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Fuertes M, Almeida R, Dionisio F. Health and Psychological Predictors of Antibiotic Use in Infancy and Fathers' Role. Eur J Investig Health Psychol Educ 2025; 15:66. [PMID: 40422295 DOI: 10.3390/ejihpe15050066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Revised: 04/11/2025] [Accepted: 04/16/2025] [Indexed: 05/28/2025] Open
Abstract
Previous research has shown that antibiotic use during the first year is associated with infants' difficult behavior, maternal low sensitivity, and infant insecure-ambivalent attachment. However, these results may depend on the extent and type of parental involvement, paternal stress related to infant care, or the infant's exposure to infections. To explore this question, we analyzed the relationship between these factors and examined potential predictors of antibiotic use among demographic, health, and psychological variables. This study included 62 Portuguese infants and their fathers as participants. Demographic and health information was collected at birth, 3, 9, and 12 months. Father-infant interactive behavior was observed in free play at 3 months and infant attachment in Strange Situation at 12 months. Parental Stress and Parents' Responsibility Scales were used at 9 and 12 months, respectively. Infants who received antibiotics in the first year were less cooperative, more difficult, and less passive in free-play interactions and were more likely to attend a center-based daycare than others. In this study, the predictors of antibiotic use are infant difficultness and daycare type.
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Affiliation(s)
- Marina Fuertes
- Center for Psychology of University of Porto (CPUP), 4200-135 Porto, Portugal
- Lisbon School of Education, Polytechnic Institute of Lisbon, 1549-003 Lisbon, Portugal
| | - Rita Almeida
- Research Center for Psychological Science (CICPSI), Faculty of Psychology, University of Lisbon, 1649-013 Lisbon, Portugal
| | - Francisco Dionisio
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisbon, Portugal
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Wang Q, Gao W, Duan Y, Ren Z, Zhang Y. Exploring predictors of interaction among low-birth-weight infants and their caregivers: a machine learning-based random forest approach. BMC Pediatr 2024; 24:648. [PMID: 39390386 PMCID: PMC11465835 DOI: 10.1186/s12887-024-05080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 09/12/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality. METHODS This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3-5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results. RESULTS The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver. CONCLUSIONS The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies.
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Affiliation(s)
- Qihui Wang
- School of Nursing, Shanghai Jiao Tong University, 227 South Chongqing Road, Building 1, Room 213, Shanghai, 200025, China
| | - Wenying Gao
- School of Nursing, Shanghai Jiao Tong University, 227 South Chongqing Road, Building 1, Room 213, Shanghai, 200025, China
| | - Yi Duan
- Shanghai First Maternity and Infant Hospital, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Zijin Ren
- School of Nursing, Shanghai Jiao Tong University, 227 South Chongqing Road, Building 1, Room 213, Shanghai, 200025, China
| | - Ying Zhang
- School of Nursing, Shanghai Jiao Tong University, 227 South Chongqing Road, Building 1, Room 213, Shanghai, 200025, China.
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Hartzell G, Shaw RJ, Givrad S. Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity. Infant Ment Health J 2023; 44:837-856. [PMID: 37815538 DOI: 10.1002/imhj.22086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent-infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full-term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad-specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration.
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Affiliation(s)
- Georgina Hartzell
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Richard J Shaw
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA
| | - Soudabeh Givrad
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
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Fuertes M, Faria A, Gonçalves JL, Antunes S, Dionisio F. Antibiotic Consumption, Illness, and Maternal Sensitivity in Infants with a Disorganized Attachment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1232. [PMID: 37508729 PMCID: PMC10378158 DOI: 10.3390/children10071232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
Prior research found an association between mother-infant attachment and antibiotic use. Ambivalent-attached infants are more likely to take antibiotics than other infants, and their mothers tend to be less sensitive to their needs than most. This finding is important because it shows the association between psychological processes, early relationships, and health outcomes. We aim to learn about children with high-risk attachment relationships, such as disorganized-attached infants. This study compares antibiotic use, infant-mother interactive behavior, and health indicators according to infant attachment patterns (including disorganized attachment). For this purpose, we observed mothers-infants' interactive behavior in free play at nine months and infants' attachment in the Ainsworth Strange Situation at twelve months. Participants included 77 girls and 104 boys (full-term and preterm) and their mothers. Paradoxically, mothers of disorganized-attached infants reported that their children were ill only 1.56 times on average, but 61% of their children used antibiotics in the first nine months. The other mothers reported that their children were sick 5.73 times on average, but only 54% of their children used antibiotics in the same period. Infants with disorganized attachment had mothers who were more literate and less sensitive. These results add to a body of research that shows that early high-risk relationships affect children's lives at multiple levels.
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Affiliation(s)
- Marina Fuertes
- Centro de Psicologia, University of Porto, 4200-135 Porto, Portugal
- Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, 1549-020 Lisboa, Portugal
| | - Anabela Faria
- Hospital de Santo Espírito da Ilha Terceira, 9700-049 Angra do Heroísmo, Portugal
| | - Joana L Gonçalves
- Instituto de Psicologia e Ciências da Educação, Universidade Lusíada de Lisboa, 1349-001 Lisboa, Portugal
- inED-Centro de Investigação e Inovação em Educação, Escola Superior de Educação, Instituto Politécnico do Porto, 4200-465 Porto, Portugal
- Department of Social and Behavior Sciences, University of Maia-ISMAI, 4475-690 Maia, Portugal
| | - Sandra Antunes
- Faculdade de Psicologia, Universidade de Lisboa, 1649-013 Lisboa, Portugal
| | - Francisco Dionisio
- cE3c-Centre for Ecology, Evolution and Environmental Changes & CHANGE-Global Change and Sustainability Institute, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
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Fuertes M, Almeida AR, Antunes S, Beeghly M. Cross-modal coherence and incoherence of early infant interactive behavior: links to attachment in infants born very preterm or full-term. Attach Hum Dev 2023; 25:390-416. [PMID: 37154225 DOI: 10.1080/14616734.2023.2210122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
Infants exhibit flexibly organized configurations of facial, vocal, affective, and motor behavior during caregiver-infant interactions that convey convergent messages about their internal states and desires. Prior work documents that greater cross-modal discrepancy at 4 months predicts disorganized attachment. Here, we evaluated whether: very preterm (VPT) or full-term (FT) status predicts cross-modal coherence or incoherence in infants' behavior with the caregiver at 3 months; and, regardless of prematurity, whether cross-modal interactive coherence or incoherence predicts 12-month attachment. Participants included 155 infants (85 FT; 70 VPT), and their mothers followed from birth to 12 months (corrected age). Infants' cross-modal coherent and incoherent responses were scored microanalytically from videotaped en-face interactions. Infants' attachment security was evaluated during Ainsworth's Strange Situation. Infants born VPT exhibited more incoherent cross-modal responses and insecure attachment than infants born FT. Regardless of prematurity, infants' coherent and incoherent cross-modal interactive behaviors at 3 months predicted different attachment patterns at 12 months.
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Affiliation(s)
- Marina Fuertes
- Centro de Psicologia da Universidade do Porto, Universidade do Porto Faculdade de Psicologia e de Ciências da Educação, Porto, Portugal
| | - Ana Rita Almeida
- Centro de Investigação em Ciência Psicológica, Universidade de Lisboa Faculdade de Psicologia, Lisboa, Portugal
| | - Sandra Antunes
- Faculdade de Psicologia e Ciências da Educação, Universidade de Lisboa, Lisboa, Portugal
| | - Marjorie Beeghly
- College of Liberal Arts and Sciences, Wayne State University, Detroit, MI, USA
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The Association between Prematurity, Antibiotic Consumption, and Mother-Infant Attachment in the First Year of Life. Antibiotics (Basel) 2023; 12:antibiotics12020309. [PMID: 36830220 PMCID: PMC9952082 DOI: 10.3390/antibiotics12020309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Antibiotics have individual and public-health drawbacks. Nevertheless, mother-infant attachment quality and maternal sensitivity are associated with antibiotic use. Ambivalent-attached infants are more likely to consume antibiotics than other infants. Conceivably, the emotional over-externalization of ambivalent-attached infants and maternal anxiety when infants are ill raise concerns in healthcare professionals, leading to antibiotic over-prescriptions. However, because infants prematurely born, particularly those with less than 32 weeks of gestation, are under more accurate health vigilance, the impact of infant and maternal behavior on antibiotic prescription may vanish in this sample. To test this hypothesis, we performed a longitudinal study to compare antibiotic use and the quality of mother-infant attachment in three groups: 86 infants born at full-term, 44 moderate-to-late preterm infants (32-36 gestation weeks), and 58 very-to-extreme preterm infants (<32 gestation weeks). Infants' attachment was observed with the Ainsworth Strange Situation's experimental paradigm at 12 months of corrected age. Findings indicate that infant attachment strategy is associated with antibiotics uptake, but results vary across samples. The proportion of infants that used antibiotics is highest among ambivalent-attached infants in the full-term sample but highest among avoidant-attached infants in the very-to-extreme premature sample. Moreover, higher infant gestational age and lower maternal sensitivity determine higher antibiotic use.
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Psychological and cultural factors influencing antibiotic prescription. Trends Microbiol 2023; 31:559-570. [PMID: 36720668 DOI: 10.1016/j.tim.2022.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023]
Abstract
Humans have inundated the environment worldwide with antimicrobials for about one century, giving selective advantage to antibiotic-resistant bacteria. Therefore, antibiotic resistance has become a public health problem responsible for increased mortality and extended hospital stays because the efficacy of antibiotics has diminished. Hospitals and other clinical settings have implemented stewardship measures to reduce antibiotic administration and prescription. However, these measures demand multifactorial approaches, including multidisciplinary teams in clinical settings and the education of professionals and patients. Recent studies indicate that individual factors, such as mother-infant attachment and parenting styles, play a critical role in antibiotic use. Also, macrocontextual factors, such as economic, social, or cultural backgrounds, may impact antibiotic use rates. Therefore, research aiming to ameliorate stewardship measures must include psychologically and sociologically based research.
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