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Findley E. "It's already stressful being a foster parent": A qualitative inquiry into foster parenting stress during COVID-19. CHILD ABUSE & NEGLECT 2023; 146:106455. [PMID: 37717544 DOI: 10.1016/j.chiabu.2023.106455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Emerging literature suggests parents were under increased stress as a result of the COVID-19 pandemic; however, fewer studies to date have examined the wellbeing of foster parents in this season. Miller et al.'s (2020) quantitative study recommended in-depth, qualitative study of the stressors faced by foster parents during COVID-19. OBJECTIVE Accordingly, this qualitative study sought to fill a gap in the literature regarding foster parents' lived experiences of foster parenting stress during the COVID-19 pandemic. PARTICIPANTS AND SETTING Virtual, semi-structured interviews were conducted with n = 20 foster parents from across one Southern U.S. state between April and July 2021. METHODS Verbatim transcripts were analyzed utilizing Braun and Clarke's (2006) thematic analysis. RESULTS Five themes emerged in the analysis: (1) Varied Descriptions of Fostering in a Pandemic; (2) Nowhere to Go; (3) COVID-Consciousness; (4) The Virtual Reality; and (5) Stress Relief. Eight total additional subthemes were recorded. All themes and subthemes were described with representative direct quotations from the data. CONCLUSIONS Findings from this study demonstrated foster parents experienced both shared and unique parenting challenges during COVID-19. Three areas for further consideration and development in practice included improving online service delivery, strengthening guidance for online parent-child visitation, and enhancing support for foster parents of children with special needs. Developing social support and self-care practices should continue to be ongoing priorities for foster parents and foster parent-serving agencies.
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Affiliation(s)
- Erin Findley
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA.
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Sánchez-Cantalejo Garrido C, Yucumá Conde D, Rueda MDM, Olry-de-Labry-Lima A, Martín-Ruiz E, Higueras-Callejón C, Cabrera-León A. Scoping review of the methodology of large health surveys conducted in Spain early on in the COVID-19 pandemic. Front Public Health 2023; 11:1217519. [PMID: 37601190 PMCID: PMC10438850 DOI: 10.3389/fpubh.2023.1217519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Background The use of health surveys has been key in the scientific community to promptly communicate results about the health impact of COVID-19. But what information was collected, where, when and how, and who was the study population? Objective To describe the methodological characteristics used in large health surveys conducted in Spain early on in the COVID-19 pandemic. Methods Scoping review. Inclusion criteria: observational studies published between January 2020 and December 2021, with sample sizes of over 2,000 persons resident in Spain. Databases consulted: PubMed, CINAHL, Literatura Latinoamericana y del Caribe en CC de la Salud, Scopus, PsycINFO, Embase, Sociological Abstracts, Dialnet and Web of Science Core Collection. We analyzed the characteristics of the literature references, methodologies and information gathered in the surveys selected. Fifty five studies were included. Results Sixty percentage of the studies included had mental health as their main topic and 75% were conducted on the general adult population. Thirteen percentage had a longitudinal design, 93% used the internet to gather information and the same percentage used non-probability sampling. Thirty percentage made some type of sampling correction to reduce coverage or non-response biases, but not selection biases. Sixty seven percentage did not state the availability of their data. Conclusions Consistent with the extensive use of non-probability sampling without any bias correction in the extraordinary setting created by COVID-19, quality population frameworks are required so that probability and representative samples can be extracted quickly to promptly address other health crises, as well as to reduce potential coverage, non-response and particularly selection biases by utilizing reweighting techniques. The low data accessibility despite the huge opportunity that COVID-19 provided for Open Science-based research is striking.
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Affiliation(s)
- Carmen Sánchez-Cantalejo Garrido
- Department of Public Health, Andalusian School of Public Health, Granada, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network, Carlos III Health Institute (ISCIII), Madrid, Spain
| | | | - María del Mar Rueda
- Department of Statistics and Operative Research, and Institute of Mathematics, University of Granada, Granada, Spain
| | - Antonio Olry-de-Labry-Lima
- Department of Public Health, Andalusian School of Public Health, Granada, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network, Carlos III Health Institute (ISCIII), Madrid, Spain
- Granada Biosanitary Research Institute, Granada, Spain
| | - Eva Martín-Ruiz
- Department of Public Health, Andalusian School of Public Health, Granada, Spain
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | | | - Andrés Cabrera-León
- Department of Public Health, Andalusian School of Public Health, Granada, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network, Carlos III Health Institute (ISCIII), Madrid, Spain
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Ghanemi A, Yoshioka M, St-Amand J. Secreted Protein Acidic and Rich in Cysteine (SPARC) to Manage Coronavirus Disease-2019 (COVID-19) Pandemic and the Post-COVID-19 Health Crisis. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10050032. [PMID: 37233608 DOI: 10.3390/medicines10050032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
Coronavirus disease-2019 (COVID-19) has had and will have impacts on public health and health system expenses. Indeed, not only it has led to high numbers of confirmed COVID-19 cases and hospitalizations, but its consequences will remain even after the end of the COVID-19 crisis. Therefore, therapeutic options are required to both tackle the COVID-19 crisis and manage its consequences during the post COVID-19 era. Secreted protein acidic and rich in cysteine (SPARC) is a biomolecule that is associated with various properties and functions that situate it as a candidate which may be used to prevent, treat and manage COVID-19 as well as the post-COVID-19-era health problems. This paper highlights how SPARC could be of such therapeutic use.
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Affiliation(s)
- Abdelaziz Ghanemi
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
- Functional Genomics Laboratory, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval Research Center, Québec, QC G1V 4G2, Canada
| | - Mayumi Yoshioka
- Functional Genomics Laboratory, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval Research Center, Québec, QC G1V 4G2, Canada
| | - Jonny St-Amand
- Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
- Functional Genomics Laboratory, Endocrinology and Nephrology Axis, CHU de Québec-Université Laval Research Center, Québec, QC G1V 4G2, Canada
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Pasi R, Babu TA, Jamir L, Ravi KS. Correlation between screen time and psychosomatic symptoms in children during COVID-19 pandemic-related lockdown. J Family Med Prim Care 2023; 12:772-776. [PMID: 37312775 PMCID: PMC10259551 DOI: 10.4103/jfmpc.jfmpc_2267_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 06/15/2023] Open
Abstract
Background This study was planned to estimate the effect of lockdown on psychosomatic problems and sleep of children and their association with screen the time during the lockdown. Methods A cross-sectional study was conducted among 1-12-year-old children at a tertiary care hospital in South India. A pre-validated questionnaire with 20 related questions was disseminated through pediatric OPD, telemedicine service, and social media to eligible parents. Results A total of 278 children aged 1-12 years with a mean (SD) age of 6.92 (3.01) years were studied. Most under 5-year-oldchildren had screen time of ≤2 hours/day, whereas 58.16% of children between 5 and 12 years spent >4 hours/day (P < 0.000). A significant proportion of participants aged 5-12 years had vision problems (P = 0.019), whereas under 5-year-old children had significant associated behavioral changes (P = 0.016) and sleep problems (P = 0.043). Conclusion Behavioral and sleep problems were significantly high and correlated with an increase in screen time among under 5-year-old children. Vision problems were more in 5-12-year-old children.
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Affiliation(s)
- Rachna Pasi
- Pediatrics, All India Institute of Medical Sciences (AIIMS), Mangalagiri, Andhra Pradesh, India
- Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Limalemla Jamir
- Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati, Assam, India
| | - Kumar S. Ravi
- Anatomy, All India Institute of Medical Sciences (AIIMS), AIIMS, Rishikesh, Uttarakhand, India
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Jemni M, Zaman R, Carrick FR, Clarke ND, Marina M, Bottoms L, Matharoo JS, Ramsbottom R, Hoffman N, Groves SJ, Gu Y, Konukman F. Exercise improves depression through positive modulation of brain-derived neurotrophic factor (BDNF). A review based on 100 manuscripts over 20 years. Front Physiol 2023; 14:1102526. [PMID: 36969600 PMCID: PMC10030936 DOI: 10.3389/fphys.2023.1102526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/30/2023] [Indexed: 03/29/2023] Open
Abstract
The aim of this review was to explore the relevant neurobiology and the association between peripheral levels of brain-derived neurotrophic factor (BDNF) and acute and short to long-term exercise regimes, as well as its relation to depression and antidepressant treatment. A 20-year literature search was conducted. The screening process resulted in 100 manuscripts. Antidepressants as well as acute exercise, particularly high-intensity, elevates BDNF in healthy humans and clinical populations, as evidenced from aerobic and resistance-based studies. Although exercise is increasingly recognised in the management of depression, acute and short-term exercise studies have failed to establish a relationship between the severity of depression and changes in peripheral BDNF. The latter rapidly returns to baseline, possibly indicating a quick re-uptake by the brain, aiding its neuroplasticity functions. The timescale of administration needed for the antidepressants to stimulate biochemical changes is longer than similar increases with acute exercise.
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Affiliation(s)
- Monèm Jemni
- Faculty of Physical Education, Ningbo University, Ningbo, Zhejiang, China
- The Carrick Institute of Neuroscience, Cape Canaveral, FL, United States
- Centre for Mental Health Research in association with The University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Monèm Jemni, ; Yaodong Gu,
| | - Rashid Zaman
- Centre for Mental Health Research in association with The University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, The University of Cambridge, Cambridge, United Kingdom
| | - Frederick Robert Carrick
- The Carrick Institute of Neuroscience, Cape Canaveral, FL, United States
- Centre for Mental Health Research in association with The University of Cambridge, Cambridge, United Kingdom
- University of Central Florida College of Medicine, Orlando, FL, United states
- MGH Institute of Health Professions, Boston, MA, United States
| | - Neil David Clarke
- Centre for Sport, Exercise and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Michel Marina
- Institut Nacional d'Educació Física de Catalunya (INEFC), Sport Performance, Barcelona, Spain
| | - Lindsay Bottoms
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom
| | | | - Roger Ramsbottom
- Sport and Health Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Norman Hoffman
- The Carrick Institute of Neuroscience, Cape Canaveral, FL, United States
| | - Shad James Groves
- The Carrick Institute of Neuroscience, Cape Canaveral, FL, United States
| | - Yaodong Gu
- Faculty of Physical Education, Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Monèm Jemni, ; Yaodong Gu,
| | - Ferman Konukman
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
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Renzi A, Conte G, Tambelli R. Somatic, Emotional and Behavioral Symptomatology in Children during COVID-19 Pandemic: The Role of Children's and Parents' Alexithymia. Healthcare (Basel) 2022; 10:2171. [PMID: 36360512 PMCID: PMC9691013 DOI: 10.3390/healthcare10112171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 09/29/2023] Open
Abstract
The COVID-19 pandemic has deeply affected the psychophysical wellbeing of children worldwide. Alexithymia, a personality trait involving difficulties in identifying and expressing feelings represents a vulnerability factor for stress-related disorders. Under pandemic stress exposure, we aimed to investigate the role of parents' and children's alexithymia in the psychophysical symptomatology shown by children and to evaluate possible differences according to age, gender and history of COVID-19 infections. The perception of parents and children about the impact of the pandemic on children's emotional, social and physiological wellbeing was also explored. Sixty-five familial triads were surveyed in the period from March to May 2022: children (n = 33 males; mean age = 9.53, sd = 1.55), mothers (mean age = 44.12; sd = 6.10) and fathers (mean age = 47.10; sd = 7.8). Both parental and children's alexithymia scores were significantly associated with somatic and externalizing symptomatology in children. Self-reported anger and externally oriented thinking scores were higher in younger children (age 8-9.9 years) than in older ones (10-12 years). Girls scored higher than boys in somatic complaints, as reported by parents. No difference emerged between children affected/not affected by COVID-19. Notably, children reported a greater negative impact of the pandemic on their emotional and psychosocial well-being than their parents. The findings emphasize the role of alexithymia in the occurrence of psychophysical symptoms in children during the COVID-19 pandemic. The reduced parental awareness of the emotional burden imposed by the pandemic on children indicates the need to better consider how epidemics affect children's mental health and to develop adequate preventive strategies to support them in these exceptional times.
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Affiliation(s)
- Alessia Renzi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy
| | - Giulia Conte
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy
| | - Renata Tambelli
- Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy
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Mental Health Consequences of COVID-19 Pandemic Period in the European Population: An Institutional Challenge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159347. [PMID: 35954706 PMCID: PMC9367746 DOI: 10.3390/ijerph19159347] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
The worldwide spread of SARS-CoV-2 has been responsible for an infectious pandemic, with repercussions on socio-economic aspects and on the physical and mental health of the general population. The present systematic review aimed to evaluate the data belonging to the European framework, analyzing the population by age group. Original articles and reviews on the state of mental health of the general European population have been researched starting from 2021. Initially, a total of 1764 studies were found, among which a total of 75 were selected. Youth were the age group most affected by pandemic consequences on mental health, with emotional and behavioral alterations observed from a third to more than a half of children and adolescents examined. Among both adolescents and adults, the female gender had a higher prevalence of psychopathological symptoms. The main risk factors were poor social support, economic difficulties, and, in particular, unemployment or job changes. Additional individual risk factors were the perception of loneliness, the presence of pre-pandemic mental illness/distress, and some personality traits, such as neuroticism, impulsiveness, and the use of maladaptive coping strategies. Unexpectedly, the elderly maintained good resilience towards change, even if a stress factor was represented by the feeling of loneliness and poor social contact. As regards suicidal behaviors, among adolescents, there was an increase in attempts of 25%, with a greater risk for the female gender. This risk increased also among adults, in association with symptoms of anxiety and depression, and poor socio-environmental conditions. In conclusion, some population groups were found to be at greater risk of psychological burden during pandemic waves, thus representing priority targets for socio-health interventions.
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Amorós-Reche V, Belzunegui-Pastor À, Hurtado G, Espada JP. Emotional Problems in Spanish Children and Adolescents during the COVID-19 Pandemic: A Systematic Review. CLÍNICA Y SALUD 2022. [DOI: 10.5093/clysa2022a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Ajanovic S, Garrido-Aguirre J, Baro B, Balanza N, Varo R, Millat-Martínez P, Arias S, Fonollosa J, Perera-Lluna A, Jordan I, Muñoz-Almagro C, Bonet-Carne E, Crosas-Soler A, Via E, Nafria B, García-García JJ, Bassat Q. How Did the COVID-19 Lockdown Affect Children and Adolescent's Well-Being: Spanish Parents, Children, and Adolescents Respond. Front Public Health 2021; 9:746052. [PMID: 34900898 PMCID: PMC8655116 DOI: 10.3389/fpubh.2021.746052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background: During the COVID-19 pandemic, lockdown strategies have been widely used to contain SARS-CoV-2 virus spread. Children and adolescents are especially vulnerable to suffering psychological effects as result of such measures. In Spain, children were enforced to a strict home lockdown for 42 days during the first wave. Here, we studied the effects of lockdown in children and adolescents through an online questionnaire. Methods: A cross-sectional study was conducted in Spain using an open online survey from July (after the lockdown resulting from the first pandemic wave) to November 2020 (second wave). We included families with children under 16 years-old living in Spain. Parents answered a survey regarding the lockdown effects on their children and were instructed to invite their children from 7 to 16 years-old (mandatory scholar age in Spain) to respond a specific set of questions. Answers were collected through an application programming interface system, and data analysis was performed using R. Results: We included 1,957 families who completed the questionnaires, covering a total of 3,347 children. The specific children's questionnaire was completed by 167 kids (7–11 years-old), and 100 adolescents (12–16 years-old). Children, in general, showed high resilience and capability to adapt to new situations. Sleeping problems were reported in more than half of the children (54%) and adolescents (59%), and these were strongly associated with less time doing sports and spending more than 5 h per day using electronic devices. Parents perceived their children to gain weight (41%), be more irritable and anxious (63%) and sadder (46%). Parents and children differed significantly when evaluating children's sleeping disturbances. Conclusions: Enforced lockdown measures and isolation can have a negative impact on children and adolescent's mental health and well-being. In future waves of the current pandemic, or in the light of potential epidemics of new emerging infections, lockdown measures targeting children, and adolescents should be reconsidered taking into account their infectiousness potential and their age-specific needs, especially to facilitate physical activity and to limit time spent on electronic devices.
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Affiliation(s)
- Sara Ajanovic
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jon Garrido-Aguirre
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain.,B2SLab, Departament d'Enginyeria de Sistemes, Automàtica i Informàtica Industrial, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Bàrbara Baro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Núria Balanza
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Sara Arias
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Jordi Fonollosa
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain.,Networking Biomedical Research Centre in the Subject Area of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Alexandre Perera-Lluna
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Iolanda Jordan
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.,Molecular Microbiology Department, Hospital Sant Joan de Deu, Esplugues, Barcelona, Spain
| | - Elisenda Bonet-Carne
- Universitat Politècnica de Catalunya, BarcelonaTech, Barcelona, Spain.,BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Aina Crosas-Soler
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Esther Via
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Begonya Nafria
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Juan José García-García
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
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