6 mo postpartum. Implemented between April 1999 and February 2003, the intervention comprised 16 home visits delivered to 220 mother–infant dyads by specially trained community health workers. A control group of 229 mother–infant dyads did not receive the intervention. Security of maternal-infant attachment was the main outcome measured at infant age 18 mo. Compared to controls, infants in the intervention group were significantly more likely to be securely attached to their primary caregiver (odds ratio [OR] = 1.7, p = 0.029, 95% CI [1.06, 2.76], d = 0.29). After the trial, 162 intervention and 172 control group children were reenrolled in a follow-up study at 13 y of age (December 2012–June 2014). At this time, DNA collected from 279 children (134 intervention and 145 control) was genotyped for a common serotonin transporter polymorphism. There were both genetic data and attachment security data for 220 children (110 intervention and 110 control), of whom 40% (44 intervention and 45 control) carried at least one short allele of the serotonin transporter gene. For these 220 individuals, carrying at least one short allele of the serotonin transporter gene was associated with a 26% higher rate of attachment security relative to controls (OR = 3.86, p = 0.008, 95% CI [1.42, 10.51], d = 0.75), whereas there was a negligible (1%) difference in security between intervention and control group individuals carrying only the long allele (OR = 0.95, p = 0.89, 95% CI [0.45, 2.01], d = 0.03). Expressed in terms of absolute risk, for those with the short allele, the probability of secure attachment being observed in the intervention group was 84% (95% CI [73%, 95%]), compared to 58% (95% CI [43%, 72%]) in the control group. For those with two copies of the long allele, 70% (95% CI [59%, 81%]) were secure in the intervention group, compared to 71% (95% CI [60%, 82%]) of infants in the control group. Controlling for sex, maternal genotype, and indices of socioeconomic adversity (housing, employment, education, electricity, water) did not change these results. A limitation of this study is that we were only able to reenroll 49% of the original sample randomized to the intervention and control conditions. Attribution of the primary outcome to causal effects of intervention in the present subsample should therefore be treated with caution. Conclusions When infant genotype for serotonin transporter polymorphism was taken into account, the effect size of a maternal-infant attachment intervention targeting impoverished pregnant women increased more than 2.5-fold when only short allele carriers were considered (from d = 0.29 for all individuals irrespective of genotype to d = 0.75) and decreased 10-fold when only those carrying two copies of the long allele were considered (from d = 0.29 for all individuals to d = 0.03). Genetic differential susceptibility means that averaging across all participants is a misleading index of efficacy. The study raises questions about how policy-makers deal with the challenge of balancing equity (equal treatment for all) and efficacy (treating only those whose genes render them likely to benefit) when implementing psychosocial interventions

Parents' assessment of parent-child interaction interventions – a longitudinal study in 101 families

<p>Abstract</p> <p>Background</p> <p>The aim of the study was to describe families with small children who participated in parent-child interaction interventions at four centres in Sweden, and to examine long term and short term changes regarding the parents' experience of parental stress, parental attachment patterns, the parents' mental health and life satisfaction, the parents' social support and the children's problems.</p> <p>Methods</p> <p>In this longitudinal study a consecutive sample of 101 families (94 mothers and 54 fathers) with 118 children (median age 3 years) was assessed, using self-reports, at the outset of the treatment (T1), six months later (T2) and 18 months after the beginning of treatment (T3). Analysis of the observed differences was carried out using Wilcoxon's Signed-Rank test and Cohen's d.</p> <p>Results</p> <p>The results from commencement of treatment showed that the parents had considerable problems in all areas examined. At the outset of treatment (T1) the mothers showed a higher level of problem load than the fathers on almost all scales. In the families where the children's problems have also been measured (children from the age of four) it appeared that they had problems of a nature and degree otherwise found in psychiatric populations. We found a clear general trend towards a positive development from T1 to T2 and this development was also reinforced from T2 to T3. Aggression in the child was one of the most common causes for contact. There were few undesired or unplanned interruptions of the treatment, and the attrition from the study was low.</p> <p>Conclusion</p> <p>This study has shown that it is possible to reach mothers as well as fathers with parenting problems and to create an intervention program with very low dropout levels – which is of special importance for families with small children displaying aggressive behaviour. The parents taking part in this study showed clear improvement trends after six months and this development was reinforced a year later. This study suggests the necessity of clinical development and future research concerning the role of fathers in parent-child interaction interventions.</p

Psychobehavioral effects of divorced mother-headed one-child families on children in China

Owing to the national “One Child per Family” policy in China, almost all children are from one-child families. Recent economic development has led to an increase in the number of children living in single parent families. These children may suffer from more mental stress than those living in two parent families. This study aims at clarifying psychobehavioral characteristics of boys and girls from mother-headed one-child families due to divorce. Three questionnaire studies, i.e., Eysenck Personality Questionnaire for Children (EPQ), Mental Health Test (MHT), and Preliminary Problems Conduct Test (PPCT) were conducted on 465 children, aged 9 to 12 years, in three elementary schools of Chengdu, China. Twenty-one boys and 26 girls from divorced families and 186 boys and 217 girls from non-divorced families were selected as study subjects. The results of the multiple stepwise logistic regression analysis indicated that boys from divorced families suffered from neurosis, loneliness, impulsiveness, rebellious tendencies and untruthfulness, whereas girls from divorced families suffered from loneliness, horrible feelings and oppressed feelings. It is suggested that the common psychobehavioral characteristic of both boys and girls from divorced families in China is loneliness; the characteristic specific of boys is “antisocial” personality and that of girls is “anxious” personality

Labor Force Supply Decisions of Rural Low-Income Mothers

Labor force participation, Rural low-income mothers, Women’s labor supply,

Consumo de álcool entre estudantes universitários Alcohol consumption by university students

O consumo de álcool é estimulado pela mídia apesar dos riscos inerentes à saúde. Estudantes da área de saúde serão os futuros profissionais a orientar a população ou servir de exemplo. O objetivo deste estudo foi analisar o consumo de álcool e fatores relacionados nestes estudantes. Participaram 608 estudantes universitários de Maceió, Alagoas, Brasil, de ambos os sexos, mediante a aplicação de um questionário autopreenchível. Foram empregados modelos de regressão de Poisson e logística multinomial. A prevalência de uso na vida de álcool foi de 90,4%. O abuso de álcool teve uma prevalência de 18,3% nos homens e 6,1% nas mulheres. Os que apresentaram maior consumo e abuso de álcool foram os do sexo masculino, de maior idade, naturais de outras cidades, fumantes e os expostos à publicidade do álcool. Os resultados deste estudo indicam uma vulnerabilidade destes jovens para condutas com risco para a saúde. Seu papel social futuro suscita necessidades distintas de formação universitária para que possam atuar profissionalmente nesta área.<br>Consumption of alcoholic beverages is widely encouraged by the mass media, despite the related health risks. Today's students in the health fields are the professionals of tomorrow who will be providing advice and serving as role models for patients. The aim of this study was to analyze alcohol consumption and related factors among these students. A total of 608 male and female university students from Maceió, the capital of Alagoas State, Brazil, completed a self-administered questionnaire. Data analysis included Poisson regression and multinomial logistic models. Prevalence of lifetime use of alcohol was 90.4%. Prevalence of alcohol abuse was 18.3% in men and 6.1% in women. Heavier alcohol consumption and alcohol abuse were observed in males, older students, non-natives of Maceió, smokers, and those exposed to alcohol advertising. The results emphasized the vulnerability of these young people to risky health behaviors. Their future social role highlights distinct needs in their university education to enable them to act professionally in this area

Understanding discordant relationships between teachers and disruptive kindergarten children: An observational study of teachers' pedagogical practices

Children with externalizing behavior problems often develop conflictual relationships with teachers, which in turn, increases the risk of school failure. Therefore, it is important to examine the protective role of sensitive teacher practices for behaviorally at-risk children. We observed teacher sensitivity and quality of behavior management in interactions with individual students in a behaviorally-diverse sample of kindergartners (N = 192). Teacher-report questionnaires were employed to assess externalizing child behavior and teacher-child relationship quality (i.e., closeness and conflict). Linear regression analyses indicated that, for girls, teacher sensitivity weakened the association between externalizing behavior and conflict. In addition, good behavior management of teachers reduced the risk of conflict for boys with externalizing behavior. The results were discussed in light of two theoretical perspectives on social gender roles and behavior development.edition: 1status: publishe

Child-care use and the association with body mass index and overweight in children from 7 months to 2 years of age.

Objectives:Studies regarding the association of child-care use with body mass index (BMI), overweight or obesity development show contradictory results. This study examined the relationship between child-care use and BMI z-scores and overweight, as well as associates of child-care use in children up to 2 years old.Methods:Longitudinal data originated from the Dutch KOALA Birth Cohort Study. Questionnaires assessed child-care use at ages 7 months and 1 and 2 years (N=2396). Height and weight assessed at 1 and 2 years were used to calculate BMI z-scores. Overweight was defined as a BMI z-score of >/=85th percentile. The influence of child-care use on weight development was tested using backward linear and logistic regression analyses. Outcomes were: (1) BMI z-score at 1 and 2 years; (2) change in BMI z-score between 1 and 2 years; (3) overweight vs non-overweight at 1 and 2 years; and (4) change from normal weight to overweight vs remaining normal weight between 1 and 2 years. The association between child-care use and parental background characteristics was tested using backward logistic regression analyses.Results:Child-care use (no/yes) at 1 and 2 years positively predicted BMI z-scores at age 2 years, as well as change in BMI z-score between 1 and 2 years. These associations were adjusted for various covariates (for example, parental working hours). Furthermore, child-care use significantly increased the odds of being overweight at age 1year. There were few differences in BMI or overweight between intensive (>16 h per week) and limited child-care use (</=16 h). Child-care use was positively associated with various parental characteristics, including parental working hours and maternal educational level.Conclusion:The findings suggest a small influence of child-care use on weight development in very young children. The child-care setting could have an important role in preventive interventions against overweight and obesity development in young children.International Journal of Obesity advance online publication, 25 May 2010; doi:10.1038/ijo.2010.100