SIPNEI EARLY LIFE RASSEGNA N.4 DI APRILE 2020 della Commissione Nazionale Sipnei Early Life.

SIPNEI EARLY LIFE
Rassegna della ricerca scientifica internazionale sulle prime fasi della vita a cura
della Commissione Nazionale Sipnei Early Life.

RASSEGNA N.4 DI APRILE 2020

Rassegna Aprile 2020 pag. 1

Care colleghe e cari colleghi SIPNEI
Siamo un gruppo di socie, che vengono da percorsi differenti ma
accomunate dal desiderio
di conoscere e dalla volontà di apprendere e migliorarci ogni
giorno; curiose per natura, abbiamo nutrito questo progetto
perché diventasse uno stimolo per i professionisti Sipnei della
cura integrata, con l’intento di potenziare la prevenzione
nell’ infanzia in funzione di adulti più sani e resilienti.
Grazie al sostegno e allo stimolo del
Prof. Francesco Bottaccioli,
la rassegna vorrà essere uno strumento di approfondimento e di studio
per altri professionisti che condividono l’interesse verso la
Psiconeuroendocrinoimmunologia, con particolare riferimento alle
prime età della vita.

In questo periodo di diffusione del Sars- Cov 2, il nostro gruppo si è
interessato agli effetti delle pandemie sui bambini, sui genitori e sulle
donne in gravidanza. Al momento la letteratura, che tratta del Covid19, è
ancora un po’ carente sull’argomento, sarà quindi nostra cura tenere
aggiornata la rassegna sulle più recenti ricerche Covid in ambito Early
Life. Quello che abbiamo inserito in rassegna è un articolo del 2013, ma
terribilmente attuale, poiché si riferisce allo stress post-traumatico di
genitori e ragazzi in seguito a pandemia (in questo articolo ci si riferiva
a H1N1 e Sars).
A seguire troverete due articoli, uno legato ai danni che lo stress
prenatale può apportare al sistema immunitario del bambino con
conseguente comparsa di malattia infiammatoria bronchiale, l’altro
legato alla cura dello stress materno attraverso la metodica della
Mindfulness e il supporto sociale.
Abbiamo scelto di correlare questi tre articoli, poiché pensiamo sia
necessario- in questo momento storico- sottolineare l’interazione tra
figure professionali che si occupano di un medesimo ambito, con
specializzazioni diverse, possa essere un valido aiuto per la
prevenzione delle patologie dell’età pediatrica e per migliorare la salute
fisica e mentale delle donne in gravidanza, ma anche dei futuri genitori.

Buona lettura!

Rassegna Aprile 2020 pag. 2

Contributi a cura di:

Dott. Marilena Coniglio - psicologa psicoterapeuta
Dott. Vera Gandini - medico pediatra
Dott. Ornella Righi - medico pediatra
Dott. Emanuela Stoppele - psicologa psicoterapeuta
Dott.ssa Federica Taricco - ostetrica
Dott.ssa Veronica Ricciuto- ostetrica
Dott.ssa Gloria Curati – osteopata, fisioterapista

Rassegna a cura di:

Dott. Gloria Curati – osteopata, fisioterapista

Rassegna Aprile 2020 pag. 3

ARTICOLO 1
Posttraumatic Stress Disorder in Parents and Youth After
Health-Related Disasters
Ginny Sprang and Miriam Silman
Published online by Cambridge University Press: 25 April 2013
ABSTRACT
Objectives
This study investigated the psychosocial responses of children and their parents to
pandemic disasters, specifically measuring traumatic stress responses in children and
parents with varying disease-containment experiences.
Methods
A mixed-method approach using survey, focus groups, and interviews produced data from
398 parents. Adult respondents completed the University of California at Los Angeles
Posttraumatic Stress Disorder Reaction Index (PTSD-RI) Parent Version and the PTSD
Check List Civilian Version (PCL-C).
Results
Disease-containment measures such as quarantine and isolation can be traumatizing to a
significant portion of children and parents. Criteria for PTSD was met in 30% of isolated or
quarantined children based on parental reports, and 25% of quarantined or isolated
parents (based on self-reports).
Conclusions
These findings indicate that pandemic disasters and subsequent disease-containment
responses may create a condition that families and children find traumatic. Because
pandemic disasters are unique and do not include congregate sites for prolonged support
and recovery, they require specific response strategies to ensure the behavioral health
needs of children and families. Pandemic planning must address these needs and
disease-containment measures. (Disaster Med Public Health Preparedness. 2013;7:105-
110)
ABSTRACT TRADOTTO
Obiettivi
Questo studio ha analizzato le risposte psicosociali dei bambini e dei loro genitori a
disastri pandemici, misurando in particolare le risposte allo stress traumatico in bambini e
genitori con diverse esperienze di contenimento della malattia.
Metodi
Un approccio a metodo misto che utilizza sondaggi, focus group e interviste ha prodotto
dati da 398 genitori. Gli adulti intervistati hanno compilato la versione genitori del
Posttraumatic Stress Disorder Reaction Index (PTSD-RI) dell'Università della California a
Los Angeles e la versione civile della PTSD Check List (PCL-C).

Rassegna Aprile 2020 pag. 4

Risultati
Le misure di contenimento della malattia come la quarantena e l'isolamento possono
essere traumatizzanti per una parte significativa di bambini e genitori. I criteri per il
disturbo post traumatico da stress (PTSD) sono stati soddisfatti nel 30% dei bambini isolati
o in quarantena in base ai rapporti fatti dai genitori e nel 25% dei genitori in quarantena o
isolati (in base ai dati auto-riportati).
Conclusioni
Questi risultati indicano che le pandemie e le successive risposte di contenimento della
malattia possono creare una condizione che famiglie e bambini trovano traumatica. Poiché
le catastrofi pandemiche sono rare e non prevedono luoghi di aggregazione per un
sostegno e un supporto prolungati, richiedono strategie di risposta specifiche per garantire
le esigenze di salute comportamentale di bambini e famiglie. La pianificazione pandemica
deve rispondere a queste esigenze e alle misure di contenimento delle
malattie. (Preparazione alla salute pubblica di Disaster Med . 2013; 7: 105-110)

COMMENTO
Questo articolo ci è sembrato fondamentale da proporre proprio perché ci riporta
all'attualità che stiamo vivendo in termini di quarantena e misure di isolamento in
riferimento alla pandemia da Covid-19.
Per lo studio, all'epoca furono intervistati, nel 2009, 586 genitori di sei stati americani,
Messico e Canada che vissero le misure di quarantena o isolamento in seguito alla
pandemia da H1N1 o SARS, con il fine di ottenere informazioni sul possibile impatto
psicosociale della pandemia stessa sui bambini e sui loro genitori e sugli effetti
dell'isolamento imposto.
L'indagine fu effettuata tramite un metodo misto, che utilizzò sondaggi, focus group e
interviste; in particolare vennero compilati il Post-traumatic Stress Disorder Reaction Index
(PTSD-RI) dell'Università della California a Los Angeles in versione per i genitori e la
versione civile della PTSD Check List (PCL-C).
I genitori riferirono che la pandemia ebbe un impatto significativo sulla salute mentale dei
loro bambini. Quasi un terzo dei bambini sottoposti ad isolamento o quarantena dimostrò
sintomi significativi per la soglia di diagnosi di PTSD, con valori vicini a quelli di bambini
che avevano vissuto disastri e altri eventi traumatici gravi.
Questo articolo è senz'altro apprezzabile in quanto evidenzia la forte relazione tra livelli
clinicamente significativi di sintomi da PTSD nei genitori intervistati e nei loro figli nella
misura del86%. La constatazione che molti genitori e bambini soddisfino
contemporaneamente i criteri per PTSD dovrebbe essere un importante suggerimento nel
considerare la cura integrata come modalità fondamentale di azione per i professionisti
che conducono screening diagnostici dopo eventi di tale portata e complessità sistemica.
L'identificazione di un disturbo post-traumatico in uno dei genitori dovrebbe portare
automaticamente ad avviare buone pratiche per promuovere approfondimenti di disturbi
nella salute dei familiari e a maggior ragione ponendo il focus attentivo sui minori.

Rassegna Aprile 2020 pag. 5

Evidenziamo senz'altro i limiti dello studio nella improbabile imparzialità delle risposte
ricavate, dovuto al metodo retrospettivo di raccolta delle informazioni su sentimenti
percepiti e comportamenti agiti da parte del genitore nonché sui sintomi e il funzionamento
del bambino.
La lettura di questo articolo e dei recentissimi correlati allegati che si riferiscono al Covid-
19 vuole promuovere più riflessioni, rispetto agli effetti delle misure di restrizione attuate e
le relative strategie di contenimento della malattia con conseguente impatto negativo sulla
salute mentale dei genitori e dei bambini; questi risultati sono molto simili tra loro
nonostante nelle ricerche attuali siano stati utilizzati strumenti, questionari e check list
differenti rispetto allo studio del 2013, nonostante si riferiscano a popolazioni asiatiche e
prendano in considerazione numeri più ampi .
Da non trascurare l'impatto psicologico su bambini e adolescenti rispetto alla chiusura
prolungata delle scuole nonostante gli sforzi per garantire l'apprendimento on-line.
Tra gli stressor individuati abbiamo la durata prolungata, le paure di infezione, la
frustrazione e la noia, le informazioni inadeguate, la mancanza di contatto in presenza,
con compagni di classe, amici e insegnanti, la mancanza di spazio personale a casa e la
perdita finanziaria della famiglia.
Ulteriore spunto di riflessione è sul ruolo attivo di tutte le agenzie coinvolte nella
promozione della salute e un appello alle singole responsabilità. Le pandemie sono rare,
ma potenzialmente devastanti da un punto di vista fisico, sociale e psicologico.
Una modalità di cura integrata è la sfida che ogni professionista della salute deve
accettare per ridurre al minimo gli effetti fisici e psicologici nel lungo termine.

Rassegna Aprile 2020 pag. 6

ARTICOLO 2
Brain Behav Immun. Febbraio 2019; 76: 275-279. doi: 10.1016 / j.bbi.2018.12.002. Epub 2018 dic 11.

Sex-specific association between prenatal life stress exposure and
infant pro-inflammatory cytokine levels during acute respiratory
infection.
Brunwasser SM1, Slavich GM2, Newcomb DC3, Gebretsadik T4, Turi KN3, Stone C
Jr3, Anderson LJ5, Hartert TV3.
ABSTRACT
BACKGROUND:
Prenatal life stress exposure is linked to dysregulated immune function and chronic
inflammatory disease in offspring, but we know little about its effects on infant immune
response during viral infection.
METHOD:
To address this issue, we examined associations between prenatal life stress exposure
and infant upper-airway inflammatory markers during acute respiratory infection (ARI)
using data from a prospective, population-based birth-cohort study (N = 180). Infant
inflammation was measured as a continuous latent factor within a structural equation
modeling framework using nasal wash concentrations of interleukin-1β, interleukin-6, and
tumor necrosis factor-α. We hypothesized that infants exposed to prenatal life stress would
have greater levels of nasal inflammation during ARI and increased risk for ARI-related
morbidity in early childhood.
RESULTS:
Our findings contradicted these hypotheses and provided evidence of sexually dimorphic
effects of prenatal stress exposure on infant immune functioning during ARI. Among boys,
but not girls, prenatal stress was negatively associated with nasal inflammation and
indirectly associated with both lower ARI severity and reduced likelihood of subsequent
ARI-related hospitalization in the 2nd and 3rd years of life.
CONCLUSION:
These data suggest that prenatal stress exposure may be beneficial for infant boys in the
context of respiratory viral infections; however, it will be critical to determine if these
benefits are offset by increased risk for chronic inflammatory diseases in later childhood.
As the participants in this cohort are being followed longitudinally through age 8, we will be
able to evaluate long-term health outcomes in future studies.

ABSTRACT TRADOTTO
BACKGROUND:
L' esposizione allo stress da vita prenatale è legata alla funzione immunitaria disregolata e
alla malattia infiammatoria cronica nella prole, ma sappiamo poco sui suoi effetti sulla
risposta immunitaria del bambino durante l'infezione virale.

Rassegna Aprile 2020 pag. 7

METODO:
Per affrontare questo problema, abbiamo esaminato le associazioni tra esposizione allo
stress della vita prenatale e marker infiammatori delle vie aeree superiori durante
l'infezione respiratoria acuta (ARI) utilizzando i dati di uno studio prospettico di coorte di
nascita basato sulla popolazione (N =180). L'infiammazione infantile è stata misurata
come un fattore latente continuo all'interno di una struttura di modellizzazione di equazioni
strutturali utilizzando concentrazioni di lavaggio nasale di interleuchina-1β, interleuchina-6
e fattore di necrosi tumorale-α. Abbiamo ipotizzato che i bambini esposti allo stress della
vita prenatale avrebbero maggiori livelli di infiammazione nasale durante l'ARI e un
aumentato rischio di morbilità correlata all'ARI nella prima infanzia.
RISULTATI:
I nostri risultati contraddicono queste ipotesi e ha fornito evidenza di effetti di dimorfismo
sessuale prenatale lo stress dell'esposizione sull'alimentazione dei neonati funzionamento
del sistema immunitario durante ARI. Tra i maschi, ma non le femmine, lo stress prenatale
è stato associato negativamente all'infiammazione nasale e indirettamente associato sia
alla gravità dell'ARI inferiore sia alla ridotta probabilità di un successivo ricovero correlato
all'ARI nel 2 ° e 3 ° anno di vita.
CONCLUSIONE:
Questi dati suggeriscono che l'esposizione allo stress prenatale può essere utile per i
bambini nel contesto di infezioni virali respiratorie; tuttavia, sarà fondamentale determinare
se questi benefici sono compensati da un aumentato rischio di malattie infiammatorie
croniche nella tarda infanzia. Poiché i partecipanti a questa coorte vengono seguiti
longitudinalmente fino all'età di 8 anni, saremo in grado di valutare i risultati sanitari a
lungo termine in studi futuri.

COMMENTO
Molti studi suggeriscono che l'esposizione alle avversità in epoca prenatale influenzi lo
sviluppo del sistema immunitario fetale e conferisca al bambino un aumentato rischio di
malattie infiammatorie croniche.
Scopo dello studio era analizzare, in bambini nati sani e a termine, gli effetti
dell’esposizione allo stress in età prenatale sul sistema immunitario tramite lo studio dei
valori di tre citochine proinfiammatorie (interleuchina 1β, interleuchina 6 e fattore di necrosi
tumorale α) durante un’infezione respiratoria acuta da virus respiratorio sinciziale o
rinovirus rilevate tramite lavaggio nasale. I principali fattori di stress durante la gravidanza
sono stati valutati al follow-up di 1 anno ed erano rappresentati da separazione / divorzio,
morte di una persona cara, lavoro ad alto stress, problemi finanziari, disoccupazione,
disoccupazione dei partner o qualsiasi altro fattore di stress riferito dai partecipanti.
Sulla base delle premesse si attendeva un’associazione tra esposizione a stress prenatale
e maggiori concentrazioni di citochine pro-infiammatorie e quindi un aumentato rischio di
marcatori di gravità della malattia acuta. Inoltre, poiché il sesso sembra influenzare l'effetto
delle avversità prenatali sugli esiti infantili, sono stati studiati separatamente maschi e
femmine.

Rassegna Aprile 2020 pag. 8

Contrariamente ai risultati attesi, i neonati maschi esposti a stress prenatale avevano livelli
più bassi di infiammazione nasale durante l’evento acuto rispetto alle loro controparti non
esposte, tra i maschi l'esposizione allo stress prenatale era indirettamente associata a una
ridotta probabilità di visite mediche per infezione respiratoria come da target dello studio e
di ricoveri ospedalieri correlati all'evento. Infine, tra le femmine, l'esposizione allo stress
prenatale non era associata ad alcun esito.
I risultati sembrano suggerire che l'esposizione allo stress prenatale possa avere un
effetto benefico per i bambini maschi durante l’infezione respiratoria acuta, modificando la
risposta immunitaria all'infezione virale.
Altri studi hanno evidenziato marcatori infiammatori elevati nella prole esposta allo stress
durante periodi di benessere come se avessero difese immunitarie innescate per
combattere le infezioni al fine di aumentare le possibilità di sopravvivenza. Questo
potrebbe spiegare perché i maschi dello studio esposti allo stress hanno mostrato meno
infiammazione nasale al momento della raccolta dei campioni. È come se, per la teoria
evoluzionistica, i bambini maschi di madri sottoposte ad eventi stressanti e quindi più a
rischio di crescere in ambienti a rischio avessero una risposta proinfiammatoria più reattiva
che possa offrire loro una chance di sopravvivenza maggiore.
Non è chiaro invece perché non dovremmo vedere questo stesso effetto nelle ragazze,
sebbene il feto femminile sia generalmente più adattabile alle avversità intrauterine e
meno suscettibile all'aumentata infiammazione.
I risultati dello studio, seppure su un campione limitato (180 bambini), rafforzano l’idea che
le avversità prenatali possono alterare il funzionamento del sistema immunitario infantile in
modo dipendente dal sesso. La differenza di genera rappresenta quindi un potenziale
moderatore nella programmazione prenatale, come già rilevato in altri studi che hanno
rilevato associazioni sessualmente dipendenti tra esposizione allo stress prenatale e
rischio di respiro sibilante nella prima infanzia e asma in particolare tra i maschi.
Questa risposta proinfiammatoria, dall'altro lato, renderebbe tali soggetti più a rischio di
malattie infiammatorie croniche.

Rassegna Aprile 2020 pag. 9

ARTICOLO 3
Stress Health. 2019 Aug;35(3):330-340. doi: 10.1002/smi.2865. Epub 2019 May 17.

The influence of mindfulness and social support on stress
reactivity during pregnancy.
Sanchez Hernandez H1, Urizar GG Jr1, Yim IS2.
ABSTRACT
Exaggerated stress reactivity can lead to negative health outcomes, which can be
especially harmful during important periods of development such as pregnancy. Therefore,
studies are needed to examine potential protective factors associated with lower perceived
stress reactivity and lower cortisol awakening response (CAR) during pregnancy. The
current cross-sectional study examined whether low-income women (n = 152) with higher
mindfulness (attentiveness and awareness of the present moment) and more perceived
social support had lower levels of perceived stress reactivity and a lower CAR during
pregnancy. Women completed self-report measures of mindfulness (Mindful Attention
Awareness Scale), social support (Medical Outcomes Study-Social Support Scale), and
perceived stressreactivity (Perceived Stress Reactivity Scale) during their first trimester of
pregnancy and collected saliva using the passive drool procedure at home (at awakening
and at 30 min after awakening). Results showed that women with greater mindfulness and
greater perceived social support had significantly lower perceived stress reactivity, but not
a lower CAR. These results provide preliminary support for mindfulness and social support
as potential protective factors of perceived stress reactivity and have implications for
experimental studies aimed at improving pregnant women's mindfulness and social
support for reducing their stress reactivity and potentially improving health outcomes.
ABSTRACT TRADOTTO
Un'eccessiva reattività allo stress può portare a esiti negativi per la salute, che possono
essere particolarmente dannosi durante importanti periodi di sviluppo come la gravidanza.
Pertanto, sono necessari studi per esaminare i potenziali fattori protettivi associati alla
reattività allo stress percepita inferiore e alla minore risposta al risveglio del cortisolo
(CAR) durante la gravidanza. L'attuale studio trasversale ha esaminato se le donne a
basso reddito (n = 152) con maggiore consapevolezza (attenzione e consapevolezza del
momento presente) e un sostegno sociale più percepito presentavano livelli più bassi di
reattività allo stress percepito e una CAR inferiore durante la gravidanza. Le donne hanno
completato le misure di autoconsapevolezza (Mindful Attention Awareness Scale),
supporto sociale (Medical Outcomes Study-Social Support Scale) e percezione dello
stress reattivo (Perceived Stress Reactivity Scale) durante il loro primo trimestre di
gravidanza e raccolto campioni di saliva applicando il test salivare a casa (al risveglio e
dopo 30 minuti dal risveglio). I risultati hanno mostrato che le donne con maggiore
consapevolezza e maggiore sostegno sociale percepito avevano una reattività allo stress
percepito significativamente inferiore, ma non una CAR inferiore. Questi risultati forniscono
supporto preliminare alla consapevolezza e supporto sociale come potenziali fattori
protettivi della reattività allo stress percepita e hanno implicazioni per studi sperimentali
volti a migliorare la consapevolezza delle donne in gravidanza e il supporto sociale per
ridurre la loro reattività allo stress e potenzialmente migliorare i risultati sulla salute.

Rassegna Aprile 2020 pag. 10

COMMENTO
Durante la gravidanza, lo stress e un basso tono dell’umore possono interferire nella
relazione madre-neonato e nello sviluppo del bambino stesso.
Molti studi hanno approfondito questa tematica, indagando i possibili effetti dello stress in
gravidanza sullo sviluppo del feto e sulla salute psico-fisica del bambino dopo la nascita e
nel corso dei primi anni di vita.
Infatti lo stress materno sperimentato durante diversi periodi della gestazione appare
legato all’aumento del rischio nel bambino di sviluppare malattie neuropsichiatriche e
fisiche durante l’infanzia ma anche in età avanzata.
La letteratura internazionale, negli ultimi anni, si è interessata notevolmente agli aspetti
sopra indicati, cercando di trovare delle soluzioni per migliorare la qualità di vita delle
donne in gravidanza e dei loro futuri bambini. La crescita esponenziale e i numerosi
benefici tratti dall’utilizzo della MindfulnessBased Stress Reduction (MBSR) hanno portato
il mondo della ricerca a sperimentare il protocollo Mindfulness anche per le future mamme.

Rassegna Aprile 2020 pag. 11

ARTICOLI CORRELATI
ARTICOLO 1
(A)
Int J Environ Res Public Health, 17 (5)   2020 Mar 6

Immediate Psychological Responses and Associated Factors During the
Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic
Among the General Population in China
Cuiyan Wang 1, Riyu Pan 1, Xiaoyang Wan 1, Yilin Tan 1, Linkang Xu 1, Cyrus S
Ho 2 3, Roger C Ho 1 3 4
ABSTRACT
Background
The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of
international concern and poses a challenge to psychological resilience. Research data
are needed to develop evidence-driven strategies to reduce adverse psychological
impacts and psychiatric symptoms during the epidemic. The aim of this study was to
survey the general public in China to better understand their levels of psychological
impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak.
The data will be used for future reference. Methods: From 31 January to 2 February 2020,
we conducted an online survey using snowball sampling techniques. The online survey
collected information on demographic data, physical symptoms in the past 14 days,
contact history with COVID-19, knowledge and concerns about COVID-19, precautionary
measures against COVID-19, and additional information required with respect to COVID-
19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R),
and mental health status was assessed by the Depression, Anxiety and Stress Scale
(DASS-21). Results: This study included 1210 respondents from 194 cities in China. In
total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or
severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported
moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress
levels. Most respondents spent 20-24 h per day at home (84.7%); were worried about their
family members contracting COVID-19 (75.2%); and were satisfied with the amount of
health information available (75.1%). Female gender, student status, specific physical
symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were
significantly associated with a greater psychological impact of the outbreak and higher
levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate
health information (e.g., treatment, local outbreak situation) and particular precautionary
measures (e.g., hand hygiene, wearing a mask) were associated with a lower
psychological impact of the outbreak and lower levels of stress, anxiety, and depression
(p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more
than half of the respondents rated the psychological impact as moderate-to-severe, and
about one-third reported moderate-to-severe anxiety. Our findings identify factors
associated with a lower level of psychological impact and better mental health status that
can be used to formulate psychological interventions to improve the mental health of
vulnerable groups during the COVID-19 epidemic.
Rassegna Aprile 2020 pag. 12

(B)
Lancet. 2020 Mar 14;395(10227):912-920. doi: 10.1016/S0140-6736(20)30460-8. Epub
2020 Feb 26.

The psychological impact of quarantine and how to reduce it: rapid
review of the evidence.
Brooks SK1, Webster RK2, Smith LE2, Woodland L2, Wessely S2, Greenberg N2, Rubin
GJ2.
ABSTRACT
The December, 2019 coronavirus disease outbreak has seen many countries ask people
who have potentially come into contact with the infection to isolate themselves at home or
in a dedicated quarantine facility. Decisions on how to apply quarantine should be based
on the best available evidence. We did a Review of the psychological impact of quarantine
using three electronic databases. Of 3166 papers found, 24 are included in this Review.
Most reviewed studies reported negative psychological effects including post-
traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine
duration, infection fears, frustration, boredom, inadequate supplies, inadequate
information, financial loss, and stigma. Some researchers have suggested long-lasting
effects. In situations where quarantine is deemed necessary, officials should quarantine
individuals for no longer than required, provide clear rationale for quarantine and
information about protocols, and ensure sufficient supplies are provided. Appeals to
altruism by reminding the public about the benefits of quarantine to wider society can be
favourable.

(C)
Lancet. 2020 Mar 21;395(10228):945-947. doi: 10.1016/S0140-6736(20)30547-X. Epub
2020 Mar 4.

Mitigate the effects of home confinement on children during the COVID-
19 outbreak.
Wang G1, Zhang Y2, Zhao J2, Zhang J3, Jiang F4.
In response to the coronavirus disease 2019 (COVID-19) outbreak, the Chinese
Government has ordered a nationwide school closure as an emergency measure to
prevent spreading of the infection. Public activities are discouraged. The Ministry of
Education estimates that more than 220 million children and adolescents are confinedto
their homes; this includes 180 million primary and secondary students and 47 million
preschool children. Thanks to the strong administrative system in China, the emergency
home schooling plan has been rigorously implemented. Massive efforts are being made by
schools and teachers at all levels to create online courses and deliver them through TV
broadcasts and the internet in record time. The new virtual semester has just started in
many parts of the country, and various courses are offered online in a well organised

Rassegna Aprile 2020 pag. 13

manner. These actions are helping to alleviate many parents’ concerns about their
children’s educational attainment by ensuring that school learning is largely undisrupted.
Although these measures and efforts are highly commendable and necessary, there are
reasons to be concerned because prolonged school closure and home confinement during
a disease outbreak might have negative effects on children’s physical and mental health.
Evidence suggests that when children are out of school ( weekends and summer
holidays), they are physically less active, have much longer screen time, irregular sleep
patterns, and less favourable diets, resulting in weight gain and a loss of cardiorespiratory
fitness.
Such negative effects on health are likely to be much worse when children are confined to
their homes without outdoor activities and interaction with same aged friends during the
outbreak. Perhaps a more important but easily neglected issue is the psychological impact
on children and adolescents.
Stressors such as prolonged duration, fears of infection, frustration and boredom,
inadequate information, lack of in-person contact with classmates, friends, and teachers,
lack of personal space at home, and family financial loss can have even more
problematicand enduring effects on children and adolescents. For example, Sprang and
Silman showed that the mean post-traumatic stress scores were four times higher in
children who had been quarantined than in those who were not quarantined. Furthermore,
the interaction between lifestyle changes and psychosocial stress caused by home
confinement could further aggravate the detrimental effects on child physical and mental
health, which could cause a vicious circle.
To mitigate the consequences of home confinement, the government, non-governmental
organisations (NGOs), the community, school, and parents need to be aware of the
downside of the situation and do more to effectively address these issues immediately.
Experiences learned from previous outbreaks can be valuable for designing a new
programme to tackle these issues in China.
The Chinese Government needs to raise the awareness of potential physical and mental
health impacts of home confinement during this unusual period. The government should
also provide guidelines and principles in effective online learning and ensure that the
contents of the courses meet the educational requirements. Yet it is also important not to
overburden the students. The government might mobilise existing resources, perhaps
involving NGOs, and create a platform for gathering the best online education courses
about healthy lifestyle and psychosocial support programmes available for schools to
choose from. For example, in addition to innovative courses for a better learning
experience, promotional videos can be useful to motivate children to have a healthy
lifestyle at home by increasing physical activities, having a balanced diet, regular sleep
pattern, and good personal hygiene.
To make these educational materials truly effective, they must be age-appropriate and
attractive. They require professional expertise and real resources to create.
Communities can serve as valuable resources in managing difficulties of family matters.
For instance, parents’ committees can work together to bridge the needs of students with
school requirements and to advocate for children’s rights to a healthy lifestyle.

Rassegna Aprile 2020 pag. 14

Psychologists can provide online services to cope with mental health issues caused by
domestic conflicts, tension with parents, and anxiety from becoming infected.
Social workers can play an active role in helping parents cope with family issues arising
from the situation, when needed. Such a social safety net could be particularly useful for
disadvantaged or single-parent families, but action is needed to make it accessible to
them. Schools have a critical role, not only in delivering educational materials to children,
but in offering an opportunity for students to interact with teachers and obtain
psychological counselling. Schools can actively promote a healthconscious schedule,
good personal hygiene, encourage physical activities,appropriate diet, and good sleep
habits, and integrate such health promotion materials into the school curriculum.
In the event of home confinement, parents are often the closest and best resource for
children to seek help from. Close and open communication with children is the key to
identifying any physical and psychological issues and to comforting children in prolonged
isolation. Parents are often important role models in healthy behaviour for children. Good
parenting skills become particularly crucial when children are confined at home. child
Besidesmonitoring performance and behaviour, parents also need to respect their identity
and needs, and they need to help children develop self-discipline skills. Children are
constantly exposed to epidemic-related news, so having direct conversations with
childrenabout these issues could alleviate their anxiety and avoid panic.
Home confinement could offer a good opportunity to enhance the interaction between
parents and children, involve children in family activities, and improve their self-sufficiency
skills.
With the right parenting approaches, family bonds can be strengthened, and child
psychological needs met. Since the COVID-19 epidemic is no longer confined to China,
school closure and home confinementrelated issues also become relevant in other
affected countries. As children are vulnerable to environmental risks and their physical
health, mental health, and productivity in adult life is deeply rooted in early years, close
attention and great efforts are required to address these emergency issues effectively and
avoid any longterm consequences in children. Any sustainable programme must involve
local professionals to culturally adapt the interventions to the administrative system and to
the regional and community environment, and it must develop contextually relevant
material for children and adolescents. Finally, children have little voices to advocate for
their needs. The latest Commission on the future of the world’s children urges a holistic
strategy in preparing for the uncertainty that all children are facing. It is the responsibility
and keen interests of all stakeholders, from governments to parents, to ensure that the
physical and mental impacts of the COVID-19 epidemic on children and adolescents are
kept minimal. Immediate actions are warranted.

Rassegna Aprile 2020 pag. 15

ARTICOLO 2
(A)
Maternal childhood and lifetime traumatic life events and infant
bronchiolitis
Margaret A. Adgent Omar Elsayed‐Ali Tebeb Gebretsadik Frances A. Tylavsky Mehmet
Kocak Stephania A. Cormier Rosalind J. Wright Kecia N. Carroll
ABSTRACT
Background
Viral bronchiolitis is a common respiratory infection that often affects term, otherwise
healthy infants. A small literature suggests maternal stress during pregnancy is associated
with bronchiolitis. However, the association between maternal exposure to lifetime
traumatic stress, including traumatic events occurring in childhood or throughout the life
course, and bronchiolitis has not been studied previously.
Objectives
To investigate the association between maternal exposure to total lifetime and childhood
traumatic stress events and infant bronchiolitis.
Methods
We studied mother‐infant dyads enrolled in a prospective prenatal cohort, recruited 2006‐
2011, and Tennessee Medicaid. During pregnancy, we assessed maternal lifetime
exposure to types of traumatic events by questionnaire. We captured bronchiolitis
diagnoses in term, non‐low birthweight infants’ first 12 months using linked Medicaid data.
In separate models, we assessed the association of maternal lifetime traumatic events (0
to 20 types) and a subset of traumatic events that occurred during childhood (0 to 3: family
violence, sexual, and physical abuse) and infant bronchiolitis using multivariable log‐
binomial models.
Results
Of 629 women, 85% were African American. The median count (interquartile range) of
lifetime traumatic events was 3 (2, 5); 42% reported ≥1 childhood traumatic event. Among
infants, 22% had a bronchiolitis diagnosis (0 to 2 lifetime traumatic events: 24%; 3 events:
20%; 4 to 5 events: 18%; 6 or more events: 24%). Total maternal lifetime traumatic events
were not associated with bronchiolitis in multivariable analyses. For maternal childhood
traumatic events, the risk of infant bronchiolitis increased with number of event types
reported: adjusted Risk ratios were 1.12 (95% confidence interval [CI] 0.80, 1.59), 1.31
(95% CI 0.83, 2.07), and 2.65 (95% CI 1.45, 4.85) for 1, 2, and 3 events, respectively, vs
none.
Conclusions
Infants born to women reporting multiple types of childhood trauma were at higher risk for
bronchiolitis. Further research is needed to explore intergenerational effects of traumatic
experiences.

Rassegna Aprile 2020 pag. 16

(B)
Stress Health. 2019 Aug;35(3):289-303. doi: 10.1002/smi.2861. Epub 2019 Apr 4.

The association between stressful life events and respiratory infections
during the first 4 years of life: The Environmental Determinants of
Diabetes in the Young study.
Roth R1,2, Lynch K3, Hyöty H4,5, Lönnrot M6, Driscoll KA7, Bennett Johnson S8; TEDDY
Study Group.
ABSTRACT
The aim of this study was to conduct a prospective analysis of the association between
negative life events (NLEs) and respiratory infections in children genetically at risk for islet
autoimmunity (IA) and type 1 diabetes (T1D). Long- and short-term temporal associations
between NLEs and rate of respiratory infection episodes (RIEs) in 5,618 children in The
Environmental Determinants of Diabetes in the Young study for at least 1 up to 4 years
were analysed. All models were adjusted for demographic, day care, season of infection,
and psychosocial factors associated with the rate of child RIEs between study visits. The
rate of child RIEs was 26% higher in Europe (Sweden, Finland, Germany) than in the
United States (rate ratio [RR] = 1.26, p < 0.001). However, the percentage of child NLEs
(odds ratio [OR] = 1.18, p < 0.001) and mother NLEs (OR = 1.83, p < 0.001) was higher in
the United States compared with Europe. In both continents (Europe, RR = 1.12,
p < 0.001; United States, RR = 1.07, p = 0.006), high child cumulative NLEs (>1 NLE per
year since study inception) was significantly associated with an increased rate of child
RIEs. This large-scale prospective study confirms observations that stress may increase
the susceptibility for infections in paediatric populations and suggests at least one
mechanism by which stress could increase risk for IA and T1D in genetically at risk
children.

(C)
Psychosom Med. Author manuscript; available in PMC 2018 Jan 1.

Impact of maternal lifetime interpersonal trauma on children’s asthma:
Mediation through maternal active asthma during pregnancy
Kelly J. Brunst, PhD,1 Maria José Rosa, DrPH,2 Calvin Jara, BS,2 Lianna R. Lipton,
BS,1 Alison Lee, MD,3 Brent A. Coull, PhD,4,5 and Rosalind J. Wright, MD, MPH1,6

ABSTRACT
Objective
Traumatic stressors, including child abuse and/or interpersonal violence over a woman’s
lifecourse, can affect the health of her children. This study examines associations between
maternal lifetime interpersonal trauma (IPT) and children’s asthma by age six years
(N=857).
Rassegna Aprile 2020 pag. 17

Methods
Pregnant women completed the Revised Conflict Tactics Scale; IPT exposure was
categorized as unexposed (55%), early (childhood and/or teen years only, 25%), late
(adulthood and/or index pregnancy, 7%), and chronic (early and late, 13%). Clinician-
diagnosed asthma in children was reported by mothers at each follow-up visit until the
child reached age 6 years. We examined effects of maternal IPT categories and child’s
asthma using logistic regression. Using structural equation models, we also examined
indirect relationships between maternal chronic IPT and child asthma operating through
active asthma in pregnancy, pre-pregnancy BMI, prenatal smoking, and/or increased
exposure to other adverse life events or environmental toxins prenatally. Effect
modification by the child’s sex was examined.
Results
Mothers were primarily Hispanic (55%) or Black (30%) with < high school education (62%).
In logistic regression models, chronic maternal IPT (compared to unexposed) was
associated with asthma in boys (OR=2.87; 95% CI, 1.48–5.57) but not girls (OR=0.69;
95% CI 0.23–2.12) (pinteraction=0.042). In SEMs, chronic IPT was associated with maternal
active asthma in pregnancy (β=0.59, p

ARTICOLO 3
(A)
BMC Pregnancy Childbirth. 2018 Jun

The mindful moms training: development of a mindfulness-based
intervention to reduce stressand overeating during pregnancy.
Vieten C1,2, Laraia BA3,4, Kristeller J5, Adler N3,5, Coleman-Phox K3, Bush NR3,6,
Wahbeh H7, Duncan LG8, Epel E3.
ABSTRACT
BACKGROUND:
Pregnancy is a time of high risk for excessive weight gain, leading to health-related
consequences for mothers and offspring. Theory-based obesity interventions that target
proposed mechanisms of biobehavioral change are needed, in addition to simply providing
nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress
and non-homeostatic eating behaviors - or eating for reasons other than hunger or caloric
need. We developed a mindfulness-based intervention for high-risk, low-income
overweight pregnant women over a series of iterative waves using the Obesity-Related
Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its
effects on stress and eating behaviors.
METHODS:
Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-
week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as
well as stress, depression and eating behaviors before and after the intervention. We also
examined whether pre-to-post intervention changes in outcomes of well-being and eating
behaviors were associated with changes in proposed mechanisms of mindfulness,
acceptance, and emotion regulation.
RESULTS:
Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and
facilitator fidelity was very good. Of the women who completed class evaluations, at least
half reported that each of the three class components (mindful breathing, mindful eating,
and mindful movement) were "very useful," and that they used them on most days at least
once a day or more. Women improved in reported levels of mindfulness, acceptance, and
emotion regulation, and these increases were correlated with reductions in stress,
depression, and overeating.
CONCLUSIONS:
These findings suggest that in pregnant women at high risk for excessive weight gain, it is
both feasible and effective to use mindfulness strategies taught in a group format. Further,
increases in certain mindfulness skills may help with better management of stress and
overeating during pregnancy.

Rassegna Aprile 2020 pag. 19

(B)
Psychol Health Med. 2019 Jan;24(1):51-58. doi: 10.1080/13548506.2018.1468028. Epub
2018 Apr 26.

Effects of mindfulness-based stress reduction on prenatal stress,
anxiety and depression.
Zhang JY1, Cui YX1, Zhou YQ1, Li YL1.
ABSTRACT
Low well-being is common among Chinese pregnant women but few effective
interventions currently exist to improve prenatal stress and negative emotions.
Mindfulness-based stress reduction (MBSR) has been proved to be effective in reducing
stress and rarely studies were focused on Chinese pregnant women. The aim of the
current paper is to investigate the effects of 8-week MBSR on prenatal stress, anxiety and
depression among Chinese pregnant women. A sample of 66 pregnant women randomly
allocated into either the MBSR group (n=34) or the control group (n=32). Participants in
the MBSR group received a group 8-week, 90-min each time intervention. The results
found a significant interaction between time and condition for prenatal stress (F=45.51,
p

on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of
low income women with overweight/obesity.
METHOD:
We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8
weeks and comparing them to 105 sociodemographically and weight equivalent pregnant
women receiving treatment as usual. Our main outcomes included weight gain (primary
outcome), perceived stress, and depression.
RESULTS:
Women in MMT showed significant reductions in perceived stress (β = - 0.16) and
depressive symptoms (β = -0.21) compared to the treatment as usual (TAU) control group.
Consistent with national norms, the majority of women (68%) gained excessive weight
according to Institute of Medicine weight-gain categories, regardless of group. Slightly
more women in the MMT group gained below the recommendation. Among secondary
outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower
glucose post-oral glucose tolerance test (β = - 0.23), being 66% less likely to have
impaired glucose tolerance, compared to the TAU group.
CONCLUSION:
A short-term intervention led to significant improvements in stress, and showed promise
for preventing glucose intolerance. However, the majority of women gained excessive
weight. A longer more intensive intervention may be needed for this high-risk population.

Rassegna Aprile 2020 pag. 21