Медицина в Україні

Mechanisms linking the Early Childhood Environment to Depression Risk How do disruptions in caregiver behaviors influence development and risk of depression? A primary psychological mechanism linking parenting behaviors in early childhood to depression is attachment security. Attachment theory posits that children develop a secure emotional bond with caregivers who are sensitive, responsive, and predictable; securely attached children will readily explore new environments and return to the caregiver for safety (Ainsworth, et al., 1978; Bowlby, 1969). In contrast, inconsistent and insensitive parenting is argued to result in an insecure attachment style, in which children are unable to use their caregiver as the foundation for exploration and safety. Several classifications of insecure attachment styles have been characterized, including anxious/avoidant, ambivalent, and disorganized/disoriented (Ainsworth et al., 1978; Main & Soloman, 1986). Insensitive and non-responsive parenting behaviors are robustly associated with the development of an insecure attachment style in infants (Egeland & Farber, 1984). Evidence also consistently suggests that children of depressed mothers are less likely to develop a secure attachment style than children of mothers without depression (Coyl, Roggman, & Newland, 2002; Martins & Gaffan, 2000; Teti, Gelfand, Messinger, & Isabella, 1995). Insecure attachment in children of depressed mothers is thought to emerge in response to a variety of insensitive and inconsistent parenting behaviors. Maternal behavior in depressed woman has been characterized as unresponsive, inattentive, intrusive, punitive, hostile, and ineffective at resolving conflict (Gelfand & Teti, 1990; Goodman & Gotlib, 1999; Gotlib & Goodman, 1999). More extreme departures from the expected environment, including maltreatment and institutional rearing, have been shown to dramatically interfere with the development of a secure attachment style. Children exposed to maltreatment and institutional rearing are particularly likely to develop insecure attachment, and many children in these adverse environments display features of a disorganized/disoriented attachment style (Carlson, Cicchetti, Barnett, & Braunwald, 1989; Zeanah, Smyke, Koga, Carlson, & The Bucharest Early Intervention Project Core Group, 2005). Disorganized/disoriented attachment is a particularly severe departure from a secure attachment style that is characterized by a lack of coherence in responses to caregiver separation and reunification, a blending of contradictory strategies, and bizarre behaviors that are not easily classified (Main & Soloman, 1986). Insecure attachment has been consistently identified as risk factor for major depression in children and adolescents (Allen, Porter, McFarland, McElhaney, & Marsh, 2007; Brumariu & Kerns, 2010; Moss et al., 2006), suggesting that attachment security is a mechanism underlying the association between adverse caregiving environments in early childhood and risk for depression. Perhaps the strongest evidence for the role of attachment security as a mechanism linking the early rearing environment to risk for depression comes from a recent study documenting that changes in attachment security were a mechanism underlying the ameliorative effects of a foster care intervention on internalizing disorders in previously institutionalized children (McLaughlin, Zeanah, Fox, & Nelson, 2012). This study suggests that randomization to an improved rearing environment prevented the onset of internalizing disorders by improving attachment security. Attachment insecurity therefore appears to have a direct effect on risk for major depression. However, disruptions in the formation of a secure attachment relationship may also lead to depression at later points in development through indirect pathways related to emotion regulation and social competence. These pathways are described in the section on middle childhood. Deviations from sensitive, responsive caregiving in early childhood can also set the stage for the onset of depression by disrupting the development of self-regulation. Maternal responsiveness, warmth, and consistency are associated with greater effortful control in the preschool period (Eisenberg et al., 2003; Kochanska et al., 2000; Lengua, Honorado, & Bush, 2007), whereas maternal negativity is associated with poor attentional and behavior regulation, including delay ability (Silverman & Ragusa, 1992). Although difficulties with effortful control have been linked most consistently to externalizing behavior problems in children (Eisenberg et al., 2000), poor effortful control—particularly poor attentional regulation—is also associated with depressive symptoms in children and adolescents (Eisenberg, Cumberland, et al., 2001; Lemery, Essex, & Smider, 2002; Muris, Meesters, & Blijlevens, 2007; Zalewski, Lengua, Wilson, Trancik, & Bazinet, 2011). Adverse rearing environments may also increase risk of depression by increasing children’s emotional and physiological reactivity to the environment. As early as the neonatal period, offspring of depressed mothers exhibit both behavioral and physiological dysregulation, which is thought to result from either a heritable biological predisposition or atypical prenatal exposure to neurochemicals associated with depression (Field, 1998). Both maternal depression and poor quality parenting in infancy can disrupt brain development in ways that increase children’s risk for depression. Specifically, these environments have been shown to influence the development of frontal electroencephalogram (EEG) asymmetry. Frontal regions of the cerebral cortex are differentially lateralized to process positive and negative stimuli and underlie both behavioral and expressive responses to emotional information. The left frontal region is activated by positive emotional stimuli and promotes approach behavior, whereas the right frontal region is activated by negative stimuli and underlies withdrawal or avoidance behavior (Davidson, 1992; Davidson, Ekman, Saron, Senulis, & Friesen, 1990; Davidson & Fox, 1982; Fox, 1991). Asymmetrical resting activation in these frontal regions can be assessed using EEG. Both poor quality maternal caregiving and maternal depression are associated with greater activation in the right relative to the left frontal cortex in infants (Field, Fox, Pickens, & Nawrocki, 1995; Hane & Fox, 2006; Hane, Henderson, Reeb-Sutherland, & Fox, 2010; Jones, Field, Davalos, & Pickens, 1997; Jones, Field, Fox, Lundy, & Davalos, 1997). Frontal EEG asymmetry has also been observed among children exposed to more extreme environments in early childhood, including institutionalization (McLaughlin, Fox, Zeanah, & Nelson, 2011). Children with this pattern of hemispheric activation are more behaviorally inhibited, socially reticent, exhibit low positive emotionality, and experience greater negative affect in response to maternal separation than those without this pattern of neural activation (Davidson & Fox, 1989; Fox, 1991; Fox et al., 1995; Fox & Davidson, 1987; Shankman et al., 2005). Moreover, frontal EEG asymmetry is associated prospectively with internalizing psychopathology in children (McLaughlin, Fox, et al., 2011) and with major depression in adults (Gotlib, Ranganathand, & Rosenfeld, 1998). Maternal depression and insensitive caregiving can also disrupt the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. Alterations in this physiological system may ultimately result in heightened risk for depression. The typical circadian rhythm of cortisol— characterized by high values in the morning, a relatively steady decline across the day, and lowest values in the evening—is evident in children as early as 12 months, although a smaller decline from morning to afternoon has been observed in early childhood as compared to later developmental periods (Watamura, Donzella, Kertes, & Gunnar, 2004). In early childhood, the transition to preschool is associated with changes in physiological stress response systems. Toddlers exhibit increases in cortisol during the period of the day when they leave home and are taken to preschool, but this increase in cortisol is less substantial for children who have secure attachments to their primary caregivers (Ahnert, Gunnar, Lamb, & Barthel, 2004). Toddlers with a secure attachment to their caregiver also exhibit a reduced cortisol response to novel situations than insecurely attached children; this effect is particularly pronounced for children with high levels of behavioral inhibition (Nachmias, Gunnar, Mangelsdorf, Parritz, & Buss, 1996). Earlylife maternal stress, maternal depression, and a lack of sensitive, responsive caregiving are related to elevated cortisol during periods of stress in early childhood (Essex, Klein, Cho, & Kalin, 2002). Children with higher levels of cortisol and greater increases in cortisol across the day at child care engage in less play with peers and lower levels of play complexity, suggesting a link between cortisol regulation and social behavior in early childhood (Watamura, Donzella, Alwin, & Gunnar, 2003). Indeed, children who exhibit high levels of cortisol within play groups at preschool are rated as lower in social competence and effortful control than children whose cortisol levels are less reactive to social group interaction (Gunnar, Tout, de Haan, Pierce, & Stanbury, 1997). Elevated morning cortisol in early childhood is also associated concurrently with behavioral inhibition and shyness (Schmidt et al., 1997). Although depression is not a disorder observed in young children, neuroendocrine changes related to poor rearing environments may set the stage for depression through their associations with risk factors for the disorder at later developmental periods, including behavioral inhibition and poor social competence.

https://sdlab.fas.harvard.edu/files/sdl ... hapter.pdf

У меня приятель в Израиле, медицина бесплатная.

В сенсі бєсплатная?

У меня приятель в Израиле, медицина бесплатная.

В сенсі бєсплатная?

всм страховку платит работодатель, для приятеля получается бесплатная.

Каждый гражданин Израиля, достигший 18 лет, обязан платить взносы на медицинское обязательное страхование. Они составляют 4,3% от заработной платы. Налог на здравоохранение взимается с пенсии, пособия по безработице и инвалидности.

У меня приятель в Израиле, медицина бесплатная.

В сенсі бєсплатная?

всм страховку платит работодатель, для приятеля получается бесплатная.

Каждый гражданин Израиля, достигший 18 лет, обязан платить взносы на медицинское обязательное страхование. Они составляют 4,3% от заработной платы. Налог на здравоохранение взимается с пенсии, пособия по безработице и инвалидности.

Нє получаєтся вона бєсплатная, а рівно 4.3% від доходу.
Наприклад, зарплата 20 тисяч шекелів, 4.3% це біля 200 баксів кожен місяць медичне страхування і це базове.

У меня приятель в Израиле, медицина бесплатная.

В сенсі бєсплатная?

всм страховку платит работодатель, для приятеля получается бесплатная.

Каждый гражданин Израиля, достигший 18 лет, обязан платить взносы на медицинское обязательное страхование. Они составляют 4,3% от заработной платы. Налог на здравоохранение взимается с пенсии, пособия по безработице и инвалидности.

В нас теж взнімаєцца ЄСВ. Але "дєнєх нєт но вьі дєржітєсь"

В этой стране -- кто за мед-страхивку 200 денег платит?
Это, кстати, серьезная проблема: нарид часто говорит "я плачу АЖ 40% налогов", а начинаешь считать -- платит какие-то 100 денег

В Україні, наразі, медичне страхування середнього рівня типу стандарт та стандарт+ стартує від 2 тис. грн./міс.

В нас теж взнімаєцца ЄСВ. Але "дєнєх нєт но вьі дєржітєсь"

До чого тут ЄСВ? Це саме взнос на медичну страховку, за шо я й кажу, на прикладі шо Успіх писав, пересадка чогось не стане несподіваним фінансовим тягарем. Окремо там зуби, скоріш за все вони не входять у базову страховку.
Але те шо написала доглядальниця в зоопарку, це ніяк не безкоштовна медицина.

до чого твоє питання до мене, а не до влади? В Польщі є складка ZUS "з трьома філярами" є здровотне. В Україні все іде в "спільний котел", а вихлоп отримують пенсіонери мірного врємєні та інші інваліди держслужби. Зараз хотаб з детройдом будуть розказувати байки як вони поізносілісь наповнючи бюджетну сіську.

У мене до тебе питань нема.
Доглядачка мавп написала шо в у її товариша в Ізраїлі медицина безкоштовна. Виявилось шо зовсім не безкоштовна. Ти написав за ЄСВ у нас, потім шось за Польщу. Для чого це все ти пишеш? Ти готуєш реферат "Безкоштовна медицина світу", чи ти замість Супрун впроваджуєш страхову медицину в нас на прикладі кращих медицин світу?

В сенсі бєсплатная?

всм страховку платит работодатель, для приятеля получается бесплатная.

Каждый гражданин Израиля, достигший 18 лет, обязан платить взносы на медицинское обязательное страхование. Они составляют 4,3% от заработной платы. Налог на здравоохранение взимается с пенсии, пособия по безработице и инвалидности.

В нас теж взнімаєцца ЄСВ. Але "дєнєх нєт но вьі дєржітєсь"

Більшість плате того ЄСВ менше 50 баксів в міс - ні в чому собі не відмовляйте

В этой стране -- кто за мед-страхивку 200 денег платит?
Это, кстати, серьезная проблема: нарид часто говорит "я плачу АЖ 40% налогов", а начинаешь считать -- платит какие-то 100 денег

В Україні, наразі, медичне страхування середнього рівня типу стандарт та стандарт+ стартує від 2 тис. грн./міс.

Обов`язкове?

В Україні, наразі, медичне страхування середнього рівня типу стандарт та стандарт+ стартує від 2 тис. грн./міс.

Як на мене ті хто купляє страховку схожі з гравцями в лотерею) лиш лотерейники думають що їм повезе а ті хто купляє страховку що не повезе) виграє завжди організатор лотереї.