Desarrollo del lenguaje en hijos e hijas de madres adolescentes por área de residencia, Ensanut 100k / Language development in children of adolescent mothers by residence area, Ensanut 100k

Resumen: Objetivo: Evaluar la asociación entre embarazo en la adolescencia y desarrollo del lenguaje (DL), en niños(as) residentes en zonas económicamente vulnerables de México. Material y métodos: Estimación y comparación del puntaje estandarizado de lenguaje de niños(as) de 12-59 meses participantes en la Ensanut 100k e hijos(as) de madres que al nacimiento fueron adolescentes (12-19 años) o adultas (>20 años). La asociación se estimó mediante regresión lineal multivariada y probamos una interacción entre condición materna y lugar de residencia. Resultados: Los hijos(as) de adolescentes que residen en áreas urbanas tuvieron un DL menor que los hijos(as) de madres adultas, (ß= -0.33 IC95%: -0.65 a -0.01; p interacción <0.01). Sin embargo, la disponibilidad de libros o apoyo materno al aprendizaje redujeron esta diferencia. Conclusiones: La presión sociocultural hacia las adolescentes en zonas urbanas podría explicar los resultados observados; no obstante, esta población podría ser susceptible de estrategias dirigidas a mejorar la relación madre-hijo y el apoyo al aprendizaje.

Abstract: Objetive: To evaluate the association between adolescent pregnancy and language development, in children living in socio-economic vulnerable areas of Mexico. Materials and methods: We estimated the standardized language score of children age 12-59 months who participated in the Ensanut 100k. Teenage mothers (TM) were those who at delivery was between 12-19 years old. The association was estimated using multivariate linear regression; moreover, we evaluated an interaction between type of mother and place of residence. Results: Children of TM who lived in urban areas had lower standardized language score than those children of adult mothers (ß= -0.33 95%CI: -0.65 a -0.01; p for interaction<0.01). However, book availability and/or mother's support for learning significantly reduce this difference. Conclusions: Sociocultural pressures towards TM in urban areas could explain the results; nevertheless, this population could be susceptible to strategies aimed to improve the mother-child relationship and support for learning.

Contexto y resultados del desarrollo infantil temprano en niños y niñas de 12 a 59 meses en México / Context and results of early childhood development in 12 to 59 months old children living in Mexico

Resumen: Objetivo: Evaluar el desarrollo infantil temprano (DIT) y sus determinantes en niños/as de 12 a 59 meses residentes en localidades de menos de 100 000 habitantes. Material y métodos: La Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes (Ensanut 100k) evaluó el nivel de lenguaje, acceso a servicios de atención al DIT e indicadores de calidad del contexto de desarrollo. Se estiman prevalencias de indicadores y puntajes estandarizados de lenguaje según variables de interés. Resultados: 20.7% de los niños/as asistió a ocho consultas del niño sano en su primer año, 13.0% recibió evaluación de DIT, 75.0% recibe apoyo al aprendizaje, 23.4% cuenta con libros y 57.7% sufre disciplina violenta. Mejores niveles de lenguaje se asocian con las capacidades económicas, escolaridad materna, asistencia a preescolar, apoyo al aprendizaje y acceso a libros. Los niños/as expuestos a más factores protectores presentan nivel de lenguaje 1.5 DE mayor que en niños/as con más factores de riesgo. Conclusión: Se requiere aumentar la cobertura de atención al DIT y mejorar las oportunidades de desarrollo en hogares.

Abstract: Objective: To evaluate early childhood development (ECD) and its determinants in 12 to 59 months old children residents of communities <100 000 inhabitants. Materials and methods: The Encuesta Nacional de Salud y Nutrición of communities <100 000 inhabitants (Ensanut 100k) evaluated language level, access to ECD care services and standardized indicators of the eight quality of the development environment. We report indicator prevalence and standardized language scores according to variables of interest. Results: 20.7% of children attended eight well-child care visits within the first year of life, 13.0% received an ECD assessment, 75.0% receive support for learning, 23.4% have books and 57.7% experiment violent discipline. Improved language levels are associate with socioeconomic capacities, maternal education, preschool attendance, support for learning and household books. Children exposed to more protective factors present a language level 1.5 standard deviations higher than their peers exposed to more risk factors. Conclusion: There is a need to increase the coverage of ECD care services and to improve early development opportunities within households.

Nuevas áreas de vida ­ Revisión muerte súbita 2018 / New areas of life ­ Sudden death review 2018

Una de cada cinco muertes en adultos en países desarrollados se debe a causas cardiovasculares; la mitad de esas muertes se produce de forma súbita y un gran porcentaje en el ámbito extrahospitalario. Las medidas de prevención se dividen en: aquellas destinadas a prevenir en primer lugar que el evento de muerte súbita cardíaca suceda, y aquellas cuyo objetivo es actuar en el momento en que el evento de muerte súbita está sucediendo. Las primeras tienen como objetivo disminuir las principales causas de muerte súbita en países desarrollados: las cardiopatías estructurales (cuya principal causa es la enfermedad coronaria). En este sentido, con el fin de intentar paliar el desarrollo de una cardiopatía que predisponga a la aparición de arritmias fatales y la MSC, se implementan medidas de prevención primarias higiénico-dietéticas y farmacológicas (con el objetivo de disminuir y el controlar los factores de riesgo) y, en aquellos con enfermedad cardiovascular ya establecida, se implementan las estrategias secundarias farmacológicas y/o quirúrgicas (revascularización, reemplazo valvular, etc.). El segundo abordaje surge del hecho de que, a pesar de todas estas medidas, un gran número de pacientes presentará eventos arrítmicos en el ámbito extrahospitalario (MSCEH), ya sea porque aunque recibieron el tratamiento óptimo presentan aún un elevado riesgo de MSC, porque no fueron diagnosticados a tiempo o porque a pesar de haber hecho estudios complementarios el diagnóstico es muy dificultoso. Existen dos estrategias: la primera son los dispositivos de cardiodesfibrilación implantables (o, más recientes, los chalecos vestibles). Estos aparatos están indicados para una población seleccionada, sea por haber presentado ya un episodio de muerte súbita abortado, o por presentar una cardiopatía (estructural o genética) que predisponga a una mayor probabilidad de sufrir un evento. La segunda estrategia es la educación y el desarrollo de programas de salud pública que permitan capacitar a la población general en la realización de RCP y el uso de desfibriladores automáticos externos (DEAs), los cuales deberían estar disponibles en cualquier lugar público. Múltiples estudios demostraron que el acceso de la población general al aprendizaje de maniobras de RCP sencillas y pragmáticas y la presencia de DEAs se traduce en un gran aumento de sobrevida sin secuelas en víctimas de MSCEH. (AU)

One of every five deaths in adults is due to cardiovascular causes, in developed countries, and half of these deaths will occur suddenly. A large percentage occur in the out of hospital setting, so measures to prevent it are divided into: those designed to prevent, in the first place, the sudden cardiac death event from happening and those whose purpose is to act when the sudden death event that has already occurred and it´s ongoing. The first aims to reduce the main causes of sudden death in developed countries: structural heart disease (with coronary heart disease as its main cause). In this regard, with the purpose to mitigate the development of a heart disease that predisposes the occurrence of fatal arrhythmias and SCD, we have primary prevention measures, like healthy life style conduct with or without pharmacological treatment, (whose objective is the reduction and control of cardiovascular risk factors) and, in those with cardiovascular disease already established, there is an implementation of pharmacological and / or surgical strategies (Revascularization, valve replacement, etc.). The second objective arises from the fact that, despite all these preventive and therapeutic measures, a large number of patients will present out-of-hospital cardiac arrest (OHCA) either because although they received optimal treatment they still remain in high risk of SCD, even because they were not diagnosed on time, or because despite having complementary studies made the diagnosis is very difficult. There are two well strategies: the first are implantable cardio-defibrillation devices (or, more recently, wearable vests). These are indicated for a selected population, either because they have already presented an episode of sudden aborted death, or because they have heart disease (structural or genetic), which predisposes to a greater probability of suffering an event. The second strategy is the education and development of public health programs that enable the general population to be trained in CPR and the use of external automatic defibrillators. (AEDs) should be available in any public place. Multiple studies showed that access to the general population for learning simple and pragmatic CPR maneuvers and the presence of AEDs is making an impact on a significant increase in survival without consequences in OHCA victims. (AU)

Detection of toxigenic Clostridioides --#1;Clostridium--#3; difficile: Usefulness of two commercially available enzyme immunoassays and a PCR assay on stool samples and stool isolates / Detección de Clostridioides --#1;Clostridium--#3; difficile toxigénico: utilidad de dos métodos de enzimoinmunoensayo comerciales y una PCR en las muestras de materia fecal y en los respectivos aislamientos

The best laboratory diagnostic approach to detect Clostridioides --#1;Clostridium--#3; difficile infection (CDI) is a subject of ongoing debate. With the aim of evaluating four laboratory diagnostic methods, 250 unformed stools from patients with suspected CDI submitted to nine medical center laboratories from November 2010 to December 2011, were studied using: (1) an immunochromatographic rapid assay test that combines the qualitative determination of glutamate dehydrogenase (GDH) plus toxins A and B (QAB), the CDIFF QUIK CHEK COMPLETE assay; (2) an enzyme immunoassay for qualitative determination of toxins A and B, the RIDASCREENTC. difficile Toxin A/B assay (RAB); (3) a PCR for the toxin B gene assay (PCR); and (4) the toxigenic culture (TC).C. difficile isolates from direct toxin negative stools by QAB, RAB and PCR were evaluated for toxigenicity by the same direct tests, in order to assess the contribution of the TC (QAB-TC, RAB-TC, PCR-TC). A combination of the cell culture cytotoxicity neutralization assay (CCCNA) in stools, and the same assay on isolates from direct negative samples (CCCNA-TC) was considered the reference method (CCCNA/CCCNA-TC). Of the 250 stools tested, 107 (42.8%) were positive by CCCNA/CCCNA-TC. The GDH and PCR/PCR-TC assays were the most sensitive, 91.59% and 87.62%, respectively. The QAB, RAB, QAB/QAB-TC and RAB/RAB-TC had the highest specificities, ca. 95%. A negative GDH result would rule out CDI, however, its low positive likelihood ratio (PLR) of 3.97 indicates that a positive result should always be complemented with the detection of toxins. If the RAB, QAB, and PCR assays do not detect toxins from direct feces, the toxigenic culture should be performed. In view of our results, the most accurate and reliable methods to be applied in a clinical microbiology laboratory were the QAB/QAB-TC, and RAB/RAB-TC, with PLRs >10 and negative likelihood ratios <0.30.

El mejor procedimiento para realizar el diagnóstico de laboratorio de la infección causada por Clostridioides --#1;Clostridium--#3; difficile (ICD) es aún objeto de debate. Con el fin de evaluar cuatro métodos diagnósticos de laboratorio, se estudiaron 250 muestras de heces diarreicas provenientes de pacientes con sospecha de ICD remitidas a los laboratorios de nueve centros médicos entre noviembre de 2010 y diciembre de 2011. Dichas muestras se analizaron mediante los siguientes métodos:1) un ensayo rápido inmunocromatográfico que combina la detección cualitativa de la glutamato deshidrogenasa (GDH) y de las toxinas Ay B (QAB), CDIFF QUIK CHEK COMPLETE;2) un enzimoinmunoanálisis para la determinación cualitativa de las toxinas A/B, RIDASCREENTC. difficile Toxin A/B (RAB);3) un método molecular basado en PCR para la detección del gen que codifica la toxina B (PCR) y 4) el cultivo toxigénico (TC). Como método de referencia se utilizó la combinación del ensayo de citotoxicidad sobre cultivo de células con la neutralización de toxina mediante anticuerpo específico en los filtrados de las heces (CCCNA) y el mismo método en sobrenadantes de aislamientos de C. difficile (CCCNA-TC). La toxigenicidad de las cepas aisladas de muestras directas negativas con QAB, RAB y PCR se evaluó con los mismos métodos, con el propósito de detectar la contribución del TC (QAB-TC, RAB-TC, PCR-TC). De las 250 muestras estudiadas, 107 (42,8%) fueron positivas por CCCNA/CCCNA-TC. Los métodos GDH y PCR/PCR-TC fueron los más sensibles: 91,59 y 87,62%, respectivamente. Los métodos QAB, RAB, QAB/QAB-TC y RAB/RAB-TC mostraron las mayores especificidades, del 95%, aproximadamente. Un resultado negativo para GDH excluiría la ICD, pero su baja razón de verosimilitud positiva (PLR), que fue 3,97, indica que un resultado positivo debe complementarse con la detección de toxinas. Cuando no se detectan toxinas directas por RAB, QAB ni PCR, debería realizarse el TC. De acuerdo con nuestros resultados, los métodos más precisos y confiables para ser aplicados en un laboratorio de microbiología clínica son QAB/QAB-TC y RAB/RAB-TC, con una PLR> 10 y una razón de verosimilitud negativa < 0,30.

Biomimetic thiamine- and niacin-decorated liposomes for enhanced oral delivery of insulin

Biomimetic nanocarriers are emerging as efficient vehicles to facilitate dietary absorption of biomacromolecules. In this study, two vitamins, thiamine and niacin, are employed to decorate liposomes loaded with insulin, thus facilitating oral absorption vitamin ligand-receptor interactions. Both vitamins are conjugated with stearamine, which works to anchor the ligands to the surface of liposomes. Liposomes prepared under optimum conditions have a mean particle size of 125-150 nm and an insulin entrapment efficiency of approximately 30%-36%. Encapsulation into liposomes helps to stabilize insulin due to improved resistance against enzymatic disruption, with 60% and 80% of the insulin left after 4 h when incubated in simulated gastric and intestinal fluids, respectively, whereas non-encapsulated insulin is broken down completely at 0.5 h. Preservation of insulin bioactivity against preparative stresses is validated by intra-peritoneal injection of insulin after release from various liposomes using the surfactant Triton X-100. In a diabetic rat model chemically induced by streptozotocin, both thiamine- and niacin-decorated liposomes showed a comparable and sustained mild hypoglycemic effect. The superiority of decorated liposomes over conventional liposomes highlights the contribution of vitamin ligands. It is concluded that decoration of liposomes with thiamine or niacin facilitates interactions with gastrointestinal vitamin receptors and thereby facilitates oral absorption of insulin-loaded liposomes.

A meta-analysis of metronidazole and vancomycin for the treatment of Clostridium difficile infection, stratified by disease severity

The aim of this meta-analysis was to compare the efficacy of metronidazole and vancomycin for the treatment of Clostridium difficileinfection, especially to investigate which agent was superior for treating either mild or severe C. difficileinfection. A meta-analysis of randomized controlled trials and cohort studies identified in Pubmed, Embase, and the Cochrane Library was conducted. Four randomized controlled trials and two cohort studies involving 1218 patients were included in this meta-analysis. Metronidazole was inferior to vancomycin for treating C. difficileinfection in terms of both initial clinical cure rates (risk ratio, RR = 0.91, 95% confidence interval, CI = 0.84-0.98, p= 0.02) and sustained cure rates (RR = 0.88, 95% CI = 0.82-0.96, p= 0.003). For mild C. difficileinfection, the efficacy of metronidazole and vancomycin resulted in similar clinical cure rates (RR = 0.94, 95% CI = 0.84-1.04, p= 0.21) and sustained cure rates (RR = 0.93, 95% CI = 0.83-1.05, p= 0.26). For severe C. difficileinfection the efficacy of vancomycin was superior to metronidazole in terms of clinical cure rates (RR = 0.81, 95% CI = 0.69-0.95, p= 0.009), whereas sustained cure rates were similar (RR = 0.86, 95% CI = 0.72-1.02, p= 0.08). Regarding microbiological cure metronidazole therapy was as effective as vancomycin therapy (RR = 0.88, 95% CI = 0.64-1.21, p= 0.43). Recurrence rates with metronidazole and vancomycin for both mild C. difficileinfection (RR = 0.95, 95% CI = 0.56-1.60, p= 0.85) and severe C. difficileinfection (RR = 1.27, 95% CI = 0.85-1.91, p= 0.25) were not different. Likewise, no difference in all-cause mortality was found as well (RR = 0.87, 95% CI = 0.56-1.35, p= 0.53). In conclusion, vancomycin provides improved initial clinical and sustained cure rates in patients with C. difficileinfection compared with metronidazole, especially in patients with severe C. difficileinfection. In view of these data, vancomycin may be considered first line therapy for severe C. difficileinfection.

Prevalencia de Trastornos Temporomandibulares según los CDI/TTM, en un Grupo de Adultos Mayores de Santiago, Chile / Prevalence of Temporomandibular Disorders According to RDC/TMD in Older People of Santiago, Chile

En la población chilena, los adultos mayores representan un 13% de la población total del país (2,2 millones), proyectándose para el 2020 un aumento del grupo de 60 años o más en un 45%. Todos los seres humanos sufren un proceso de envejecimiento y, los tejidos orales y periorales no escapan de este proceso. Las repercusiones sobre el sistema estomatognático, podrían manifestarse a través de sintomatología en alguno de sus componentes, compatible con un trastorno temporomandibular (TTM). El objetivo de este trabajo, fue determinar la prevalencia de TTM según los Criterios de Investigación Diagnóstica ó CDI/TTM (Eje I), en adultos mayores examinados en la Clínica Odontológica de la Facultad de Odontología de la Universidad de Chile (FOUCh), durante el año 2012 y establecer la relación entre ambos sexos. Este estudio determinó, que existe una alta prevalencia de TTM en la muestra de adultos mayores chilenos estudiados (47%), principalmente diagnósticos de tipo articular y sin una relación significativa entre ambos sexos.

In Chilean population, elders represent a 13% of the overall population (2.2 million), projected for 2020 an increase of 45%, from the group of 60 and over. All humans undergo a process of aging. Oral and perioral tissues do not escape from this process, whose impact on the condyle and articular disc could be observed, in the presence of symptoms consistent with temporomandibular disorders (TMD). The aim of this study was to determine the prevalence of TMD according to the Research Diagnostic Criteria or RDC/TMD (Axis I), in older adults examined at the Dental Clinic of the Faculty of Dentistry, University of Chile during 2012, and establish the relationship between the sexes. In conclusion, this study found that there is a high prevalence of TMD in Chilean elderly sample studied (47%), mainly articular diagnoses without a statistically significant relationship between the sexes.

Indicadores psicométricos do Inventário de Depressão Infantil em amostra infanto-juvenil / Psychometric Indicators of Children's Depression Inventory and Childhood Sample / Indicadores Psicométricos del Inventario de Depresión Infantil en una Muestra Infanto-Juvenil

Este estudo verificou aspectos de validade, fidedignidade e normatização do Inventário de Depressão Infantil (CDI) numa amostra da população de crianças e adolescentes da cidade de Teresina - PI. Participaram do estudo 730 escolares, entre 9 e 17 anos (M=13,6; DP=2,45), 55,7% do sexo feminino. Efetuou-se uma análise fatorial com o método Maximum Likelihood - ML e os resultados indicaram uma solução unifatorial, composta por 17 itens. Esta estrutura explicou 22,56% da variância total, com índice de consistência interna α=0,82 (alfa de Cronbach). Sugere-se o ponto de corte 16 como screening na identificação dessa alteração psicoafetiva. Os resultados revelaram que o instrumento possui parâmetros psicométricos aceitáveis para a estrutura unifatorial mantida e reforçam sua validade e utilidade na identificação de sintomas depressivos no contexto infanto-juvenil...

This study aimed for the verification of validity, fidedignity and normalization aspects of the Children's Depression Inventory (CDI) for a children and teenagers population sample in the city of Teresina, PI. Seven hundred and thirty scholars participated in the study with ages ranging from nine to seventeen (M=13.6; DP=2.45), being 55.7% female. It was made a factor analysis based on the Maximum Likelihooh method - ML and the results indicated anunifactor solution, consisted by seventeen items. The structure explained 22.56% of total variance, with a internal consistency indicator of α=0.82 (Cronbach’s alpha). It is suggested a cut-off point of sixteen to be used as screening in the identification of these psychoaffective changes. Results revealed the instrument possess acceptable psychometric parameters to the unifactor structure kept and reinforce its validity and utility in the identification of depressive symptoms in the juvenille context...

En este estudio, el objetivo ha sido la verificación de aspectos de eficacia, fidedigno y estándar del Inventario de la Depresión Infantil (CDI) para una muestra de población de niños y adolescentes de Teresina - PI. Participaron en el estudio 730 alumnos, con edades entre 9 y 17 años (M=13,6; DP=2,45), siendo el 55,7% del sexo femenino. Se ha efectuado un análisis factorial a partir del método Maximum Likelihood - ML y los resultados indicaron una solución unifactorial, compuesta por 17 ítems. Esta estructura determinó un 22,56% de la variancia total, con un índice de consistencia interna α=0,82 (alfa de Cronbach). La sugerencia de este estudio proporciona un punto de corte 16 para ser utilizado como screening en la identificación de esta alteración psicoafectiva. Los resultados apuntan parámetros psicométricos aceptables para la estructura factorial mantenida y refuerzan su eficacia y utilidad en la identificación de los síntomas depresivos en el contexto infanto-juvenil...

Psychosocial Risk Factors Associated with Internet Addiction in Korea

OBJECTIVE: The aim of this study was to examine the prevalence of Internet addiction in middle school students and to identify associated psychosocial risk factors and depression. METHODS: This study was part of a larger epidemiological study on childhood psychiatric disorders conducted in Osan, a city of Republic of Korea. We used IAS for internet addiction, K-YSR for subjects' emotional and behavioral problems and K-CDI for depressive symptoms. We used the data of n=1217 completed cases. We put on independent variables, which are sex, age, smoking and alcohol experiences, economic status, age of first Internet use, K-YSR and K-CDI score. RESULTS: The subjects consisted of addicted users (2.38%), over users (36.89%) and normal Internet users (60.72%). Attention problems, sex, delinquent problems, K-CDI scores, thought problems, age and aggressive behavior were predictable variables of internet addiction. Age of initial Internet use negatively predicted Internet addiction. CONCLUSION: This result showed similar to other researches about sociodemographic, emotional or behavioral factors related to internet addiction. Generally, subjects with more severe internet addiction had more emotional or behavioral problems. It means that they already have had various difficulties when we found internet addiction of adolescents. Therefore it is necessary to evaluate whether the subjects have any emotional or behavioral troubles and to intervene to prevent internet addiction.

Estudio comparativo de dos escalas de depresión en relación al intento de suicidio en adolescentes no consultantes / Comparative study of two scales of depression in relating to suicide attempt in no consultant adolecents

Introduction: 80 percent of young people who attempt suicide and 90 percent of those who consume it have a history of psychiatric disorders. The more involved psychopathologies are the mood disorders, especially depression. Objective: Characterize the behavior of 2 depression scales applied to adolescents in relation to suicidal attempts. Method: Cross-sectional analytical study. 195 adolescents were surveyed in the "Liceo Nueva Zelandia' of Santa Juana (Sampling error = 0.0445) media random sampling provided by sex and grade, including the application of Beck's Depression Inventory (BDI), Child Depression Inventory (CDI) and a history of attempted suicide. X², T-Student, Mann-Whitney U, Spearman linear correlation and binary logistic regression were used. Results: When analyzing the mean scores obtained by both groups, both scales show significant differences statistically (p < 0.001). The scales present a strong to moderate linear correlation (p < 0.001). Only BDI is significant in the logistic regression model (p = 0.001). Discussion: Although these scales evaluated the depression construct similarly, the CDI would be redundant to associate it with the suicide attempt. It would be necessary to implement the factorial studies of the composition of the BDI to identify components associated with attempted suicide...

Introducción: El 80 por ciento de los jóvenes que intentan suicidarse y el 90 por ciento de quienes lo consuman tienen historia de desordenes psiquiátricos. Las psicopatologías más involucradas son los trastornos del ánimo, especialmente la Depresión. Objetivo: Caracterizar el comportamiento de 2 escalas para Depresión aplicada en adolescentes relacionado al intento de suicidio. Método: Estudio analítico de corte transversal. Se encuestó a 195 adolescentes del Liceo Nueva Zelandia de Santa Juana (Error de muestreo = 0,0445) mediante muestreo aleatorio proporcionado por sexo y curso, incluyendo Escala de Depresión de Beck (BDI), Cuestionario de Depresión Infantil (CDI) y antecedentes de intento de suicidio. Se utilizaron estadísticos descriptivos, X², T-student, U Mann-Whitney, correlación lineal de Spearman y Regresión logística binaria. Resultados: Al analizar los promedios de los puntajes obtenidos por los grupos intentadores y no intentadores en ambas escalas presentan diferencias estadísticamente significativas (p < 0,001). Las escalas presentan una correlación lineal moderada a fuerte (p < 0,001). Sólo la BDI es significativa en el modelo de regresión logística (p = 0,001). Discusión: Si bien ambas escalas evalúan el constructo de depresión de manera similar, la CDI sería redundante al asociarla al intento de suicidio. Sería necesario poner en práctica los estudios factoriales de la composición de la BDI para identificar los componentes asociados al intento de suicidio...

Psychological characteristics of Korean children and adolescents with type 1 diabetes mellitus

PURPOSE: This study investigates the behavioral and emotional characteristics of Korean children and adolescents with type 1 diabetes mellitus (T1DM) as compared to healthy controls, and examines whether their psychological status is associated with glycemic control, insulin regimens, or disease duration. METHODS: A total of 37 Korean children and adolescents with T1DM, aged 6-17 years, and 38 sex- and age-matched healthy controls were included in this study. Psychological distress was assessed using the Korean child behavior checklist (K-CBCL) and children's depression inventory (CDI) after the subjects and their parents were interviewed. RESULTS: The CDI and K-CBCL scores were significantly higher in T1DM subjects compared to normal controls. The T1DM subjects with "poorly controlled" blood glucose (glycosylated hemoglobin > or =8%) and "old patients" (disease duration > or =1 year) had a tendency to show higher CDI and K-CBCL scores. There were no significant differences in CDI and K-CBCL scores between the intensive and conventional insulin therapy groups. CONCLUSION: Children and adolescents with T1DM seem to have inferior psychological adjustment to their normal counterparts, which might be associated with glycemic control and disease duration. Psychological evaluation and intervention should be considered in the management of T1DM in children and adolescents.

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Esta atualização da Diretriz de Insuficiência Cardíaca Crônica (IC) - 2012 surge para reavaliar as recomendações através de uma avaliação criteriosa das pesquisas (considerando-se a qualidade dos estudos), fundamental para que se atinja esse propósito. Para tanto, foi dada ênfase ao efeito em desfechos de morte, à qualidade "CONSORT" (Consolidated Standards of Reporting Trials), à descrição qualitativa e quantitativa da otimização da medicação, à população realmente incluída, às metanálises somente de estudos qualidade "CONSORT", à custo-efetividade, à existência de efeito de classe, ao número de pacientes incluídos e à análise de subgrupos apenas para gerar hipóteses. Na área da epidemiologia, as recentes abordagens das características da IC com fração de ejeção preservada (ICFEP) e da importância da IC como causa de morte no Brasil foram revisadas. Além disso, este documento contempla a reavaliação do valor dos biomarcadores no diagnóstico e no seguimento da IC, o papel diagnóstico da angiotomografia coronariana nos casos de risco intermediário ou baixo risco de doença coronariana, a não recomendação de rotina do telemonitoramento; o surgimento da avaliação familiar como recomendação importante, e a reavaliação da restrição da adição de sal na dieta. As clínicas de IC e reabilitação física, apesar de alguns resultados negativos ou controversos quanto à mortalidade, continuam com recomendação importante. No campo do tratamento farmacológico, abrange-se a reavaliação da indicação do nebivolol, introduz-se a ivabradina como um novo paradigma no tratamento, os antagonistas da aldosterona não têm efeito de classe reconhecido, o ômega 3 passa a ser recomendado, o ferro administrado por via endovenosa e o sildenafil recebem indicação em casos selecionados. Todas as recomendações para outras etiologias são expandidas para a Doença de Chagas. Na área da anticoagulação, recomenda-se a utilização dos escores CHA2DS2VASC e o HAS-BLED na fibrilação ...

CDI e tempestade elétrica, qual a melhor conduta?: [revisão] / CDI and electrical storm, what is the best practice?: [review]

A tempestade elétrica nos portadores de CDI, na maioria das vezes é responsável por choques de repetição. Essa situação se constitui em um dos mais dramáticos quadros clínicos da cardiologia moderna. A conduta terapêutica, que muitas vezes pressupõe terapia intensiva e até mesmo não farmacológica através de ablação por cateter é eficaz, propiciando um bom prognóstico.

Prevalência da sintomatologia depressiva nas cidades de Ribeirão Preto e região / Prevalence of depressive symptoms in Ribeirão Preto and neighboring cities

Esta pesquisa estuda a prevalência da sintomatologia depressiva em 5.974 escolares, faixa etária de 6 a 18 anos, em Ribeirão Preto e 6 cidades da região, e a dependência do sexo e da idade, usando o CDI. A prevalência achada foi de 6,4%, usando a nota de corte de 17, para a amostra total. As prevalências por cidade são: Ribeirão Preto: 6,10%, Franca: 4,90%, Sertãozinho: 9,60%, Descalvado: 5,12%, Cravinhos: 8,15%, Brodowski: 8,17%, Batatais: 4,50%. A diferença é estatisticamente significativa, usando-se o teste do quiquadrado. Também encontramos diferenças estatisticamente significativas com relação a idade e sexo. Crianças do sexo feminino têm maior prevalência do que as do sexo masculino, com exceção do caso de Ribeirão Preto, onde a diferença não foi estatisticamente significativa. A prevalência é maior para crianças de 6 e 13 anos de idade. Estes resultados mostram a importância de se implantar serviços de prevenção secundária para transtornos depressivos em crianças e adolescentes.

Factor Analysis of Children's Depression Inventory: In a Population of General Children in a Small City in Korea / 신경정신의학

OBJECTIVES: The Children's Depression Inventory (CDI) is one of the most widely used self-report instruments for the assessment of childhood depression, and it has been especially valid for epidemiological purposes. The aim of this study is to assess self-reported depressive symptoms in 5th grade students in a small city by gender, using the Korean version of the CDI. In addition, factorial analysis was performed on the 27 items of the CDI in the subjects in order to identify potential composite dimensions. METHODS: The participants were 2,293 5th grade students from elementary schools (1,148 males and 1,145 females). The initial factors were extracted by maximum likelihood factor analysis and then rotated according to promax criteria in order to achieve a simple structure. Only those items with a loading of .30 or greater were included in the identified factors. RESULTS: The mean CDI score was 13.95+/-7.11. A total of 557 (24.3%) children showed clinically significant scores of more than 19 points. There was no significant difference in mean score between the boys and girls. Factorial analysis yielded four factors: dysphoria/biological dysregulation, externalizing/self-deprecation, social problems and school problems. The factor that accounted for the highest variability was externalizing/self-depreciation in boys and dysphoria/biological dysregulation in girls. CONCLUSION: The cut-off score on the CDI in children should be considered to be higher than that in previous studies. The factorial structure for 11-year-old children in Korea seems to be similar to that of adolescents in Western countries.

Suprasellar Mass Lesions Presenting with Central Diabets Insipidus

Central diabetes insipidus(CDI) may result from any abnormalities in the supraoptic-neuropituitary axis. Since 1984, we have studied 7 suprasellar mass lesions presenting with CDI. There were 3 suprasellar germinomas including 1 pituitary stalk(infundibular) microgerminoma, 1 suprasellar lymphoma, 1 craniopharyngioma, 2 suprasellar mass lesions whose pathologies were not confirmed. In two case of germinoma, one at infundibulum and another at suprasellar region, the diagnosis was made on the basis of radiological and endocrinological findings and rapid disappearance of the mass after irradiation. The symptoms of CDI had improved within 2 months after the irradiation in all 3 cases of germinoma. Another 4 cases had been on DDAVP during follow-up periods more than one year. Primary tumorous lesions presenting with CDI always demonstrate pituitary stalk enlargement, suprasellar mass, or both. Among parasellar lesions presenting with CDI, germinoma and lymphoma are very sensitive to radiotherapy and have no need of surgery which and result in pituitary stalk damage and permanent CDI. And lesions of infectious and systemic disease also have no need of surgery. To avoid unnecessary surgery or biopsy, preoperative differential diagnosis of these lesions by CT scan findings and other systemic evaluations is important. In addition, elevation of serum prolactin level appeared to be related to infundibular lesions as a few authors suggested previously but not to aid differential diagnosis.