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Maternal mental health and infant emotional reactivity: a 20-year two-cohort study of preconception and perinatal exposures
- Elizabeth Spry, Margarita Moreno-Betancur, Denise Becker, Helena Romaniuk, John B. Carlin, Emma Molyneaux, Louise M. Howard, Joanne Ryan, Primrose Letcher, Jennifer McIntosh, Jacqui A. Macdonald, Christopher J. Greenwood, Kimberley C. Thomson, Helena McAnally, Robert Hancox, Delyse M. Hutchinson, George J. Youssef, Craig A. Olsson, George C. Patton
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- Journal:
- Psychological Medicine / Volume 50 / Issue 5 / April 2020
- Published online by Cambridge University Press:
- 10 April 2019, pp. 827-837
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Background
Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied.
MethodsWe used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum.
ResultsThirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4–3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure.
ConclusionsMaternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.
Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children
- Amaly Rahman, Sarah Curtis, Beth DeBruyne, Sunil Sookram, Denise Thomson, Shari Lutz, Samina Ali
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 1 / February 2015
- Published online by Cambridge University Press:
- 08 December 2014, pp. 66-71
- Print publication:
- February 2015
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Introduction
The undertreatment of pediatric pain is a significant concern among families, clinicians, and researchers. Although some have examined prehospital pain management, the deterrents to pediatric analgesia administration by Emergency Medical Services (EMS) have not yet been examined in Canada.
ProblemThis study describes EMS pain-management practices and prehospital provider comfort treating pediatric pain. It highlights differences in pain management between adults and children and assesses the potential barriers, misconceptions, difficulties, and needs related to provision of pediatric analgesia.
MethodsA study-specific survey tool was created and distributed to all Primary Care Paramedics (PCPs) and Advanced Care Paramedics (ACPs) over four mandatory educational seminars in the city of Edmonton (Alberta, Canada) from September through December 2008.
ResultsNinety-four percent (191/202) of EMS personnel for the city of Edmonton completed the survey. The majority of respondents were male (73%, 139/191), aged 26-35 (42%, 80/191), and had been in practice less than 10 years (53%, 101/191). Seventy-four percent (141/191) of those surveyed were ACPs, while 26% (50/191) were PCPs. Although the majority of respondents reported using both pain scales and clinical judgement to assess pain for adults (85%, 162/191) and adolescents (86%, 165/191), children were six times more likely than adults (31%, 59/191 vs 5%, 10/191) to be assessed by clinical judgement alone. Emergency Medical Services personnel felt more comfortable treating adults than children (P < .001), and they were less likely to treat children even if they were experiencing identical types and intensities of pain as adults (all P values <.05) and adolescents (all P values < .05). Twenty-five percent of providers (37/147) assumed pediatric patients required less analgesia due to immature nervous systems. Three major barriers to treating children's pain included limited clinical experience (34%, 37/110), difficulty in communication (24%, 26/110) and inability to assess children's pain accurately (21%, 23/110).
ConclusionEmergency Medical Services personnel self-report that children's pain is less rigorously measured and treated than adults’ pain. Educational initiatives aimed at increasing clinical exposure to children, as well as further education regarding simple pain measurement tools for use in the field, may help to address identified barriers and discomfort with assessing and treating children.
. ,Rahman A ,Curtis S ,DeBruyne B ,Sookram S ,Thomson D ,Lutz S .Ali S Emergency Medical Services Provider Comfort with Prehospital Analgesia Administration to Children . Prehosp Disaster Med.2015 ;30 (1 ):1 -6