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1.
Podium (Pinar Río) ; 19(1)abr. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550628

ABSTRACT

Es bien sabido que la forma más común de reducir los efectos del trastorno por déficit de atención con hiperactividad ha sido históricamente a través de productos farmacológicos. Sin embargo, es irrefutable que la influencia del ejercicio físico ha evitado indeseables efectos secundarios y ha logrado cambios favorables significativos en los pacientes. Esta actividad física fue implementada básicamente de forma preventiva, principalmente bajo condiciones médicas, crónicas y discapacidades, también para contribuir a la esfera cognitiva y comportamental. El objetivo de este trabajo consistió en proponer un grupo de recomendaciones metodológicas en la clase de Educación Física para mejorar las condiciones de vida de niños con trastorno por déficit de atención con hiperactividad en la Unidad Educativa Fiscomisional Sagrado Corazón de Esmeraldas, Ecuador. Los métodos empíricos que se utilizaron fueron la observación científica, la encuesta aplicada a estudiantes y la entrevista dirigida a profesores; también se emplea, una vez implementadas estas recomendaciones, una encuesta a ambos componentes del proceso para obtener una valoración preliminar sobre el efecto de esta propuesta, debido a que resultó ser una ayuda metodológica de alto valor para preparar los profesores y estudiantes en sus influencias como orientador en el caso del profesor y como colectivo social académico en el caso del grupo de estudiantes.


É bem sabido que a forma mais comum de reduzir os efeitos do transtorno de déficit de atenção e hiperatividade tem sido historicamente por meio de produtos farmacológicos. Contudo, é irrefutável que a influência do exercício físico evitou efeitos colaterais indesejáveis e alcançou mudanças favoráveis significativas nos pacientes. Essa atividade física foi implementada basicamente de forma preventiva, principalmente em condições médicas, crônicas e deficiências, também para contribuir na esfera cognitiva e comportamental. O objetivo deste trabalho foi propor um conjunto de recomendações metodológicas nas aulas de Educação Física para melhorar as condições de vida de crianças com transtorno de déficit de atenção e hiperatividade na Unidade Educacional Fiscomisional Sagrado Corazón de Esmeraldas, Equador. Os métodos empíricos utilizados foram a observação científica, o inquérito aplicado aos alunos e a entrevista dirigida aos professores; Uma vez implementadas estas recomendações, recorre-se também a um levantamento de ambas as componentes do processo para obter uma avaliação preliminar do efeito desta proposta, porque se revelou uma ajuda metodológica de elevado valor para preparar professores e alunos nas suas influências. como conselheiro no caso do professor e como coletivo social acadêmico no caso do grupo de alunos.


It is well known that the most common way to reduce the effects of Inclusive methodological strategy for teaching - learning football in students with attention deficit hyperactivity disorder in the physical culture class (ADHD) has historically been through pharmacological products. However, it is irrefutable that the influence of physical exercise has avoided undesirable side effects and has achieved significant favorable changes in patients. This physical activity was basically implemented preventively, mainly under medical, chronic conditions and disabilities, also to contribute to the cognitive and behavioral sphere. The objective of this work consisted of proposing a group of methodological recommendations in the Physical Education class to improve the living conditions of children with ADHD in the Sagrado Corazón Fiscomisional Educational Unit of Esmeraldas, Ecuador. The empirical methods used were scientific observation, the survey applied to students and the interview directed to teachers. Once these recommendations were implemented, a survey of both components of the process was also used to obtain a preliminary assessment of the effect of this proposal, because it turned out to be a methodological aid of high value to prepare teachers and students in their influences as a counselor in the case of the teacher and as an academic social collective in the case of the group of students.

2.
Arq. neuropsiquiatr ; 82(1): s00441779298, 2024. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1533838

ABSTRACT

Abstract Background Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. Objective This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. Methods This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. Results Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p< 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p= 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p= 0.001. Conclusion PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.


Resumo Antecedentes Pacientes com epilepsia (PCE) frequentemente apresentam comorbidades psiquiátricas, principalmente depressão e ansiedade. O transtorno do déficit de atenção e hiperatividade (TDAH) também é mais frequente nos PCE, porém foi pouco estudado na população adulta de PCE. Objetivo Comparar a presença de sintomas de TDAH entre PCE adultos e a população geral. Métodos Noventa e cinco PCE adultos de um centro terciário no Sul do Brasil foram comparados a 100 controles saudáveis. Todos os sujeitos foram submetidos a três escalas estruturadas: 1) a Escala Autorrelatada de TDAH em Adultos da Organização Mundial da Saúde, versão 1.1 (ASRS); 2) a Escala Hospitalar de Ansiedade e Depressão (HADS); e 3) o Perfil de Eventos Adversos (AEP). Variáveis dicotômicas foram analisadas através dos testes chi-quadrado e exato de Fisher, conforme apropriado, e as variáveis não paramétricas foram analisadas através do teste U de Mann-Whitney. Resultados As medianas e os intervalos interquartis (IIQ) foram: 1) ASRS: 26.00 (IIQ: 18 a 38) em PCE versus 17.00 (IIQ: 11 a 24) nos controles, p< 0,001; 2) HADS: 14.00 (IIQ: 8 a 21) em PCE versus 11.00 (IIQ: 8 a 16) nos controles, p= 0,007; 3) AEP: 38.00 (IIQ: 31 a 49) em PCE versus 33.00 (IIQ: 23 a 43) nos controles, p= 0,001. Conclusão PCE apresentaram uma maior carga de sintomas de TDAH, depressão e ansiedade quando comparados aos controles, o que replica na população brasileira os achados da literatura atual, que apontam para uma maior prevalência de tais transtornos entre PCE.

3.
Arq. bras. oftalmol ; 87(2): e2021, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527840

ABSTRACT

ABSTRACT Purpose: This study aimed to screen the ocular surface of children with attention deficit hyperactivity disorder and identify the adverse effects of methylphenidate related to dry eye disease. Methods: This cross-sectional study included children with attention deficit hyperactivity disorder and healthy children (all aged 5-18 years). They were randomized into Group A (without methylphenidate treatment), Group B (with methylphenidate treatment), and Group C (healthy children). Tear film break-up time, Ocular Surface Disease Index questionnaire, tear meniscus height, tear meniscus area, and Schirmer test results were evaluated. Furthermore, symptom severity in attention deficit hyperactivity disorder was assessed by Turgay DSM-IV-based Child and Adolescent Behavioral Disorders Screening and Rating Scale and Conners Parent Rating Scale-48. Results: Groups A, B, and C consisted of 34, 40, and 60 individuals (n=34, 40, and 60 eyes; age=11.44 ± 2.79, 11.70 ± 2.83, and 11.96 ± 3.63 years, median age=12, 12, and 11.5 years), respectively. Tear film break-up time, Ocular Surface Disease Index, tear meniscus height, tear meniscus area, and Schirmer test results were not significantly different between Groups A and C (p=0.964, 0.336, 0.445, 0.439, and 0.759, respectively). However, Group B showed a significant decrease in tear film break-up time (10.50 ± 3.39 vs. 12.52 ± 2.46 s; p=0.005), tear meniscus height (307.40 ± 5.53 vs. 310.82 ± 7.30 µm; p=0.025), tear meniscus area (0.024 ± 0.0037 vs. 0.026 ± 0.0046 mm2; p=0.010) and Schirmer test (12.75 ± 3.96 vs. 15.41 ± 3.75 mm; p=0.004) results compared with Group A. Conclusion: Compared with healthy children, children with attention deficit hyperactivity disorder showed ocular surface parameters suggestive of dry eye disease despite taking methylphenidate. Thus, they require close ophthalmologic follow-up to prevent sight-threatening dry eye complications.


RESUMO Objetivos: Este estudo teve como objetivo examinar a superfície ocular de crianças com transtorno de déficit de atenção com hiperatividade e identificar os efeitos adversos do metilfenidato relacionados à síndrome do olho seco. Métodos: Este estudo transversal incluiu crianças com transtorno de déficit de atenção e hiperatividade e crianças saudáveis (todas entre 5-18 anos de idade). Elas foram randomizadas no Grupo A (sem tratamento com metilfenidato), Grupo B (com tratamento com metilfenidato) e Grupo C (crianças saudáveis). Foram avaliados o tempo de ruptura do filme lacrimal, questionário sobre Índice de Doenças de Superfície Ocular (IDSO), altura do menisco lacrimal, área do menisco lacrimal e os resultados do teste de Schirmer. Além disso, a gravidade dos sintomas no transtorno de déficit de atenção com hiperatividade foi avaliada usando a Turgay DSM-IV-based Child and Adolescent Behavioral Disorders Screening and Rating Scale com base na escala de Conners Parent Rating Scale-48. Resultados: Os Grupos A, B e C consistiram de 34, 40 e 60 indivíduos (n=34, 40 e 60 olhos; idade=11,44 ± 2,79, 11,70 ± 2,83 e 11,96 ± 3,63 anos, idade média=12, 123 e 11,5 anos), respectivamente. O tempo de ruptura do filme lacrimal, o Índice de Doença da Superfície Ocular, as altura do menisco lacrimal, a área do menisco lacrimal e o teste de Schirmer não foram significativamente diferentes entre os Grupo A e C (p=0,964, 0,336, 0,445, 0,439 e 0,759, respectivamente). Entretanto, o Grupo B mostrou uma redução significativa no tempo de ruptura do filme lacrimal (10,50 ± 3,39 vs 12,52 ± 2,46 seg; p=0,005), altura do menisco lacrimal (307,40 ± 5,53 vs 310,82 ± 7,30 µm; p= 0,025), área do menisco lacrimal (0,024 ± 0,0037 vs 0,026 ± 0,0046 mm2; p=0,010) e teste de Schirmer (12,75 ± 3,96 vs 15,41 ± 3,75 mm; p=0,004), resultados com0arados com o Grupo A. Conclusão: Em comparação com crianças saudáveis, crianças com transtorno de déficit de atenção com hiperatividade apresentaram parâmetros de superfície ocular sugestivos de olho seco, apesar do uso de metilfenidato. Assim, elas requerem um acompanhamento oftalmológico próximo para evitar complicações oculares de olho seco que ameaçam a visão.

4.
Saúde Soc ; 33(1): e230509pt, 2024. tab
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1551056

ABSTRACT

Resumo A catação de materiais recicláveis é uma ocupação com crescente número de trabalhadores, que encontram nela sustento diante das desigualdades socioeconômicas e do desemprego. Este artigo descreve as estratégias de resistência de mulheres catadoras que fazem parte de uma associação no Nordeste brasileiro, além da forma como elas lidaram com problemas de saúde durante a pandemia de covid-19, especialmente no que se refere aos medicamentos. Utilizamos uma abordagem quantitativa e uma etnográfica, coletando dados sociodemográficos de 13 participantes e dos medicamentos presentes em suas casas, e também realizando observação participante e entrevistas aprofundadas. Em meio à crise sanitária, foram mencionados problemas como o desemprego, as relações de gênero, a violência e os estigmas do trabalho. Se por um lado a pandemia vulnerabilizou ainda mais alguns segmentos populacionais, por outro potencializou estratégias coletivas de enfrentamento. As catadoras e a associação se organizaram para obter insumos e melhorias tanto na sede quanto no bairro. Identificamos 58 unidades de medicamentos, prescritos e obtidos principalmente na Unidade Básica de Saúde. Desses, 27,6% tinham ação sobre o sistema nervoso (analgésicos, psicolépticos e psicoanalépticos) e 17,2% sobre o sistema cardiovascular e sobre o trato alimentar e metabolismo. As catadoras desenvolveram práticas de autoatenção com os medicamentos, destacando o papel central deles no enfrentamento dos problemas de saúde.


Abstract The collection of recyclable materials is an occupation with an increasing number of workers, who find in it a livelihood in a context of socioeconomic inequalities and unemployment. This article describes resistance strategies of women collectors who are part of an association in Northeast Brazil, in addition to describing how they managed health problems during the COVID-19 pandemic, especially regarding medicines. A quantitative and an ethnographic approach were used by collecting data on sociodemographic and medicines present in the homes of 13 participants and conducting participant observation and in-depth interviews. Amid the health crisis, the participants mentioned problems such as unemployment, gender relations, violence, and work stigmas. If, on the one hand, the pandemic has further increased vulnerability for certain population segments, on the other hand, it has enhanced collective resistance strategies. The collectors of the association organized to obtain various materials and benefits both for their headquarters and their neighborhood. We identified 58 units of medicines, prescribed and obtained mainly at the Basic Health Unit. Of these, 27.6% had action on the nervous system (analgesics, psycholeptics, and psychoanaleptics) and 17.2% on the cardiovascular system and on the alimentary tract and metabolism. The collectors developed self-attention practices with the medicines highlighting their central role in facing health problems.

5.
Psico (Porto Alegre) ; 55(1): 42541, 2024.
Article in Portuguese | LILACS | ID: biblio-1552571

ABSTRACT

A interação com videogame aumentou significativamente na pandemia de COVID-19. Por outro lado, um aspecto atencional que pode apresentar alterações relacionadas à quantidade de interação com videogames de ação é o mindfulness. Portanto, o objetivo deste estudo foi verificar uma possível relação entre o uso de videogames de ação (em horas semanais), o mindfulness e o medo da COVID-19. Para tanto, solicitou-se a jogadores e não jogadores de videogames de ação com idades entre 18 e 29 anos (n = 384, M = 21,6, DP = 2,6) que respondessem à Escala de Medo da COVID-19 e à Escala de Facetas do Mindfulness. Os resultados não demonstraram relação significativa entre uso de videogames de ação e mindfulness, mas apontaram que jogadores de videogame de ação apresentaram menos medo da COVID-19. Discute-se como o escapismo proporcionado pelo jogo pode explicar, em parte, uma diminuição da atenção a informações relativas à doença


Interaction with video games increased significantly in the COVID-19 pandemic. On the other hand, an attentional aspect that may show changes related to the amount of interaction with action video games is mindfulness. Therefore, the objective of this study was to verify a possible relationship between the use of action video games (in weekly hours), mindfulness and fear of COVID-19. To this end, players and non-players of action video games aged between 18 and 29 years (n = 384, M = 21.6, SD = 2.6) were asked to respond to the Covid Fear Scale and the Facets of Mindfulness. Results did not demonstrate a significant relationship between the use of action video games and mindfulness, but showed that action video game players were less afraid of COVID-19. It is discussed how the escapism provided by the game can partly explain a decrease in attention to information related to the disease


La interacción con videojuegos aumentó en la pandemia de COVID-19. Por otro lado, un aspecto atencional que puede presentar cambios relacionados con la cantidad de interacción con los videojuegos de acción es el mindfulness. Luego, el objetivo de este estudio fue verificar una relación entre uso de video-juegos de acción, mindfulness y miedo al COVID-19. Se pidió a jugadores y no jugadores de videojuegos de acción de entre 18 y 29 años (n = 384, M = 21,6, SD = 2,6) que respondieran a la Escala de Miedo al COVID y la Escala de Facetas de Mindfulness. Los resultados no demostraron una relación significativa entre uso de videojuegos de acción y mindfulness, pero señalaron que jugadores de videojuegos de acción tenían menos miedo a la COVID-19. Se discute cómo el escapismo proporcionado por el juego explicaría en parte una disminución en la atención a la información relacionada con la enfermedad


Subject(s)
Adult
6.
Psicol. Estud. (Online) ; 29: e55617, 2024. tab
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1529192

ABSTRACT

RESUMO O diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade - TDAH é bastante complexo, podendo ser influenciado por fatores contextuais, e seu tratamento pode envolver diferentes intervenções. A participação dos usuários nas decisões a respeito do tratamento vem sendo promovida por instituições de diversos países e, no Brasil, é prevista pelas legislações do Sistema Único de Saúde. Este estudo investigou o processo de tomada de decisão no tratamento de crianças com indicadores de TDAH a partir da percepção de oito profissionais de serviços públicos de saúde mental, que foram entrevistados individualmente. Os dados foram examinados através da análise temática, revelando desafios relativos ao excesso de demanda nos serviços e à complexidade do processo diagnóstico. O envolvimento de usuários e familiares nas decisões foi percebido como parcial, ocorrendo geralmente após a elaboração do plano terapêutico pelas equipes, e envolvendo dificuldades na comunicação entre profissionais e pacientes e divergências de interesses entre as crianças e seus familiares. Esses aspectos poderão ser abordados em futuros estudos e intervenções a fim de facilitar e melhorar a qualidade da tomada de decisão nesse contexto.


RESUMEN El diagnóstico del trastorno por déficit de atención con hiperactividad - TDAH es bastante complejo y puede verse influenciado por factores contextuales, y su tratamiento puede implicar diferentes intervenciones. La participación de los usuarios en las decisiones sobre tratamiento ha sido promovida por instituciones de diferentes países y, en Brasil, está prevista por las leyes del Sistema Único de Salud. Este estudio investigó el proceso de toma de decisiones en el tratamiento de niños con indicadores TDAH desde la percepción de 8 profesionales de la salud mental pública, que fueron entrevistados individualmente. Los datos fueron examinados a través del análisis temático, revelando desafíos relacionados con el exceso de demanda en los servicios y la complejidad del proceso de diagnóstico. La implicación de los usuarios y familiares en las decisiones se percibió como parcial, ocurriendo generalmente después de la elaboración del plan terapéutico por los equipos, y implicando dificultades en la comunicación entre profesionales y pacientes y divergencias de intereses entre los niños y sus familias. Estos aspectos pueden abordarse en futuros estudios e intervenciones con el fin de facilitar y mejorar la calidad de la toma de decisiones en este contexto.


ABSTRACT The diagnosis of Attention Deficit Hyperactivity Disorder - ADHD is quite complex. Contextual factors may influence it, and its treatment may involve different interventions. Institutions in several countries have promoted the participation of users in treatment decisions. In Brazil, it is provided by the Unified Health System. This study investigated the decision-making process in treating children with ADHD indicators from the perception of 8 public mental health services professionals interviewed individually. Data were examined through thematic analysis, revealing challenges related to excessive demand for services and the complexity of the diagnostic process. The involvement of users and family members in the decisions was perceived as partial, generally occurring after elaborating the therapeutic plan by the teams, and involving difficulties in communication between professionals and patients and differences of interests between children and their families. These aspects may be addressed in future studies and interventions to facilitate and improve the quality of the decision-making process in this context.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Attention Deficit Disorder with Hyperactivity/psychology , Child Behavior/psychology , Health Personnel/psychology , Decision Making , Therapeutics/psychology , Family/psychology , Family Relations/psychology , Psychosocial Intervention , Case Reports as Topic , Mental Health Services
7.
Rev. Headache Med. (Online) ; 15(1): 18-24, 2024. graf
Article in English | LILACS | ID: biblio-1538390

ABSTRACT

INTRODUCTION: Migraine is a disease that affects the overall performance of the patient, especially attention and executive functions (EF), with a direct impact on the person's functionality, highlighting the importance of studies in order to minimize its damage. OBJECTIVE: The objective of this study was to evaluate if there is a link between migraine and executive and attentional functions. METHODOLOGY: Observational study (44 subjects; 29 migraineurs and 15 non-migraineurs) on attentional and executive functioning changes in migraine. Subjects over 18 years of age were included in the study, regardless of gender, recruited for convenience at CAM FAME, FAME and Centro AMA, primary recruitment centers, following the criteria of the International Classification of Headache Disorders (ICHD-3). The participants underwent neuropsychological tests that estimated executive and attentional functioning. For attention, the Psychological Attention the Assessment Battery (AAB) was used, and for EF, the Five-Digit Test (FDT) was used. Student's t test, ANOVA, Mann-Whitney and/or Kruskal-Wallis U test were used, whose analyzes fixed the type I error at 0.05. RESULTS: All AAB subtests pointed to a reduction in the attentional potential in migraineurs when compared to the control group. The FDT showed lowering in the migraineurs group subjects, when compared with the non- migraineurs group. Multivariate analysis identified a relationship between EF, Attention and migraine (p<0.05). CONCLUSION: migraineurs present a decrease in executive functioning and attentional skills and an increase in execution time when compared to non-migraineurs individuals


INTRODUÇÃO: A enxaqueca é uma doença que afeta o desempenho global do paciente, principalmente a atenção e as funções executivas (FE), com impacto direto na funcionalidade da pessoa, destacando a importância de estudos a fim de minimizar seus danos. OBJETIVO: O objetivo deste estudo foi avaliar se existe ligação entre enxaqueca e funções executivas e atencionais. METODOLOGIA: Estudo observacional (44 indivíduos; 29 com enxaqueca e 15 sem enxaqueca) sobre alterações de atenção e funcionamento executivo na enxaqueca. Foram incluídos no estudo indivíduos maiores de 18 anos, independente do sexo, recrutados por conveniência no CAM FAME, FAME e Centro AMA, centros primários de recrutamento, seguindo os critérios da Classificação Internacional de Cefaleias (ICHD-3). Os participantes foram submetidos a testes neuropsicológicos que estimaram o funcionamento executivo e atencional. Para atenção foi utilizada a Bateria de Avaliação da Atenção Psicológica (AAB) e para FE foi utilizado o Teste de Cinco Dígitos (FDT). Foram utilizados teste t de Student, ANOVA, Mann-Whitney e/ou teste U de Kruskal-Wallis, cujas análises fixaram o erro tipo I em 0,05. RESULTADOS: Todos os subtestes da AAB apontaram redução do potencial atencional em enxaquecosos quando comparados ao grupo controle. O FDT apresentou redução nos indivíduos do grupo com enxaqueca, quando comparado com o grupo sem enxaqueca. A análise multivariada identificou relação entre FE, Atenção e enxaqueca (p<0,05). CONCLUSÃO: enxaquecosos apresentam diminuição do funcionamento executivo e das habilidades de atenção e aumento no tempo de execução quando comparados a indivíduos não enxaquecosos


Subject(s)
Humans , Male , Female , Patients/statistics & numerical data , Executive Function/classification , Migraine Disorders/complications
8.
Chinese Journal of Rehabilitation Theory and Practice ; (12): 1-9, 2024.
Article in Chinese | WPRIM | ID: wpr-1013278

ABSTRACT

ObjectiveTo investigate the developmental characteristics of gross motor skills and executive functions, and the correlation between them in school-age children with attention deficit hyperactivity disorder (ADHD). MethodsFrom November, 2020 to May, 2021, 90 children with ADHD were recruited from Peking University Sixth Hospital and Beijing Haidian Wanquan Primary School, and other 90 children with normal development from this primary school were recruited matched their age and gender. Gross motor skills were assessed with the Test of Gross Motor Development in Children, Third Edition (TGMD-3), and inhibitory control, working memory, and cognitive flexibility were assessed with Stroop Color Words Test (SCWT), Rey-Osterrich Complex Figure Test (ROCFT) and Trail Making Test (TMT), respectively. ResultsThe TGMD-3 score was significantly lower in children with ADHD than in normal children (t = -6.275, P < 0.001), while the test results of SCWT, ROCFT and TMT were worse (|t| ≥ 1.986, P ≤ 0.05). The TGMD-3 score of children with ADHD was negatively correlated with the word sense reaction time (r = -0.261), the number of word sense errors (r = -0.404) and the number of color errors (r = -0.326) (P < 0.05), positively correlated with the delayed structural memory scores (r = 0.228) (P < 0.05), and negatively correlated with the TMT-A reaction time (r = -0.255), the number of TMT-A errors (r = -0.329), TMT-B reaction time (r = -0.214) and the number of TMT-B errors (r = -0.474) (P < 0.05). Stratified linear regression analyses showed that the TGMD-3 score of children with ADHD was significant only in predicting test results for inhibitory control and cognitive flexibility (P < 0.05), with explanations of 8.7% and 22.5%, respectively. ConclusionDevelopments of both gross motor skills and executive function delay in children with ADHD, and there is a relation between them, especially the level of gross motor skills relating to the developments of inhibitory control and cognitive flexibility.

9.
Journal of Environmental and Occupational Medicine ; (12): 146-152, 2024.
Article in Chinese | WPRIM | ID: wpr-1012472

ABSTRACT

Background Sleep quality is one of the important factors affecting soldiers’ task performance. Objective To explore the effects of mindful attention awareness, burnout, and occupational stress on sleep quality among soldiers in plateau areas. Methods A total of 1090 soldiers were selected from four units in plateau areas by cluster sampling method and were asked to participate a cross-sectional questionnaire survey using the Pittsburgh Sleep Quality Index (PQSI), Occupational Stress Inventory (OSI), Maslach Burnout Inventory-General Survey (MBI-GS), and Mindful Attention Awareness Scale (MAAS). Correlation analysis, regression analysis, and mediated effect test were conducted for the study. Results Of the 1090 soldiers recruited, 1082 soldiers returned valid questionnaires, and the valid recovery rate was 99.26%. The median (P25, P75) score of PSQI was 4.00 (2.00,7.00), the median score of OSI was 26.00 (17.00, 34.00), the median score of MBI-GS was 3.53 (3.13, 4.00), and the median score of MAAS was 71.00 (59.00, 82.00). The burnout and mindful attention awareness levels varied among military personnel of different age groups (P<0.05), so did the burnout and occupational stress levels among military personnel of different length of service groups (P<0.05), and the occupational stress, PSQI, burnout, and mindful attention awareness levels among military personnel with different educational backgrounds and genders (P<0.05). The results of mediated effect test showed that occupational stress and burnout had both a parallel mediated effect and a sequential mediating effect on the relationship between mindful attention awareness and sleep quality, with effect sizes of 15.3%, 21.5% and 31.8%, respectively. Conclusion There is a mediated effect on the relationship between mindful attention awareness and sleep quality by the occupational stress and burnout of military personnel in plateau areas, and sleep quality is also affected by mindful attention awareness through the chain-mediated effect of occupational stress and burnout.

10.
Chinese Journal of School Health ; (12): 91-94, 2024.
Article in Chinese | WPRIM | ID: wpr-1011354

ABSTRACT

Objective@#The association between school bullying and attention deficit hyperactivity disorder (ADHD) symptoms among students in primary schools and the moderating role of gender was explored to provide scientific evidence for the prevention and control of school bullying.@*Methods@#A total of 4 764 students from 2 primary schools in Wuhan were selected using the convenience sampling method in March 2023. The Olweus Bully/Victim Questionnaire and Strengths and Difficulties Questionnaire were used. A Pearson χ 2 test was used to compare differences in school bullying rates among children with and without ADHD symptoms. Pearson correlation analysis and Process 3.3 were used to analyse the association between ADHD symptoms, and school bullying behaviour and the moderating role of gender.@*Results@#The reported rate of bullying victims in primary schools was 24.2% and the rate of bullying perpetration was 3.8%. The rate of ADHD symptom detection among primary school students was 5.9%. ADHD symptoms were positively associated with bullying and bullying victim behaviour ( r =0.16, 0.27, P <0.01). Specifically, the association between ADHD symptoms and bullying behavior tended to be stronger among boys than girls ( β boy =0.17, t =11.13; β girl =0.07, t =4.11, P <0.01).@*Conclusions@#ADHD symptoms are an important factor influencing school bullying behaviors in students, and gender moderates the association. In the process of preventing and controlling school bullying, ADHD symptoms and gender differences should be emphasized and comprehensive interventions should be implemented.

11.
Acta colomb. psicol ; 26(2)dic. 2023.
Article in English | LILACS-Express | LILACS | ID: biblio-1533378

ABSTRACT

Background: The objective of this study was to test a treatment program in Serious Games (SG) format to improve attention in children from Catalonia, Spain, with Attention Deficit Hyperactivity Disorder (ADHD). The activities adapted to the SG format consisted of (1) stimulus selection, (2) mark equal drawings, (3) eight differences, (4) hidden figures, (5) compare texts, (6) compare measures and shapes, (7) put model keys, (8) labyrinths and (9) memorization of drawings. Method: A pretest-posttest design was used with a cohort of 30 children between 8 and 10 years old diagnosed with ADHD, with 20% girls (n = 6) and 80% boys (n = 24) with a mean age of 9.4 years (SD = 0.63; range of 8 to 10 years). Four schools and a clinical center from Catalonia, Spain participated in the sample composition. Half of the sample participated in an attention improvement program for nine sessions of 30-45 minutes each in Serious Games format. They were presented with a series of game challenges with various virtual scenarios through a monitor. The other half did the same attention improvement program in pencil and paper format. Results: The children in the Serious Games group progressed and improved more during treatment, as shown by the average number of errors of commission (p =.02) than those in the pencil and paper group. Both groups also improved in the total score and concentration scale of the D2 test (p < .001). Conclusions: Attentional training through programs in Serious Games format seems to have a more significant effect on commission errors than attentional training in pencil and paper format.


Antecedentes: El objetivo del presente estudio ha sido poner a prueba un programa de tratamiento en formato Serious Games (SG) para mejorar la atención en niños de Cataluña, España, con Trastorno por Déficit de Atención/Hiperactividad (TDAH). Las actividades adaptadas al formato SG consistieron en (1) selección de estímulos, (2) marcar dibujos iguales, (3) ocho diferencias, (4) figuras ocultas, (5) comparar textos, (6) comparar medidas y formas, (7) poner llaves modelo, (8) laberintos y (9) memorización de dibujos. Método: Se utilizó un diseño pretest-postest con una cohorte de 30 niños entre 8 y 10 años con diagnóstico de TDAH, con un 20% de niñas (n = 6) y un 80% de niños (n = 24) con una edad media de 9.4 años (DE = 0.63; rango de 8 a 10 años). La mitad de la muestra participó en un programa de mejora de la atención durante 9 sesiones de entre 30-45 minutos cada una en formato de Serious Games. Se les presentó una serie de desafios de juego con varios escenarios virtuales a través de un monitor. La otra mitad de la muestra hizo el mismo programa de mejora de la atención, pero en formato lápiz y papel. Resultados: Los niños del grupo de Serious Games progresaron y mejoraron más durante el tratamiento, como lo demuestra el promedio de errores de comisión (p = .02), en comparación con los niños del grupo de lápiz y papel. Ambos grupos también mejoraron en la puntuación total y en la escala de concentración de la prueba D2 (ambos p < .001). Conclusiones: El entrenamiento atencional a través de programas en formato Serious Games parece tener un mayor efecto que el entrenamiento atencional en formato lápiz y papel sobre los errores de comisión.

12.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 45(6): 470-481, Nov.-Dec. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1533997

ABSTRACT

Objective: To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15. Methods: Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment. Results: Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65). Conclusion: This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.

13.
Humanidad. med ; 23(3)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1534559

ABSTRACT

El presente trabajo está dirigido a exponer elementos inherentes de un modelo de orientación familiar en la prevención del trastorno por déficit de atención/hiperactividad en la primera infancia. Deriva de una investigación que se ejecuta en la especialidad de Rehabilitación en Salud, adscrita a la Universidad de Ciencias Médicas de Camagüey. Se emplearon métodos teóricos como: el análisis y síntesis, inductivo-deductivo y el método sistémico estructural funcional para fundamentar el carácter de sistema del modelo y su diseño. Se concluye con el establecimiento de un modelo estructurado por dos subsistemas. Las relaciones de coordinación y complementariedad establecidas posibilitaron la extrapolación cognitiva para la orientación familiar en la prevención del trastorno referido.


The present work is aimed at exposing inherent elements of a family counseling model in the prevention of attention deficit/hyperactivity disorder in early childhood. It derives from research carried out in the specialty of Health Rehabilitation, attached to the University of Medical Sciences of Camagüey. Theoretical methods such as: analysis and synthesis, inductive-deductive and the structural-functional systemic method were used to substantiate the system character of the model and its design. It concludes with the establishment of a model structured by two subsystems. The established coordination and complementarity relationships enabled cognitive extrapolation for family guidance in the prevention of the aforementioned disorder.

14.
Arq. neuropsiquiatr ; 81(12): 1053-1069, Dec. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527903

ABSTRACT

Abstract Emerging studies indicate the persistence of symptoms beyond the acute phase of COVID-19. Cognitive impairment has been observed in certain individuals for months following infection. Currently, there is limited knowledge about the specific cognitive domains that undergo alterations during the post-acute COVID-19 syndrome and the potential impact of disease severity on cognition. The aim of this review is to examine studies that have reported cognitive impairment in post-acute COVID-19, categorizing them into subacute and chronic phases. The methodology proposed by JBI was followed in this study. The included studies were published between December 2019 and December 2022. The search was conducted in PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo, and EBSCOHost. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. A total of 7,540 records were identified and examined, and 47 articles were included. The cognitive domains most frequently reported as altered 4 to 12 weeks after acute COVID-19 were language, episodic memory, and executive function, and after 12 weeks, the domains most affected were attention, episodic memory, and executive function. The results of this scoping review highlight that adults with post-acute COVID-19 syndrome may have impairment in specific cognitive domains.


Resumo Estudos emergentes indicam a persistência dos sintomas além da fase aguda da COVID-19. O comprometimento cognitivo foi observado em alguns indivíduos durante meses após a infecção. Atualmente, há pouco conhecimento sobre os domínios cognitivos específicos que sofrem alterações durante a síndrome pós-aguda da COVID-19 e o possível impacto da gravidade da doença na cognição. O objetivo desta revisão é examinar estudos que relataram comprometimento cognitivo na COVID-19 pós-aguda, categorizando-os em fases subaguda e crônica. A metodologia proposta pela Joanna Briggs Institute foi seguida neste estudo. Os estudos incluídos foram publicados entre dezembro de 2019 e dezembro de 2022. A busca foi realizada no PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo e EBSCOHost. A extração de dados incluiu detalhes específicos sobre a população, os conceitos, o contexto e as principais descobertas ou recomendações relevantes para os objetivos da revisão. Um total de 7.540 registros foi identificado e examinado, e 47 artigos foram incluídos. Os domínios cognitivos mais frequentemente relatados como alterados de 4 a 12 semanas após a COVID-19 aguda foram linguagem, memória episódica e função executiva e, após 12 semanas, os domínios mais afetados foram atenção, memória episódica e função executiva. Os resultados dessa revisão de escopo destacam que adultos com síndrome pós-aguda da COVID-19 podem apresentar comprometimento em domínios cognitivos específicos.

15.
Humanidad. med ; 23(3)dic. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1528707

ABSTRACT

Ser atendido por el estomatólogo es una de las situaciones que genera más miedo y ansiedad en las personas. Se sugiere que la musicoterapia contribuye a reducir estos síntomas. Teniendo en cuenta que muchos pacientes presentan ansiedad y miedo al ser atendidos en el sillón dental y que necesitan un ambiente más agradable, constituye el motivo que condujo a la realización de este trabajo haciendo uso de la musicoterapia con el objetivo de evaluar su influencia en el paciente durante la atención. Se realizó un estudio de intervención, desde marzo a junio del 2022 en el Servicio Estomatológico, Policlínico Tula Aguilera. La muestra, 40 pacientes, fue seleccionada al azar, independientemente de sentir temor o no al tratamiento estomatológico. Las sesiones se dividieron: primera visita (sin música) y segunda visita (con música). Los datos se recogieron en encuesta. Los niveles de miedo disminuyeron con la aplicación de la terapia, por lo cual se constató que la musicoterapia tiene una notable influencia en los pacientes al desaparecer y disminuir el miedo o sensaciones desagradables durante la atención estomatológica. Todos los pacientes manifestaron satisfacción con el uso de la música, durante el servicio.


To be assisted by the odontologist is one of the situations that generates more fear and anxiety in people. It is suggested that the musical-therapy contributes to reduce these symptoms. Keeping in mind that many patients present anxiety and fear when being assisted in the dental armchair and that they need a more pleasant atmosphere, it constitutes the reason that led to the realization of this work making use of the musical-therapy with the objective of evaluating their influence in the patient during the attention. He was carried out an intervention study, from March to June of the 2022 in the Dentistry Service, Clinical Tula Aguilera. The sample, 40 patients, it was selected at random, independently of feeling fear or not to the dentistry treatment. The sessions were divided: first visit (without music) and second visit (with music). The data were picked up in survey. The levels of fear diminished with the application of the therapy, reason why it was verified that the musical-therapy has a notable it influences in the patients when disappearing and to diminish the fear or unpleasant sensations during the dentristry attention. All the patients manifested satisfaction with the music's use, during the service.

16.
Kinesiologia ; 42(4): 269-274, 20231215.
Article in Spanish, English | LILACS-Express | LILACS | ID: biblio-1552532

ABSTRACT

Introducción. En Chile las tasas de sedentarismo infantil han aumentado, siete de cada 10 niños no cumple con los estándares mínimos recomendados por la Organizaciónn Mundial de la Salud. Faltan en Chile estudios que asocien el sedentarismo de tiempo libre y las horas sedentes en jornada escolar con las habilidades cognitivas. Objetivo. Determinar los cambios en las habilidades cognitivas posterior a la realización de quiebres en la conducta sedentaria. Métodos. Participaron 83 alumnos de 12 a 14 años, pertenecientes a 7° y 8° básico de la región metropolitana de Santiago de Chile. Los alumnos fueron distribuidos aleatoriamente como casos (42) y control (41). Se realizó durante 10 días, un protocolo de quiebres en la conducta sedentaria de 3 minutos cada 40 minutos, durante toda la jornada escolar. Ambos grupos tuvieron evaluaciones fisiológicas y aplicación de test de memoria y atención pre y post intervención. Resultados. Se encontraron diferencias estadísticamente significativas en la variable de atención con un valor p-value de (< 0,005) a favor del grupo intervenido. En valores de presión arterial sistólica y frecuencia cardiaca se evidencio un descenso significativo en el grupo intervenido (p<0,005) Conclusión. En este estudio se demuestra que el protocolo aplicado, mejora la habilidad cognitiva de atención en la población estudiada y además se reducen los valores de parámetros fisiológicos.


Background. In Chile, child sedentary lifestyle rates have increased; seven out of 10 children do not meet the minimum standards recommended by the World Health Organization. There is a lack of studies in Chile that associate free-time sedentary behavior and seated hours during the school day with cognitive skills. Objective. To determine the changes in cognitive abilities after the completion of sedentary behavior breaks. Methods. 83 students from 12 to 14 years old participated, belonging to 7th and 8th grade of the metropolitan region of Santiago de Chile. Students were randomly distributed as cases (42) and control (41). A protocol of sedentary behavior breaks of 3 minutes every 40 minutes was carried out during 1 week, during the whole school day. Both groups had physiological evaluations and application of memory tests and pre and post intervention care. Results. Statistically found differences were found both in the care variables with a p-value of <0.005 in favor of the intervened group, as well as in the systolic blood pressure and heart rate values evidencing a significant decrease in the intervened group (p < 0.005) Conclusion. This study shows that the applied protocol improves the cognitive ability of attention in the studied population and also reduces values of physiological parameters.

17.
Arch. argent. pediatr ; 121(5): e20220283, oct. 2023. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1509727

ABSTRACT

El mercurio es un metal tóxico que puede atravesar la placenta y la barrera hematoencefálica, y causar la interrupción de varios procesos celulares. Estudios han investigado la exposición al mercurio y trastornos en el neurodesarrollo, por lo que se requiere un análisis crítico y riguroso de esta evidencia. El objetivo de esta revisión fue evaluar la evidencia científica disponible sobre los efectos de la exposición al mercurio durante las etapas prenatal y posnatal, y su relación con el desarrollo de trastornos neuroconductuales. Se realizó una búsqueda sistemática en las bases de datos MEDLINE y ScienceDirect; los resultados se presentaron a través de tablas y síntesis narrativa. Solo 31 estudios cumplieron los criterios de elegibilidad. En general, la evidencia es limitada sobre los efectos de la exposición al mercurio y trastornos del neurodesarrollo en niños. Entre los posibles efectos reportados, se hallan problemas en el aprendizaje, autismo y trastorno por déficit de atención e hiperactividad.


Mercury is a toxic metal which can cross the placenta and the blood-brain barrier and cause the disruption of various cellular processes. Studies have investigated mercury exposure and neurodevelopmental disorders; therefore, a critical and rigorous analysis of this evidence is required. The objective of this review was to evaluate the available scientific evidence on the effects of mercury exposure during the prenatal and postnatal periods and its relationship with the development of neurobehavioral disorders. A systematic search of the MEDLINE and ScienceDirect databases was conducted; the results were presented in tables and narrative synthesis. Only 31 studies met the eligibility criteria. Overall, the evidence on the effects of mercury exposure and neurodevelopmental disorders in children is limited. Learning disabilities, autism, and attention deficit hyperactivity disorder were some of the reported potential effects.


Subject(s)
Humans , Female , Pregnancy , Child, Preschool , Child , Attention Deficit Disorder with Hyperactivity , Autistic Disorder , Neurodevelopmental Disorders/chemically induced , Mercury/toxicity
18.
Medicina (B.Aires) ; 83(supl.4): 40-45, oct. 2023. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1521200

ABSTRACT

Resumen El Trastorno por déficit de atención con hiperactivi dad (TDAH) es un trastorno del neurodesarrollo de ori gen biológico con una base genética del 70 al 80%, que afecta al 5% de niños y adolescentes y a un 2.5% de los adultos, cuyos síntomas principales son la inatención, hiperactividad e impulsividad. Por muchos años se pensó que afectaba solo a los niños; actualmente en el DSM 5 se acepta que se puede diagnosticar en adolescentes y adultos. El tratamiento debe ser individualizado, los objetivos principales son mejorar los síntomas centrales de las personas con TDAH, y su calidad de vida. El abordaje terapéutico es psicológico, conductual y farmacológico. Los medicamentos se clasifican en estimulantes y no estimulantes, siendo los de primera línea los estimu lantes tales como el metilfenidato, lisdexanfetamina y dexanfetamina. Entre los no estimulantes se cuentan a la guanfacina y atomoxetina. El tratamiento es funda mental porque mejora la calidad de vida de la persona a nivel familiar, educativo, laboral y social.


Abstract Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder of biological origin with a 70 to 80% genetic basis, which affects 5% of children and adolescents and 2.5% of adults, whose main symptoms are inattention, hyperactivity, and impulsivity. For many years it was thought that it only affected children; currently in the DSM 5 it is accepted that it can be diagnosed in adolescents and adults. Treatment must be individualized, the main objec tives are to improve the core symptoms of people with ADHD, and their quality of life. The therapeutic approach is psychological, behavioral, and pharmacological. Medications are classified as stimulants and non-stimulants, with stimulants such as methylphenidate, lisdexamfetamine, and dexamphetamine being the first line. Non-stimulants include guanfacine and atomox etine. Treatment is essential because it improves the qual ity of life of the person at the family, educational, work, and social levels.

19.
Medicina (B.Aires) ; 83(supl.4): 52-56, oct. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1521202

ABSTRACT

Resumen Las enfermedades raras y enfermedades sin diag nóstico se han posicionado en los últimos años como condiciones clínicas que han permitido avanzar el en tendimiento de las funciones de los genes y el im pacto en el desarrollo del individuo. En esta revisión, presentamos como los esfuerzos individuales hechos por muchos años para entender la fisiopatología de en fermedades comunes, enfermedades raras y otras aún más raras, como las enfermedades sin diagnóstico, que se unen hoy para, de manera cooperativa, avanzar en el conocimiento científico. Estos avances en el conoci miento permiten aplicar los avances obtenidos en un grupo de condiciones clínicas a otras con características fenotípicas similares o viceversa. El trabajo conjunto de equipos multidisciplinarios y la comunicación entre clínicos e investigadores proporcionarán oportunidades para proveer mejores oportunidades de tratamiento para pacientes y familias a lo largo de múltiples diagnósticos comunes o raros.


Abstract Rare diseases and undiagnosed diseases have re cently positioned themselves as clinical entities that provide important opportunities to advance our under standing of gene functions and the impact of them in the individual development. In this review, we present how efforts made over years to understand common diseases, rare diseases and even undiagnosed diseases come together today to cooperatively advances scientific knowledge. These advance in science and new acquired knowledge, make possible to apply the advances ob tained in a group of clinical conditions to others with similar phenotypic characteristics or vice versa. The cooperative work of multidisciplinary teams and the communication between clinicians and researchers have and will provide opportunities for better treatments for patients and families across multiple common and rare diseases.

20.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 45(5): 397-404, Sept.-Oct. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527996

ABSTRACT

Objectives: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention‐deficit/hyperactivity disorder (ADHD) in children. Methods: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. Results: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. Conclusion: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

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